title: Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging.
abstract: OBJECTIVE
  To evaluate accuracy and interobserver variability with the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 for detection of prostate cancer at multiparametric magnetic resonance (MR) imaging in a biopsy-naïve patient population.
  
  
  METHODS
  This retrospective HIPAA-compliant study was approved by the local ethics committee, and written informed consent was obtained from all patients for use of their imaging and histopathologic data in future research studies. In 101 biopsy-naïve patients with elevated prostate-specific antigen levels who underwent multiparametric MR imaging of the prostate and subsequent transrectal ultrasonography (US)-MR imaging fusion-guided biopsy, suspicious lesions detected at multiparametric MR imaging were scored by five readers who were blinded to pathologic results by using to the newly revised PI-RADS and the scoring system developed in-house. Interobserver agreement was evaluated by using κ statistics, and the correlation of pathologic results with each of the two scoring systems was evaluated by using the Kendall τ correlation coefficient.
  
  
  RESULTS
  Specimens of 162 lesions in 94 patients were sampled by means of transrectal US-MR imaging fusion biopsy. Results for 87 (54%) lesions were positive for prostate cancer. Kendall τ values with the PI-RADS and the in-house-developed scoring system, respectively, at T2-weighted MR imaging in the peripheral zone were 0.51 and 0.17 and in the transitional zone, 0.45 and -0.11; at diffusion-weighted MR imaging, 0.42 and 0.28; at dynamic contrast material-enhanced MR imaging, 0.23 and 0.24, and overall suspicion scores were 0.42 and 0.49. Median κ scores among all possible pairs of readers for PI-RADS and the in-house-developed scoring system, respectively, for T2-weighted MR images in the peripheral zone were 0.47 and 0.15; transitional zone, 0.37 and 0.07; diffusion-weighted MR imaging, 0.41 and 0.57; dynamic contrast-enhanced MR imaging, 0.48 and 0.41; and overall suspicion scores, 0.46 and 0.55.
  
  
  CONCLUSIONS
  Use of the revised PI-RADS provides moderately reproducible MR imaging scores for detection of clinically relevant disease.
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Berrend G
authors.initials: BG
authors.lastname: Muller
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Shih
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sankineni
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Jamie
authors.initials: J
authors.lastname: Marko
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Arvin Koruthu
authors.initials: AK
authors.lastname: George
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Jean J M C H
authors.initials: JJ
authors.lastname: de la Rosette
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Peter
authors.initials: P
authors.lastname: Pinto
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.affiliation: From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.).
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology