Multi-class deep learning architecture for classifying lung diseases from chest X-Ray and CT images.

Medical imaging is considered a suitable alternative testing method for the detection of lung diseases. Many researchers have been working to develop various detection methods that have aided in the prevention of lung diseases. To better understand the condition of the lung disease infection, chest X-Ray and CT scans are utilized to check the disease's spread throughout the lungs. This study proposes an automated system for the detection multi lung diseases in X-Ray and CT scans. A customized convolutional neural network (CNN) and two pre-trained deep learning models with a new image enhancement model are proposed for image classification. The proposed lung disease detection comprises two main steps: pre-processing, and deep learning classification. The new image enhancement algorithm is developed in the pre-processing step using k-symbol Lerch transcendent functions model which enhancement images based on image pixel probability. While, in the classification step, the customized CNN architecture and two pre-trained CNN models Alex Net, and VGG16Net are developed. The proposed approach was tested on publicly available image datasets (CT, and X-Ray image dataset), and the results showed classification accuracy, sensitivity, and specificity of 98.60%, 98.40%, and 98.50% for the X-Ray image dataset, respectively, and 98.80%, 98.50%, 98.40% for the CT scans dataset, respectively. Overall, the obtained results highlight the advantages of the image enhancement model as a first step in processing.

Clinical, Laboratory, and Ultrasound Related Diagnoses of Thyroid Disorders: Using a Family Medicine Center Data to Assess Thyroiditis and Thyroid Nodules in the Eastern Province of Saudi Arabia.

INTRODUCTION/OBJECTIVES: The prevalence of thyroid disorders is high in Saudi Arabia. Among the disorders, goiter and thyroiditis are the most common and have unique ultrasound (US) features, underscoring the need for US screening for thyroid pathologies. This study aimed to determine the prevalence of thyroiditis and thyroid nodules in patients attending the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University. METHODS: This registry-based cross-sectional study analyzed laboratory and US data from 240 patients who attended the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University from January 2020 to December 2021. Abnormalities of the thyroid gland were categorized according to laboratory and US data. Associations between different types of thyroid pathology and clinical and laboratory findings were assessed using appropriate statistical methods. RESULTS: The majority of participants were Saudi women. The prevalence of thyroiditis in the study population was 43%. Approximately 25% of these patients had more than 1 nodule, and fine-needle aspiration biopsy showed that most nodules were benign. Most nodules were found in clinically euthyroid patients. Thyroiditis might be associated with abnormal thyroid function. CONCLUSIONS: Thyroiditis and thyroid nodules were common in our cohort. Vitamin D deficiency, other autoimmune diseases, and a family history of thyroid disorders were associated with thyroiditis and thyroid nodules. US is useful for identifying the type of thyroid disease.

Determinants of time-to-disposition in patients who underwent CT for pulmonary embolism: a retrospective study.

BACKGROUND: Pulmonary embolism (PE) is a common life-threatening medical emergency that needs prompt diagnosis and management. Providing urgent care is a key determinant of quality in the emergency department (ED) and time-based targets have been implemented to reduce length of stay and overcrowding. The study aimed to determine factors that are associated with having a time-to-disposition of less than 4 h in patients with suspected PE who underwent computed tomography pulmonary angiography (CT-PA) to confirm the diagnosis. METHODS: After obtaining approval from the ethics committee, we conducted a retrospective observational study by examining CT-PA scans that was performed to rule out PE in all adult patients presenting at the ED between January 2018 and December 2019. Demographic information and clinical information, as well as arrival and disposition times were collected from electronic health records. Multivariable regression analysis was used to identify the independent factors associated with meeting the 4-h target in the ED. RESULTS: In total, the study involved 232 patients (76 men and 156 women). The median length of stay in the ED was 5.2 h and the 4-h target was achieved in 37% of patients. Multivariable logistic regression analysis revealed that a positive CT-PA scan for PE was independently associated with meeting the four-hour target in the ED (odds ratio [OR]: 2.2; 95% CI: 1.1-4.8). Furthermore, Hemoptysis was the only clinical symptom that served as an independent factor associated with meeting the 4-h target in the ED (OR: 10.4; 95% CI: 1.2-90.8). CONCLUSION: Despite the lower number of staff and higher volume of patients on weekends, patients who presented on weekends had shorter stays and were more likely to meet the 4-h target. Careful clinical assessment, prior to requesting a CT-PA scan, is crucial, since negative CT-PA scans may be associated with failure to meet the 4-h target.

