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Urinary Imaging

E2943. PI-RADS v2 as Reviewed Through Images

Tillman B1,  Dryden J1,  Lee M1,  Montgomery R1,  Marks R.1,2 1. Naval Medical Center San Diego, San Diego, CA; 2. Uniformed Services University of the Health Sciences, Bethesda, MD

Address correspondence to J. Dryden (jrdryden@gmail.com)

Background Information: Prostate cancer is the second-most common cause of male cancer death in the United States. Multiparametric MRI of the prostate can aid in the initial diagnosis, local staging, and clinical decision making with regard to prostate cancer, while Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) provides a standardized means of reporting imaging findings.

Educational Goals/Teaching Points: The goal of this exhibit is to review pertinent anatomy and terminology of the prostate and prostate cancer, provide institutional indications for prostate MRI, discuss institutional imaging protocols for prostate MRI, and discuss PI-RADS v2 scoring and categories via imaging examples from an active imaging program.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: PI-RADS v2 provides a structured reporting scheme for the evaluation of the prostate for cancer. T2-weighted, dynamic contrast-enhanced (DCE), and DWI are obtained using a multiparametric technique. Images are then used to grade the prostate on a 5-point scale, ranging from PI-RADS 1 (very low, clinically significant cancer is highly unlikely to be present) to PI-RADS 5 (very high, clinically significant cancer is highly likely to be present). Examples of specific features to assess imaging include size of lesions, intensity, extraprostatic extension, invasion of local structures, local lymph node involvement, and contrast enhancement. Specific imaging examples of each of these findings provide a visual explanation of the scoring/grading system.

Conclusion: Prostate MRI aids clinicians in initial diagnosis, local staging, and clinical decision making with regard to prostate cancer, while PI-RADS v2 provides a standardized system for reporting imaging findings to clinicians. A review of PI-RADS v2 via imaging examples from an active program provides a visual explanation of the reporting system.