Prevalence and Significance of Incidental Findings in Multiparametric Magnetic Resonance Imaging of the Prostate

<b>Objective:</b> This study aims to assess the prevalence of clinically significant incidental findings as well as incidental findings of minor clinical significance in multiparametric MRI (mpMRI) of the prostate. <b>Materials and Methods:</b> A retrospective analysis was conducted on 607 male patients (mean age: 72 years) who underwent prostate MRI between 2018 and 2023 at a single center. Two radiologists reviewed in consensus the scans for incidental findings during multiparametric MRI of the prostate. The findings were classified according to their clinical relevance, organ group and patient age. <b>Results:</b> Among 607 male patients (mean age: 72 years), 665 incidental findings were identified in 410 patients (67.5%; 95% CI 63.7-71.1). This corresponds to an average of 1.10 incidental findings per patient across the entire cohort. Of the 665 findings, 12 (1.8%; 95% CI 0.9-3.1) were classified as clinically significant. These included cases of sarcoma, rectal carcinoma, hydronephrosis, aortic aneurysm, avascular necrosis of the femoral head and high-grade disc protrusion with spinal canal stenosis and diverticulitis. <b>Conclusions:</b> Our data indicate that incidental findings are common in prostate mpMRI examinations; however, only a small proportion are clinically significant. This underscores the need for awareness of such findings, while avoiding unnecessary follow-up for those without clinical relevance.