الفهرس 
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Abstract
This study was a prospective study including 50 patients, starts from March 2013 to March 2016, performed in Radiology department, Minia University. All referred patients clinically suspected to have prostate cancer. They have abnormal high PSA level with or without suspicious DRE.
All patients underwent MRI examination of the prostate gland including (T1, T2 and DWI/ADC) & MRS in selected patients according to the availability.
mp-MRI is considered the best anatomical and functional imaging modality that is used for detection and characterization of prostate tumors. Prostate Imaging Reporting and Data System (PI-RADS) guidelines aimed at standardizing the acquisition, interpretation and reporting of prostate MRI. Although trans-rectal U/S guided biopsy is still the gold standard technique in diagnosis but it has many complications. Thus, trans-rectal US had a sensitivity of 33%, a specificity of 88% and a positive predictive value of 57% for the detection of prostate cancer.
In this study, DRE and total PSA alone are of low accuracy (52-54%) in detection and characterization of malignant changes. This markedly improved when correlated with PSA ratio. This elevated the accuracy up to 94%. This matched with (Nicholas P, Francois C, 2011) who reports that risk factors/PSA correlation that is >25%, had low risk for prostate carcinoma. Therefore, the most effective combination in assessment of prostatic carcinoma is DRE/PSA ratio with annual monitoring of PSA velocity.
In prostate MRI, using representative images for the relevant scores, and to add a scoring table that combines the aggregated multipara-metric scores to a total PI-RADS score according to the Likert scale. In addition, a standardized graphic prostate reporting scheme which enables accurate communication of the findings to the urologist. The standardized graphic reporting scheme facilitates the communication with referring colleagues and promotes widespread use of the method and implementation of large-scale multicenter studies, which are needed for further evaluation of the PI-RADS system, in analogy to the BI-RADS system used in breast imaging.
In pre-treatment assessment of prostate cancer, MRI can estimate the tumor size, loco-regional lymph node assessment with limited value in assessment of distant metastasis outside the examined FOV (field of view), TNM has a major effect upon the treatment planning of the prostatic carcinoma. One of the important indications of prostate MRI in patients known to have prostatic carcinoma is evaluation of clinical staging (TNM),
Diffusion MRI examination of the prostate is more helpful in evaluation of the peripheral zone lesions compared to the central gland lesions. Mostly due to the histological composition of peripheral zone which formed is from glandular tissue & hypertrophied central gland that formed from mixed of stromal and glandular tissue. Benign stromal nodules had diffusion restriction, in our study 2 patients had central gland stromal nodules with diffuse restriction of score (4) not correlated with T2 score (2), in peripheral zone malignant lesions (n=30) had diffusion & non-malignant lesions (n=6) had non-significant diffusion restriction.
ADC value is non-subjective methods to evaluate the prostatic lesions, differentiation between benign and malignant lesions, main ADC value of the benign lesions above 1x10-3cm/s & for malignant lesions below this value best applicable for peripheral zone lesions.