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An update of pitfalls in prostate mpMRI: a practical approach through the lens of PI-RADS v. 2 guidelines
Valeria Panebianco1, Francesco Giganti2, Yu Xuan Kitzing3
1Department of Radiological Sciences, Oncology & Pathology, Sapienza, University of Rome, V.le Regina Elena, 324 00161, Rome, Italy. valeria.panebianco@gmail.com.
Objectives:
The aim of the current report is to provide an update in the imaging interpretation of prostate cancer on multiparametric magnetic resonance imaging (mpMRI), with a special focus on how to discriminate pathological tissue from the most common pitfalls that may be encountered during daily clinical practice using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 guidelines.
Methods:
All the cases that are shown in this pictorial review comply with the European Society of Urogenital Radiology (ESUR) guidelines for technical mpMRI requirements.
Results:
Despite the standardised manner to report mpMRI (PI-RADS v. 2), some para-physiologic appearances of the prostate can mimic cancer. As such, it is crucial to be aware of these pitfalls, in order to avoid the under/overestimation of prostate cancer.
Conclusions:
A detailed knowledge of normal and abnormal findings in mpMRI of the prostate is pivotal for an accurate management of the wide spectrum of clinical scenarios that radiologists may encounter during their daily practice.
Teaching Points:
• Some para-physiologic appearances of the prostate may mimic cancer. • Knowledge of normal and abnormal findings in prostate mpMRI is pivotal. • Any radiologist involved in prostate mpMRI reporting should be aware of pitfalls.
Insights
Understanding prostate multiparametric magnetic resonance imaging (mpMRI) is key to accurately diagnosing prostate cancer. This review highlights common pitfalls in PI-RADS v2 interpretation to prevent misdiagnosis.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Multiparametric magnetic resonance imaging (mpMRI) is essential for prostate cancer detection.
- Accurate interpretation of prostate mpMRI is crucial for patient management.
- The Prostate Imaging Reporting and Data System (PI-RADS) version 2 provides standardized reporting guidelines.
Purpose of the Study:
- To update the interpretation of prostate cancer on mpMRI.
- To focus on discriminating pathological tissue from common pitfalls.
- To ensure accurate diagnosis using PI-RADS v2 guidelines.
Main Methods:
- Review of cases adhering to European Society of Urogenital Radiology (ESUR) guidelines for mpMRI.
- Pictorial review focusing on interpretation challenges.
- Application of PI-RADS v2 criteria.
Main Results:
- Despite standardized reporting (PI-RADS v2), some prostate appearances can mimic cancer.
- Awareness of these pitfalls is critical to avoid under/overestimation of prostate cancer.
- Distinguishing benign mimics from malignancy is a key challenge.
Conclusions:
- Detailed knowledge of normal and abnormal findings in prostate mpMRI is pivotal for accurate management.
- Radiologists must be aware of potential pitfalls in prostate mpMRI reporting.
- Accurate interpretation ensures appropriate clinical decision-making for prostate cancer.
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