34b - Answer: 75-year-old male presents with elevated PSA level measuring 8.99 ng/mL
HISTORY:
This 75-year-old male presents with elevated PSA level measuring 8.99 ng/mL. History of positive prostate biopsy.
PRIMARY FINDING:
PI-RADS 3.
FINDINGS:
The prostate gland measures 4.4cm in CC, 4cm in RL and 3.2cm in AP dimensions. Calculated prostate volume is 36cc and PSA density is 0.25.
Transitional zone hyperplasia is present. No suspicious T2-hypointense area with substantive diffusion restriction to suggest malignant neoplastic process in the transitional zone. Non-mass-like, T2 hypointensity is seen in the posterior peripheral zone of the right mid through apical segments with moderate diffusion restriction and early arterial enhancement (PI-RADS 3).
The lesion abuts the anatomical prostate capsule without substantive evidence of extracapsular extension. Bilateral neurovascular bundles and seminal vesicles are clear.
Rectum wall and rectoprostatic angles are preserved. Severe diverticular disease of the sigmoid colon is noted.
No lymphadenopathy in the pelvis or inguinal regions.
Small, fat-containing, left inguinal hernia is noted.
Urinary bladder is not full. No filling defect or focal wall thickening identified.
Pseudocyst formations at the right acetabular weightbearing surface, suggestive of high-grade chondromalacia in the right hip.
Mild hydrocele is noted at the film edge.
CONCLUSION:
1. Non-mass-like, T2 hypointensity in the posterior peripheral zone of the right mid through apical segments with moderate diffusion restriction and early arterial enhancement (PI-RADS 3).
2. Severe diverticular disease of the sigmoid colon without evidence of acute diverticulitis.
3. Small hydrocele identified at the film edge.
4. Subchondral pseudocyst formation at the right acetabular weightbearing surface suggestive of high-grade chondromalacia.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021