Background
In recent years, the use of multi-parametric MRI (mp-MRI) in the diagnosis, staging and treatment planning of prostate cancer has become increasingly widespread. The use of mp-MRI has been proven to be a cost-effective strategy in triaging men with high serum prostate specific antigen (PSA) levels. While there are international guidelines established on the interpretation of MRI for prostate cancer (PI-RADS v2.1), interpretation can be difficult as benign conditions or normal anatomical structures can mimic malignancy, especially for radiologists who are not familiar with these potential pitfalls. Awareness of these pitfalls is essential in reducing diagnostic errors.
Educational Goals / Teaching Points
The objectives are to recognize imaging pitfalls related to normal anatomical structures, identify benign conditions mimicking prostate cancer, as well as review methods to mitigate technical/physiological artefacts.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal anatomical structures which may be erroneously interpreted as malignancy include hypertrophic anterior fibromuscular stroma, periprostatic neurovascular bundle and thick surgical capsule. Benign conditions which can mimic prostate cancer include bilateral benign prostatic hyperplasia (BPH) proliferation, ectopic BPH nodule, prostatitis, hemorrhage, atrophy and necrosis of the prostate. The exhibit will include case examples for each condition illustrating key imaging findings which help to distinguish from malignancy.
Conclusion
As the use of mp-MRI prostate becomes increasingly widespread, it is essential for radiologists to be familiar with potential pitfalls which may be confused for malignancy. Knowledge of these pitfalls is imperative to avoid overestimation of prostate cancer and reduce unnecessary biopsies.
