An update of pitfalls in prostate mpMRI: a practical approach through the lens of PI-RADS v. 2 guidelines

Panebianco, Valeria; Giganti, Francesco; Kitzing, Yu Xuan; Cornud, F.; Campa, Riccardo; Rubeis, Gianluca De; Ciardi, Antonio; Catalano, Carlo; Villeirs, Geert

doi:10.1007/s13244-017-0578-x

Cited by 80 publications

(64 citation statements)

References 24 publications

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“… 25 On the other hand, prostatitis, granuloma, abscess, and hemorrhage may represent pitfalls in prostate mpMRI, which leads to the results of PI-RADS inconsistent with reality. 16 Among the 102 lesions in patients in the PSA gray zone group, 66 were histopathologically diagnosed as benign prostatic hyperplasia, 3 prostatitis, 9 benign prostatic hyperplasia with prostatitis, 1 granuloma, and 1 hemorrhage. This may not only lead to an elevation in PSA levels but also lead to higher PI-RADS scores, resulting in an increase in the false positive rate and a decrease in the sensitivity of PI-RADS.…”

Section: Discussionmentioning

confidence: 99%

“…However, there can be some pitfalls associated with PI-RADS v2 in the detection of PCa. 16 In addition, overdiagnosis and overtreatment are important problems for identifying and managing patients with PCa and clinically significant PCa (CSPCa). 17 To our knowledge, few studies have evaluated its performance among men exhibiting serum PSA levels in the “gray zone” (4–10 ng ml −1 ).…”

Section: Introductionmentioning

confidence: 99%

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Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment

Liu

Wang

et al. 2018

Asian J Androl

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Prostate cancer (PCa) is one of the most common cancers among men globally. The authors aimed to evaluate the ability of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) to classify men with PCa, clinically significant PCa (CSPCa), or no PCa, especially among those with serum total prostate-specific antigen (tPSA) levels in the “gray zone” (4–10 ng ml−1). A total of 308 patients (355 lesions) were enrolled in this study. Diagnostic efficiency was determined. Univariate and multivariate analyses, receiver operating characteristic curve analysis, and decision curve analysis were performed to determine and compare the predictors of PCa and CSPCa. The results suggested that PI-RADS v2, tPSA, and prostate-specific antigen density (PSAD) were independent predictors of PCa and CSPCa. A PI-RADS v2 score ≥4 provided high negative predictive values (91.39% for PCa and 95.69% for CSPCa). A model of PI-RADS combined with PSA and PSAD helped to define a high-risk group (PI-RADS score = 5 and PSAD ≥0.15 ng ml-1 cm-3, with tPSA in the gray zone, or PI-RADS score ≥4 with high tPSA level) with a detection rate of 96.1% for PCa and 93.0% for CSPCa while a low-risk group with a detection rate of 6.1% for PCa and 2.2% for CSPCa. It was concluded that the PI-RADS v2 could be used as a reliable and independent predictor of PCa and CSPCa. The combination of PI-RADS v2 score with PSA and PSAD could be helpful in the prediction and diagnosis of PCa and CSPCa and, thus, may help in preventing unnecessary invasive procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment

Liu

Wang

et al. 2018

Asian J Androl

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“…A glimpse at the T1W sequence is necessary to exclude hemorrhage in all cases. Atrophy, calcifications, and necrosis are usually not confused with suspicious lesions when PI-RADS v2 is systematically followed 20,23 (►Fig. 16).…”

Section: Pitfalls Of Pi-radsmentioning

confidence: 99%

Multiparametric MRI Approach to Prostate Cancer with a Pictorial Essay on PI-RADS

Popat

Maheshwari

Sable

et al. 2019

Journal of Gastrointestinal and Abdominal Radiology

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The biology of prostate cancer is indolent, and incidence does not reflect mortality. This has led to reframed screening guidelines pivoting around serum prostate-specific antigen (PSA) and conceptualizing clinically significant prostate cancer (CSC), triaging active surveillance and intervention. A resultant paradigm shift in magnetic resonance imaging (MRI) from diagnosing cancer to focusing on detecting CSC led to the establishment of PI-RADS v2 (prostate imaging reporting and data systems, version 2). In this article, we present an approach to analyzing suspicious prostate lesions on multiparametric MRI (mp-MRI) and assigning them a PI-RADS assessment score based on the current version 2 for standardized reporting, strengthening diagnostic accuracy, and improving clinical acceptance. We also present pitfalls and challenges that a radiologist should be aware of, for increasing diagnostic accuracy.

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“…For example, detection of PCa in the transition zone (TZ) is often perceived as a difficult task. Pictorial reviews and case series have touched on the topic of FPs [10][11][12], but systematic studies specifically investigating FPs in a pure clinical setting are scarce and from the pre-PIRADS era [13]. We hypothesized that, when not educated properly, the novice reader will, in daily clinical practice, cause unnecessary biopsies especially in the TZ.…”

Section: Introductionmentioning

confidence: 99%

False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location

et al. 2019

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Purpose To investigate the effect of reader experience and zonal location on the occurrence of false positives (FPs) in PIRADS (V2) 3, 4, and 5 lesions on multiparametric (MP)-MRI of the prostate. Materials and methods This retrospective study included 139 patients who had consecutively undergone an MP-MRI of the prostate in combination with a transrectal ultrasound MRI fusion-guided biopsy between 2014 and 2017. MRI exams were prospectively read by a group of inexperienced radiologists (cohort 1; 54 patients) and an experienced radiologist (cohort 2; 85 patients). Multivariable logistic regression analysis was performed to determine the association of experience of the radiologist and zonal location with a FP reading. FP rates were compared between readings by inexperienced and experienced radiologists according to zonal location, using Chi-square (χ 2) tests. Results A total of 168 lesions in 139 patients were detected. Median patient age was 68 years (Interquartile range (IQR) 62.5-73), and median PSA was 10.9 ng/mL (IQR 7.6-15.9) for the entire patient cohort. According to multivariable logistic regression, inexperience of the radiologist was significantly (P = 0.044, odds ratio 1.927, 95% confidence interval [CI] 1.017-3.651) and independently associated with a FP reading, while zonal location was not (P = 0.202, odds ratio 1.444, 95% CI 0.820-2.539). In the transition zone (TZ), the FP rate of the inexperienced radiologists 59% (17/29) was significantly higher (χ 2 P = 0.033) than that of the experienced radiologist 33% (13/40). Conclusion Inexperience of the radiologist is significantly and independently associated with a FP reading, while zonal location is not. Inexperienced radiologists have a significantly higher FP rate in the TZ.

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An update of pitfalls in prostate mpMRI: a practical approach through the lens of PI-RADS v. 2 guidelines

Cited by 80 publications

References 24 publications

Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment

Using the prostate imaging reporting and data system version 2 (PI-RIDS v2) to detect prostate cancer can prevent unnecessary biopsies and invasive treatment

Multiparametric MRI Approach to Prostate Cancer with a Pictorial Essay on PI-RADS

False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location

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