Pitfalls in Prostate MR Imaging Interpretation

mpMR imaging has proven to be a valuable tool in diagnosing and staging prostate cancer, often sur -passing traditional methods such as transrectal ultrasound-guided biopsy. Standardized protocols such as PI-RADS v2.1 aid radiologist in evaluating prostate mpMR imaging, taking into account zonal anatomy and the main sequences used for cancer detection. Radiologists must thoroughly study prostate imaging in different planes and sequences while being knowledgeable about the pit-falls discussed to prevent misinterpretation of images. The use of additional sequences, such as DWI, can assist in cases of uncertainty on T2-weighted imaging. Incorporating DWI/ADC maps and DCE can significantly improve the sensitivity for detecting tumors. This review emphasizes the importance of recognizing various factors that can complicate the interpretation of prostate MR imaging. Both normal anatomic structures and pathologic conditions can mimic the appearance of prostate cancer on MR imaging, highlighting the need for awareness to minimize interpretation errors and reconcile discrepancies between biopsy and MR imaging findings. Given these challenges, an MR imaging-guided biopsy should be considered for patients with an equivocal MR imaging who have clinical suspicion of prostate cancer.