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E1455. Radiologists Beware: Challenging Pathology and Incidental Findings on Prostate MRI
Weill Cornell Medical Center
NYU Langone Health
Over the past several years, multiparametric MRI (mpMRI) of the prostate has been increasingly used for active surveillance of prostate cancer. With this higher utilization, a significant number of incidental findings of varying clinical significance are often revealed on prostate MRI. Approximately half of all prostate MRIs have been shown to have incidental findings with clinically significant findings most often found in patients greater than age 65. It is increasingly important for the radiologist to be familiar with pathology in the structures surrounding the prostate, to recognize benign versus clinically significant pathology, and to discern when patients require additional follow-up, which reduces costs of workup, minimizes patient anxiety, and aids appropriate patient management.
Educational Goals / Teaching Points
The goals of this exhibit is to describe the standard MRI prostate protocol and the importance of each sequence; diagnose common and uncommon incidental pathology seen on prostate MRI; recognize benign versus clinically significant disease and when to take action; and identify imaging findings that mimic prostate cancer.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit includes: 1) review rates of incidental findings in radiologic imaging, the abdomen and pelvis, and specifically MRI prostate, including demographics of clinically significant findings; 2) standard prostate MRI protocol (standard sequences and optional add-ons; typical FOV; importance of each sequence; review of MRI signal characteristics; advantages and disadvantages of optional sequences); and 3) benign versus malignant incidental findings surrounding the prostate. This includes: genitourinary (bladder diverticula, bladder calculi, urothelial carcinoma, neuroendocrine carcinoma), bolorectal (sigmoid diverticulitis, hemorrhoids, polyps, gastrointestinal stromal tumor [GIST], rectal cancer), beurovascular (peripheral nerve sheath tumor, schwannomatosis, deep venous thrombosis, periprostatic venous varix, aneurysms); musculoskeletal (intramuscular lipoma, avascular necrosis, trochanteric bursitis, benign skeletal lesions, skeletal metastasis); and hepatobiliary (edge of the field findings: hepatocellular carcinoma and other benign incidental liver lesions). The exhibit also includes non-cancerous incidental imaging findings within the prostate (utricle versus müllerian cyst, Cowper’s duct cyst, bacille Calmette-Guérin [BCG] granuloma, infarcted benign prostatic hyperplasia [BPH], prostate calcifications, prostatic cystadenoma, and prostatic abscess).
As mpMRI of the prostate becomes increasingly utilized for the diagnosis and surveillance of prostate cancer, it becomes increasingly important for the radiologist to become familiar with the variety of possible incidentalomas to correctly diagnose disease and help manage patient care. Being aware of the mentioned entities and appropriately recommending follow-up can reduce anxiety and risks to patients from additional unnecessary examinations, including unnecessary procedures or biopsies, as well as limit the costs of follow-up imaging.