Sclerosing Encapsulating Carcinomatous Peritonitis: A Case Report.

Sclerosing encapsulating peritonitis (SEP) is a rare clinical condition characterized by the formation of a thick, fibrous membrane encasing the intestines, which may lead to intestinal obstruction. The pathogenesis is not completely understood, but various risk factors are well established. However, there are only few reported cases of SEP associated with peritoneal carcinomatosis. Herein, we report a case of a 69-year-old male patient who presented clinically with acute intestinal obstruction 2 years after undergoing a resection procedure for gastric cancer. An abdominal computed tomography revealed findings typical of SEP. Consequently, the patient underwent exploratory laparoscopy, which confirmed the diagnosis of SEP and established the etiology as peritoneal metastases. The patient was managed conservatively, and his symptoms showed some improvement. The patient was at an advanced stage of the disease, and thus remained on palliative care and passed away 1 month later. Although very rare, physicians should consider SEP in their differential diagnoses of intestinal obstruction in patients, particularly in those with a history of intra-abdominal malignancies.

Castleman's Disease and Anticonvulsant Therapy: A Case of 52-Year-Old Female.

Castleman's disease is a disorder of the lymph nodes that encompasses heterogeneous clinical conditions and can be classified into two main types - hyaline vascular and plasma cell. The affected age group ranges widely from two to 80 years old at the time of diagnosis, with a variable clinical presentation. The etiology of Castleman's disease is not yet well-understood; however, a number of factors have been linked to its pathogenesis including certain cytokines, viral infections, autoimmunity, immunodeficiency, chronic inflammation, and Kaposi sarcoma. In this study, we present a case of a 52-year-old Saudi female with a history of pulmonary embolism and deep venous thrombosis, who was then found to have mild splenomegaly, mediastinal, bilateral hilar, supraclavicular, paraaortic, and right axillary lymphadenopathy on CT scan, to be later diagnosed as a multicentric Castleman's disease (MCD). Moreover, the clinical picture, pathogenesis, clinical and histological variants, as well as the treatment options of MCD are discussed.

Digital Eye Strain Among Radiologists: A Survey-based Cross-sectional Study.

BACKGROUND: Computers have become a fundamental part of clinical radiology departments. Radiologists tend to spend long hours in front of computers, reading and analyzing medical images. This prolonged use of computers is associated with digital eye strain. Therefore, this study aimed to estimate the prevalence of digital eye strain among radiologists and determine its contributory factors. METHODS: An online survey was sent to radiologists practicing in hospitals in the Eastern Province of Saudi Arabia. The survey addressed demographic information, workload and workstation environment, personal eye care, and evaluation of digital eye strain symptoms as well as the strategies employed to reduce these symptoms. Results were analyzed descriptively using Chi-square tests and logistic regression analyses. RESULTS: The survey was completed by 198 participants (111 men and 87 women), including residents (40.9%), senior registrars (27.3%), and consultants (27.3%). Most participants (71.2%) were aged below 40 years. Most participants tend to spend 7-9 hours daily reviewing medical images. Overall, 50 participants (25.3%) take a break from work once daily only. A total of 53 participants (26.8%) reported undergoing an eye examination within the past year and 100 participants (50.5%) reported experiencing digital eye strain. Multivariate logistic regression analysis revealed that female sex (odds ratio [OR] = 3.9; 95% confidence interval [95% CI]: 1.6-10.0) and the practice of taking breaks once a day (OR = 15.1; 95% CI: 2.4-94.1) or twice a day (OR = 5.5; 95% CI: 1.1-28.4) only were associated with higher rates of digital eye strain symptoms. CONCLUSION: Digital eye strain is a prevalent condition among radiologists regardless of their subspecialty. It is more commonly seen among radiology residents. Being a female and not taking frequent breaks were associated with higher rates of digital eye strain.

Clinical and imaging profiles of pulmonary embolism: a single-institution experience.

