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Purpose <p>The<?tk 2?> qualitative heterogeneity of multiparametric MRI (mpMRI) poses significant challenges for the diagnostic pathway of prostate cancer (PCa). The Prostate Imaging Quality Score (PI-QUAL) is a novel tool for the qualitative assessment of mpMRI. Aim of this study was to evaluate the impact of PI-QUAL on consistency of radiological to pathological T-stage.<?tk 0?></p> Methods <p>Patients undergoing MRI-TRUS fusion biopsy and radical prostatectomy (RP) from 01/2016 to 03/2024 were retrospectively included. PI-QUAL was determined by two expert radiologists and categorised: inadequate (1–2), sufficient (3) and optimal (4–5). Primary endpoint was upstaging from locally confined disease in mpMRI (mrT ≤ 2) to advanced in RP-specimen (pT ≥ 3a). Variables were compared using analysis of variance and χ<sup>2</sup> or Fisher’s exact test. Uni- and multivariate binary regression identified independent predictors.</p> Results <p>Of 349 patients included, 18 had PI-QUAL 1–2, 44 PI-QUAL 3 and 287 PI-QUAL 4–5. Patient characteristics, PI-RADS scores and biopsy counts were balanced between these groups. Upstaging from mrT ≤ 2 to pT ≥ 3a was significantly more frequent in PI-QUAL 1–2 (22.4%) and PI-QUAL 3 (22.7%) compared to PI-QUAL 4–5 (10.8%) (<i>p</i> = 0.031). Suboptimal mpMRI harbours an increased risk of upstaging (HR 2.22; 95% CI 1.05–4.71; <i>p</i> = 0.037). Optimal mpMRI quality independently predicts higher PI-RADS grading (PI-RADS ≥ 4) (HR 2.27; 95% CI 1.02-5.00; <i>p</i> = 0.043).</p> Conclusion <p>PI-QUAL (≤ 3) significantly influences PI-RADS grading and predicts for upstaging from radiological to pathological staging. In case of suboptimal image quality, repetition of mpMRI should be considered.</p>

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Impact of the PI-QUAL MRI quality score on histopathological up-staging from MRI fusion biopsy to final prostatectomy specimen

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月30日

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  • Maximilian Haack,
  • Mohamad Turkman,
  • Tobias Jorg,
  • Lukas Müller,
  • Gregor Duwe,
  • Lisa Johanna Frey,
  • Maximilian Peter Brandt,
  • Axel Haferkamp,
  • Hendrik Borgmann,
  • Robert Dotzauer

摘要

Purpose

The qualitative heterogeneity of multiparametric MRI (mpMRI) poses significant challenges for the diagnostic pathway of prostate cancer (PCa). The Prostate Imaging Quality Score (PI-QUAL) is a novel tool for the qualitative assessment of mpMRI. Aim of this study was to evaluate the impact of PI-QUAL on consistency of radiological to pathological T-stage.

Methods

Patients undergoing MRI-TRUS fusion biopsy and radical prostatectomy (RP) from 01/2016 to 03/2024 were retrospectively included. PI-QUAL was determined by two expert radiologists and categorised: inadequate (1–2), sufficient (3) and optimal (4–5). Primary endpoint was upstaging from locally confined disease in mpMRI (mrT ≤ 2) to advanced in RP-specimen (pT ≥ 3a). Variables were compared using analysis of variance and χ2 or Fisher’s exact test. Uni- and multivariate binary regression identified independent predictors.

Results

Of 349 patients included, 18 had PI-QUAL 1–2, 44 PI-QUAL 3 and 287 PI-QUAL 4–5. Patient characteristics, PI-RADS scores and biopsy counts were balanced between these groups. Upstaging from mrT ≤ 2 to pT ≥ 3a was significantly more frequent in PI-QUAL 1–2 (22.4%) and PI-QUAL 3 (22.7%) compared to PI-QUAL 4–5 (10.8%) (p = 0.031). Suboptimal mpMRI harbours an increased risk of upstaging (HR 2.22; 95% CI 1.05–4.71; p = 0.037). Optimal mpMRI quality independently predicts higher PI-RADS grading (PI-RADS ≥ 4) (HR 2.27; 95% CI 1.02-5.00; p = 0.043).

Conclusion

PI-QUAL (≤ 3) significantly influences PI-RADS grading and predicts for upstaging from radiological to pathological staging. In case of suboptimal image quality, repetition of mpMRI should be considered.