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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Standardized Reporting of Prostate MRI: Comparison of the Prostate Imaging Reporting and Data System (PI-RADS)
Susanne Tewes1, Nikolaj Mokov2, Dagmar Hartung1
1Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
Introduction:
Objective of our study was to determine the agreement between version 1 (v1) and v2 of the Prostate Imaging Reporting and Data System (PI-RADS) for evaluation of multiparametric prostate MRI (mpMRI) and to compare their diagnostic accuracy, their inter-observer agreement and practicability.
Material And Methods:
mpMRI including T2-weighted imaging, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) of 54 consecutive patients, who subsequently underwent MRI-guided in-bore biopsy were re-analyzed according to PI-RADS v1 and v2 by two independent readers. Diagnostic accuracy for detection of prostate cancer (PCa) was assessed using ROC-curve analysis. Agreement between PI-RADS versions and observers was calculated and the time needed for scoring was determined.
Results:
MRI-guided biopsy revealed PCa in 31 patients. Diagnostic accuracy for detection of PCa was equivalent with both PI-RADS versions for reader 1 with sensitivities and specificities of 84%/91% (AUC = 0.91 95%CI[0.8-1]) for PI-RADS v1 and 100%/74% (AUC = 0.92 95% CI[0.8-1]) for PI-RADS v2. Reader 2 achieved similar diagnostic accuracy with sensitivity and specificity of 74%/91% (AUC = 0.88 95%CI[0.8-1]) for PI-RADS v1 and 81%/91% (AUC = 0.91 95%CI[0.8-1]) for PI-RADS v2. Agreement between scores determined with different PI-RADS versions was good (reader 1: κ = 0.62, reader 2: κ = 0.64). Inter-observer agreement was moderate with PI-RADS v2 (κ = 0.56) and fair with v1 (κ = 0.39). The time required for building the PI-RADS score was significantly lower with PI-RADS v2 compared to v1 (24.7±2.3 s vs. 41.9±2.6 s, p<0.001).
Conclusion:
Agreement between PI-RADS versions was high and both versions revealed high diagnostic accuracy for detection of PCa. Due to better inter-observer agreement for malignant lesions and less time demand, the new PI-RADS version could be more practicable for clinical routine.
Insights
The Prostate Imaging Reporting and Data System (PI-RADS) v2 shows improved inter-observer agreement and is faster than v1 for prostate cancer detection using MRI. Both PI-RADS versions offer high accuracy in identifying malignant lesions.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer diagnosis relies heavily on multiparametric MRI (mpMRI).
- The Prostate Imaging Reporting and Data System (PI-RADS) standardizes mpMRI interpretation.
- Comparing PI-RADS versions is crucial for optimizing diagnostic protocols.
Purpose of the Study:
- To evaluate agreement between PI-RADS version 1 (v1) and version 2 (v2).
- To compare diagnostic accuracy, inter-observer agreement, and practicability of PI-RADS v1 and v2.
- To assess the utility of PI-RADS v2 in clinical routine for prostate cancer detection.
Main Methods:
- Re-analysis of 54 mpMRI scans (T2-weighted, DWI, DCE) using PI-RADS v1 and v2 by two independent readers.
- Diagnostic accuracy assessed via ROC curve analysis for prostate cancer (PCa) detection.
- Calculation of agreement between PI-RADS versions and observers, and measurement of scoring time.
Main Results:
- Both PI-RADS versions demonstrated high diagnostic accuracy for PCa detection.
- PI-RADS v2 showed improved inter-observer agreement (κ=0.56) compared to v1 (κ=0.39).
- Scoring time was significantly reduced with PI-RADS v2 (24.7s) versus v1 (41.9s).
Conclusions:
- High agreement was observed between PI-RADS v1 and v2.
- PI-RADS v2 offers enhanced practicability due to better inter-observer agreement and reduced time demand.
- PI-RADS v2 is a potentially more efficient tool for routine clinical use in prostate cancer detection.
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