Multiparametric Prostate MRI: PI-RADS V.2
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1 Multiparametric Prostate MRI: PI-RADS V.2 Katarzyna J. Macura, MD, PhD, FACR, FSCBTMR The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD SCBT MR 201 1
2 Objectives Discuss PI-RADS v2 Anatomical localization of abnormalities on multiparametric MRI (mpmri) of the prostate 36 prostate sectors Scoring imaging findings on T2WI, -ADC, DCE MRI Review PI-RADS v2 assessment categories
3 Prostate Sectors (36) Anatomy Laterality: Right R / Left L Superior to Inferior: Seminal Vesicle Base Mid Apex Urethra Zones: Anterior fibromuscular Stroma (AS) Transition Zone (TZ) Central Zone (CZ) Peripheral Zone (PZ) Additional modifiers: Anterior (a), Posterior (p), Lateral (l), Medial (m)
4 Prostate Sectors (36) Anatomy RSV LSV RB AS LB AS RB TZa LB TZa RB TZp LB TZp RB PZa LB PZa RB PZpl LB PZpl RB CZ LB CZ RM AS LM AS RM TZa LM TZa RM TZp LM TZp RM PZa LM PZa RM PZpl LM PZpl RM PZpm LM PZpm RX AS LX AS RX TZa LX TZa RX TZp LX TZp RX PZa LX PZa RX PZpl LX PZpl RX PZpm LX PZpm US
5 PI-RADS Peripheral Zone T2WI Peripheral Zone (PZ) 1 Uniformly hyperintense (normal) 2 Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin 3 Non-circumscribed, rounded, mild hypointensity Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1. cm in greatest dimension Same as but 1.cm in greatest dimension or
6 PI-RADS Peripheral Zone T2WI Peripheral Zone (PZ) 1 Uniformly hyperintense (normal) 2 Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin 3 Non-circumscribed, rounded, mild hypointensity Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1. cm in greatest dimension Same as but 1.cm in greatest dimension or
7 PI-RADS Peripheral Zone T2WI Peripheral Zone (PZ) 1 Uniformly hyperintense (normal) 2 Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin 3 Non-circumscribed, rounded, mild hypointensity Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1. cm in greatest dimension Same as but 1.cm in greatest dimension or
8 PI-RADS Peripheral Zone T2WI Peripheral Zone (PZ) 1 Uniformly hyperintense (normal) 2 Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin 3 Non-circumscribed, rounded, mild hypointensity Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1. cm in greatest dimension Same as but 1.cm in greatest dimension or
9 PI-RADS Peripheral Zone T2WI Peripheral Zone (PZ) 1 Uniformly hyperintense (normal) 2 Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin 3 Non-circumscribed, rounded, mild hypointensity Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1. cm in greatest dimension Same as but 1.cm in greatest dimension or
10 PI-RADS Transition Zone T2WI Transition Zone (TZ) Homogeneous intermediate signal intensity (normal) Circumscribed hypointense or heterogeneous encapsulated nodule(s) (BPH) Heterogeneous signal intensity with obscured margins Non-circumscribed, homogeneous, moderately hypointense, and <1. cm in greatest dimension Same as, but 1.cm in greatest dimension or
11 PI-RADS Transition Zone T2WI Transition Zone (TZ) Homogeneous intermediate signal intensity (normal) Circumscribed hypointense or heterogeneous encapsulated nodule(s) (BPH) Heterogeneous signal intensity with obscured margins Non-circumscribed, homogeneous, moderately hypointense, and <1. cm in greatest dimension Same as, but 1.cm in greatest dimension or
12 PI-RADS Transition Zone T2WI Transition Zone (TZ) Homogeneous intermediate signal intensity (normal) Circumscribed hypointense or heterogeneous encapsulated nodule(s) (BPH) Heterogeneous signal intensity with obscured margins Non-circumscribed, homogeneous, moderately hypointense, and <1. cm in greatest dimension Same as, but 1.cm in greatest dimension or
13 PI-RADS Transition Zone T2WI Transition Zone (TZ) Homogeneous intermediate signal intensity (normal) Circumscribed hypointense or heterogeneous encapsulated nodule(s) (BPH) Heterogeneous signal intensity with obscured margins Non-circumscribed, homogeneous, moderately hypointense, and <1. cm in greatest dimension Same as, but 1.cm in greatest dimension or
14 PI-RADS Transition Zone T2WI Transition Zone (TZ) Homogeneous intermediate signal intensity (normal) Circumscribed hypointense or heterogeneous encapsulated nodule(s) (BPH) Heterogeneous signal intensity with obscured margins Non-circumscribed, homogeneous, moderately hypointense, and <1. cm in greatest dimension Same as, but 1.cm in greatest dimension or
15 PI-RADS Peripheral Zone 1 Peripheral Zone (PZ) No abnormality (normal) on ADC or high b-value 2 Indistinct mildy hypointense on ADC 3 Focal mildy hypointense on ADC and isointense/mildly hyperintense on high b-value Focal moderately hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 1
16 PI-RADS Peripheral Zone 1 Peripheral Zone (PZ) No abnormality (normal) on ADC or high b-value 2 Indistinct mildy hypointense on ADC 3 Focal mildy hypointense on ADC and isointense/mildly hyperintense on high b-value Focal moderately hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 16
