MR of the Prostate

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Abdomen and Pelvis: 0.50

Magnetic Resonance Imaging: 2.75
Image Production: 0.75
Sequence Parameters and Options: 0.25
Data Acquisition, Processing, and Storage: 0.50
Procedures: 2.00
Body: 2.00

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Endocrine and Oncology Procedures: 1.00

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Abdominal Section: 2.50

Sonography: 1.00
Procedures: 1.00
Abdomen: 1.00

Radiation Therapy: 1.50
Patient Care: 1.00
Patient and Medical Record Management: 1.00
Procedures: 0.50
Treatment Sites and Tumors: 0.50

Outline

1. Introduction
2. Clinical Background and Specific MR Imaging Considerations
   1. Prostate Cancer Screening
   2. Transrectal US and Guided Biopsy
   3. Role of MR Imaging in Screening, Localization, and Biopsy
   4. Staging of Prostate Cancer
3. Anatomy, Histologic Features, and Morphologic Imaging of the Prostate
   1. Imaging Anatomy of the Prostate
   2. Grading of Prostate Cancer with the Gleason System
   3. Morphologic Imaging with T2-weighted and T1-weighted Sequences
   4. Staging of Prostate Cancer with Morphologic Imaging
4. Diffusion-weighted Imaging and ADC Mapping
5. MR Spectroscopy
6. Dynamic Contrast-enhanced MR Imaging
7. Prostate MR Imaging at 3T versus 1.5T
8. MR Imaging-guided Biopsy
9. Development of an Imaging Algorithm
10. Summary

Objectives

Upon completion of this course, students will:

1. recognize what percentage of all cancers in males are prostate cancers
2. understand that the prevalence of prostate cancer increases with age, and that up to 70% of men 80 years and older have histologic evidence of prostate cancer
3. realize that the 5 year survival rate for all stages of prostate cancer has been increasing for the last 25 years, and is now almost 99%
4. know the local, minimally invasive options available for cancer confined to the prostate
5. know the three dimensions in the accurate assessment of prostate cancer
6. know what markers are currently used for prostate cancer screening
7. know the lifetime risk of a diagnosis of prostate cancer for men
8. know the risk of death from prostate cancer
9. recognize what is considered clinically significant prostate cancer
10. know what percentage of patients with mild elevation of PSA have the increased levels as a result of a benign condition
11. know the definition of prostate density
12. know the percentage of prostate cancers that are isoechogenic to normal parenchyma
13. know the recommended time for repeat prostate biopsy after an initial biopsy is indicated by abnormal PSA levels, or other abnormal finding
14. be familiar with the volume of the prostate gland that is extracted during a biopsy session
15. compare transperineal with transrectal biopsy of the prostate
16. know which method of prostate evaluation can provide spatial information about prostate cancer
17. know what percentage of prostate cancers are underestimated by clinical staging
18. know why MRI is ideally suited for evaluation of the prostate
19. identify the MRI contrast agent that allows detection of almost all pathologically involved lymph nodes
20. know the zonal anatomy of the prostate
21. know which type of cancer makes up 95% of prostate cancers
22. be familiar with the appearance of the capsule of the prostate on T2-weighted images
23. understand the anatomy of the prostate and how it allows cancer to spread outside the prostate
24. know how many grades make up the final Gleason score
25. know the lowest Gleason score for cancer in the United States
26. understand the value of T1-weighted imaging for the prostate
27. know some criteria for extracapsular extension of prostate cancer
28. know reasons for reduced diffusion in prostate cancer
29. know that ADC is reduced in prostate cancer and by how much, compared to normal tissues
30. understand what DWI reflects at high b-values
31. be able to characterize lower b-value DWI images
32. be familiar with the reason for increased ADC values in aging males
33. list some reasons for susceptibility-induced distortions on DWI
34. know the units for expressing chemical shift
35. be able to name the chemical solution used as a reference for the null point in MR spectroscopy
36. understand why adequate saturation bands around the prostate are important in MR spectroscopy
37. be able to name two MR spectroscopic methods
38. know the classic MR spectral signature of prostate cancer
39. understand the behavior of prostate cancer during dynamic contrast-enhanced MR studies
40. list tumor types that can be difficult to detect due to partial volume effect