Related Experiment Video
Updated: May 10, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Inter-reader agreement of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard
L Schimmöller1, M Quentin, C Arsov
1Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
Objectives:
The recent European Society of Urogenital Radiology (ESUR) guidelines for evaluation and reporting of prostate multiparametric magnetic resonance imaging (mp-MRI) include the Prostate Imaging Reporting and Data System (PI-RADS). The aim of this study was to investigate the inter-reader agreement of this scoring system.
Methods:
One hundred and sixty-four lesions in 67 consecutive patients with elevated prostate-specific antigen and previously negative trans-rectal ultrasound (TRUS)-guided biopsy were scored retrospectively by three blinded readers using PI-RADS. Mp-MRI was performed at 3 T using T2-weighted, diffusion-weighted and dynamic contrast-enhanced imagings (T2WI, DWI, DCE-MRI). Histology of all lesions was obtained by in-bore MRI-guided biopsy. Cohen's kappa statistics were calculated for all readers.
Results:
Inter-reader agreement for all lesions was good to moderate (T2WI, κ = 0.55; DWI, κ = 0.64; DCE-MRI, κ = 0.65). For tumour lesions it was good (T2WI, κ = 0.66; DWI, κ = 0.80; DCE-MRI, κ = 0.63) and for benign lesions moderate to good (T2WI, κ = 0.46; DWI, κ = 0.52; DCE-MRI, κ = 0.67). Using an overall PI-RADS score with a threshold of ≥10, we achieved a sensitivity of 85.7 %, and negative predictive value of 90.1 % for biopsied lesions.
Conclusion:
PI-RADS score shows good to moderate inter-reader agreement and enables standardised evaluation of prostate mp-MRI, with high sensitivity and negative predictive value.
Key Points:
• The European Society of Urogenital Radiology recently published guidelines for prostate MRI. • We have evaluated inter-reader agreement of ESUR scoring for multiparametric prostate MRI. • PI-RADS shows good to moderate inter-reader agreement and is clinically applicable. • PI-RADS achieves in our series high sensitivity and negative predictive value for biopsied lesions. • PI-RADS can be used as standardised scoring system in prostate cancer detection.
Insights
The Prostate Imaging Reporting and Data System (PI-RADS) shows good to moderate inter-reader agreement for prostate multiparametric MRI (mp-MRI). This standardized scoring system is clinically applicable, demonstrating high sensitivity and negative predictive value for detecting prostate cancer.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- The European Society of Urogenital Radiology (ESUR) has released guidelines for prostate multiparametric magnetic resonance imaging (mp-MRI) evaluation, incorporating the Prostate Imaging Reporting and Data System (PI-RADS).
- Accurate and consistent interpretation of prostate mp-MRI is crucial for diagnosing prostate cancer, especially in cases with previously negative biopsies.
Purpose of the Study:
- To assess the inter-reader agreement of the PI-RADS scoring system for prostate mp-MRI.
- To evaluate the clinical applicability and diagnostic performance of PI-RADS in identifying prostate lesions.
Main Methods:
- Retrospective scoring of 164 lesions in 67 patients by three blinded readers using PI-RADS.
- mp-MRI performed at 3T, including T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE-MRI) sequences.
- Histological confirmation of all lesions via MRI-guided biopsy and calculation of Cohen's kappa statistics for inter-reader agreement.
Main Results:
- Good to moderate inter-reader agreement was observed for all lesions across different sequences (T2WI: κ=0.55, DWI: κ=0.64, DCE-MRI: κ=0.65).
- For tumor lesions, agreement was good (T2WI: κ=0.66, DWI: κ=0.80, DCE-MRI: κ=0.63), and for benign lesions, it was moderate to good (T2WI: κ=0.46, DWI: κ=0.52, DCE-MRI: κ=0.67).
- An overall PI-RADS score threshold of ≥10 yielded a sensitivity of 85.7% and a negative predictive value of 90.1% for biopsied lesions.
Conclusions:
- The PI-RADS scoring system demonstrates good to moderate inter-reader agreement, facilitating standardized evaluation of prostate mp-MRI.
- PI-RADS is clinically applicable and exhibits high sensitivity and negative predictive value, making it a valuable tool for prostate cancer detection and reporting.
