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Updated: Mar 16, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review
Elmira Hassanzadeh1, Daniel I Glazer2, Ruth M Dunne2
1Department of Radiology, Surgical Planning Lab, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB1-L1-Room 050, Boston, MA, 02115, USA. elmitt@gmail.com.
Abstract:
The most recent edition of the prostate imaging reporting and data system (PI-RADS version 2) was developed based on expert consensus of the international working group on prostate cancer. It provides the minimum acceptable technical standards for MR image acquisition and suggests a structured method for multiparametric prostate MRI (mpMRI) reporting. T1-weighted, T2-weighted (T2W), diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging are the suggested sequences to include in mpMRI. The PI-RADS version 2 scoring system enables the reader to assess and rate all focal lesions detected at mpMRI to determine the likelihood of a clinically significant cancer. According to PI-RADS v2, a lesion with a Gleason score ≥7, volume >0.5 cc, or extraprostatic extension is considered clinically significant. PI-RADS v2 uses the concept of a dominant MR sequence based on zonal location of the lesion rather than summing each component score, as was the case in version 1. The dominant sequence in the peripheral zone is DWI and the corresponding apparent diffusion coefficient (ADC) map, with a secondary role for DCE in equivocal cases (PI-RADS score 3). For lesions in the transition zone, T2W images are the dominant sequence with DWI/ADC images playing a supporting role in the case of an equivocal lesion.
Insights
The Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) standardizes multiparametric MRI for prostate cancer detection. It uses a dominant sequence approach for lesion assessment, improving diagnostic accuracy for clinically significant cancers.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer diagnosis relies on accurate imaging interpretation.
- The Prostate Imaging Reporting and Data System (PI-RADS) provides standardized reporting for prostate MRI.
- PI-RADS version 2 (PI-RADS v2) is the latest expert consensus for multiparametric MRI (mpMRI).
Purpose of the Study:
- To outline the technical standards and reporting structure of PI-RADS v2.
- To explain the mpMRI sequences recommended by PI-RADS v2.
- To describe the PI-RADS v2 scoring system for assessing clinically significant prostate cancer.
Main Methods:
- PI-RADS v2 specifies minimum technical standards for MR image acquisition.
- Recommended mpMRI sequences include T1-weighted, T2-weighted (T2W), diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging.
- PI-RADS v2 employs a dominant MR sequence based on lesion location (DWI for peripheral zone, T2W for transition zone).
Main Results:
- PI-RADS v2 provides a structured method for mpMRI reporting.
- The scoring system assesses the likelihood of clinically significant cancer (Gleason score ≥7, volume >0.5 cc, or extraprostatic extension).
- The dominant sequence concept differs from PI-RADS v1, focusing on specific sequences for different prostate zones.
Conclusions:
- PI-RADS v2 offers a standardized approach to mpMRI for prostate cancer.
- The system aids in differentiating clinically significant cancers from insignificant ones.
- Understanding the dominant sequence concept is crucial for accurate PI-RADS v2 interpretation.
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