0:00

Now, let's talk about the transition zone for a minute.

0:04

The tz, you know, this is a difficult area first,

0:08

in my experience, it is very common

0:10

to have diffusion restricted nodules in the tz,

0:14

and the overwhelming number

0:15

of these are gonna end up being either nothing

0:17

or Gleason six, which

0:20

has now become a controversial Gleason score

0:23

because some people interpret that to mean pre-cancer

0:26

or non-cancer, especially in somebody over 60

0:30

or 65 years of age.

0:31

So you have to approach these nodules very carefully so

0:35

that the patient doesn't get overtreated.

0:38

The major criteria in the transitional zone is the T

0:41

two weighted image, not the DWI.

0:44

The DWI is the major criteria in the peripheral zone or pz.

0:50

So the T two weighted image can be graded by the following,

0:55

1, 2, 3, 4, and five.

0:57

But what does that mean?

0:59

I've already been through what the DWI criteria are,

1:04

and we'll talk about what the dynamic contrast enhanced

1:08

criteria of positive or negative mean to get us

1:11

to our PI RAD score.

1:13

But to get us to our PI RAD score, we have

1:15

to focus on the T two signal intensity

1:19

more than anything else.

1:21

So let's explain what one through five means

1:24

in the upcoming vignette.

1:27

Let's do it.

PI-RADS assessment - Transition Zone

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0:00

Now, let's talk about the transition zone for a minute.

0:04

The tz, you know, this is a difficult area first,

0:08

in my experience, it is very common

0:10

to have diffusion restricted nodules in the tz,

0:14

and the overwhelming number

0:15

of these are gonna end up being either nothing

0:17

or Gleason six, which

0:20

has now become a controversial Gleason score

0:23

because some people interpret that to mean pre-cancer

0:26

or non-cancer, especially in somebody over 60

0:30

or 65 years of age.

0:31

So you have to approach these nodules very carefully so

0:35

that the patient doesn't get overtreated.

0:38

The major criteria in the transitional zone is the T

0:41

two weighted image, not the DWI.

0:44

The DWI is the major criteria in the peripheral zone or pz.

0:50

So the T two weighted image can be graded by the following,

0:55

1, 2, 3, 4, and five.

0:57

But what does that mean?

0:59

I've already been through what the DWI criteria are,

1:04

and we'll talk about what the dynamic contrast enhanced

1:08

criteria of positive or negative mean to get us

1:11

to our PI RAD score.

1:13

But to get us to our PI RAD score, we have

1:15

to focus on the T two signal intensity

1:19

more than anything else.

1:21

So let's explain what one through five means

1:24

in the upcoming vignette.

1:27

Let's do it.

Report

Editorial Note

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

John F. Feller, MD

Chief Medical Officer, HALO Diagnostics. Medical Director & Founder, Desert Medical Imaging. Chief of Radiology, American Medical Center, Shanghai, China.

HALO Diagnostics

Lesson

Introduction

Lesson

Prostate Anatomy

Lesson

Evaluating BPH

Lesson

What's New in PI-RADS 2.1

Lesson

Prostate MRI Imaging Caveats

Lesson

Prostate MRI Case Reviews

Lesson

PI-RADS 2.1 Case Review

Lesson

Multiparametric MRI Case Review with Dr. John Feller

PI-RADS assessment - Transition Zone