Prostate MRI: stromal nodule

Case contributed by Dr Matthew Bastian-Jordan

Presentation

Screening MRI for increased PSA and positive family history

Patient Data

Age: 65 years
Gender: Male
MRI

mpMRI of the prostate

There is a prominent nodule at the right base transition zone (TZ) that displays homogeneous T2 signal (smudged charcoal appearance) but is very well-defined.

It does not enhance but has borderline signal on DWI and low ADC (8-900).

Despite its smooth appearance on T2 (dominant sequence in TZ), the well-defined appearance leads to a grading of 2 on T2 and neither DWI or DCE can upgrade. If the lesion was not encapsulated it would get a grading of 5 most likely.

Nuclear medicine

PSMA PET shows no uptake in the right TZ nodule.

Photo

MRI biopsy report.

Case Discussion

This highlights the difficulty in interrogating the transition zone of the prostate. This nodule was biopsied and proved benign under MRI guidance and was also not avid at PSMA PET.

The well-defined appearance (in all three planes on T2W) is the key to defining this as a stromal nodule on T2W. If it enhances or restricts, it does not change this. If you feel it is ill-defined then a T2W grading of 3 or maybe 4 can be used. If a T2W grading of 3 then a DWI grading of 5 will upgrade the overall grading to 4.

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Case information

rID: 46499
Case created: 6th Jul 2016
Last edited: 20th Mar 2018
Inclusion in quiz mode: Included

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