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Prostate MRI quality: clinical impact of the PI-QUAL score in prostate cancer diagnostic work-up.
- Source :
-
The British journal of radiology [Br J Radiol] 2022 May 01; Vol. 95 (1133), pp. 20211372. Date of Electronic Publication: 2022 Feb 18. - Publication Year :
- 2022
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Abstract
- Objective: To assess the reproducibility and impact of prostate imaging quality (PI-QUAL) scores in a clinical cohort undergoing prostate multiparametric MRI.<br />Methods: PI-QUAL scores were independently recorded by three radiologists (two senior, one junior). Readers also recorded whether MRI was sufficient to rule-in/out cancer and if repeat imaging was required. Inter-reader agreement was assessed using Cohen's κ. PI-QUAL scores were further correlated to PI-RADS score, number of biopsy procedures, and need for repeat imaging.<br />Results: Image quality was sufficient (≥PI-QUAL-3) in 237/247 (96%) and optimal (≥PI-QUAL-4) in 206/247 (83%) of males undergoing 3T-MRI. Overall PI-QUAL scores showed moderate inter-reader agreement for senior ( K = 0.51) and junior-senior readers ( K = 0.47), with DCE showing highest agreement ( K = 0.47). With PI-QUAL-5 studies, the negative MRI calls increased from 50 to 87% and indeterminate PI-RADS-3 rates decreased from 31.8. to 10.4% compared to lower quality PI-QUAL-3 studies. More patients with PI-QUAL scores 1-3 underwent biopsy for negative (47%) and indeterminate probability (100%) MRIs compared to PI-QUAL score 4-5 (30 and 75%, respectively). Ability to rule-in cancer increased with PI-QUAL score, from 50% at PI-QUAL 1-2 to 90% for PI-QUAL 4-5, with a similarly, but greater effect for ruling-out cancer and at a lower threshold, from 0% for scans of PI-QUAL 1-2 to 67.1% for PI-QUAL 4 and 100% for PI-QUAL-5.<br />Conclusion: Higher PI-QUAL scores for image quality are associated with decreased uncertainty in MRI decision-making and improved efficiency of diagnostic pathway delivery.<br />Advances in Knowledge: This study demonstrates moderate inter-reader agreement for PI-QUAL scoring and validates the score in a clinical setting, showing correlation of image quality to certainty of decision making and clinical outcomes of repeat imaging and biopsy of low-to-intermediate risk cases.
Details
- Language :
- English
- ISSN :
- 1748-880X
- Volume :
- 95
- Issue :
- 1133
- Database :
- MEDLINE
- Journal :
- The British journal of radiology
- Publication Type :
- Academic Journal
- Accession number :
- 35179971
- Full Text :
- https://doi.org/10.1259/bjr.20211372