How to cite: Verma SM. Post Ablation Imaging: Interpretation and Standardized Reporting. Grand Rounds in Urology. October 2025. Accessed February 2026. https://grandroundsinurology.com/post-ablation-imaging-interpretation-and-standardized-reporting/
Summary
Sadhna M. Verma, MD, MBA, FSAR, Professor of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, outlines the interpretation of magnetic resonance imaging (MRI) following focal therapy and emphasises that pretreatment imaging remains the most critical component of the focal workflow because accurate mapping of the index lesion is essential for post-treatment comparison. She states that post-ablation MRI appearances are similar across modalities and that radiologists rely on predictable patterns rather than modality-specific features.
Dr. Verma explains that in the immediate and early period, the treated zone demonstrates edema, architectural distortion, and heterogeneous signal changes. Dynamic contrast-enhanced sequences reveal a necrotic central zone with peripheral enhancement, a hallmark of early post-treatment imaging. Through the intermediate period, a hemosiderin ring appears around the ablation zone.
In the late period, she describes progressive volume loss, fibrosis, scarring, capsular retraction, and occasional development of a fluid cavity that may communicate with the urethra. She notes that T2-weighted images and Apparent Diffusion Coefficient (ADC) maps become less valuable because fibrosis produces a uniformly dark signal. Mild early diffusion restriction should not be mistaken for a tumor.
Dr. Verma discusses structured scoring systems, including prostate imaging after focal ablation (PI-FAB) and transatlantic recommendations for prostate gland evaluation with MRI after focal therapy (TARGET). Both rely primarily on dynamic contrast enhancement. PI-FAB classifies findings on a three-point scale, whereas TARGET uses a five-point scale with individual scores for T2 diffusion and contrast. She presents examples in which Dynamic Contrast-Enhanced (DCE) imaging determines the final suspicion level even when diffusion appears concerning. She then demonstrates cases of out-of-field recurrence and highlights the importance of comparing them with pretreatment imaging.
Dr. Verma emphasizes that MRI is essential for post-focal therapy assessment, but notes that scoring systems require larger validation studies. Additionally, she highlights that prostate-specific membrane antigen (PSMA)-based imaging plays a complementary role as part of a multidisciplinary follow-up.
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ABOUT THE AUTHOR
Sadhna Verma, MD, MBA, FSAR, is an Adjunct Professor-Affiliate of Radiology at the University of Cincinnati in Ohio. Dr. Verma established and continues to serve as the Director of the Prostate MRI Program at the University of Cincinnati and established the university’s CT imaging program for CT Urography and CT Enterography. Dr. Verma is the associate Chair of Quality and Performance Improvement at the Prostate Cancer Midwest Center of Excellence and the Director of the Prostate Cancer Imaging Program for the U.S. Department of Veterans Affairs. She is an international expert in the fields of GI and GU Imaging.
Dr. Verma earned her medical degree from the University of Louisville in Kentucky. She then completed an internship in Internal Medicine at the University of Pittsburgh in Pennsylvania. Dr. Verma completed a residency in Diagnostic Radiology and a fellowship in Health Service and Outcomes Research at the University of Cincinnati and then completed a fellowship in Body Imaging/3D Imaging at Johns Hopkins University in Baltimore, Maryland. Dr. Verma earned her MBA from the University of Chicago Booth School of Business in Illinois.
Dr. Verma is a member of the International Prostate MRI Working Group. She conducts local and national workshops to help train radiologists and inform clinicians and patients about this test. Dr. Verma has over 100 published articles and book chapters in her field.
