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Application of Sonographic Classification on MRI

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We're talking about BPH or benign

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prostatic hypertrophy on MRI.

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If you've watched other vignettes, you know

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there is a low bar classification system

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that breaks down BPH into anterior to the

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urethra type 1, posterior to the urethra

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above the verumontanum, which would be

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right here, type 2, balanced or equally

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hypertrophied type 3, and pedunculated

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masses extending into the urethra type 4.

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This one is balanced, but slightly

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errs towards the side of anterior.

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So anterior more than posterior

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superior, so it's more of a type 1.

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We see the urethra is now a bit angulated.

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It makes kind of a kinked turn.

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So this compression right here may

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lead to difficulty in urination.

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Now our surgical colleagues for years have

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been using The sonographic classification

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system, so let's just briefly review that.

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If you've got very prominent bilateral,

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lateral lobes, or TZ lobes, on either

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side, that's a sonographic type 1.

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If the enlargement is almost exclusively

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retrourethral, above the verumontanum,

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that would be a sono classification type 2.

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If you've got both lateral TZ, or said

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another way, anterolateral TZ hypertrophy

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and posterosuperior hypertrophy, which

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would be the equivalent of balanced lobar

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type 3, is the same as sonographic 3.

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Then type 4, which is analogous to the

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type 4 on lobar classification, would

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be A solitary or multifocal pedunculated

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lesion that prolapses into the urethra.

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Type 5, a pedunculated prolapsing

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mass with retrourethral enlargement.

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Type 6, subtrigonal or ectopic enlargement.

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And type 7, anything else that doesn't fit into

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the other criteria that we have already discussed.

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So now you're able to compare what surgeons

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use for their classification sonographically

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with the low bar classification system,

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which perhaps is a little bit more simple.

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Now when you're looking at these, especially when

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you have posterosuperior gland enlargement, this

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tissue, if it's very polypoid, can stick up into

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the bladder, the bladder can collapse on itself,

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and these pedunculated masses can be entrapped

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in the bladder, so you wanna see if there's a

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narrow neck or stalk to the posterosuperior.

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Variety for it too can sometimes be pedunculated.

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The classic pedunculated lesion, however, is

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gonna be found in the urethra, prolapsing into it.

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The so-called low bar type four, or

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sonographic rating system type four.

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This is an example of a patient

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with a relatively balanced.

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Pattern of hypertrophy, although

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the anterior component is slightly

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bigger than the posterior component.

Report

Editorial Note

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

John F. Feller, MD

Chief Medical Officer, HALO Diagnostics. Medical Director & Founder, Desert Medical Imaging. Chief of Radiology, American Medical Center, Shanghai, China.

HALO Diagnostics

Tags

Ultrasound

Prostate/seminal vesicles

MRI

Genitourinary (GU)

Body

Acquired/Developmental

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