Prostate Cancer - PI-RADS v2.1
前列腺癌 - PI-RADS v2.1

The PI-RADS assessment categories are based on the findings of multiparametric MRI, which is a combination of T2-weighted (T2W), diffusion weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging.
PI-RADS 评估类别基于多参数 MRI 的结果，多参数 MRI 是 T2 加权 （T2W）、弥散加权成像 （DWI） 和动态对比增强 （DCE） 成像的组合。
It is an accurate tool in the detection of clinically significant prostate cancer.
它是检测具有临床意义的前列腺癌的准确工具。

In PI-RADS v2.1 clinically significant cancer is defined on pathology as: 
在 PI-RADS v2.1 中，具有临床意义的癌症在病理学上定义为：

• Gleason score ≥ 7 - including 3+4 with prominent but not predominant Gleason 4 component and/or 
  格里森评分≥ 7 - 包括 3+4，格里森 4 分量突出但不占主导地位和/或
• Tumor volume > 0.5cc and/or 
  肿瘤体积>0.5cc和/或
• Extraprostatic extension (EPE).
  前列腺外延伸 （EPE）。

Gleason score 格里森评分
The Gleason score is used by pathologists to grade prostate cancers.
病理学家使用格里森评分对前列腺癌进行分级。
If the cancer cells and their growth patterns look very abnormal, a grade 5 is assigned. The Gleason score is the sum of the two most prevalent patterns.
如果癌细胞及其生长模式看起来非常异常，则分配 5 级。格里森评分是两种最普遍模式的总和。
These 2 grades are added to yield the Gleason score.
将这两个等级相加得出格里森分数。

The highest Gleason score therefore is 10.
因此，格里森的最高分是10分。
For example, if the Gleason score is written as 3+4=7, it means that most of the tumor is grade 3 and the second most common or most malignant grade is 4.
例如，如果格里森评分写成 3+4=7，则表示大多数肿瘤为 3 级，第二常见或最恶性为 4 级。

PI-RADS version 2.1 PI-RADS 版本 2.1

This is the PI-RADS version 2.1.
这是 PI-RADS 2.1 版。
Changes from the old version 2.0 are indicated in light red.
与旧版本 2.0 相比的更改以浅红色表示。

Assignment of a PI-RADS assessment category for each lesion is based on the scoring of T2W, DWI/ADC, and DCE sequences, according to zonal anatomy.
根据区域解剖学，根据 T2W、DWI/ADC 和 DCE 序列的评分，为每个病灶分配 PI-RADS 评估类别。
Since the dominant sequence for PI-RADS assessment in the peripheral zone is different from the transition zone, identification of the zonal location of a lesion is vital.
由于外周区 PI-RADS 评估的主要顺序与过渡区不同，因此确定病变的区域位置至关重要。

Peripheral zone (PZ) 外围区 （PZ）
The peripheral zone is situated on the posterior and lateral side of the prostate, surrounding the transition zone.
外周区位于前列腺的后侧和外侧，围绕过渡区。
For the peripheral zone the DWI/ADC is the primary determining sequence (dominant technique) to assign the PI-RADS assessment category.
对于外围区域，DWI/ADC 是分配 PI-RADS 评估类别的主要决定序列（主导技术）。
A lesion assessed as suspicion category 3 based on ADC/DWI, remains a PI-RADS score 3 if there is no focal enhancement (negative), however, it becomes a PI-RADS score 4 if there is focal enhancement (positive).
根据 ADC/DWI 评估为可疑类别 3 的病变，如果没有局灶性增强（阴性），则仍为 PI-RADS 评分 3，但如果有局灶性增强（阳性），则变为 PI-RADS 评分 4。

Changes in PI-RADS version 2.1:
PI-RADS 2.1 版中的更改：

• There is a more precise description of peripheral zone lesions in PI-RADS category 2 and 3. 
  PI-RADS 2 类和 3 类对外周区病变有更精确的描述。

Transition zone (TZ)
过渡区 （TZ）
The transition zone surrounds the prostatic urethra and enlarges in aging men as a result of benign prostatic hyperplasia.
过渡区围绕着前列腺尿道，由于良性前列腺增生，在老年男性中扩大。
For the transition zone the T2W imaging is the primary determining sequence (dominant technique) to assign the PI-RADS assessment category.
对于过渡区，T2W 成像是分配 PI-RADS 评估类别的主要决定序列（主要技术）。
A lesion assessed as category 2 based on T2W images remains PI-RADS score 2 if the DWI/ADC is ≤ 3, however it becomes PI-RADS score 3 if the DWI is ≥ 4.
如果 DWI/ADC ≤ 3，则根据 T2W 图像评估为 2 类的病变仍为 PI-RADS 评分 2，但如果 DWI ≥为 4，则变为 PI-RADS 评分 3。
A lesion assessed as category 3 based on T2W images remains PI-RADS score 3 if the DWI is ≤ 4, however, it becomes a PI-RADS score 4 if the DWI/ADC is score 5. 
如果 DWI ≤为 4，则根据 T2W 图像评估为 3 类的病变仍为 PI-RADS 评分 3，但是，如果 DWI/ADC 为 5 分，则变为 PI-RADS 评分 4。

Changes in PI-RADS version 2.1:
PI-RADS 2.1 版中的更改：

• Round, completely encapsulated nodules are now assigned as PI-RADS score 1. 
  圆形、完全包膜的结节现在被指定为 PI-RADS 评分 1。
• Lesions in the transition zone with a T2W score 2 remain a PI-RADS score 2 score if the DWI/ADC score is ≤ 3, however, they become a PI-RADS score 3 score if the DWI/ADC score is ≥ 4. 
  如果 DWI/ADC 评分为 ≤ 3，则 T2W 评分为 2 的过渡区病变仍然是 PI-RADS 评分 2 分，但是，如果 DWI/ADC 评分为 ≥ 4，则它们将成为 PI-RADS 评分 3 分。

Peripheral zone (PZ) 外围区 （PZ）
A lesion assessed as suspicion category 3 based on DWI/ADC, remains a PI-RADS score 3 if there is no focal enhancement (negative), however, it becomes a PI-RADS score 4 if there is focal enhancement (positive).
根据 DWI/ADC 评估为可疑类别 3 的病变，如果没有局灶性增强（阴性），则仍为 PI-RADS 评分 3，但如果有局灶性增强（阳性），则变为 PI-RADS 评分 4。

Transition zone (TZ) 过渡区 （TZ）
A lesion assessed as category 2 based on T2W images remains PI-RADS score 2 if the DWI/ADC is ≤ 3, however it becomes PI-RADS score 3 if the DWI is ≥ 4.
如果 DWI/ADC ≤ 3，则根据 T2W 图像评估为 2 类的病变仍为 PI-RADS 评分 2，但如果 DWI ≥为 4，则变为 PI-RADS 评分 3。
A lesion assessed as category 3 based on T2w images remains PI-RADS score 3 if the DWI is ≤ 4, however, it becomes a PI-RADS score 4 if the DWI/ADC is score 5. 
如果 DWI ≤为 4 分，则根据 T2w 图像评估为 3 类的病变仍为 PI-RADS 评分 3，但是，如果 DWI/ADC 为 5 分，则变为 PI-RADS 评分 4。

