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Are T2WI PI-RADS sub-scores of transition zone prostate lesions biased by DWI information?: A multi-reader, single-center study

Purpose - According to PI-RADS v2.1, T2-weighted imaging (T2WI) is the dominant sequence for transition zone (TZ) lesions. This study aimed to assess, whether diffusion-weighted imaging (DWI) information influences the assignment of T2WI scores. - Method - Out of 283 prostate MRI examinations with c...

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Main Authors: Zhang, Kevin Sun (Author) , Mayer, Philipp (Author) , Glemser, Philip (Author) , Tavakoli, Andrej (Author) , Keymling, Myriam (Author) , Rotkopf, Lukas Thomas (Author) , Meinzer, Clara (Author) , Görtz, Magdalena (Author) , Kauczor, Hans-Ulrich (Author) , Hielscher, Thomas (Author) , Stenzinger, Albrecht (Author) , Bonekamp, David (Author) , Hohenfellner, Markus (Author) , Schlemmer, Heinz-Peter (Author)
Format: Article (Journal)
Language:English
Published: October 2023
In: European journal of radiology
Year: 2023, Volume: 167, Pages: 1-8
ISSN:1872-7727
DOI:10.1016/j.ejrad.2023.111026
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.ejrad.2023.111026
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0720048X23003406
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Author Notes:Kevin Sun Zhang, Philipp Mayer, Philip Alexander Glemser, Anoshirwan Andrej Tavakoli, Myriam Keymling, Lukas Thomas Rotkopf, Clara Meinzer, Magdalena Görtz, Hans-Ulrich Kauczor, Thomas Hielscher, Albrecht Stenzinger, David Bonekamp, Markus Hohenfellner, Heinz-Peter Schlemmer
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Summary:Purpose - According to PI-RADS v2.1, T2-weighted imaging (T2WI) is the dominant sequence for transition zone (TZ) lesions. This study aimed to assess, whether diffusion-weighted imaging (DWI) information influences the assignment of T2WI scores. - Method - Out of 283 prostate MRI examinations with correlated biopsy results, fourty-four patients were selected retrospectively: first, 22 patients with a TZ lesion with T2WI and DWI scores ≥ 4, to represent lesions with unequivocal suspicion on T2WI and DWI. Second, 22 additional patients with TZ lesions of similar T2WI appearance but with corresponding DWI score ≤ 3 were added as control. Four residents and one board-certified radiologist each performed two assessments of the included patients: First, only T2WI was available (T2-only read); second, both T2WI and DWI sequences were available (biparametric read). Lesion scores were assessed using Wilcoxon signed-rank test, inter-reader agreement using weighted kappa and Kendall's W statistics, and sensitivity/specificity using McNemar test. - Results - The T2WI scores were significantly different between the T2-only and biparametric read for 3 out of 4 residents (p ≤ 0.049) but not for the radiologist. The overall PI-RADS scores derived from the two reading sessions differed considerably for 35/220 cases (all readers pooled). Inter-reader agreement was fair for the T2WI and overall PI-RADS scores (mean kappa 0.27-0.30) and moderate for the DWI scores (mean kappa 0.43). - Conclusions - For inexperienced readers, assessment of T2WI is variable and potentially biased by availability of DWI information, which can lead to changes of overall PI-RADS score and consequently clinical management. Assessment of T2WI should be performed before reviewing DWI to ensure non-biased interpretation of TZ lesions in the dominant sequence.
Item Description:Gesehen am 08.11.2023
Physical Description:Online Resource
ISSN:1872-7727
DOI:10.1016/j.ejrad.2023.111026

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