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Performance Characteristics of mpMRI at Centers of Excellence Peter Choyke, MD National Cancer Institute
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Optimizing Prostate MRI Before the MRI – Dedicated personnel who: Access medical records Obtain history PSA Prior biopsy results with location and Gleason score Understand the purpose of the examination Safety check for implants Evacuate bladder and bowel
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Optimizing Prostate MRI During the MRI – Assure patient comfort to reduce motion – 3T or late model 1.5T with or without ERC Dedicated Technologist(s) Same machine – High quality T2 (no fat sat) – Diffusion weighted MRI Use b values between 100-1000 for ADC High b value image above 1500 – DCE MRI with temporal resolution <7 sec Carry out to 4 minutes
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Optimizing Prostate MRI After the Exam – Rapid structured report PI-RADS v2 format PI-RADS Map – Images transferred to workstation for MR-US fusion biopsy Segment the prostate Localize the lesions Follow-up on path report
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The PIRADS v2 mapping Schema
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Limitations Total Hip Replacement Motion Obesity False borders of the tumor – Careful correlation with histology – Corona effect
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Patient-Specific MR-based Mold Shah et al. Rev Sci Instrum. 2009 Oct;80(10):104301 (Research Highlight for Oct’09 issue) Tissue Blocks Obtained from Prostatectomy Specimen Virtual Mold T2W 3D PrintingMold Printed at CIT, NIH Marcelino Bernardo
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Follow-up of Ablations Requires careful uniform imaging in followup Surrogates of residual disease: – Enhancement – DWI – PET agents?
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Pre-treatment T2W MRI Pre-treatment ADC map Pre-treatment DCE MRI Post-treatment T2W MRI Post-treatment ADC map Post-treatment DCE MRI
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PET Imaging of Residual Disease 58, M, PSA=8.2 Gleason 3+4 tumor
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Summary Center of Excellence requires attention to detail before, during and after the MRI There are a number of important limitations of MRI in performing/monitoring ablation that must be acknowledged MRI for followup of ablation can be non- specific. – Newer PET agents may be helpful in detecting recurrence
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