Summarise the main features of PI-RADS v2 Highlight the key differences between PI-RADS v1 and v2 Describe and illustrate the technical considerations, PI-RADS v2 assessment and reporting Explore and discuss PI-RADS v2 limitations and future directions

Multi-parametric magnetic resonance imaging (mpMRI) has been validated in the detection and characterization of prostate tumours and can help in risk stratification and treatment selection. In 2012, the European Society of Urogenital Radiology (ESUR) established the Prostate Imagingd Reporting and Data System (PI-RADS) guidelines with the aim of standardising the acquisition, interpretation and reporting of prostate MRI. In 2014, a joint committee formed by the ACR, ESUR, and the AdMeTech Foundation announced an updated version (PI-RADS v2). Prostatic mpMRI indications: Local staging Cancer detection (with...

1. Prostatic mpMRI technique Patient preparation: Antispasmodic agents- recommended but not obligatory (adverse effects) Previous evacuation Ventral decubitus may be indicated in the presence of rectal gas (reduces the artifacts) NOTE: In the case of a prior biopsy, haemorrhage may influence image interpretation, specially when the mpMRI is performed for local staging (recommended interval of 6 weeks). Technical considerations: Magnetic field 1.5T or 3T (preference for the 3T) Endorrectal antenna is not necessary - More time and cost - Deforms the gland - More artifacts...

PI-RADS v2 should be used in conjunction with other resources in the evaluation and risk assessment of patients with suspected PCa prior to or after transrectal ultrasound biopsy. Improved risk management with better identification of significant versus insignificant cancers may lead to more specific and individualised treatment options and less overtreatment of indolent disease. Outcome data derived from MRI-targeted biopsies are needed to develop new nomograms that define patients’ risk on the basis of clinical variables in combination with overall PI-RADS v2 assessment categories. PI-RADS...

Auer T, Edlinger M, Bektic J, Nagele U, Herrmann T, Schäfer G, Aigner F, Junker D. Performance of PI-RADS version 1 versus version 2 regarding the relation with histopathological results. World J Urol. 2016 Aug 10 Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F et al. Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use. Eur Urol. 2016 Jan;69(1):41-9 Barrett T, Turkbey B, Choyke PL. PI-RADS version 2: what you need to know. Clin...