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.