Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Br J Radiol. 2022 May 1;95(1133):20211372. doi: 10.1259/bjr.20211372. Epub 2022 Feb 18.
To assess the reproducibility and impact of prostate imaging quality (PI-QUAL) scores in a clinical cohort undergoing prostate multiparametric MRI.
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.
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 ( = 0.51) and junior-senior readers ( = 0.47), with DCE showing highest agreement ( = 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.
Higher PI-QUAL scores for image quality are associated with decreased uncertainty in MRI decision-making and improved efficiency of diagnostic pathway delivery.
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.
评估前列腺成像质量（PI-QUAL）评分在接受前列腺多参数 MRI 检查的临床患者中的可重复性和影响。
三位放射科医生（两位资深，一位初级）独立记录 PI-QUAL 评分。读者还记录了 MRI 是否足以排除或确诊癌症，以及是否需要重复成像。使用 Cohen's κ 评估读者间的一致性。进一步将 PI-QUAL 评分与 PI-RADS 评分、活检次数和重复成像的需求相关联。
237/247（96%）名男性的图像质量充足（≥PI-QUAL-3），206/247（83%）名男性的图像质量最佳（≥PI-QUAL-4）。对于高级和初级-高级读者，整体 PI-QUAL 评分的读者间一致性为中等（ = 0.51），动态对比增强 MRI 显示出最高的一致性（ = 0.47）。与 PI-QUAL-5 研究相比，PI-QUAL-3 研究的阴性 MRI 诊断率从 50%增加到 87%，PI-RADS-3 不确定率从 31.8%降低到 10.4%。与 PI-QUAL 评分 4-5 相比，PI-QUAL 评分 1-3 的患者接受活检的阴性（47%）和不确定概率（100%）MRI 更多。PI-QUAL 评分越高，诊断癌症的能力越强，从 PI-QUAL 1-2 的 50%到 PI-QUAL 4-5 的 90%，而对于排除癌症的能力，PI-QUAL 评分的影响更大，且阈值更低，从 PI-QUAL 1-2 的 0%到 PI-QUAL 4 的 67.1%和 PI-QUAL 5 的 100%。
更高的 PI-QUAL 图像质量评分与 MRI 决策的不确定性降低以及诊断途径提供效率的提高相关。
本研究证明了 PI-QUAL 评分具有中等程度的读者间一致性，并在临床环境中验证了该评分，表明图像质量与决策的确定性以及低至中度风险病例的重复成像和活检的临床结果相关。
