Abstract
Aim: The purpose of this study was to evaluate accuracy of multi-parametric MRI (mpMRI) in detection of clinically significant (CS) prostate cancer (PC) and determine agreement of Prostate Imaging Reporting and Data Systems version2 (PI-RADS v2) among three readers.
 Material and Method: The study included 65 (32 malignancy, 33 benign) patients with clinically suspected PC who were underwent mpMRI between January 2017 and January 2020 followed by biopsy or prostatectomy. The images were evaluated by three readers who were blinded to patient data. The inter-observer agreement was analyzed with Cohen’s weighted kappa statistics.
 Results: 74 lesions were detected in 46 patients among 65 patients. When a PI-RADS assessment category ≥3 (K value, 0.406-0.632) was considered positive for CS PC for readers, higher sensitivity, lower specificity and lower agreement was found than PI-RADS ≥4 (K value, 0.545-0.667). The sensitivity and specificity of index lesion detection ranged from 71.8%-90.6%, 60.6%-72.7%, respectively. We found moderate to substantial agreement for index lesion detection. The agreement of PZ lesions was higher than TZ lesions. The agreement in DWI scores was higher than the agreement in T2 scores between readers.
 Conclusion: By using PI-RADS v2, high sensitivity but moderate specificity was found in detection of index lesion. The agreement in PI-RADS category assignment was moderate among readers. The agreement and sensitivity in threshold of PI-RADS 4 was higher than PI-RADS 3. TZ lesions showed more variability among radiologists than PZ lesions by using PI-RADS v2.
Highlights
The use blood prostatic specific antigen (PSA) is the main screening method to detect prostate cancer (PC)
41 patients who had not histopathologic evaluation in our hospital were excluded from this study. 105 patients that were followed by radical prostatectomy (RP), trans-vesical prostatectomy or systematic 12-core trans-rectal ultrasound (TRUS)-guided biopsy, were included in this study. 34 of the 105 patients included in this study were positive for PC by histopathologic analysis
In remaining 3 patients, clinically significant (CS) PC was detected in peripheral zone (PZ) (ISUP 1 in two patients, International Society of Urological Pathology (ISUP) 2 in 1 patient)
Summary
The use blood prostatic specific antigen (PSA) is the main screening method to detect prostate cancer (PC). Low specificity and false positive results of PSA may result in unnecessary biopsy procedures [1]. In recent years, multi-parametric magnetic resonance imaging (mpMRI) has become a widely used modality for diagnosis of clinically significant (CS) PC prior to biopsy [2,3]. In PI-RADS v1, lesions were scored 1 to 5 in each individual pulse sequence. This categorization caused variability in assessing PC among radiologists due to lack of strength in determination of final overall score. If a lesion score cannot be defined with dominant sequence, contrast enhancement in PZ and diffusion restriction in TZ is used to specify PI-RADS score [5]
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