How does PI-RADS v2.1 impact patient classification? A head-to-head comparison between PI-RADS v2.0 and v2.1
Ana Sofia Linhares Moreira1, Pieter De Visschere2, Charles Van Praet3
1Radiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
Background:
PI-RADS classification has recently been updated, with the magnitude of changes implemented currently unknown.
Purpose:
To quantify the categorization shifts between PI-RADS v2.0 and v2.1.
Material And Methods:
Retrospective review of 535 consecutive diagnostic magnetic resonance imaging (MRI) studies performed over 18 months, assigning to each case a PI-RADS category in the peripheral zone (PZ), the transition zone (TZ), and the whole gland using both PI-RADS v2.0 and v2.1. Significance of changes in category assignments and of differences in the number of positive or negative MRIs were evaluated using the McNemar test.
Results:
Comparing v2.0 to v2.1 for the whole gland, 11.2% of PI-RADS 2 categories shifted to PI-RADS 1 (6.9% in the PZ, 56.8% in the TZ), 16.1% of PI-RADS 3 categories shifted to PI-RADS 2 (15.0% in the PZ, 20.0% in the TZ), and 2.1% of PI-RADS 2 categories shifted to PI-RADS 3 (0.3% in the PZ, 1.9% in the TZ). The proportion of PI-RADS 1 significantly increased from 0.6% to 7.3%, PI-RADS 2 significantly decreased from 60.0% to 53.8%, and PI-RADS 3 non-significantly decreased from 11.6% to 11.0%. The total number of positive exams (PI-RADS 3-5) did not change significantly (39.4% versus 38.8%).
Conclusion:
The most prominent change between v2.0 and v2.1 was observed in the TZ with the downgrading of typical benign prostatic hyperplasia nodules from category 2 into category 1. Overall, there were no significant changes in the number of positive and negative MRI results, with an expected low influence in clinical management.
Insights
The updated Prostate Imaging Reporting and Data System (PI-RADS) v2.1 classification primarily downgraded benign nodules in the transition zone. This change had minimal impact on overall positive prostate MRI detection rates.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- The Prostate Imaging Reporting and Data System (PI-RADS) classification for prostate MRI has been updated.
- The extent of changes introduced by the PI-RADS v2.1 update is not yet fully understood.
Purpose of the Study:
- To quantify the shifts in PI-RADS categorization between version 2.0 and version 2.1.
- To evaluate the impact of PI-RADS updates on prostate MRI interpretation.
Main Methods:
- Retrospective analysis of 535 diagnostic prostate MRI studies.
- Assigning PI-RADS categories (v2.0 and v2.1) to peripheral zones, transition zones, and the whole gland.
- Statistical evaluation using the McNemar test to assess significance of category changes.
Main Results:
- PI-RADS v2.1 showed a notable downgrading of PI-RADS 2 categories to PI-RADS 1, particularly in the transition zone (56.8%).
- The proportion of PI-RADS 1 significantly increased (0.6% to 7.3%), while PI-RADS 2 significantly decreased (60.0% to 53.8%).
- No significant change in the overall proportion of positive prostate MRI exams (PI-RADS 3-5) was observed (39.4% vs. 38.8%).
Conclusions:
- The primary change in PI-RADS v2.1 involves downgrading benign prostatic hyperplasia nodules in the transition zone from category 2 to category 1.
- The updated PI-RADS classification did not significantly alter the number of positive or negative MRI findings.
- The clinical management impact of PI-RADS v2.1 is expected to be low.
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