Skip to main content
SpringerLink
Log in

PI-RADS: what is new and how to use it

  • Special Section: Prostate cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

The prostate imaging reporting and data system (PI-RADS) has revolutionized the use of magnetic resonance imaging (MRI) for the management of prostate cancer (PCa). The most recent version 2.1, PI-RADS v2.1, provides specific refinements in the performance, relaxing some recommendations which were not found to be helpful, while reinforcing and clarifying others. The interpretation of T2-weighted imaging (T2WI) in the transition zone (TZ), and the overall assessment of TZ nodules, now allows for a clearer distinction between those which are clearly benign and those which might warrant tissue sampling. Additional changes also resolve discrepancies in T2WI and diffusion-weighted imaging (DWI) of the peripheral zone (PZ). PI-RADS v2.1 is a simpler, more straightforward, and more reproducible method to better communicate between physicians regarding findings on prostate MRI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Murphy G, Haider M, Ghai S, Sreeharsha B. The expanding role of MRI in prostate cancer. AJR Am J Roentgenol. 2013;201(6):1229-38.

    PubMed  Google Scholar 

  2. Gasser TC, Streule K, Nidecker A, Rist M. MRI and ultrasonography in staging prostate cancer. N Engl J Med. 1991;324(7):494-5.

    CAS  PubMed  Google Scholar 

  3. Sumers EH. Staging prostate cancer with MR imaging. Radiology. 1993;187(3):875.

    CAS  PubMed  Google Scholar 

  4. Park BK, Park JW, Park SY, Kim CK, Lee HM, Jeon SS, et al. Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR Am J Roentgenol. 2011;197(5):W876-81.

    PubMed  Google Scholar 

  5. Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol. 2013;64(5):713-9.

    PubMed  PubMed Central  Google Scholar 

  6. Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A, et al. Diagnostic Pathway with Multiparametric Magnetic Resonance Imaging Versus Standard Pathway: Results from a Randomized Prospective Study in Biopsy-naive Patients with Suspected Prostate Cancer. Eur Urol. 2017;72(2):282-8.

    PubMed  Google Scholar 

  7. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-77.

    PubMed  Google Scholar 

  8. Barrett T, Haider MA. The Emerging Role of MRI in Prostate Cancer Active Surveillance and Ongoing Challenges. AJR Am J Roentgenol. 2017;208(1):131-9.

    PubMed  Google Scholar 

  9. Stamatakis L, Siddiqui MM, Nix JW, Logan J, Rais-Bahrami S, Walton-Diaz A, et al. Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer. 2013;119(18):3359-66.

    PubMed  PubMed Central  Google Scholar 

  10. Calio B, Kasson M, Sugano D, Ortman M, Gaitonde K, Verma S, et al. Multiparametric MRI: An Opportunity for Focal Therapy of Prostate Cancer. Semin Roentgenol. 2018;53(3):227-33.

    PubMed  Google Scholar 

  11. Barentsz JOaRJaCRaCPaVSaVGaROaLVaFJJaE. ESUR prostate MR guidelines 2012. European Radiology. 2012;22(4):746-57.

  12. Pinto PAaCPHaRARaBAAaKJaBCJaXSaYPa. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. The Journal of Urology. 2011;186(4):1281-5.

  13. Natarajan S, Marks LS, Margolis DJ, Huang J, Macairan ML, Lieu P, et al. Clinical application of a 3D ultrasound-guided prostate biopsy system. Urol Oncol. 2011;29(3):334-42.

    PubMed  PubMed Central  Google Scholar 

  14. Vache T, Bratan F, Mege-Lechevallier F, Roche S, Rabilloud M, Rouviere O. Characterization of prostate lesions as benign or malignant at multiparametric MR imaging: comparison of three scoring systems in patients treated with radical prostatectomy. Radiology. 2014;272(2):446-55.

    PubMed  Google Scholar 

  15. Thompson JE, van Leeuwen PJ, Moses D, Shnier R, Brenner P, Delprado W, et al. The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer. J Urol. 2016;195(5):1428-35.

    CAS  PubMed  Google Scholar 

  16. Grey AD, Chana MS, Popert R, Wolfe K, Liyanage SH, Acher PL. Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting. BJU Int. 2015;115(5):728-35.

    CAS  PubMed  Google Scholar 

  17. Purysko AS, Rosenkrantz AB, Barentsz JO, Weinreb JC, Macura KJ. PI-RADS Version 2: A Pictorial Update. Radiographics. 2016;36(5):1354-72.

    PubMed  Google Scholar 

  18. Weinreb JCaBJOaCPLaCFaHMAaMKJaMDaSMD. PI - RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. European Urology. 2016;69(1):16-40.

