How to report MRI Prostate for Cancer Cases : Guidelines, Tips with examples

Interpretation

1. Calculate Prostate gland volume: It is measured using the formula - maximum anterior posterior diameter x maximum transverse diameter × maximum longitudinal diameter x 0.52. We personally prefer T2W and T2 Fat suppressed images for the measurements. 

2. Peripheral Zone : ​Scan peripheral zone of Prostate for any focus of restricted diffusion on DWI & ADC Map images. 

3. Transition Zone : ​Scan transition zone of Prostate on T2W images.

 Formulate Report

After interpreting images, it is time to formulate the report. The report should include 

1. ​Technical details : About the MRI Scanner and sequences used. The mentioning of sequences is important for follow up of case.
2. Brief clinical details : Presenting complaints, DRE examination findings*, PSA values*, Biopsy details* & any previous MRI study, if available. 
3. Findings : The size of the Prostate. The details about lesions (size, location, signal intensity, restricted diffusion, contrast enhancement locoregional spread/infiltration). Presence or absence of possible lymph nodal and bone metastases.​ Additional / incidental finding if any. 
4. Impression : The brief conclusion of findings with PI-RADS V2 Score. 
5. Key images : The size of Prostate measured on T2W Axial and T2W Sagittal; The delineation of lesion(s) on T2W, DWI, ADC & Contrast Axial images.
6. Prostate Sector Map : 

Reporting Template : Normal 

MR IMAGING OF PELVIS: PLAIN & CONTRAST 

Multiplanar multiecho MRI study has been performed on 1.5 Tesla MRI using above sequences. In addition, dynamic post contrast images are obtained. 

Clinical Details :

FINDINGS :
Prostate & seminal vesicles:
The prostate is normal in size, shape and signal pattern. No obvious discrete mass lesion or abnormal enhancing focus within. No significant median lobe projection over bladder base. The prostatic capsule appears intact. Periprostatic fat planes are normal.

Both seminal vesicles appear normal in size and MR morphology for present age. No significant pelvic lymphadenopathy.

Urinary bladder:
Urinary Bladder is partially distended. The urine is homogenous in signal. No obvious mass lesion.

Pelvic cavity:
The visualized bowel loops appear normal in morphology. No free fluid in peritoneal cavity.

Musculoskeletal:
The hip and sacro-iliac joints joint appears normal. The visualized bones appear normal with normal marrow signal. The visualized pelvic musculature and extrapelvic soft tissues are within normal limits.

IMPRESSION :

• MR Imaging of Pelvis is within normal limits.

Reporting Template : Abnormal 

MR IMAGING OF PELVIS: PLAIN & CONTRAST 

Multiplanar multiecho MRI study has been performed on 1.5 Tesla MRI using above sequences. In addition, dynamic post contrast images are obtained. 

Clinical Details : C/o Mild prostatic symptoms. Raised PSA 6.0. Firm consistency of right lobe of Prostate on DRE.

FINDINGS :
Prostate & seminal vesicles:
Prostate is mildly enlarged (measures 4.5 x 4.1 x 3.5 cm; Vol: 33.6) with diffuse expansion and marked heterogeneity of the transition zone, mild thinning of the peripheral zone and heterogeneous parenchymal enhancement, suggestive of prostatic hyperplasia. There is focal T2W hypointense signal intensity lesion in right peripheral zone of mid prostate extending down to the apex level, measures upto 9mm. It shows low signal intensity on corresponding ADC map. There is early and higher enhancement of the lesion relative to the normal parenchyma after administration of contrast. Thickening and irregularity of adjoining prostatic capsule is present. In addition, few similar nodular and ill-defined areas are seen in transition zone of mid prostate on both sides, largest measures upto 7mm. Rest of the prostatic capsule appears intact. 

Both seminal vesicles are visualized separately; appear normal in size and MR morphology for present age.

No significant pelvic lymphadenopathy.

Urinary bladder:
Urinary Bladder is well distended. The urine is homogenous in signal. Mild diffuse wall thickening and mucosal irregularity of bladder noted, consistent with chronic cystitis. No obvious bladder mass lesion.

Pelvic cavity:
The visualized bowel loops appear normal in morphology. No free fluid in peritoneal cavity.

Musculoskeletal:

The visualized pelvic musculature and extrapelvic soft tissues are within normal limits.

IMPRESSION : MRI Pelvis study reveals –

• Mildly enlarged prostate showing diffuse expansion of the transition zone, mild thinning of the peripheral zone and heterogeneous enhancement - suggestive of Prostatic hyperplasia.

• Focal T2W hypointense signal intensity lesion in right peripheral zone of mid prostate extending down to the apex level, measures upto 9mm. It shows low signal intensity on corresponding ADC map. There is early and higher enhancement of the lesion relative to the normal parenchyma after administration of contrast. Thickening and irregularity of adjoining prostatic capsule is present. In addition, few similar nodular and ill-defined areas are seen in transition zone of mid prostate on both sides, largest measures upto 7mm. These findings are suspicious for multi-focal Prostatic Malignancy (T3a Disease / PI-RADS 4). 

• No suspicious locoregional / pelvic lymph nodes or bone lesions in imaged regions. 

Tip to insert Sector Map in Word Template:

1. Download Black / White or Color Sector Map Picture on your computer by using right click of Mouse and Save as option.

2. Insert Picture in your report and take a printout. Highlight the areas of signal abnormality by Pen.  

PI-RADS™ v2 assessment categories