Prostate Imaging Reporting And Data System V2 Research Articles

Round table: arguments against using multiparametric prostate MRI protocols

Biparametric MRI (bpMRI), which uses only T2-weighted imaging and diffusion-weighted imaging, continues to gain support for the detection of prostate cancer, as this imaging technique offers many benefits over traditional mpMRI. However, the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 document released in 2019 emphasized that mpMRI is still preferred over bpMRI in most clinical scenarios. As one article in a series of four providing arguments for and against using mpMRI and bpMRI protocols, this paper provides arguments against using mpMRI. Within this article, we discuss recent data suggesting equivalent performance between bpMRI and mpMRI in the detection of prostate cancer. The limited utility of dynamic contrast enhancement in the evaluation of prostate cancer according to the PI-RADS v2.1 document is also reviewed. Finally, we detail the large financial and time costs, legal and logistical issues, and potential for patient harm that must be considered with the administration of contrast.

Interreader variability in prostate MRI reporting using Prostate Imaging Reporting and Data System version 2.1.

To evaluate the agreement among readers with different expertise in detecting suspicious lesions at prostate multiparametric MRI using Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. We evaluated 200 consecutive biopsy-naïve or previously negative biopsy men who underwent MRI for clinically suspected prostate cancer (PCa) between May and September 2017. Of them, 132 patients underwent prostate biopsy. Seven radiologists (four dedicated uro-radiologists and three non-dedicated abdominal radiologists) reviewed and scored all MRI examinations according to PI-RADS v2.1. Agreement on index lesion detection was evaluated with Conger's k coefficient, agreement coefficient 1 (AC1), percentage of agreement (PA), and indexes of specific positive and negative agreement. Clinical and radiological features that may influence variability were evaluated. Agreement in index lesion detection among all readers was substantial (AC1 0.738; 95% CI 0.695-0.782); dedicated radiologists showed higher agreement compared with non-dedicated readers. Clinical and radiological parameters that positively influenced agreement were PSA density ≥ 0.15ng/mL/cc, pre-MRI high risk for PCa, positivity threshold of PI-RADS score 4 + 5, PZ lesions, homogeneous signal intensity of the PZ, and subjectively easy interpretation of MRI. Positive specific agreement was significantly higher among dedicated readers, up to 93.4% (95% CI 90.7-95.4) in patients harboring csPCa. Agreement on absence of lesions was excellent for both dedicated and non-dedicated readers (respectively 85.1% [95% CI 78.4-92.3] and 82.0% [95% CI 77.2-90.1]). Agreement on index lesion detection among radiologists of various experiences is substantial to excellent using PI-RADS v2.1. Concordance on absence of lesions is excellent across readers' experience. • Agreement on index lesion detection among radiologists of various experiences is substantial to excellent using PI-RADS v2.1. • Concordance between experienced readers is higher than between less-experienced readers. • Concordance on absence of lesions is excellent across readers' experience.

Perspective: a critical assessment of PI-RADS 2.1.

In this article we take a critical look at the key changes of the newest edition of the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 (v2.1) and indicate future directions for further development of the system. PI-RADS v2.1 addresses some of the shortcomings of its widely embraced precursor version 2, largely to simplify interpretation and improve interobserver agreement without changing the fundamental acquisition and scoring guidelines. Biparametric MRI is acknowledged in the newest version, but multiparametric MRI including dynamic contrast-enhanced imaging is still recommended for most scenarios. Management recommendations and guidance on evaluation of follow-up MRI's are still not included in the system.

PI-RADS V2 as a Prostate Cancer Detectability Tool is it Dependable for Usage in Diagnosis?

