Use of the Prostate Imaging Reporting and Data System (PI-RADS) for Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: A Diagnostic Meta-analysis.
PURPOSE The purpose of this study was to evaluate the magnetic resonance prostate imaging reporting and data system (PI-RADS) for the detection of prostate cancer by the results of magnetic resonance imaging (MRI)-guided biopsy of the prostate as a reference standard. PATIENTS AND METHODS In 55 patients who had undergone MRI-guided biopsy of the prostate, we retrospectively matched every biopsy core with the corresponding lesion in previously acquired endorectal multiparametric MRI including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) at 1.5 T. Two readers blinded to the results of the biopsy evaluated each biopsied lesion according to the PI-RADS scoring system. The results of the targeted biopsy were used as a reference standard. Receiver operating characteristic analysis was performed for statistical analysis. RESULTS A total of 113 lesions in the 55 patients were evaluated; 30 lesions were malignant. When evaluated according to the criteria of the PI-RADS scoring system, DCE-MRI revealed a lower area under the receiver operating characteristic curve (AUC) (0.76) compared with T2WI (0.88; P=0.06) and DWI (0.93; P=0.004). A sum score combining T2WI, DWI, and DCE-MRI yielded an AUC of 0.93, whereas a sum score combining only T2WI and DWI yielded an AUC of 0.95. In central gland lesions, T2WI showed a numerically higher AUC compared with DWI (0.98 and 0.95), whereas, in peripheral zone lesions, DWI was superior (AUC of 0.93 and 0.73; P=0.04). An approach assigning a PI-RADS score for T2WI to central gland lesions and for DWI to peripheral zone lesions yielded an AUC of 0.96 and was numerically superior compared with any sequence alone and sum scores combining T2WI and DWI as well as T2WI, DWI, and DCE-MRI. CONCLUSIONS The PI-RADS scoring system shows a good diagnostic performance for the detection of prostate cancer when using a sum score. However, DCE-MRI does not seem to add significant value when evaluated according to the recommended criteria. Assigning a score for T2WI to central gland lesions and for DWI to peripheral zone lesions might be sufficient for stratification of patients for further diagnostic workup.