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Prostate MRI quality: clinical impact of the PI-QUAL score in prostate cancer diagnostic work-up

Eleftherios Karanasios1, Iztok Caglic2, Jeries P Zawaideh2,3

  • 1Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.

The British Journal of Radiology
|February 18, 2022
PubMed
Abstract

Insights

Prostate imaging quality (PI-QUAL) scores show moderate agreement among radiologists and are crucial for accurate prostate cancer diagnosis. Higher PI-QUAL scores improve MRI diagnostic certainty and streamline patient care pathways.

Area of Science:

  • Radiology
  • Medical Imaging
  • Oncology

Background:

  • Prostate multiparametric MRI (mpMRI) is vital for prostate cancer detection.
  • Standardized assessment of mpMRI quality is essential for reliable interpretation.
  • The Prostate Imaging Quality (PI-QUAL) score aims to standardize image quality assessment.

Purpose of the Study:

  • To evaluate the reproducibility of PI-QUAL scores among radiologists.
  • To determine the impact of PI-QUAL scores on diagnostic decision-making in prostate mpMRI.
  • To assess the correlation between PI-QUAL scores and clinical outcomes such as repeat imaging and biopsy rates.

Main Methods:

  • Three radiologists independently assigned PI-QUAL scores to prostate mpMRI examinations.
  • Readers determined MRI sufficiency for cancer diagnosis and need for repeat imaging.
  • Inter-reader agreement was assessed using Cohen's kappa (κ), and PI-QUAL scores were correlated with PI-RADS scores and clinical outcomes.

Main Results:

  • 96% of 3T-mpMRI scans were deemed sufficient quality (≥PI-QUAL-3), and 83% were optimal (≥PI-QUAL-4).
  • Moderate inter-reader agreement was observed for PI-QUAL scores (senior readers: κ=0.51; junior-senior: κ=0.47).
  • Higher PI-QUAL scores correlated with increased ability to rule-in/out cancer, reduced PI-RADS-3 rates, and fewer biopsies for negative/indeterminate cases.

Conclusions:

  • PI-QUAL scoring demonstrates moderate reproducibility in a clinical setting.
  • Higher PI-QUAL scores are associated with increased diagnostic certainty and efficiency in the prostate cancer diagnostic pathway.
  • The PI-QUAL score is a validated tool for assessing prostate mpMRI quality and its impact on clinical decision-making.

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