 Okay, we're going to get into some cases today, but I'd like to snip it a little anatomy and then talk about Pirates 2.0, which Includes both diffusion-related MRI T2 MRI But pushes down dynamic contrast enhanced MRI a little bit so that we don't Quantitate or semi-quantitate DC MRI. We're just going to look at positives and negatives and we'll elaborate on that in a few moments There is an axial image of the prostate showing the region of the urethra The peri urethral glands with some gland openings and it's not uncommon as you see as you've seen in prior prior snippets For these to dilate and for you to get little cysts Peri urethral cysts sometimes arising from the prosthetic Utrical or the region of the virumontanum which we see here in the coronal projection you all know that the Prostate gland is divided into a central region and a peripheral region The central region is composed of the transitional zone Which when you're younger is not that big but houses about five percent of the glands and the central zone which when you're young is pretty thin and These together are central region. Sorry central zone or region and these together make up the central portion of the gland Whereas the peripheral portion of the gland consists of the peripheral zone which has most of the glands as many as 75% of the glands The peripheral zone has about two-thirds of the cancer is sometimes reported as up to 70% Which makes sense because that's where most of the glands are and that's where most of the cancers arise from There's a coronal projection showing you the course of the urethra right down the midline Which separates the gland into a right half and the left half and also into a base and an apex And it is the apex and the antioapical region that is most difficult for urologists to see and or get to Either with biopsy or with trans rectal ultrasound these little nubbins of blue Color represent the periprostatic venous plexus and as mentioned before although not drawn in We have the neurovascular bundles which are going to be at seven o'clock and five o'clock in our clock face in the axial projection Here's a magnified view of the axial projection, which is going to be our guts projection our hallmark projection for assessing Prostate carcinoma with the coronal and the sagittal being used to modify Position and nomenclature. So here we are again in the central region of the prostate gland Which contains the urethra some peri urethral tissues some glandular tissue the transitional zone Which is now more enlarged and an older patient and the central zone gets bigger too although not quite as big as the Transitional zone and sometimes we'll get pressed together as a fairly thin area here We've drawn it in very clearly in yellow and together these make up the central region of the prostate and here in brown Is the peripheral region or zone of the prostate? Don't forget there is an anterior fibromuscular stromal area Which becomes very important when you have very far anterior cancers that infiltrate into this area and become very hard Not only to diagnose and see By the urologist, but also a little bit confusing for the radiologist because remember this is an anterior fibromuscular Stroma and that stroma is dark and the cancers are going to be smudgy and charcoal like and they're also going to be dark So they could blend together kind of wax on wax off appearance And it may be very difficult for you without diffusion restriction and some of the other components of prostate MR to make a proper Diagnosis it's going to be much easier when you have a nice simple round hypervascular Neurovascular diffusion restricted nodule in the peripheral zone. That's easy anybody can figure that out after a short discussion Like the one we're having today, and then we now have drawn in the neurovascular bundle at the seven and five o'clock positions in the axial projection This is a sagittal projection lying on its side This is the front and is showing you the the length of the anterior fibromuscular zone It is in this location the patient is lying on their back It is in this location where the cancers are very difficult for the urologist to see and where MR is at its Absolute strongest and this is the central region of the prostate Notice the peripheral zone or region of the prostate goes all the way around and especially when you're off to the side It forms almost a complete envelope all the way around the central region of the prostate So you have to be very careful in the sagittal projection to inspect all the way in the back All the way down and around and all the way peripherally in the front So these paris sagittal views can be very helpful, but also a little bit confusing unless you understand the 3d anatomy Here we are again back into the coronal projection showing you the neurovascular bundle out to the sides and the base and apex and mid portion of the prostate gland with some Vascularity including the urethral branches of the vascular anatomy which penetrate the prostate and sometimes you'll actually be able to see Small dots in the prostate that represent vessels Sometimes you'll see small dots that represent Prostatalists or calcification and these are two features that may completely confuse you when you're looking at the diffusion Maps or the ADC maps these may show up as darker areas and may produce some confusion in the high-rats 2.0 diagnosis Then I've got a very simplified diagram of the prostate Helping you understand the base the base and apical anatomy of the prostate gland base up near the bladder apex down below We've got the external sphincter drawn in very nicely here, which by the way you can see in the coronal projection You'll also hear nomenclatures in some other Cultures and countries describe the prostate gland as a proximal zone and a distal zone and a mid zone Here in the United States We use most commonly basal mid and apical the mid portion of the prostate, which is the widest is often Divided into a lateral or outer one-half and an intermediate or inner one-half at the mid level So this is a coronal core terminology that you should be aware of Before we get into our pirates 2.0 at designation I'd like to talk about Gleason grading and scoring So if you're interested come on on to the next vignette and we'll help you understand what Gleason really means