Diagnostic performance of biparametric MRI according to prostate imaging quality (PI-QUAL) version 2: Analysis of...

To evaluate the impact of image quality on the diagnostic performance of biparametric MRI (bpMRI) for detecting clinically significant prostate cancer (csPCa).

This retrospective study included patients who underwent bpMRI at outside imaging facilities and were referred to our tertiary centre between January 2020 and November 2021. The image quality of bpMRI was assessed by two radiologists in consensus using Prostate Imaging Quality Score version 2 (PI-QUAL v2). Technical parameters of T2WI and DWI were extracted, and their associations with imaging quality criteria were evaluated. Sensitivity, specificity, and positive and negative predictive values for detecting csPCa were compared according to PI-QUAL v2 scores.

Among 112 men who underwent bpMRI at 69 different imaging facilities, 47 (42.0 %) MRIs were considered not applicable for PI-QUAL v2 scoring. Of the remaining MRIs, 30 (26.8 %), 17 (15.2 %), and and 18 (16.1 %) were assigned PI-QUAL v2 scores of 1, 2, and 3, respectively. MRIs with PI-QUAL v2 scores ≤ 1 demonstrated significantly lower sensitivity (74.3 %) than those with scores of 2 or 3 (100.0 %; P = 0.045). In-plane resolution on T2WI and the number of b values on DWI were significantly associated with image quality assessment (P = 0.037 and 0.028).

The diagnostic accuracy of bpMRI for detecting csPCa is influenced by image quality, as assessed by the PI-QUAL v2 scoring system. Adequate in-plane resolution on T2WI and the use of at least three b values on DWI should be emphasised to achieve optimal image quality and diagnostic performance.