Post-prostate biopsy: hemorrhage exclusion

Case contributed by Dr Derek Smith


Elevated PSA. Prostate biopsy 8 weeks prior. Index imaging.

Patient Data

Age: 60 years
Gender: Male

Imaging degraded by hemorrhage. 

Multifocal disease in both sides displaying restricted diffusion.

No extra-prostatic disease.

Annotated image

Area in peripheral zone demonstrating lack of signal on T1w (absence of blood products), low T2w, and restricted diffusion. 

Case Discussion


Multiple bilateral core biopsies. Adenocarcinoma in all cores. Highest Gleason score 3+4=7.


In early post-biopsy prostate imaging, hemorrhage can degrade image quality (with T1w hyperintensities). The matter of timing is contentious, especially if imaging will steer treatment options.

In some cases, abnormal prostate tissue will not produce normal levels of citrate, an endogenous anticoagulant, which results in areas with less blood product than expected. This "hemorrhage exclusion sign", in conjunction T2w and DWI findings can help identify tumors.

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Case information

rID: 50691
Published: 17th Jan 2017
Last edited: 16th Jul 2018
System: Urogenital
Inclusion in quiz mode: Included

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