BACKGROUND: Pulmonary embolism (PE) is a common life-threatening condition with non-specific clinical presentations. The diagnosis of PE depends highly on imaging studies, which may also provide prognostic information. This study aimed to describe the clinical and imaging profiles of patients with PE, emphasizing the differences between central and peripheral PE. METHODS: After ethics review board approval, this retrospective observational study examined the non-negative results in adult patients who underwent computed tomography pulmonary angiography (CT-PA) at our hospital between May 2016 and December 2019. Demographic and clinical information and imaging findings were collected from the electronic medical records. RESULTS: The study included 85 cases that were identified after re-interpreting the 103 non-negative CT-PA scans. Six cases were excluded for incomplete data and 12 cases were false-positive. Central PE was found in 63.5% of the cases. Obesity was the most common risk factor seen in 37.6% of the cases. Furthermore, 9.4% of the patients had sickle cell disease, which tended to be associated with peripheral PE. There was no difference between the peripheral and central PE in most clinical and imaging parameters evaluated (P > 0.05). However, patients with isolated subsegmental PE were more likely to develop hemoptysis (P = 0.04). CONCLUSION: This study suggests that patients with obesity and sickle cell disease constitute an important proportion of all PE cases. Furthermore, the clinical and imaging profiles in patients with peripheral PE are similar to those in patients with central PE. Future research should focus on the clinical value of peripheral PE in patients with sickle cell disease.

Physical exercise among radiologists in Saudi Arabia: a cross-sectional study.

BACKGROUND: The practice of clinical radiology has become more sedentary in the era of the Picture Archiving and Communication System. Physical inactivity is a well-known risk factor for various chronic diseases. This study aimed to determine the frequency and pattern of physical exercises among radiologists in the Eastern Province of Saudi Arabia and the association between physical exercises and the prevalence of work-related musculoskeletal symptoms. METHODS: An online survey was sent to radiologists in all hospitals (academic, public, and private) in the major cities of the Eastern Province of Saudi Arabia. It covered information about demographic characteristics and the frequency and pattern of physical exercises. It also included an evaluation of work-related musculoskeletal symptoms using the Nordic Musculoskeletal Questionnaire. This survey of 263 radiologists was conducted in April 2019. The study outcome was the presence of disabling musculoskeletal symptoms in any body region which restricted the performance of normal activities within the last 12 months. The study results were analyzed descriptively using the Chi-square test. RESULTS: The survey was completed by 198 participants (111 men and 87 women) with a response rate of 75.3%. Most participants (71.2%) were less than 40 years. Eighty-three men (74.8%) did a physical exercise at least weekly, compared to 45 (51.7%) women. Men were more likely to engage in various physical exercises than women. Overall, 60.9% of participants who did not do any physical exercise regularly (less than monthly) reported having disabling neck pain. This figure was found lower among participants who did physical exercises monthly (45.8%) or at least weekly (32.8%). A similar pattern was observed with shoulder pain, with 45.7% found in participants who did not exercise and only 25.8% in those engaging in physical activities at least weekly. CONCLUSIONS: Physical inactivity is common among radiologists, especially female ones, in the Eastern Province of Saudi Arabia. The physical inactivity was significantly associated with work-related musculoskeletal symptoms. Gender-specific health promotion programs are needed to mitigate the negative health outcomes due to the sedentary nature of the radiology current practice.

Gastric Schwannoma In a Patient Undergoing Sleeve Gastrectomy: Uncommon Gastric Tumor Discovered Incidentally During a Common Gastric Procedure.

BACKGROUND Obesity is a major global health issue associated with significant co-morbidities. Regarding its treatment, the use of bariatric procedures is increasing due to their efficacy in weight reduction and improved management of the associated medical conditions. Although comprehensive preoperative evaluation is essential, routine upper endoscopy is controversial. CASE REPORT We present the case of a 27-year-old woman with a history of morbid obesity, hypertension, and diabetes mellitus. She had multiple unsuccessful attempts at lifestyle modification for weight reduction. Accordingly, she was scheduled for sleeve gastrectomy. However, the operation was canceled due to the incidental intra-operative finding of a gastric mass. She was diagnosed as having gastric schwannoma, which is considered a rare gastrointestinal neoplasm. CONCLUSIONS Comprehensive preoperative evaluation of patients undergoing bariatric procedures is essential. The present case is a good example of the value of upper endoscopy in the evaluation of patients, including those who are asymptomatic.

The use of clinical decision rules for pulmonary embolism in the emergency department: a retrospective study.

BACKGROUND: Pulmonary embolism (PE) is a common and life-threatening medical condition with non-specific clinical presentation. Computed tomography pulmonary angiography (CT-PA) has been the diagnostic modality of choice, but its use is not without risks. Clinical decision rules have been established for the use of diagnostic modalities for patients with suspected PE. This study aims to assess the adherence of physicians to the diagnostic algorithms and rules. METHODS: A retrospective observational study examining the utilization of CT-PA in the Emergency Department of King Fahd Hospital of Imam Abdulrahman Bin Faisal University for patients with suspected PE from May 2016 to December 2019. The electronic health records were used to collect the data, including background demographic data, clinical presentation, triage vital signs, D-dimer level (if ordered), risk factors for PE, and the CT-PA findings. The Wells score and pulmonary embolism rule-out (PERC) criteria were calculated retrospectively without knowledge of the results of D-dimer and the CT-PA. RESULTS: The study involved a total of 353 patients (125 men and 228 women) with a mean age of 46.7 ± 18.4 years. Overall, 200 patients (56.7%) were classified into the "PE unlikely" group and 153 patients (43.3%) in the "PE likely" group as per Wells criteria. Out of all the CT-PA, 119 CT-PA (33.7%) were requested without D-dimer assay (n = 114) or with normal D-dimer level (n = 5) despite being in the "PE unlikely" group. Only 49 patients had negative PERC criteria, of which three patients had PE. CONCLUSIONS: The study revealed that approximately one-third of all CT-PA requests were not adhering to the clinical decision rules with a significant underutilization of D-dimer assay in such patients. To reduce overutilization of imaging, planned interventions to promote the adherence to the current guidelines seem imperative.

Predictors of positive computed tomography pulmonary angiography results.

PURPOSE: Computed tomography pulmonary angiography (CT-PA) is the diagnostic modality used for pulmonary embolism (PE). This study aimed to estimate the positive CT-PA rate and identify the predictors of positive CT-PA results. METHODS: A retrospective observational study was conducted by examining the CT-PA data for ruling out PE in all adult patients who visited the King Fahd Hospital of Imam Abdulrahman Bin Faisal University. The data regarding background demographic information, clinical information, and CT-PA findings were collected from electronic health records. Data were analyzed descriptively using the chi-squared test. Multivariate regression analysis was used to identify the predictors of positive CT-PA results. RESULTS: In total, 548 patients (209 male, 339 female) who underwent CT-PA scans were included. The positive CT-PA rate was 18.8%. The Charlson Comorbidity Index was not significantly associated with positive CT-PA results (p = 0.456). Multivariate logistic regression analysis revealed that smoking (odds ratio [OR] 4.96; 95% confidence interval [95% CI] 2.05-12.02) was an independent factor associated with positive CT-PA results. The CT-PA scans performed in winter and spring were 43% (OR 0.43; 95% CI 0.22-0.84) and 52% (OR 0.52; 95% CI 0.28-0.97) less likely to show positive results compared with those performed in autumn, respectively. CONCLUSION: The positive CT-PA rate varied significantly between seasons. Smoking was a predictor of positive CT-PA results. These findings may assist in developing interventions for improving the utilization of CT-PA scans to avoid unnecessary exposure of patients to radiation. CLINICAL TRIAL REGISTRATION: N/A.

Splenosis of the Mesoappendix with Acute Appendicitis: A Case Report.

BACKGROUND Splenosis is a benign condition involving the auto-transplantation of splenic tissue at various locations, resulting from splenic injury or splenectomy. CASE REPORT A 40-year-old male, with a history of remote exploratory laparotomy with splenectomy secondary to blunt abdominal trauma, presented with symptoms consistent with acute appendicitis, which was subsequently confirmed by computed tomography scan of the abdomen that further demonstrated the presence of multiple abdominal nodules, one of which was adjacent to the appendix. A laparoscopic appendectomy was then performed along with resection of the nodule located in the mesoappendix, which was confirmed to be a splenic tissue based on histopathological examination. CONCLUSIONS Abdominal splenosis is not an uncommon condition in patients with a history of splenic injury. However, the involvement of the mesoappendix, which may or may not contribute to acute inflammation of the appendix, is very rare.

Concomitant bilateral elastofibroma in the infrascapular and gluteal regions: a report of a rare case.

