A Case of Seminal Vesicle / Prostatic Reflux Causing Intense Focal Fluorodeoxyglucose Uptake in the Prostate Gland
WH Ma, EYP Lee, ASH Lai, PL Khong
Hong Kong J Radiol 2016;19:49-51
DOI: 10.12809/hkjr1615333
We report an interesting case of benign persistent intense focal fluorodeoxyglucose (FDG) activity in the prostate gland. A 66-year-old man with a history of prostatism and benign prostate hypertrophy presented with elevated prostate-specific antigen. Three prostatic biopsies obtained by transrectal ultrasonography (TRUS) were negative for malignancy. Magnetic resonance imaging of the prostate revealed a hypointense signal at the right prostate base on T2-weighted images. FDG positron emission tomography/computed tomography (CT) was performed for further evaluation and demonstrated intense FDG activity, similar to urine, posterior to the prostate. Delayed CT scan showed serpiginous excretion of contrast into the seminal vesicles and peripheral zone of the prostate, corresponding to areas of intense and persistent FDG activity, compatible with seminal vesicle and prostatic reflux of urine resulting in intense FDG uptake. Awareness of this pathological entity that may be a complication of TRUS or due to chronic prostatitis may avoid misinterpretation, especially in the absence of administration of CT contrast to delineate the prostatic ducts.
中文摘要
精囊／前列腺回流引致前列腺的FDG強烈攝取
馬慧嫻、李燕蘋、黎紹豪、孔碧蘭
本文報告有關前列腺出現持續FDG強烈攝取的一個有趣病例。一名曾有前列腺炎和前列腺增生症病史的66歲男性病發時出現前列腺特異抗原水平升高。經直腸超聲檢（TRUS）進行的惡性腫瘤檢查所得的三個前列腺活檢均呈陰性。前列腺磁共振成像顯示T2加權圖像的右側前列腺基地呈低信號。FDG正電子發射斷層成像／電腦斷層掃描（CT）顯示前列腺後方有類似尿液的FDG強烈攝取。延遲CT顯示有匐行狀的造影劑流入精囊和前列腺的外週帶，與FDG強烈攝取區域相對應，可以解釋精囊和尿回流而產生的FDG強烈攝取。這可能是由於TRUS誘發的併發症或者慢性前列腺炎所致。了解這種病理情況可避免誤診，尤其是當未進行CT造影檢查前列腺導管時。