MRI of the pelvis for prostatitis

MRI diagnostics of the prostate gland: what does the study of the prostate with and without contrast shows?

Prostate MRI creates a visualized computer model of the anatomy of the organ, which allows you to determine the volume, structure and location of all pathological changes in the gland, as well as the degree of involvement in the spread of the disease of neighboring tissues. This is a harmless and highly informative technology of modern medicine. It differs from CT in safety and more accurate results.

Diagnosis of prostate diseases using MRI

The use of magnetic resonance imaging provides high accuracy and allows you to detect the following diseases:

Prostatitis is an inflammation of the prostate gland in acute and chronic forms, as well as in the abscess phase with a layer of pus. Hyperplasia (adenoma) - proliferation of connective tissues, resulting in compression of the urethra. The disease is dangerous with serious complications. Early detection is the key to effective treatment. Crayfish. The problem of curability consists in diagnosing the disease in the first phase. At the beginning, the disease has no specific symptoms. The study of the prostate using MRI provides the most qualitative and reliable data on the presence of cancer, its stage and localization. The organ under study is small and deeply immersed in the body. In this regard, classical magnetic exposure is not enough for high-quality diagnostics. In this case, additionally assigned:

• MR spectroscopy. The result of the study is the chemical composition of the gland.
• MR diffusion/perfusion that separates normal and diseased tissues.

Types of MRI examination of the prostate:

Classic study without the introduction of contrast markers and probe. Within 30-40 minutes, the desired area of the body is scanned. With contrast. Before the procedure, the patient is injected with a substance, its traces are clearly visible on the screen. Blood carries the drug to all tissues, including the tumor. Contrast does not harm, it only helps to better see the boundaries of the disease. With endorectal coil. A thin flexible wire covered with an elastic braid is inserted into the rectum. It creates an additional magnetic field in the desired area, which makes the image more distinct. Multiparamatic MRI is a combination of all types of magnetic tomography. Magnetic resonance imaging, including the prostate gland, has a high reliability of results, higher than that of other diagnostic methods. In addition to this advantage, unlike a CT scan of the prostate, it does not expose the patient to the harmful effects of x-rays. The exception is people who have contraindications for MRI. For them, a CT scan of the prostate is provided.

Advantages of magnetic resonance imaging methods:

• safety - the technology does not involve the use of ionizing radiation and non-invasive intervention;
• high level of detail and accuracy of results;
• the ability to obtain not only an image and determine the structure of an organ, but also to conduct its chemical analysis;
• Speed of examination - the procedure lasts 30-40 minutes.

Preparation for tomography

To perform a high-quality examination, patient preparation is necessary, namely:

• Prepare documents for the doctor - referral, conclusions about previous studies.
• During the day before the procedure, limit the use of foods that cause increased gas formation - cabbage, legumes, fruits, milk, black bread. Espumizan should be taken to avoid flatulence.
• Empty your bowels. If necessary, give an enema.
• Stop eating 4 hours before diagnosis.
• 2 hours before the procedure, drink water to fill the bladder.
• Half an hour before the examination, take an antispasmodic (No-shpa, Spazmalgon, others).
• If the patient is anxious, a mild sedative may be used.

Steps of the procedure

The magnetic resonance tomograph is a complex device consisting of a retractable table and a cylindrical tunnel surrounded by a magnet. For patients with claustrophobia or weighing more than 130 kg, models of devices with open side walls are provided. An MRI examination of the prostate is carried out as follows:

The patient must change in the locker room and deposit valuables, watches, electronic devices. The doctor injects a gadolinium-based contrast agent into the vein, if contrast was provided. During a dynamic study, a dropper with a saline solution is placed in the patient, into which a marker is added after the start of the scan. If it is intended to use an endorectal coil, then the specialist prepares it as follows.A special cuff is smeared with petroleum jelly or gel. The sensor is placed in it. The cuff is inserted into the rectum and then inflated. At the end of the procedure, it is deflated and removed from the patient's body. The patient lies on a sliding table on his back. Puts on headphones or puts earplugs in the ears. Inside the tomograph there is a voice communication for communication with the staff. The specialist instructs the patient about the upcoming procedure and the rules of conduct during it, including the obligation to maintain complete immobility. Scanning lasts 30-40 minutes. If necessary, the session can last as long as necessary to obtain a quality result. The specialist deciphers the images and sends it to the treating doctor. Contrasting for more precision

