PI-RADS

PI-RADS is an acronym for Prostate Imaging Reporting and Data System, defining standards of high quality clinical service for multi-parametric Magnetic Resonance Imaging (mpMRI), including image creation and reporting.

History

In 2007, the AdMeTech Foundation's International Prostate MRI Working Group [1] convened the key global experts, including members of the European Society of Urogenital Radiology (ESUR) and the American College of Radiology (ACR). In March 2009 in Vienna an ESUR Prostate MRI Committee was formed, with the aim to produce minimal and maximal standards for acquisition and reporting of prostate MRI. This standardization was endorsed by the results of a consensus meeting in London in December 2009[2]

Dr. Jelle Barentsz published with the ESUR Prostate MRI Committee the first PI-RADS (v.1) version in December 2011.[3] Following this initiative the ACR, ESUR, and the AdMeTech Foundation formed a Joint Steering Committee, and by 2016 published a second version of PI-RADS (v.2) in European Urology.[4] This paper enabled acceptance of the urologists of prostate MRI and was awarded “Best clinical scientific paper of 2016 in European Urology”. In 2019 the PI-RADS Steering Committee published an updated version: PI-RADS v2.1.[5] Prostate MRI using PI-RADS to detect clinically significant cancer is now widely by European urologists, as is illustrated with the '2020 EAU Innovators in Urology Award' for Dr. Barentsz.

Purpose

The aim of prostate MRI using PI-RADS is to assess the risk of clinically significant prostate cancer being present. Furthermore, the PI-RADS v2 system is designed to standardize prostate MRI. The focus is especially to provide good image quality and reporting.

Performance

Various studies have compared the predictive performance of PI-RADS v1 for detecting significant prostate cancer against either image-guided biopsy results (definitive pathology) and/or prostatectomy specimens (histopathology). In a 2015 articles in the Journal of Urology, Thompson reported multi-parametric MRI detection of significant prostate cancer had sensitivity of 96%, specificity of 36%, negative predictive value and positive predictive values of 92% and 52%; when PI-RADS was incorporated into a multivariate analysis (PSA, digital rectal exam, prostate volume, patient age) the area under the curve (AUC) improved from 0.776 to 0.879, p<0.001.[6] A similar paper in European Radiology found that when correlated with histopathology, PI-RADS v2 correctly identified 94-95% of prostate cancer foci ≥0.5 mL, but was limited for the assessment of GS ≥4+3 (significant) tumors ≤0.5 mL; in their series, DCE-MRI offered limited added value to T2WI+DW-MRI.[7] Other applications for which PI-RADS may be useful include prediction of termination of Active Surveillance due to tumor progression/aggressiveness,[8] detection of extraprostatic extension of prostate cancer,[9] and supplemental information when considering whether to re-biopsy patients with a history of previous negative biopsy.[10]

PI-RADS v2 is designed to improve detection, characterization and risk stratification in patients suspected of prostate cancer with a goal of better treatment decisions, improved outcomes and simplified reporting. However, multi-center validation trials are needed and expected to lead to modifications in the scoring system.[11]

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References
  1. "AdMeTech Foundation's International Prostate MRI Working Group". www.admetech.org. Retrieved 2015-09-19.
  2. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, et al. (April 2011). "Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting". European Urology. 59 (4): 477–94. doi:10.1016/j.eururo.2010.12.009. PMID 21195536.
  3. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. (April 2012). "ESUR prostate MR guidelines 2012". European Radiology. 22 (4): 746–57. doi:10.1007/s00330-011-2377-y. PMC 3297750. PMID 22322308.
  4. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. (January 2016). "PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2". European Urology. 69 (1): 16–40. doi:10.1016/j.eururo.2015.08.052. PMC 6467207. PMID 26427566.
  5. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. (March 2019). "Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2". European Urology. 76 (3): 340–351. doi:10.1016/j.eururo.2019.02.033. PMID 30898406.
  6. Thompson JE, van Leeuwen PJ, Moses D, Shnier R, Brenner P, Delprado W, et al. (May 2016). "The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer". The Journal of Urology. 195 (5): 1428–1435. doi:10.1016/j.juro.2015.10.140. PMID 26529298.
  7. Vargas HA, Hötker AM, Goldman DA, Moskowitz CS, Gondo T, Matsumoto K, et al. (June 2016). "Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference". European Radiology. 26 (6): 1606–12. doi:10.1007/s00330-015-4015-6. PMC 4803633. PMID 26396111.
  8. Abdi H, Pourmalek F, Zargar H, Walshe T, Harris AC, Chang SD, et al. (February 2015). "Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer". Urology. 85 (2): 423–8. doi:10.1016/j.urology.2014.09.060. PMID 25623709.
  9. Schieda N, Quon JS, Lim C, El-Khodary M, Shabana W, Singh V, et al. (October 2015). "Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma". European Journal of Radiology. 84 (10): 1843–8. doi:10.1016/j.ejrad.2015.06.016. PMID 26137904.
  10. Sperling D. "MRI Biopsy Guidance Better than TRUS". Sperling Prostate Center. Retrieved 5 February 2016.
  11. Turkbey B, Choyke PL (27 August 2015). "PIRADS 2.0: what is new?". Diagnostic and Interventional Radiology. 21 (5): 382–4. doi:10.5152/dir.2015.15099. PMC 4557320. PMID 26200484.
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