PI-RADS is an acronym for Prostate Imaging Reporting and Data System, defining standards of high quality clinical service for multi-parametric Magnetic Resonance Imaging (mpMRI), including image creation and reporting.
In 2007, the AdMeTech Foundation's International Prostate MRI Working Group [1] convened the key global experts, including members of the European Society of Urogenital Radiology (ESUR) and the American College of Radiology (ACR). In March 2009 in Vienna an ESUR Prostate MRI Committee was formed, with the aim to produce minimal and maximal standards for acquisition and reporting of prostate MRI. This standardization was endorsed by the results of a consensus meeting in London in December 2009 [2]
Dr. Jelle Barentsz published with the ESUR Prostate MRI Committee the first PI-RADS (v.1) version in December 2011. [3] Following this initiative the ACR, ESUR, and the AdMeTech Foundation formed a Joint Steering Committee, and by 2016 published a second version of PI-RADS (v.2) in European Urology. [4] This paper enabled acceptance of the urologists of prostate MRI and was awarded “Best clinical scientific paper of 2016 in European Urology”. In 2019 the PI-RADS Steering Committee published an updated version: PI-RADS v2.1. [5] Prostate MRI using PI-RADS to detect clinically significant cancer is now widely by European urologists, as is illustrated with the '2020 EAU Innovators in Urology Award' for Dr. Barentsz.[ citation needed ]
The aim of prostate MRI using PI-RADS is to assess the risk of clinically significant prostate cancer being present. Furthermore, the PI-RADS v2 system is designed to standardize prostate MRI. The focus is especially to provide good image quality and reporting.[ citation needed ]
Various studies have compared the predictive performance of PI-RADS v1 for detecting significant prostate cancer against either image-guided biopsy results (definitive pathology) and/or prostatectomy specimens (histopathology). In a 2015 articles in the Journal of Urology, Thompson reported multi-parametric MRI detection of significant prostate cancer had sensitivity of 96%, specificity of 36%, negative predictive value and positive predictive values of 92% and 52%; when PI-RADS was incorporated into a multivariate analysis (PSA, digital rectal exam, prostate volume, patient age) the area under the curve (AUC) improved from 0.776 to 0.879, p<0.001. [6] A similar paper in European Radiology found that when correlated with histopathology, PI-RADS v2 correctly identified 94-95% of prostate cancer foci ≥0.5 mL, but was limited for the assessment of GS ≥4+3 (significant) tumors ≤0.5 mL; in their series, DCE-MRI offered limited added value to T2WI+DW-MRI. [7] Other applications for which PI-RADS may be useful include prediction of termination of Active Surveillance due to tumor progression/aggressiveness, [8] detection of extraprostatic extension of prostate cancer, [9] and supplemental information when considering whether to re-biopsy patients with a history of previous negative biopsy. [10]
PI-RADS v2 is designed to improve detection, characterization and risk stratification in patients suspected of prostate cancer with a goal of better treatment decisions, improved outcomes and simplified reporting. However, multi-center validation trials are needed and expected to lead to modifications in the scoring system. [11]
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. MRI does not involve X-rays or the use of ionizing radiation, which distinguishes it from CT and PET scans. MRI is a medical application of nuclear magnetic resonance (NMR) which can also be used for imaging in other NMR applications, such as NMR spectroscopy.
Prostate cancer is cancer of the prostate. The prostate is a gland in the male reproductive system that surrounds the urethra just below the bladder. Most prostate cancers are slow growing. Cancerous cells may spread to other areas of the body, particularly the bones and lymph nodes. It may initially cause no symptoms. In later stages, symptoms include pain or difficulty urinating, blood in the urine, or pain in the pelvis or back. Benign prostatic hyperplasia may produce similar symptoms. Other late symptoms include fatigue, due to low levels of red blood cells.
Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging.
Prostate-specific antigen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), P-30 antigen, is a glycoprotein enzyme encoded in humans by the KLK3 gene. PSA is a member of the kallikrein-related peptidase family and is secreted by the epithelial cells of the prostate gland.
Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's prostate gland to be examined for the presence of prostate cancer. It is typically performed when the result from a PSA blood test is high. It may also be considered advisable after a digital rectal exam (DRE) finds possible abnormality. PSA screening is controversial as PSA may become elevated due to non-cancerous conditions such as benign prostatic hyperplasia (BPH), by infection, or by manipulation of the prostate during surgery or catheterization. Additionally many prostate cancers detected by screening develop so slowly that they would not cause problems during a man's lifetime, making the complications due to treatment unnecessary.
The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph node/s is/are the target organs primarily reached by metastasizing cancer cells from the tumor.
Prostate cancer screening is the screening process used to detect undiagnosed prostate cancer in men without signs or symptoms. When abnormal prostate tissue or cancer is found early, it may be easier to treat and cure, but it is unclear if early detection reduces mortality rates.
One alternative to mammography, Breast MRI or contrast enhanced magnetic resonance imaging (MRI), has shown substantial progress in the detection of breast cancer.
Magnetic resonance elastography (MRE) is a form of elastography that specifically leverages MRI to quantify and subsequently map the mechanical properties of soft tissue. First developed and described at Mayo Clinic by Muthupillai et al. in 1995, MRE has emerged as a powerful, non-invasive diagnostic tool, namely as an alternative to biopsy and serum tests for staging liver fibrosis.
In vivo magnetic resonance spectroscopy (MRS) is a specialized technique associated with magnetic resonance imaging (MRI).
KH domain-containing, RNA-binding, signal transduction-associated protein 3 is a protein that in humans is encoded by the KHDRBS3 gene.
Urology Robotics, or URobotics, is a new interdisciplinary field for the application of robots in urology and for the development of such systems and novel technologies in this clinical discipline. Urology is among the medical fields with the highest rate of technology advances, which for several years has included the use medical robots.
Prostate cancer antigen 3 is a gene that expresses a non-coding RNA. PCA3 is only expressed in human prostate tissue, and the gene is highly overexpressed in prostate cancer. Because of its restricted expression profile, the PCA3 RNA is useful as a tumor marker.
The term radiogenomics is used in two contexts: either to refer to the study of genetic variation associated with response to radiation or to refer to the correlation between cancer imaging features and gene expression.
In medicine, breast imaging is a sub-speciality of diagnostic radiology that involves imaging of the breasts for screening or diagnostic purposes. There are various methods of breast imaging using a variety of technologies as described in detail below. Traditional screening and diagnostic mammography uses x-ray technology. Breast tomosynthesis is a new digital mammography technique that produces 3D images of the breast using x-rays. Xeromammography and Galactography also use x-ray technology and are also used infrequently in the detection of breast cancer. Breast ultrasound is another technology employed in diagnosis & screening and specifically can help differentiate between fluid filled and solid lumps that can help determine if cancerous. Breast MRI is, yet, another technology reserved for high-risk patients and can help determine the extent of cancer if diagnosed. Lastly, scintimammography is used in a subgroup of patients who have abnormal mammograms or whose screening is not reliable on the basis of using traditional mammography or ultrasound.
In the field of medicine, radiomics is a method that extracts a large number of features from radiographic medical images using data-characterisation algorithms. These features, termed radiomic features, have the potential to uncover disease characteristics that fail to be appreciated by the naked eye. The hypothesis of radiomics is that the distinctive imaging features between disease forms may be useful for predicting prognosis and therapeutic response for various conditions, thus providing valuable information for personalized therapy. Radiomics emerged from the medical field of oncology and is the most advanced in applications within that field. However, the technique can be applied to any medical study where a disease or a condition can be imaged.
Fluciclovine (18F), also known as anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (FACBC), or as Axumin, and colloquially as anti-3[18F] FACBC or F18, is a diagnostic agent "indicated for positron emission tomography (PET) imaging in men with suspected prostate cancer recurrence based on elevated prostate specific antigen (PSA) levels."
Dr. Daniel Przybysz is a Brazilian Radiation-Oncologist. His practice is mainly focused on lung cancer treatment and high technology approaches toward better patient care.
Caroline M. Moore is the first woman to be made a professor of urology in the United Kingdom. She works in the diagnosis and treatment of prostate cancer at University College London.
Professor Mark Emberton is a urologist and prostate cancer research specialist using novel imaging techniques and minimally invasive treatments to improve diagnosis and treatment of prostate cancer.