The injected substance is instantly carried by the blood through the internal organs, reaching the prostate and tumors. On the computer screen, the boundaries of the prostate and tumors are clearly visible. You can accurately find out the geometric parameters, the structure of not only the tumor, but also the smallest metastases.

When using contrast, side effects may occur in the form of fever, third-party taste in the mouth, rapid breathing and palpitations. Such manifestations should be reported to the doctor immediately. To do this, the device provides voice communication.

MRI for prostate cancer

Prostate cancer often affects older men. The disease first manifests itself in difficulty urinating, incomplete outpouring of the contents of the bladder. Then there is intoxication, weakness, depression. Already when such signs appear, you should contact a urologist and undergo an MRI of the prostate gland.

The most important advantage of endorectal MRI in diagnosing pancreatic cancer is the accurate visualization and localization of the size, nature and location of the tumor. The sources of information are foci of low signal intensity in the peripheral region of the prostate. Irregular, uneven contours, diffuse spread are signs of a malignant disease.

Advantages of multiparametric MRI

Multiparametric MRI is a combined study, where all methods of magnetic resonance diagnostics are involved. This procedure gives the most accurate result known. With this integrated approach, it is possible to evaluate the following:

• with dynamic contrasting, the work of blood vessels in the prostate and neighboring organs is analyzed;
• diffusion-weighted tomography shows the parameters of water exchange in the studied tissues;
• MRI spectroscopy determines the level of concentration of various substances in the prostate gland;
• 3D modeling creates an overall picture and eliminates misinterpretation of the various parameter values obtained during the survey.

The use of such an integrated approach to the diagnosis of pathologies is especially effective when combined with a biopsy. This allows you to identify the most aggressive areas of the cancerous tumor. The advantage is that a conventional biopsy is performed at random with multiple punctures. With multiparametric MRI, the doctor knows the location of the neoplasm and takes point samples under the simultaneous control of the ultrasound machine and the tomograph, which minimizes errors in the penetration of the needle into the body of the tumor.

When is CT diagnostics indicated?

There are patients for whom MRI is contraindicated. For them, CT and other diagnostics of the prostate gland are prescribed, despite the fact that this is a less accurate method, because the tissue of the examined organ contains many liquid components and is surrounded by bone structures. The procedure can be applied to the category of patients who:

• allergic to contrast agents;
• pacemakers;
• metal implants;
• insulin pumps;
• surgical clips in vessels and tissues;
• hearing aid in the middle ear;
• claustrophobia;
• weight over 130 kg.

CT of the affected prostate cancer is performed in the following cases:

• in order to determine the degree of damage by a cancerous tumor to neighboring tissues with a high risk of spread, calculated according to the Glisson scale;
• to detect regional screenings in the pelvic lymph nodes;
• for accurate planning of surgery and radiotherapy;
• to clarify an already diagnosed diagnosis.

When the patient's condition is severe, the procedure is performed to distinguish between acute parenchymal prostatitis and prostate abscess.The CT examination is carried out as follows:

• the doctor examines the patient, fixes his condition, finds out if there are any allergies to contrasts, chronic diseases;
• the patient lies on the couch of the tomograph, a catheter is inserted into the vein to inject a contrast marker;
• the catheter is connected to the injector;
• scanning is carried out, sometimes several times in different phases of contrast absorption;
• The results are interpreted by a specialist and transferred to the attending physician.

Making an MRI of the prostate: preparation for the study and the procedure

Magnetic resonance imaging of the prostate gland is included in the category of basic procedures that are prescribed for men with suspected pathologies in the tissues. Preparing for an MRI of the prostate involves informing the patient about the rules for undergoing diagnostics and identifying data about his state of health.