Background: Prostate Imaging Reporting and Data System (PI-RADS) is a scoring system that aims to enable consistent interpretation, communication, and reporting of prostate multiparametric MRI (mpMRI) findings. Aim: To evaluate and investigate the upgrade of the multi-parametric MRI prostate besides the role of PIRADS as a reporting and grading system in prostatic diseases. Methodology: A clinical research trial conducted on 52 male study subjects having prostatic symptoms (from February 2015 till October 2016), the research was conducted within the radiology department of the Kasr AL-Ainy hospitals, and Egyptian national cancer institute. Cases recruited were referred from the Outpatient clinics of the urology department. Results: All cases 100% of pathologically proven carcinoma were suspected to be in the peripheral zone by MRI, with T2 scoring PIRADS 3 were 8 cases ( 24.2%), PIRADS 4 were 12 cases (36.4%) and PIRADS 5 were 13 cases (39.4%).Only 3 cases had mild hemorrhage after TRUS guided biopsy with no major symptomatic adverse effects noted. Conclusions: Multi-parametric MRI prostate is cornerstone advanced tool for diagnosis and gives better results in the diagnosis of prostatic diseases. PIRADS is an efficient way to help in the diagnosis that will result resulting in better management and aids in guiding TRUS biopsy for better visualization of lesions pre-biopsy leading to more precise biopsy and accurate diagnosis.

PI-RADS v2 and periprostatic fat measured on multiparametric magnetic resonance imaging can predict upgrading in radical prostatectomy pathology amongst patients with biopsy Gleason score 3 + 3 prostate cancer

Purpose: An underestimated biopsy Gleason score 3 + 3 can result in unfounded optimism amongst patients and cause physicians to miss the window for prostate cancer (PCa) cure. This study aims to evaluate the effectiveness of Prostate Imaging Reporting and Data System (PI-RADS) version 2 as well as periprostatic fat (PPF) measured on multiparametric magnetic resonance imaging (mp-MRI) at predicting pathological upgrading amongst patients with biopsy Gleason score 3 + 3 disease.Patients and methods: A retrospective analysis of 56 patients with biopsy Gleason score 6 PCa who underwent prebiopsy mp-MRI and radical prostatectomy (RP) between November 2013 and March 2018 was conducted. Two radiologists performed PI-RADS v2 score evaluation and different fat measurements on mp-MRI. The associations amongst clinical information, PI-RADS v2 score, different fat parameters and pathologic findings were analyzed. A nomogram predicting upgrading was established based on the results of logistic regression analysis.Results: A total of 38 (67.9%) patients were upgraded to Gleason ≥7 disease on RP specimens. Prostate-specific antigen density (PSAD) (p < .001), positive core (p < .001), single-core positivity (p = .039), PI-RADS score (p < .001), front PPF area (p = .007) and front-to-total ratio (the ratio of front PPF area to total contour area) (p < .001) were risk factors for upgrading. On multivariate analysis, Epstein criteria (p = .02), PI-RADS score >3 (p = .024), and front-to-total ratio (p = .006) were independent risk factors for pathologic upgrading. The AUC value of the nomogram was 0.893 (95% CI, 0.787–0.999).Conclusion: The combination of PI-RADS v2 and periprostatic fat measured on mp-MRI can help predict pathologic upgrading amongst patients with biopsy Gleason score 3 + 3 PCa.

Interobserver Agreement and Positivity of PI-RADS Version 2 Among Radiologists with Different Levels of Experience

To evaluate interobserver agreement of Prostate Imaging Reporting and Data System (PI-RADS) v2 category among radiologists with different levels of experience. The secondary objective was to evaluate the positivity for significant cancer among each category (splitting category 4 into two) and among different lesion sizes. Institutional review board and ethics comitee approved retrospective study. Eight radiologists with different levels of experienced in prostatic magnetic resonance imaging-two more experienced, four with intermediate experience, and two abdominal radiology fellows-interpreted 160 lesions. Reference standard was fusion-targeted biopsy. Percentage agreement, k coefficients, and analysis concordance were used. Coefficient of concordance according to categories was 0.71 considering both zones, 0.72 for peripheral zone (PZ) and 0.44 for peripheral zone (TZ). Agreement for PI-RADS score of 3 or greater was 0.48 in PZ and 0.57 in TZ. Tumor positivity rates were 54.3% and 66.0% for PI-RADS 3 + 1 and 4 for PZ, respectively; and 25.0 and 49.2% for PI-RADS 3 + 1 and 4 for TZ, respectively (p < 0.001 in both analysis). Lesions <10, 10-14, and ≥15 mm had 55.3%, 74.6%, and 93.5% of positivity rates for cancer in PZ (p = 0.002 and <0.001) and 26.7%, 56.5%, and 59.6% in TZ, respectively (p = 0.245 and 0.632). Sensitivities, specificities, and accuracies of magnetic resonance imaging for prostate cancer using PI-RADS v2 were 76%, 72%, and 74% for PZ; and 76%, 69%, and 71% for TZ, respectively. This study shows that PI-RADS v2 has overall good interobserver agreement among radiologists with different levels of experience. PI-RADS category 3 + 1 showed lower positivity rates for significant cancer compared to category 4. Lastly, lesions 10-14 mm has similar positivity rates compared to ≥15 mm for TZ lesions.

Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 Status Update and Future Directions

ContextThe Prostate Imaging-Reporting and Data System (PI-RADS) v2 analysis system for multiparametric magnetic resonance imaging (mpMRI) detection of prostate cancer (PCa) is based on PI-RADS v1, accumulated scientific evidence, and expert consensus opinion. ObjectiveTo summarize the accuracy, strengths and weaknesses of PI-RADS v2, discuss pathway implications of its use and outline opportunities for improvements and future developments. Evidence acquisitionFor this consensus expert opinion from the PI-RADS steering committee, clinical studies, systematic reviews, and professional guidelines for mpMRI PCa detection were evaluated. We focused on the performance characteristics of PI-RADS v2, comparing data to systems based on clinicoradiologic Likert scales and non–PI-RADS v2 imaging only. Evidence selections were based on high-quality, prospective, histologically verified data, with minimal patient selection and verifications biases. Evidence synthesisIt has been shown that the test performance of PI-RADS v2 in research and clinical practice retains higher accuracy over systematic transrectal ultrasound (TRUS) biopsies for PCa diagnosis. PI-RADS v2 fails to detect all cancers but does detect the majority of tumors capable of causing patient harm, which should not be missed. Test performance depends on the definition and prevalence of clinically significant disease. Good performance can be attained in practice when the quality of the diagnostic process can be assured, together with joint working of robustly trained radiologists and urologists, conducting biopsy procedures within multidisciplinary teams. ConclusionsIt has been shown that the test performance of PI-RADS v2 in research and clinical practice is improved, retaining higher accuracy over systematic TRUS biopsies for PCa diagnosis. Patient summaryMultiparametric magnetic resonance imaging (MRI) and MRI-directed biopsies using the Prostate Imaging-Reporting and Data System improves the detection of prostate cancers likely to cause harm, and at the same time decreases the detection of disease that does not lead to harms if left untreated. The keys to success are high-quality imaging, reporting, and biopsies by radiologists and urologists working together in multidisciplinary teams.

MP40-07 3T MULTIPARAMETRIC MRI BASED DETECTION OF PROSTATE CANCER: FEATURES OF DETECTED AND MISSED TUMORS BASE ON PIRADS V2 IN 429 PATIENTS- USING WHOLE MOUNT HISTOPATHOLOGY REFERENCE

