What to expect in a 3T Prostate MRI report

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I am having a 3T prostate MRI with and without contrast at the University of California, San Francisco (UCSF) in about 8 days. I'm expecting the report to contain the following:

  1. PIRADS scoring system assessing the MRI's T2, DWI and perfusion contrast imaging biomarkers.
  2. an assessment of whether or not there is extracapsular extension if a tumor is found (has the tumor spread beyond the prostate)
  3. calculated prostate volume
  4. comments about the presence of BPH and a comment about the prostate median lobe

In addition to the report, I will also be able to get a CD/DVD of the images if I request them (naturally, I will).

Anyone want to comment on anything that might be missing. I'm paying for the MRI myself, so if I want them to do something it needs to be during the first time the doctor(s) look at the images. I imagine if I ask for something after the fact where a doctor needs to look at the images again, they will charge me. As an example, I found out that they normally don't provide a comment about the median lobe, but will if the patient asks them to.

For those who are interested, the 3T prostate MRI with and without contrast is supposed to cost me just over $1,300. I also got a quote from a facility near Seattle for just over $1,200.

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  • Posted

    Hello: My MRI, with contrast, was covered by insurance. The two things me and my Uro wanted to see was size and if there were any lesions. Result was 265g and no lesions. Next step was to remove the mass, which caused acute retention. I was in the OR 3-weeks later. Performed a Simple Robotic Prostatectomy and shelled out the mass (want to see a picture, message me). That was last August and I could not be happier.

    Dave

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  • Posted

    your radiologist should in his report indicate ADC value, those are are the bases to determine the final PIRADS scoring, also based on published research, there is strong correlation between ADC and gleason number, so knowing ADC values you can assess your risk as far as potential gleason, that can come only from pathology, search for correlation between ADC values and gleason number for further details, ADC values above 1000 are good, below 1000 are showing some potential risk

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    • Posted

      The ADC is the apparent diffusion coefficient of water molecules within tissue. The DWI, which I mentioned above, is diffusion weighted image. Sounds like the two are related. However, DWI appears to refer only to images whereas the ADC you mention would be a number or series of numbers. I've been in contact with a radiologist at UCSF and I'll ask him about the ADC. I'll mention the ADC gleason number correlation.

      Thanks.

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    • Posted

      Dr.Busch, if you know who he is, maintains, the next issue of PIRADS, version 3, will likely require to indicate ADC values to justify any PIRADS scoring

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  • Posted

    The key to such imaging is the reputation of the radiologist reporting on it. Hopefully he/she is an expert in reporting on prostates. In my case I had a 2T because of other issues that prevented me having a 3T. That said, the radiologist was an expert and though he reported at length on the variables you list, the urologist was interested in only 2: the PIRADS score and the volume of the prostate.

    The lower both are the better.

    In my case I had a PIRADS 4, which indicates a very good probability of PCa. And they were right.

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    • Posted

      "The key to such imaging is the reputation of the radiologist reporting on it. Hopefully he/she is an expert in reporting on prostates"

      this is the most important issue, some just learning, you really need some radiologist who has done few thousands of 3TMRI prostate readings

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    • Posted

      Thanks for your response. To my knowledge, I have no control over who will be reading and reporting on the MRI. UCSF has a great reputation when it comes to prostate 3T MRI and they do a fair amount of prostate 3T MRI research as well. In SF alone, they have multiple 3T MRI machines. One of them is designed for people who are claustrophobic (i.e. I was told it has more space). Even though I am not claustrophobic (as far as I know), I chose that machine.

      However, I have noticed some inconsistencies. For example, for some reason they have not updated the preparation instructions to show use of a pelvic coil instead of endorectal coil. The instructions say I need to use a FLEET enema because of the endorectal coil. OTOH, they have been good about communicating with me by e-mail. I'm scheduled to call a nurse today to clear up some of these issues.

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    • Posted

      you should have FLEET enema as this eliminates gases in rectum, gases are one of the problems in getting quality image, regardless if this is with endorectal coil or not, most MRI's are done without, so I will always have FLEET enema, even if they say not needed, which is BS

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    • Posted

      Even when a medical center has a good reputation, it does not follow that all the staff are equally good.

