| Title: |
Real-world Inter-rater Agreement of PI-QUAL Version 2 for Prostate Magnetic Resonance Imaging Quality Assessment and Its Association with Diagnostic Accuracy |
| Authors: |
van den Kroonenberg,Daniel L.; Barentsz,Jelle; Hamstra,Bo J.; van den Bosch,Stijn M.; Gijsbertsen,Joris Jan; Reitsma, Johannes B.; Brembilla,Giorgio; Caglic,Iztok; Raat,H. P.J.; de Rooij,Maarten; Postema,Arnoud W.; Giganti,Francesco; Oddens,Jorg R.; Epi Methoden Team 4; Circulatory Health; JC onderzoeksprogramma Methodology |
| Publication Year: |
2026 |
| Subject Terms: |
Diagnostic performance; Image quality; Magnetic resonance imaging; Prostate; Prostate Imaging Quality; Prostate Imaging Reporting and Data System; Urology |
| Description: |
Background and objective: Magnetic resonance imaging (MRI) has been shown to improve the detection of prostate cancer, the second most diagnosed cancer among men. This study evaluates the inter-rater agreement for MRI quality using Prostate Imaging Quality (PI-QUAL) v2. It studies the association of PI-QUAL with diagnostic accuracy and the proportion of indeterminate Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions with PI-QUAL scores. Methods: This multicenter cohort study included biopsy-naïve patients from the PCAVISION trial (NCT06281769) who underwent MRI for a suspicion of prostate cancer. Four radiologists independently scored PI-QUAL v2 and PI-RADS. PI-QUAL v2 scores were dichotomized as PI-QUAL 1 versus PI-QUAL ≥2. PI-RADS was dichotomized as PI-RADS ≤2 versus PI-RADS ≥3 and evaluated using percentage agreement, kappa, and Gwet's agree coefficient (AC) 1. The PI-QUAL consensus score was defined by the majority score or by a referee if no majority was reached. In cases with biopsy pathology, the association between PI-QUAL and diagnostic accuracy was assessed. Key findings and limitations: In total, 352 MRI scans were included, with 150 multiparametric MRI and 202 biparametric MRI scans. The percentage agreement for dichotomized PI-QUAL was 53% (95% confidence interval [CI] 51–56%) with AC1 of 0.11 (95% CI 0.06–0.16), mainly due to one reader who strictly applied technical criteria classifying 83% as inadequate (PI-QUAL 1), compared with 12–43% by others. Exclusion of this reader resulted in a percentage agreement of 69% (95% CI 65–73%) and an AC1 of 0.51 (95% CI 0.44–0.58). Consensus classified 24% of MRI scan as PI-QUAL 1 and 76% as PI-QUAL ≥2. In an exploratory analysis, the negative predictive value was 68% (95% CI 47–85%) for PI-QUAL 1 and 74% (95% CI 60–85%) for PI-QUAL ≥2, and the positive predictive value was 62% (95% CI 45–78%) and 50% (95% CI 42–59%), respectively. The proportion of PI-RADS 3 lesions was higher in PI-QUAL 1 scans than in PI-QUAL ≥2 scans (difference of –6.5%, 95% ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
2666-1691 |
| Relation: |
https://dspace.library.uu.nl/handle/1874/469202 |
| Availability: |
https://dspace.library.uu.nl/handle/1874/469202 |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.268B630A |
| Database: |
BASE |