Wallström Jonas, Thimansson Erik, Andersson Jim, Karlsson Mathias, Zackrisson Sophia, Bratt Ola, Jäderling Fredrik
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur J Radiol Open. 2024 Dec 12;14:100625. doi: 10.1016/j.ejro.2024.100625. eCollection 2025 Jun.
High-quality assessment of prostate MRI is fundamental in both clinical practice and screening. There is a lack of national level data on variability in prostate volume measurement and PI-RADS assessment. Methods of quality assurance need to be developed.
All Swedish radiology departments were invited to participate in an external quality assurance of prostate MRI reading. Ten prostate MRI cases were selected by an expert panel to reflect common findings. Readers measured whole gland volume (ellipsoid formula method) and assigned a PI-RADS score in a web-based PACS with full clinical functionality. Expert consensus was used as reference standard. Descriptive statistics were used to show the distribution of volume measurements and PSA density. Reader agreement was assessed using percentages and kappa scores. A feedback document was sent to all participants upon completion of the quality assurance program.
Forty-three radiologists representing 17 departments read at least 7 out of 10 cases. The median difference in prostate volume assessment compared to the reference volume for the 10 cases ranged from -23 mL to + 6 mL. Per case agreement ranged from 33 % to 86 % for the assigned PI-RADS score and from 35 % to 98 % for PI-RADS 1-3 versus PI-RADS 4-5. Interreader agreement was moderate with a median kappa score of 0.53 (IQR 0.48-0.62).
This online model for national quality assurance programs was feasible. Rather large per-case reader variations in prostate volume assessment and PI-RADS scoring were shown. To reduce variability in clinical practice, systematic interreader comparisons should be encouraged.
前列腺MRI的高质量评估在临床实践和筛查中都至关重要。目前缺乏关于前列腺体积测量和PI-RADS评估变异性的国家级数据。需要制定质量保证方法。
邀请瑞典所有放射科参与前列腺MRI读片的外部质量保证。由一个专家小组挑选出10例前列腺MRI病例以反映常见表现。读者使用基于网络的具备完整临床功能的PACS测量整个腺体体积（椭圆公式法）并给出PI-RADS评分。专家共识被用作参考标准。使用描述性统计来展示体积测量值和PSA密度的分布情况。通过百分比和kappa值评估读者间的一致性。质量保证项目完成后向所有参与者发送了一份反馈文件。
来自17个科室的43名放射科医生阅读了至少10例中的7例。10例病例中前列腺体积评估与参考体积相比的中位数差异范围为-23mL至+6mL。对于指定的PI-RADS评分，每例的一致性范围为33%至86%，对于PI-RADS 1-3与PI-RADS 4-5的情况，一致性范围为35%至98%。读者间的一致性为中等，中位数kappa值为0.53（四分位间距0.48-0.62）。
这种用于国家质量保证项目的在线模式是可行的。结果显示在前列腺体积评估和PI-RADS评分方面，读者间每例的差异相当大。为减少临床实践中的变异性，应鼓励进行系统的读者间比较。
