Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Multiphase Contrast-Enhanced Magnetic Resonance Imaging Features of Bacillus Calmette-Guérin-Induced Granulomatous Prostatitis in Five Patients

  • Received : 2014.01.24
  • Accepted : 2014.11.24
  • Published : 2015.04.01
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Abstract

Objective: To evaluate the multiphase contrast-enhanced magnetic resonance (MR) imaging features of Bacillus Calmette-$Gu\acute{e}rin$(BCG)-induced granulomatous prostatitis (GP). Materials and Methods: Magnetic resonance images obtained from five patients with histopathologically proven BCG-induced GP were retrospectively analyzed for tumor location, size, signal intensity on T2-weighted images (T2WI) and diffusion-weighted images (DWI), apparent diffusion coefficient (ADC) value, and appearance on gadolinium-enhanced multiphase images. MR imaging findings were compared with histopathological findings. Results: Bacillus Calmette-$Gu\acute{e}rin$-induced GP (size range, 9-40 mm; mean, 21.2 mm) were identified in the peripheral zone in all patients. The T2WI showed lower signal intensity compared with the normal peripheral zone. The DWIs demonstrated high signal intensity and low ADC values (range, $0.44-0.68{\times}10^{-3}mm^2/sec$; mean, $0.56{\times}10^{-3}mm^2/sec$), which corresponded to GP. Gadolinium-enhanced multiphase MR imaging performed in five patients showed early and prolonged ring enhancement in all cases of GP. Granulomatous tissues with central caseation necrosis were identified histologically, which corresponded to ring enhancement and a central low intensity area on gadolinium-enhanced MR imaging. The findings on T2WI, DWI, and gadolinium-enhanced images became gradually obscured with time. Conclusion: Bacillus Calmette-$Gu\acute{e}rin$-induced GP demonstrates early and prolonged ring enhancement on gadolinium-enhanced MR imaging which might be a key finding to differentiate it from prostate cancer.

Keywords

References

  1. Morales A, Eidinger D, Bruce AW. Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol 1976;116:180-183 https://doi.org/10.1016/S0022-5347(17)58737-6
  2. Lamm DL, Stogdill VD, Stogdill BJ, Crispen RG. Complications of bacillus Calmette-Guerin immunotherapy in 1,278 patients with bladder cancer. J Urol 1986;135:272-274 https://doi.org/10.1016/S0022-5347(17)45606-0
  3. Oates RD, Stilmant MM, Freedlund MC, Siroky MB. Granulomatous prostatitis following bacillus Calmette-Guerin immunotherapy of bladder cancer. J Urol 1988;140:751-754 https://doi.org/10.1016/S0022-5347(17)41803-9
  4. Miyashita H, Troncoso P, Babaian RJ. BCG-induced granulomatous prostatitis: a comparative ultrasound and pathologic study. Urology 1992;39:364-367 https://doi.org/10.1016/0090-4295(92)90214-H
  5. Naik KS, Carey BM. The transrectal ultrasound and MRI appearances of granulomatous prostatitis and its differentiation from carcinoma. Clin Radiol 1999;54:173-175 https://doi.org/10.1016/S0009-9260(99)91009-7
  6. Gevenois PA, Stallenberg B, Sintzoff SA, Salmon I, Van Rogemorter G, Struyven J. Granulomatous prostatitis: a pitfall in MR imaging of prostatic carcinoma. Eur Radiol 1992;2:365-367 https://doi.org/10.1007/BF00175443
  7. Takeuchi M, Suzuki T, Sasaki S, Ito M, Hamamoto S, Kawai N, et al. Clinicopathologic significance of high signal intensity on diffusion-weighted MR imaging in the ureter, urethra, prostate and bone of patients with bladder cancer. Acad Radiol 2012;19:827-833 https://doi.org/10.1016/j.acra.2012.01.013
  8. Ma W, Kang SK, Hricak H, Gerst SR, Zhang J. Imaging appearance of granulomatous disease after intravesical Bacille Calmette-Guerin (BCG) treatment of bladder carcinoma. AJR Am J Roentgenol 2009;192:1494-1500 https://doi.org/10.2214/AJR.08.1962
  9. Suzuki T, Takeuchi M, Naiki T, Kawai N, Kohri K, Hara M, et al. MRI findings of granulomatous prostatitis developing after intravesical Bacillus Calmette-Guerin therapy. Clin Radiol 2013;68:595-599 https://doi.org/10.1016/j.crad.2012.12.005
  10. Oppenheimer JR, Kahane H, Epstein JI. Granulomatous prostatitis on needle biopsy. Arch Pathol Lab Med 1997;121:724-729
  11. Bour L, Schull A, Delongchamps NB, Beuvon F, Muradyan N, Legmann P, et al. Multiparametric MRI features of granulomatous prostatitis and tubercular prostate abscess. Diagn Interv Imaging 2013;94:84-90 https://doi.org/10.1016/j.diii.2012.09.001
  12. Engin G, Acunas B, Acunas G, Tunaci M. Imaging of extrapulmonary tuberculosis. Radiographics 2000;20:471-488; quiz 529-530, 532 https://doi.org/10.1148/radiographics.20.2.g00mc07471
  13. Fan ZM, Zeng QY, Huo JW, Bai L, Liu ZS, Luo LF, et al. Macronodular multi-organs tuberculoma: CT and MR appearances. J Gastroenterol 1998;33:285-288 https://doi.org/10.1007/s005350050085
  14. Kawamori Y, Matsui O, Kitagawa K, Kadoya M, Takashima T, Yamahana T. Macronodular tuberculoma of the liver: CT and MR findings. AJR Am J Roentgenol 1992;158:311-313 https://doi.org/10.2214/ajr.158.2.1729789
  15. Padhani AR, Harvey CJ, Cosgrove DO. Angiogenesis imaging in the management of prostate cancer. Nat Clin Pract Urol 2005;2:596-607
  16. Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics 2011;31:677-703 https://doi.org/10.1148/rg.313105139

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