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
Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data
Andrew B Rosenkrantz1, Sooah Kim, Ruth P Lim
1Department of Radiology, Department of Pathology, and Division of Urologic Oncology, Department of Urology, Langone Medical Center, NYU School of Medicine, 560 First Ave, TCH-HW202, New York, NY 10016.
Purpose:
To compare the recently proposed Prostate Imaging Reporting and Data System (PI-RADS) scale that incorporates fixed criteria and a standard Likert scale based on overall impression in prostate cancer localization using multiparametric magnetic resonance (MR) imaging.
Materials And Methods:
This retrospective study was HIPAA compliant and institutional review board approved. Seventy patients who underwent 3-T pelvic MR imaging, including T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast material-enhanced imaging, with a pelvic phased-array coil before radical prostatectomy were included. Three radiologists, each with 6 years of experience, independently scored 18 regions (12 peripheral zone [PZ], six transition zone [TZ]) using PI-RADS (range, scores 3-15) and Likert (range, scores 1-5) scales. Logistic regression for correlated data was used to compare scales for detection of tumors larger than 3 mm in maximal diameter at prostatectomy.
Results:
Maximal accuracy was achieved with score thresholds of 8 and higher and of 3 and higher for PI-RADS and Likert scales, respectively. At these thresholds, in the PZ, similar accuracy was achieved with the PI-RADS scale and the Likert scale for radiologist 1 (89.0% vs 88.2%, P = .223) and radiologist 3 (88.5% vs 88.2%, P = .739) and greater accuracy was achieved with the PI-RADS scale than the Likert scale for radiologist 2 (89.6% vs 87.1%, P = .008). In the TZ, accuracy was lower with the PI-RADS scale than with the Likert scale for radiologist 1 (70.0% vs 87.1%, P < .001), radiologist 2 (87.6% vs 92.6%, P = .002), and radiologist 3 (82.9% vs 91.2%, P < .001). For tumors with Gleason score of at least 7, sensitivity was higher with the PI-RADS scale than with the Likert scale for radiologist 1 (88.6% vs 82.6%, P = .032), and sensitivity was similar for radiologist 2 (78.0% vs 76.5, P = .467) and radiologist 3 (77.3% vs 81.1%, P = .125).
Conclusion:
Radiologists performed well with both PI-RADS and Likert scales for tumor localization, although, in the TZ, performance was better with the Likert scale than the PI-RADS scale.
Supplemental Material:
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122233/-/DC1.
Insights
The Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales showed similar accuracy for prostate cancer localization in the peripheral zone. However, the Likert scale demonstrated better performance in the transition zone.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Multiparametric magnetic resonance (MR) imaging is crucial for prostate cancer detection.
- Standardized reporting systems improve diagnostic accuracy and consistency.
- Comparing novel scales aids in refining prostate MR interpretation.
Purpose of the Study:
- To compare the diagnostic performance of the Prostate Imaging Reporting and Data System (PI-RADS) scale against a standard Likert scale for prostate cancer localization.
- To evaluate the efficacy of PI-RADS with fixed criteria versus Likert scale based on overall impression.
Main Methods:
- Retrospective analysis of 70 patients undergoing 3-T pelvic MR imaging before radical prostatectomy.
- Independent scoring of 18 prostate regions by three experienced radiologists using PI-RADS and Likert scales.
- Logistic regression analysis to compare scale performance in detecting tumors >3 mm.
Main Results:
- Both PI-RADS and Likert scales achieved high accuracy in the peripheral zone (PZ), with PI-RADS showing slightly greater accuracy for one radiologist.
- The Likert scale demonstrated significantly higher accuracy than PI-RADS in the transition zone (TZ) across all radiologists.
- PI-RADS showed higher sensitivity for tumors with Gleason score ≥7 in one radiologist, with similar sensitivity for others.
Conclusions:
- Radiologists demonstrated proficiency using both PI-RADS and Likert scales for prostate cancer localization.
- The Likert scale outperformed the PI-RADS scale in the transition zone for tumor detection.
- Further refinement of PI-RADS may be needed for optimal performance in specific prostate zones.