Why is an MRI of the prostate prescribed for men?

The prostate is the most important organ of the male genitourinary system, located under the bladder. This gland is responsible for the production of substances that give sperm viability.

Prostate cancer occupies one of the initial positions in the list of deaths from oncology among the stronger sex.

At the first stages of development, the disease is accompanied by symptoms in the form of pain, disruption of the urethra, blood in the urine. Pathology can develop over a long period without characteristic signs.

A screening examination is used as an effective way to detect cancers at an early stage, which involves an examination by a urologist, analysis of prostate specific antigen and MRI. At this time, therapy is still able to give positive results.

The last type of examination is highly accurate and helps to identify various diseases, in particular oncology. The procedure is completely safe for the patient, during which he does not feel discomfort and pain.

MRI allows you to get the clearest images, on the basis of which the specialist draws up a competent treatment regimen.

As a rule, an examination is prescribed for suspected cancers that are concentrated in the prostate. Diagnostics allows you to determine the dynamics of the development of the disease, whether the tumor is limited by the size of the gland, or it has already gone beyond its boundaries.

Most often, the pathology is accompanied by a violation of the urinary system, inadequate outflow of urine, regular urge to urinate. At the last stage, traces of blood sometimes appear in the urine.

Among other indications for diagnostics, there are:

Carrying out magnetic resonance imaging and deciphering the results

During the procedure, the doctor checks the condition of the prostate and adjacent organs (lymph nodes, bladder, rectum).

The result reflected in the picture helps to assess the pathologies in the tissues, to determine the form of the disease. If the patient is completely healthy, the device displays the absence of symptoms of the disease.

The prostate gland has a fairly miniature size and a deep location in the body of a man. Because of this, it is often impossible to diagnose using ultrasound or only a magnetic field. To make the procedure as informative as possible, auxiliary techniques are used during the MRI.

In the case of the traditional variant, the patient is placed on a horizontal surface, which, during the diagnosis, moves into a separate chamber, which has the shape of a cylinder and is surrounded on each side by magnets. To fix the position of a man in a stationary state inside the structure, special straps and pillows are used.

This prevents distortion of the final results of the procedure.

Therefore, all the patient has to do is lie on the table without moving. The examination can be carried out with or without contrast.

In the first case, the patient is injected into a vein with a special substance of an unusual color range, the shade of which has significant differences on the monitor of the device. This method helps to identify healthy and affected areas.

The final decision on the diagnosis with or without contrast is made by the physician. As a rule, the first method is used in case of suspicion of a malignant tumor originating in the prostate gland.

In such a situation, differences are observed not only during the MRI, but also in preparation for it. The patient must be examined in advance for the presence of a reaction to the dye.

If the tests did not reveal any violations, on the eve of the diagnosis, the patient is given an enema. In addition, he must refrain from eating.

MRI of the prostate: preparation for the study

Preparatory measures before the examination help to detect even minor changes in the tissues of the prostate.

Before an MRI, it is recommended to follow a number of rules:

• diet. The day before the start of the diagnosis, it is necessary to exclude from the diet foods that provoke flatulence. These are fresh vegetables, legumes, sweet fruits, sodas, dairy products and cereals. You should also prevent the manifestation of gas formation. To do this, you can take the pharmacy Espumizan or regular activated charcoal;
• colon cleansing. The next step is bowel cleansing with an enema. During the normal work of the digestive organ, you can go to the toilet in the usual way;
• other important preparations. Drink plenty of water 2 hours before your procedure to fill your bladder. Take an antispasmodic 30 minutes before the start of the examination. You can drink No-shpu or its analogue - domestically produced pills Drotaverin. If you feel very anxious, use drugs that have a sedative effect.

