非特异性肉芽肿性前列腺炎类似前列腺癌3例MRI特征分析并文献复习

Characteristic Analysis of Nonspecific Granulomatous Prostatitis MRI Features Which Mimic Prostate Adenocarcinoma(Report of Three Cases with Literature Review)

目的探讨非特异性肉芽肿性前列腺炎(nonspecific granulomatous prostatitis,NSGP)类似前列腺癌(PCa)的MRI特征表现。方法回顾性分析3例术前MRI表现类似PCa特征且术前误诊为PCa的NSGP患者临床、MRI及病理学资料。结果 3例PSA均有增高,平均13.18 ng/ml,病理结果均为NSGP,3例T_2WI上外围带均见低信号,2例为局灶性,1例为弥漫性;DWI上病变呈轻度扩散受限;MRS病灶ROI取点Cit/Cho+Cr值均有倒置,但Cho峰值与正常信号区相近,提示Cho为相对升高;动态增强(DCE))病变呈早期强化、后期减退,时间-信号强度曲线类型为Ⅲ型即流出型曲线。结论 NSGP多参数(T_2WI、DWI、DCE、MRS)MRI特征与Pca非常类似,但对扩散轻度受限、Cit/Cho+Cr值虽有倒置、但Cho峰值与正常信号区基本相近的病例,要考虑到NSGP的可能性,在患者行根治性手术前建议行穿刺活检,避免不必要的手术。

Objective To report Nonspecific granulomatous prostatitis with MRI features which mimic Prostate Adenocarcinoma. Methods The clinical,MRI and pathological data of 3 patients with NSGP which was preoperatives misdiagnosed as Pca on MRI examination were retrospectively analyzed. Results 3 cases of pathological findings were classified as non-specific granulomatous prostatitis. The MRI features included patchy or diffuse low inensity signal within the lesions on T2WI. High intensity on DWI and ADC showed low intensity. Cit/Cho ＋ Cr values were inverted. Lesions displayed early heterogeneous enhancement. Two cases demonstrate a type 3（ washout） curve. Conclusion When MRI findings with suspicious lesions confused with Pca,such as DWI showed mild limitation,time-signal intensity displayed a rapid washin and washout,Cit/Cho ＋ Cr value,although inverted,but Cho content within the contralateral normal area has similar Cho content will account for the possibility of NSGP. In order to avoid unnecessary surgery,all patients with suspicious prostate lesions on MRI require formal histopathologic disease confirmation before proceeding to radical treatment.