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PI-RADS (Prostate Imaging Reporting and Data System) v2 determination is dependent on whether the lesion is in the peripheral zone (PZ) or transitional zone (TZ).
For PZ the primary determining sequence is DWI. That is, the PI-RADS score is determined by DWI appearance, with the exception of PI-RADS 3 lesions, at which further reference is made to the presence or absence of dynamic contrast enhancement (DCE) in an attempt to minimise "indeterminate" lesions.
Conversely, for TZ lesions, the primary determining sequence is T2WI. That is, the PI-RADS score is determined by T2W appearance, with the exception of PI-RADS 3 lesions, at which further reference is made to DWI.
These flowchart diagrams summarise the PI-RADS v2 assessment of prostate lesions.