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European Radiology
Published in: European Radiology 5/2017

01-05-2017 | Magnetic Resonance

Multiparametric magnetic resonance imaging characteristics of normal, benign and malignant conditions in the prostate

Authors: Pieter J. L. De Visschere, Anne Vral, Gianpaolo Perletti, Eva Pattyn, Marleen Praet, Vittorio Magri, Geert M. Villeirs

Published in: European Radiology | Issue 5/2017

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Abstract

Objectives

To identify the multiparametric magnetic resonance imaging (mpMRI) characteristics of normal, benign and malignant conditions in the prostate.

Methods

Fifty-six histopathological whole-mount radical prostatectomy specimens from ten randomly selected patients with prostate cancer (PC) were matched with corresponding transverse mpMRI slices. The mpMRI was performed prior to biopsy and consisted of T2-weighted imaging (T2-WI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced imaging (DCE) and magnetic resonance spectroscopic imaging (MRSI).

Results

In each prostate specimen, a wide range of histopathological conditions were observed. They showed consistent but overlapping characteristics on mpMRI. Normal glands in the transition zone showed lower signal intensity (SI) on T2-WI, lower ADC values and lower citrate peaks on MRSI as compared to the peripheral zone (PZ) due to sparser glandular elements and more prominent collagenous fibres. In the PZ, normal glands were iso-intense on T2-WI, while high SI areas represented cystic atrophy. Mimickers of well-differentiated PC on mpMRI were inflammation, adenosis, HG-PIN and post-atrophic hyperplasia.

Conclusion

Each prostate is a unique mix of normal, benign and/or malignant areas that vary in extent and distribution resulting in very heterogeneous characteristics on mpMRI. Understanding the main concepts of this mpMRI-histopathological correlation may increase the diagnostic confidence in reporting mpMRI.

Keypoints

• In each prostate specimen a wide range of histopathological conditions was observed.
• Interpretation of mpMRI may be difficult because benign conditions may mimic PC.
• High signal intensity areas in the PZ on T2-WI represented cystic atrophy.
• The TZ showed sparser glands and more collagenous fibres than the PZ.
Appendix
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Metadata
Title
Multiparametric magnetic resonance imaging characteristics of normal, benign and malignant conditions in the prostate
Authors
Pieter J. L. De Visschere
Anne Vral
Gianpaolo Perletti
Eva Pattyn
Marleen Praet
Vittorio Magri
Geert M. Villeirs
Publication date
01-05-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4479-z

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