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2018MP40-07 3T MULTIPARAMETRIC MRI BASED DETECTION OF PROSTATE CANCER: FEATURES OF DETECTED AND MISSED TUMORS BASE ON PIRADS V2 IN 429 PATIENTS- USING WHOLE MOUNT HISTOPATHOLOGY REFERENCE Amirhossein Mohammadian Bajgiran, Sohrab Afshari Mirak, Ely Felker, Preeti Ahuja, Cleo Maehara, William Hsu, David Lu, Robert Reiter, Anthony Sisk, and Steve Raman Amirhossein Mohammadian BajgiranAmirhossein Mohammadian Bajgiran More articles by this author , Sohrab Afshari MirakSohrab Afshari Mirak More articles by this author , Ely FelkerEly Felker More articles by this author , Preeti AhujaPreeti Ahuja More articles by this author , Cleo MaeharaCleo Maehara More articles by this author , William HsuWilliam Hsu More articles by this author , David LuDavid Lu More articles by this author , Robert ReiterRobert Reiter More articles by this author , Anthony SiskAnthony Sisk More articles by this author , and Steve RamanSteve Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1274AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although some studies have already been published in order to the diagnosis performance of Prostate Imaging Reporting and Data System (PI-RADS) Version 2 in the detection of PCa, still there is some discrepancy between their results. The purpose of this study was to determine the performance of 3T multiparametric MRI in prostate cancer, using PIRADS v2, and explain the characteristics of detected and missed tumors. METHODS A retrospective study was performed of 429 consecutive men who underwent mp-MRI before radical prostatectomy at a single referral academic center between Dec 2009 and Jun 2016. Clinical, mp-MRI (i.e., T2-weighted imaging, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging) and pathologic features were obtained. A structural report system, based on PI-RADS v2, was used for reporting qualitative and quantitative (DWI and DCE) features of each MRI detected lesion. MRI detected lesions were matched with previously finalized whole mount thin section histopathology (WMHP) in a joint session by a genitourinary (GU) radiologist and GU pathologist. MRI lesion detection rate was calculated. RESULTS Of 874 PCa lesions in 429 patients on WMHP, 3T MRI detected 443(49.3%) overall and 334 of 429 (77.9%) index lesions based on PIRADS v2. The 3T MRI detection rate was significantly higher in larger (70.4%, pathology size > 1cm) and higher grade (71.8%, Gleason score =7) PCa (p-value < 0.001). Of 441 missed lesions 308 (76.6%) had Gleason score = 6 and 287 (81.3%) were = 1 cm. Detection rate was highest in the mid gland 55.1% compared to the base and apex (p<0.001). The detection rate was not significantly different in the peripheral and transitional zones (50.8% vs 46% p =0.217). Sensitivity for index lesions detection was significantly higher in solitary (87.5%) vs multifocal tumors (74.7%) (p-value = 0.003). Prostate volume was significantly less in detected tumors (39.4cc), compared to missed tumors (47.1cc), p-value <0.001. PSA density was significantly higher in detected index lesions compared to the missed lesions. CONCLUSIONS In this large 3T Prostate MRI cohort with WMHP, tumor detection rate based on PIRADS v2 increased by PCa size, grade and stage was significantly higher for index lesions. Index and overall tumor detection rate was similar in the TZ and PZ and was higher with higher PSA density, in solitary tumors and smaller prostate volumes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e522 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amirhossein Mohammadian Bajgiran More articles by this author Sohrab Afshari Mirak More articles by this author Ely Felker More articles by this author Preeti Ahuja More articles by this author Cleo Maehara More articles by this author William Hsu More articles by this author David Lu More articles by this author Robert Reiter More articles by this author Anthony Sisk More articles by this author Steve Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AB206. 135. Comparing MRI PIRADS v2 scores and template biopsies of the prostate over time

Background: Globally prostate cancer is a major health concern. Increasing longevity among populations and improved diagnostics has led to significantly increased detection rates. The use of multi parametric MRI (mpMRI) as an adjunct to diagnosis and surveillance is now common practice in prostate cancer. In 2012 the Prostate Imaging, Reporting and Data System (PIRADS) and subsequent revised version in 2015, PIRADS v2, were introduced to help categorize mpMRI reporting. We investigate the correlation between mpMRI scan results and template guided, sector mapping prostate biopsy performed by a single urologist and its evolution over time.

PI-RADS v2 in Prostate Cancer and Correlation with T Staging, PSA Levels and ADC Values

Background: Magnetic resonance imaging of the prostate is a major diagnostic tool in prostate cancer detection. In 2012, prostate imaging reporting and data system (PI-RADS) was published by the European society of urogenital radiology. Due to certain limitations in this version, arevised version namedProstate Imaging Reporting and Data System version 2 (PI-RADS v2) was proposed by the American College of Radiology in 2014 Objectives: To evaluate the role of multiparametric magnetic resonance imaging based prostate imaging reporting and data system (PI-RADS) version 2 for the assessment of peripheral zone prostate cancer and its correlation with the T staging, prostatic specific antigen (PSA) levels and apparent diffusion coefficient (ADC) values. Patients and Methods: Eighty seven patients underwent MRI at 1.5 T units. Dynamic contrast enhanced (DCE) imaging was done in 73 patients as 14 patients had deranged renal functions. Patients with a PI-RADS v2 score of ≥ 2 underwent biopsy except in one patient with a score of 1. The histopathological report was used as gold standard. T staging was done based on MRI. The score was correlated with T staging, ADC values and serum prostate-specific antigen (S.PSA) levels by two experienced blinded radiologists. Statistical analysis was done. Results: Highly significant correlation was observed between PI-RADS v2 score, T staging, ADC values and s PSA levels with P value < 0.005. DCE had added advantage in one patient only for up-gradation of score from 3 to 4. Conclusion: The dominant MR imaging sequence for the peripheral zone prostate cancer is diffusion weighted sequence and the corresponding ADC values, with the role of DCE sequences in doubtful cases only. PI-RADS v2 gives a scoring system on MRI for prostate cancer assessment. It should be routinely incorporated in the reporting protocol. Our study concluded that there is a highly significant correlation between lesion score on PI-RADS v2 with the T stage, corresponding ADC values and S.PSA levels, although larger study groups may be required for further evaluation and beyond doubt PI-RADS version 3 is already in its earliest stages.

