# PI-RADS — Prostate Imaging Reporting and Data System v2.1

> Assessment of clinically significant prostate cancer likelihood on multiparametric MRI, with the dominant sequence depending on zone.

**Situação:** vigente · **Órgão:** Próstata · **Órgão emissor:** ACR, ESUR, AdMeTech · **Versão:** v2.1 · **Ano:** 2019

## Procedência e vigência
- Família: léxico
- Tipo de lógica: matrix
- Modalidade: MRI
- Fonte primária: Turkbey B, Rosenkrantz AB, Haider MA, et al.. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2 (2019) — https://doi.org/10.1016/j.eururo.2019.02.033
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Use DWI/ADC as the dominant sequence in the peripheral zone and T2W in the transition zone. DCE only upgrades a peripheral-zone DWI score 3 to overall category 4 when positive; category and clinical management are separate decisions.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 1 | Very low likelihood of clinically significant cancer | Very low likelihood. With diagnostic sequences, a peripheral-zone lesion maps here when DWI/ADC score is 1; a transition-zone finding maps here when T2W score is 1, meaning a normal-appearing transition zone or a round completely encapsulated typical nodule. | PI-RADS v2.1 says biopsy should not be based on category 1 alone, but it does not prescribe management. Final action must incorporate PSA and other laboratory data, clinical history, examination, local expertise, and standards of care. | Clinically significant prostate cancer is highly unlikely to be present. This is a qualitative imaging likelihood, not a numeric patient-level probability or guarantee of absence. | ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-21; assessment-category meaning and management-scope paragraph p 10. | ✓ |
| 2 | Low | Low likelihood. In the peripheral zone, DWI/ADC score 2 determines overall category 2. In the transition zone, T2W score 2 remains category 2 when DWI/ADC is 3 or lower; T2W score 2 with DWI/ADC 4 or 5 instead upgrades to category 3. | PI-RADS v2.1 says biopsy should not be based on category 2 alone, but it does not prescribe management. A clinically discordant negative MRI still requires patient-level assessment rather than automatic reassurance. | Clinically significant prostate cancer is unlikely to be present. The category reflects mpMRI appearance only and must not absorb PSA, digital rectal examination, history, or treatment plans. | ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-21; transition-zone matrix p 11 and management-scope paragraph p 10. | ✓ |
| 3 | Intermediate, equivocal | Intermediate or equivocal likelihood. In the peripheral zone, DWI/ADC score 3 remains category 3 when DCE is negative and upgrades to category 4 when DCE is positive. In the transition zone, category 3 results from T2W score 2 with DWI/ADC at least 4, or T2W score 3 with DWI/ADC no greater than 4. | Biopsy may or may not be appropriate. PI-RADS v2.1 supplies no PSA-density cutoff or fixed follow-up interval; the decision must use factors outside mpMRI, including laboratory and clinical history, local expertise, and standards of care. | The presence of clinically significant prostate cancer is equivocal. Category 3 is deliberately an uncertainty state and does not itself justify a deterministic biopsy or surveillance instruction. | ACR/ESUR/AdMeTech PI-RADS v2.1 assessment-category and management-scope text p 10; peripheral- and transition-zone matrices p 11; DCE definition/caveats pp 22-23. | ✓ |
| 4 | High | High likelihood. In the peripheral zone, DWI/ADC score 4 maps to category 4, as does DWI/ADC score 3 with positive focal DCE. In the transition zone, T2W score 4 maps here, and T2W score 3 upgrades here only when DWI/ADC is 5. Score-4 morphology or diffusion restriction is under 15 mm unless definite extraprostatic extension is present. | Biopsy should be considered, but PI-RADS v2.1 does not make it mandatory and does not prescribe the biopsy strategy. Final management must incorporate laboratory and clinical history, local expertise, and standards of care. | Clinically significant prostate cancer is likely to be present. The category is a qualitative imaging likelihood and should remain separate from patient-level pretest probability and management. | ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-23; management-scope paragraph p 10 and zone matrices p 11. | ✓ |
| 5 | Very high | Very high likelihood. In the peripheral zone, DWI/ADC score 5 determines category 5; in the transition zone, T2W score 5 determines category 5. The defining score-5 lesion is at least 15 mm in greatest dimension with score-4 features, or shows definite extraprostatic extension or invasive behavior. | Biopsy should be considered, but PI-RADS v2.1 does not make it mandatory and does not prescribe downstream treatment. Final management must incorporate laboratory and clinical history, local expertise, and standards of care. | Clinically significant prostate cancer is highly likely to be present. This is the highest qualitative PI-RADS likelihood category, not a histopathologic diagnosis or a fixed percentage. | ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-21; assessment-category meaning and management-scope paragraph p 10. | ✓ |

### Citações por categoria
- **1**: Turkbey B, Rosenkrantz AB, Haider MA, et al.. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2 (2019) — https://doi.org/10.1016/j.eururo.2019.02.033 · ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-21; assessment-category meaning and management-scope paragraph p 10.
- **2**: Turkbey B, Rosenkrantz AB, Haider MA, et al.. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2 (2019) — https://doi.org/10.1016/j.eururo.2019.02.033 · ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-21; transition-zone matrix p 11 and management-scope paragraph p 10.
- **3**: Turkbey B, Rosenkrantz AB, Haider MA, et al.. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2 (2019) — https://doi.org/10.1016/j.eururo.2019.02.033 · ACR/ESUR/AdMeTech PI-RADS v2.1 assessment-category and management-scope text p 10; peripheral- and transition-zone matrices p 11; DCE definition/caveats pp 22-23.
- **4**: Turkbey B, Rosenkrantz AB, Haider MA, et al.. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2 (2019) — https://doi.org/10.1016/j.eururo.2019.02.033 · ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-23; management-scope paragraph p 10 and zone matrices p 11.
- **5**: Turkbey B, Rosenkrantz AB, Haider MA, et al.. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2 (2019) — https://doi.org/10.1016/j.eururo.2019.02.033 · ACR/ESUR/AdMeTech PI-RADS v2.1 pp 10-11, 18, and 20-21; assessment-category meaning and management-scope paragraph p 10.

## Referências cruzadas
- _fronteira compartilhada_ → [BI-RADS — Breast Imaging Reporting and Data System, 5th edition](https://radcommons.laudos.ai/systems/bi-rads-2013.md) — Shares the Reporting and Data System framework that BI-RADS established.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2019-03-01 | revised | PI-RADS v2.1 published, updating v2 (2015). | confirmed |


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