Prostate Image Reporting and Data System (PI-RADS)

In recent years, multiparametric MRI (mpMRI) of the prostate has emerged a robust imaging approach for non-invasive characterization of prostate cancer at 3T (Hegde et al. 2013). mpMRI includes morphological (T2-weighted Imaging, or T2WI) and functional imaging (Diffusion Weighted Imaging with high b-values (>1600) (DWI), Dynamic Contrast Enhanced (DCE), and Magnetic Resonance Spectroscopic Imaging (MRSI) sequences). While the performance of the individual sequences is being investigated, and the acquisition techniques are being refined, integration of mpMRI into the clinical practice has been challenging due to the lack of consistent approaches for assessing mpMRI and reporting of the clinical findings. Prostate Imaging Reporting and Data System (PI-RADS) is a scoring system that aims to enable consistent interpretation, communication and reporting of prostate multiparametric MRI (mpMRI) findings (Barentsz et al. 2012; Dickinson et al. 2011). In 2015 version 2 of the PI-RADS guidelines were released by an international group of prostate imaging experts (Barentsz et al. 2015; Weinreb et al. 2016).

NCIGT Prostate project is actively involved in research projects that are related to the development and promotion of adoption of PI-RADS v2 along several directions:

  • All prostate MR exams at our BWH site are performed according to the PI-RADS v2 guidelines.
  • We are collecting clinical evidence in support of evaluation and refinement of PI-RADS (see recent studies by Hassanzadeh et al. (Hassanzadeh et al. 2016))
  • We are applying PI-RADS as part of the mpMRI evaluation protocol in the preparation and planning all stages of the in-bore MRI-guided prostate biopsy procedures, in place of the Likert scale rating used in the initial stages of the project described in (Penzkofer et al. 2015)
  • Facilitated by several collaborations, such as the one with the Quantitative Image Informatics for Cancer Research (QIICR) project, we are developing and improving DICOM standard to enable communication of image processing results, biopsy outcomes and PI-RADS scores.
  • We are developing infrastructure within 3D Slicer, our clinical research platform, to support PI-RADS reading workflows.

References

 

  1. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O, Logager V, Fütterer JJ. European Society of Urogenital Radiology. ESUR Prostate MR Guidelines 2012. Eur Radiol. 2012 Apr;22(4):746-57. PubMed PMID: 22322308. PMC3297750.
  2. Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F, Padhani AR, Margolis D, Macura KJ, Haider MA, Cornud F, Choyke PL. Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use. Eur Urol. 2016 Jan;69(1):41-9. PubMed PMID: 26361169.
  3. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin PJ, Kirkham A, Padhani AR, Persad R, Puech P, Punwani S, Sohaib AS, Tombal B, Villers A, van der Meulen J, Emberton M. Magnetic Resonance Imaging for the Detection, Localisation, and Characterisation of Prostate Cancer: Recommendations from a European Consensus Meeting. Eur Urol. 2011 Apr;59(4):477-94. PubMed PMID: 21195536.
  4. Hassanzadeh E, Glazer DI, Dunne RM, Fennessy FM, Harisinghani MG, Tempany CM. Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2): A Pictorial Review. Abdom Radiol (NY). 2016 Aug 13. Review. PubMed PMID: 27522352.
  5. Hegde JV, Mulkern RV, Panych LP, Fennessy FM, Fedorov A, Maier SE, Tempany CM. Multiparametric MRI of Prostate Cancer: An Update on State-of-the-art Techniques and their Performance in Detecting and Localizing Prostate Cancer. J Magn Reson Imaging. 2013 May;37(5):1035-54. Review. PubMed PMID: 23606141. PMC3741996.
  6. Penzkofer T, Tuncali K, Fedorov A, Song SE, Tokuda J, Fennessy FM, Vangel MG,  Kibel AS, Mulkern RV, Wells WM, Hata N, Tempany CM. Transperineal In-Bore 3-T MR Imaging-guided Prostate Biopsy: A Prospective Clinical Observational Study. Radiology. 2015 Jan;274(1):170-80. PubMed PMID: 25222067. PMC4334270.
  7. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016 Jan;69(1):16-40. PubMed PMID: 26427566.