![]() ![]() 3: heterogeneous signal intensity or non-circumscribed, rounded, moderate hypointensity includes others that do not qualify as 2, 4, or 5.2: linear or wedge-shaped hypointensity or diffuse mild hypointensity, usually indistinct margin.1: uniform high signal intensity (normal).5: same as 4, but ≥1.5 cm in greatest dimension or definite extraprostatic extension/invasive behaviorįor transition zone lesions, the overall PI-RADS assessment usually follows the T2W score, but scores of 2 or 3 can be upgraded by the DWI (see below).4: lenticular or non-circumscribed, homogeneous, moderately hypointense, and 3: heterogeneous signal intensity with obscured margins includes others that do not qualify as 2, 4, or 5.2: a mostly encapsulated nodule or a homogeneous circumscribed nodule without encapsulation ("atypical nodule"), or a homogeneous mildly hypointense area between nodules.1: normal appearing transition zone (rare) or a round, completely encapsulated nodule ("typical nodule" of benign prostatic hyperplasia).T2 weighted imaging (T2W) score Transition zone For the peripheral zone, the PI-RADS assessment is primarily determined by the DWI score and sometimes modified by the presence of dynamic contrast enhancement. For the transition zone, the PI-RADS assessment is primarily determined by the T2W score and sometimes modified by the DWI score. The contribution of these scores to the overall PI-RADS assessment differs depending on whether the lesion is located in the transition zone or peripheral zone of the prostate. However, in general, biopsy should be considered for PI-RADS 4 or 5 lesions, but not PI-RADS 1 or 2 lesions.Įach lesion can be scored 1-5 on DWI and on T2W, as well as by the absence or presence of dynamic contrast enhancement. PI-RADS v2.1 does not contain management recommendations, as these decisions also depend on other factors such as prostate specific antigen, clinical history, local expertise, and patient preferences. PI-RADS X: component of exam technically inadequate or not performed.PI-RADS 5: very high (clinically significant cancer is highly likely to be present).PI-RADS 4: high (clinically significant cancer is likely to be present).PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal).PI-RADS 2: low (clinically significant cancer is unlikely to be present).PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present).Gleason score ≥7 (including 3+4 with prominent but not predominant Gleason 4 component)Įach lesion is assigned a score from 1 to 5 indicating the likelihood of clinically significant cancer:.A combination of imaging findings ( T2W, DWI, and dynamic contrast enhancement ) predicts the probability of a cancer that is clinically significant, which is defined as the presence of any of the following 6: ![]()
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