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Let's look at a classification system for

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benign prostatic hypertrophy on MR imaging.

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We've got three two-dimensional fast

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spin echo images of the prostate,

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axial, sagittal, and coronal.

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So let's begin with the low bar

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classification system for BPH.

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Type 1.

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The enlargement is predominantly anterior

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and pushes the urethra towards the back.

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There is some anterior hypertrophy in this case.

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Type 2.

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There'd be a solitary area of retrourethral,

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there's the urethra, retrourethral

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enlargement, but above the verumontanum.

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And we do have that.

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If we had that and it was

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isolated, it would be a type 2.

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What's a type 3?

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Type 3 is when you have both and they're balanced.

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This one is a type 3.

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It's balanced.

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Both the anterior gland, maybe a little

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imbalanced, and the posterosuperior gland

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are enlarged above the verumontanum.

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So I would say this one's a little

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bigger, it's slightly imbalanced

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towards the back than the front.

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What's it type for?

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Prominence of the median lobe, the periurethral

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tissues, which may push the central zone up,

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but also invaginate and encroach on the urethra.

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As a pedunculated mass.

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This one is actually the least common

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and hardest to see because everything

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gets crowded around the urethra.

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And it's hard to know whether you're

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seeing an intramural lesion that's

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pushing in or a pedunculated lesion

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with a stalk that's pushing in.

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So that one to designate in an isolated

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fashion as a type 4 requires very high

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resolution one-millimeter or thinner MRI.

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So those are the four low bar classifications.

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Which you can use and

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extrapolate onto the MR image.

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This, an example of a pretty balanced hypertrophy.

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A little more in the back than the front.

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A type 3 pattern of lobar BPH.