title: Prostate MRI based on PI-RADS version 2: how we review and report.
abstract: Prostate imaging and interpretation is based on prostate imaging reporting and data system version 2 (PI-RADS™ v2) providing clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) of the prostate. PI-RADS™ v2 aims to promote global standardisation, to diminish variation in the acquisition, interpretation and reporting of prostate mpMRI examinations and to improve detection, localisation, and risk stratification in patients with suspected cancer in treatment naïve prostate glands. It does not address detection of recurrence, progression during active surveillance and evaluation of other parts of the body.PI-RADS™ v2 improves and standardises communication between radiologists and urologists to detect or exclude the presence of significant prostate cancer with a high likelihood. Findings on mpMRI are assessed on a 5-point category scale based on the probability that a combination of findings on T2-weighted (T2w) sequences, diffusion-weighted MRI (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) correlates with the presence of a clinically significant prostate cancer at a particular location. PI-RADS assessment categories range from 1 to 5 with 5 being most likely to represent clinically significant prostate cancer. The dominant sequence to detect prostate cancer in the peripheral zone is DWI, whereas for tumour detection in the transition zone T2w is the most important sequence. DCE-MRI has been attributed a minor role and only qualitative assessment with presence or absence of focal enhancement is suggested. Up to four suspicious lesions of category 3, 4 and 5 are assigned on a sector map and the index lesion should be identified.
authors.affiliation: Department of Radiology, Neuroradiology, and Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010, Bern, Switzerland. Philipp.Steiger@med.unibe.ch.|Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, CH-3010, Bern, Switzerland. Philipp.Steiger@med.unibe.ch.
authors.forename: Philipp
authors.initials: P
authors.lastname: Steiger
authors.affiliation: Department of Radiology, Neuroradiology, and Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010, Bern, Switzerland.|Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, CH-3010, Bern, Switzerland.
authors.forename: Harriet C
authors.initials: HC
authors.lastname: Thoeny
mesh_terms: D003142:Communication; D003287:Contrast Media; D003626:Data Display / Q000592:standards; D038524:Diffusion Magnetic Resonance Imaging / Q000592:standards; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D006801:Humans; D007089:Image Enhancement / Q000592:standards; D007090:Image Interpretation, Computer-Assisted / Q000592:standards; D007400:Interprofessional Relations; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D009364:Neoplasm Recurrence, Local; D011467:Prostate / Q000473:pathology; D011470:Prostatic Hyperplasia / Q000175:diagnosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D011873:Radiology Information Systems / Q000592:standards*
chemical_list: D003287:Contrast Media
keywords: Multiparametric magnetic resonance imaging (mpMRI); Prostate Imaging Reporting and Data System version 2 (PI-RADS™ v2); Prostate cancer