Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging

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The Prostate Imaging Reporting and Data System (PI-RADS) is an important standardization tool for reporting multiparametric MR imaging results; in this study the authors show that, like the first version of PIRADS, the second version is only moderately reproducible.


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.

Materials and 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.


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.


Use of the revised PI-RADS provides moderately reproducible MR imaging scores for detection of clinically relevant disease.

© RSNA, 2015

Online supplemental material is available for this article.


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Article History

Received December 8, 2014; revision requested January 9, 2015; revision received February 16; accepted March 31; final version accepted April 17.
Published online: June 18 2015
Published in print: Dec 2015