Calculate Pi rads v2 1 | CMS & Clinical Guidelines

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PI-RADS v2.1 Assessment

Lesion Characteristics

Lesion Location

DWI Score (Dominant Sequence for PZ)

Awaiting Sequences

Select the lesion location and provide the required mpMRI sequence scores to calculate the PI-RADS category.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

When to Use PI-RADS v2.1

Multiparametric prostate MRI (mpMRI) in biopsy-naïve men with elevated PSA or abnormal digital rectal exam (DRE)

Prior negative systematic biopsy with persistent clinical suspicion of prostate cancer

Active surveillance of low-risk prostate cancer to detect progression

Staging of known prostate cancer (local extent, extraprostatic extension, seminal vesicle invasion)

Preoperative planning for radical prostatectomy or focal therapy

Post-treatment assessment in select cases (though not primary indication for v2.1)

Risk stratification to guide targeted biopsy vs systematic biopsy vs surveillance

Definition of Clinically Significant Prostate Cancer (csPCa)

For PI-RADS v2.1 purposes, csPCa is defined as: • Gleason score ≥ 7 (ISUP Grade Group ≥ 2), including 3+4 with prominent Gleason 4 component • AND/OR tumor volume > 0.5 cm³ • AND/OR extraprostatic extension (EPE)

Patient Preparation and Technical Requirements

3T scanner preferred (1.5T acceptable with endorectal coil in some cases)

No endorectal coil required at 3T for diagnostic quality

Interval of at least 6 weeks after prostate biopsy to minimize hemorrhage artifact

Antispasmodics (e.g., glucagon) to reduce bowel motion artifact

Multiparametric protocol: T2-weighted (T2W), Diffusion-weighted imaging (DWI) with ADC map, Dynamic contrast-enhanced (DCE)

High b-value DWI (≥1400 s/mm²) mandatory

Last Comprehensive Review: 2026