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BPH Pitfalls (2)

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We're talking BPH on MRI, and there are

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two teaching points to this case.

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The peripheral zone and central

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zone are very hard to discriminate.

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As the peripheral zone, let's take a look at

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the sagittal for a minute, the peripheral zone

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is heterogeneously low in signal intensity.

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So, that makes it really hard to

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identify in the axial projection.

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That being said, you might get a little scared

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by this mass that is seen in the midline.

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This is a not uncommon location to see

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epithelial and stromal hyperplasia and fibrosis.

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This dark pseudomass can be identified as nothing

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more than a benign fibrotic muscular hypertrophic

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process by its position in the midline, by its

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absence of mass effect, and then when you go from

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the B0 to the B1500 diffusion image, there is no

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diffusion restriction in the midline anywhere.

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So, this is not a cancer.

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Another lesion that might scare you a

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little bit, that has been discussed in

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another vignette, is an area of stromal

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hyperplasia and acinar glandular hypertrophy.

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It's very bright, and sometimes

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can be very pedunculated.

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It looks like it doesn't even come off the

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prostate sometimes if it's very exophytic,

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but it is coming off the prostate.

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Now when you look at your lower B value

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diffusion images, it looks scary, right?

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It looks like it's diffusion restricted,

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but the B value isn't high enough.

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You gotta have a B value of 1,200,

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1,500, 1,600, and you will see this.

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Area of proteinaceous fluid fades away,

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and it does, on the B1500 image.

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If this was a cancer, it'd be

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getting brighter, not darker.

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Furthermore, marked hyperintensity on a

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T2-weighted image is a countersign, a sign

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that goes against the diagnosis of cancer.

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For cancers are gray, or

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charcoal; they are not bright.

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So, two teaching points in this case.

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A midline area of stromal and epithelial

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hyperplasia and fibrosis that fades

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away on the high B-value image.

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And an area of stromal hypertrophy and

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glandular acinar hypertrophy that also fades

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away on the B1500 diffusion-weighted image.

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

Prostate/seminal vesicles

MRI

Genitourinary (GU)

Body

Acquired/Developmental

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