Pitfalls in Prostate Multiparametric MRI and how to avoid them: a practical guide
Type:Educational Electronic Presentation
Authors: Sofia Frade Santos, Diogo Correia Baptista, José Venâncio
Keywords:prostate cancer, multiparametric-MRI, pitfalls
Educational objective

To discuss and illustrate the normal and abnormal findings that may mimic prostate cancer at multiparametric magnetic resonance imaging (mpMRI).

To provide basic tools for recognizing and avoiding common pitfalls when interpreting mpMRI of the prostate.

Topic Review

Prostate multiparametric MRI had significant development in recent years, with an increasing role in the management of patients with suspected or known prostate cancer. [1-4]

Standardization provided by PI-RADS (Prostate Imaging-Reporting and Data System) assists in reporting and detection of clinically significant lesions. However, a wide range of findings can still be challenging during image evaluation in daily practice. [1]

The appearance of many benign conditions and even normal anatomical structures can be quite similar to prostatic cancer in mpMRI. To differentiate between prostate cancer and other conditions that may mimic or masquerade it, the radiologist needs to understand the prostate anatomy as well as the range of normal and benign imaging appearances. [1-4] The integration of clinical data and an interdisciplinary discussion can contribute to solve...

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Table 1 - Pitfalls in primary diagnosis and staging
Fig.1 - Anterior fibromuscular stroma. T2-weighted images (A-axial; B-coronal) show a hypointense area (green arrow) in the anterior portion of the prostate gland. The signal in the ADC map is low (D). However, there is no correspondent high signal in high b values (C- b2000). Moreover, the hypovascular behavior in the dynamic contrast-enhanced (E), the regular contour and symmetry (demonstrated in the morphologic sequences, especially the coronal T2 image) are typical features of this anatomic area that can be more preeminent in some individuals compared with others.


Radiologists should be aware of the common anatomic and pathological benign conditions that may simulate prostate cancer. Furthermore, prostate cancer may rarely arise from normal structures such as anterior fibromuscular stroma and the central zone, which corroborates the need for an adequate knowledge of the normal MRI appearance of these anatomic areas. [1]

Therefore, besides the attribution of a PI-RADS score, an accurate evaluation of an mp-MRI requires a detailed assessment of the prostate anatomy in a multiplanar and multiparametric approach. [2]

Awareness of diagnostic pitfalls is pivotal to avoid both false-positive and false-negative interpretations when reporting prostate multiparametric MRI. Indeed, recognizing potential pitfalls in daily practice contributes to improve diagnostic performance of mpMRI and, consequently, patient...

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