Does the Prostate Imaging-Reporting and Data System (PI-RADS) version 2 improve accuracy in reporting anterior lesions on multiparametric magnetic resonance imaging (mpMRI)?

Multiparametric MRI (mpMRI) is useful in detecting anterior prostate tumours. Due to the location of anterior tumours, they are often diagnosed with a large size and may be suspicious for extra-prostatic extension (EPE). We aim to evaluate whether PI-RADS v2 is more accurate in assessing anterior prostate lesions identified on mpMRI compared to PI-RADS v1. Patients with anterior prostate lesions diagnosed on mpMRI who proceeded to a cognitive fusion transperineal prostate biopsy were identified. Each mpMRI was blinded and read by two experienced prostate MRI radiologists and assigned a PI-RADS v1 and PI-RADS v2 score, and the presence of EPE was estimated. Correlation was made with transperineal histopathology and, where relevant, radical prostatectomy histopathology. Concordance measures between PI-RADS v1 and PI-RADS v2, and between examiners of the same PI-RADS score were calculated using a weighted kappa. Fifty-eight consecutive men were identified. Concordance between the examiners for PI-RADS v1 and for v2 showed substantial agreement (version 1: weighted kappa 0.71; version 2: weighted kappa 0.69). There was no difference in accuracy when using PI-RADS v1 or PI-RADS v2 to predict clinically significant cancer. There was poor correlation between EPE measured on mpMRI compared with EPE in radical prostatectomy histopathology. PI-RADS v2 is reproducible between radiologists but does not have improved accuracy for diagnosing anterior tumours of the prostate when compared to PI-RADS v1. Multiparametric MRI is accurate at detecting anterior tumours with a sensitivity of 86-88%.

Clinically insignificant prostate cancer suitable for active surveillance according to Prostate Cancer Research International: Active surveillance criteria: Utility of PI-RADS v2.

Active surveillance (AS) is an important treatment strategy for prostate cancer (PCa). Prostate Imaging-Reporting and Data System (PI-RADS) v2 has been addressed, but few studies have reported the value of PI-RADS v2 for assessing risk stratification in patients with PCa, especially on selecting potential candidates for AS. To investigate the utility of PI-RADS v2 and apparent diffusion coefficient (ADC) in evaluating patients with insignificant PCa, who are suitable for AS. Retrospective. In all, 238 patients with PCa who met the Prostate Cancer Research International: Active Surveillance criteria underwent radical prostatectomy. 3.0T, including T2 -weighted, diffusion-weighted, and dynamic contrast-enhanced imaging. Insignificant cancer was defined histopathologically as an organ-confined disease with a tumor volume <0.5 cm3 without Gleason score 4-5. Patients were divided into two groups based on the PI-RADS v2 and tumor ADC: A, PI-RADS score ≤3 and ADC ≥1.095 × 10-3 mm2 /s; and B, PI-RADS score 4-5 or ADC <1.095 × 10-3 mm2 /s. Preoperative clinical and imaging variables were evaluated regarding the associations with insignificant cancer. Of the 238 patients, 101 (42.8%) were diagnosed with insignificant cancer on pathological findings. The number of positive cores, prostate-specific antigen density (PSAD), PI-RADS v2 and tumor ADC were significantly associated with insignificant cancer on univariate analysis (P < 0.05). However, multivariate analysis indicated tumor ADC (odds ratio [OR] = 4.57, P < 0.001) and PI-RADS v2 (OR = 3.60, P < 0.001) were independent predictors of insignificant cancer. Area under the receiver operating characteristics curve (AUC) reached 0.803 when PI-RADS v2 (AUC = 0.747) was combined with tumor ADC (AUC = 0.786). The PI-RADS v2 together with tumor ADC may be a useful marker for predicting patients with insignificant PCa when considering AS. 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1072-1079.