      I would try to investigate which radiologist has a better name than others and ask for him to review your films. I do this often even with far less important matters than PCa and never have I been refused. Sometimes staff look at me weirdly as though my request is odd. But I insist on a particular radiologist saying "I was recommended him and would like him to report . Oh, and if he isn't working today, that's cool, I can wait until he's back at work to report on it".

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  • Posted

    The 3T MRI will also indicate any issues with the bladder. It will indicate the size of all three lobes. I had mine done in Sarasota, Florida. Self pay was 700 dollars with and without contrast.

    I scheduled in on the day the doctor would be on site to read it. So about 30 minutes after the scan I had a 30 minute or so with the doctor to discuss the results.

    results

    1. one lesion ,,,, stated 80 percent chance it was cancer
    2. The medium lobe was 35 g and pressing against the bladder creating some issues.
    3. Bladder wall was a little thicker than normal
    4. Total size of prostate was 97g

      Left there and visited a URO in the area he recommended for a biopsy, Schedule the biopsy The URO and the Doctor who preformed my PAE two years before both reviewed the MRI scan and they both stated they were not so sure it was cancer, but both stated a biopsy was probably a smart move. Had biopsy using the 3T MRI as a guide.

      16 cores .. 8 in the area of the lesion and 8 in other sections of the prostate where cancer is common. NO cancer.

      3T MRI is worth the money. Good luck to you.

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    • Posted

      Thanks, Ed. Right now the plan is that they will forward the results to my referring urologist, but I have the right to request the report and images. I am currently in email contact with one of the "expert radiologist overseeing the clinical prostate MR exams" and he responds fairly quickly and doesn't seem to be overly arrogant. We'll see.

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  • Posted

    Hi rdemyan,

    I've had 2 mp3T MRIs over the years for my very large prostate. The first one showed a 7mm lesion that was classified as Pirads 4 - very scary! My urologist wanted to do a fusion, saturation biopsy with 32 cores of the region!! Having had 3 12-core blind TRUS biopsies over the years that were all negative but all of which left me with bleeding and infections I declined.

    I found Dr. Karamanian in Houston. I uploaded my CDs from the MRI and he read them for free and got back to me within a day. I flew down to Houston and he performed a targeted biopsy of the lesion and sent it to pathology. It was very easy with minimal discomfort. Turned out the lesion was just some benign inflammation associated with a PAE I had had a few months earlier.

    So my first recommendation is that if anything shows up on your MRI it is important to get a second opinion and Dr. Karamanian is the best in my opinion.

    Secondly I suggest you request a contrast agent for your MRI called Dotarem. The usual contrast agent is called Gadolinium which has been implicated in dementia and other brain disorders. Another forum discusses this issue.

    Dr. K only uses Dotarem as well. I had a follow-up MRI last fall for my lesion and requested Dotarem at my local hospital. Dr. K then read the MRI and it showed that my Pirads 4 had been reduced to Pirads 2 so Dr. K was correct. Good luck. Howard

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    • Posted

      Thanks, Howard. I had thought about Dr. K, but your post has convinced me to get that 2nd opinion if needed. I've been told they plan to use Gadolinium. I'm compiling a list of questions to e-mail a doctor I've been emailing at UCSF. I'll ask the question about Dotarem!

      In terms of risk of infection and bleeding, how is the targeted biopsy performed by Dr. K different than a TRUS biopsy(fusion or not)?

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    • Posted

      Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique?

      https://www.ncbi.nlm.nih.gov/pubmed/27568655

      insfection risk?

      you can protect yourself with this additional simple method

      https://www.ncbi.nlm.nih.gov/pubmed/26436913

      search this ttle for info/videos how to do,

      I have done it, and others too

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    • Posted

      Hi rdemyan,

      On the Fleet enema I also was told to do one the morning of my MRI. They want to make sure your bowel is cleaned out and not impinging on the prostate region, even with the pelvic coil which is what I had. I am claustrophobic and had the new wide bore 3T-MRI. It was very easy for me as it is well lit and only 6 feet long and they have a great fan blowing cool air on the face which really helps with the closed-in feeling. They also offered me a headset with music of my choice but I declined that as the MRI magnets are very loud and would make the music irritating. I have to say that I always the like the sound of the magnets - they are very musical in their own way. The whole scan, including the dynamic contrast part took 45minutes.