  19. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic Performance of Prostate Imaging Reporting and Data System Version 2 for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-analysis. Eur Urol. 2017;72(2):177-88.

    PubMed  Google Scholar 

  20. Smith CP, Turkbey B. PI-RADS v2: Current standing and future outlook. Turk J Urol. 2018;44(3):189-94.

    PubMed  PubMed Central  Google Scholar 

  21. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-22.

    PubMed  Google Scholar 

  22. Rosenkrantz AB, Ginocchio LA, Cornfeld D, Froemming AT, Gupta RT, Turkbey B, et al. Interobserver Reproducibility of the PI-RADS Version 2 Lexicon: A Multicenter Study of Six Experienced Prostate Radiologists. Radiology. 2016;280(3):793-804.

    PubMed  PubMed Central  Google Scholar 

  23. Borofsky S, George AK, Gaur S, Bernardo M, Greer MD, Mertan FV, et al. What Are We Missing? False-Negative Cancers at Multiparametric MR Imaging of the Prostate. Radiology. 2018;286(1):186-95.

    PubMed  Google Scholar 

  24. Muller BG, Shih JH, Sankineni S, Marko J, Rais-Bahrami S, George AK, et al. Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging. Radiology. 2015;277(3):741-50.

    PubMed  PubMed Central  Google Scholar 

  25. Benndorf M, Hahn F, Krönig M, Jilg CA, Krauss T, Langer M, et al. Diagnostic performance and reproducibility of T2w based and diffusion weighted imaging (DWI) based PI-RADSv2 lexicon descriptors for prostate MRI. Eur J Radiol. 2017;93:9-15.

    PubMed  Google Scholar 

  26. Rosenkrantz AB, Oto A, Turkbey B, Westphalen AC. Prostate Imaging Reporting and Data System (PI-RADS), Version 2: A Critical Look. AJR Am J Roentgenol. 2016;206(6):1179-83.

    PubMed  Google Scholar 

  27. Ullrich T. UCSF BLINDED MANUSCRIPT. 2020.

  28. Moran K, Breau RH, Cagiannos I, Lavallee LT, Morash C, O’Sullivan J, et al. Standardized reporting templates with mandatory reporting fields and “pick-list” options improve use of Prostate Imaging and Data Reporting System version 2 in clinical practice: A plan-do-study-act analysis. Can Urol Assoc J. 13. Canada2019. p. 212-4.

  29. Barrett T, Rajesh A, Rosenkrantz AB, Choyke PL, Turkbey B. PI-RADS version 2.1: one small step for prostate MRI. Clin Radiol. 2019;74(11):841-52.

  30. Barrett TaKHaBMaCPL. Macromolecular MRI contrast agents for imaging tumor angiogenesis. European Journal of Radiology. 2006;60(3):353-66.

    Google Scholar 

  31. Othman AE, Falkner F, Weiss J, Kruck S, Grimm R, Martirosian P, et al. Effect of Temporal Resolution on Diagnostic Performance of Dynamic Contrast-Enhanced Magnetic Resonance Imaging of the Prostate. Invest Radiol. 2016;51(5):290-6.

    PubMed  Google Scholar 

  32. Sun C, Chatterjee A, Yousuf A, Antic T, Eggener S, Karczmar GS, et al. Comparison of T2-Weighted Imaging, DWI, and Dynamic Contrast-Enhanced MRI for Calculation of Prostate Cancer Index Lesion Volume: Correlation With Whole-Mount Pathology. AJR Am J Roentgenol. 2019;212(2):351-6.

    PubMed  Google Scholar 

  33. Brizmohun Appayya M, Adshead J, Ahmed HU, Allen C, Bainbridge A, Barrett T, et al. National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection - recommendations from a UK consensus meeting. BJU Int. 2018;122(1):13-25.

    PubMed  PubMed Central  Google Scholar 

  34. Caglic I, Barrett T. Optimising prostate mpMRI: prepare for success. Clin Radiol. 2019;74(11):831-40.

    CAS  PubMed  Google Scholar 

  35. Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology. 1988;168(2):497-505.

    PubMed  Google Scholar 

  36. Vezyraki P, Vlachaki A, Baltogiannis D, Batistatou A, Tsampalas S, Y VS, et al. Impact of total PSA and percent free PSA in the differentiation of prostate disease: a retrospective comparative study implicating neoplastic and non-neoplastic entities. J buon. 2019;24(5):2107-13.

  37. Washino S, Okochi T, Saito K, Konishi T, Hirai M, Kobayashi Y, et al. Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patients. BJU Int. 2017;119(2):225-33.

