1 Uniform hyperintense signal intensity (normal). 2 Linear (arrow), wedge-shaped, or diffuse mild hypointensity, usually indistinct margin.
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1 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 margin. 3 Heterogeneous signal intensity or non-circumscribed, rounded, moderate hypointensity (arrow). 4 Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1.5 cm in greatest dimension (arrow). 5 Same as 4 but 1.5cm in greatest dimension (arrows) or definite extraprostatic extension/invasive behavior. 56 American College of Radiology
2 57 Figure 4 PI-RADS assessment for transition zone on T2-weighted imaging. 1 Homogeneous intermediate signal intensity (normal). 2 Circumscribed (arrows) hypointense or heterogeneous encapsulated nodule(s) (BPH). 3 Heterogeneous signal intensity with obscured margins (arrow). Includes others that do not qualify as 2, 4, or 5. 4 Lenticlular (arrow) or non- circumscribed, homogeneous, moderately hypointense, and <1.5 cm in greatest dimension. 5 Same as 4, but 1.5cm in greatest dimension (arrows) or definite extraprostatic extension/invasive behavior. American College of Radiology 57
3 Figure 5 PI-RADS assessment for peripheral zone on diffusion weighted imaging. 1 No abnormality (i.e. normal) on ADC and high b- value DWI. 2 Indistinct hypointense on ADC (arrow). 3 Focal mildly/moderately hypointense on ADC (arrow) and isointense/mildly hyperintense on high b-value DWI. 4 Focal markedly hypointense on ADC (arrow) and markedly hyperintense on high b-value DWI; <1.5cm on axial images. 5 Same as 4 but 1.5cm in greatest dimension (arrow) or definite extraprostatic extension / invasive behavior. High b-value DWI ADC map 58 American College of Radiology
4 59 Figure 6 PI-RADS assessment for transition zone on diffusion weighted imaging. 1 No abnormality (i.e. normal) on ADC and high b-value DWI. 2 Indistinct hypointense on ADC. 3 Focal mildly/moderately hypointense on ADC (arrow) and isointense/mildly hyperintense on high b-value DWI. 4 Focal markedly hypointense on ADC (arrow) and markedly hyperintense on high b-value DWI; <1.5cm on axial images. 5 Same as 4 but 1.5cm in greatest dimension (arrow) or definite extraprostatic extension / invasive behavior. High b-value DWI ADC map American College of Radiology 59
5 Figure 7 PI-RADS assessment for dynamic contrast enhanced MRI. Negative No early enhancement, or; diffuse enhancement not corresponding to a focal finding on T2WI and/or DWI, or; focal enhancement corresponding to a lesion demonstrating features of BPH on T2W Positive Focal (arrow), and; earlier than or contemporaneously with enhancement of adjacent normal prostatic tissues, and; corresponds to suspicious finding on T2WI and/or DWI Peripheral Zone Transition Zone 60 American College of Radiology
6 PI-RADS Assessment Peripheral Zone (PZ) DWI T2W DCE PI-RADS 3 Any Transition Zone (TZ) T2W DWI DCE PI-RADS 3 4 Any 3 5 Any 4 18 American College of Radiology
7 PI-RADS Assessment Peripheral Zone (PZ) DWI T2W DCE PI-RADS 3 Any Transition Zone (TZ) T2W DWI DCE PI-RADS 3 4 Any 3 5 Any 4 18 American College of Radiology
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