Prostatitis crónica: Aporte del contraste endovenoso en fase tardía para su caracterización en resonancia magnética multiparamétrica de próstata / Chronic Prostatitis: Contrast Contribution in Late Phase for its Characterization in Multiparametric-Magnetic Resonance Imaging of the Prostate

Resumen Objetivo: El objetivo de este estudio es demostrar la utilidad de una secuencia tardía post-contraste en la resonancia magnética multiparamétrica de próstata (RMMP) para caracterizar lesiones PI-RADS II. Materiales y métodos: Se analizaron en forma retrospectiva las RMMP realizadas entre enero de 2015 y diciembre de 2016. El protocolo de la RMMP fue basado en las recomendaciones del PI-RADS versión 2, y se agregó una adquisición tardía luego del dinámico post-contraste. Los reportes fueron revisados bajo la versión 2.1. Resultados: Se seleccionaron 31 pacientes que presentaron lesiones categorizadas como PI-RADS II en la zona periférica, los cuales se encontraban en seguimiento del antígeno prostático específico y presentaron confirmación histológica de prostatitis crónica. Se evidenció un realce tardío de la lesión en todos los pacientes. Según los resultados histopatológicos, 30 presentaban prostatitis crónica y el restante tejido benigno (tejido fibromuscular). Discusión: La prostatitis crónica no muestra realce temprano, y presenta realce tardío debido al tejido conectivo fibroso que la compone. En la RMMP, la prostatitis puede imitar el cáncer de próstata. Agregar una adquisición tardía solo adiciona 150 segundos al estudio y podría ayudar a resolver aquellos casos inciertos categorizados como PI-RADS III empleando las secuencias convencionales, debido a que el realce tardío de la lesión es altamente sugestivo de un proceso inflamatorio (PI-RADS II). Conclusión: La presencia de realce tardío es una herramienta útil para realizar un adecuado diagnóstico de una lesión PI-RADS II en la zona periférica, pudiendo evitar una biopsia innecesaria.

Abstract Objective: The aim of this study is to demonstrate the utility of a post-contrast late sequence in multiparametric magnetic resonance imaging (RMMP) to characterize PI-RADS II lesions. Materials and methods: The RMMPs performed between January 2015 and December 2016 were retrospectively analyzed. The RMMP protocol was based on the recommendations of the PI-RADS version 2, and a late acquisition was added, after the dynamic post-contrast. The reports were reviewed under the version 2.1. Results: 31 patients with PI-RADS II lesions in the peripheral zone were selected, who were in prostate specific antigen follow-up and had histological confirmation of chronic prostatitis. A late enhancement of the lesion was evidenced in all patients. According to the histopathological results, 30 had chronic prostatitis and the remaining benign tissue (fibromuscular tissue). Discussion: Chronic prostatitis does not show early enhancement, and presents late enhancement due to its fibrous connective tissue. In RMMP, prostatitis may mimic prostate cancer. Adding a late sequence only adds 150 seconds to the study and could help to resolve those uncertain cases categorized as PI-RADS III using traditional sequences because the late enhancement of the lesion is highly suggestive of an inflammatory process (PI-RADS II). Conclusion: The presence of late enhancement is a useful tool to perform an adequate diagnosis of a PI-RADS II lesion in the peripheral zone, helping to avoid an unnecessary biopsy.

Evaluation of prostatic diseases with transrectal ultrasonography

A study was conducted in radiology department CMH Rawalpindi to determine the role of transrectal ultrasonography in the evaluation of prostatic diseases. A total of 78 cases were examined with transrectal ultrasound probe and later followed for histopathological findings. Transrectal ultrasound was found correct in 51 cases of benign prostatic hyperplasia and 16 cases of prostatic carcinoma. Two cases of prostatitis with prostatic abscess were also noted. The sensitivity and positive predictive value for prostatic carcinoma in our study were 80% and 76.19% respectively. In 16 cases of prostatic carcinoma, the digital rectal examination was positive in only 08 cases and raised serum prostate specific antigen were noted in 13 cases. In view of this study, it is recommended that transrectal ultrasonography should be adopted for pre-operative assessment of benign prostatic hyperplasia, diagnosis / staging of prostatic carcinoma and in all clinically suspected cases of prostatic abscess

Detection of chlamydia trachomatis deoxyribonucleic acid in prostatic tissue in chronic abacterial prostatitis by in situ polymerase chain reaction

The aim of this study was to assess the pathogenic role of Chlamydia trachomatis in chronic abacterial prostatitis by in situ polymerase chain reaction [PCR] using transrectal ultrasonic guided biopsy. Thirty-five patients with chronic prostatitis and five age-matched patients suffering from lower obstructive urinary symptoms served as controls were included in the study. In situ PCR detected Chlamydia trachomatis DNA in six out of five cases of chronic abacterial prostatitis and in none of the control group. Chlamydia trachomatis DNA was found in chronic inflammatory cells of all the six positive cases and in prostatic epithelial cells in only one patient. The results supported the hypothesis that Chlamydia trachomatis has an etiological role in chronic prostatitis patients

Role of radiology in diagnosis of prostatitis

Prostatitis is a vague angima in urology and a very insignificant condition in radiology. Three cases of acute prostatitis and 15 cases of chronic prostatitis have been examined clinically and by radiology. Patients with prostatic secretion containing an increased number of pus cells and with positive culture for bacteria were included in this study. It was observed that radiology is of no help in the diagnosis, however, associated or complicating conditions can be revealed