BPH: Lobar Classifications
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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.
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
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