More Than Detection of Adenocarcinoma – Indications and Findings in Prostate MRI in Benign Prostatic Disorders

Abstract

Background Multiparametric MRI of the prostate has become a fundamental tool in the diagnostic pathway for prostate cancer and is recommended before (or after negative) biopsy to guide biopsy and increase accuracy, as a staging examination (high-risk setting), and prior to inclusion into active surveillance. Despite this main field of application, prostate MRI can be utilized to obtain information in a variety of benign disorders of the prostate.

Methods Systematic bibliographical research with extraction of studies, national (German) as well as international guidelines (EAU, AUA), and consensus reports on MRI of benign disorders of the prostate was performed. Indications and imaging findings of prostate MRI were identified for a) imaging the enlarged prostate, b) prostate MRI in prostatic artery embolization, c) imaging in prostatitis and d) imaging in congenital anomalies.

Results and Conclusions Different phenotypes of the enlarged prostate that partly correlate with severity of symptoms are discussed. We provide an overview of the different types of prostatitis and possible imaging findings, highlighting abscesses as a severe complication. The most common congenital anomalies of the prostate are utricular cysts, whereas anomalies like aplasia, hypoplasia, and ectopia are rare disorders. Knowledge of indications for imaging and imaging appearance of these conditions may improve patient care and enhance differential diagnosis.

Key Points: 

• Current guidelines do not implement indications for mpMRI apart from prostate carcinoma.

• MRI can distinguish different anatomical phenotypes of prostatic enlargement.

• Prostatic artery embolization represents a valuable treatment option in cases of symptomatic benign prostatic enlargement.

• Different forms of prostatitis exist and may mimic prostate carcinoma in MRI.

• MRI can be used to evaluate anatomical prostate anomalies.

Citation Format

• Oerther B, Sigle A, Franiel T et al. More Than Detection of Adenocarcinoma – Indications and Findings in Prostate MRI in Benign Prostatic Disorders. Fortschr Röntgenstr 2022; 194: 481 – 490

Zusammenfassung

Hintergrund Die multiparametrische MRT der Prostata bildet einen der Grundsteine im diagnostischen Vorgehen zur Erkennung des Prostatakarzinoms. Sie wird vor Biopsie (oder nach negativer Biopsie mit fortbestehendem Karzinomverdacht), zur Erhöhung der diagnostischen Genauigkeit, als Staging (im Hochrisiko-Setting) und vor Einschluss in die Active Surveillance empfohlen. Außerhalb dieser etablierten Indikationen bietet die MRT jedoch weiteren Nutzen bei benignen Krankheitsbildern der Prostata.

Methodik Es erfolgte eine systematische Literaturrecherche mit Datenextraktion aus Studien und aktuellen deutschen sowie internationalen Guidelines (EAU, AUA) bezüglich benigner Erkrankungen der Prostata. Hieraus ergaben sich Indikationen und bildgebende Charakteristika im Rahmen von a) benigner Prostatavergrößerung, b) Prostataarterienembolisation, c) Prostatitis and d) kongenitalen anatomischen Varianten.

Ergebnisse und Schlussfolgerung Es werden verschiedene Phänotypen der vergrößerten Prostata vorgestellt, deren Bildcharakteristika teilweise mit dem klinischen Beschwerdebild korrelieren. Wir bieten einen Überblick über die verschiedenen Formen der Prostatitis, speziell über die intraprostatische Abszedierung als deren schwerwiegende Komplikation und die jeweiligen Charakteristika in der MRT. Die häufigste anatomische Aberration der Prostata stellt die Utriculuszyste dar. Anlageanomalien wie die glanduläre Aplasie, Hypoplasie und Ektopie gehören zu den selteneren Erscheinungsbildern. Die Kenntnis über Bildgebungsindikation und die bildmorphologischen Charakteristika der genannten Erkrankungen können zur Verbesserung der Patientenversorgung und genaueren Differenzialdiagnostik beitragen.

Kernaussagen: 

• Aktuelle Leitlinien implizieren keine Indikationen für die multiparametrische MRT der Prostata außerhalb der Diagnostik des Prostatakarzinoms.

• Eine Differenzierung verschiedener anatomischer Phänotypen der benignen Prostatavergrößerung ist mittels MRT möglich.

• Prostataarterienembolisation stellt eine effektive Therapieoption im Rahmen einer symptomatischen Prostatavergrößerung dar.

• Verschiedene Formen der Prostatitis kommen als Differenzialdiagnose des Prostatakarzinoms in der MRT infrage.

• Anomalien der Prostata oder Samenblasen können mittels MRT dargestellt werden.

Key words

multiparametric MRI - prostate carcinoma - prostatitis - prostatic artery embolization - prostate enlargement - prostatic anomalies

Publication History

Received: 01 July 2021

Accepted: 18 November 2021

Article published online:
26 January 2022

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