Evaluation of the PI-RADS scoring system for classifying mpMRI findings in men with suspicion of prostate cancer

Biomed Res Int. 2013;2013:252939. doi: 10.1155/2013/252939. Epub 2013 Dec 16.


Purpose: To evaluate the ESUR scoring system (PI-RADS) for multiparametric MRI of the prostate in clinical routine and to define a reliable way to generate an overall PI-RADS score.

Methods: Retrospective analysis of all patients with a history of negative prebiopsies, who underwent 3 Tesla multiparametric MRI from October 2011 to April 2013 (n = 143): PI-RADS scores for each single modality were defined. To generate the overall PI-RADS score, an algorithm based approach summing up each single-modality score to a sum-score was compared to a more subjective approach, weighting the single modalities dependent on the radiologist's impression. Because of ongoing cancer suspicion 73 patients underwent targeted mpMRI-ultrasound image fusion rebiopsy. For this group thresholds for tumor incidences and malignancy were calculated.

Results: 39 (53%) out of 73 targeted rebiopsies were cancer positive. The PI-RADS score correlated well with tumor incidence (AUC of 0.86, 95% CI 0.78 to 0.94) and malignancy (AUC 0.84, 95% CI 0.68 to 0.99). Regarding the sum-score a threshold of ≥ 10 turned out to be reliable for cancer detection (sensitivity 90%, specificity 62%) and for ≥ 13 for indicating higher malignancy (Gleason ≥ 4 + 3) (sensitivity 80%, specificity 86%). To generate the overall PI-RADS score, the use of an algorithm based approach was more reliable than that of the approach based on the radiologist's impression.

Conclusion: The presented scoring system correlates well with tumor incidence and malignancy. To generate the overall PI-RADS score, it seems to be advisable to use an algorithm based instead of a subjective approach.

MeSH terms

  • Biopsy
  • Humans
  • Magnetic Resonance Imaging / classification*
  • Male
  • Middle Aged
  • Prostate / pathology
  • Prostatic Neoplasms / diagnosis*
  • ROC Curve
  • Research Design*
  • Ultrasonics