BACKGROUND: Elastofibroma is a benign soft tissue tumor characterized by the presence of elastic fibers in a stroma of collagen and mature adipose tissue. It is reported to have a prevalence of 2.73%, as shown by a study through computed tomography (CT) images. However, multiple elastofibromas are uncommon. CASE PRESENTATION: We report a case of concomitant bilateral elastofibroma in the infrascapular and gluteal regions. A 63-year-old male patient presented with a 6-month history of gradually increasing painless swellings in the upper back. On physical examination, firm, painless bilateral infrascapular masses were identified; these masses were more noticeable on forward arm flexion. Contrast-enhanced computed tomography showed well-defined bilateral infrascapular masses deep to the serratus anterior muscles as well as poorly defined bilateral gluteal masses with attenuation similar to that of the adjacent skeletal muscle. Magnetic resonance imaging revealed heterogenous masses with internal fatty streaks, consistent with elastofibroma. The histopathological diagnosis of elastofibroma was established based on the results of image-guided core-needle biopsy. The patient underwent surgical excision of both infrascapular elastofibromas with no post-operative complications. As the gluteal masses were incidental, surgical management was not warranted. CONCLUSION: The presence of multiple elastofibromas is unusual. This report describes a rare case of multiple elastofibromas and its typical imaging features, and alerts us that elastofibromas are not exclusive to the periscapular region.

Virtual and augmented reality: potential applications in radiology.

The modern-day radiologist must be adept at image interpretation, and the one who most successfully leverages new technologies may provide the highest value to patients, clinicians, and trainees. Applications of virtual reality (VR) and augmented reality (AR) have the potential to revolutionize how imaging information is applied in clinical practice and how radiologists practice. This review provides an overview of VR and AR, highlights current applications, future developments, and limitations hindering adoption.

Musculoskeletal symptoms among radiologists in Saudi Arabia: a multi-center cross-sectional study.

BACKGROUND: Musculoskeletal symptoms account for the majority of work-related illnesses resulting in a significant economic burden on society. Computer users are subject to unique repetitive strains that predispose them to musculoskeletal symptoms. In the digitalized field of radiology, radiologists spend long hours interpreting medical images on computers. This study aimed to determine the prevalence of musculoskeletal symptoms among radiologists in Saudi Arabia and their contributing factors. METHODS: An online survey was sent to radiologists in all hospitals (academic, public and private) in the major cities of the Eastern Province of Saudi Arabia covering demographic characteristics, workload (e.g. the time spent at a computer workstation), and workstation environments including the number of monitors as well as the adjustability of the height of the workstation and the viewing distance. This survey of 263 radiologists was conducted in April 2019. It included an evaluation of musculoskeletal symptoms using the Nordic Musculoskeletal Questionnaire. The study outcome was the presence of disabling musculoskeletal symptoms in any body region, which restricted the performance of normal activities in the last 12 months. Results were analyzed descriptively using a Chi-square test and logistic regression analysis to estimate the odd ratio of experiencing disabling musculoskeletal symptoms in the last 12 months. RESULTS: The survey was completed by 198 participants (111 men and 87 women) with a response rate of 75.3%. Most participants (71.2%) were aged below 40 years. A multivariate logistic regression analysis revealed being a female radiologist (OR = 2.7; 95% CI: 1.2-6.5), aged 30-39 years (OR = 4.1; 95% CI: 1.1-15.3), and predominantly reviewing computed tomography (CT) images (OR = 4.1; 95% CI: 1.4-12.3) or ultrasound scans (OR = 5.9; 95% CI: 1.4-25.3) were associated with higher prevalence of disabling musculoskeletal symptoms, compared to those aged below 30 years and those who reviewed various imaging modalities, respectively. CONCLUSIONS: Musculoskeletal symptoms are common among radiologists with lower back and neck pain being the most frequent complaints. Being a female radiologist, aged 30-39 years, and reviewing CT or ultrasound scans were associated with higher rates of disabling musculoskeletal symptoms.

A rare form of Mayer-Rokitansky-Küster-Hauser syndrome: Case report and review of literature.

INTRODUCTION: Primary amenorrhea is failure to reach menarche. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea, after gonadal dysgenesis. Herein, we report a rare case of an unusual subtype of MRKH syndrome. CASE REPORT: This report describes the case of a 28-year-old woman with primary amenorrhea and coital difficulties. On examination, she had normal secondary sexual characteristics but a blind-ending vagina. Her hormonal profile was within normal limits; ultrasound examination was inconclusive due to technical difficulties. Subsequently, she underwent pelvic magnetic resonance imaging, which revealed bilateral rudimentary uterine horns in the presence of normal ovaries and normal length of a blind-ending narrow vagina. CONCLUSION: MRKH syndrome with bilateral rudimentary uterine horns and normal-length vagina is an unusual form of Müllerian agenesis.

