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
Gender: Male

Mp MRI of the prostate

Modality: MRI

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

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 encapsulated 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.

Modality: Nuclear medicine

The PSMA PET shows no uptake in the right TZ nodule.

Modality: Photo

MRI biopsy report.

Case Discussion

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

The well encapsulated appearance (in all 3 planes on T2) is the key to defining this as a stromal nodule on T2. If it enhances or restricts does not change this. If you feel it is ill-defined then a T2 grading of 3 or maybe 4 can be used. If a T2 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: 7th Jul 2016
Inclusion in quiz mode: Included

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