Practice Patterns and Challenges of Performing and Interpreting Prostate MRI: A Survey by the Society of Abdominal Radiology Prostate Disease-Focused Panel

External Validation of an Artificial Intelligence Algorithm Using Biparametric MRI and Its Simulated Integration with Conventional PI-RADS for Prostate Cancer Detection

PURPOSE

Prostate imaging reporting and data systems (PI-RADS) experiences considerable variability in inter-reader performance. Artificial Intelligence (AI) algorithms were suggested to provide comparable performance to PI-RADS for assessing prostate cancer (PCa) risk, albeit tested in highly selected cohorts. This study aimed to assess an AI algorithm for PCa detection in a clinical practice setting and simulate integration of the AI model with PI-RADS for assessment of indeterminate PI-RADS 3 lesions.

PATIENTS AND METHODS

This retrospective cohort study externally validated a biparametric MRI-based AI model for PCa detection in a consecutive cohort of patients who underwent prostate MRI and subsequently targeted and systematic prostate biopsy at a urology clinic between January 2022 and March 2024. Radiologist interpretations followed PI-RADS v2.1, and biopsies were conducted per PI-RADS scores. The previously developed AI model provided lesion segmentations and cancer probability maps which were compared to biopsy results. Additionally, we conducted a simulation to adjust biopsy thresholds for index PI-RADS category 3 studies, where AI predictions within these studies upgraded them to PI-RADS category 4.

RESULTS

Among 144 patients with a median age of 70 years and PSA density of 0.17ng/mL/cc, AI's sensitivity for detection of PCa (86.6%) and clinically significant PCa (csPCa, 88.4%) was comparable to radiologists (85.7%, p=0.84, and 89.5%, p=0.80, respectively). The simulation combining radiologist and AI evaluations improved clinically significant PCa sensitivity by 5.8% (p=0.025). The combination of AI, PI-RADS and PSA density provided the best diagnostic performance for csPCa (area under the curve [AUC]=0.76).

CONCLUSION

The AI algorithm demonstrated comparable PCa detection rates to PI-RADS. The combination of AI with radiologist interpretation improved sensitivity and could be instrumental in assessment of low-risk and indeterminate PI-RADS lesions. The role of AI in PCa screening remains to be further elucidated.

Current Practice Patterns, Challenges, and Need for Education in Performing and Reporting Advanced Pelvic US and MRI to Investigate Endometriosis: A Survey by the Canadian Association of Radiologists Endometriosis Working Group

Purpose: The Canadian Association of Radiologists (CAR) Endometriosis Working Group developed a national survey to evaluate current practice patterns associated with imaging endometriosis using advanced pelvic ultrasound and MRI to inform forthcoming clinical practice guidelines for endometriosis imaging. Methods: The anonymous survey consisted of 36 questions and was distributed electronically to CAR members. The survey contained a mix of multiple choice, Likert scale and open-ended questions intended to collect information about training and certification, current practices and protocols associated with imaging endometriosis, opportunities for quality improvement and continuing professional development. Descriptive statistics were used to summarize the results. Results: Canadian radiologists were surveyed about their experience with imaging endometriosis. A total of 89 responses were obtained, mostly from Ontario and Quebec. Most respondents were community radiologists, and almost 33% were in their first five years of practice. Approximately 38% of respondents reported that they or their institution performed advanced pelvic ultrasound for endometriosis, with most having done so for less than 5 years, and most having received training during residency or fellowship. 70% of respondents stated they currently interpret pelvic endometriosis MRI, with most having 1-5 years of experience. Conclusion: Many radiologists in Canada do not perform dedicated imaging for endometriosis. This may be due to a lack of understanding of the benefits and limited access to training. However, dedicated imaging can improve patient outcomes and decrease repeated surgeries. The results highlight the importance of developing guidelines for these imaging techniques and promoting a multidisciplinary approach to endometriosis management.

Use of Imaging and Biopsy in Prostate Cancer Diagnosis: A Survey From the Asian Prostate Imaging Working Group

OBJECTIVE

To elucidate the use of radiological studies, including nuclear medicine, and biopsy for the diagnosis and staging of prostate cancer (PCA) in clinical practice and understand the current status of PCA in Asian countries via an international survey.

MATERIALS AND METHODS

The Asian Prostate Imaging Working Group designed a survey questionnaire with four domains focused on prostate magnetic resonance imaging (MRI), other prostate imaging, prostate biopsy, and PCA backgrounds. The questionnaire was sent to 111 members of professional affiliations in Korea, Japan, Singapore, and Taiwan who were representatives of their working hospitals, and their responses were analyzed.

RESULTS

This survey had a response rate of 97.3% (108/111). The rates of using 3T scanners, antispasmodic agents, laxative drugs, and prostate imaging-reporting and data system reporting for prostate MRI were 21.6%-78.9%, 22.2%-84.2%, 2.3%-26.3%, and 59.5%-100%, respectively. Respondents reported using the highest b-values of 800-2000 sec/mm² and fields of view of 9-30 cm. The prostate MRI examinations per month ranged from 1 to 600, and they were most commonly indicated for biopsy-naïve patients suspected of PCA in Japan and Singapore and staging of proven PCA in Korea and Taiwan. The most commonly used radiotracers for prostate positron emission tomography are prostate-specific membrane antigen in Singapore and fluorodeoxyglucose in three other countries. The most common timing for prostate MRI was before biopsy (29.9%). Prostate-targeted biopsies were performed in 63.8% of hospitals, usually by MRI-ultrasound fusion approach. The most common presentation was localized PCA in all four countries, and it was usually treated with radical prostatectomy.

CONCLUSION

This survey showed the diverse technical details and the availability of imaging and biopsy in the evaluation of PCA. This suggests the need for an educational program for Asian radiologists to promote standardized evidence-based imaging approaches for the diagnosis and staging of PCA.

Canadian Association of Radiologists Prostate MRI White Paper

Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.