Magnetic resonance imaging of solid urethral and peri-urethral lesions

Solid urethral and peri-urethral lesions are rare and encompass benign and malignant aetiologies. A diagnosis without imaging is often challenging secondary to non-specific clinical symptoms and overlapping findings at the time of physical examination. Magnetic resonance (MR) imaging may be helpful in confirming a diagnosis while providing anatomical detail and delineating disease extent. This article reviews the normal MR anatomy of the male and female urethra, the MR appearance of solid primary and secondary urethral lesions, and the MR appearance of solid urethral lesion mimics. Teaching points • MRI is an important imaging technique in the evaluation of the spectrum of solid urethral lesions.• With excellent soft tissue resolution, MR is accurate in staging primary urethral carcinoma.• Disruption of the zonal anatomy of the female urethral wall indicates peri-urethral extension.• Be aware of benign urethral lesions, particularly those that may mimic solid urethral masses.