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. 2020 Sep 29;10:15982. doi: 10.1038/s41598-020-72544-z

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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(a) Oval-shaped lesion in the left PZ with DWI isointensity and mild indistinct ADC hypointensity. It was scored a 2 according to PI-RADS v2.0 and a 3 according to PI-RADS v2.1. TB of this lesion revealed no cancer. Patient age: 68 years. (b) Fully encapsulated and heterogeneous nodule in the right TZ with a diameter of 1.5 cm. It shows heterogeneous signal on high b-value DWI and on ADC images. It was scored into category 2 according to PI-RADS v2.0 and into category 1 according to PI-RADS v2.1 and showed no cancer upon systematic biopsy. Patient age: 56 years. (c) Incompletely encapsulated nodule in the left TZ with marked DWI hyperintensity and marked ADC hypointensity. Patient age: 59 years. (d) Lesion in the right apical TZ with the same characteristics as in c. Patient age: 52 years. The new DWI upgrading rule was applied to lesions in c and d. In both cases systematic biopsy showed no cancer.