1、贵州省人民医院贵州省人民医院 放射科放射科Prostate Imaging Reporting and Data System （PI-RADS Version 2）Tang lei贵州省人民医院贵州省人民医院 放射科放射科2/28 Introductionv Prostate cancer is the second most common cancer in men worldwide. Two thirds of prostate cancer cases are diagnosed in more developed regions of the worldv Presently, M
2、RI became the best method of choice for detection and staging of prostate cancerv MRI not only offers an excellent resolution of the prostatic gland, but also evaluates locoregional extension, pelvic lymph nodes involvement and bone metastases in the pelvis贵州省人民医院贵州省人民医院 放射科放射科3/28v PI-RADS Version
3、1: Adapted from breast imaging, PI-RADS version 1 was published by the European Society of Urogenital Radiology (ESUR) in 2012v PI-RADS version 2: In 2014，it had been updated by a steering committee including the American College of Radiology (ACR), ESUR, and the AdMeTech FoundationPI-RADS( Prostate
4、 Imaging Reporting and Data System ) 贵州省人民医院贵州省人民医院 放射科放射科4/28Objectives of PI-RADSv The objectives of PI-RADS are to promote global standardisation of prostate imaging, to improve detection, localisation, characterisation, risk stratification of prostate cancer in treatment naive prostate as well a
5、s to improve communication with referring urologists贵州省人民医院贵州省人民医院 放射科放射科5/28Prostate Imaging Reporting and Data System （PI-RADS Version 2）贵州省人民医院贵州省人民医院 放射科放射科6/28I. Clinical significant prostate cancerv Prostate cancer is divided into clinically insignificant and significant prostate cancer, depen
6、ding on its likelihood to affect a patients lifetimev Definition for clinical significant prostate cancer: Pathology / histology with Gleason score 7 and/or volume 0.5 cc and/or extra prostatic extension (EPE)贵州省人民医院贵州省人民医院 放射科放射科7/28II. PI-RADS V1 & V2v The first guideline paper was based on a summ
7、ary score for each lesion assessed in different sequences of mp-MRI, consisting of T2WI, DWI，DCE-MRI and spectroscopyv In version 2，spectroscopy was omitted and DCE-MRI was attributed a minor role. In contrast to version 1, each lesion is attributed a single score based on findings of mp-MRIPI-RADS
8、V1: T2WI + DWI + DCE-MRI + MRSPI-RADS V2: T2WI + DWI + DCE-MRI 贵州省人民医院贵州省人民医院 放射科放射科8/28III. MRI protocolv MRI of the prostate is performed according to the PI-RADS V2 guidelines on a 3.0 T scanner with an endorectal coilv Recommended Approach: plain MR + DWI + DCE-MRv High-resolution T2WI sequence:
9、 Axial, Coronal, Sagittalv A precontrast T1WI sequence is needed to exclude hemorrhage v Axial DWI sequence with b-values of 0 2000 s/mm2贵州省人民医院贵州省人民医院 放射科放射科9/28Score 1 Clinically significant disease is highly unlikely to be present Score 2 Clinically significant cancer is unlikely to be present Sc
10、ore 3 Clinically significant cancer is equivocalScore 4 Clinically significant cancer is likely to be present Score 5 Clinically significant cancer is highly likely to be present IV.PI-RADS (5-point scale)The PI-RADS version 2 assesses the likelihood of clinically significant prostate cancer on a 5-
11、point scale for each lesion as follows:贵州省人民医院贵州省人民医院 放射科放射科10/28v PI-RADS V2 uses Partition Model to divide prostate, seminal vesicles and menlibranous urethrav There are 39 regions, including 36 prostatic regions, 2 seminal vesicles and 1 menlibranous urethraV. Sctor maps for division of prostatic
