Multiparametric Prostate MRI: PI-RADS V.2

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

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

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)

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

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

PI-RADS Transition Zone T2WI 1 2 3 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

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

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

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

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

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

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

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

Peripheral Zone -ADC Abnormality location PI-RADS v2 Assessment Category Transition Zone T2WI 1 PI-RADS 1 1 2 3 PI-RADS 2 DCE - PI-RADS 3 2 3 PI-RADS PI-RADS

Overall PI-RADS v2 Assessment T2W DCE PIRADS Category 1 Any Any 1 2 Any Any 2 3 Any - 3 + Any Any Any Any

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 - 3 + Any Any Any Any

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