E4993. Recognizing Incidental Musculoskeletal Findings on Prostate MRI: When to Worry and What to Do
  1. Carl Collins; No Affiliation
  2. Stephen Zintsmaster; No Affiliation
Prostate MRI (pMRI) utilization has expanded over the past decade at an exceptional rate. Protocols typically include small FOV-dedicated prostate sequences, as well as larger FOV high-resolution images. These larger FOV images frequently include incidental musculoskeletal findings (IMFs), especially given the typical patient population. This exhibit will explore the most common incidental findings, what conclusions can or cannot be made on standard pMRI sequences, and the best next steps.

Educational Goals / Teaching Points
The primary objective of the presentation is to review the imaging characteristics of commonly and uncommonly encountered IMFs on pMRI and help guide a body imager with the appropriate next steps. By reviewing the key MSK-related anatomic and pathophysiologic details available on pMRI, we will be able to help the non-MSK imager make informed, appropriate recommendations, and give them confidence when no further recommendations are warranted.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
IMFs are a common occurrence on high resolution pMRI. pMRI protocols typically include a variety of sequences including standard T1-weighted, T2-weighted, DWI, and dynamic contrast-enhanced sequences. Although IMFs are usually peripheral findings on these sequences, they frequently are seen with enough detail to be able to describe their origin and determine their clinical significance. Some of the frequently encountered entities include tendon or muscle tears, tendinopathies, and ganglion cysts, as well as both benign and sometimes malignant soft tissue or osseous tumors. Knowing the key differences of these frequently encountered entities and the more concerning lesions will allow the interpreting radiologist to confidently guide the referring clinician with the most appropriate next step.

The increasing utilization of pMRI and typical patient population undergoing the exams has led to a substantial increase in IMFs. Radiologists are now faced with not only interpreting the prostate specific findings but identifying and interpreting the peripheral findings that almost invariably involve the musculoskeletal system. Most of these IMFs can be managed conservatively with reassurance being given in the interpretation. However, knowing the key imaging findings of the typically benign entities and the findings which may point to more concerning diagnoses will help the radiologist give more concrete guidance to both the referring clinician and the patient, optimizing their care.