Multiparametric MRI Appearances of Primary Granulomatous Prostatitis

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2019 Apr 10

PMID 30964700

Citations 13

Authors

Su-Min Lee

Konrad Wolfe

Peter Acher

Sidath H Liyanage

Affiliations

Soon will be listed here.

Abstract

Objective: Radiological features of granulomatous prostatitis (GP) overlap with those of prostate adenocarcinoma. Identification of specific GP features may aid diagnosis. We aimed to evaluate the multiparametric MRI (mpMRI) features of GP.

Methods: We retrospectively reviewed 16 patients from a cohort undergoing mpMRI and transperineal sector-guided prostate biopsies between July 2012 and May 2017. Images were analysed for lesion location, shape, size, extracapsular extension, signal intensity (SI), apparent diffusion coefficient (ADC) values, dynamic contrast enhancement (DCE) pattern and PI-RADS (Prostate Imaging - Reporting and Data System) v2 score.

Results: Histology revealed 13 cases of nonspecific GP and 3 cases of xanthogranulomatous prostatitis. GP lesions were diffuse involving > 50% of the prostate ( = 13) or nodular ( = 3). Signal intensity on weighted imaging was low and high on diffusion-weighted imaging. ADC values were low (mean 702 ± 79 × 10 mm/s ). Five patients had DCE imaging with all cases 'positive' as per PI-RADS scoring, with two cases displaying further ring enhancement consistent with abscess formation. Overall PI-RADS score for all cases was 5, indicating high suspicion of prostate cancer.

Conclusion: GP is difficult to differentiate from prostate cancer, but typically gives diffuse changes involving > 50% of the gland on mpMRI, with extracapsular extension and rim-enhancing areas. It should be considered a differential diagnosis in patients with recent urinary tract infection (UTI) or prior Bacillus Calmette-Guerin (BCG) treatment.

Advances In Knowledge: Prostate MRI imaging features including diffuse changes, extracapsular extension and rim-enhancing areas, in patients with recent UTI or BCG treatment may help identify granulomatous prostatitis cases.

Citing Articles

Interpreting Prostate Multiparametric MRI: Beyond Adenocarcinoma - Anatomical Variations, Mimickers, and Post-Intervention Changes.

Yilmaz E, Esengur O, Gelikman D, Turkbey B Semin Ultrasound CT MR. 2024; 46(1):2-30.

PMID: 39580037 PMC: 11741936. DOI: 10.1053/j.sult.2024.11.001.

Granulomatous prostatitis following Bacillus Calmette-Guérin therapy.

Hegde S, Lakhani D, Prisneac I, Markovich B J Clin Imaging Sci. 2024; 14:39.

PMID: 39530419 PMC: 11450486. DOI: 10.25259/JCIS_47_2023.

The role of multiparametric magnetic resonance ımaging in the diagnosis of granulomatous prostatitis mimicking prostate cancer.

Ogreden E, Oguz U, Demirelli E, Tok D, Aslan S, Tok B Abdom Radiol (NY). 2024; 49(7):2305-2310.

PMID: 38652127 DOI: 10.1007/s00261-024-04288-7.

Prediction of false-positive PI-RADS 5 lesions on prostate multiparametric MRI: development and internal validation of a clinical-radiological characteristics based nomogram.

Cheng Y, Fan B, Fu Y, Yin H, Lu J, Li D BMC Urol. 2024; 24(1):76.

PMID: 38566091 PMC: 10986137. DOI: 10.1186/s12894-024-01465-0.

Granulomatous prostatitis: mimicking locally advanced prostate adenocarcinoma.

Mannatrizio D, Eusebi L, Yehia M, Filosa A, Guglielmi G Acta Biomed. 2023; 94(5):e2023245.

PMID: 37850783 PMC: 10644919. DOI: 10.23750/abm.v94i5.13751.

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