17 PI-RADS Peripheral Zone 1 Peripheral Zone (PZ) No abnormality (normal) on ADC or high b-value 2 Indistinct mildy hypointense on ADC 3 Focal mildy hypointense on ADC and isointense/mildly hyperintense on high b-value Focal moderately hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 17
18 PI-RADS Peripheral Zone 1 Peripheral Zone (PZ) No abnormality (normal) on ADC or high b-value 2 Indistinct mildy hypointense on ADC 3 Focal mildy hypointense on ADC and isointense/mildly hyperintense on high b-value Focal moderately hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 18
19 PI-RADS Peripheral Zone 1 Peripheral Zone (PZ) No abnormality (normal) on ADC or high b-value 2 Indistinct mildy hypointense on ADC 3 Focal mildy hypointense on ADC and isointense/mildly hyperintense on high b-value Focal moderately hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 19
20 PI-RADS Transition Zone 1 Transition Zone (TZ) No abnormality (normal) on ADC or high b-value 2 Hypointense within a BPH nodule on ADC 3 Focal mildly hypointense on ADC and isointense/mildly hyperintense on high b-value Focal markedly hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 20
21 PI-RADS Transition Zone 1 Transition Zone (TZ) No abnormality (normal) on ADC or high b-value 2 Hypointense within a BPH nodule on ADC 3 Focal mildly hypointense on ADC and isointense/mildly hyperintense on high b-value Focal markedly hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 21
22 PI-RADS Transition Zone 1 Transition Zone (TZ) No abnormality (normal) on ADC or high b-value 2 Hypointense within a BPH nodule on ADC 3 Focal mildly hypointense on ADC and isointense/mildly hyperintense on high b-value Focal markedly hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 22
23 PI-RADS Transition Zone 1 Transition Zone (TZ) No abnormality (normal) on ADC or high b-value 2 Hypointense within a BPH nodule on ADC 3 Focal mildly hypointense on ADC and isointense/mildly hyperintense on high b-value Focal markedly hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 23
24 PI-RADS Transition Zone 1 Transition Zone (TZ) No abnormality (normal) on ADC or high b-value 2 Hypointense within a BPH nodule on ADC 3 Focal mildly hypointense on ADC and isointense/mildly hyperintense on high b-value Focal markedly hypointense on ADC and markedly hyperintense on high b-value ; <1.cm on axial Same as but 1.cm in greatest dimension or 2
25 DCE: Positive / Negative Positive DCE Negative DCE Focal, early enhancement corresponding to a focal peripheral zone or transition zone lesion on T2 and/or MRI Lack of early enhancement Diffuse enhancement not corresponding to a focal lesion on T2 and/or MRI Focal enhancement corresponding to a BPH lesion
26 PI-RADS DCE PZ DCE Status Positive (+) Negative (-) PZ / TZ Enhancement Focal, earlier or contemporaneous with enhancement of adjacent normal prostatic tissues, and corresponding to a suspicious finding on T2WI and/or No early enhancement, or; diffuse enhancement so that margins do not correspond to a finding on T2WI and/or, or; focal enhancement corresponding to a lesion demonstrating features of BPH on T2WI
27 PI-RADS DCE TZ DCE Status Positive (+) Negative (-) PZ / TZ Enhancement Focal, earlier or contemporaneous with enhancement of adjacent normal prostatic tissues, and corresponding to a suspicious finding on T2WI and/or No early enhancement, or; diffuse enhancement so that margins do not correspond to a finding on T2WI and/or, or; focal enhancement corresponding to a lesion demonstrating features of BPH on T2WI
28 PI-RADS DCE DCE Status Positive (+) Negative (-) PZ / TZ Enhancement Focal, earlier or contemporaneous with enhancement of adjacent normal prostatic tissues, and corresponding to a suspicious finding on T2WI and/or No early enhancement, or; diffuse enhancement so that margins do not correspond to a finding on T2WI and/or, or; focal enhancement corresponding to a lesion demonstrating features of BPH on T2WI
29 PI-RADS v2 Overall Assessment Likelihood of the presence of clinically significant cancer 1 Very low clinically significant cancer highly unlikely 2 Low clinically significant cancer is unlikely 3 Intermediate clinically significant cancer is equivocal High clinically significant cancer is likely Very high clinically significant cancer is highly likely
30 Peripheral Zone -ADC Abnormality location PI-RADS v2 Assessment Category Transition Zone T2WI 1 PI-RADS PI-RADS 2 DCE - PI-RADS PI-RADS PI-RADS
31 Overall PI-RADS v2 Assessment T2W DCE PIRADS Category 1 Any Any 1 2 Any Any 2 3 Any Any Any Any Any
32 Overall PI-RADS v2 Assessment Peripheral Zone (PZ) Nodule 10 mm T2W DCE PIRADS Category 1 Any Any 1 2 Any Any 2 3 Any Any Any Any Any
33 Overall PI-RADS v2 Assessment Peripheral Zone (PZ) Nodule 10 mm T2W DCE PIRADS Category 1 Any Any 1 2 Any Any 2 3 Any Any Any Any Any
34 Thank you!
1 Uniform hyperintense signal intensity (normal). 2 Linear (arrow), wedge-shaped, or diffuse mild hypointensity, usually indistinct margin.
Figure 3 PI-RADS assessment for peripheral zone on T2-weighted imaging. 1 Uniform hyperintense signal intensity (normal). 2 Linear (arrow), wedge-shaped, or diffuse mild hypointensity, usually indistinct
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