Fig. 4

Positive mpMRI in patient with high grade Gleason tumor and elevated PSA (> 1.5 ng/mL) after RP. 69 year old male treated with radical prostatectomy for T3a, Gleason 8 adenocarcinoma presented with BCR after RP (PSA 5.2 ng/mL). Multiparametric MRI including axial T1 (a), axial T2 (b), sagittal T2 (c) axial diffusion weighted images (d), axial apparent diffusion coefficient (ADC) images (e), dynamic contrast enhanced (DCE) MRI (f) images and contrast enhancement time curves (g) reveal confluent T2 hyperintense soft tissue at the level of the vesicourethral anastomosis, consistent with residual prostate tissue. Additionally, an eccentric T1 heterogeneous, T2 hyperintense mass involving the left lateral aspect of the vesicourethral anastomosis is observed (arrows in a, b), extending into the peri-anastomotic soft tissues (arrows in c). The mass is associated with restricted diffusion (arrows in d and e) and focal enhancement (arrows in f). Contrast enhancement time curves (g) demonstrate a pattern of rapid contrast wash in and washout associated with malignancy (curves 1, 2, and 3 = tumor, curve 4 = arterial). Recurrent tumor was confirmed by transurethral biopsy