Kitzing Yu Xuan, Prando Adilson, Varol Celi, Karczmar Gregory S, Maclean Fiona, Oto Aytekin
From the Departments of Medical Imaging (Y.X.K.) and Urology (C.V.), Macquarie University Hospital, Sydney, Australia; Department of Radiology, Hospital Vera Cruz, Campinas, Brazil (A.P.); Department of Radiology, University of Chicago, Chicago, Ill (G.S.K., A.O.); and Douglass Hanly Moir Pathology, Sydney, Australia (F.M.).
Radiographics. 2016 Jan-Feb;36(1):162-75. doi: 10.1148/rg.2016150030. Epub 2015 Nov 20.
Multiparametric magnetic resonance (MR) imaging combines anatomic and functional imaging techniques for evaluating the prostate and is increasingly being used in diagnosis and management of prostate cancer. A wide spectrum of anatomic and pathologic processes in the prostate may masquerade as prostate cancer, complicating the imaging interpretation. The histopathologic and imaging findings of these potential mimics are reviewed. These entities include the anterior fibromuscular stroma, surgical capsule, central zone, periprostatic vein, periprostatic lymph nodes, benign prostatic hyperplasia (BPH), atrophy, necrosis, calcification, hemorrhage, and prostatitis. An understanding of the prostate zonal anatomy is helpful in distinguishing the anatomic entities from prostate cancer. The anterior fibromuscular stroma, surgical capsule, and central zone are characteristic anatomic features of the prostate with associated low T2 signal intensity due to dense fibromuscular tissue or complex crowded glandular tissue. BPH, atrophy, necrosis, calcification, and hemorrhage all have characteristic features with one or more individual multiparametric MR imaging modalities. Prostatitis constitutes a heterogeneous group of infective and inflammatory conditions including acute and chronic bacterial prostatitis, infective and noninfective granulomatous prostatitis, and malacoplakia. These entities are associated with variable clinical manifestations and are characterized by the histologic hallmark of marked inflammatory cellular infiltration. In some cases, these entities are indistinguishable from prostate cancer at multiparametric MR imaging and may even exhibit extraprostatic extension and lymphadenopathy, mimicking locally advanced prostate cancer. It is important for the radiologists interpreting prostate MR images to be aware of these pitfalls for accurate interpretation. Online supplemental material is available for this article.
多参数磁共振(MR)成像结合了解剖和功能成像技术来评估前列腺,并且越来越多地用于前列腺癌的诊断和管理。前列腺中广泛的解剖和病理过程可能伪装成前列腺癌,使影像解读变得复杂。本文回顾了这些潜在模仿病变的组织病理学和影像学表现。这些病变包括前部纤维肌基质、外科包膜、中央区、前列腺周围静脉、前列腺周围淋巴结、良性前列腺增生(BPH)、萎缩、坏死、钙化、出血和前列腺炎。了解前列腺的分区解剖有助于将解剖结构与前列腺癌区分开来。前部纤维肌基质、外科包膜和中央区是前列腺的特征性解剖结构,由于致密的纤维肌组织或复杂拥挤的腺组织,其T2信号强度较低。BPH、萎缩、坏死、钙化和出血在一种或多种多参数MR成像模式下都有特征性表现。前列腺炎是一组异质性的感染性和炎症性疾病,包括急性和慢性细菌性前列腺炎、感染性和非感染性肉芽肿性前列腺炎以及软斑病。这些病变与不同的临床表现相关,其特征是有明显炎症细胞浸润的组织学特征。在某些情况下,这些病变在多参数MR成像上与前列腺癌难以区分,甚至可能表现出前列腺外侵犯和淋巴结病,酷似局部晚期前列腺癌。解读前列腺MR图像的放射科医生了解这些陷阱对于准确解读很重要。本文提供在线补充材料。