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Quality of Prostate MRI: Is the PI-RADS Standard Sufficient?
Jonathan Sackett1, Joanna H Shih2, Sarah E Reese3
1Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA; Loma Linda University School of Medicine, Loma Linda, CA, USA.
Rationale And Objective:
The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) published a set of minimum technical standards (MTS) to improve image quality and reduce variability in multiparametric prostate MRI. The effect of PIRADSv2 MTS on image quality has not been validated. We aimed to determine whether adherence to PI-RADSv2 MTS improves study adequacy and perceived quality.
Materials And Methods:
Sixty-two prostate MRI examinations including T2 weighted (T2W) and diffusion weighted image (DWI) consecutively referred to our center from 62 different institutions within a 12-month period (September 2017 to September 2018) were included. Six readers assessed images as adequate or inadequate for use in PCa detection and a numerical image quality ranking was given using a 1-5 scale. The PI-RADSv2 MTS were synthesized into sets of seven and 10 rules for T2W and DWI, respectively. Image adherence was assessed using Digital Imaging and Communications in Medicine (DICOM) metadata. Statistical analysis of survey results and image adherence was performed based on reader quality scoring (Kendall Rank tau-b) and reader adequate scoring (Wilcoxon test for association) for T2 and DWI quality assessment.
Results:
Out of 62 images, 52 (83%) T2W and 38 (61%) DWIs were rated to be adequate by a majority of readers. Reader adequacy scores showed no significant association with adherence to PI-RADSv2. There was a weak (tau-b = 0.22) but significant (p value = 0.01) correlation between adherence to PIRADSv2 MTS and image quality for T2W. Studies following all PI-RADSv2 T2W rules achieved a higher median average quality score (3.58 for 7/7 vs. 3.0 for <7/7, p = 0.012). No statistical relationship with PI-RADSv2 MTS adherence and DWI quality was found.
Conclusion:
Among 62 sites performing prostate MRI, few were considered of high quality, but the majority were considered adequate. DWI showed considerably lower rates of adequate studies in the sample. Adherence to PI-RADSv2 MTS did not increase the likelihood of having a qualitatively adequate T2W or DWI.
Insights
Adherence to Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) minimum technical standards did not improve multiparametric prostate MRI adequacy. While T2W image quality showed a weak correlation, DWI quality was unaffected by PI-RADSv2 adherence.
Area of Science:
- Radiology
- Medical Imaging
- Prostate Cancer Detection
Background:
- The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) established minimum technical standards (MTS) to enhance multiparametric prostate MRI quality and consistency.
- The impact of PI-RADSv2 MTS on actual image quality and study adequacy remains underexplored.
Purpose of the Study:
- To evaluate whether adherence to PI-RADSv2 MTS improves the adequacy and perceived quality of multiparametric prostate MRI studies.
- To assess the correlation between PI-RADSv2 MTS adherence and image quality for T2-weighted (T2W) and diffusion-weighted imaging (DWI).
Main Methods:
- Sixty-two prostate MRI examinations from diverse institutions were reviewed by six readers for adequacy and rated on a 1-5 quality scale.
- PI-RADSv2 MTS were defined for T2W (7 rules) and DWI (10 rules), and adherence was assessed using DICOM metadata.
- Statistical analyses, including Kendall Rank tau-b and Wilcoxon tests, were employed to correlate adherence with reader assessments.
Main Results:
- A majority of T2W (83%) and DWI (61%) studies were deemed adequate, but adequacy scores did not significantly correlate with PI-RADSv2 MTS adherence.
- A weak but significant positive correlation was found between PI-RADSv2 MTS adherence and T2W image quality (tau-b = 0.22, p=0.01).
- Studies fully adhering to T2W PI-RADSv2 rules showed higher median quality scores (3.58 vs. 3.0), but no significant relationship was found for DWI quality.
Conclusions:
- While most prostate MRI studies were adequate, adherence to PI-RADSv2 MTS did not consistently improve T2W or DWI adequacy.
- A notable proportion of studies, particularly DWI, did not meet quality standards, indicating room for improvement in adherence and quality control.
- The findings suggest that PI-RADSv2 MTS adherence has a limited impact on overall study adequacy and perceived quality, especially for DWI sequences.
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