How Does One Read MRI Results???

I wanted to look at my MRI images to see if I could find the hidden deadly cancer tumor that may or may not actually exist. What does cancer look like on an MRI? Do any of you guys know what any of this means?

Prostate 5.1x3.5x4.1cm Volume 39oz
Moderate central gland BPH. No isolated anterior gland tumor. Patchy decreased signal throughout peripheral zone of the prostate on the T2 on the weighted images may obscure small and low grade lesions. PSA density 0.088ng/cc/cc

"There is a focal region of early enhancement measuring 1.1cm at 3:00 in the left peripheral zone at the mid gland. This is not differentiated from the remainder of the patchy T2 hypo intense signal throughout the peripheral zone. It does demonstrate early enhancement and may have washout. On diffusion there is mildly increased signal and mild decreased signal on the ADC map PIRADS 4"

At the left side of the prostate there is a smudgy T2 hypointense that blurs the region between the central gland and the junctional zone. This extends 5-6:00 and measures approx. 1.6cm. This has mildly increased signal on diffusion and moderately low signal on ADC map, heterogeneous. No abnormal enhancement is identified in this area. PIRADS 3

An MRI can't be used to diagnoses cancer--only a ranking of "suspiciousness." Currently each lesion is scored on a 1-5 PIRADS scale for the likelihood of it being cancerous. See "How to Read your MIR Report". A lesion on an MRI is any spot or area that appears to be abnormal to the experienced eye.

PI-RADS 1: Very low
PI-RADS 2: Low
PI-RADS 3: Intermediate (undetermined)
PI-RADS 4: High
PI-RADS 5: Very High

Basically if you have a 3-5 lesion it should be followed up with a targeted biopsy that takes a sample for a pathologist to examine under the microscope. This direct observation of the architecture of the prostate cells is the only way to know with certainty if a lesion is cancerous. BTW, every study I've come across has concluded that PI-RADS 3 lesions (in the "gray area") should be biopsied.

It's not rare for a PIRADS 4 or 5 lesion to come back as benign after a biopsy.

I'll be adding a thread with a link to a just-published study that looked at the actual and perceived risk of having prostate cancer based on PIRAD scores (1-5) on MRIs.

Djin

Well, it is clear to me that some basic machinery maintenance is in order.

Those diffuse and patchy and grainy and smudgy washout blurred images are indicative that the lens is dirty and needs some Windex or 409 and a clean paper towel……..a little spit and polish, as we say. Plus, the repeated increased and decreased intensity of the signal and hypo intense signal confirms the battery needs charging and a better surge protector installed.

Sounds simple to me!

As others have said, the MRI indicates you need a guided biopsy. The MRI has proven to be an effective tool to help guide the practioner’s focus and concentrate some of the biopsy needles to the MRI indicated areas instead of just following the traditional grid method.

Historically, 50% of unguided biopsies are negative. That doesn’t mean there is no cancer, just that where they looked nothing was found. A 12 needle biopsy samples less than 1% of the gland. Think needle in a haystack. We can either thrash around the haystack and hope we get stuck by the needle, or we can bring a magnet (MRI) to the search and increase our odds of finding the needle.

Get all the information you can and use all the tools possible to find out what is going on so you can chart the best treatment path.

halbert said...
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Will there eventually a way to definitively diagnose PC without biopsy? Without a doubt. Someday. But not today.
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Funny you should ask! I came across these two just today. I think one idea is that the surgical outcomes would be improved without the insult of a biopsy. Of course if they remove you prostate and find no cancer, feel free to insult your surgeon.

Radical Prostatectomy Without Prior Biopsy in Selected Patients Evaluated by 18F-Labeled Prostate-Specific Membrane Antigen-Ligand Positron Emission Tomography/Computed Tomography and Multiparameter Magnetic Resonance Imaging: A Single-Center, Prospective, Single-Arm Trial (2024)

Robot-Assisted Radical Prostatectomy in PIRADS 5 Lesions Without Prior Biopsy: Is Biopsy Really Necessary in This Cohort? (2024)

There is a reason that non radiologists call MRI's, CT Scans, and to some extend X-Rays "Shadows from shadowland"
Note that all of these reports say things like "suspect" and "probable" and "possible", and rarely use definitive language.