title: Characterization of prostate lesions as benign or malignant at multiparametric MR imaging: comparison of three scoring systems in patients treated with radical prostatectomy.
abstract: OBJECTIVE
  To compare the subjective Likert score to the Prostate Imaging Reporting and Data System (PIRADS) and morphology-location-signal intensity (MLS) scores for categorization of prostate lesions as benign or malignant at multiparametric magnetic resonance (MR) imaging.
  
  
  METHODS
  Two hundred fifteen patients who underwent T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced multiparametric MR imaging of the prostate before radical prostatectomy were included in a prospective database after they signed the institutional review board-approved forms. Senior readers 1 and 2 prospectively noted the location, shape, and signal intensity of lesions on MR images from individual pulse sequences and scored each for likelihood of malignancy by using a Likert scale (range, 1-5). A junior reader (reader 3) retrospectively reviewed the database and did the same analysis. The MLS score (range, 1-13) was computed by using the readers' descriptions of the lesions. Then, the three readers again scored the lesions they described by using the PIRADS score (range, 3-15). MLS and PIRADS scores were compared with the Likert score by using their areas under the receiver operating characteristic curves.
  
  
  RESULTS
  Areas under the receiver operating characteristic curves of the Likert, MLS, and PIRADS scores were 0.81, 0.77 (P = .03), and 0.75 (P = .01) for reader 1; 0.88, 0.74 (P < .0001), and 0.76 (P < .0001) for reader 2; and 0.81, 0.78 (P = .23), and 0.75 (P = .01) for reader 3. For diagnosing cancers with Gleason scores greater than or equal to 7, the Likert score was significantly more accurate than the others, except for the MLS score for reader 3. Weighted κ values were 0.470-0.524, 0.405-0.430, and 0.378-0.441 for the Likert, MLS, and PIRADS scores, respectively.
  
  
  CONCLUSIONS
  The Likert score allowed significantly more accurate categorization of prostate lesions on MR images than did the MLS and PIRADS scores.
authors.affiliation: From the Departments of Urinary and Vascular Radiology (T.V., F.B., O.R.) and Pathology (F.M.L.), Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 place d'Arsonval, 69437 Lyon Cedex 03-France; Université de Lyon, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France (F.B., O.R.); Inserm, U1032, LabTau, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, France (F.B., O.R.); Department of Biostatistics, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, Villeurbanne, France (S.R., M.R.).
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Vaché
authors.forename: Flavie
authors.initials: F
authors.lastname: Bratan
authors.forename: Florence
authors.initials: F
authors.lastname: Mège-Lechevallier
authors.forename: Sylvain
authors.initials: S
authors.lastname: Roche
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouvière
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015588:Observer Variation; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery