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Peripheral zone lesions of intermediary risk in multiparametric prostate MRI: Frequency and validation of the

Matthias Benndorf1, Lorenz Waibel1, Malte Krönig2

  • 1Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.

European Journal of Radiology
|January 25, 2018
PubMed
Abstract

Insights

The Prostate Imaging Reporting and Data System (PI-RADSv2) algorithm shows a trend of increasing cancer rates for PI-RADSv2 category 3, upgraded category 4, and category 4 lesions. Separate reporting of upgraded category 4 and category 4 lesions is recommended for future meta-analyses.

Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) is used for prostate cancer risk stratification.
  • Peripheral zone lesions with PI-RADSv2 category 3 represent an intermediate risk, requiring careful evaluation.
  • Accurate risk assessment is crucial for guiding patient management and biopsy decisions.

Purpose of the Study:

  • To validate the PI-RADSv2 risk stratification algorithm for intermediate-risk (category 3) peripheral zone lesions based on contrast enhancement.
  • To compare cancer detection rates among PI-RADSv2 category 3, upgraded category 4, and category 4 lesions defined by markedly low apparent diffusion coefficient (ADC) values.

Main Methods:

  • Retrospective analysis of 172 patients with 315 histopathologically verified prostate lesions.
  • Inclusion of peripheral zone lesions categorized as PI-RADSv2 category 3 or 4.
  • Comparison of cancer rates using the two-sided chi-squared test.
  • Assessment of inter-observer agreement for contrast enhancement evaluation in category 3 lesions.

Main Results:

  • Cancer rates were 8.8% for PI-RADSv2 category 3, 23.5% for upgraded category 4, and 40.6% for category 4 (based on low ADC value) (P < 0.01).
  • Peripheral PI-RADS 3, upgraded PI-RADS 4, and PI-RADS 4 lesions represented 10.8%, 10.8%, and 20.3% of lesions, respectively.
  • Moderate inter-observer agreement (kappa 0.46-0.5) was observed for contrast enhancement assessment.

Conclusions:

  • A trend of increasing cancer rates was observed from PI-RADSv2 category 3 to upgraded category 4 to category 4 lesions.
  • Peripheral intermediate-risk lesions (PI-RADSv2 category 3) constitute a significant proportion (21.6%) of all prostate lesions.
  • Separate reporting of upgraded category 4 and category 4 lesions is recommended for future PI-RADSv2 versions to facilitate meta-analyses of cancer rates.
Keywords:
MRIMultiparametricPI-RADSProstateRisk stratificationValidation

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