Korean J Radiol.  2022 Jan;23(1):60-67. 10.3348/kjr.2020.1369.

Imaging Patterns of Bacillus Calmette–Guérin-Related Granulomatous Prostatitis Based on Multiparametric MRI

• Lee S
• Oh YT
• Kim HM
• Jung DC
• Hong H

• KMID: 2523736
• DOI: http://doi.org/10.3348/kjr.2020.1369

Abstract

Objective
To categorize multiparametric MRI features of Bacillus Calmette–Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer.
Materials and Methods
The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50–88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm² ) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types.
Results
The median lesion size was 22 mm with the interquartile range (IQR) of 18–26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen’s kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4–8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions.
Conclusion
BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.

Keyword

Magnetic resonance imaging; BCG vaccine; Prostatitis; Prostate cancer INTRODUCTION The Bacillus Calmette–Guérin (BCG) vaccine is primarily used against tuberculosis. Since Morales et al. [1] introduced intravesical BCG instillation as a treatment for Obj