0:00

Now I'd like to talk with you about the T two signal

0:03

in the peripheral zone.

0:04

And this is kind of a bonus

0:05

because even though you can score the T two signal in the

0:09

peripheral zone one through five,

0:10

and remember these are not the PY rats criteria

0:13

when we are in the peripheral zone, it doesn't matter

0:15

what the T two signal intensity is.

0:18

Any score combined with a score of four

0:23

or five on the DWI is gonna take you into a PI RAD score

0:27

of four or five.

0:29

That being said, let's talk about the severity in the shape

0:33

and signal in the peripheral zone

0:35

of the T two weighted image,

0:37

because in my heart I feel this does add

0:41

to the confidence in the diagnosis of cancer.

0:44

So score one uniform hyperintense signal intensity in the

0:48

peripheral zone, which is what you should see.

0:50

However, in people over 60 chronic prostatitis

0:54

and a number of other factors frequently make the peripheral

0:58

zone lower in signal intensity.

1:01

In addition, people with TZ enlargement

1:04

or BPH as they get older, start

1:06

to press on the peripheral zone

1:08

and it can get very thin a score of two linear

1:12

or wedge-shaped hypo intensity

1:14

or diffuse mild hypo intensity, which I just described

1:17

with a, an indistinct margin, a score of three

1:22

heterogeneous signal intensity

1:24

or non circumscribed rounded moderate hypo intensity

1:29

or a three doesn't meet the score criteria for a two,

1:33

a four or a five.

1:34

So it's kind of a tweener, a score of four, a circumscribed,

1:39

homogeneous, moderate, hypo intense focus that is mass like

1:44

frequently round or elliptical, confined to the prostate

1:47

and less than 1.5 centimeter in greatest dimension.

1:50

You know, one way to think about this is a little bit like

1:53

how you think about breast imaging.

1:55

You think about lesions that are mass, like

1:57

and non mass, like the mass, like ones tend to be round

2:00

or oval in shape.

2:02

The non mass like ones tend to be more amorphous

2:04

or linear criteria five, exactly the same as four,

2:08

but greater than

2:10

or equal to 1.5 centimeters in greatest dimension.

2:14

Let's move on, shall we?