Evaluation and Targeting No More Blind Biopsies. Previous Negative Biopsies Active Surveillance Focal Therapy. Icahn School of Medicine at Mount Sinai
Icahn School of Medicine at Mount Sinai
Art Rastinehad D.O Director, Focal Therapy and Interventional Urologic Oncology Associate Prof. of Urology a...
• Evaluates the Brownian motion of free water within tissue • Tissue diffusion is restricted •increased cellularity •the water path is interrupted by cell membranes. •Prostate Cancer
• B Values? – How does this impact your ADC map? – What kind of B values are used • 0‐750 five equal divisions • 0, 800, 1000, 1500, 2000 • Possibly remove the 0 B value for improved ADC maps
– Does the results of ADC map correlate with pathology?
• Comparison of signal intensities with and without DWI taking into account the ‐1/b value – Creates a Ratio that is then graphed • ADC = log slope of the line of the signal values ratio
– ADC Maps • decrease T2 shine through • Possibly increase cancer detection with b‐values > 1000 to 2000* *AJR Am J Roentgenol. 2010 Jan;194(1):W33-7.
DWI MRI
ADC b=0
s/mm2 b = 188 s/mm2
b = 375 s/mm2
b = 563 s/mm2
b = 750 s/mm2
Turkbey, Rastinehad, Pinto et al. Radiology 2011
Gleason Pattern 3
Less Restricted
Gleason Pattern 4
Gleason Pattern 5
Restricted
Free Motion of Water
• Evaluates the VASCULARITY of tumors • Prostate cancers usually show early and rapid enhancement, early washout
JAMA. 2015 Jan 27;313(4):390-7.
• Level 1 Evidence
– MR US Targeted Biopsy outperforms 12 core – Detects 30% more high risk cancer • 17% less low grade disease
– Accuracy (WMH) • 77% Targeted vs 53% Std Biopsy
Urol Oncology Sept 201
77% + MRI
STD BX + CaP 36% MRI Neg MRI + SAT Bx 29% Gleason 6
+ MRI + CaP 87%
- Bx 28%
+ CaP 93%
Elevated PSA NO BIOPSY
Standard 12 core US Guided Biopsy
33‐45% of Men Negative MRI
67% MRI Clinically Significant Images
Department of Radiology and Urology Mt. Sinai School of Medicine
What a Urologist Needs to Know
Art Rastinehad D.O Director, Focal Therapy and Interventional Urologic Oncology Assistant Prof. of Urology and Radiology