PI-RADS PI-RADS的

For the peripheral zone the DWI/ADC is the primary determining sequence to assign the PI-RADS assessment category.
对于外围区域，DWI/ADC 是分配 PI-RADS 评估类别的主要决定序列。

Peripheral zone - DWI/ADC category 1
外设区域 - DWI/ADC 类别 1

• No abnormality visible on ADC and high b-value DWI. 
  ADC上无可见异常，b值DWI较高。

Peripheral zone - DWI/ADC category 2
外设区域 - DWI/ADC 类别 2

• Linear/wedge shaped configurations with hypointensities on ADC and/or linear/wedge shaped hyperintensities on high b-value DWI.
  线性/楔形构型，ADC上具有低强度，/或线性/楔形高信号，高b值DWI上具有线性/楔形高信号。

Peripheral zone - DWI/ADC category 3
外设区域 - DWI/ADC 类别 3

• Focal (discrete and different from the background) hypointensity on ADC and/or focal hyperintensities on high 3 b-value DWI
  ADC 的局灶性（离散且与背景不同）低信号和/或高 3 b 值 DWI 的局灶性高信号
• May be markedly hypointensity on ADC or markedly hyperintensity on high b-value DWI, but not both. 
  ADC 上可能明显低信号，高 b 值 DWI 上可能明显高信号，但不能同时出现两者。
• A category 3 lesion  remains a PI-RADS score 3 if there is no focal enhancement (negative), but becomes a PI-RADS score 4 if the enhancement is focal.
  如果没有局灶性增强（阴性），则 3 类病变仍为 PI-RADS 评分 3，但如果增强为局灶性，则变为 PI-RADS 评分 4。

Peripheral zone - DWI/ADC category 4
外设区域 - DWI/ADC 类别 4

• Focal markedly hypointensity on ADC and markedly hyperintensity on high b-value DWI
  ADC 局灶性低信号和高 b 值 DWI 显著高信号
• <1.5cm in greatest dimension.
  最大尺寸<1.5厘米。

Peripheral zone - 
外围区域 -DWI/ADC category 5 DWI/ADC 类别 5

• Same as as assessment score 4 but ≥1.5cm in greatest dimension or
  与评估分数相同 4 分，但最大尺寸≥1.5 厘米或 
  
• Definite extraprostatic extension (EPE) or invasive behavior.
  明确的前列腺外延伸 （EPE） 或侵入性行为。

Examples of PI-RADS 1-5
PI-RADS 1-5 示例

Examples of PI-RADS scores 1-5 are given in the table.
表中给出了 PI-RADS 分数 1-5 的示例。

In the peripheral zone, the PI-RADS assessment category of a lesion is determined primarily on DWI/ADC and correlated to T2W- and DCE-images.
在外周区域，病变的 PI-RADS 评估类别主要根据 DWI/ADC 确定，并与 T2W 和 DCE 图像相关。

In the peripheral zone an equivocal or indeterminate lesion (category 3) is assigned to PI-RADS category 4 if DCE is positive, i.e focal or earlier contrast enhancement.
在外周区，如果 DCE 为阳性，即局灶性或更早的造影剂增强，则将模棱两可或不确定的病变（3 类）归入 PI-RADS 4 类。

The lesion remains assigned to PI-RADS category 3 if the DCE is negative, i.e. no early enhancement or diffuse enhancement and not corresponding to the focal T2W/DWI lesion or focal enhancement corresponding to BPH.
如果 DCE 为阴性，即没有早期增强或弥漫性增强，并且不对应于 BPH 的局灶性 T2W/DWI 病灶或局灶性增强，则病灶仍被归入 PI-RADS 3 类。

Prostate cancer in PZ
PZ 中的前列腺癌

For the peripheral zone the DWI/ADC is the primary determining sequence to assign the PI-RADS assessment category.
对于外围区域，DWI/ADC 是分配 PI-RADS 评估类别的主要决定序列。

First look at the images and describe what you see.
首先看一下图像并描述你所看到的。

A 16 mm lesion (measurement not shown) was detected and located dorsally in the peripheral zone of the mid-portion of the prostate on the right.
检测到一个 16 毫米的病变（未显示测量值），并位于右侧前列腺中部的外围区域。
This lesion was assigned to PI-RADS category 5, based on marked hypointensity on ADC and marked hyperintensity on DWI (score 5 - dominant sequence), correlated to markedly hypointensity on T2W (score 5).
根据 ADC 上明显的低信号和 DWI 上的显着高信号（评分 5 - 显性序列），该病变被分配到 PI-RADS 类别 5，与 T2W 上的显着低信号相关（评分 5）。
The Gleason score was 3+4, which means intermediate risk of an aggressive cancer.
格里森评分为3+4，这意味着侵袭性癌症的中等风险。
The lesion does not abut the pseudocapsule and there is no sign of extraprostatic growth.
病变不与假性包膜相邻，也没有前列腺外生长的迹象。

Suspicious lesions in the peripheral zone typically have the following characteristics on T2W-images:
外周区的可疑病变在 T2W 图像上通常具有以下特征：

• ill-defined 定义不清
• hypointense signal on ADC and T2w images
  ADC 和 T2w 图像上的低信号
  
  

Less suspicious features are the following characteristics on T2W-images:
T2W 图像上的以下特征是不太可疑的特征：

• bilateral 双边
• symmetry 对称
• diffusely distributed signal changes
  扩散分布的信号变化
• wedge shaped 楔形
• sharply demarcated foci of hypointensity
  低信号病灶清晰划定

First look at the images and then continue reading.
首先查看图像，然后继续阅读。

The findings are: 研究结果如下：

• A 17 mm lesion (measurement not shown) is located in the peripheral zone, dorsally on the left in the mid-portion of the prostate.
  一个 17 毫米的病变（未显示测量值）位于外周区，位于前列腺中部左侧背侧。
• It is markedly hypointense on ADC, and markedly hyperintens on DWI.
  ADC明显低信号，DWI明显高信号。
• It corresponds to a hypointense area on T2W.
  它对应于 T2W 上的低信号区域。
• On T2W there is broad-based contact with the capsula.
  在 T2W 上，与荚膜有广泛的接触。

This lesion was assigned to PI-RADS category 5 with suspicion of extraprostatic extension.
该病变被归入 PI-RADS 5 类，怀疑前列腺外延伸。
The Gleason score was 4+3.
格里森的得分是4+3。
This suspected lesion has significant diffusion restriction .
这种疑似病变具有明显的扩散受限。
The ADC measured 440 mm2/s.
ADC的测量值为440 mm2/s。
Low ADC values indicate a higher risk of malignancy.
低ADC值表明恶性肿瘤的风险较高。

The actual ADC value is inversely correlated to the likelihood of a clinically significant malignancy.
实际ADC值与临床上显著恶性肿瘤的可能性成反比。
Values above 900 mm2/s are considered likely benign and below 750 mm2/s likely malignant.
高于 900 mm2/s 的值被认为是良性的，低于 750 mm2/s 的值可能是恶性的。
However quantification results may vary substantially between scanners and protocols.
然而，不同扫描仪和实验方案的定量结果可能会有很大差异。

First look at the images and then continue reading.
首先查看图像，然后继续阅读。

The findings are: 研究结果如下：

• A lesion with PI-RADS assessment category 4 located in the left peripheral zone in the mid-portion of the prostate.
  PI-RADS 评估类别为 4 的病变位于前列腺中部的左侧外周区。
  Focal marked hypointensity on ADC (yellow arrow) (score 4), corresponding an hypointense area on T2W (score 4).
  ADC 上的局灶性低信号（黄色箭头）（4 分），对应于 T2W 上的低信号区域（4 分）。
  The Gleason score of this lesion was 3+4.
  该病变的格里森评分为3+4。

• A lesion with PI-RADS assessment category 3 is located in the right peripheral zone, with mild focal hypointensity on ADC (green arrow) with isointensity on DWI (score 3).
  PI-RADS 评估为 3 类的病变位于右侧外周区，ADC 上有轻度局灶性低信号（绿色箭头），DWI 上有等强度（评分 3）。

 No DCE was performed and no further discrimination could be determined. Biopsy did not show any sign of malignancy.
没有进行DCE，也无法确定进一步的歧视。活检未见任何恶性肿瘤体征。

PI-RADS PI-RADS的

Transitional zone - T2W category 1
过渡区 - T2W 类别 1

• Normal appearing TZ (rare) or
  正常出现 TZ（罕见）或 
• Round completely encapsulated nodule (“typical nodule”) 
  圆形完全包膜的结节（“典型结节”）
     

Transitional zone - T2W category 2
过渡区 - T2W 类别 2

• Mostly encapsulated nodule or
  多为包膜结节或
• Homogeneous circumscribed nodule without encapsulation. (“atypical nodule”) or
  均匀的边界结节，无包膜。（“非典型结节”）或 
• Homogeneous mildly hypointense area between nodules 
  结节之间均匀的轻度低信号区域
• If the DWI has a score 4 or more, then the lesion is categorized as PI-RADS category 3. 
  如果 DWI 的评分为 4 分或更高，则病变被归类为 PI-RADS 3 类。
  
   

Transitional zone - T2W category 3
过渡区 - T2W 类别 3

• Heterogeneous signal intensity with obscured margins
  边距模糊的异质信号强度
• Includes others that do not qualify as 2, 4, or 5
  包括不符合 2、4 或 5 条件的其他内容
• If the DWI has a score of <4, then the lesion is categorized as PI-RADS score 3.
  如果 DWI 评分为 <4，则病变被归类为 PI-RADS 评分 3。
• If the DWI has a score of 5, then the lesion is categorized as PI-RADS score 4.  
  如果 DWI 评分为 5，则病变被归类为 PI-RADS 评分 4。
  

Transitional zone - T2W category 4
过渡区 - T2W 类别 4

• Lenticular or non-circumscribed, homogeneous, moderately hypointense,
  透镜状或非外接线，均质，中度低信号，
• and <1.5 cm in greatest dimension  
  最大尺寸为 <1.5 厘米
  

Transitional zone - T2W category 5
过渡区 - T2W 类别 5

• Same as score 4, but ≥1.5cm in greatest dimension or
  与分数 4 相同，但最大尺寸≥1.5 厘米或 
• Definite extraprostatic extension or invasive behavior      
  明确的前列腺外延伸或侵入性行为

Examples of PI-RADS 1-5
PI-RADS 1-5 示例

In the transition zone, the PI-RADS assessment category of a lesion is determined primarily on T2W-images and then correlated to DWI/ADC.
在过渡区，病变的 PI-RADS 评估类别主要根据 T2W 图像确定，然后与 DWI/ADC 相关联。

Examples of PI-RADS categories 1-2 are given in the table.
表中给出了PI-RADS类别1-2的示例。
Click to enlarge the image.
点击放大图片。

In the transition zone an equivocal or indeterminate lesion (category 3) is assigned to PI-RADS category 4 if the DWI corresponds with score 5 (markedly intense greater than 1.5cm).
在过渡区，如果 DWI 与 5 分相对应（明显强烈大于 1.5cm），则将模棱两可或不确定的病变（3 类）归入 PI-RADS 4 类。

The lesion remains assigned to PI-RADS category 3 if the DWI corresponds to DWI score 4 (markedly intense but less than 1.5cm) or a lower score.
如果 DWI 对应于 DWI 评分 4（明显强烈但小于 1.5cm）或更低的评分，则病变仍被归入 PI-RADS 3 类。

Examples of PI-RADS categories 3-5 are given in the table.
表中给出了PI-RADS类别3-5的示例。
Click to enlarge the image.
点击放大图片。

Prostate cancer in TZ
TZ 中的前列腺癌

Suspicious lesions typically have the following characteristics:
可疑病变通常具有以下特征：

• non-circumscribed 无限制
• homogeneous 同质
• relatively hypointense 相对低强度
• smudged appearance on T2W images, sometimes mentioned as "erased charcoal" appearance.
  T2W 图像上的污迹外观，有时称为“擦除的木炭”外观。
• lenticular or droplet-like shape
  透镜状或液滴状
• spiculated margins. 针状边缘。

Images  图像
There is a lesion in the right anterior part of the transition zone.
过渡区的右前部有病变。
It has irregular margins on T2W images (score 4) and is focal markedly hypointense on ADC (680 mm/s) (score 4), not exceeding 15 mm in length.
它在 T2W 图像上有不规则的边缘（评分 4），在 ADC 上呈局灶性显着低信号 （680 mm/s）（评分 4），长度不超过 15 mm。
This lesion corresponds to a PI-RADS category 4.
该病变对应于 PI-RADS 类别 4。
MR-Ultrasound fusion-guided biopsy resulted in a Gleason 3+4.
MR-Ultrasound融合引导下活检结果为格里森3+4。

In the right peripheral zone there is a wedge-shaped slightly hypo-intense area (score 2) without suspicious chracteristics on DWI/ADC (score 2).
在右侧外周区有一个楔形、轻微的低强度区域（2 分），DWI/ADC 上没有可疑的 chracteristic（2 分）。
It was assigned as PIRADS category 2.This region is benign and has most likely glandular atrophy or focal inflammatory findings on histopathology.    
它被指定为 PIRADS 类别 2.该区域是良性的，最有可能有腺萎缩或组织病理学上的局灶性炎症发现。

High-grade tumors often reveal a lower T2W signal intensity than low-grade tumors.
与低级别肿瘤相比，高级别肿瘤的 T2W 信号强度通常较低。
Extension into the anterior fibromuscular stroma or the urethral sphincter can be seen.
可见延伸至前纤维肌间质或尿道括约肌。
In general, suspicious lesions in the transition zone are frequently challenging to distinguish from the surrounding hyperintense glandular and hypointense stromal tissue.
一般而言，过渡区的可疑病变通常难以与周围的高信号腺体和低信号基质组织区分开来。

Images 图像
There is a lesion located anteriorly in the midline, most likely in the anterior fibromuscular stroma at the junction of the base and the mid-portion of the prostate.
病变位于中线前方，最有可能位于前列腺基底和中段交界处的前纤维肌基质中。
There is no extraprostatic extension.
没有前列腺外延伸。
The lesion has irregular margins on T2W images with an "erased charcoal" appearance, exceeding 15 mm in maximum length (score 5) and is markedly hypointense on ADC (score 5).
病变在 T2W 图像上边缘不规则，具有“擦除的木炭”外观，最大长度超过 15 mm（评分 5），并且在 ADC 上明显低信号（评分 5）。
Category: PI-RADS 5. 类别： PI-RADS 5.
MR/Ultrasound fusion-guided biopsy resulted in a Gleason 3+4.
MR/超声融合引导下活检结果为格里森3+4。

Images 图像 
27mm lesion anterior in the apex of the transition zone, with an "erased charcoal" appearance.
27mm病变位于过渡区顶点前方，具有“擦除的木炭”外观。
This corresponds to an area of restricted diffusion with a droplet-shape.
这对应于具有液滴形状的受限扩散区域。

The lesion was scored a PIRADS category 5.
病变被评定为 PIRADS 5 类。
MR/Ultrasound fusion-guided biopsy resulted in a Gleason 3+4.
MR/超声融合引导下活检结果为格里森3+4。

The normal AFMS shows bilaterally symmetric shape (“crescentic”) and symmetric low signal intensity similar to that of the obturator or pelvic floor muscles on T2W, ADC, and high b-value DWI without early enhancement. 
正常AFMS在T2W、ADC和高b值DWI上显示双侧对称形状（“新月形”）和对称低信号强度，类似于闭孔或盆底肌肉的信号强度，而没有早期增强。

Since prostate cancer does not originate from the AFMS, when reporting a suspicious lesion in the AFMS, criteria for either the PZ or TZ should be applied, depending on the zone from which the lesion appears most likely to be originating. 
由于前列腺癌并非起源于AFMS，因此在AFMS中报告可疑病变时，应应用PZ或TZ的标准，具体取决于病变最有可能起源的区域。

This is an example of an adenocarcinoma involving the AFMS.
这是涉及AFMS的腺癌的一个例子。

Images 图像
T2W: The left anterior TZ zone shows a lenticular hypointense lesion.
T2W：左前TZ区显示透镜状低信号病变。
A focal markedly hyperintense region on DWI corresponds to hypointense focal markedly area on ADC.
DWI 上的局灶性显著高信号区域对应于 ADC 上的低信号显著局灶性区域。
DCE: The region of interest shows early enhancement.
DCE：感兴趣的区域显示出早期增强。

PI-RADS score: 4. PI-RADS得分：4。
Histopathology: Gleason score 4+4 following MRI fusion-guided targeted biopsy.
组织病理学：MRI 融合引导的靶向活检后 Gleason 评分为 4+4。

TNM-staging is based on clinical (c) and pathological (p) findings, and if indicated on additional imaging findings.
TNM 分期基于临床 （c） 和病理 （p） 结果，如果需要其他影像学检查结果。

For T-staging a prostate MRI is advised in:
对于 T 分期，建议在以下情况下进行前列腺 MRI：

• intermediate-risk prostate cancer (predominantly Gleason 4 pattern = ISUP ≥3)
  中危前列腺癌（主要是格里森 4 型 = ISUP ≥3）
• high-risk localized prostate cancer
  高危局限性前列腺癌
• locally advanced prostate cancer
  局部晚期前列腺癌

Nowadays there is increased utilization of prostate MRI in the primary diagnostic work-up.
如今，前列腺 MRI 在初级诊断检查中的使用率越来越高。

The table only shows the stages that are relevant for imaging.
该表仅显示与成像相关的阶段。

The full table is found here
完整的表格可以在这里找到

Locally advanced prostate cancer
局部晚期前列腺癌

The prostate does not have a true capsule.
前列腺没有真正的胶囊。
However on MRI the outer border of the prostate does have a thin, hypointense line, which is histopathologically composed of a fibromuscular band.
然而，在 MRI 上，前列腺的外缘确实有一条细的低信号线，在组织病理学上由纤维肌带组成。
This hypointense line can be used to assess extraprostatic tumor growth.
该低信号线可用于评估前列腺外肿瘤的生长。

The neurovascular bundles are located at the posterolateral aspect of the prostate (at the 5 and 7 o'clock position, see example on the left).
神经血管束位于前列腺的后外侧（在 5 点钟和 7 点钟位置，见左图）。
Involvement of the neurovascular bundle should be specifically reported, as nerve-sparing surgery will not be possible.
应特别报告神经血管束受累，因为无法进行保留神经的手术。

Scroll through the images of locally advanced prostate cancer.
滚动浏览局部晚期前列腺癌的图像。

There is a large lobulated tumor originating from the left prostate lobe infiltrating the mesorectum, the rectum as well as the left pelvic wall (i.e. T4).
有一个大的分叶肿瘤起源于左前列腺叶，浸润直肠系膜、直肠和左骨盆壁（即 T4）。

There are large para-iliac and mesorectal lymphnodes distributed mainly on the left side of the pelvis (i.e. at least N1).
大的髂旁淋巴结和直肠系系膜淋巴结主要分布在骨盆左侧（即至少N1）。

Left prostate needle biopsies proved localization of adenocarcinoma of the prostate.
左前列腺穿刺活检证实定位为前列腺腺癌。
Gleason score 9 (5 +4), volume percentage estimated 90%.
格里森得分 9 （5 +4），体积百分比估计为 90%。

