Normal Male Pelvic MRI Report

A normal male pelvic MRI report should preserve the difference between routine pelvic imaging and multiparametric prostate MRI. Wide-field routine images do not assess small prostate lesions as reliably as a PI-RADS protocol. When prostate cancer is the clinical question, a normal routine template is not an adequate substitute for targeted imaging.

Age, prostate volume, prior biopsy, treatment, and lower urinary tract symptoms affect appearance. Bladder filling and rectal gas can also limit pelvic assessment and should be recorded in the technique section.

Assessment framework

• Assess bladder wall in relation to the degree of distention.
• Review prostate size, zonal anatomy, and any conspicuous focal lesion.
• Inspect seminal vesicles for symmetry, signal, and distention.
• Survey rectum, mesorectum, pelvic floor, and sidewalls.
• Check ureters, lymph nodes, vessels, bones, and inguinal canals.

What the report should contain

• State the limits of prostate assessment on a routine pelvic protocol.
• Measure prostate size only when suitable planes are available.
• Do not make a definitive wall-thickness assessment in an underfilled bladder.
• Interpret seminal vesicle asymmetry with age and physiologic context.
• Do not use a normal template after surgery or radiotherapy.

Common errors

• Excluding clinically significant prostate cancer on routine pelvic MRI.
• Mistaking an underfilled thick-walled bladder for tumor.
• Calling a benign prostatic hyperplasia nodule definite cancer.

Example report wording

Example impression: The adequately distended bladder has no conspicuous wall mass. The prostate is appropriate in size for age, with preserved zonal anatomy and no conspicuous focal lesion on this routine pelvic protocol. Seminal vesicles are symmetric. No pelvic lymphadenopathy, free fluid, or suspicious marrow lesion is identified.

For suspected prostate cancer, use the PI-RADS v2.1 guide and the dedicated protocol.

References

1. American College of Radiology. Practice Parameter for MRI of the Soft-Tissue Components of the Pelvis. Source (opens in a new tab)
2. American College of Radiology. Practice Parameter for CT of the Abdomen and Pelvis. Source (opens in a new tab)

Clinical note: This material is for radiology education. Do not generate an automatic diagnosis or management decision without checking guideline scope, patient factors, and local policy.