Accuracy of Prostate Magnetic Resonance Imaging: Reader Experience Matters

Abstract

Background Prostate magnetic resonance imaging (MRI) is increasingly used in the detection, image-guided biopsy, and active surveillance of prostate cancer. The accuracy of prostate MRI may differ based on factors including imaging technique, patient population, and reader experience. Objective To determine whether the accuracy of prostate MRI varies with reader experience. Design, setting, and participants We rescored regions of interest from 194 consecutive patients who had undergone MRI/ultrasonography fusion biopsy. Original prostate MRI scans had been interpreted by one of 33 abdominal radiologists (AR group). More than 14 mo later, rescoring was performed by two blinded, prostate MRI radiologists (PR group). Likert scoring was used for both original MRI reports and rescoring. Outcome measurements and statistical analysis Test performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of prostate MRI was defined for the AR and PR groups. A Likert score of 4–5 was considered test positive and clinically significant prostate carcinoma (csPCa; Gleason grade group [GGG] ≥2) was considered outcome positive. Results and limitations MRI-positive lesions (Likert 4–5) scored by the PR group resulted in csPCa more frequently than those scored by the AR group (64.9% vs 39.3%). MRI-negative lesions (Likert 2–3) were more likely to result in a clinically insignificant biopsy (benign pathology or GGG 1) when scored by the PR versus the AR group (91.8% vs 76.6%). Sensitivity and specificity of MRI to detect csPCa were higher for the PR group than for the AR group (sensitivity 85.9% vs 70.7%; specificity 77.3% vs 46.8%). Overall diagnostic accuracy was higher for the PR group than for the AR group (80.1% vs 54.6%). Conclusions Sensitivity, specificity, PPV, and NPV of prostate MRI were higher for the PR group than for the AR group. Patient summary We examined the accuracy of prostate magnetic resonance imaging (MRI) in two groups of radiologists. Experienced radiologists were more likely to detect clinically significant prostate cancer on MRI.

Comparison of Multiparametric Magnetic Resonance Imaging with Prostate-Specific Membrane Antigen Positron-Emission Tomography Imaging in Primary Prostate Cancer Diagnosis: A Systematic Review and Meta-Analysis

“…This may prompt further insight into the more modern PI-RADS v2.0 and v2.1 scoring systems in reducing false-negative reports. It is known that inter-reader variability and reader experience in assigning PI-RADS scores and the subsequent detection of csPCa has been shown to affect the detection rates of csPCa [ 44 , 45 , 46 ]. However, image quality has also been shown to significantly affect the diagnostic performance of mpMRI [ 47 , 48 ].…”

A Combined Radiomics and Machine Learning Approach to Distinguish Clinically Significant Prostate Lesions on a Publicly Available MRI Dataset

“…In addition, combining ML algorithms and radiomics has several advantages and potentialities. Since conventional image interpretation is based on radiologists’ experience, this technique could decrease inter-individual variability, as well as reporting time, leading to a potential benefit for less-experienced radiologists [ 59 ].…”

Canadian Association of Radiologists Prostate MRI White Paper

“…88 Moreover, investigators evaluating the importance of reader experience in prostate MRI have used differing endpoints including overall accuracy, interobserver agreement and positive predictive value (PPV). [88][89][90][91][92] The Canadian Association of Radiologists (CAR) currently suggest that outcome data from mammography reporting should be reported including the date range of audit, total number of exams performed, number of BI-RADS 0, 4 and 5 cases and biopsy results of BI-RADS 4 and 5 lesions. 93 Furthermore, the CAR suggests radiologists supervise/interpret/report ≥150 breast MRI examinations over 36 months (e.g.…”