前列腺癌mp-MRI误诊原因及影像特征分析OA

Objective To investigate the causes of misdiagnosis of prostate cancer(PCa)and the imaging features on multiparametric MRI(mp-MRI).Methods patients with initially misdiagnosed PCa admitted to our hospital between June 2022 and September 2024.Results One patient presented with frequent micturition and a prostate-specific antigen(PSA)level of 8.4 μg/L,and was initially misdiagnosed with chronic prostatitis.mp-MRI revealed a peripheral zone lesion with low T2 signal,high signal on diffusion-weighted imaging(DWI),and an apparent diffusion coefficient(ADC)value of 0.72×10-3 mm2/s,yielding a Prostate Imaging Reporting and Data System(PI-RADS)score of 5.The patient was diagnosed with prostate cancer by MRI-ultrasound fusion targeted biopsy pathology and underwent laparoscopic radical prostatectomy.The misdiagnosis lasted 46 d.At the 3-month follow-up,no urinary incontinence was reported.Another patient presented with dysuria and a PSA level of 6.8 μg/L,and was misdiagnosed with benign prostatic hyperplasia(BPH).Re-evaluation of MRI in another hospital revealed a lenticular-shaped T2 hypointensity in the peripheral zone,an ADC value of 0.68× 10-3 mm2/s,and a type Ⅲ dynamic contrast-enhanced(DCE)curve,with a PI-RADS score of 4.Confirmation of prostate cancer was obtained via transrectal MRI-ultrasound fusion targeted biopsy,with a misdiagnosis duration of 135 d,and subsequently received three-dimensional conformal radiotherapy combined with Leuprorelin.No radiation enteritis was observed during the 6-month follow-up.The third patient presented with painless gross hematuria,and was preliminarily diagnosed with bladder cancer after relevant examinations,with a PSA level of 18.5 μg/L.Subsequent mp-MRI revealed a large mass in the central zone extending to the bladder neck,with loss of the intervening bladder wall interface,high DWI signal,an ADC value of 0.65×10-3 mm2/s,and seminal vesicle invasion.The patient was diagnosed with prostate cancer by transrectal ultrasound-guided targeted biopsy,with a misdiagnosis duration of 21 d,and received endocrine therapy with Leuprorelin and Bicalutamide.The hematuria resolved after 2 months,and follow-up was continued.Conclusion PCa is prone to misdiagnosis due to overlapping imaging features with benign lesions,atypical growth locations,and non-specific initial clinical symptoms.Typical imaging features suggestive of PCa include peripheral zone hypointensity combined with ADC values＜0.75×10-3 mm2/s,as well as flat bladder neck thickening with seminal vesicle involvement.For patients with elevated PSA unresponsive to conservative treatment for more than 4 weeks,routine mp-MRI is recommended.Immediate targeted biopsy should be performed when PI-RADS ≥4 or ADC ≤0.75×10-3 mm2/s to reduce misdiagnosis.