The role of T1 hyperintensity in differentiating granulomatous prostatitis from prostate cancer - a retrospective analysis of 31 lesions

Q: What is the main purpose of this study?

To investigate mpMRI characteristics of granulomatous prostatitis and describe findings from 31 pathologically confirmed GP lesions in 19 patients.

Q: How were patients and controls selected for comparison?

Nineteen patients with available prebiopsy mpMRI and pathologically confirmed GP were included, and 280 biopsy-naïve clinically significant prostate cancer patients served as the control group.

Q: What mpMRI feature helped differentiate GP from prostate cancer?

T1-WI hyperintensity was significantly more frequent in GP than in clinically significant prostate cancer, on both a per-patient and per-lesion basis.

Sep 29, 2026

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This retrospective two-center study evaluates multiparametric MRI markers that distinguish granulomatous prostatitis (GP) from prostate cancer (PCa), using 31 pathologically confirmed GP lesions in 19 patients and a control group of 280 biopsy-naïve patients with clinically significant PCa. Prebiopsy mpMRI features were assessed by consensus and included lesion morphology, extraprostatic extension indicators, signal characteristics on T1/T2/DWI, ADCmean, enhancement patterns, and PI-RADS scoring. GP lesions showed frequent T1-WI hyperintensity without prior biopsy, occurring far more often than in PCa.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Purpose

Methods

Results

Conclusion

Clinical Significance

Keywords

Copyright @ 2026 Author(s) -[Available online at dirjournal.org.](Available online at dirjournal.org. ORIGINAL)[ ORIGINAL](Available online at dirjournal.org. ORIGINAL) ARTICLE Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. The role of T1 hyperintensity in differentiating granulomatous prostatitis from prostate cancer: a retrospective analysis of 31 lesions Selahattin Durmaz 1 Mert Kılıç2,3 Bilgen Coşkun4 Sergin Akpek4 Barış Bakır5 Tarık Esen2,3 Metin Vural4 Emre Altınmakas6,7 1Gaziosmanpaşa Training and Research Hospital, Clinic of Radiology, İstanbul, Türkiye 2American Hospital, Clinic of Urology, İstanbul, Türkiye 3Koç University School of Medicine, Department of Urology, İstanbul, Türkiye 4American Hospital, Clinic of Radiology, İstanbul, Türkiye 5 İstanbul University İstanbul Faculty of Medicine, Department of Radiology, İstanbul, Türkiye 6 Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular and Interventional Radiology, New York, USA 7Koç University School of Medicine Department of Radiology, İstanbul, Türkiye Corresponding author: Selahattin Durmaz [E-mail:](E-mail: drselahattindurmaz@gmail.com)[ drselahattindurmaz@gmail.com](E-mail: drselahattindurmaz@gmail.com) Received 06 February 2025; revision requested 19 March 2025; accepted 05 April 2025. Epub: 20.05.2025 Publication date: 02.01.2026 DOI: 10.4274/dir.2025.253242 PURPOSE To investigate the multiparametric magnetic resonance imaging (mpMRI) characteristics of granulomatous prostatitis (GP) and share our experience with 31 pathologically confirmed GP lesions in 19 patients. METHODS This two-center retrospective study reviewed the pathological and imaging data of 856 patients who underwent prostate biopsy between January 2012 and April 2024. Of these, 19 patients with available prebiopsy mpMRI and a pathologically confirmed diagnosis of GP were included. Additionally, 280 biopsy-naïve patients diagnosed with clinically significant prostate cancer (csPCa) were included as a control group for comparative analysis. Prebiopsy mpMR images of patients with GP were assessed by consensus between two of three radiologists (M.V., B.C., S.D.), evaluating lesion location, size, shape, multifocality, extraprostatic extension (EPE), signal characteristics on T1-, T2-, and diffusion-weighted imaging (DWI), the mean apparent diffusion coefficient (ADCmean) value, enhancement patterns, and prostate imaging reporting and data system (PI-RADS) scores. Statistical analyses were conducted using SPSS version 30.0. RESULTS In 19 patients, 31 pathologically confirmed GP lesions were identified on prebiopsy mpMRI. Twenty-six lesions were located in the peripheral zone and five in the transitional zone. Multifocal involvement was observed in nine patients (47.3%). Thirty of 31 lesions were hypointense on T2-WI, and seven showed capsular bulging and/or irregularity, suggesting EPE. DWI revealed markedly impeded diffusion in all lesions. The median ADCmean value was 825 × 10-3 mm2/s (IQR: 230 × 10-3 mm2/s). On dynamic contrast-enhanced sequences, 25 lesions showed early enhancement, five showed prolonged enhancement, and one showed prolonged ring enhancement. Based on mpMRI findings, 17 lesions were assigned a PI-RADS score of 4, and 13 lesions were assigned a PI-RADS score of 5. Notably, 22 lesions (71%) in 14 patients with GP (73.7%) exhibited hyperintensity onT1-WI despite no prior prostate biopsy history. Statistical analysis comparing the GP and csPCa groups revealed that hyperintensity on T1-WI was significantly more frequent in GP, both on a per-patient basis (73.7% vs. 3.2%) and a per-lesion basis (71.0% vs. 3.1%) (P < 0.0001 for both) . CONCLUSION GP shares overlapping imaging features with prostate cancer on mpMRI. However, hyperintensity on T1-WI may serve as a distinguishing feature, potentially reducing unnecessary prostate

FAQs

What is the main purpose of this study?

To investigate mpMRI characteristics of granulomatous prostatitis and describe findings from 31 pathologically confirmed GP lesions in 19 patients.

How were patients and controls selected for comparison?

Nineteen patients with available prebiopsy mpMRI and pathologically confirmed GP were included, and 280 biopsy-naïve clinically significant prostate cancer patients served as the control group.

What mpMRI feature helped differentiate GP from prostate cancer?

T1-WI hyperintensity was significantly more frequent in GP than in clinically significant prostate cancer, on both a per-patient and per-lesion basis.

Sep 29, 2026

Upload by Bintang