Journal
EUROPEAN JOURNAL OF RADIOLOGY
Volume 84, Issue 10, Pages 1843-1848Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ejrad.2015.06.016
Keywords
Prostate cancer; Prostate imaging reporting and data system; PI-RADS; Extra-prostatic extension; Staging; Magnetic resonance imaging
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Introduction: To evaluate extra-prostatic extension (EPE) comparing PI-RADS to non-standardized reporting. Materials and methods: With IRB approval, 145 consecutive patients underwent radical prostatectomy (RP) and multi-parametric (T2W + DWI + DCE) MRI between 2012 and 2013. Eighty patients (66.3% with EPE) were staged without PI-RADS and 65 patients (64.6% with EPE) were staged using a 5-point PI-RADS scoring system. Studies were reported by fellowship-trained radiologists in routine clinical practice. Individual PIRADS scores were assessed using ROC to determine the score which optimized sensitivity/specificity. Diagnostic accuracy for EPE was compared with/without PI-RADS using the McNemar test. Subgroup analysis by radiologist experience was performed using Spearman correlation and chi-square. Results: Area under ROC curve for EPE using PI-RADS was 0.62 and optimal sensitivity/specificity was achieved with PI-RADS score >= 3. Compared to non-standardized reporting, sensitivity for EPE improved with PI-RADS (59.5% [49.1-68.2] vs. 24.5% [16.7-31.2]), p = 0.01; with no difference in specificity (68.0% [50.5-82.6]) vs. (75.0% [60.1-87.6]), p = 0.06. Overall accuracy improved with PI-RADS (62.7% [49.6-73.6] vs. 42.0% [31.7-50.7%]), p = 0.006. Diagnostic accuracy was better among experienced radiologists without PI-RADS (p = 0.005); however, there was no difference in accuracy by reader experience using PI-RADS (p = 0.24). Conclusion: The PI-RADS criteria for EPE improves sensitivity without reducing specificity. PI-RADS may reduce differences in accuracy by reader experience. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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