,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,贵州省人民医院,放射科,*,/28,贵州省人民医院 放射科,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Prostate Imaging Reporting and Data System,（,PI-RADS Version 2,）,Tang lei,Prostate Imaging Reporting and,Introduction,Prostate cancer is the second most common cancer in men worldwide.Two thirds of prostate cancer cases are diagnosed in more developed regions of the world,Presently,MRI became the best method of choice for detection and staging of prostate cancer,MRI not only offers an excellent resolution of the prostatic gland,but also evaluates locoregional extension,pelvic lymph nodes involvement and bone metastases in the pelvis,IntroductionProstate cancer i,PI-RADS Version 1:Adapted from breast imaging,PI-RADS version 1 was published by the European Society of Urogenital Radiology(ESUR)in 2012,PI-RADS version 2:In 2014,，,it had been updated by a steering committee including the American College of Radiology(ACR),ESUR,and the AdMeTech Foundation,PI-RADS(Prostate Imaging Reporting and Data System),PI-RADS Version 1:Adapted fro,Objectives of PI-RADS,The objectives of PI-RADS are to promote global standardisation of prostate imaging,to improve detection,localisation,characterisation,risk stratification of prostate cancer in treatment naive prostate as well as to improve communication with referring urologists,Objectives of PI-RADSThe objec,Prostate Imaging Reporting and Data System,（,PI-RADS Version 2,）,Prostate Imaging Reporting and,I.Clinical significant prostate cancer,Prostate cancer is divided into clinically insignificant and significant prostate cancer,depending on its likelihood to affect a patients lifetime,Definition for,clinical significant prostate cancer,:,Pathology/histology with Gleason score 7,and/or volume 0.5 cc,and/or extra prostatic extension(EPE),I.Clinical significant prost,II.PI-RADS V1&V2,The first guideline paper was based on a summary score for each lesion assessed in different sequences of mp-MRI,consisting of T2WI,DWI,，,DCE-MRI and spectroscopy,In version 2,，,spectroscopy was omitted and DCE-MRI was attributed a minor role.In contrast to version 1,each lesion is attributed a single score based on findings of mp-MRI,PI-RADS V1:T2WI+DWI+DCE-MRI+,MRS,PI-RADS V2:T2WI+DWI+DCE-MRI,II.PI-RADS V1&V2The first,III.MRI protocol,MRI of the prostate is performed according to the PI-RADS V2 guidelines on a,3.0 T scanner with an endorectal coil,Recommended Approach:,plain MR+DWI+DCE-MR,High-resolution T2WI sequence:Axial,Coronal,Sagittal,A precontrast T1WI sequence is needed to exclude hemorrhage,Axial DWI sequence with b-values of,0 2000 s/mm,2,III.MRI protocolMRI of the,Score 1 Clinically significant disease is highly unlikely to be present,Score 2 Clinically significant cancer is unlikely to be present,Score 3 Clinically significant cancer is equivocal,Score 4 Clinically significant cancer is likely to be present,Score 5 Clinically significant cancer is highly likely to be present,PI-RADS(,5-point scale,),The PI-RADS version 2 assesses the likelihood of clinically significant prostate cancer on a 5-point scale for each lesion as follows:,Score 1 Clinically signifi,PI-RADS V2 uses Partition Model to divide prostate,seminal vesicles and menlibranous urethra,There are 39 regions,including 36 prostatic regions,2 seminal vesicles and 1 menlibranous urethra,V.Sctor maps for division of prostatic regions,PI-RADS V2 uses Partition Mode,PZ:Peripheral zone,CZ:Central zone,TZ,：,Transition zone,AS,：,anterior stroma,V.Sctor maps for division of prostatic regions,PZ:Peripheral zoneV.Sctor m,The predominant sequence is DWI in the peripheral zone and T2WI sequence in the transition zone,In case of PI-RADS assessment category 3 in the peripheral zone,DCE-MRI determines the final PI-RADS assessment category,and in PI-RADS assessment category 3 in the transition zone,DWI determines the final PI-RADS assessment category,VI.Image interpretation,The predominant sequence is DW,PI-RADS-V2-影像英语课件,PI-RADS-V2-影像英语课件,Case 1,Case 1,Case1,Clinical Notes:,PSA last year:31.4 ng/ml.Actual PSA:27.5 ng/ml;One year previous:prostate biopsy revealed no cancer.,MR Findings:,Enlarged prostate of circa 43 ml(44 mm 51 mm 37 mm 0.52).,Transition zone:Midlevel on T2WI image depicts a focal lesion of 20 mm maximal extension(white arrows).,Case1Clinical Notes:,PI-RADS-V2-影像英语课件,Case1,DWI:,The lesion shows a high signal intensity in the anterior fibromuscular stroma and the left anterior transition zone on the high b-value DWI image(white arrowheads)with corresponding low signal intensity on the ADC map(black arrowheads)(ADC 580 10,6,mm,2,/s).,Case1DWI:,PI-RADS-V2-影像英语课件,DCE-MRI is rated positive,showing a focal enhancement,earlier than adjacent prostate tissue(black arrows).,No suspicious locoregional or pelvic lymph nodes.No suspicious bone lesions.No additional findings.,Conclusion:,Clinically significant prostate cancer is highly likely to be present in the anterior fibromuscular stroma and in the left anterior transit