Malrotated right supernumerary kidney: Case report of a rare anomaly.

Supernumerary Kidney is a one of the rarest congenital renal anomalies with less than 100 cases reported in the literature. This accessory kidney has its own collecting system, vascular supply and well-defined capsule. We report a case of 18-year-old lady with a history of vague intermittent abdominal pain and has palpable abdominal mass who was found to have malrotated right supernumerary kidney with pelviureteric junction obstruction.

Transurethral Resection for the Treatment of an Inflammatory Myofibroblastic Tumor of the Urinary Bladder: A Case Report.

Inflammatory myofibroblastic tumors (IMT) of the urinary bladder is a remarkably rare bladder tumor. To this day, no standardized treatment protocol has been recognized. Here we report a case of bladder IMT in a 14-year-old girl presenting with urgency, frequency, and gross painless hematuria for a week. Complete excision of the bladder IMT was amenable with transurethral resection of bladder tumor (TURBT). Follow-up cystoscopy did not detect any recurrence. Minimally invasive bladder-sparing treatments are a valid option for treating IMT of the bladder.

Is primary tumor detectable in prostatic carcinoma at routine contrast-enhanced CT?

OBJECTIVES: To determine if prostatic carcinoma (PCa) is detectable at routine contrast-enhanced CT (CECT). MATERIALS AND METHODS: With institutional review board approval, 63 consecutive PCa patients underwent CECT before therapy. Two blinded radiologists assessed for rounded focal enhancing peripheral zone nodules. Diagnostic accuracy and inter-observer agreement were compared by Gleason Score (GS). RESULTS: Overall sensitivity was 63-76% with moderate agreement, K=0.42. The false-positive rate was 15%. Sensitivities and agreement for GS 9-10, 7-8 and 6 PCa were 84-91%, 73-84%, 41-71%, (P=.023 and .001) and K=(0.72, 0.69, 0.23). CONCLUSIONS: CECT has good sensitivity for detecting GS ≥7 PCa with substantial agreement and a low false-positive rate.

Prostatic ductal adenocarcinoma: an aggressive tumour variant unrecognized on T2 weighted magnetic resonance imaging (MRI).

INTRODUCTION: Prostatic ductal adenocarcinoma (DCa) is an aggressive variant. The purpose of this study was to determine if T2 signal intensity (SI) differs from conventional adenocarcinoma (CCa). MATERIALS AND METHODS: A retrospective study of patients who underwent preoperative MRI and prostatectomy between 2009 and 2012 was performed. T2 SI ratios (SIR) for tumour (T) to obturator internus muscle (M) and normal peripheral zone (PZ) were compared. Two radiologists evaluated the central gland/PZ to detect tumours and compared diagnostic accuracy. RESULTS: T2 SIR for DCa were 3.60 (T/M), 0.66 (T/PZ); 2.68 (T/M), 0.47 (T/PZ) for Gleason 9; 2.50 (T/M), 0.47 (T/PZ) for Gleason 7/8 and 3.95 (T/M), 0.73 (T/PZ) for Gleason 6 tumours. There was a difference in T2 T/M and T/PZ SIR between DCa and Gleason 9 (p = 0.003, p = 0.004) and Gleason 7/8 (p = 0.006, p = 0.002), but no difference in SIR between DCa and Gleason 6 tumours. The sensitivity for tumour detection was 0-27 % for DCa, 64-82 % for Gleason 9, 44-88 % for Gleason 7-8 and 0-20 % for Gleason 6. There was a difference in the sensitivity of detecting Gleason 9 and 7/8 tumours when compared to DCa (p = 0.004, p = 0.001). CONCLUSIONS: DCa resembles Gleason score 6 tumour at T2-weighted MRI, which underestimates tumour grade and renders the tumour occult. KEY POINTS: Prostatic ductal adenocarcinoma is aggressive, resembling endometrial carcinoma at histopathology. Prostatic ductal adenocarcinoma resembles Gleason score 6 tumour at T2-weighted MRI. MRI grading may underestimate ductal adenocarcinoma based on increased T2 signal.