Diffusion-Weighted Imaging and Multiparametric Prostate MRI in the Differentiation of PI-RADS 3, 4, and 5 Peripheral Zone Lesions

Year 2026, Volume: 21 Issue: 1 , 15 - 22 , 28.03.2026

Abdullah Enes Berksoy , Kamil Doğan , Adem Doğaner

https://doi.org/10.17517/ksutfd.1686570

https://izlik.org/JA57CS85HC

Abstract

Objective: PI-RADS (Prostate Imaging Reporting and Data System, Version) categorization based on multiparametric magnetic resonance imaging is an accepted method that has been revised several times for the early detection of prostate cancer. PI-RADS 2.1 is a scoring system designed to standardize assessment between centers. Based on the experience gained after the announcement of PI-RADS 2.0, version 2.1 offers important updates and clarifications, although it is an active scoring that continues to be updated. However, even the latest revision has introduced subjective concepts such as mild or marked. Improving the categorization may involve reorganization with objective numerical data. Continued advances in the study of prostate cancer and innovations in imaging technology will undoubtedly shape the future version of the reporting system. Material and Methods: Digital ADC (Apparent diffusion coefficient) mapping measurements, the basis of PI-RADS categorization for the peripheral zone, were determined in 91 pathologically diagnosed peripheral zone lesions with PI-RADS categories 3, 4, and 5. The mean values of these lesions were measured on ADC imaging, including at least 5 mm in the most prominent slice in the axial plane. Results: Statistically significant numerical cut-off values were determined based on ADC mapping characteristics, and an objective value was obtained that can be used instead of the terms mild or prominent in peripheral zone lesions. Conclusion: The obtained cut-off can be used in the scoring of peripheral zone lesions by predicting the malignancy risk of the lesion. The data obtained can also be used to revise the PI-RADS categorization. Thus, the accuracy of both the radiologist and the clinician can be proven. In addition, unnecessary biopsies can be prevented.

Keywords

PI-RADS , multiparametric prostate MRI , diffusion weighted imaging , ADC mapping , prostate cancer.

Periferik Zon Lezyonlarında PI-RADS 3, 4 ve 5 Ayrımında Difüzyon Ağırlıklı Görüntüleme ve Multiparametrik Prostat MR

https://izlik.org/JA57CS85HC

Abstract

Amaç: Multiparametrik manyetik rezonans görüntülemeye dayalı PI-RADS (Prostate Imaging Reporting and Data System) kategorizasyonu, prostat kanserinin erken saptanmasında kabul görmüş bir yöntem olup çeşitli revizyonlardan geçmiştir. PI-RADS 2.1, merkezler arası değerlendirmeyi standardize etmeyi amaçlayan bir skorlama sistemidir. PI-RADS 2.0 sonrası kazanılan deneyime dayanarak geliştirilen 2.1 sürümü önemli güncellemeler ve açıklamalar sunmakla birlikte, güncellenmeye devam eden dinamik bir yapıya sahiptir. Bununla birlikte, en güncel revizyonda dahi “hafif” veya “belirgin” gibi öznel kavramlar yer almaktadır. Kategorizasyonun iyileştirilmesi, objektif sayısal verilerle yeniden düzenlemeyi gerektirebilir. Prostat kanseri araştırmalarındaki ilerlemeler ve görüntüleme teknolojisindeki yenilikler, raporlama sisteminin gelecekteki sürümlerini şekillendirecektir. Gereç ve Yöntemler: Periferik zon kategorizasyonunun temelini oluşturan dijital ADC (Apparent Diffusion Coefficient) haritalama ölçümleri, patolojik olarak tanı almış PI-RADS 3, 4 ve 5 kategorilerindeki 91 periferik zon lezyonunda gerçekleştirildi. Ortalama ADC değerleri, aksiyel planda en belirgin kesitte en az 5 mm’lik alanı kapsayacak şekilde ölçüldü. Bulgular: ADC haritalama özelliklerine dayalı olarak istatistiksel açıdan anlamlı sayısal eşik (cut-off) değerleri belirlendi ve periferik zon lezyonlarında “hafif” veya “belirgin” tanımlamaları yerine kullanılabilecek objektif bir değer elde edildi. Sonuç: Elde edilen eşik değer, periferik zon lezyonlarının malignite riskinin öngörülmesine dayalı skorlama sürecinde kullanılabilir. Bu veriler, PI-RADS kategorizasyonunun revizyonuna katkı sağlayabilir. Böylece hem radyolog hem de klinisyen açısından tanısal doğruluk artırılabilir ve gereksiz biyopsilerin önüne geçilebilir.

Keywords

PI-RADS , multiparametrik prostat MRG , difüzyon ağırlıklı görüntüleme , ADC haritalama , prostat kanseri.

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