A multifaceted approach to quality in the MRI-directed biopsy pathway for prostate cancer diagnosis

Padhani, Anwar R.; Schoots, Ivo G.; Türkbey, Barış; Giannarini, Gianluca; Barentsz, Jelle O.

doi:10.1007/s00330-020-07527-9

Cited by 23 publications

(15 citation statements)

References 29 publications

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“…As prostate MRI becomes increasingly used, there is now an emphasis on improving prostate MRI quality as poor quality exams may negatively impact diagnostic test performance. 1,2 Prostate MRI performed with suboptimal quality can lead to diagnostic errors, create doubt in clinical care pathways and may result in unnecessary repeat exams. The Prostate Imaging and Reporting Data System (PI-RADS) and other authorities stress the importance of prostate image quality and provide advice for MRI practitioners on how to effectively acquire prostate MRI to achieve adequate image quality.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality

et al. 2021

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Purpose: To compare 5 different rectal preparation strategies for prostate MRI. Methods: This 5-arm quality-assurance study evaluated 56 patients per arm (280 patients) including: no preparation, clear-fluids diet (CFD) beginning at 00:00 hours on the day of MRI, Fleet®-enema, enema + CFD, enema + CFD + IV-antispasmodic agent. The study was powered to 0.80 with alpha-error of 0.05. Three blinded radiologists independently evaluated T2-Weighted (T2W) and Diffusion Weighed Imaging (DWI) for: rectal diameter (maximal AP diameter), rectal content (stool, fluid, gas), rectal motion, T2W/DWI image quality, T2W image sharpness and DWI susceptibility artifact using 5-point Likert scales. Overall comparisons were performed using analysis of variance (ANOVA) and Kruskal-Wallis, with pair-wise comparisons using paired t-tests and Wilcoxon sign-rank tests. Results: Rectal diameter and amount of gas were lower in enema compared to non-enema groups (p < 0.001), with smallest diameter and least gas in the enema + CFD + IV-antispasmodic group (p = 0.022-<0.001). T2W image quality and sharpness were highest in the enema + CFD groups (p < 0.001) with no difference comparing enema + CFD with/without IV-antispasmodic (p = 0.064, 0.084). Motion artifact was least in enema + CFD + IV-antispasmodic group compared to all other groups (p < 0.001), followed by the enema + CFD group (p = 0.008-<0.001). DWI image quality was highest (p < 0.001) and DWI susceptibility artifact lowest (p < 0.001) in the enema + CFD groups (p < 0.001) and did not differ comparing enema + CFD with/without anti-spasmodic (p = 0.058-0.202). Conclusions: Use of enema + clear-fluids diet before prostate MRI yields the highest T2W and DWI image quality with the least DWI artifact. IV-antispasmodic use reduces motion on T2W but does not improve image quality on T2W or DWI, or lessen DWI artifact compared to enema + clear-fluids diet.

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Section: Introductionmentioning

confidence: 99%

Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality

et al. 2021

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“…Our results suggest that the PI-QUAL score can be applied with reasonable consistency by radiologists familiar with prostate MRI on the basis of a clear understanding of the lexicon provided in the scoring sheet [29]. However, it needs to be stressed that only genitourinary radiologists with appropriate training in prostate MRI should assess the quality of the scans [30]. The findings of our study may be also useful for guiding the future iteration of the PI-QUAL score, which should focus on the features that have the greatest objective reproducibility and that should receive more emphasis in the future versions.…”

Section: Discussionmentioning

confidence: 95%

Inter-reader agreement of the PI-QUAL score for prostate MRI quality in the NeuroSAFE PROOF trial

et al. 2021

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Objectives The Prostate Imaging Quality (PI-QUAL) score assesses the quality of multiparametric MRI (mpMRI). A score of 1 means all sequences are below the minimum standard of diagnostic quality, 3 implies that the scan is of sufficient diagnostic quality, and 5 means that all three sequences are of optimal diagnostic quality. We investigated the inter-reader reproducibility of the PI-QUAL score in patients enrolled in the NeuroSAFE PROOF trial. Methods We analysed the scans of 103 patients on different MR systems and vendors from 12 different hospitals. Two dedicated radiologists highly experienced in prostate mpMRI independently assessed the PI-QUAL score for each scan. Interobserver agreement was assessed using Cohen’s kappa with standard quadratic weighting (κw) and percent agreement. Results The agreement for each single PI-QUAL score was strong (κw = 0.85 and percent agreement = 84%). A similar agreement (κw = 0.82 and percent agreement = 84%) was observed when the scans were clustered into three groups (PI-QUAL 1–2 vs PI-QUAL 3 vs PI-QUAL 4–5). The agreement in terms of diagnostic quality for each single sequence was highest for T2-weighted imaging (92/103 scans; 89%), followed by dynamic contrast-enhanced sequences (91/103; 88%) and diffusion-weighted imaging (80/103; 78%). Conclusion We observed strong reproducibility in the assessment of PI-QUAL between two radiologists with high expertise in prostate mpMRI. At present, PI-QUAL offers clinicians the only available tool for evaluating and reporting the quality of prostate mpMRI in a systematic manner but further refinements of this scoring system are warranted. Key Points • Inter-reader agreement for each single Prostate Imaging Quality (PI-QUAL) score (i.e., PI-QUAL 1 to PI-QUAL 5) was strong, with weighted kappa = 0.85 (95% confidence intervals: 0.51 – 1) and percent agreement = 84%. • Interobserver agreement was strong when the scans were clustered into three groups according to the ability (or not) to rule in and to rule out clinically significant prostate cancer (i.e., PI-QUAL 1-2 vs PI-QUAL 3 vs PI-QUAL 4–5), with weighted kappa = 0.82 (95% confidence intervals: 0.68 – 0.96) and percent agreement = 84%. • T2-weighted acquisitions were the most compliant with the Prostate Imaging Reporting and Data System (PI-RADS) v. 2.0 technical recommendations and were the sequences of highest diagnostic quality for both readers in 95/103 (92%) scans, followed by dynamic contrast enhanced acquisition with 81/103 (79%) scans and lastly by diffusion-weighted imaging with 79/103 (77%) scans.

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“…The associated downside of the increased use of prostate MRI is variable image quality between centers and scanners [5]. Good-quality prostate MRI is the starting point and prerequisite for optimal patient management, which affects all downstream steps in the diagnostic pathway [6]. Sub-optimal image quality can lead to decreased diagnostic accuracy and increased uncertainty.…”

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confidence: 99%

PI-QUAL v.1: the first step towards good-quality prostate MRI

Rooij

Barentsz

2021

Eur Radiol

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It is mandatory to evaluate the image quality of a prostate MRI scan, and to mention this quality in the report.• PI-QUAL v1 is an essential starting tool to standardize the evaluation of the quality of prostate MR-images as objectively as possible. • PI-QUAL will step by step develop into a reliable quality assessment tool to ensure that the first step of the MRIpathway is as accurate as possible.

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A multifaceted approach to quality in the MRI-directed biopsy pathway for prostate cancer diagnosis

Cited by 23 publications

References 29 publications

Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality

Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality

Inter-reader agreement of the PI-QUAL score for prostate MRI quality in the NeuroSAFE PROOF trial

PI-QUAL v.1: the first step towards good-quality prostate MRI

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