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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
Prostatitis: imaging appearances and diagnostic considerations
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<blockquote data-quote="madman" data-source="post: 196670" data-attributes="member: 13851"><p><strong><em>Acute and chronic inflammation of the prostate gland can be attributed to several underlying aetiologies, including but not limited to, bacterial prostatitis, granulomatous prostatitis, and Immunoglobulin G4-related prostatitis. </em></strong>In this review, we provide an overview of the general imaging appearances of the different types of prostatitis, their distinguishing features, and characteristic appearances at cross-sectional imaging. Common imaging pitfalls are presented and illustrated with examples.</p><p></p><p></p><p></p><p></p><p><strong>Introduction </strong></p><p><strong></strong></p><p><strong><em>Prostatitis is an inflammatory condition of the prostate with a prevalence of 8.7%,1 which encompasses several conditions including acute and chronic bacterial prostatitis, granulomatous prostatitis, and Immunoglobulin G4 (IgG4)-related prostatitis.2,3</em></strong> <strong><em><u>Although recent advances in multiparametric prostate magnetic resonance imaging (MRI) have improved significantly, the diagnostic accuracy of prostatitis and its mimics is limited by the many overlapping radiological features, which can make the differentiation from clinically significant prostate carcinoma challenging</u>. </em></strong>The purpose of this review is to illustrate the multimodality imaging appearances of the various subtypes of prostatitis and when to consider this diagnosis. We also aim to emphasize the key imaging features that can help make a distinction of prostatitis from other conditions, namely prostate carcinoma.</p><p></p><p></p><p></p><p></p><p><strong>Bacterial prostatitis</strong></p><p><em>*Imaging features</em></p><p><em>*Management</em></p><p></p><p><strong>Granulomatous prostatitis</strong></p><p><em>*Imaging features</em></p><p></p><p><strong>IgG4-related prostatitis</strong></p><p><em>*Imaging features</em></p><p></p><p></p><p></p><p></p><p><strong>Conclusion</strong></p><p><strong></strong></p><p><strong><em>Prostatitis encompasses several entities, which have overlapping clinical and radiological features. Accurate diagnosis of the specific type of prostatitis is important so the correct therapy can be initiated, and unnecessary surgical intervention avoided.</em> <u>The main MRI findings include focal or diffuse prostate enlargement, T2 signal hypointensity, diffusion restriction, and corresponding low signal intensity on ADC maps</u>. </strong>A previous history of BCG immunotherapy confirmed TB infection, or TURP should prompt consideration of a diagnosis of granulomatous prostatitis. In patients with metachronous organ involvement outside of the prostate gland, IgG4-related disease should be considered. The synchronous disease should also be sought, as IgG4-related disease responds well to corticosteroid therapy and immunomodulators.</p><p></p><p><strong><em>The radiological features of prostatitis often overlap with prostate carcinoma, which is the most important differential diagnosis to consider. </em></strong>On T2WI, the hypointense T2 signal areas in prostatitis are usually geographic and ill-defined and generally do not exert mass effect on the adjacent normal prostate tissue in contrast with prostate carcinoma. Although both diseases demonstrate diffusion restriction, in prostatitis it is usually to a lesser degree than seen in prostate carcinoma.52,53 Similarly the ADC values tend to be higher in prostatitis patients compared with prostate carcinoma patients11, 12. <em><strong><u>Although prostatitis can mimic prostate carcinoma radiologically, it is important to bear in mind the two may coexist</u>.54</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 196670, member: 13851"] [B][I]Acute and chronic inflammation of the prostate gland can be attributed to several underlying aetiologies, including but not limited to, bacterial prostatitis, granulomatous prostatitis, and Immunoglobulin G4-related prostatitis. [/I][/B]In this review, we provide an overview of the general imaging appearances of the different types of prostatitis, their distinguishing features, and characteristic appearances at cross-sectional imaging. Common imaging pitfalls are presented and illustrated with examples. [B]Introduction [I]Prostatitis is an inflammatory condition of the prostate with a prevalence of 8.7%,1 which encompasses several conditions including acute and chronic bacterial prostatitis, granulomatous prostatitis, and Immunoglobulin G4 (IgG4)-related prostatitis.2,3[/I][/B] [B][I][U]Although recent advances in multiparametric prostate magnetic resonance imaging (MRI) have improved significantly, the diagnostic accuracy of prostatitis and its mimics is limited by the many overlapping radiological features, which can make the differentiation from clinically significant prostate carcinoma challenging[/U]. [/I][/B]The purpose of this review is to illustrate the multimodality imaging appearances of the various subtypes of prostatitis and when to consider this diagnosis. We also aim to emphasize the key imaging features that can help make a distinction of prostatitis from other conditions, namely prostate carcinoma. [B]Bacterial prostatitis[/B] [I]*Imaging features *Management[/I] [B]Granulomatous prostatitis[/B] [I]*Imaging features[/I] [B]IgG4-related prostatitis[/B] [I]*Imaging features[/I] [B]Conclusion [I]Prostatitis encompasses several entities, which have overlapping clinical and radiological features. Accurate diagnosis of the specific type of prostatitis is important so the correct therapy can be initiated, and unnecessary surgical intervention avoided.[/I] [U]The main MRI findings include focal or diffuse prostate enlargement, T2 signal hypointensity, diffusion restriction, and corresponding low signal intensity on ADC maps[/U]. [/B]A previous history of BCG immunotherapy confirmed TB infection, or TURP should prompt consideration of a diagnosis of granulomatous prostatitis. In patients with metachronous organ involvement outside of the prostate gland, IgG4-related disease should be considered. The synchronous disease should also be sought, as IgG4-related disease responds well to corticosteroid therapy and immunomodulators. [B][I]The radiological features of prostatitis often overlap with prostate carcinoma, which is the most important differential diagnosis to consider. [/I][/B]On T2WI, the hypointense T2 signal areas in prostatitis are usually geographic and ill-defined and generally do not exert mass effect on the adjacent normal prostate tissue in contrast with prostate carcinoma. Although both diseases demonstrate diffusion restriction, in prostatitis it is usually to a lesser degree than seen in prostate carcinoma.52,53 Similarly the ADC values tend to be higher in prostatitis patients compared with prostate carcinoma patients11, 12. [I][B][U]Although prostatitis can mimic prostate carcinoma radiologically, it is important to bear in mind the two may coexist[/U].54[/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
Prostatitis: imaging appearances and diagnostic considerations
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