Incidental findings at Multi-Parametric Prostate Mri: a pictorial review
Number:27ESURABS0050
Type:Educational Electronic Presentation
Authors: Riccardo Ciabattoni, Gianluca Visalli, Alessandro Sartori, Michele Bertolotto, Marco Francesco Maria Cavallaro, Irene Campo, Camilla Sachs, Maria Cova
Keywords:prostate mpMRI
SECTIONS
Educational objective
  • To understand the normal anatomy of prostatic and peri-prostatic region to localize theincidental findings encountered during a multi-parametric prostate MRI (mp-MRI).
  • To review the spectrum of incidental findings and their features and to be able to successfully diagnose incidental findings on mpMRI and to analyse their clinical implications. 

Topic Review

The widespread use of multiparametric MRI in prostate cancer is boosting the detection of incidental pathologies. Indeed, the Mp-MRI prostate protocol, as described in PIRADS v2.1, includes axial T2-weighted sequences and a minimum of one additional orthogonal plane, T1 images, axial diffusion-weighted and DCE-MRI, with a wide field of view from renal hilum to the pubic symphysis, that can highlight unexpected pathologies. In addition to the prostate gland, mp-MRI could identify incidental findings in the field of view, which may be indolent or have a significant impact on the patient’s management.

Given the potential clinical implications, these incidental findings need to be correctly identified and characterized, preventing any form of diagnostic errors. Incidental findings can be distinguished into genitourinary and non-genitourinary, with high or low to moderate...

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A prostatic utricle cyst (red arrow) in a 45 yo man showed respectively in sagittal (a), axial (b) and coronal (c) . PU cysts are very similar to Mullerian duct cysts, but they’re are always in the midline and arises from the level of the verumontanum, so they don’t extend above the level of prostate base, like Mullerian cysts do ( yellow arrow in figure d). Furthermore, prostatic utricle cysts tend to be smaller (less than 10 mm ) in size and sometimes communication with uretra is visible.
M, 38 y, with unilateral left VS cyst, with high signal on T1w sequences (a) and intermediate signal (b) on T2w, due to proteinaceus content. A wide field of view scan shows ipsilateral renal agenesis (Zinner Syndrome)


Conclusions

To review the spectrum of incidental findings and their features and be able to successfully diagnose incidental findings on mpMRI and to analyse their clinical implications.

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