Multiparametric Magnetic Resonance Imaging Characteristics of Prostate Tuberculosis

Abstract

Objective: To describe the multiparametric magnetic resonance imaging (MRI) appearance of prostate tuberculosis.

Materials and methods: Six patients with prostate tuberculosis were analyzed retrospectively. The mean age of the patients was 60.5 years (range, 48-67 years). The mean prostate specific antigen concentration was 6.62 ng/mL (range, 0.54-14.57 ng/mL). All patients underwent a multiparametric MRI examination.

Results: The histopathological results were obtained from biopsies in four men and from transurethral resection of the prostate in two men after the MRI examination. Nodular (33%, 2/6 patients) and diffuse lesions (67%, 4/6 patients) were seen on MRI. The nodular lesions were featured by extremely low signal intensity (similar to that of muscle) on T2-weighted imaging (T2WI). The T2WI signal intensity of the diffuse lesions was low but higher than that of muscle, which showed high signal intensity on diffusion weighted imaging and low signal intensity on an apparent diffusion coefficient map. MR spectroscopic imaging of this type showed a normal-like spectrum. Abscesses were found in one patient with the nodular type and in one with the diffuse type.

Conclusion: The appearance of prostate tuberculosis on MRI can be separated into multiple nodular and diffuse types. Multiparametric MRI may offer useful information for diagnosing prostate tuberculosis.

Keywords: Diffuse; MRI; Multiple nodular; Prostate tuberculosis.

Fig. 1. Pathological specimens obtained at biopsy.

A. Hematoxylin and eosin staining reveals presence of multinucleated giant cells (× 400). B. Acid-fast staining shows bacilli (× 400).

Fig. 2. Nodular type of prostate tuberculosis in 63-year-old man.

A. Axial T2-weighted image (T2WI) shows multiple extremely low signal intensity nodules in left peripheral zone (arrowheads). B. Coronal T2WI shows multiple nodules in peripheral and transition zones. Images C and D were taken from same slice as image A. Nodules were hypointense on diffusion-weighted image (C) and apparent diffusion coefficient map (D).

Fig. 3. Nodular type prostate tuberculosis in 48-year-old man.

(A) Coronal T2-weighted image (T2WI) shows multiple low signal intensity nodules (arrowheads) in prostate. Hyperintense area (arrow) was detected in nodule on T2WI (B), which appeared as markedly high signal intensity on diffusion-weighted image (C) and relative low signal intensity on apparent diffusion coefficient map (D).

Fig. 4. Diffuse type prostate tuberculosis in 67-year-old man.

(A) Bilateral peripheral zone shows diffuse hypointensity (arrowheads) on T2-weighted image, high signal intently on diffusion weighted image (DWI), (B) low signal intensity on apparent diffusion coefficient (ADC) map (C) (arrowheads), and small patchy area (arrow) with markedly high signal intensity on DWI and markedly low signal intensity on ADC. (D) Magnetic resonance spectroscopic imaging of left peripheral zone reveals high peak of citrate and low peak of choline.