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Imaging Patterns of Bacillus Calmette-Guérin-Related Granulomatous Prostatitis Based on Multiparametric MRI

 Seungsoo Lee  ;  Young Taik Oh  ;  Hye Min Kim  ;  Dae Chul Jung  ;  Hyesuk Hong 
 KOREAN JOURNAL OF RADIOLOGY, Vol.23(1) : 60-67, 2022-01 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; BCG Vaccine / adverse effects ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multiparametric Magnetic Resonance Imaging* ; Prostatic Neoplasms* / diagnostic imaging ; Prostatitis* / chemically induced ; Prostatitis* / diagnostic imaging ; Retrospective Studies ; Urinary Bladder Neoplasms
BCG vaccine ; Magnetic resonance imaging ; Prostate cancer ; Prostatitis
Objective: To categorize multiparametric MRI features of Bacillus Calmette-Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer.

Materials and methods: The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50-88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm²) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types.

Results: The median lesion size was 22 mm with the interquartile range (IQR) of 18-26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen's kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4-8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions.

Conclusion: BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hye Min(김혜민) ORCID logo https://orcid.org/0000-0002-2899-9480
Oh, Young Taik(오영택) ORCID logo https://orcid.org/0000-0002-4438-8890
Lee, Seung Soo(이승수) ORCID logo https://orcid.org/0000-0002-6268-575X
Jung, Dae Chul(정대철) ORCID logo https://orcid.org/0000-0001-5769-5083
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