Apical and anterior lesions are particularly important to identify on MRI, as they may be undersampled by systematic biopsy.Pathology (targeted biopsy)/Final Diagnosis: Gleason 7 (4+3) prostate cancer. Scrolling through both the raw DCE and subtraction DCE images is helpfulĮxample 1 – What PI-RADS score would you assign to this lesion?įindings: Lesion in the left anterior apical peripheral zone with marked DWI hyperintensity, marked ADC hypointensity, homogeneous circumscribed T2 hypointensity, and positive DCE. Corresponds to suspicious finding on T2W and/or DWI.Earlier than or contemporaneous with enhancement of adjacent normal prostatic tissues.Focal enhancement corresponding to a lesion demonstrating features of BPH on T2WI (including features of extruded BPH in the PZ).Diffuse multifocal enhancement NOT corresponding to a focal finding on T2W and/or DWNo early or contemporaneous enhancement.Same as 4 but ≥1.5cm in greatest dimension or definite extraprostatic extension/invasive behaviorĭWI assessment should occur on the “high” b-value images (b ≥ 1400 s/mm 2)Īdapted from the PI-RADS V2.1 Manual 1 PI-RADS v2.1 Scoring: DCE for Peripheral Zone Score Linear/wedge shaped hypointense on ADC and/or linear/wedge shaped hyperintense on high b-value DWIįocal (discrete and different from the background) hypointense on ADC and/or focal hyperintense on high b-value DWI may be markedly hypointense on ADC or markedly hyperintense on high b-value DWI, but not both.įocal markedly hypointense on ADC and markedly hyperintense on high b-value DWI <1.5cm in greatest dimension PI-RADS v2.1 Scoring: DWI for Peripheral Zone or Transition Zone Score AFS – Apply TZ or PZ scoring criteria depending on perceived most likely zone of lesion origin.Central Zone – No discrete scoring criteria, assess for focal early enhancement and/or asymmetry on DWI and T2W.Transition Zone – T2W is the primary sequence for scoring DWI relevant for T2W scores of 2 or 3.Peripheral Zone – DWI is the primary sequence for scoring DCE relevant for DWI score of 3.Implication of PI-RADS Assessment Scores ScoreĬlinically significant cancer highly unlikelyĬlinically significant cancer highly likelyĭerived from PI-RADS V2.1 manual pages 11-14 1 specific scoring criteria for the PZ and TZ are included in the dedicated sections later in this document Anatomical Zones of the Prostate Gland as seen on MRI 2 PI-RADS v2.1 ( ) was introduced in 2019, and at the time of writing is the most current version.
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