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Introduction PI-RADS 2.1

3 min.
Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
CME Eligible

I am Dr. Steven Pomeranz. Welcome to MRI Online's review of PI-RADS 2.1 changes and designations for assessment of prostate MRI. Let's start with a review of the changes we're going to be describing and breaking down. First, Image Data Acquisition: Technical Specifications. Now, the T2 weighted image, it's recommended to perform the T2 you in either a straight, axial, orthogonal plane and at least one additional plane and we'll drill into that a little further, what we mean by one additional plane. Diffusion weighted imaging: clarification of b-values for purposes of diffusion weighted imaging acquisition and for ADC map calculation. Third DCE or Dynamic Contrast Enhanced MRI, where you have to put an IV in the patient and inject. Temporal resolution should be no greater than 15 seconds. In our personal practice, it's about seven to eight seconds per image, per location. So less than 15 seconds per dynamic is advised. 3D T1 GRE is preferred.

Clarifications in Interpretation Criteria: Further description of assessment of lesions in the CZ and anterior fibromuscular stroma is one of the biggest and most important changes, for you'll see in our experience, the overwhelming majority of lesions in the TZ have been over called. Revision and criteria for T2 weighted imaging scores, for score 1 and score 2, in the TZ area, which further contributes to our analysis of TZ lesions. Revision in determination of overall assessment of what we're going to call aggressive, intermediate, or not aggressive in the TZ area. Revisions and criteria for diffusion weighted imaging scores of 2 and 3. Clarification of the distinction between positive and negative enhancement on DCE MRI, clarification and measurement of the prostate volume and revision of the sector map. And finally, a discussion of biparametric MRI: what is biparametric MRI? Well, in order to understand that you've got to know what multiparametric MRI is. Multiparametric MRI revolves around T2, diffusion weighted imaging, spectroscopy and dynamic contrast enhanced MRI. In biparametric MRI, you're relying on two important criteria, the T2 weighted imaging and the diffusion weighted characteristics of the lesion as evidenced on the diffusion weighted series and the ADC map.

LESSON 2, TOPIC 1

Mastery Series: PI-RADS 2.1 Update

Mastery Series

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Content reviewed: December 29, 2021

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