0:00

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

0:15

is heterogeneously low in signal intensity.

0:19

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

0:27

by this mass that is seen in the midline.

0:30

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

0:42

more than a benign fibrotic muscular hypertrophic

0:47

process by its position in the midline, by its

0:52

absence of mass effect, and then when you go from

0:55

the B0 to the B1500 diffusion image, there is no

1:01

diffusion restriction in the midline anywhere.

1:04

So, this is not a cancer.

1:07

Another lesion that might scare you a

1:09

little bit, that has been discussed in

1:11

another vignette, is an area of stromal

1:15

hyperplasia and acinar glandular hypertrophy.

1:18

It's very bright, and sometimes

1:20

can be very pedunculated.

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It looks like it doesn't even come off the

1:24

prostate sometimes if it's very exophytic,

1:27

but it is coming off the prostate.

1:29

Now when you look at your lower B value

1:32

diffusion images, it looks scary, right?

1:34

It looks like it's diffusion restricted,

1:37

but the B value isn't high enough.

1:39

You gotta have a B value of 1,200,

1:43

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

1:45

Area of proteinaceous fluid fades away,

1:48

and it does, on the B1500 image.

1:52

If this was a cancer, it'd be

1:53

getting brighter, not darker.

1:56

Furthermore, marked hyperintensity on a

1:59

T2-weighted image is a countersign, a sign

2:03

that goes against the diagnosis of cancer.

2:06

For cancers are gray, or

2:07

charcoal; they are not bright.

2:11

So, two teaching points in this case.

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A midline area of stromal and epithelial

2:16

hyperplasia and fibrosis that fades

2:19

away on the high B-value image.

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And an area of stromal hypertrophy and

2:26

glandular acinar hypertrophy that also fades

2:29

away on the B1500 diffusion-weighted image.