It is advisable to take with you to the appointment a referral for an MRI, data on previous prostate diagnostics (if any), photographs, and a conclusion. Thanks to these documents, the specialist will be able to adjust the examination scheme, pay special attention to problem areas, and determine the degree of change in the state of the prostate.

Related video

How to prepare for an MRI scan of the abdomen and pelvis:

In view of its maximum efficiency, tomography is one of the most modern methods that allows to differentiate pathology with particular accuracy. The main thing is to prepare well for the MRI. Correct diagnosis and timely therapy help to avoid the most unfortunate consequences for the patient.

MRI of the pelvis in the diagnosis of prostate diseases

MRI of the pelvis in the diagnosis of prostate diseases

In the diagnosis of prostate diseases, the role of MRI is especially great. In economically developed countries, Prostate cancer occupies one of the first places in the structure of oncological diseases, so the interest in methods for its early detection is especially great.

MRI is most often used for the detection and differential diagnosis of prostate cancer, as well as for the diagnosis of other diseases of the prostate and seminal vesicles.

Let's consider some diseases of the prostate gland and seminal vesicles detected by MRI examination of the pelvis:

1. Benign prostatic hyperplasia

This is an adenomatous enlargement of the transition zone of the prostate. Typically occurs in men over 50 years of age, most often progresses over time. Clinically manifested by dysuric phenomena, weakening of the urine stream, chronic urinary retention.

Rarely causes prostate cancer.

A) T2-tra b) T2-sag The zonal anatomy of the prostate is well visualized, pronounced hyperplasia of the transition zone of an inhomogeneous structure, compression of the peripheral zone against this background. The transition zone protrudes into the lumen of the bladder (b).

2. Prostate cancer.

Adenocarcinoma is the most common malignant tumor of the prostate, usually occurring in the peripheral zone. In men, it is the most common malignant tumor. Clinically, an asymptomatic course is characteristic for a long time; palpation, as a rule, only large, peripherally located tumors are determined. Urinary retention, infravesical obstruction - late complications of adenocarcinoma. Deterioration of the general condition in patients occurs with metastatic prostate cancer.

The frequency of occurrence increases with age. Screening, including determination of the level of PSA and digital rectal examination of the prostate, should begin at age 50.

A) T2-axial image b) T2-coronal image.

Male, 62 years old. Verified prostate cancer. In the posterior-lateral sections of the peripheral zone of the left lobe of the gland (on the border of the central and apical parts of the prostate), an area of pathologically reduced MR signal is visualized. The intact capsule of the gland is preserved (stage T2a).

T2-VI, axial plane. Ca (cancer) is a small focus of a pathologically reduced MR signal.

The area of the pathologically reduced MR signal is determined in the peripheral zone of the left lobe of the prostate (the central part of the gland). In this case, a violation of the integrity of the capsule of the prostate gland (T3a stage) is visualized.

A) T2-cor b) T2-tra c) T1FS din+C

A large tumor of the right lobe of the prostate gland with invasion of its capsule, spreading to the paraprostatic tissue (arrows) is determined. With intravenous dynamic contrast (c) in the arterial phase, a pronounced, diffusely inhomogeneous enhancement of the tumor tissue is determined.

A) T2-axial image b) T2-coronal image

The tumor of the left lobe of the prostate is determined with signs of spread to the base of the left seminal vesicle (arrows, b).

3. Acute prostatitis.

Acute prostatitis is an acute inflammatory process in the prostate gland, characterized by signs of general intoxication, pain in the perineum and inguinal region, as well as painful sensations when emptying the bladder and frequent urge to urinate (especially at night). The pain syndrome leads to difficulty urinating, sometimes to acute urinary retention.

In some cases, whitish or colorless purulent discharge from the urethra is possible.

Male, 45 years old. Acute prostatitis. On the presented tomograms in T2-WI, the axial plane (a) and T2 with fat suppression in the coronal plane, an increase in the volume of the peripheral zone, its swelling is determined.

4. Prostate abscess.

The reason for the formation of a prostate abscess is pathogenic bacteria that caused the development of prostatitis, and in the case of a hematogenous abscess, bacteria that contributed to the development of the main focus of infection in the body.

