Dr. P here talking about image interpretation for DCE, dynamic contrast enhanced MRI and focusing on the differences in a negative score from PI-RAD 2.0 to 2.1. Let's start out with what we said was a positive score. A positive score would mean you have focal earlier than or contemporaneous enhancement with adjacent tissues but still pretty darn early and this corresponds to a suspicious finding on T2 or DWI. That's easy and it's the same on both. Now let me give you an analogy in the breast. When I look at a breast MRI and I see the arteries, the aorta, the arterials, and that very initial blush, if I see something come in all by itself in the breast, I am worried. And then I drill down into that lesion. Now let's go to the designation of a negative score. In 2.0, no early enhancement. In 2.1 no early enhancements so those are the same.
But then we also don't want to see any contemporaneous enhancement similar to surrounding tissues. And I certainly don't want to see something standing out before there's any enhancement of the rest of the BPH portion of the gland. Diffuse multifocal enhancement that doesn't correspond to a focal finding on T2 or DWI, even though it's diffuse and maybe somewhat impressive, that's still a negative.
If there's focal enhancement in the TZ, that's okay as long as it corresponds to an area of typical BPH. In other words, there's a nodule that's well-defined. That nodule may have a capsule around it or a partial capsule around it. It's round and it's clearly different with a sharp zone of transition from the surrounding background. And there's one other additional caveat between score negative and 2.0 and score negative and 2.1 and that is the extruded BPH nodule. The extruded BPH nodule should be contiguous with the transitional zone. Here's the transitional zone. Sometimes a nodule will pop out like this. It's round. It's encapsulated. It's partially encapsulated as long as the area that enhances corresponds to that typical TZ appearance, smooth, round, encapsulated, partially encapsulated, that gets a negative score. That concludes our discussion in the changes of DCE MRI between PI-RADS 2.0 and PI-RADS 2.1. Dr. P out.
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Content reviewed: December 29, 2021