PI-RADS version 2.1: one small step for prostate MRI

Barrett, Tristan; Arora, Rajesh; Rosenkrantz, Andrew B.; Choyke, P L; Türkbey, Barış

doi:10.1016/j.crad.2019.05.019

Cited by 128 publications

(90 citation statements)

References 61 publications

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“…One of the limitations to this study was the use of different slice thickness and gap parameters at different magnet strengths; however, the protocols remained within the technical specifications of the PI-RADS guidelines and this was done to ensure that optimal imaging quality is achieved on both 3-T and 1.5-T scanning systems. Finally, we employed a Likert scoring system rather than PI-RADS; however, PI-RADS scoring can only be used for baseline evaluation and cannot be used for the follow-up assessment of patients on AS [32], and outcome data in biopsy-naïve patients has shown Likert-based scoring to perform well [33][34][35]. Future prospective studies assessing the predictive value of PRECISE with standardized AS end-points are required to address these limitations [16].…”

Section: Discussionmentioning

confidence: 99%

MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance

et al. 2020

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Objectives To assess the predictive value and correlation to pathological progression of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system in the follow-up of prostate cancer (PCa) patients on active surveillance (AS). Methods A total of 295 men enrolled on an AS programme between 2011 and 2018 were included. Baseline multiparametric magnetic resonance imaging (mpMRI) was performed at AS entry to guide biopsy. The follow-up mpMRI studies were prospectively reported by two sub-specialist uroradiologists with 10 years and 13 years of experience. PRECISE scores were dichotomized at the cut-off value of 4, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Diagnostic performance was further quantified by using area under the receiver operating curve (AUC) which was based on the results of targeted MRI-US fusion biopsy. Univariate analysis using Cox regression was performed to assess which baseline clinical and mpMRI parameters were related to disease progression on AS. Results Progression rate of the cohort was 13.9% (41/295) over a median follow-up of 52 months. With a cut-off value of category ≥ 4, the PRECISE scoring system showed sensitivity, specificity, PPV and NPV for predicting progression on AS of 0.76, 0.89, 0.52 and 0.96, respectively. The AUC was 0.82 (95% CI = 0.74–0.90). Prostate-specific antigen density (PSA-D), Likert lesion score and index lesion size were the only significant baseline predictors of progression (each p < 0.05). Conclusion The PRECISE scoring system showed good overall performance, and the high NPV may help limit the number of follow-up biopsies required in patients on AS. Key Points • PRECISE scores 1–3 have high NPV which could reduce the need for re-biopsy during active surveillance. • PRECISE scores 4–5 have moderate PPV and should trigger either close monitoring or re-biopsy. • Three baseline predictors (PSA density, lesion size and Likert score) have a significant impact on the progression-free survival (PFS) time.

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Section: Discussionmentioning

confidence: 99%

MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance

et al. 2020

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“…4 Ella es similar a la puntuación del T2 para la categoría 2 de PZ y debe ayudar a reducir la puntuación potencial de la inflamación como resultado 3 en DWI, que a su vez puede ser elevado a una categoría PI-RADS IV si demuestra realce focal temprano asociado. 19 La puntuación 3 se define como un área focal de señal aumentada en alto valor b de DWI y/o baja señal en ADC, pudiendo ser marcadamente hipointensa en ADC o hiperintensa en alto valor b de DWI pero no en ambas. Las puntuaciones 1, 4 y 5 no se han modificado.…”

Section: Discussionunclassified

Prostatitis crónica: Aporte del contraste endovenoso en fase tardía para su caracterización en resonancia magnética multiparamétrica de próstata

Aineseder

Grove

Pietrani

et al. 2020

Revista Argentina de Radiología / Argentinian Journal of Radiol

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Resumen Objetivo El objetivo de este estudio es demostrar la utilidad de una secuencia tardía post-contraste en la resonancia magnética multiparamétrica de próstata (RMMP) para caracterizar lesiones PI-RADS II. Materiales y métodos Se analizaron en forma retrospectiva las RMMP realizadas entre enero de 2015 y diciembre de 2016. El protocolo de la RMMP fue basado en las recomendaciones del PI-RADS versión 2, y se agregó una adquisición tardía luego del dinámico post-contraste. Los reportes fueron revisados bajo la versión 2.1. Resultados Se seleccionaron 31 pacientes que presentaron lesiones categorizadas como PI-RADS II en la zona periférica, los cuales se encontraban en seguimiento del antígeno prostático específico y presentaron confirmación histológica de prostatitis crónica. Se evidenció un realce tardío de la lesión en todos los pacientes. Según los resultados histopatológicos, 30 presentaban prostatitis crónica y el restante tejido benigno (tejido fibromuscular). Discusión La prostatitis crónica no muestra realce temprano, y presenta realce tardío debido al tejido conectivo fibroso que la compone. En la RMMP, la prostatitis puede imitar el cáncer de próstata. Agregar una adquisición tardía solo adiciona 150 segundos al estudio y podría ayudar a resolver aquellos casos inciertos categorizados como PI-RADS III empleando las secuencias convencionales, debido a que el realce tardío de la lesión es altamente sugestivo de un proceso inflamatorio (PI-RADS II). Conclusión La presencia de realce tardío es una herramienta útil para realizar un adecuado diagnóstico de una lesión PI-RADS II en la zona periférica, pudiendo evitar una biopsia innecesaria.

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“…Even though in the meanwhile numerous studies converge to the conclusion that gadolinium could be omitted without hampering the diagnostic accuracy of MRI, the use of gadolinium enhancer is a matter of debate [27] and a recommendation in the current prostate imaging guidelines [7,8,50]. With our contribution, we opt to strengthen the cumulating evidence towards the optimization of the upcoming guidelines for prostate diagnostics.…”

Section: Discussionmentioning

confidence: 99%

“…However, the field remains heavily debated by datasets that support the DCE value in the diagnosis of clinically significant Pca (CSPca) towards the insignificant Pca (IPca) [24–28], especially in the hands of inexperienced readers [28] or for smaller lesions [29]. Currently, DCE is a standard recommendation in the most recent update of the prostate imaging guidelines (PI-RADSv2.1) [7,8] and a common practice for many radiological units.…”

Section: Introductionmentioning

confidence: 99%

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

et al. 2019

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ObjectiveProstate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE).Materials and methodsThe study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately.ResultsSignificant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively.ConclusionDCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.

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PI-RADS version 2.1: one small step for prostate MRI

Cited by 128 publications

References 61 publications

MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance

MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance

Prostatitis crónica: Aporte del contraste endovenoso en fase tardía para su caracterización en resonancia magnética multiparamétrica de próstata

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

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