Should PI-RADS 3 be Subclassified According to ADC Values in the Transition Zone?

The premise of this paper starts from the fact that a more precise definition related to the intensity of the lesions on the ADC sequence can lead to a new subclassification of PI-RADS 3 lesions in the transitional zone and to an improvement of the specificity of the PI-RADS classification. The study was retrospective and included only patients who, based on prostate MRI examinations, contained exclusively PI-RADS 3 lesions, without other PI-RADS 4 or 5 lesions. The number of cases that meet all these conditions was reduced to 18, where a series of characteristics were noted for each one: PI-RADS 3 lesion area on the ADC sequence, the minimum and average ADC value of the lesion, the average ADC value of the transitional zone outside the lesion, PSA, prostatic volume, PSA density and biopsy result. The average ADC value of the negative lesions was 865(165) m2/sec, and of the positive ones was 869(118) m2/sec, which denies the hypothesis that there could be a value limit ADC to delimit PI-RADS 3 from PI-RADS 2 or 4 in this sample of patients. Furthermore, we reported the average ADC value of each such lesion to the adjacent unchanged transitional zone and obtained a greater difference of 432(163) m2/sec between the negative lesions and their adjacent transitional zone, compared to the difference of 399(127) m2/sec between the positive lesions and their adjacent ones.