The vascular insertion at both the base and apex are susceptible locations for extraprostatic extension.
底部和顶端的血管插入是前列腺外延伸的易感位置。
Seminal vesicle invasion can be observed by direct tumor extension into the vesicles.
通过肿瘤直接延伸到囊泡中，可以观察到精囊浸润。
Expansion of the vesicles, focal or diffuse low T2W signal intensity, abnormal contrast enhancement or restricted diffusion can also be features of involvement.
囊泡扩张、局灶性或弥漫性低 T2W 信号强度、对比度增强异常或扩散受限也可能是受累的特征。
In addition, involvement is likely present when the angle between the prostate base and the vesicle is obliterated.
此外，当前列腺基底和囊泡之间的夹角消失时，可能存在受累。
When the external urethra is involved at the apex, surgical excision can cause sphincter malfunction, resulting in incontinence.
当外尿道受累于尿道顶点时，手术切除会导致括约肌功能障碍，从而导致尿失禁。

Images 图像
The axial T2W-image at the level of the prostate base demonstrates low signal intensity replacing the normal signal intensity of the left peripheral zone, with direct tumor extension from the base of the prostate into both seminal vesicles (arrow).
前列腺基底水平的轴向 T2W 图像显示低信号强度取代了左侧外周区的正常信号强度，肿瘤从前列腺基部直接延伸到两个精囊（箭头）。
Restricted diffusion appears as an area of low signal intensity on the ADC map.
受限扩散在ADC图上显示为低信号强度区域。
Gleason score: 4+3. 格里森得分：4+3。

N-stage N级

DWI is the best sequence for detection of lymph nodes.
DWI是检测淋巴结的最佳序列。

T1W series are useful for interpretation of the border contour and signal characteristics of lymph nodes.
T1W系列可用于解读淋巴结的边界轮廓和信号特征。

MR has a low accuracy for distinguishing positive or negative lymph nodes if characterization is based on size alone.
如果仅根据大小进行表征，MR 在区分阳性或阴性淋巴结方面的准确性较低。

The following characteristics are considered suspicious:
以下特征被认为是可疑的：

• round shape and short axis of ≥8mm
  圆形，短轴≥8mm
• oval shape and short axis of ≥10mm
  椭圆形，短轴≥10mm
• heterogeneous appearance 异质外观
• irregular margins 边缘不规则

Regional lymph nodes (green) are below the level of the common iliac junction and are staged N1:
区域淋巴结（绿色）低于髂总交界处的水平，分期为 N1：

• pelvic 盆腔
• hypogastric 下腹部
• sacral 骶
• iliac (internal, external)
  髂骨（内髂、外髂）

Distant lymph nodes (red) are outside these regions and are staged as metastatic disease M1a:
远处淋巴结（红色）位于这些区域之外，并被分期为转移性疾病 M1a：

• aortic 主动 脉
• common iliac 髂总
• inguinal 腹股沟
• supraclavicular 锁骨上

Benign prostate hyperplasia
良性前列腺增生

Benign prostate hyperplasia (BPH) results in the formation of well-circumscribed, encapsulated nodules in the transition zone.
良性前列腺增生 （BPH） 导致在过渡区形成边界清楚、包裹的结节。
Some of these nodules have dense stroma with low T2W signal intensity and low ADC (yellow arrow).
其中一些结节具有致密的基质，具有低 T2W 信号强度和低 ADC（黄色箭头）。

The most important characteristic feature to distinguish BPH nodules from malignancy is the generally well-defined and well-circumscribed morphology interpreted in axial, coronal and sagittal series.
区分良性前列前列腺增生结节和恶性肿瘤的最重要特征是通常在轴向、冠状和矢状状序列中解释的轮廓明确且界限清楚的形态。

The left peripheral zone lesion was classified as PI-RADS 5 (red arrow).
左侧外周区病变被归类为 PI-RADS 5（红色箭头）。
MRI- targeted biopsy revealed a Gleason 3+4.
MRI靶向活检显示格里森3+4。

T2 hypointense BPH nodules can be less distinctly circumscribed within the transition zone and may show some degree of restricted diffusion.
T2 低信号性 BPH 结节在过渡区内的边界可能不太明显，并且可能表现出一定程度的扩散受限。
Also, these nodules tend to enhance early and intensely on DCE, making conclusive characterization difficult.
此外，这些结节往往在 DCE 早期强烈增强，使结论性表征变得困难。

Here a patient with BPH in the transition zone seen as heterogenous stroma with a large cystic area (arrow).
在这里，一名处于过渡区的 BPH 患者被视为具有大囊性区域的异质性基质（箭头）。

Biopsies showed chronic benign prostatitis.
活检显示慢性良性前列腺炎。

Not all nodules exist in the transition zone.
并非所有结节都存在于过渡区。
Some can be ectopic and may be found in the peripheral zone (arrow).
有些可能是异位的，可能在外周区发现（箭头）。
This entity shouldn’t be confused with prostate cancer. 
该实体不应与前列腺癌混淆。

BPH consists of a mixture of stromal and glandular hyperplasia and may appear as band-like areas and/or encapsulated round nodules with circumscribed or encapsulated margins. 
良性前列腺增生由基质和腺体增生的混合物组成，可能表现为带状区域和/或包膜的圆形结节，边缘有边界或包膜。

Image 图像
This coronal T2W image shows various types of BPH nodules.
这张冠状 T2W 图像显示了各种类型的 BPH 结节。

• glandular nodule (blue circle)
  腺结节（蓝色圆圈）
• atypical nodule (yellow circle)
  非典型结节（黄色圆圈）
• nodule in nodule (various smaller nodules inside contained in a larger nodule) (green circle).
  结节中的结节（大结节中包含各种较小的结节）（绿色圆圈）。

Predominantly glandular BPH nodules and cystic atrophy exhibit moderate-marked T2 hyperintensity and are distinguished from malignant tumors by their signal and capsule. 
以腺体 BPH 结节为主的结节和囊性萎缩表现出中度显著的 T2 高信号，并通过其信号和包膜与恶性肿瘤区分开来。

Image 图像
Axial T2W image shows a glandular BPH nodule with hyperintensity on T2W image surrounded by a capsule.
轴向 T2W 图像显示腺体 BPH 结节伴高信号，T2W 图像被包膜包围。

Prostatitis 前列腺炎

Prostatitis or rather inflammation is a common finding in men and can occur in the absense of any clinical history or symptoms.
前列腺炎或更确切地说是炎症是男性的常见发现，可以在没有任何临床病史或症状的情况下发生。
Prostatitis and other benign features like glandular fibrosis, scarring, atrophy and post-biopsy hemorrhage can mimic prostate cancer in the peripheral zone, since all present as a focus of low signal on ADC.
前列腺炎和其他良性特征（如腺体纤维化、瘢痕形成、萎缩和活检后出血）可以模仿外周区的前列腺癌，因为所有这些都表现为 ADC 上的低信号焦点。
However benign features mostly presents as a band-like or wedge-shaped or diffuse area of low signal intensity, while prostate cancer is more round or droplet-shaped.
然而，良性特征主要表现为低信号强度的带状或楔形或弥漫性区域，而前列腺癌则更呈圆形或液滴状。

