Incidental findings in multiparametric MRI of the prostate
Imaging is an integral part of diagnosis and treatment. Multiparametric MR prostate imaging is primarily done to evaluate the prostate and to identify targets for biopsy. This helps to reduce sampling errors and improve subsequent correct diagnosis and management of prostate cancers. It is called multiparametric imaging as various sequences such as T2W, T1W, DWI, ADC and sometimes dynamic post-contrast studies are performed.
Prostate MRI by itself is quite challenging/interesting to evaluate as pathologies are not as white and grey as in other organs. Many times the lesions are small and subtle, requiring an experienced radiologist to interpret the images. However, it is also an opportunity to pick up various incidental findings. As the name suggests, these are not primary pathologies of the prostate, but additional findings in the other organs or anatomical structures that are within the field of view.
Although it is prudent to answer the specific clinical question, it is equally important to identify/look for incidental/ additional pathology when a body part is imaged. This is essential as there is risk of increased cost of further evaluation, patient anxiety and iatrogenic morbidity. It is also important since treating any significant incidental findings, such as neoplasm of other organs, at the earlier stage leads to better patient outcomes as opposed to finding the lesion when the patient is symptomatic from the disease.
Hence, once evaluation of prostate and seminal vesicles is performed, we should evaluate adjacent structures (urinary bladder, gastrointestinal tract, vessels, peritoneum, pelvic bones and lymph nodes).
Incidental findings, as identified in numerous studies, vary from 40% to 70% and the clinically significant among these between 5% and 10%. Our own single institutional study had 6% clinically significant incidental findings with positive predictive value of 86% for neoplasm.
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