    CAS  PubMed  Google Scholar 

  38. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203-13.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Bjurlin MA, Meng X, Le Nobin J, Wysock JS, Lepor H, Rosenkrantz AB, et al. Optimization of prostate biopsy: the role of magnetic resonance imaging targeted biopsy in detection, localization and risk assessment. J Urol. 2014;192(3):648-58.

    PubMed  PubMed Central  Google Scholar 

  40. Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, et al. Overdiagnosis and overtreatment of prostate cancer. Eur Urol. 2014;65(6):1046-55.

    PubMed  PubMed Central  Google Scholar 

  41. Puech P, Rouviere O, Renard-Penna R, Villers A, Devos P, Colombel M, et al. Prostate Cancer Diagnosis: Multiparametric MR-targeted Biopsy with Cognitive and Transrectal US-MR Fusion Guidance versus Systematic Biopsy--Prospective Multicenter Study. Radiology. 2013;268(2):461-9.

    PubMed  Google Scholar 

  42. Lo GC, Margolis DJA. Prostate MRI with PI-RADS v2.1: initial detection and active surveillance. Abdom Radiol (NY). 2019.

  43. Vourganti S, Rastinehad A, Yerram N, Nix J, Volkin D, Hoang A, et al. Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol. 2012;188(6):2152-7.

    PubMed  PubMed Central  Google Scholar 

  44. Faria R, Soares MO, Spackman E, Ahmed HU, Brown LC, Kaplan R, et al. Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS). Eur Urol. 2018;73(1):23-30.

    PubMed  PubMed Central  Google Scholar 

  45. de Rooij M, Crienen S, Witjes JA, Barentsz JO, Rovers MM, Grutters JP. Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective. Eur Urol. 2014;66(3):430-6.

    PubMed  Google Scholar 

  46. Cerantola Y, Dragomir A, Tanguay S, Bladou F, Aprikian A, Kassouf W. Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. Urol Oncol. 2016;34(3):119.e1-9.

    Google Scholar 

  47. Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L, et al. Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol. 2013;63(1):125-40.

    PubMed  Google Scholar 

  48. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2015;68(3):438-50.

    PubMed  Google Scholar 

  49. Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. Jama. 2015;313(4):390-7.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Bass EJ, Freeman A, Jameson C, Punwani S, Moore CM, Arya M, et al. Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK. BMJ Open. 2018;8(10):e024941.

    PubMed  PubMed Central  Google Scholar 

  51. Marzouk K, Ehdaie B, Vertosick E, Zappala S, Vickers A. Developing an effective strategy to improve the detection of significant prostate cancer by combining the 4Kscore and multiparametric MRI. Urol Oncol. 2019;37(10):672-7.

    PubMed  PubMed Central  Google Scholar 

  52. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019;76(3):340-51.

  53. Padhani AR, Barentsz J, Villeirs G, Rosenkrantz AB, Margolis DJ, Turkbey B, et al. PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway. Radiology. 2019:182946.

  54. Elsherif SB, Kuchana V, Aslam R, Kamat A, Bhosale PR, Klekers AR. Locally advanced prostate cancer imaging findings and implications for treatment from the surgical perspective. Abdom Radiol (NY). 2019.

  55. Dinh CV, Steenbergen P, Ghobadi G, Heijmink SW, Pos FJ, Haustermans K, et al. Magnetic resonance imaging for prostate cancer radiotherapy. Phys Med. 2016;32(3):446-51.

    PubMed  Google Scholar 

  56. Al-Hakeem Y, Raz O, Gacs Z, Maclean F, Varol C. Magnetic resonance image-guided focal laser ablation in clinically localized prostate cancer: safety and efficacy. ANZ J Surg. 2019;89(12):1610-4.

    PubMed  Google Scholar 

  57. Shropshire EL, Chaudhry M, Miller CM, Allen BC, Bozdogan E, Cardona DM, et al. LI-RADS Treatment Response Algorithm: Performance and Diagnostic Accuracy. Radiology. 2019;292(1):226-34.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA

    Silvina P. Dutruel, Sunil Jeph, Daniel J. A. Margolis & Natasha Wehrli

Authors
  1. Silvina P. Dutruel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunil Jeph
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel J. A. Margolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natasha Wehrli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel J. A. Margolis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dutruel, S.P., Jeph, S., Margolis, D.J.A. et al. PI-RADS: what is new and how to use it. Abdom Radiol 45, 3951–3960 (2020). https://doi.org/10.1007/s00261-020-02482-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02482-x

Keywords

Search

Navigation