How can prostatic haemorrhage and prostate cancer be differentiated?
Haemorrhage can be detected on multiparametric prostate MRI on T1w images as hyperintense areas, due to the paramagnetic effect of methaemoglobin. Regarding tumour detection, the impact of haemorrhage is most pronounced on T2-weighted imaging so that functional sequences (DWI and DCE) become more important.
Are there imaging signs of seminal vesicle invasion?
Yes, there is direct extra-glandular tumour extension from the base of the prostate to the left seminal vesicle and along the left ejaculatory duct.
What are signs of seminal vesicle invasion on MRI?
Low signal intensity on T2 and ADC without corresponding high signal on T1, positive DCE, asymmetric wall thickening or mass.
What are the signs of extraprostatic extension in this case?
There is a broad capsular contact, there is an extremely irregular contour with capsular breaches in many locations, there is an obliteration of the rectoprostatic angle and neurovascular asymmetry.
Key findings:
- large prostatic haemorrhage in the apical and midglandular zone of the prostate (blue arrows) - best visible in T1-weighted images, due to the paramagnetic effect of methaemoglobin
- extensive tumour growth in the base and midglandular zones of the prostate expressed by the "erased charcoal sign" (red arrows) with correspondent hyperintensity in b1400 images (red arrowheads) with irregular prostatic margins, breaches, and neurovascular bundle asymmetry (green arrowhead)
- tumour invasion of the inferior portion of the left seminal vesicle (orange arrowhead)
- bleeding/haemorrhage in the mid and lateral portion of the left seminal vesicle (blue arrowheads)