Figure 5d:

Images in a 63-year-old biopsy-naïve patient with a PSA level of 6.25 ng/mL. (a) Axial T2-weighted MR image shows an area of low signal intensity (arrow) in the midline anterior transition zone. (b) Axial ADC map obtained with DW imaging reveals a hypointense lesion (arrow) in the same location. (c) DW MR image (b = 2000 sec/mm² ) shows the lesion (arrow) as a mildly hyperintense focus. (d) Dynamic contrast-enhanced MR image shows corresponding mild focal hyperenhancement (arrow). (e) Whole-mount pathologic specimen obtained at robotic-assisted prostatectomy shows Gleason 4+4 disease corresponding to the identified lesion (red outline). However, the extent of the lesion was underestimated with MR imaging, particularly in the left transition zone. In addition, a Gleason 3+4 lesion was seen in the right peripheral zone (red outline). This lesion was not apparent at prospective or retrospective review (PI-RADS category 1). See also Movies E4–E6 (online).