Prostate Imaging: PI-RADS, PET-MRI, and PSMA | Off The Cuff with Mark Moyad, MD

PCRI’s resident moderator Mark Moyad, MD, sits down with radiologist Daniel Margolis, MD, to discuss developments in prostate imaging ranging from PIRADS to PET/MRI combination scans.

Daniel Margolis, MD, is an Associate Professor of Radiology at the Weill Cornell Medical College and an Associate Attending Radiologist at New York-Presbyterian Hospital. He received a B.A. from UC Berkeley in 1992 and his medical degree at the Keck School of Medicine of USC in 1998. He went on to serve his community by completing an internship at the Los Angeles Department of Veterans Affairs. He finished his residency at the UCLA Medical Center in 2003 and completed a prestigious fellowship at Stanford University sponsored by the National Cancer Institute. Dr. Margolis specializes in abdominal imaging and has co-authored nearly 100 publications, many of which focus on prostate imaging.

0:17 Dr. Moyad asks Dr. Margolis what he thinks the most important development in prostate imaging was while he was at UCLA (1999-2003). Dr. Margolis answers that PI-RADS (Prostate Imaging, Reporting, and Data Systems) was the most important development while he was in his residency at UCLA. PI-RADS is a set of technical standards for producing images and a universal language used by physicians from different institutions and specialties to interpret MRI images. Without going into the details, PI-RADS categorizes lesions on a scale of 1-5 where “1” means no risk, “2” means low risk, “3” means intermediate risk, “4” means high risk, and “5” is very high risk. The use of PI-RADS by an institution should reassure a patient about the quality of its radiologists. The only cases when an institution should not use PI-RADS is when it is operating at such a high level that it has its own better system (e.g. Sloan Kettering, UCLA) in which case they would use both their system and PI-RADS if they were communicating with another institution.

3:40 Dr. Moyad then asks Dr. Margolis about the most exciting thing happening in New York right now (regarding prostate imaging). Dr. Margolis answers that the combination of MRI and PET scans is the most exciting development for him right now. The advantage of this approach is that you get all of the tissue and functional characterization from the MRI scan along with the specificity from recently developed PET agents (e.g. C11 Choline/Acetate, Fluciclovine/Axumin, PSMA).

6:57 Dr. Moyad asks if the use of a combination of PET/MRI scans will be standard in the future. Dr. Margolis responds by saying that this approach is only appropriate for specific cases in which physicians need information that can only be provided by doing the two scans: MRI for prostate and surrounding tissue characterization and PET for suspicion of metastatic disease.

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