title: In-gantry MRI guided prostate biopsy diagnosis of prostatitis and its relationship with PIRADS V.2 based score.
abstract: BACKGROUND
  The recent literature has focussed predominantly on prostate cancer detection which has been revolutionized by multiparametric magnetic resonance imaging (mpMRI). Due to an overlap of features, prostatitis may mimic prostate cancer on MRI, especially in patients with chronic prostatitis. We retrospectively analysed our in-gantry MRI-guided biopsy (MRGB) results to determine incidental detection rate of prostatitis in Prostate Imaging Reporting and Data System (PIRADS) 3, 4 and 5 foci reported on diagnostic MRI of the prostate.
  
  
  METHODS
  About 137 patients underwent in-gantry MRGB for lesions with PIRADS score of 3 or above. All the biopsies were performed utilizing the dynaTRIM™ system (Invio Inc, Germany) on a three-tesla MRI scanner (Ingenia 3.0T, Philips, Netherlands) by a Radiologist and a Urologist.
  
  
  RESULTS
  We biopsied 228 lesions in 137 patients. There were 55 lesions that returned positive for prostate cancer with a Gleason Score of 3 + 3 = 6 or above. There were 62 lesions that showed inflammation. The distribution of these lesions was 3 (5%) in the central zone, 32 (52%) in the transitional zone and 27 (43%) in the peripheral zone. Inflammation was found in 36 (58%) PIRADS 3 lesions, 24 (39%) PIRADS 4 lesions and 2 (3%) PIRADS 5 lesions on pre biopsy MRI evaluation.
  
  
  CONCLUSIONS
  In our series, biopsies which showed inflammation had a radiological appearance on mpMRI more likely of a PIRADS 3 or 4 lesions with only 3% of PIRADS 5 biopsies showing inflammation. This would suggest that a higher PIRADS score can more reliably differentiate between prostate cancer and prostatitis.
authors.affiliation: Calvary Hospital, Universal Medical Imaging, Bruce, Canberra, Australian Capital Territory, Australia.|Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Jyoti
authors.affiliation: Department of Urology, The Canberra Hospital, Garran, Canberra, Australian Capital Territory, Australia.
authors.forename: Noel Hamesh
authors.initials: NH
authors.lastname: Jina
authors.affiliation: Australian National University, Canberra, Australian Capital Territory, Australia.|Department of Urology, The Canberra Hospital, Garran, Canberra, Australian Capital Territory, Australia.
authors.forename: Hodo Z
authors.initials: HZ
authors.lastname: Haxhimolla
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging; D011472:Prostatitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies
keywords: MRI guided biopsy; Prostate Imaging and Reporting Data System; mp-MRI; prostatitis