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Park SY, Woo S, Park KJ, Westphalen AC. A pictorial essay of PI-RADS pearls and pitfalls: toward less ambiguity and better practice. Abdom Radiol (NY) 2024; 49:3190-3205. [PMID: 38704782 DOI: 10.1007/s00261-024-04273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/02/2024] [Accepted: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Prostate Imaging Reporting and Data System (PI-RADS) was designed to standardize the interpretation of multiparametric magnetic resonance imaging (MRI) of the prostate, aiding in assessing the probability of clinically significant prostate cancer. By providing a structured scoring system, it enables better risk stratification, guiding decisions regarding the need for biopsy and subsequent treatment options. In this article, we explore both the strengths and weaknesses of PI-RADS, offering insights into its updated diagnostic performance and clinical applications, while also addressing potential pitfalls using diverse, representative MRI cases.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA.
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, 10016, USA
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Antonio C Westphalen
- Department of Radiology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
- Department of Urology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St., 2nd Floor, Seattle, WA, 98195, USA
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Oerther B, Nedelcu A, Engel H, Schmucker C, Schwarzer G, Brugger T, Schoots IG, Eisenblaetter M, Sigle A, Gratzke C, Bamberg F, Benndorf M. Update on PI-RADS Version 2.1 Diagnostic Performance Benchmarks for Prostate MRI: Systematic Review and Meta-Analysis. Radiology 2024; 312:e233337. [PMID: 39136561 DOI: 10.1148/radiol.233337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Background Prostate MRI for the detection of clinically significant prostate cancer (csPCa) is standardized by the Prostate Imaging Reporting and Data System (PI-RADS), currently in version 2.1. A systematic review and meta-analysis infrastructure with a 12-month update cycle was established to evaluate the diagnostic performance of PI-RADS over time. Purpose To provide estimates of diagnostic accuracy and cancer detection rates (CDRs) of PI-RADS version 2.1 categories for prostate MRI, which is required for further evidence-based patient management. Materials and Methods A systematic search of PubMed, Embase, Cochrane Library, and multiple trial registers (English-language studies published from March 1, 2019, to August 30, 2022) was performed. Studies that reported data on diagnostic accuracy or CDRs of PI-RADS version 2.1 with csPCa as the primary outcome were included. For the meta-analysis, pooled estimates for sensitivity, specificity, and CDRs were derived from extracted data at the lesion level and patient level. Sensitivity and specificity for PI-RADS greater than or equal to 3 and PI-RADS greater than or equal to 4 considered as test positive were investigated. In addition to individual PI-RADS categories 1-5, subgroup analyses of subcategories (ie, 2+1, 3+0) were performed. Results A total of 70 studies (11 686 lesions, 13 330 patients) were included. At the patient level, with PI-RADS greater than or equal to 3 considered positive, meta-analysis found a 96% summary sensitivity (95% CI: 95, 98) and 43% specificity (95% CI: 33, 54), with an area under the summary receiver operating characteristic (SROC) curve of 0.86 (95% CI: 0.75, 0.93). For PI-RADS greater than or equal to 4, meta-analysis found an 89% sensitivity (95% CI: 85, 92) and 66% specificity (95% CI: 58, 74), with an area under the SROC curve of 0.89 (95% CI: 0.85, 0.92). CDRs were as follows: PI-RADS 1, 6%; PI-RADS 2, 5%; PI-RADS 3, 19%; PI-RADS 4, 54%; and PI-RADS 5, 84%. The CDR was 12% (95% CI: 7, 19) for transition zone 2+1 lesions and 19% (95% CI: 12, 29) for 3+0 lesions (P = .12). Conclusion Estimates of diagnostic accuracy and CDRs for PI-RADS version 2.1 categories are provided for quality benchmarking and to guide further evidence-based patient management. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Tammisetti and Jacobs in this issue.
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Affiliation(s)
- Benedict Oerther
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Andrea Nedelcu
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Hannes Engel
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Christine Schmucker
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Guido Schwarzer
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Timo Brugger
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Ivo G Schoots
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Michel Eisenblaetter
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - August Sigle
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Christian Gratzke
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Fabian Bamberg
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Matthias Benndorf
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
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Liu Y, Wang S, Xu G, Zhou B, Zhang Y, Ye B, Xiang L, Zhang Y, Xu H. Effectiveness and Accuracy of MRI-Ultrasound Fusion Targeted Biopsy Based on PI-RADS v2.1 Category in Transition/Peripheral Zone of the Prostate. J Magn Reson Imaging 2023; 58:709-717. [PMID: 36773016 DOI: 10.1002/jmri.28614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND MRI-ultrasound fusion targeted biopsy (MRI-TBx) improves the clinically significant prostate cancer (csPCa) detection with fewer cores. However, whether systematic biopsy-guided by transrectal ultrasound (TRUS-SBx) can be omitted when undergoing MRI-TBx in transition zone (TZ) and peripheral zone (PZ) remains unclear. PURPOSE To assess the performance and effectiveness of MRI-TBx based on PI-RADS v2.1 for csPCa diagnosis in TZ and PZ, respectively. STUDY TYPE Retrospective. SUBJECTS A total of 309 selected cases (median age 70 years) with 356 lesions who underwent both MRI-TBx and TRUS-SBx were enrolled. FIELD STRENGTH/SEQUENCE A 3.0 T, multiparametric MRI (mp-MRI) including T2-weighted turbo-spin echo imaging (T2WI), diffusion-weighted spin-echo echo planar imaging (DWI), dynamic contrast-enhanced MRI with time-resolved T1-weighted imaging (DCE). ASSESSMENT Mp-MRI was assessed by two radiologists using PI-RADS v2.1. The csPCa detection rates provided by MRI-TBx, TRUS-SBx and combined biopsy in TZ and PZ were calculated, respectively. STATISTICAL TESTS McNemar test was used to compare the csPCa detection rates in TZ and PZ, respectively. The frequencies and distribution of all detected prostate cancers by different biopsy methods were also compared. P < 0.05 was considered statistically significant. RESULTS Among 356 lesions in 309 patients, 208 (68 in TZ, 140 in PZ) were pathologically confirmed as csPCa. In TZ, there were significant differences for csPCa detection with PI-RADS 3 between combined biopsy and TRUS-SBx (23.5% vs. 15.3%), MRI-TBx (23.5% vs. 16.3%), respectively. MRI-TBx detected 23% (19/83) cases missed by TRUS-SBx in which 68% (13/19) were csPCa. In PZ, there were no statistical differences between MRI-TBx and combined biopsy with PI-RADS 3-5 (P = 0.21, 0.25, 0.07, respectively). In 9% (14/152) cases only detected by MRI-TBx, 86% (12/14) were clinically significant. Five percent (7/152) of cases only detected by TRUS-SBx were completely nonclinically significant. DATA CONCLUSION MRI-TBx played a positive role on csPCa diagnosis in TZ, but combined biopsy might be the best choice especially in the subgroup PI-RADS 3. In PZ, MRI-TBx had an advantage over TRUS-SBx for csPCa detection. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Yunyun Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Shuai Wang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Bangguo Zhou
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Ying Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Beibei Ye
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Lihua Xiang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Yifeng Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Huixiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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