Dr. P back again talking transitional zone and their corresponding TZ scores, as they relate to T2 imaging. Remember I've said in the past that one of the issues with the original PI-RADS 2.0 designation and interpretation thereof was over-calling disease in the transitional zone.
So now let's look at a score of 1. Not PI-RADS, but the overall T2 score within the TZ. If we've got a nodule like this one right here, that's gray with a nice dark capsule around it, there's the capsule right there, that's black, I'm just putting some arrows on it right now... this should get a T2 score of 1, a completely encapsulated nodule. By the way, that completely encapsulated nodule, as long as it's completely encapsulated, it can have a nodule in a nodule, like this right here. Or it can have some cystic change within the nodule, as well as a nodule within a nodule. It can have multiple areas of cystic change, and it doesn't have to be perfectly round. It can be oval.
What about a T2 score within the TZ of 2? While that will also be a homogeneous, circumscribed nodule, but this time no capsule around the periphery. In other words, there is no identifiable rim, even though the zone of transition between it and the background tissue is very sharp. So homogeneous once again, but this time no capsule, the score elevates to a T2 score of 2. This will also apply to oval nodules, as well as round nodules, oval being seen in two planes.
Another T2 score of 2 can be assigned if we have a nodule that is partially encapsulated, but the majority of it is encapsulated, as illustrated by this black line around the outside of our nodule. Some variants here also include cystic change within the nodule. It can be a single cystic area or multiple cystic areas. The nodule can be round or the nodule can be oval. It can be round in one plane, oval in another, round in both, or oval in both.
So these latter two get a T2 TZ score of 2, whereas the nodule that is completely encapsulated, all the way around the outside, as designated by this black band between it and the surrounding TZ background, no matter what the internal character, gets a T2 score of 1.
And that should clarify it for you. Dr. P out.
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Content reviewed: December 29, 2021