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Urinary Imaging

E2908. Prostate MRI: The Incidentals

Dryden J1,  Grillon J2,  Montgomery R1,  O'Neal E1,  Hahn M.2 1. Naval Medical Center San Diego, San Diego, CA; 2. University of California San Diego Medical Center, San Diego, CA

Address correspondence to J. Dryden (jrdryden@gmail.com)

Background Information: Multiparametric MRI of the prostate can aid in the initial diagnosis, local staging, and treatment of prostate cancer, the second leading cause of male cancer death in the United States. In addition to prostatic findings, however, numerous nonprostatic incidentals are often discovered, which can also affect patient management.

Educational Goals/Teaching Points: We provide background to prostate MRI and PI-RADSv2; discuss institutional imaging protocols for prostate MRI, including FOV; review pertinent nonprostatic incidental findings through a case-based presentation; and correlate nonprostatic findings with different imaging modalities and discuss clinical importance.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: In prostate MRI, T2-weighted, dynamic contrast-enhanced (DCE), and DW images are obtained using a multiparametric technique. While these images are then used to grade prostatic findings using PI-RADSv2, the field of view allows for evaluation of multiple adjacent organs. Incidental, nonprostatic findings discovered in the process may prove to be of equal or greater clinical significance than the prostatic ones. Examples of nonprostatic findings include: vascular (deep venous thrombosis and aneurysm), tumors (renal cell carcinoma, bladder cancer, peripheral nerve sheath tumors), bone lesions (fibrous dysplasia, Paget disease of bone, osteonecrosis of the femoral head), hernias (inguinal, femoral, Spigelian), and others (diverticular disease). Specific imaging examples of incidental findings with multimodal correlation and clinical discussion provide a visual atlas of potential nonprostatic pitfalls for those interpreting prostate MRI.

Conclusion: In addition to aiding clinicians in initial diagnosis, local staging, and treatment of prostate cancer, prostate MRI can detect multiple clinically relevant nonprostatic incidental findings. A review of these potential findings via multiple imaging examples provides a visual atlas of potential nonprostatic pitfalls.