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European Radiology
Published in: European Radiology 8/2020

Open Access 01-08-2020 | Prostate Cancer | Urogenital

Validation of the PI-RADS language: predictive values of PI-RADS lexicon descriptors for detection of prostate cancer

Authors: Madhuri M. Rudolph, Alexander D. J. Baur, Matthias Haas, Hannes Cash, Kurt Miller, Samy Mahjoub, Alexander Hartenstein, David Kaufmann, Roman Rotzinger, Chau Hung Lee, Patrick Asbach, Bernd Hamm, Tobias Penzkofer

Published in: European Radiology | Issue 8/2020

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Abstract

Objectives

To assess the discriminatory power of lexicon terms used in PI-RADS version 2 to describe MRI features of prostate lesions.

Methods

Four hundred fifty-four patients were included in this retrospective, institutional review board–approved study. Patients received multiparametric (mp) MRI and subsequent prostate biopsy including MRI/transrectal ultrasound fusion biopsy and 10-core systematic biopsy. PI-RADS lexicon terms describing lesion characteristics on mpMRI were assigned to lesions by experienced readers. Positive and negative predictive values (PPV, NPV) of each lexicon term were assessed using biopsy results as a reference standard.

Results

From a total of 501 lesions, clinically significant prostate cancer (csPCa) was present in 175 lesions (34.9%). Terms related to findings of restricted diffusion showed PPVs of up to 52.0%/43.9% and NPV of up to 91.8%/89.7% (peripheral zone or PZ/transition zone or TZ). T2-weighted imaging (T2W)–related terms showed a wide range of predictive values. For PZ lesions, high PPVs were found for “markedly hypointense,” “lenticular,” “lobulated,” and “spiculated” (PPVs between 67.2 and 56.7%). For TZ lesions, high PPVs were found for “water-drop-shaped” and “erased charcoal sign” (78.6% and 61.0%). The terms “encapsulated,” “organized chaos,” and “linear” showed to be good predictors for benignity with distinctively low PPVs between 5.4 and 6.9%. Most T2WI-related terms showed improved predictive values for TZ lesions when combined with DWI-related findings.

Conclusions

Lexicon terms with high discriminatory power were identified (e.g., “markedly hypointense,” “water-drop-shaped,” “organized chaos”). DWI-related terms can be useful for excluding TZ cancer. Combining T2WI- with DWI findings in TZ lesions markedly improved predictive values.

Key Points

• Lexicon terms describing morphological and functional features of prostate lesions on MRI show a wide range of predictive values for prostate cancer.
• Some T2-related terms have favorable PPVs, e.g., “water-drop-shaped” and “organized chaos” while others show less distinctive predictive values. DWI-related terms have noticeable negative predictive values in TZ lesions making DWI feature a useful tool for exclusion of TZ cancer.
• Combining DWI- and T2-related lexicon terms for assessment of TZ lesions markedly improves PPVs. Most T2-related lexicon terms showed a significant decrease in PPV when combined with negative findings for “DW hyperintensity.”
Appendix
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Metadata
Title
Validation of the PI-RADS language: predictive values of PI-RADS lexicon descriptors for detection of prostate cancer
Authors
Madhuri M. Rudolph
Alexander D. J. Baur
Matthias Haas
Hannes Cash
Kurt Miller
Samy Mahjoub
Alexander Hartenstein
David Kaufmann
Roman Rotzinger
Chau Hung Lee
Patrick Asbach
Bernd Hamm
Tobias Penzkofer
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06773-1

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