PI-RADS-V2-影像英语课件

ProstateImagingReportingandDataSystem（PI-RADSVersion2）TangleiIntroductionProstatecanceristhesecondmostcommoncancerinmenworldwide.TwothirdsofprostatecancercasesarediagnosedinmoredevelopedregionsoftheworldPresently,MRIbecamethebestmethodofchoicefordetectionandstagingofprostatecancerMRInotonlyoffersanexcellentresolutionoftheprostaticgland,butalsoevaluateslocoregionalextension,pelviclymphnodesinvolvementandbonemetastasesinthepelvisPI-RADSVersion1:Adaptedfrombreastimaging,PI-RADSversion1waspublishedbytheEuropeanSocietyofUrogenitalRadiology(ESUR)in2012PI-RADSversion2:In2014，ithadbeenupdatedbyasteeringcommitteeincludingtheAmericanCollegeofRadiology(ACR),ESUR,andtheAdMeTechFoundationPI-RADS

(ProstateImagingReportingandDataSystem)

ObjectivesofPI-RADSTheobjectivesofPI-RADSaretopromoteglobalstandardisationofprostateimaging,toimprovedetection,localisation,characterisation,riskstratificationofprostatecancerintreatmentnaiveprostateaswellastoimprovecommunicationwithreferringurologistsProstateImagingReportingandDataSystem（PI-RADSVersion2）I.ClinicalsignificantprostatecancerProstatecancerisdividedintoclinicallyinsignificantandsignificantprostatecancer,dependingonitslikelihoodtoaffectapatient’slifetimeDefinitionforclinicalsignificantprostatecancer:

●Pathology/histologywithGleasonscore≥7

●and/orvolume≥0.5cc

●and/orextraprostaticextension(EPE)II.PI-RADSV1&V2Thefirstguidelinepaperwasbasedonasummaryscoreforeachlesionassessedindifferentsequencesofmp-MRI,consistingofT2WI,DWI，DCE-MRIandspectroscopyInversion2，spectroscopywasomittedandDCE-MRIwasattributedaminorrole.Incontrasttoversion1,eachlesionisattributedasinglescorebasedonfindingsofmp-MRIPI-RADSV1:T2WI+DWI+DCE-MRI+MRSPI-RADSV2:T2WI+DWI+DCE-MRIIII.MRIprotocolMRIoftheprostateisperformedaccordingtothePI-RADSV2guidelinesona3.0TscannerwithanendorectalcoilRecommendedApproach:plainMR+DWI+DCE-MRHigh-resolutionT2WIsequence:Axial,Coronal,SagittalAprecontrastT1WIsequenceisneededtoexcludehemorrhageAxialDWIsequencewithb-valuesof0~2000s/mm2Score1Clinicallysignificantdiseaseishighlyunlikelytobepresent

Score2Clinicallysignificantcancerisunlikelytobepresent

Score3ClinicallysignificantcancerisequivocalScore4Clinicallysignificantcancerislikelytobepresent

Score5Clinicallysignificantcancerishighlylikelytobepresent

PI-RADS(5-pointscale)

ThePI-RADSversion2assessesthelikelihoodofclinicallysignificantprostatecancerona5-pointscaleforeachlesionasfollows:PI-RADSV2usesPartitionModeltodivideprostate,seminalvesiclesandmenlibranousurethraThereare39regions,including36prostaticregions,2seminalvesiclesand1menlibranousurethraV.SctormapsfordivisionofprostaticregionsPZ:PeripheralzoneCZ:CentralzoneTZ：TransitionzoneAS：anteriorstromaV.SctormapsfordivisionofprostaticregionsThepredominantsequenceisDWIintheperipheralzoneandT2WIsequenceinthetransitionzoneIncaseofPI-RADSassessmentcategory3intheperipheralzone,DCE-MRIdeterminesthefinalPI-RADSassessmentcategory,andinPI-RADSassessmentcategory3inthetransitionzone,DWIdeterminesthefinalPI-RADSassessmentcategoryVI.ImageinterpretationCase1Case1ClinicalNotes:

PSAlastyear:31.4ng/ml.ActualPSA:27.5ng/ml;Oneyearprevious:prostatebiopsyrevealednocancer.MRFindings:

Enlargedprostateofcirca43ml(44mm×51mm×37mm×0.52).Transitionzone:MidlevelonT2WIimagedepictsafocallesionof20mmmaximalextension(whitearrows).Case1DWI:Thelesionshowsahighsignalintensityintheanteriorfibromuscularstromaandtheleftanteriortransitionzoneonthehighb-valueDWIimage(whitearrowheads)withcorrespondinglowsignalintensityontheADCmap(blackarrowheads)(ADC~580×10−6mm2/s).DCE-MRIisratedpositive,showingafocalenhancement,earlierthanadjacentprostatetissue(blackarrows).Nosuspiciouslocoregionalorpelviclymphnodes.Nosuspiciousbonelesions.Noadditionalfindings.Conclusion:

Clinicallysignificantprostatecancerishighlylikelytobepresentintheanteriorfibromuscularstromaandintheleftanteriortransitionzoneinthemidlevel,withgreatestdimension≥1.5cmcorrespondingtoPI-RADS5.Score5：ClinicallysignificantcancerishighlylikelytobepresentHistology:PCa,Gleasonscore4+3=7Case1Case2Case2ClinicalNotes:KnownprostatecancerGleason6underactivesurveillancediagnosed1yearago.PSA5.4ng/ml.Underα1-adrenergicreceptortherapyforBPH.MRFindings:Enlargedprostateofcirca48ml(58mm×38mm×42mm×0.52).T2WI:lesionof9mmmaximalextension(whitearrow)atthemid-levelintheanteriorhalfontherightwithheterogeneous,indistincttriangular,signalintensitywithobscuredmarginswithmildhypointensesignal.Case2DWI:Thelesionisshowingmildlyhyperintensesignalonhighb-valueDWIimage(whitearrowhead)andmoderatesignalintensityonADCmap(b