Preliminary Diagnosis: Benign Prostatic Hypertrophy

I. What imaging technique is first-line for this diagnosis?

  • CT of the abdomen and pelvis with intravenous contrast and/or CT urography/cystography

II. Describe the advantages and disadvantages of this technique for diagnosis of benign prostatic hypertrophy.

Advantages

  • Relatively quick imaging modality

  • Offers exquisite detail of the underlying and surrounding anatomical structures including osseous, vascular, soft tissue, and lymphatic structures

  • May help guide treatment

  • Sensitive in detailing any underlying prostate calcifications

Disadvantages

  • Less adept in characterizing surrounding soft tissue infiltration/invasion than companion MRI

  • Exposes patients to ionizing radiation

  • Less portable than sonographic imaging

III. What are the contraindications for the first-line imaging technique?

May be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • Contrasted MRI of the prostate

  • Endorectal sonographic evaluation of the pelvis and prostate

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of benign prostatic hypertrophy.

Contrasted MRI of the prostate
Advantages

  • Does not expose patients to ionizing radiation

  • More sensitive to subtle soft tissue invasion and can better characterize the extent of soft tissue infiltration than CT

  • May better characterize the volume of the prostate gland than CT

  • Offers exquisite detail of any underlying prostate nodules

Disadvantages

  • Expensive

  • Time consuming

  • Require significant patient cooperation to minimize motion artifact

  • Less adept in detailing the surrounding osseous structures

Endorectal sonographic evaluation of the pelvis and prostate
Advantages

  • Highly portable.

  • Does not expose patients to ionizing radiation

  • More sensitive in detailing any underlying hypervascular nodules

Disadvantages

  • Highly operator dependent

  • Offers less exquisite detail of the surrounding osseous structures than companion CT

VI. What are the contraindications for the alternative imaging techniques?

Contrasted MRI of the prostate

Contraindicated in patients with non-MR-compatible hardware

Endorectal sonographic evaluation of the pelvis and prostate

No specific contraindications to sonographic imaging exist.

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