Highlights
- •Detection of index lesion (IL) by MRI is crucial to perform targeted biopsy, to monitor the progression of the PCa and to guide the focal therapy.
- •In prostate with multifocal lesions, the IL can be the smallest markedly hypointense lesion vs the largest with moderate hypointensity on ADC maps.
- •Sensitivity in the detection of IL was 79.6–83% and 93.2–94.9% with the PI-RADS v2.1 and S-PI-RADS criteria, respectively
Abstract
Objective
To assess the diagnostic performance of simplified PI-RADS (S-PI-RADS) with biparametric
MRI (bpMRI) vs PI-RADS v2.1 with multiparametric MRI (mpMRI) in identifying lesion
index (IL) in patients with multifocal prostate cancer (PCa)., The inter- and intra-observer
variability was also determined with two readers.
Materials and methods
Retrospective analysis of the prostate MRI of 59 patients with multifocal PCa (two
or more tumors ascertained by TRUS/guided MRI targeted prostate biopsy). Two radiologists
with experience in prostate MRI identified the IL in each patient according to S-PI-RADS-dedicated
bpMRI. According to S-PI-RADS in multifocal intraprostatic lesions the IL was defined
as the one with the greatest volume (when lesions with similar signal hypointensity
on apparent diffusion coefficient (ADC) maps coexist), or as the lesion with marked
hypointensity irrespective of volume (when lesions with moderate and marked signal
hypointensity on ADC map coexist). Otherwise, according to PI-RADS v2.1 the IL is
the one intraprostatic with the highest score.
The agreement between the S-PI-RADS and PI-RADS v2.1 results and the histological
data was expressed as a percentage of agreement or sensitivity (percentage of PCa
or IL correctly identified on the total of PCas). The intra- and inter-observer agreement
was evaluated with Cohen's kappa (k) coefficient.
Results
The 133 lesions identified were compared with the biopsy results. Sensitivity in the
detection of IL was 79.6–83% and 93.2–94.9% with the PI-RADS v2.1 and S-PI-RADS criteria,
respectively, whereas the specificity was 83.8–86.5& and 94.6–96%. With both observers,
the overall diagnostic accuracy was significantly higher using S-PI-RADS.
Concerning the S-PI-RADS, the concordance between IL and tumor index (PCa with the
highest Gleason score) was found in 56/59 patients (93%) both in the peripheral and
transition zone. In the detection of the IL the agreement between the two readers
was moderate (k = 0.701) for the PI-RADS v2.1 and good (k = 0.844) for the S-PI-RADS.
A poor agreement between the two readers 0.38 (95% CI: 0.0653 to 0.693) and 0.41 (95%
CI: 0.123 to 0.696) was revealed.
Conclusions
In patients with multifocal PCa, S-PI-RADS-based bpMRI showed significantly higher
performance in IL detection and good inter-observer agreement.
Keywords
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Article info
Publication history
Published online: December 07, 2022
Accepted:
November 21,
2022
Received in revised form:
November 1,
2022
Received:
May 25,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