      Dr K's procedure for doing a targeted biopsy on a clinically significant lesion is very advanced. he actually does it real-time while you are in the MRI machine. I can explain more if you wish.

      The problem with the so-called fusion biopsies is that the urologist over-layes the old MRI scans with a conventional ultrasound scan real time. So if the lesion is small (under 10mm) there are what are called registration errors which means the "fusion" of the MRI and U/S scans may be in error. This is why so many cores are necessary.

      With Dr. K he hit the small lesion right on in real time and got 4 cores from the lesion itself. He goes through the rectum into the prostate the same way he does FLA. there is no pain and no bleeding.

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    • Posted

      Thanks, Howard. I checked my emails again and just realized that the UCSF radiologist wrote that I do not need a FLEET enema since a pelvic phased-array coil will be used.

      I didn't realize that you had an MRI guided biopsy with Dr. K. So it was "safer" because he was able to target the lesion and take less cores. However, there is still the risk of infection since the cores are taken via the rectum; just less so because of the relatively small number of cores taken.

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    • Posted

      Yes - actually Dr.K asked me to take a Cipro pill the day before and the day after.

      Also he pointed out that fusion biopsies are notoriously inaccurate for large prostates because just pushing in the biopsy needles causes the prostate to move out of registration with the old MRI images. And since the lesion cannot be seen on the ultrasound (unless very large) then the urologist is in effect shooting blind which is why they wanted 32 cores in my case. But Dr. K targets the lesion real-time with the MRI.

      I had my MRI done in Detroit at the hospital and they still wanted me cleaned out with an enema that morning.

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    • Posted

      It cost $2200.00 including the pathology analysis. I am surprised you have to pay for your MRI. Mine was covered by Medicare because of my BPH. But I had to pay out of pocket for Dr.K.

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    • Posted

      I'm not on Medicare yet and Kaiser does not have 3T MRI available at least in the SF and Seattle areas. Of course as you might expect the uros are pushing for TRUS biopsy but do not have an issue with me getting the MRI. But if the MRI shows something they will be strongly recommend TRUS biopsy.

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    • Posted

      I'm not on Medicare yet and Kaiser does not have 3T MRI available at least in the SF and Seattle areas. Of course as you might expect the uros are pushing for TRUS biopsy but do not have an issue with me getting the MRI. But if the MRI shows something they will be strongly recommend TRUS biopsy.

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    • Posted

      You may have already mentioned this but what is the reason for your getting the MRI? Do you have an elevated PSA trend or a suspicious DRE exam? Do you have BPH?

      You might want to check with Dr. Karamanian's office regarding the cost for the MRI to check your prostate, including dynamic contrast. I don't think it is that much and if he sees a lesion at the time he can still biopsy it while you are in the machine so it would save you some money. He is very responsive and will phone you back quickly at no cost. Then your only extra cost is to fly to Houston and spend one night at the hotel. Might be worth it for the added peace of mind.

      Yes it cost $2200.00 for me as an individual out of pocket. It does seem low but I wasn't going to complain! That was 3 years ago.

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    • Posted

      it's a lot more now, more like twice or ~$4500 last time I checked a

      year ago for MRI biopsy and pathology report for self paying patients, surprisingly Dr.Busch was less expensive ($$4300), that's where I went

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    • Posted

      Do you think that price might also include the initial mp 3T-MRI with dynamic contrast plus the MRI-guided biopsy if needed? I recall writing Donnie, Dr. K's assistant last year about just flying down for my MRI and a follow-up biopsy on the lesion if necessary and I think he quoted a total price in that range. But I could be wrong. Still since rdemyan has to pay cash anyway it might be worth a call to see what the combined procedures would cost.

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    • Posted

      I believe it's total, including initial MRI, to decide if you need more work and for the following MRI guided biopsy and pathology, if you need one,

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