Multiparametric MRI appearances of primary granulomatous prostatitis

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Su-Min Lee1, Konrad Wolfe2, Peter Acher3

  • 11 Department of Urology, Bristol Urological Institute, Southmead Hospital , Bristol , UK.

The British Journal of Radiology
|April 10, 2019
PubMed
Abstract

Insights

Granulomatous prostatitis (GP) on multiparametric MRI (mpMRI) often mimics prostate cancer. Key MRI findings like diffuse changes and rim enhancement can suggest GP, especially after urinary tract infections or BCG treatment.

Area of Science:

  • Radiology
  • Urology
  • Oncology

Background:

  • Radiological features of granulomatous prostatitis (GP) can overlap with prostate adenocarcinoma, complicating diagnosis.
  • Multiparametric MRI (mpMRI) is a key imaging modality for evaluating prostate conditions.

Observation:

  • This study analyzed mpMRI features in 16 patients with histologically confirmed GP.
  • GP lesions were often diffuse (>50% of prostate), with low T2 signal intensity and low Apparent Diffusion Coefficient (ADC) values.
  • Dynamic Contrast Enhancement (DCE) showed positive enhancement in all cases, with some exhibiting ring enhancement suggestive of abscess formation.

Findings:

  • GP lesions typically present as diffuse changes involving more than half the prostate gland on mpMRI.
  • Extracapsular extension and rim-enhancing areas were observed in GP cases.
  • Despite mimicking prostate cancer with high PI-RADS scores (v2 score 5), GP has distinct imaging characteristics.

Implications:

  • Recognizing specific mpMRI features of GP can aid in differentiating it from prostate cancer.
  • GP should be considered in the differential diagnosis for patients with a history of urinary tract infection (UTI) or Bacillus Calmette-Guerin (BCG) therapy.
  • mpMRI findings like diffuse changes, extracapsular extension, and rim enhancement in the context of recent UTI or BCG treatment can help identify GP.

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