Evaluation of Prostate Imaging Reporting and Data System Classification in the Prediction of Tumor Aggressiveness in Targeted Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy

Objectives: The study aimed to evaluate the prediction of Prostate Imaging Reporting and Data System (PI-RADS) with respect to the prostate cancer (PCa) detection rate and tumor aggressiveness in magnetic resonance imaging (MRI)/ultrasound-fusion-biopsy (fusPbx) and in systematic biopsy (sysPbx). Materials and Methods: Six hundred and twenty five patients undergoing multiparametric MRI were investigated. MRI findings were classified using PI-RADS v1 or v2. All patients underwent fusPbx combined with sysPbx (comPbx). The lesion with the highest PI-RADS was defined as maximum PI-RADS (maxPI-RADS). Gleason Score ≥7 (3 + 4) was defined as significant PCa. Results: The overall PCa detection rate was 51% (n = 321; 39% significant PCa). The detection rate was 43% in fusPbx (n = 267; 34% significant PCa) and 36% in sysPbx (n = 223; 27% significant PCa). Nine percentage of significant PCa were detected by sysPbx alone. A total of 1,162 lesions were investigated. The detection rate of significant PCa in lesions with PI-RADS 2, 3, 4, and 5 were 9% (18/206), 12% (56/450), 27% (98/358), and 61% (90/148) respectively. maxPI-RADS ≥4 was the strongest predictor for the detection of significant PCa in comPbx (OR 2.77; 95% CI 1.81-4.24; p < 0.005). Conclusions: maxPI-RADS is the strongest predictor for the detection of significant PCa in comPbx. Due to a high detection rate of additional significant PCa in sysPbx, fusPbx should still be combined with sysPbx.

Multiparametric Magnetic Resonance Imaging of the Prostate: Repeatability of Volume and Apparent Diffusion Coefficient Quantification.

The aim of this study was to evaluate the repeatability of a region of interest (ROI) volume and mean apparent diffusion coefficient (ADC) in standard-of-care 3 T multiparametric magnetic resonance imaging (mpMRI) of the prostate obtained with the use of endorectal coil. This prospective study was Health Insurance Portability and Accountability Act compliant, with institutional review board approval and written informed consent. Men with confirmed or suspected treatment-naive prostate cancer scheduled for mpMRI were offered a repeat mpMRI within 2 weeks. Regions of interest corresponding to the whole prostate gland, the entire peripheral zone (PZ), normal PZ, and suspected tumor ROI (tROI) on axial T2-weighted, dynamic contrast-enhanced subtract, and ADC images were annotated and assessed using Prostate Imaging Reporting and Data System (PI-RADS) v2. Repeatability of the ROI volume for each of the analyzed image types and mean ROI ADC was summarized with repeatability coefficient (RC) and RC%. A total of 189 subjects were approached to participate in the study. Of 40 patients that gave initial agreement, 15 men underwent 2 mpMRI examinations and completed the study. Peripheral zone tROIs were identified in 11 subjects. Tumor ROI volume was less than 0.5 mL in 8 of 11 subjects. PI-RADS categories were identical between baseline-repeat studies in 11/15 subjects and differed by 1 point in 4/15. Peripheral zone tROI volume RC (RC%) was 233 mm (71%) on axial T2-weighted, 422 mm (112%) on ADC, and 488 mm (119%) on dynamic contrast-enhanced subtract. Apparent diffusion coefficient ROI mean RC (RC%) were 447 × 10 mm/s (42%) in PZ tROI and 471 × 10 mm/s (30%) in normal PZ. Significant difference in repeatability of the tROI volume across series was observed (P < 0.005). The mean ADC RC% was lower than volume RC% for tROI ADC (P < 0.05). PI-RADS v2 overall assessment was highly repeatable. Multiparametric magnetic resonance imaging sequences differ in volume measurement repeatability. The mean tROI ADC is more repeatable compared with tROI volume in ADC. Repeatability of prostate ADC is comparable with that in other abdominal organs.

The role of different PI-RADS versions in prostate multiparametric magnetic resonance tomography assessment.

Background. Standardised Prostate Imaging Reporting and Data System (PI-RADS) guidelines for the assessment of prostate alterations were designed for the assessment of prostate pathology. Published by the ESUR in 2012, PI-RADS v1 was based on the total score of different MRI sequences with subsequent calculation. PI-RADS v2 was published by the American College of Radiology in 2015 and featured different assessment criteria for prostate peripheral and transitory zones.Aim. To assess the correlations of PI-RADS v1 and PI-RADS v2 with Gleason score values and to define their predictive values of the diagnosis of prostate cancer.Materials and methods. A retrospective analysis of 66 patients. Prostate specific antigen (PSA) value and the Gleason score (GS) were assessed. One the most malignant focal lesion was selected in the peripheral zone of each lobe of the prostate (91 in total). Statistical analysis was carried out applying SPSS software, v.23, p < 0.05.Results. Focal lesions assessed by PI-RADS v1 score: 10% – 1, 12% – 2, 41% – 3, 23% – 4, 14% – 5. Assessment applying PI-RADS v.2: 20% – 1, 7.5% – 2, 26%, 29.5%, and 17% were assessed by 3, 4, and 5 scores. Statistically relevant correlation was found only between GS and PI-RADS (p = 0.033).The positive predictive value of both versions of PI-RADS – 75%, negative predictive value of PI-RADS v1 – 46%, PI-RADS v2 – 43%.Conclusions. PI-RADS v1 was more statistically relevant in assessing the grade of tumour. Prediction values were similar in both versions

Role of PI-RADSv2 with multiparametric MRI in determining who needs active surveillance or definitive treatment according to PRIAS.

To evaluate the role of Prostate Imaging Reporting and Data System v. 2 (PI-RADSv2) in triaging patients with prostate cancer according to Prostate Cancer Research International: Active Surveillance (PRIAS). Between January 2012 and December 2014, 456 patients with biopsy-proven cancer underwent multiparametric 3T magnetic resonance imaging (MRI) using T2 -weighted, diffusion-weighted, and dynamic contrast-enhanced MRI sequences, and then radical prostatectomy. Two radiologists independently reviewed MR images using PI-RADSv2. For AS, PRIAS required clinical stage <T3, prostate-specific antigen (PSA) ≤10 ng/mL, PSA density <0.2 ng/mL2 , Gleason score (GS) ≤6, and the number of positive cores ≤2. For AS, PI-RADSv2 required an index lesion scored <4. Standard reference was prostatectomy, in which insignificant cancer was defined as a small (<0.5 cm3 ) organ-confined lesion with GS ≤6. Sensitivity and specificity for insignificant cancer were obtained with PRIAS, PI-RADSv2, and both. The sensitivity and specificity with PRIAS were 82.9% (68/82) and 70.9% (265/374), respectively. PI-RADSv2 decreased the sensitivity to 61% (50/82) to 80.5% (66/82), but increased the specificity to 77.8% (291/374) to 90.8% (340/374). The combination of PRIAS and PI-RDASv2 increased significantly the specificity to 89.6% (335/374) to 92.8% (347/374) (P < 0.001). PRIAS using multiparametric MRI can identify a greater number of insignificant cancers than PI-RADSv2. However, PI-RADSv2 helps detect many significant cancers that are misdiagnosed as insignificant cancer with PRIAS. 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1753-1759.

Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: Prostate Imaging Reporting and Data System Version 1 versus Version 2.

