I want to summarize what's a somewhat confusing subject, score 2 for T2 imagining in the transitional zone. Remember, score 2 is not synonymous with PI-RADS 2. PI-RADS 2 is a summation of individual scores for say, DWI and for T2, and for potentially some other parameters in multiparametric MRI.
The T2 score 2 consists of a mostly encapsulated nodule. So let's look at a nodule. I'm going to make my nodule orange so we can see it, and this nodule is mostly encapsulated. In other words, it has a rim around it. We'll use a color like blue and we'll say the capsule mostly goes around it. On the other hand, if we have an unencapsulated nodule, so one that doesn't have a rim around it, so we're going to make our nodule, again, we have another nodule in the prostate. But this one, because it's unencapsulated, must be homogeneous and that will get a score of 2.
There's one other area that can be scored in the transitional zone, and that's when you have some tissue in-between. We'll make it blue, but it's not the same as the background of the TZ, which in this case is all this gray background of the slide. So this signal between nodules is different than the background signal, which is gray. I'll make it gray just to be consistent, so the background of the prostate would be gray. So this intervening tissue would also get a score of 2.
However, if the intervening tissue has the same signal as the rest of the TZ, it doesn't get scored, and that's illustrated in this next slide. Only score nodules, or lesions, or regions, between nodules that differ from the background TZ. Findings that are similar to the background, even if they exhibit a little bit of mass effect or a little bit of distortion, as long as they're the same intensity as the background TZ, they should not be scored. Also, typical BPH nodules, round, completely encapsulated, are now not assigned a score.
We're not talking PI-RADS. We're talking a score within the TZ, for T2 weighted imaging and PI-RADS designation 2.1.
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Content reviewed: December 29, 2021