Skip to main content

Multiparametric MRI of Prostate: Analysis and Recommendations of Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1

  • Chapter
  • First Online:
Reading MRI of the Prostate
  • 780 Accesses


Multiparametric MRI, comprising of anatomic T1 weighted and T2 weighted imaging combined with functional imaging techniques, (presently diffusion weighted imaging and dynamic contrast enhanced (DCE) MRI), is the standard of care for evaluation of prostate cancer. Efforts have been taken to standardize prostate MRI reporting and interpretation by the international community comprising of both radiologists and urologists. These efforts have led to consensus guidelines in the shape of PI-RADS recommendations, the second version of which was released in 2015. PI-RADS v2 recommendations and subsequent PI-RADS v2.1 updates are geared towards detection of clinically significant cancer. Clinically significant cancer is defined as cancer with Gleason score ≥ 3 + 4 = 7, tumor volume >0.5 ml, and/or extraprostatic extension.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  1. Furlan A, Borhani AA, Westphalen AC. Multiparametric MR imaging of the prostate. Radiol Clin North Am. 2018;56:223. [cited 2017 Dec 13].

    Article  PubMed  Google Scholar 

  2. Cruz M, Tsuda K, Narumi Y, Kuroiwa Y, Nose T, Kojima Y, et al. Characterization of low-intensity lesions in the peripheral zone of prostate on pre-biopsy endorectal coil MR imaging. Eur Radiol. 2002;12(2):357–65.

    Article  CAS  Google Scholar 

  3. Mizuno R, Nakashima J, Mukai M, Ookita H, Nakagawa K, Oya M, et al. Maximum tumor diameter is a simple and valuable index associated with the local extent of disease in clinically localized prostate cancer. Int J Urol. 2006;13(7):951–5.

    Article  Google Scholar 

  4. Tamada T, Sone T, Jo Y, Yamamoto A, Yamashita T, Egashira N, et al. Prostate cancer: relationships between postbiopsy hemorrhage and tumor detectability at MR diagnosis. Radiology. 2008;248(2):531–9.

    Article  Google Scholar 

  5. Delongchamps NB, Rouanne M, Flam T, Beuvon F, Liberatore M, Zerbib M, et al. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int. 2011;107(9):1411–8.

    Article  Google Scholar 

  6. Haider MA, van der Kwast TH, Tanguay J, Evans AJ, Hashmi A-T, Lockwood G, et al. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. Am J Roentgenol. 2007;189(2):323–8.

    Article  Google Scholar 

  7. Hötker AM, Mazaheri Y, Aras Ö, Zheng J, Moskowitz CS, Gondo T, et al. Assessment of prostate cancer aggressiveness by use of the combination of quantitative DWI and dynamic contrast-enhanced MRI. AJR Am J Roentgenol. 2016;206(4):756–63.

    Article  Google Scholar 

  8. Kitajima K, Kaji Y, Fukabori Y, Yoshida K, Suganuma N, Sugimura K. Prostate cancer detection with 3 T MRI: comparison of diffusion-weighted imaging and dynamic contrast-enhanced MRI in combination with T2-weighted imaging. J Magn Reson Imaging. 2010;31(3):625–31.

    Article  Google Scholar 

  9. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol. 2019 [cited 2019 Jun 27].

  10. Verma S, Turkbey B, Muradyan N, Rajesh A, Cornud F, Haider MA, et al. Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. AJR Am J Roentgenol. 2012;198(6):1277–88.

    Article  Google Scholar 

  11. Yu KK, Hricak H, Alagappan R, Chernoff DM, Bacchetti P, Zaloudek CJ. Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology. 1997;202(3):697–702.

    Article  CAS  Google Scholar 

  12. Hoeks CMA, Barentsz JO, Hambrock T, Yakar D, Somford DM, Heijmink SWTPJ, et al. Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology. 2011;261(1):46–66.

    Article  Google Scholar 

  13. Zhang L, Tang M, Chen S, Lei X, Zhang X, Huan Y. A meta-analysis of use of Prostate Imaging Reporting and Data System Version 2 (PI-RADS V2) with multiparametric MR imaging for the detection of prostate cancer. Eur Radiol. 2017;27:5204.

    Article  Google Scholar 

  14. Polanec S, Helbich TH, Bickel H, Pinker-Domenig K, Georg D, Shariat SF, et al. Head-to-head comparison of PI-RADS v2 and PI-RADS v1. Eur J Radiol. 2016;85(6):1125–31.

    Article  Google Scholar 

  15. Kasel-Seibert M, Lehmann T, Aschenbach R, Guettler FV, Abubrig M, Grimm M-O, et al. Assessment of PI-RADS v2 for the detection of prostate cancer. Eur J Radiol. 2016;85(4):726–31.

    Article  Google Scholar 

  16. Muller BG, Shih JH, Sankineni S, Marko J, Rais-Bahrami S, George AK, et al. Prostate cancer: interobserver agreement and accuracy with the revised prostate imaging reporting and data system at multiparametric MR imaging. Radiology. 2015;277(3):741–50.

    Article  Google Scholar 

  17. Purysko AS, Bittencourt LK, Bullen JA, Mostardeiro TR, Herts BR, Klein EA. Accuracy and interobserver agreement for prostate imaging reporting and data system, version 2, for the characterization of lesions identified on multiparametric MRI of the prostate. AJR Am J Roentgenol. 2017;209(2):339–49.

    Article  Google Scholar 

  18. Greer MD, Brown AM, Shih JH, Summers RM, Marko J, Law YM, et al. Accuracy and agreement of PI-RADSv2 for prostate cancer mpMRI: a multireader study. J Magn Reson Imaging. 2017;45(2):579–85.

    Google Scholar 

  19. Liddell H, Jyoti R, Haxhimolla HZ. mp-MRI prostate characterised PI-RADS 3 lesions are associated with a low risk of clinically significant prostate cancer - a retrospective review of 92 biopsied PI-RADS 3 lesions. Curr Urol. 2015;8(2):96–100.

    Google Scholar 

  20. Mertan FV, Greer MD, Shih JH, George AK, Kongnyuy M, Muthigi A, et al. Prospective evaluation of the prostate imaging reporting and data system version 2 for prostate cancer detection. J Urol. 2016;196(3):690–6.

    Article  Google Scholar 

  21. Scialpi M, Martorana E, Aisa MC, Rondoni V, D’Andrea A, Bianchi G. Score 3 prostate lesions: a gray zone for PI-RADS v2. Turk J Urol. 2017 Sep;43(3):237–40.

    Article  Google Scholar 

  22. Scialpi M, Martorana E, Aisa MC, Rondoni V, D’Andrea A, Brunese L. Abbreviated biparametric prostate MR Imaging: is it really an alternative to multiparametric MR imaging? Radiology. 2018;286(1):360–1.

    Article  Google Scholar 

  23. Kuhl CK, Bruhn R, Krämer N, Nebelung S, Heidenreich A, Schrading S. Abbreviated biparametric prostate MR imaging in men with elevated prostate-specific antigen. Radiology. 2017;285(2):493–505.

    Article  Google Scholar 

  24. Yu AC, Badve C, Ponsky LE, Pahwa S, Dastmalchian S, Rogers M, et al. Development of a combined MR fingerprinting and diffusion examination for prostate cancer. Radiology. 2017;283(3):729–38.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Vikas Gulani .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Panda, A., Gulani, V. (2020). Multiparametric MRI of Prostate: Analysis and Recommendations of Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1. In: Panda, A., Gulani, V., Ponsky, L. (eds) Reading MRI of the Prostate. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-99355-3

  • Online ISBN: 978-3-319-99357-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics