Research Article

Evaluation of the PI-RADS Scoring System for Classifying mpMRI Findings in Men with Suspicion of Prostate Cancer

Table 3

Single-modality scores according to the ESUR panel [10].

(A1) T2W imaging for the peripheral zone
(1) Uniform high signal intensity
(2) Linear, wedge-shaped, or geographical areas of lower signal intensity, usually not well demarcated
(3) Intermediate appearances not in categories 1/2 or 4/5
(4) Discrete, homogeneous low-signal focus/mass confined to the prostate
(5) Discrete, homogeneous low-signal-intensity focus with extracapsular extension/invasive behavior or mass effect on the capsule (bulging) or broad (>1.5 cm) contact with the surface
(A2) T2W imaging for the transition zone
(1) Heterogeneous transition zone adenoma with well-defined margins: “organized chaos”
(2) Areas of more homogeneous low signal intensity, however, well marginated, originating from the transition zone/benign prostatic hyperplasia
(3) Intermediate appearances not in categories 1/2 or 4/5
(4) Areas of more homogeneous low signal intensity, ill defined: “erased charcoal sign”
(5) Same as 4, but involving the anterior fibromuscular stroma or the anterior horn of the peripheral zone, usually lenticular or water-drop shaped
(B) Diffusion-weighted imaging
(1) No reduction in ADC compared with normal glandular tissue; no increase in signal intensity on any high-b-value image (≥b800)
(2) Diffuse, hyper signal intensity on ≥b800 image with low ADC; no focal features; however, linear, triangular, or geographical features are allowed
(3) Intermediate appearances not in categories 1/2 or 4/5
(4) Focal area(s) of reduced ADC but isointense signal intensity on high-b-value images (≥b800)
(5) Focal area/mass of hyper signal intensity on the high-b-value images (≥b800) with reduced ADC
(C) Dynamic contrast-enhanced MRI
(1) Type 1 enhancement curve
(2) Type 2 enhancement curve
(3) Type 3 enhancement curve
(+1) For focal enhancing lesion with curve types 2-3
(+1) For asymmetric lesion or lesion at an unusual place with curve types 2-3