Multiparametric MRI for Localized Prostate Cancer: Lesion Detection and Staging

Figure 2

Staging of prostate cancer on T2-weighted imaging. Gross invasion of an irregular, low signal mass (thick arrow) from the prostate to the rectoprostatic angle (thin arrows), the location of the neurovascular bundles (a), which, in the absence of associated hemorrhage, signifies near-certain extraprostatic extension. A low signal mass bulges the capsule (thick arrow) with blurring of the dark line denoting the prostate “capsule” (b), which is high suspicious for at least capsular involvement if not microscopic extraprostatic extension. A low signal mass (thick arrow) with bulging but preservation of this dark line signifying the “capsule” (c) is suspicious for capsular involvement but not frank extraprostatic extension. Focal low signal (thick arrow) which abuts the capsule without a broad base of contact or bulging (d) is low suspicious for capsular involvement. A subtle oval area of low signal (thick arrow) on T2-weighted imaging (e) is confirmed by associated restricted diffusion (f) on the apparent diffusion coefficient map and is not suspicious for capsular involvement or extraprostatic extension. These 5 cases could also be ranked on a 5-point scale, with (a) considered level 5/5 (certain) suspicious for extraprostatic extension and (e) level 1/5 or no suspicious for extraprostatic extension.

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