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Updated: May 1, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Bone abnormal signal incidentally found in pre-biopsy diffusion-weighted MRI for suspected prostate cancer: what does
Yuki Yachida1, Soichiro Yoshida, Hideki Takeshita
1Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Objective:
To clarify the clinical significance of incidentally found diffusion-weighted MRI (DW-MRI)-positive findings on pre-biopsy MRI in patients with suspected prostate cancer.
Patients And Methods:
754 consecutive patients with suspected prostate cancer underwent pelvic MRI including DW-MRI. 43 DW-MRI-positive bone lesions were found in 27 patients. Imaging findings of these lesions were compared with the clinical diagnosis.
Results:
Of the 43 DW-MRI-positive bone lesions, 21 (48.8%) were diagnosed as metastatic prostate cancer. The remaining 22 (51.2%) were diagnosed as red bone marrow in 17, enchondroma in 1, ganglion in 1, osteoma in 1, fibrous dysplasia in 1 and bone infarction in 1. Enchondroma, ganglion, osteoma and fibrous dysplasia all showed T1-weighted imaging (T1WI) low and T2-weighted imaging (T2WI) high signals, while others, including prostate cancer metastases, showed T1WI and T2WI low signals. Of the 40 lesions with T1WI and T2WI low signals, metastatic prostate cancer had higher apparent diffusion coefficient values (median 0.42 × 10(-3) mm(2)/s) than other lesions (0.26 × 10(-3) mm(2)/s; p < 0.0001).
Conclusions:
DW-MRI-positive bone lesions represent various coexisting types of bone lesions, including metastatic cancer in patients with suspected prostate cancer. T2WI findings and apparent diffusion coefficient values can be helpful in diagnosing metastatic cancer.
Insights
Diffusion-weighted MRI (DW-MRI) can reveal bone lesions in prostate cancer patients. While some are metastases, others are benign. Apparent diffusion coefficient values and T2-weighted imaging help differentiate these findings.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Prostate cancer diagnosis often involves imaging.
- Diffusion-weighted MRI (DW-MRI) is increasingly used in prostate cancer assessment.
- Incidental bone findings on pre-biopsy MRI require careful interpretation.
Purpose of the Study:
- To determine the clinical significance of DW-MRI-positive bone lesions found incidentally before prostate biopsy.
- To evaluate the diagnostic utility of DW-MRI in differentiating prostate cancer metastases from other bone lesions.
Main Methods:
- Retrospective analysis of 754 patients with suspected prostate cancer undergoing pelvic MRI with DW-MRI.
- Identification and characterization of 43 DW-MRI-positive bone lesions.
- Comparison of imaging features with clinical diagnoses.
Main Results:
- Approximately 48.8% of DW-MRI-positive bone lesions were confirmed as prostate cancer metastases.
- The remaining 51.2% included benign conditions like red bone marrow, enchondroma, and osteoma.
- Metastatic lesions showed significantly higher apparent diffusion coefficient values (0.42 × 10(-3) mm(2)/s) compared to benign lesions (0.26 × 10(-3) mm(2)/s) in T1WI and T2WI low signal areas.
Conclusions:
- DW-MRI-positive bone lesions in patients with suspected prostate cancer can represent diverse pathologies, including metastases.
- T2-weighted imaging characteristics and apparent diffusion coefficient values are valuable tools for distinguishing metastatic prostate cancer from other bone lesions.