Background:Prostate Imaging Reporting and Data System (PI-RADS) is a globally acceptable standardization for multiparametric magnetic resonance imaging (mp-MRI) in prostate cancer (PCa) diagnosis. The American College of Radiology revised the PI-RADS to address the limitations of version 1 in December 2014. This study aimed to determine whether the PI-RADS version 2 (PI-RADS v2) scoring system improves the diagnostic accuracy of mp-MRI of the prostate compared with PI-RADS v1.Methods:This retrospective study was approved by the institutional review board. A total of 401 consecutive patients, with clinically suspicious PCa undergoing 3.0 T mp-MRI (T2-weighted imaging + diffusion-weighted imaging + DCE) before transrectal ultrasound-guided biopsy between June 2013 and July 2015, were included in the study. All patients were scored using the 5-point PI-RADS scoring system based on either PI-RADS v1 or v2. Receiver operating characteristics were calculated for statistical analysis. Sensitivity, specificity, and diagnostic accuracy were compared using McNemar's test.Results:PCa was present in 150 of 401 (37.41%) patients. When we pooled data from both peripheral zone (PZ) and transition zone (TZ), the areas under the curve were 0.889 for PI-RADS v1 and 0.942 for v2 (P = 0.0001). Maximal accuracy was achieved with a score threshold of 4. At this threshold, in the PZ, similar sensitivity, specificity, and accuracy were achieved with v1 and v2 (all P > 0.05). In the TZ, sensitivity was higher for v2 than for v1 (96.36% vs. 76.36%, P = 0.003), specificity was similar for v2 and v1 (90.24% vs. 84.15%, P = 0.227), and accuracy was higher for v2 than for v1 (92.70% vs. 81.02%, P = 0.002).Conclusions:Both v1 and v2 showed good diagnostic performance for the detection of PCa. However, in the TZ, the performance was better with v2 than with v1.

The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS Version 2 in the diagnosis of clinically significant prostate cancer

ObjectivesTo investigate the efficiency of multiparametric MRI (mpMRI) based on Prostate Imaging Reporting and Data System (PI-RADS) Version 2 (v2) in detecting clinically significant prostate cancer (PCa) and to test the interobserver consistency. MethodsBased on PI-RADS v2, two radiologists reviewed the images of 372 patients who underwent prostate biopsy and prebiopsy mpMRI. ResultsThere's significant correlation between higher PI-RADS score and the presence of clinical significant PCa (P<.001). PI-RADS score 3 was the best cutoff point with sensitivity and specificity over 80%. The diagnostic concordance was moderate (kappa=0.478). ConclusionsPI-RADS v2 demonstrated good accuracy in detecting clinically significant PCa, however the interobserver consistency needs to be improved.

Assessment of PI-RADS v2 for the Detection of Prostate Cancer

PurposeTo evaluate the diagnostic performance and inter-reader reliability of the multiparametric magnetic resonance imaging (mpMRI) based prostate imaging reporting and data system (PI-RADS) version 1 and version 2 for the assessment of prostate cancer. Material and methodsA cohort of 82 patients underwent endorectal mpMRI at 1.5T. Patients had at least one lesion with a PI-RADS v1 assessment category of ≥3 and were selected for targeted in-bore MR-guided biopsy in a subsequent session. The results of the histopathological workup were used as reference standard. All lesions were retrospectively evaluated according to PI-RADS v2 by an experienced and unexperienced blinded reader. Diagnostic performance was compared by analyzing the area under the Receiver Operating Characteristics Curve (AUC). The weighted kappa method was used to calculate inter-reader reliability. ResultsTargeted MR-guided biopsy was performed in 136 lesions and revealed 39 malignant lesions in 31 patients. AUC values increased for the experienced reader (PI-RADS v1 0.79; PI-RADS v2 0.83) and unexperienced reader (PI-RADS v1 0.70; PI-RADS v2 0.83). When excluding the cases of low grade cancer (Gleason score=3+3), AUC values increased further for the experienced reader (PI-RADS v1 0.88; PI-RADS v2 0.91) and unexperienced reader (PI-RADS v1 0.78; PI-RADS v2 0.90). Specificity at the selected threshold of a PI-RADS v1/v2 assessment category ≥4 improved for both readers. Inter-reader agreement increased from κ=0.55 in PI-RADS v1 to κ=0.68 in v2. ConclusionPI-RADS v2 improved diagnostic performance for the assessment of suspicious intraprostatic lesions identified in PI-RADS v1 for both readers and led to higher inter-reader reliability. These results suggest that PI-RADS v2 is a reliable and replicable reporting system for the assessment of prostate cancer.