Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA.
Grand Traverse Radiologists PC, Munson Medical Center, Traverse City, MI, USA.
Abdom Radiol (NY). 2018 Sep;43(9):2505-2512. doi: 10.1007/s00261-018-1481-8.
To evaluate a 12-month long-distance prostate MRI quality assurance (QA) program.
The need for IRB approval was waived for this prospective longitudinal QA effort. One academic institution experienced with prostate MRI [~ 1000 examinations/year (Site 2)] partnered with a private institution 240 miles away that was starting a new prostate MRI program (Site 1). Site 1 performed all examinations (N = 249). Four radiologists at Site 1 created finalized reports, then sent images and reports to Site 2 for review on a rolling basis. One radiologist at Site 2 reviewed findings and exam quality and discussed results by phone (~ 2-10 minutes/MRI). In months 1-6 all examinations were reviewed. In months 7-12 only PI-RADS ≤ 2 and 'difficult' cases were reviewed. Repeatability was assessed with intra-class correlation (ICC). 'Clinically significant cancer' was Gleason ≥ 7.
Image quality significantly (p < 0.001) improved after the first three months. Inter-rater agreement also improved in months 3-4 [ICC: 0.849 (95% CI 0.744-0.913)] and 5-6 [ICC: 0.768 (95% CI 0.619-0.864)] compared to months 1-2 [ICC: 0.621 (95% CI 0.436-0.756)]. PI-RADS ≤ 2 examinations were reclassified PI-RADS ≥ 3 in 19% (30/162); of these, 23 had post-MRI histology and 57% (13/23) had clinically significant cancer (5.2% of 249). False-negative examinations [N = 18 (PI-RADS ≤ 2 and Gleason ≥ 7)] were more common at Site 1 during months 1-6 [9% (14/160) vs. 4% (4/89)]. Positive predictive values for PI-RADS ≥ 3 were similar.
Remote quality assurance of prostate MRI is feasible and useful, enabling new programs to gain durable skills with minimal risk to patients.
评估为期 12 个月的前列腺磁共振成像（MRI）质量保证（QA）计划。
本前瞻性纵向 QA 工作无需获得机构审查委员会（IRB）的批准。一家有经验的前列腺 MRI 机构（每年约 1000 次检查[Site 2]）与 240 英里外的一家新开设前列腺 MRI 项目的私立机构（Site 1）合作。Site 1 完成所有检查（N=249）。Site 1 的 4 名放射科医生完成最终报告，然后将图像和报告定期发送到 Site 2 进行审查。Site 2 的一名放射科医生审查发现和检查质量，并通过电话（约 2-10 分钟/MRI）讨论结果。在第 1-6 个月审查所有检查。在第 7-12 个月，仅审查 PI-RADS≤2 和“困难”病例。使用组内相关系数（ICC）评估可重复性。“临床显著癌症”定义为 Gleason≥7。
图像质量在头三个月后显著提高（p<0.001）。在第 3-4 个月（ICC：0.849[95%CI 0.744-0.913]）和第 5-6 个月（ICC：0.768[95%CI 0.619-0.864]），与第 1-2 个月（ICC：0.621[95%CI 0.436-0.756]）相比，观察者间的一致性也有所提高。PI-RADS≤2 级的检查重新分类为 PI-RADS≥3 级的检查占 19%（30/162）；其中，23 例有 MRI 后组织学检查，57%（13/23）有临床显著癌症（249 例中的 5.2%）。在第 1-6 个月，Site 1 中假阴性检查[PI-RADS≤2 级且 Gleason≥7]更为常见[9%（14/160）比 4%（4/89）]。PI-RADS≥3 级的阳性预测值相似。
前列腺 MRI 的远程 QA 是可行且有用的，使新的项目能够在对患者风险最小的情况下获得持久的技能。