The following forms of prostate abscess are distinguished:

• Primary - in the presence of an infectious process outside the genitourinary system;
• Secondary - as a complication of prostatitis.

Prostate abscess is characterized by all the symptoms of prostatitis, but to a greater extent. The general condition is severe, the temperature is high with chills, tachycardia, profuse sweating. Sharp, pulsating, unilateral (because an abscess often affects one side of the organ in isolation), pain radiating to the rectum is characteristic. Pain syndrome leads to difficulty in defecation and urination, including acute urinary retention. In the event of an abscess rupture, cloudy urine is noted, or the presence of pus in the feces.

A) T2-tra b) T1-tra+C c)DW

On the T2-axial image (a), an irregularly rounded focus of increased MR signal intensity in the central zone of the left lobe of the prostate gland is determined. With intravenous contrasting (b), there is a peripheral enhancement of this focus (capsule), with non-contrasting central sections. On the diffusion-weighted image, signs of diffusion limitation from a given cavity formation (abscess) are determined.

5. Agenesis of the seminal vesicle.

35. Male, 31 years old with infertility. The T2-axial image shows the absence of the left seminal vesicle in the presence of the left vas deferens (arrows).

6. Autosomal dominant polycystic kidney and seminal vesicles.

The presence of cysts in the seminal vesicles in autosomal dominant polycystic kidney disease is of great clinical significance. With ultrasound, this pathology can be erroneously interpreted as prostate cysts.

The clinical picture of polycystic disease may include hemospermia.

On the presented T2-WI with fat suppression, bilateral cysts of the seminal vesicles (a, axial plane) and enlargement of the kidneys due to multiple cysts (b, frontal plane) are determined.

37. a) T1-tra FS b) T2-tra c) T1-tra+contrast

Man, 31 years old. Hematuria. A cavitary inclusion of an irregularly oval shape is determined in the projection of the left seminal vesicle, which has signal characteristics different from liquid (hyperintense MR signal in T1-WI, a - a sign of hemorrhage). With intravenous contrast (c), there is no peripheral enhancement, which indicates the absence of infection of the cyst.

7. Festering cyst of the left seminal vesicle.

38 a) Т1-tra+С b) Т1-cor+С

Man, 78 years old. In the projection of the left seminal vesicle, a cystic inclusion is determined with non-bumpy contours and signs of peripheral contrast enhancement of the capsule (a festering cyst-abscess).

8. Mullerian duct cyst.

Müllerian duct cyst is more common in boys with hypospadias and in intersex people. Sizes vary considerably. Clinically, they often do not manifest themselves in any way, but in some cases there may be discomfort in the perineum, dysuria, hematuria, urinary retention, urinary tract infections, epididymitis, oligospermia.

38. Male, 72 years old with prostate cancer. Large cyst of the Mullerian duct. A fluid inclusion is seen between the rectum and the prostate in the midline. For such a cyst, localization along the midline is typical, which makes it possible to differentiate it from a seminal vesicle cyst.

9. Vesiculitis.

Vesiculitis is an inflammation of the seminal vesicles. Clinically characteristic is the appearance of pain above the pubis and in the perineum, which radiate to the lower back, groin or sacrum. Pain is aggravated by defecation and urge to urinate. During defecation, there is also a discharge of mucous contents from the urethra, sometimes with streaks of blood, this is the secret of vesicles.In addition, with vesiculitis, ejaculation becomes painful and traces of blood appear in the semen. There is an erection disorder. The general condition also suffers: weakness, headache, increased fatigue and temperature are characteristic. The accompanying symptoms of prostatitis are often exacerbated.

40 a) T2-tra b) T1-tra + contrast

Man, 34 years old with hematospermia. Pre-contrast T2-WI (a) and post-contrast T1-WI images (b) in the axial plane demonstrate diffuse thickening of the walls of the seminal vesicles, heterogeneity of their internal structure.