Abstract
Purpose
Multiparametric magnetic resonance imaging (mp-MRI) and MRI/Ultrasound (US) fusion-guided biopsy are relatively new techniques for improved detection, staging, and active surveillance of prostate cancer (PCa). As with all imaging modalities, MRI reveals incidental findings (IFs) which carry the risk of increased cost, patient anxiety, and iatrogenic morbidity due to workup of IFs. Herein, we report the IFs from 684 MRIs for evaluation of PCa and consider their characteristics and clinical significance.
Methods
Patients underwent mp-MRI prostate protocol incorporating triplanar T2-weighted, diffusion-weighted, and dynamic contrast-enhanced pelvic MRI as well as a post-contrast abdominopelvic MRI with the primary indication of detection or evaluation of PCa. A total of 684 consecutive prostate MRI reports performed in a series of 580 patients were reviewed. All extraprostatic findings reported were logged and then categorized by organ system and potential clinical significance.
Results
There were 349 true IFs found in 233 (40%) of the 580 patients. One hundred nineteen additional extraprostatic findings were unsuspected but directly related to PCa staging, while the 349 IFs were unrelated and thus truly incidental beyond study indication. While the majority of true IFs were non-urologic, only 6.6% of IFs were considered clinically significant, non-urologic findings, and more than a third of MRI reports had urologic IFs not related to PCa.
Conclusions
Rates of incidental findings on prostate indication MRI are similar to other abdominopelvic imaging studies. However, only 6.6% of the IFs were considered to be clinically significant non-urologic findings. Further investigations are needed to assess downstream workup of these IFs and resulting costs.
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Abbreviations
- AMH:
-
asymptomatic microscopic hematuria
- AS:
-
active surveillance
- CT:
-
computed tomography
- DRE:
-
digital rectal examination
- IF:
-
incidental finding
- MRI:
-
magnetic resonance imaging
- mp-MRI:
-
multiparametric magnetic resonance imaging
- PCa:
-
prostate cancer
- PSA:
-
prostate-specific antigen
- TRUS:
-
transrectal ultrasound
- US:
-
ultrasound
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Soroush Rais-Bahrami and Jeffrey W. Nix are consultants for Philips/InVivo Corp. Rachael L. Sherrer, Win Shun Lai, and John V. Thomas have no conflicts of interest to declare.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Sherrer, R.L., Lai, W.S., Thomas, J.V. et al. Incidental findings on multiparametric MRI performed for evaluation of prostate cancer. Abdom Radiol 43, 696–701 (2018). https://doi.org/10.1007/s00261-017-1237-x
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DOI: https://doi.org/10.1007/s00261-017-1237-x