PMC3056370_01
Prostatic abscess - case 1. Axial T2W image (A) of the prostate shows a focus of hyperintense signal (arrow) in the left midzone of the peripheral gland. On the axial T1W image (B), the lesion is barely seen. An axial, contrast-enhanced, T1W image (C) shows that the lesion (arrow) has peripheral enhancement and central non enhancement. DWI (b value=800) (D) shows high signal in the lesion (arrow) due to restriction of diffusion. The corresponding ADC map (E) shows low signal (arrow)
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T1W images [Figure 1B] with peripheral enhancement on postgadolinium images [Figure 1C]. The DWI revealed diffusion restriction in the lesions [Figure 1D]. The corresponding ADC map revealed low signal [Figure 1E], with mean values of 0.63 +- 0.07 x 10-3 mm2/s, using an average of 5 ROIs of 0.08 sq cm each. The urine culture was sterile. The patient improved after administration of antibiotics (ofloxacin) for 4 weeks.
PMC3056370_02
Prostatic abscess - case 2. Axial T2W MRI of the prostate (A) shows high signal (arrow) in the central gland, in the left midzone. Axial T1W image (B) shows mixed signal intensity with peripheral hyperintensity (arrow). Axial, contrast-enhanced T1W image (C) shows a peripherally enhancing abscess (arrow). DWI (b=800) (D) shows restriction of diffusion (arrow) in the lesion. The corresponding ADC map (E) shows low signal (arrow)
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MRI, using the same sequences as in the first patient, revealed a T2-hyperintense signal [Figure 2A] in the central gland in the left midzone, barely appreciated on T1W images [Figure 2B], with peripheral enhancement suggesting an abscess [Figure 2C]. On DWI, the lesion appeared bright due to the restriction of diffusion [Figure 2D]. A low signal was seen on the ADC map [Figure 2E] (mean ADC values. -0.61 +- 0.06 x 10-3).
Follow up images of case 2 after 4 months. DWI (b=800) (A) shows resolution of the previously shown lesion. Normalization of signal is also seen in the respective ADC map (B)
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A repeat MRI carried out after 4 months revealed no diffusion restriction [Figure 3A] in the previously abnormal area, with no definite low signal in the corresponding ADC map [Figure 3B].