The hypointensity on ADC in inflammatory prostatic tissue is usually not accompanied by hyperintensity on high b-value DWI series.
炎症性前列腺组织中ADC的低信号通常不伴有高信号，在高b值DWI系列中。
Also ADC values in prostate cancer tend to be lower than ADC levels in prostatitis.
此外，前列腺癌中的ADC值往往低于前列腺炎中的ADC水平。
On DCE there is increased enhancement, which is therefore not helpful in the differentiation.
在DCE上，增强增强，因此对分化没有帮助。
In case of chronic inflammation, concordant fibrosis and focal atrophy may be observed, which presents as focal retraction in the normal anatomic convexity of the peripheral zone.
在慢性炎症的情况下，可以观察到一致的纤维化和局灶性萎缩，表现为外周区正常解剖凸起的局灶性回缩。

Here we see the differences between prostatitis ( images on the left) and prostate cancer (images on the right).
在这里，我们看到前列腺炎（左图）和前列腺癌（右图）之间的区别。

Left 左
The images on the left show a wedge-shaped area of mild hypointensity on T2W and ADC with no concordant high signal on DWI located dorsally in the right peripheral zone of the midportion of the prostate (yellow arrow).
左图显示T2W和ADC上有一个楔形区域，轻度低信号，DWI上没有一致的高信号，位于前列腺中部中部右侧外周区的背侧（黄色箭头）。
This was interpreted as focal inflammation (PI-RADS category 2).
这被解释为局灶性炎症（PI-RADS 2 类）。
No biopsy performed. 未进行活检。

Right 右
The images on the right show a clinically significant prostate cancer with an ill-defined zone of markedly hypointensity on T2W and ADC and focal high signal intensity on DWI dorsally in the left peripheral zone (PI-RADS category 4).
右图显示具有临床意义的前列腺癌，T2W 和 ADC 上有一个不明确的明显低信号区域，左侧外周区背侧的 DWI 上具有局灶性高信号强度（PI-RADS 4 类）。

MRI-targeted biopsies showed a Gleason score of 4+3.
MRI靶向活检显示格里森评分为4+3。

The images show bilateral wedge-shaped, sharply demarcated hypointense lesions in the peripheral zone with minimal low ADC signal.
图像显示外周区双侧楔形、边界清晰的低信号病变，ADC 信号极低。

These findings can be regarded as benign characteristics, i.e. inflammation.
这些发现可以被视为良性特征，即炎症。

Biopsies showed focally some inflammation with glandular hyperplasia.
活检显示局灶性炎症伴腺体增生。

The T2W-images show a diffusely hypointense peripheral zone.
T2W 图像显示弥漫性低信号外周区。
The ADC does not show any foci of significant low signal intensity.
ADC未显示任何显著低信号强度的病灶。
The DWI is hyperintense on both sides.
DWI 两侧均呈高信号。
The ADC value was 830 mm2/s.
ADC值为830 mm2/s。

This was interpreted as benign characteristics (PI-RADS category 2) and diagnosed as chronic inflammation.
这被解释为良性特征（PI-RADS 2 类）并被诊断为慢性炎症。

Biopsies showed focal chronic active prostatitis and no malignancy.
活检显示局灶性慢性活动性前列腺炎，无恶性肿瘤。

A 70-year old patient was referred with a raised PSA of 9ng/ml, a PSA density 0.10.
一名 70 岁患者因 PSA 升高至 9ng/ml，PSA 密度 0.10 转诊。
A PI-RADS score of 5 was given to a hypointense area in the right peripheral zone at the midgland, with diffusion restriction (black arrow).    
PI-RADS 评分为 5 分，位于中腺右侧外周区的低信号区域，伴有弥散受限（黑色箭头）。

The DCE  showed vivid and peripheral enhancement of the lesion (arrowheads). 
DCE显示病变（箭头）的生动和外周增强。

A biopsy was performed and the histopathology results showed abscess formations. 
进行活检，组织病理学结果显示脓肿形成。

Peripheral enhancement and diffusion restriction are typical imaging findings of an abscess. 
外周增强和弥散受限是脓肿的典型影像学表现。

Hemorrhage 出血

Hemorrhage in the peripheral zone and in the seminal vesicles is common after biopsy.
活检后外周区和精囊出血很常见。
It appears as focal or diffuse hyperintense signal on T1W and iso- or hypointense signal on T2W.
它在 T1W 上表现为局灶性或弥漫性高信号，在 T2W 上表现为等信号或低信号。
However, chronic blood products may appear hypointense on all MR sequences.
然而，慢性血液制品在所有 MR 序列上都可能出现低信号。

This is a case of a 78-year old patient with raised PSA that underwent a prostate biopsy the previous year before undertaking one again.
这是一例 78 岁的 PSA 升高患者，在前一年接受了前列腺活检，然后再次进行了活检。

Images 图像
Hypointense lesions are seen on T2W in the anterior TZ zone.
低信号病变见于前 TZ 区的 T2W。
These small lesions have high signal on T1W, indicating blood products.
这些小病变在 T1W 上具有高信号，表明血液制品。

No cancer was found after fusion-guided targeted biopsy.
融合引导的靶向活检未发现癌症。
Hemorrhage findings should always be reported.
出血结果应始终报告。

Cysts 囊肿

A variety of cysts can occur in the prostate and adjacent structures.
前列腺和邻近结构中可发生多种囊肿。
As elsewhere in the body, cysts in the prostate may contain “simple” fluid and appear markedly hyperintense on T2W and hypointense on T1W.
与身体其他部位一样，前列腺囊肿可能含有“简单”液体，在 T2W 上表现为明显高信号，在 T1W 上表现为低信号。
However, they can also contain blood products or proteinaceous fluid, which may demonstrate a variety of signal characteristics, including hyperintense signal on T1W.
然而，它们也可能含有血液制品或蛋白液，它们可能表现出多种信号特征，包括 T1W 上的高信号。

Images 图像
T2W image shows a focal region of hyperintensity in the left peripheral zone of the prostate.
T2W 图像显示前列腺左侧外周区高信号的局灶性区域。
This area corresponds to a hypointense area in DCE images (images prior to  enhancement).
该区域对应于 DCE 图像（增强前的图像）中的低信号区域。
Restricted diffusion is present.
存在受限扩散。
This corresponds to a proteinaceous cyst.
这对应于蛋白质囊肿。

Prostate volume determines the feasibility of external radiation therapy, which can be performed up to a volume of 55cc.
前列腺体积决定了外部放射治疗的可行性，其体积可达 55cc。
Please note that this limit is only valid for conventional extern radiation.
请注意，此限制仅适用于常规外部辐射。
For proton radiation this limit don't exist.
对于质子辐射，这个限制是不存在的。

PSA density-values of ≥ 0,20 contribute towards the suspicion of a clinically significant prostate malignancy.
PSA 密度值 ≥ 0,20 有助于怀疑具有临床意义的前列腺恶性肿瘤。

