Magnetic resonance imaging characteristics of chronic prostatitis in patients under the age of 50: is it more than the eye can see?

ABSTRACT

BACKGROUND: The magnetic resonance (MRI) diagnosis of chronic prostatitis (CP) is insufficiently evaluated. PURPOSE: To evaluate the MRI appearance of CP in young patients by comparing it to individuals with non-prostatic related pathology. MATERIAL AND METHODS: The study included 47 patients with prostatitis-like symptoms evaluated by urologists and referred to pelvic MRI examination (mean age=40.23±7 years; age range=23-49 years) and 93 age-matched individuals with non-prostatic related pathology (mean age=37.5±7 years; age range=21-49 years). All MRI examinations were performed on a 1.5-T machine using a prostate-specific protocol for the prostatitis group and different protocols that included high-resolution small field of view T2-weighted (T2WI) and diffusion-weighted imaging (DWI), for the control group, depending on the clinical indication. RESULTS: Four different T2WI intensity patterns were observed hyperintense homogenous; slightly to moderate homogenous hypointense; inhomogeneous; and marked hypointense. We found statistically significant differences between the two analyzed groups regarding mean ADC values (P<0.001), distribution of T2WI intensity patterns (P<0.0001), and the presence of dilated venous plexus (P=0.0007). No differences were found regarding prostate volume (P=0.15). In multivariate analysis, all four analyzed imaging parameters were independent predictors of chronic prostatitis (R2=0.67; P<0.0001). Considered together, an age >28 years, an inhomogeneous or marked hypointense T2WI intensity pattern (types 3 and 4), an ADC value ≤1250, and the presence of dilated venous plexus are able to predict CP with an AUC of 93% (sensitivity=85.1%, specificity=88.4%). CONCLUSION: MR parameters like T2WI intensity patterns, ADC values, and venous plexus appearance are promising non-invasive tools in the challenging environment of CP diagnosis.