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Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review

Abstract

The most recent edition of the prostate imaging reporting and data system (PI-RADS version 2) was developed based on expert consensus of the international working group on prostate cancer. It provides the minimum acceptable technical standards for MR image acquisition and suggests a structured method for multiparametric prostate MRI (mpMRI) reporting. T1-weighted, T2-weighted (T2W), diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging are the suggested sequences to include in mpMRI. The PI-RADS version 2 scoring system enables the reader to assess and rate all focal lesions detected at mpMRI to determine the likelihood of a clinically significant cancer. According to PI-RADS v2, a lesion with a Gleason score ≥7, volume >0.5 cc, or extraprostatic extension is considered clinically significant. PI-RADS v2 uses the concept of a dominant MR sequence based on zonal location of the lesion rather than summing each component score, as was the case in version 1. The dominant sequence in the peripheral zone is DWI and the corresponding apparent diffusion coefficient (ADC) map, with a secondary role for DCE in equivocal cases (PI-RADS score 3). For lesions in the transition zone, T2W images are the dominant sequence with DWI/ADC images playing a supporting role in the case of an equivocal lesion.

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Acknowledgements

Grant funding provided by the National Institutes of Health Grant Number: U01CA151261 (FMF), the National Institutes of Health Grant Number: R25CA89017 (DIG), Massachusetts Department of Public Health Grant Number: DPH403516 (EH), and National Institutes of Health Grant Number: P41 EB015898 (CT, FMF).

Author information

Correspondence to Elmira Hassanzadeh.

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Funding

This study was funded by Grant numbers U01CA151261 (FMF), R25CA89017 (DIG), DPH403516 (EH), and P41 EB015898 (CT, FMF).

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study was HIPAA compliant and approved by the Institutional Review Board. Informed consent was waived because of the retrospective nature of the study.

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Hassanzadeh, E., Glazer, D.I., Dunne, R.M. et al. Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review. Abdom Radiol 42, 278–289 (2017). https://doi.org/10.1007/s00261-016-0871-z

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Keywords

  • Apparent Diffusion Coefficient
  • Peripheral Zone
  • Prostate Adenocarcinoma
  • Extraprostatic Extension
  • Dominant Sequence