In this case the measurements of the prostate are 36 x 50 x 60mm (AP x LR x CC).
在这种情况下，前列腺的测量值为 36 x 50 x 60 毫米 （AP x LR x CC）。
This results in a volume of 0,52 x (3,6 x 5,0 x 6,0) = 56,2 cc.
这导致体积为 0,52 x （3,6 x 5,0 x 6,0） = 56,2 cc。

The PSA level in this patient was 5.
该患者的PSA水平为5。
The PSA density is 5 : 56,2 = 0,09.
PSA密度为5：56.2=0.09。
This is a low PSA density and this patient probably has no clinically significant malignancy.
这是一个低 PSA 密度，该患者可能没有临床显着的恶性肿瘤。

Ellipsoid formulation: 椭球体公式：
Maximum AP and longitudinal diameters on a mid-sagittal T2W image and maximum transverse diameter on an axial T2W image multiplied by 0.52.
中矢状面 T2W 图像上的最大 AP 和纵向直径以及轴向 T2W 图像上的最大横向直径乘以 0.52。

In PI-RADS v2.1 the recommended sequences and settings are:
在 PI-RADS v2.1 中，推荐的序列和设置如下：

• T2WI T2WI系列
  Axial plane is axial to the patient or in an oblique axial perpendicular to the long axis of the prostate. At least one additional orthogonal plane (sagittal and/or coronal).
  轴向平面是与患者轴向或垂直于前列腺长轴的斜轴。至少一个额外的正交平面（矢状面和/或冠状面）。
• DWI DWI公司
  ADC map calculation should be performed using a low b-value set at 0-100 sec/mm2 (with preference for 50-100 sec/mm2), an intermediate b-value set at 800-1000 sec/mm2, and optionally additional b-values in the range of 100-1000 sec/mm2.
  ADC映射计算应使用设置为0-100秒/mm2的低b值（优先为50-100秒/mm2），设置为800-1000秒/mm2的中间b值，以及100-1000秒/mm2范围内的可选其他b值。
  A high b-value (≥1,400 sec/mm2) image set is also mandatory (preferably obtained from a separate acquisition or calculated from the low and intermediate b-value images).
  高 b 值 （≥1,400 sec/mm2） 图像集也是强制性的（最好从单独的采集中获得或从低和中等 b 值图像计算）。
• DCE 大交所
  Temporal resolution ≤15 seconds is advised and 3D T1W GRE is preferred.
  建议时间分辨率为 ≤15 秒，首选 3D T1W GRE。

Spasmolytic agents 解痉剂

Spasmolytic agents can be considered prior to examination to reduce movements of the small and large bowel.
检查前可考虑使用解痉剂，以减少小肠和大肠的运动。

Air and feces within the rectum can impair diffusion assessment.
直肠内的空气和粪便会损害弥散评估。

The images are of a patient who did not receive any preparation prior to the MR-exam.
这些图像是 MR 检查前未接受任何准备的患者。
The presence of air and stool in the rectum induces discrete linear artifactual distortion in the region of the prostate, restricting the diagnostic accuracy of both the DWI and ADC series.
直肠中空气和粪便的存在会导致前列腺区域出现离散的线性伪影畸变，从而限制了 DWI 和 ADC 系列的诊断准确性。

Here an example of a patient who did receive a minimal preparation enema administered a few hours prior to the exam.
这里有一个患者的例子，他在检查前几个小时接受了最低限度的准备灌肠。
This resulted in an evacuated rectum. Although an enema may induce rectal peristalsis, no artifacts were observed in this patient.
这导致直肠排空。虽然灌肠可能会诱发直肠蠕动，但在该患者中未观察到伪影。

T1W T1W系列

T1W-images determine the presence of post-biopsy hemorrhage.
T1W 图像确定是否存在活检后出血。
This patient had systematic TRUS-guided biopsies 3 weeks earlier
该患者在 3 周前接受了系统的 TRUS 引导活检

Images 图像
High signal intensity on T1W image in the right peripheral zone, with little signal reduction on T2W images, and no restricted diffusion on DWI / ADC (yellow arrow).
右侧外围区域的T1W图像上的信号强度高，T2W图像上的信号几乎没有减弱，DWI/ADC（黄色箭头）上的扩散不受限制。
Furthermore, a suspicious lesion was identified right anteriorly in the transition zone with low signal intensity on T2W and ADC and high signal intensity on DWI (black arrow).
此外，在过渡区正前方发现了一个可疑病变，T2W 和 ADC 的信号强度较低，DWI 的信号强度较高（黑色箭头）。

This lesion showed a Gleason score 4+3 following MRI-targeted biopsy.
该病变在 MRI 靶向活检后显示 Gleason 评分为 4+3。

A large FOV up to the aortic bifurcation helps to assess extraperitoneal and pelvic lymph node involvement and osseous metastatic disease (arrow in figure).
主动脉分叉处的大 FOV 有助于评估腹膜外和盆腔淋巴结受累以及骨转移性疾病（图中的箭头）。

T2W T2W系列

High-resolution T2W FSE sequences are obtained in the axial and sagittal plane.
在轴向和矢状面上获得高分辨率的T2W FSE序列。
T2W images show anatomical information on normal and abnormal prostatic tissue.
T2W图像显示正常和异常前列腺组织的解剖信息。

Additional 3D T2 acquisitions can be used for reconstruction in all three anatomic planes and potential radiotherapeutic purposes.
额外的 3D T2 采集可用于所有三个解剖平面的重建和潜在的放射治疗目的。

The video nicely demonstrates the high resolution of the transverse 3D images with coronal and sagittal reconstructions.
该视频很好地展示了具有冠状和矢状重建的横向 3D 图像的高分辨率。

DWI DWI公司

Diffusion restriction is present when a lesion with high DWI signal corresponds to low signal on the ADC map, which is highly correlated to malignant cells.
当 DWI 信号高的病变对应于 ADC 图谱上的低信号时，存在扩散限制，这与恶性细胞高度相关。
The exact ADC value of the lesion is inversely correlated to the likelyhood of a malignant lesion.
病灶的确切 ADC 值与恶性病灶的可能性成反比。

High b-values are necessary to create a high signal-to-noise ratio.
高 b 值对于创建高信噪比是必要的。
B-value of at least 1400 is recommended.
建议 B 值至少为 1400。
Notice the difference between the B1000 and B1400 images.
请注意 B1000 和 B1400 映像之间的差异。

A fusion guided biopsy of the lesion anterior in the prostate demonstrated a Gleason 3+4.
前列腺前部病变的融合引导活检显示格里森 3+4。

DCE 大交所

The criteria for a negative or positive dynamic contrast enhancement series are shown in the table.
负或正动态对比度增强系列的标准显示在表中。
DCE can be of additional value in confirming the suspicious conspicuity of a lesion, but are frequently non-specific as prostate cancer may reveal early and increased enhancement but also normal enhancement compared to normal prostate tissue.
DCE 在确认病变的可疑明显性方面可能具有额外价值，但通常是非特异性的，因为与正常前列腺组织相比，前列腺癌可能显示早期和增加的增强，但也有正常的增强。
Lack of enhancement does not exclude malignancy, and increased enhancement can be the result of acute or chronic inflammation.
缺乏增强并不能排除恶性肿瘤，增强增加可能是急性或慢性炎症的结果。

The temporal resolution of ≤15 seconds is advised and 3D T1W GRE is preferred
建议时间分辨率为 ≤15 秒，首选 3D T1W GRE.