12、 regions贵州省人民医院贵州省人民医院 放射科放射科11/28PZ: Peripheral zoneCZ: Central zoneTZ：Transition zoneAS：anterior stromaV. Sctor maps for division of prostatic regions贵州省人民医院贵州省人民医院 放射科放射科12/28v The predominant sequence is DWI in the peripheral zone and T2WI sequence in the transition zonev In case of PI-RADS asse
13、ssment category 3 in the peripheral zone, DCE-MRI determines the final PI-RADS assessment category, and in PI-RADS assessment category 3 in the transition zone, DWI determines the final PI-RADS assessment categoryVI. Image interpretation贵州省人民医院贵州省人民医院 放射科放射科13/28贵州省人民医院贵州省人民医院 放射科放射科14/28贵州省人民医院贵州省人
14、民医院 放射科放射科15/28Case 1贵州省人民医院贵州省人民医院 放射科放射科16/28Case1Clinical Notes: PSA last year: 31.4 ng/ml. Actual PSA: 27.5 ng/ml; One year previous: prostate biopsy revealed no cancer.MR Findings: Enlarged prostate of circa 43 ml (44 mm 51 mm 37 mm 0.52). Transition zone: Midlevel on T2WI image depicts a focal
15、 lesion of 20 mm maximal extension (white arrows). 贵州省人民医院贵州省人民医院 放射科放射科17/28贵州省人民医院贵州省人民医院 放射科放射科18/28Case1DWI: The lesion shows a high signal intensity in the anterior fibromuscular stroma and the left anterior transition zone on the high b-value DWI image (white arrowheads) with corresponding low
16、 signal intensity on the ADC map (black arrowheads) (ADC 580 106 mm2/s).贵州省人民医院贵州省人民医院 放射科放射科19/28贵州省人民医院贵州省人民医院 放射科放射科20/28DCE-MRI is rated positive, showing a focal enhancement, earlier than adjacent prostate tissue (black arrows). No suspicious locoregional or pelvic lymph nodes. No suspicious bo
17、ne lesions. No additional findings.Conclusion: Clinically significant prostate cancer is highly likely to be present in the anterior fibromuscular stroma and in the left anterior transition zone in the midlevel, with greatest dimension 1.5 cm corresponding to PI-RADS 5. Score 5 ：Clinically significa
18、nt cancer is highly likely to be presentHistology: PCa, Gleason score 4 + 3 = 7Case1贵州省人民医院贵州省人民医院 放射科放射科21/28Case 2贵州省人民医院贵州省人民医院 放射科放射科22/28Case2Clinical Notes: Known prostate cancer Gleason 6 under active surveillance diagnosed 1 year ago. PSA 5.4 ng/ml. Under 1-adrenergic receptor therapy for BP
19、H.MR Findings: Enlarged prostate of circa 48 ml (58 mm 38 mm 42 mm 0.52). T2WI: lesion of 9 mm maximal extension (white arrow) at the mid-level in the anterior half on the right with heterogeneous, indistinct triangular, signal intensity with obscured margins with mild hypointense signal. 贵州省人民医院贵州省
20、人民医院 放射科放射科23/28贵州省人民医院贵州省人民医院 放射科放射科24/28Case2DWI: The lesion is showing mildly hyperintense signal on high b-value DWI image (white arrowhead) and moderate signal intensity on ADC map (black arrowhead) (ADC 850 106 mm2/s). DCE-MRI is rated positive, showing a focal enhancement, earlier than adjace
21、nt prostate tissue (black arrow). Multiple circumscribed hypointense encapsulated nodules (BPH) (PI-RADS 2). No suspicious locoregional or pelvic lymph nodes. No suspicious bone lesions. No additional findings.贵州省人民医院贵州省人民医院 放射科放射科25/28贵州省人民医院贵州省人民医院 放射科放射科26/28贵州省人民医院贵州省人民医院 放射科放射科27/28Case2Conclusion: The presence of clinically significant prostate cancer is equivocal in the transition zone showing a lesion in the right anterior mid-level corresponding to PI-RADS 3. Score 3 ：Clinically significant cancer is equivocal, needing follow-up.贵州省人民医院贵州省人民医院 放射科放射科28/28The End
