Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS...
Transcript of Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS...
![Page 1: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/1.jpg)
Finding significant Cancer :
the PI-RADS current status
Caroline Escourrou
François Cornud
Pôle imagerie (Pr Legmann)
Hôpital Cochin, Paris
20 septembre 2014
![Page 2: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/2.jpg)
• Combination of
– T2W-MRI
• Anatomy
– DW-MRI
• cellular density
– DCE-MRI
• angiogenesis
Multiparametric MRI of PCa: definition
T2W ADC
b1600 DCE
![Page 3: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/3.jpg)
Standardization of interpretation: PI-RADS Prostate Imaging and Reporting Archiving Data System
• Initiated by the ESUR
– currently modified by an ACR/ESUR comittee
• Aim: to standardize reporting mpMRI
• Expected benefits
– low inter-observer reporting variability
– uniform communication with clinicians
– homogenous clinical research
![Page 4: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/4.jpg)
The PI-RADS score
• Combination of the individual score of – T2W/DW-MRI (5 point scale)
– DCE-MRI (0 or 1)
• Overall score relies on the dominant sequence – peripheral zone : DW-MRI
– transition zone : T2W-MRI
• The presence of a significant PCa is – PIRADS 1 = highly unlikely
– PIRADS 2 = unlikely
– PIRADS 3 = equivocal
– PIRADS 4 = likely
– PIRADS 5 = highly likely
![Page 5: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/5.jpg)
T2W-MRI
• Peripheral Zone
• Transition Zone
![Page 6: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/6.jpg)
PZ-T2W : PIRADS 1
• Diffuse hypersignal of the PZ
•normal finding : hyposignal of the CZ
![Page 7: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/7.jpg)
PZ-T2W : PIRADS 2
• Linear or wedge shaped hypointense areas
![Page 8: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/8.jpg)
PZ-T2W : PIRADS 2
• Diffuse hypointense areas
– Indistinct margins
![Page 9: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/9.jpg)
• Focal nodular/mass-like hyposignal
– homogenous, circumscribed
– confined to the prostate and < 1,5cm
PZ-T2W : PIRADS 4
![Page 10: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/10.jpg)
• Same as 4 but
– extra-prostatic spread or
– > 1,5 cm
PZ-T2W : PIRADS 5
![Page 11: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/11.jpg)
• Focal, but not a 2 not a 4
– non circumbscribed
– rounded or geographic
PZ-T2W : PIRADS 3
![Page 12: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/12.jpg)
T2W-MRI
• Peripheral Zone
• Transition Zone
![Page 13: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/13.jpg)
• PIRADS 1
– heterogenous pattern
• PIRADS 2
– encapsulated nodule
– hypointense or
heterogenous
• ADC-DW-DCE
– not considered
TZ-T2W : PIRADS 1 and 2
![Page 14: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/14.jpg)
• Focal hyposignal, homogenous, indistinct
– lenticular shape
– anteriorly located
– confined, < 1.5 cm
TZ-T2W : PIRADS 4
![Page 15: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/15.jpg)
TZ-T2W : PIRADS 5
• Same as 4 but
– > 1.5 cm
– invasive (AFMS or PZ)
![Page 16: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/16.jpg)
TZ-T2W : PIRADS 3
• Focal, same as 4 but heterogenous • Non lenticular shape
• No size limitation
![Page 17: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/17.jpg)
DW-MRI
![Page 18: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/18.jpg)
• No focal abnormality on ADC map and high b-DW-MRI
DW-PZ/TZ : PIRADS 1
T2 ADC b1600
![Page 19: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/19.jpg)
• Linear: hypoS on ADC map, isoS on DWI
DW-PZ : PIRADS 2
T2 ADC b ≥ 1400
![Page 20: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/20.jpg)
• Diffuse: hypoS on ADC, iso/hyperS on DWI
DW-PZ : PIRADS 2
T2 ADC b1600
![Page 21: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/21.jpg)
• Within a BHP hypoS on ADC, hyperS on DWI
DW-TZ/PZ : PIRADS 2
![Page 22: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/22.jpg)
DW-PZ : PIRADS 4
• Focal : hypoS on ADC /hyperS on DW-MRI
– T2 effect : not observed at b-values ≥1400
– No BHP
– <1.5cm on axial
T2W ADC
b800 b1600
![Page 23: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/23.jpg)
• Focal: hypoS on ADC/hyperS on DWI • brighter than the brightest area
• < 1.5 cm on axial
• No BHP
DW-TZ PIRADS 4
T2 ADC b1600
![Page 24: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/24.jpg)
• Focal: hypoS on ADC/hyperS on DWI
– >1.5cm on axial
DW-PZ : PIRADS 5
T2 ADC b1600
![Page 25: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/25.jpg)
DW-TZ : PIRADS 5
• Focal : hypoS on ADC /hyperS on DW-MRI
– >1.5cm on axial
T2 ADC
![Page 26: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/26.jpg)
• Focal: hypoS on ADC/hyperS on DWI
• >1.5 cm
DW-TZ : PIRADS 5
T2 ADC b1600
![Page 27: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/27.jpg)
DW-TZ/PZ : PIRADS 3
•Focal
– IsoS on DW: as bright as the rest of the prostate
– HypoS or isoS on ADC map
PIRADS 3 on the right side of the TZ
![Page 28: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/28.jpg)
DW : PIRADS 3
• bilateral significant tumor (GS 7, 15% grade 4)
b1600
![Page 29: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/29.jpg)
DCE-MRI
![Page 30: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/30.jpg)
DCE : PI-RADS
• Currently modified
– types 2-3 curves do not ≠ PCa
• from prostatitis (PZ)
• from stromal nodules(TZ)
– DCE may be dichotomized 0/1
• 1 = focal early enhancement
– on a corresponding hypointense focus (except BPH)
– wash out not considered
![Page 31: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/31.jpg)
PZ-DCE : PI-RADS +1
• focal early enhancement on a hypointense focus
![Page 32: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/32.jpg)
TZ-DCE : PI-RADS +1
• focal early enhancement on a hypointense focus
![Page 33: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/33.jpg)
Overall PI-RADS Assessment
![Page 34: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/34.jpg)
Overall PI-RADS Assessment
• Peripheral Zone (PZ) > DWI
DWI T2W DCE PIRADS Category
1 Any Any 1
2 Any Any 2
3 Any - 3
+ 4
4 Any Any 4
5 Any Any 5
![Page 35: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/35.jpg)
Overall PI-RADS Assessment
• Transition Zone (TZ) > T2
T2W DWI DCE PIRADS
Category
1 Any Any 1
2 Any Any 2
3 ≤4
Any 3
5 Any 4
4 Any Any 4
5 Any Any 5
![Page 36: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/36.jpg)
Conclusion
• Objectives of the PIRADS
– detection of most significant tumors
– decrease the number of useless biopsies
• Updates in the last version
– dominant sequence
• DW for the PZ and T2W for the TZ
– DCE : optional in most cases
• Advanced DW-MRI will improve its accuracy
![Page 37: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/37.jpg)
Case#1 : Overall PI-RADS Score ?
• 65 y/o; PSA level 7 ng/ml
• MRI before biopsy
1. PIRADS 1
2. PIRADS 2
3. PIRADS 3
4. PIRADS 4
5. PIRADS 5
![Page 38: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/38.jpg)
Case#1
• 65 y/o; PSA level 7 ng/ml
• MRI before biopsy
• PIRADS scores
– T2W: 2
– DW : 4
– DCE : 0
![Page 39: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/39.jpg)
Case#1
• 65 y/o; PSA level 7 ng/ml
• MRI before biopsy
• PIRADS scores
– T2W: 2
– DW : 4
– DCE : 0
• PZ lesion
– dominant sequence= DW
– PIRADS score 2-4-0 = 4
• Gleason 74+3 Ca
![Page 40: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/40.jpg)
Case#2 : Overall PI-RADS Score ?
• 67 y/o; PSA: 6ng/ml
• MRI before biopsy
1. PIRADS 1
2. PIRADS 2
3. PIRADS 3
4. PIRADS 4
5. PIRADS 5
![Page 41: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/41.jpg)
Case#2
• 67 y/o; PSA: 6ng/ml
• MRI before biopsy
• PIRADS scores
– T2W : 3
– DW : 4
– DCE : 0
![Page 42: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/42.jpg)
Case#2
• 67 y/o; PSA: 6ng/ml
• MRI before biopsy
• PIRADS scores
– T2W:3
– DW : 4
– DCE: 0
• PZ lesion
– dominant sequence = DW
– PIRADS score 3-4-0 = 4
• Gleason 74+3 Ca
![Page 43: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/43.jpg)
Case#3 : Overall PI-RADS Score ?
• 64 y/o; PSA: 9ng/ml
• MRI prior 4th set of bxs
1. PIRADS 1
2. PIRADS 2
3. PIRADS 3
4. PIRADS 4
5. PIRADS 5
![Page 44: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/44.jpg)
Case#3
• 64 y/o; PSA: 9ng/ml
• MRI prior 4th set of bxs
• PIRADS scores
– T2W: 5
– DW : 5 (>15mm)
– DCE: 0
![Page 45: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/45.jpg)
Case#3
• 64 y/o; PSA: 9ng/ml
• MRI prior 4th set of bxs
• PIRADS scores
– T2W: 5
– DW : 5 (>15mm)
– DCE: 0
• TZ lesion
– dominant sequence=T2
– PIRADS score 5-5-0 = 5
• Gleason 73+ 4 Ca
![Page 46: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/46.jpg)
Case#4 : Overall PI-RADS Score ?
• 64 y/o; PSA (579ng/ml)
• MRI prior biopsies
1. PIRADS 1
2. PIRADS 2
3. PIRADS 3
4. PIRADS 4
5. PIRADS 5
![Page 47: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/47.jpg)
Case#4 : Overall PI-RADS Score ?
• 64 y/o; PSA (579ng/ml)
• MRI prior biopsies
• PIRADS scores
– T2W: 2
– DW : 2
– DCE: +1
![Page 48: Finding significant Cancer : the PI-RADS current status · Finding significant Cancer : the PI-RADS current status Caroline Escourrou François Cornud Pôle imagerie (Pr Legmann)](https://reader031.fdocuments.us/reader031/viewer/2022022513/5aed88997f8b9a585f9059c6/html5/thumbnails/48.jpg)
Case#4 : Overall PI-RADS Score ?
• 64 y/o; PSA (579ng/ml)
• MRI prior biopsies
• PIRADS scores
– T2W: 2
– DW : 2
– DCE: +1
• TZ lesion
– dominant sequence =T2
– PIRADS score 2-2-1 = 2
• TB+SB : benign