Purysko, AS; Baroni, RH; Giganti, F; Costa, D; Renard-Penna, R; Kim, CK; Raman, SS; (2020) PI-RADS Version 2.1: A Critical Review (AJR Special Series on Radiology Reporting and Data Systems). American Journal of Roentgenology 10.2214/AJR.20.24495. (In press).

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Abstract

TThe Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 provides updates to the technical parameters for multiparametric MRI (mpMRI) of the prostate, along with revisions to the imaging interpretation criteria, while maintaining the framework introduced in version 2. These changes have been considered an improvement, although some issues remain unresolved and new issues have emerged. Areas for improvement discussed in this review include: (1) need for more detailed mpMRI protocols, with optimization for 1.5T and 3T systems; (2) lack of validation of revised transition zone interpretation criteria and need for clarifications regarding the revised DWI and dynamic contrast-enhanced imaging criteria and central zone assessment; (3) need for systematic evaluation and reporting of background signal changes in the prostate that can negatively affect cancer detection; (4) creation of a new category for lesions that do not fit into the PI-RADS assessment categories (i.e., PI-RADS “M” category); (5) inclusion of quantitative parameters beyond size to evaluate lesion aggressiveness; (6) adjustments to the structured report template, including a standardized assessment of the risk of extraprostatic extension; (7) development of parameters for image quality and performance control; and (8) suggestions for expansion of the system to other indications (e.g., active surveillance and recurrence).

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