Taking PI-QUAL beyond the prostate: Towards a standardized radiological image quality score (RI-QUAL)

Purpose: To compare the interreader agreement of a novel quality score, called the Radiological Image Quality Score (RI-QUAL), to a slighly modified version of the existing Prostate Imaging Quality (mPI-QUAL) score for magnetic resonance imaging (MRI) of the prostate. Methods: A total of 43 consecutive scans were evaluated by two subspecialized radiologists who assigned scores using both the RI-QUAL and mPI-QUAL methods. The interreader agreement was analyzed using three statistical methods: concordance correlation coefficient (CCC), intraclass correlation coefficient (ICC), and Cohen's kappa. Time needed to arrive at a quality judgment was measured and compared using the Wilcoxon signed rank test. Results: The interreader agreement for RI-QUAL and mPI-QUAL scores was comparable, as evidenced by the high CCC (0.76 vs. 0.77, p = 0.93), ICC (0.86 vs. 0.87, p = 0.93), and moderate Cohen's kappa (0.61 vs. 0.64, p = 0.85) values. Moreover, RI-QUAL assessment was faster than mPI-QUAL (19 vs. 40 s, p = 0.001). Conclusion: RI-QUAL is a new quality score that has comparable interreader agreement to the mPI-QUAL score, but with the potential to be applied to different MRI protocols and even different modalities. Like PI-QUAL, RI-QUAL may also facilitate communication about quality to referring physicians, as it provides a standardized and easily interpretable score. Further studies are warranted to validate the usefulness of RI-QUAL in larger patient cohorts and for other imaging modalities

PI-RADS Version 2.1: A Critical Review (AJR Special Series on Radiology Reporting and Data Systems)

TThe Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 provides updates to the technical parameters for multiparametric MRI (mpMRI) of the prostate, along with revisions to the imaging interpretation criteria, while maintaining the framework introduced in version 2. These changes have been considered an improvement, although some issues remain unresolved and new issues have emerged. Areas for improvement discussed in this review include: (1) need for more detailed mpMRI protocols, with optimization for 1.5T and 3T systems; (2) lack of validation of revised transition zone interpretation criteria and need for clarifications regarding the revised DWI and dynamic contrast-enhanced imaging criteria and central zone assessment; (3) need for systematic evaluation and reporting of background signal changes in the prostate that can negatively affect cancer detection; (4) creation of a new category for lesions that do not fit into the PI-RADS assessment categories (i.e., PI-RADS “M” category); (5) inclusion of quantitative parameters beyond size to evaluate lesion aggressiveness; (6) adjustments to the structured report template, including a standardized assessment of the risk of extraprostatic extension; (7) development of parameters for image quality and performance control; and (8) suggestions for expansion of the system to other indications (e.g., active surveillance and recurrence)