48b - Answer: 76-year-old male presents with elevated PSA level
HISTORY:
This 76-year-old male presents with elevated PSA level and family history of prostate cancer. The most recent prostate PSA level measures approximately 12ng/mL. History of two negative biopsies; one year and two years prior.
PRIMARY FINDING:
PI-RADS 2.
FINDINGS:
Prostate gland measures 4cm in CC, 3.6cm in AP and 5cm in RL dimensions. Calculated prostate volume is 47cc and PSA density is 0.25. No suspicious T2 hypointense area with substantive diffusion restriction to suggest malignant neoplastic process in the transitional zone. A comma-shaped, moderate diffusion restriction is seen within the left midsegment anterior transitional zone corresponds to stromal component of a nodular hyperplasia. Generalized T2 hypointensity is seen in the peripheral zone of the prostate gland without demonstrable malignant neoplastic process such as T2 hypointensity with early arterial enhancement on washout or severe diffusion restriction. Anatomical prostate capsule, neurovascular bundles, rectoprostatic angles, and seminal vesicles are clear. Slightly T2 low-signal in the seminal vesicles may suggest complex contents such as proteinaceous material or hemorrhage.
Urinary bladder is not completely full but demonstrates mild trabecular appearance. No diverticula formation.
Diverticular disease of the sigmoid colon without evidence of acute diverticulitis. Rectum wall appears normal.
No lymphadenopathy in the pelvis or inguinal regions.
Musculoskeletal structures are grossly normal. No abnormal enhancement identified.
Vasculature is unremarkable.
CONCLUSION:
1. PI-RADS 2, benign hyperplasia of the prostate gland.
2. Complex content in the seminal vesicles which may represent hemorrhagic or proteinaceous material.
3. Diffusely decreased signal intensity in the peripheral zone, suggestive of scarring. Assessment for prostatitis is also recommended.
4. Sigmoid colon diverticular disease without evidence of acute diverticulitis.
Case Challenge: Prostate MRI Cases
Case Challenge
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Content reviewed: October 25, 2021