Timing of the examination
考试时间

Post-biopsy changes, i.e. hemorrhage and inflammation, are usually located in the peripheral zone or the seminal vesicles.
活检后的变化，即出血和炎症，通常位于外周区或精囊。
These changes may adversely affect the interpretation of multiparametric MRI whereas signal intensities might be altered.
这些变化可能会对多参数 MRI 的解释产生不利影响，而信号强度可能会改变。

As these changes tend to diminish over time, an time interval of at least 6 weeks or longer between biopsy and MRI is recommended in the PIRADS guideline.
由于这些变化往往会随着时间的推移而减少，因此 PIRADS 指南建议活检和 MRI 之间的时间间隔至少为 6 周或更长时间。

In current daily practice there is a tendency to perform multiparametric MRI before obtaining biopsies which consequently resolve this issue.
在目前的日常实践中，有一种趋势是在进行活检之前进行多参数 MRI，从而解决这个问题。

Marked is defined as “a more pronounced signal change than any other focus in the same zone”. 
标记被定义为“比同一区域中的任何其他焦点更明显的信号变化”。

Images 图像
Marked signal change in a patient aged 69 years old showed a raised PSA of 13.3ng/ml, PSA density 0.16.
一名 69 岁患者的显着信号变化显示 PSA 升高 13.3ng/ml，PSA 密度 0.16。
A score of PI-RADS 5 was given due to a low intensity area in the right peripheral zone of the midgland with characteristics of extraprostatic extension.
由于中腺右侧外周区域的低强度区域具有前列腺外延伸的特征，因此给出了 PI-RADS 5 的评分。
There is marked restriction of diffusion.
扩散受到明显限制。
The diameter of the lesion is 1.7cm.
病灶直径为1.7cm。

Biopsy was performed with fusion guided targeted mpMRI – TRUS method.
使用融合引导的靶向 mpMRI – TRUS 方法进行活检。
Histopathology results showed adenocarcinoma of Gleason 8 (4+4) with extraprostatic extension.    
组织病理学结果显示Gleason 8（4+4）腺癌伴前列腺外延伸。

Non-circumscribed  无限制
Non-circumscribed means "Ill-defined”
非限定意味着“定义不明确”

Image 图像
A non-circumscribed region (ill-defined) shows restriction of diffusion corresponding to a PI-RADS 3 nodule.
非边界区域（定义不清）显示对应于 PI-RADS 3 结节的扩散限制。

Wedge in the peripheral zone is defined as “having the shape of a wedge, pie, or V shaped”
外围区域的楔形被定义为“具有楔形、饼形或 V 形的形状”

Focal is defined as “discrete and different from the background”.
焦距被定义为“离散且与背景不同”。

Images 图像
Focal lesion in a patient aged 79 years old.
一名 79 岁患者的局灶性病变。
Due to a raised PSA of 6.4ng/ml, PSA density 0.05, mpMRI was followed and a score of PI-RADS 4 was given due to a low intensity area in the right anterior TZ zone in the midgland.
由于 PSA 升高 6.4ng/ml，PSA 密度 0.05，随 mpMRI 检查，由于中腺右前 TZ 区的低强度区域，PI-RADS 4 评分。
There is focal restriction of diffusion and the diameter of the lesion was 1.2cm. 
有局灶性扩散受限，病灶直径1.2cm。

Biopsy was performed with the fusion guided targeted mpMRI – TRUS method that showed an adenocarcinoma of Gleason 9 (4+5)    
使用融合引导的靶向 mpMRI – TRUS 方法进行活检，显示 Gleason 9 （4+5） 腺癌

Linear is defined as in a line or band-like shape.
线性被定义为线状或带状形状。

Images 图像
Linear configuration in the left peripheral zone, corresponds to a PI-RADS 2 score.
左侧外围区域的线性配置对应于 PI-RADS 2 分数。

Lenticular is defined as having the shape of a double-convex lens, crescentic.
透镜被定义为具有双凸透镜的形状，新月形。

Completely encapsulated nodule
完全包膜的结节
Bounded by a distinct, uniform, smooth low-signal line (BPH nodule).
以清晰、均匀、光滑的低信号线（BPH 结节）为界。
Completely encapsulated nodule is entirely surrounded by a smooth low-signal line in at least two imaging planes and is called a typical nodule. 
完全包膜的结节在至少两个成像平面上完全被光滑的低信号线包围，称为典型结节。

Mostly encapsulated nodule 
多为包膜结节

Almost completely or incompletely encapsulated nodule is not entirely surrounded by a smooth low-signal line (“atypical nodule”) “
几乎完全或不完全包膜的结节并不完全被光滑的低信号线（“非典型结节”）包围。

Homogeneous mildly hypointense area between nodules
结节之间均匀的轻度低信号区域

Images 图像
Homogeneous mildly hypointense area (arrowheads) between nodules in the TZ zone corresponds to a PI-RADS 2 score.
TZ 区结节之间均匀的轻度低信号区域（箭头）对应于 PI-RADS 2 评分。

Heterogeneous signal intensity with obscured margins
边距模糊的异质信号强度
This means “not clearly seen or easily distinguished “
这意味着“看不清或不容易区分”

Images 图像
A heterogeneous signal intensity (green arrowheads)  suggesting benign features (T2W - score 2), however with possible obscured margins (T2W) with limited restricted diffusion (DWI/ADC - score 3), corresponds to a sum PI-RADS 3 score.
异质信号强度（绿色箭头）提示良性特征（T2W - 评分 2），但可能边缘模糊 （T2W） 和有限的扩散（DWI/ADC - 评分 3），对应于 PI-RADS 3 总分。

Reporting is done according to the checklist as shown in the table.
报告是根据表中所示的清单进行的。

Before we start the interpretation of the MRI, we need to be informed about:
在我们开始解释 MRI 之前，我们需要了解：

• Family history 家族史
• Digital rectal examination
  直肠指检
• PSA level PSA水平
• Prior biopsies (quantity, location, Gleason score)
  既往活检（数量、位置、格里森评分）
• Prior therapy 既往治疗

In case of multiple suspicious findings, the index lesion is the lesion with the highest PI-RADS assessment category.
如果出现多个可疑发现，则指示病变是具有最高 PI-RADS 评估类别的病变。