PI-RADS v2 and ADC values: is there room for improvement?



To determine the diagnostic accuracy of ADC values in combination with PI-RADS v2 for the diagnosis of clinically significant prostate cancer (CS-PCa) compared to PI-RADS v2 alone.

Materials and methods

This retrospective study included 155 men whom underwent 3-Tesla prostate MRI and subsequent MR/US fusion biopsies at a single non-academic center from 11/2014 to 3/2016. All scans were performed with a surface coil and included T2, diffusion-weighted, and dynamic contrast-enhanced sequences. Suspicious findings were classified using Prostate Imaging Reporting and Data System (PI-RADS) v2 and targeted using MR/US fusion biopsies. Mixed-effect logistic regression analyses were used to determine the ability of PIRADS v2 alone and combined with ADC values to predict CS-PCa. As ADC categories are more practical in clinical situations than numeric values, an additional model with ADC categories of ≤ 800 and > 800 was performed.


A total of 243 suspicious lesions were included, 69 of which were CS-PCa, 34 were Gleason score 3+3 PCa, and 140 were negative. The overall PIRADS v2 score, ADC values, and ADC categories are independent statistically significant predictors of CS-PCa (p < 0.001). However, the area under the ROC of PIRADS v2 alone and PIRADS v2 with ADC categories are significantly different in both peripheral and transition zone lesions (p = 0.026 and p = 0.03, respectively) Further analysis of the ROC curves also shows that the main benefit of utilizing ADC values or categories is better discrimination of PI-RADS v2 4 lesions.


ADC values and categories help to diagnose CS-PCa when lesions are assigned a PI-RADS v2 score of 4.

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Author information



Corresponding author

Correspondence to Antonio C. Westphalen.

Ethics declarations


This study was not funded.

Conflict of interest

Eric J. Jordan: none. Charles Fiske: none. Ronald Zagoria: consultant for Recor Medical, Inc. Antonio C. Westphalen: scientific advisory board member for 3D Biopsy, LLC.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

IRB statement

This retrospective study was approved by the UCSF Institutional Committee for Human Research.

Appendix 1

Appendix 1

See Table 5.

Table 5 Prostate MR sequence specifications

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Jordan, E.J., Fiske, C., Zagoria, R. et al. PI-RADS v2 and ADC values: is there room for improvement?. Abdom Radiol 43, 3109–3116 (2018). https://doi.org/10.1007/s00261-018-1557-5

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  • Prostate MRI
  • ADC values
  • Prostate cancer