Prostate imaging: multiparametric MRI: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Prostate imaging: multiparametric MRI

Sample item

A man with PSA of 9 ng/ml and a negative first biopsy has a multiparametric prostate MRI. Which finding in the peripheral zone gives the highest suspicion of clinically significant cancer?

ADiffuse bright T2 signal of the whole glandBA focal low T2 signal lesion with marked restricted diffusion and early enhancementCA central gland nodule with a hyperintense capsuleDA well-defined hyperintense T2 cyst

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. A focal low T2 signal lesion with marked restricted diffusion and early enhancement

In the peripheral zone, diffusion-weighted imaging is the dominant sequence for scoring, and a focal lesion with low ADC, T2 hypointensity and early enhancement carries a high PI-RADS score. MRI-targeted biopsy then samples that lesion.

Option by option

A. Diffuse bright T2 signal of the whole gland
Diffuse T2 brightness is typical of normal peripheral zone tissue.
B. A focal low T2 signal lesion with marked restricted diffusion and early enhancement (correct)
Correct. Restricted diffusion with T2 hypointensity is the classic malignant pattern.
C. A central gland nodule with a hyperintense capsule
An encapsulated central gland nodule with a hyperintense capsule favours benign hyperplasia.
D. A well-defined hyperintense T2 cyst
A cyst is benign and bright on T2.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, A focal low T2 signal lesion with marked restricted diffusion and early enhancement. In the peripheral zone, diffusion-weighted imaging is the dominant sequence for scoring, and a focal lesion with low ADC, T2 hypointensity and early enhancement carries a high PI-RADS score.

Why is "Diffuse bright T2 signal of the whole gland" not the answer?

Diffuse T2 brightness is typical of normal peripheral zone tissue.

Why is "A central gland nodule with a hyperintense capsule" not the answer?

An encapsulated central gland nodule with a hyperintense capsule favours benign hyperplasia.

Why is "A well-defined hyperintense T2 cyst" not the answer?

A cyst is benign and bright on T2.

What concept does this question test?

It tests Prostate imaging: multiparametric MRI in Radiology. MRI-targeted biopsy then samples that lesion.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Prostate imaging: multiparametric MRI?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.