PI-RADS 2.1 – Befundinterpretation: Die wichtigsten Neuerungen und ihre klinischen Implikationen

Zusammenfassung

Hintergrund Die multiparametrische Magnetresonanztomografie (MRT) der Prostata übernimmt inzwischen eine zentrale Rolle in der Diagnostik bei Patienten mit Verdacht auf Prostatakarzinom. Zum Erfolg der Methode trägt die zunehmende Verbreitung der zuletzt im Jahr 2019 auf die Version 2.1 aktualisierte Leitlinie zur Standardisierung von Bildakquisition, Auswertung und Befundung (Prostate Imaging – Reporting and Data System, PI-RADS) bei.

Material und Methoden Die zentralen Neuerungen der im Frühjahr 2019 vorgestellten PI-RADS-Version 2.1 gegenüber der Vorgängerversion PI-RADS 2.0 werden vorgestellt und bezüglich ihrer klinischen Implikationen diskutiert.

Ergebnisse Die PI-RADS-Version 2.1 zielt darauf ab, die Anwendung zu vereinfachen, ohne dabei das Grundkonzept der dominanten Sequenz (DWI in der peripheren Zone, T2 in der Transitionszone) zu ändern. Von besonderer Bedeutung sind die stärkere Gewichtung der Diffusionsbildgebung in der Transitionszone, der nun obligatorische hohe b-Wert von mindestens 1400 s/mm² und neue Hinweise zur Beurteilung der zentralen Zone und des anterioren fibromuskulären Stromas.

Schlussfolgerung Die 2019 veröffentlichte PI-RADS-Version 2.1 adressiert verschiedene Änderungen, die sowohl Untersuchungstechnik als auch Befundung betreffen. Inwieweit sich damit die Ziele der Reduktion der Interreader-Variabilität und der Erhöhung der Detektionsrate in der Transitionszone erreichen lassen, müssen prospektive klinische Studien zeigen.

Kernaussagen: 

• Die neue PI-RADS-Version 2.1 umfasst einzelne Änderungen bezüglich Befundinterpretation und Untersuchungstechnik.

• In der Transitionszone wird die Rolle der Diffusionsbildgebung gestärkt.

• Ein ultrahoher b-Wert von mindestens 1400 s/mm² ist nach PI-RADS 2.1 obligat.

• Die biparametrische MRT wird nicht zur generellen Anwendung empfohlen.

Zitierweise

• Beyer T, Schlemmer H, Weber M et al. PI-RADS 2.1 – Image Interpretation: The Most Important Updates and Their Clinical Implications. Fortschr Röntgenstr 2021; 193: 787 – 796

Key words

prostate - PI-RADS - prostate cancer - uroradiology - MR imaging

Publication History

Received: 04 March 2020

Accepted: 10 November 2020

Article published online:
21 December 2020

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