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PI-RADS 2.1

 

PI-RADS Assessment

Peripheral Zone (PZ)
DWI T2W DCE PIRADS
1 Any* Any 1
2 Any Any 2
3 Any - 3
+ 4
4 Any Any 4
5 Any Any 5
* "Any" indicates 1-5

 

Transition Zone (TZ)
T2W DWI DCE PIRADS
1 Any Any 1
2 ≤ 3 Any 2
≥ 4 Any 3
3 ≤ 4 Any 3
5 Any 4
4 Any Any 4
5 Any Any 5

 

 

 

PI-RADS Assessment Without Adequate DWI

Peripheral Zone (PZ) and Transition Zone (TZ)
T2W DWI DCE PIRADS
1 X Any 1
2 X Any 2
3 X - 3
+ 4
4 X Any 4
5 X Any 5

 

 

 

PI-RADS Assessment Without Adequate DCE

Peripheral Zone (PZ): Determined by DWI Assessment Category
       
Transition Zone (TZ)
T2W DWI DCE PIRADS
1 Any X 1
2 ≤ 3 X 2
≥ 4 X 3
3 ≤ 4 X 3
5 X 4
4 Any X 4
5 Any X 5

 

 

 

PI-RADS Assessment for T2W

Score Peripheral Zone (PZ)
1 Uniform hyperintense signal intensity (normal)
2 Linear or wedge-shaped hypointensity or diffuse mild hypointensity, usually indistinct margin
3

Heterogeneous signal intensity or non-circumscribed, rounded, moderate hypointensity

Includes others that do not qualify as 2, 4, or 5

4 Circumscribed, homogeneous moderate hypointense focus/mass confined to prostate and < 1.5 cm in greatest dimension
5 Same as 4 but ≥ 1.5 cm in greatest dimension or definite extraprostatic extension/invasive behavior

 

Score Transition Zone (TZ)
1 Normal appearing TZ (rare) or a round, completely encapsulated nodule. ("typical nodule")
2 A mostly encapsulated nodule OR a homogeneous circumscribed nodule without encapsulation. ("atypical nodule") OR a homogeneous mildly hypointense area between nodules
3

Heterogeneous signal intensity with obscured margins

Includes others that do not qualify as 2, 4, or 5

4 Lenticular or non-circumscribed, homogeneous, moderately hypointense, and < 1.5 cm in greatest dimension
5 Same as 4 but ≥ 1.5 cm in greatest dimension or definite extraprostatic extension/invasive behavior

 

 

 

PI-RADS Assessment of DWI

Score Peripheral Zone (PZ) or Transition Zone (TZ)
1 No abnormality (i.e. normal) on ADC and high b-value DWI
2 Linear/wedge shaped hypointense on ADC and/or linear/wedge shaped hyperintense on high b-value DWI
3 Focal (discrete and different from background) hypointense on ADC and/or focal hyperintense on high b-value DWI; may be markedly hypointense on ADC or markedly hyperintense on high b-value DWI, but not both
4 Focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI; < 1.5 cm in greatest dimension
5 Same as 4 but ≥ 1.5 cm in greatest dimension or definite extraprostatic extension/invasive behavior

 

 

PI-RADS Assessment for DCE

Score Peripheral Zone (PZ) or Transition Zone (TZ)
(-) No early or contemporaneous enhancement; or diffuse multifocal enhancement NOT corresponding to a focal finding on T2W and/or DWI or focal enhancement corresponding to a lesion demonstrating features of BPH on T2W (including features of extruded BPH in the PZ)
(+) focal, and; earlier than or contemporaneously with enhancement of adjacent normal prostatic tissues, and; corresponds to suspicious finding on T2W and/or DWI

 

 

 

PI-RADS 2.1 Revision Presentation

 

Click here to download PI-RADS Version 2.1 PDF

 

Prostate Anatomy

 

Peripheral zone

Transitional zone

 

DCE

 

 

BPH

 

 

Central zone

 

AFS