0:00

I want to take you through a short journey on the

0:02

international working groups changes on PY rads, uh,

0:06

version 2.0 to 2.1 and

0:09

and talk about some of the high points.

0:12

We will address some imaging data specifications,

0:15

technical specifications that have been requested

0:19

on T two weighted imaging.

0:20

It's recommended to perform this assessment

0:24

in the axial plane for T two signal alteration

0:27

and at least one additional plane,

0:28

either sagittal or coronal.

0:31

We happen to do it in axial, sagittal

0:33

and coronal in our practice diffusion weighted imaging.

0:36

We're gonna clarify the B values

0:38

that are used usually at the minimum two B values a thousand

0:43

or less, and then one B value at

0:46

around 1400 or greater.

0:49

And the B value is integral in the interpretation

0:53

of the peripheral zone.

0:54

And for a DC MAP calculation, dynamic

0:57

contrast enhanced MRI, somewhat controversial

1:01

because some have claimed that it's optional,

1:02

others have claimed that it's mandatory,

1:05

but the temporal resolution should be no greater than

1:08

15 seconds per temporal interval, we use about seven

1:12

to 12 seconds, so pretty quick.

1:15

And three DT one weighted GRE is the preferred

1:19

dynamic sequence.

1:20

And then some clarifications and interpretation criteria.

1:23

There has been some further description

1:25

of lesions in the central zone

1:28

and the anterior fibromuscular zone.

1:29

The term central gland is no longer in use, so I kind

1:34

of steer away from that 'cause

1:35

that produces some confusion with central zone.

1:38

There are revisions in the criteria for T two scores of one

1:42

and two in the transitional zone.

1:44

And we'll elaborate on this.

1:46

T two is a major criteria for the transitional zone,

1:50

not diffusion weighted imaging while

1:52

diffusion weighted imaging.

1:53

And the A DC map is a major criteria

1:56

for the peripheral zone.

1:58

There have been some revisions in determination

2:00

of the overall assessment category in the transitional zone.

2:04

For instance, we look at lesions in the transitional zone,

2:07

which frequently diffusion restrict.

2:09

This is no longer a major criteria,

2:11

but when we have diffusion restriction, we'll look at

2:14

how much encapsulation

2:16

and how round the lesion is in the transitional zone

2:19

to push us towards lower RADS grades.

2:23

Revisions in criteria for DWI scores of two

2:27

and three in the peripheral zone or transitional zone.

2:30

We'll show those to you in a separate vignette.

2:32

And then classification of the distinction between positive

2:36

and negative enhancement on dynamic contrast.

2:39

Enhanced MRI, this will be relatively simple.

2:42

And then we will clarify the measurement

2:44

of prostate volume using the ellipsoid technique,

2:47

which seems to be preferred.

2:49

So maximum AP measurement

2:51

and we do this in the sagittal projection

2:53

or off the sagittal maximal height

2:56

or longitudinal measurement.

2:57

We do this off the

2:59

Sagittal and then maximal side to side, medial lateral

3:02

or transverse dimension.

3:03

We measure this off the axial. We multiply at times 0.52.

3:09

Up until recently we have been using the bullet

3:12

technique length times width times height times 3.14 divided

3:16

by six, which a lot of people still do use.

3:19

But the ellipsoid method is preferred in version 2.1.

3:24

And then some minor revisions to the sector map,

3:26

which we'll briefly review

3:28

and then we'll talk about by parametric MRI, in other words,

3:31

using diffusion weighted imaging

3:33

and T two as opposed to using more than two techniques

3:38

to decide on the PI rads grade.

3:40

In other words, you add in dynamic contrast, enhanced MRI,

3:44

you add in spectroscopy

3:45

and then you have something called multiparametric

3:48

assessment, uh, of the prostate.

3:50

Most people have gone to PI to BI parametric evaluation.

3:54

And then in some cases we'll add on dynamic

3:58

contrast enhanced MRI,

3:59

and we'll talk about when that use is more helpful.

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If you wanna learn more about the PY rads V 2.1 upgrade,

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I refer you to the full document and here is the link online

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and you can read it in its entirety.