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, 11 (9), e0162879
eCollection

Standardized Reporting of Prostate MRI: Comparison of the Prostate Imaging Reporting and Data System (PI-RADS) Version 1 and Version 2

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Standardized Reporting of Prostate MRI: Comparison of the Prostate Imaging Reporting and Data System (PI-RADS) Version 1 and Version 2

Susanne Tewes et al. PLoS One.

Abstract

Introduction: Objective of our study was to determine the agreement between version 1 (v1) and v2 of the Prostate Imaging Reporting and Data System (PI-RADS) for evaluation of multiparametric prostate MRI (mpMRI) and to compare their diagnostic accuracy, their inter-observer agreement and practicability.

Material and methods: mpMRI including T2-weighted imaging, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) of 54 consecutive patients, who subsequently underwent MRI-guided in-bore biopsy were re-analyzed according to PI-RADS v1 and v2 by two independent readers. Diagnostic accuracy for detection of prostate cancer (PCa) was assessed using ROC-curve analysis. Agreement between PI-RADS versions and observers was calculated and the time needed for scoring was determined.

Results: MRI-guided biopsy revealed PCa in 31 patients. Diagnostic accuracy for detection of PCa was equivalent with both PI-RADS versions for reader 1 with sensitivities and specificities of 84%/91% (AUC = 0.91 95%CI[0.8-1]) for PI-RADS v1 and 100%/74% (AUC = 0.92 95% CI[0.8-1]) for PI-RADS v2. Reader 2 achieved similar diagnostic accuracy with sensitivity and specificity of 74%/91% (AUC = 0.88 95%CI[0.8-1]) for PI-RADS v1 and 81%/91% (AUC = 0.91 95%CI[0.8-1]) for PI-RADS v2. Agreement between scores determined with different PI-RADS versions was good (reader 1: κ = 0.62, reader 2: κ = 0.64). Inter-observer agreement was moderate with PI-RADS v2 (κ = 0.56) and fair with v1 (κ = 0.39). The time required for building the PI-RADS score was significantly lower with PI-RADS v2 compared to v1 (24.7±2.3 s vs. 41.9±2.6 s, p<0.001).

Conclusion: Agreement between PI-RADS versions was high and both versions revealed high diagnostic accuracy for detection of PCa. Due to better inter-observer agreement for malignant lesions and less time demand, the new PI-RADS version could be more practicable for clinical routine.

Conflict of interest statement

The authors confirm that this does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Example of PI-RADS scoring with version 1 and 2 in a patient with prostate cancer.
mpMRI of an 82-year-old man with elevated PSA of 8.2 μg/l. The dominant lesion is located in the apex of the prostate in the pz and measures 12 x 18 x 17 mm. According to PI-RADS v2, DWI is the leading sequence. As the lesion has high signal intensity on b1000 with corresponding strong ADC reduction of 0.5 10−3 mm2/s as well as a diameter >15 mm the lesion was scored PI-RADS 5, highly likely to be malignant. No other sequence is required for scoring according to PI-RADS v2. With PI-RADS v1 a score for each sequence needs to be determined. For this patient the following scores were assigned: T2 TSE PI-RADS 5, DWI PI-RADS 5, DCE PI-RADS 5. This results in in a PI-RADS sum of 15 and a global PI-RADS 5. In this patient the time need for PI-RADS scoring with v2 after inspection of all images was 9 seconds, while it was 59 seconds with v1. MRI-guided in-bore biopsy revealed Gleason 3+4 = 7 tumor.
Fig 2
Fig 2. Diagnostic accuracy of PI-RADS scoring with the two versions for experienced and unexperienced readers.
ROC-curves show diagnostic accuracy of PI-RADS scoring for an experienced (reader 1) and less experienced reader (reader 2) with PI-RADS version 1 (continuous line) and version 2 (dashed line). Points and triangles correspond to PI-RADS thresholds. Sensitivies and specificities as well as Youden-selected thresholds are given in Table 2.
Fig 3
Fig 3. Diagnostic accuracy of PI-RADS scoring with the two versions for peripheral and transitional zone lesions.
ROC-curves depict diagnostic accuracy of PI-RADS scoring for peripheral and transitional zone lesions with PI-RADS version 1 (continuous line) and version 2 (dashed line). Points and triangles correspond to PI-RADS thresholds. Sensitivies and specificities as well as Youden-selected thresholds are given in Table 3.

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Grant support

KH and ST received funding from the Junge Akademie program Hannover Medical School. KH has a research collaboration with Siemens Healthcare outside the work submitted. FW receives institutional grants from Siemens Healthcare and Promedicus Ltd and Delcath Systems Inc. outside the work submitted. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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