PI-RADS 2.1 – Image Interpretation: The Most Important Updates and Their Clinical Implications

Abstract

Background Multiparametric magnetic resonance imaging (MRI) of the prostate plays a central role in the diagnosis of patients with suspected prostate cancer. The increasing distribution and application of the guideline for the standardization of image acquisition, evaluation, and reporting (Prostate Imaging – Reporting and Data System, PI-RADS), which was updated in 2019 to version 2.1, contributes to the success of the technique. Materials and Methods The most important updates of PI-RADS version 2.1 presented in 2019 compared to the previous version PI-RADS 2.0 are highlighted and interpreted with regard to their clinical implications. Results PI-RADS version 2.1 aims to simplify the application of the scoring scheme without changing the basic concept of dominant sequences (DWI in the peripheral zone, T2 in the transition zone). Of particular importance are the increasing role of diffusion-weighted imaging in the transition zone, the now mandatory high b-value of at least 1400 s/mm2, and new information on the assessment of the central zone and the anterior fibromuscular stroma. Conclusion PI-RADS version 2.1 published in 2019 addresses a number of changes to the previous version, including both the examination technique and image interpretation. Prospective clinical studies have yet to prove the extent to which the goals of reducing interreader variability and increasing the detection rate in the transition zone will be achieved. Key Points:  Citation Format