Background High variability in prostate MRI quality might reduce accuracy in prostate cancer detection. Purpose To prospectively evaluate the quality of MRI scanners taking part in the quality control phase of the global PRIME (Prostate Imaging Using MRI ± Contrast Enhancement) trial using the Prostate Imaging Quality (PI-QUAL) standardized scoring system, give recommendations on how to improve the MRI protocols, and establish whether MRI quality could be improved by these recommendations. Materials and Methods In the prospective clinical trial (PRIME), for each scanner, centers performing prostate MRI submitted five consecutive studies and the MRI protocols (phase I). Submitted data were evaluated in consensus by two expert genitourinary radiologists using the PI-QUAL scoring system that evaluates MRI diagnostic quality using five points (1 and 2 = nondiagnostic; 3 = sufficient; 4 = adequate, 5 = optimal) between September 2021 and August 2022. Feedback was provided for scanners not achieving a PI-QUAL 5 score, and centers were invited to resubmit new imaging data using the modified protocol (phase II). Descriptive comparison of outcomes was made between the MRI scanners, feedback provided, and overall PI-QUAL scores. Results In phase I, 41 centers from 18 countries submitted a total of 355 multiparametric MRI studies from 71 scanners, with nine (13%) scanners achieving a PI-QUAL score of 3, 39 (55%) achieving a score of 4, and 23 (32%) achieving a score of 5. Of the 48 (n = 71 [68%]) scanners that received feedback to improve, the dynamic contrast-enhanced sequences were those that least adhered to the Prostate Imaging Reporting and Data System, version 2.1, criteria (44 of 48 [92%]), followed by diffusion-weighted imaging (20 of 48 [42%]) and T2-weighted imaging (19 of 48 [40%]). In phase II, 36 centers from 17 countries resubmitted revised studies, resulting in a total of 62 (n = 64 [97%]) scanners with a final PI-QUAL score of 5. Conclusion Substantial variation in global prostate MRI acquisition parameters as a measure of quality was observed, particularly with DCE sequences. Basic evaluation and modifications to MRI protocols using PI-QUAL can lead to substantial improvements in quality. Clinical trial registration no. NCT04571840 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almansour and Chernyak in this issue.
Radiology. 2023 Oct [Epub]
Francesco Giganti, Alexander Ng, Aqua Asif, Vinson Wai-Shun Chan, Marimo Rossiter, Arjun Nathan, Pramit Khetrapal, Louise Dickinson, Shonit Punwani, Chris Brew-Graves, Alex Freeman, Mark Emberton, Caroline M Moore, Clare Allen, Veeru Kasivisvanathan, PRIME Quality Improvement Group
From the Departments of Radiology (F.G., L.D., S.P., C.A.), Pathology (A.F.), and Urology (M.E., C.M.M., V.K.), University College London Hospital NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, UCL, 43-45 Foley St, 3rd Floor, Charles Bell House, London W1W 7TS, United Kingdom (F.G., A. Ng, A.A., V.W.S.C., A. Nathan, P.K., M.E., C.M.M., C.A., V.K.); Royal Free London, NHS Foundation Trust, London, United Kingdom (A. Ng); British Urology Researchers in Surgical Training (BURST), London, United Kingdom (A. Ng, A.A., V.W.S.C., M.R., A. Nathan, V.K.); UCL Medical School, University College London, London, United Kingdom (M.R.); Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (P.K.); Centre for Medical Imaging, University College London, London, United Kingdom (S.P.); and National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, United Kingdom (C.B.G.).