• Clayton P Smith, Stephanie A Harmon, Tristan Barrett, Leonardo K Bittencourt, Yan Mee Law, Haytham Shebel, Julie Y An, Marcin Czarniecki, Sherif Mehralivand, Mehmet Coskun, Bradford J Wood, Peter A Pinto, Joanna H Shih, Peter L Choyke, and Baris Turkbey.
• Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, Maryland, USA.
• J Magn Reson Imaging. 2019 Jun 1; 49 (6): 1694-1703.

BackgroundThe Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) has been in use since 2015; while interreader reproducibility has been studied, there has been a paucity of studies investigating the intrareader reproducibility of PI-RADSv2.PurposeTo evaluate both intra- and interreader reproducibility of PI-RADSv2 in the assessment of intraprostatic lesions using multiparametric magnetic resonance imaging (mpMRI).Study TypeRetrospective.Population/SubjectsIn all, 102 consecutive biopsy-naïve patients who underwent prostate MRI and subsequent MR/transrectal ultrasonography (MR/TRUS)-guided biopsy.Field Strength/SequencesProstate mpMRI at 3T using endorectal with phased array surface coils (TW MRI, DW MRI with ADC maps and b2000 DW MRI, DCE MRI).AssessmentPreviously detected and biopsied lesions were scored by four readers from four different institutions using PI-RADSv2. Readers scored lesions during two readout rounds with a 4-week washout period.Statistical TestsKappa (κ) statistics and specific agreement (Po ) were calculated to quantify intra- and interreader reproducibility of PI-RADSv2 scoring. Lesion measurement agreement was calculated using the intraclass correlation coefficient (ICC).ResultsOverall intrareader reproducibility was moderate to substantial (κ = 0.43-0.67, Po  = 0.60-0.77), while overall interreader reproducibility was poor to moderate (κ = 0.24, Po  = 46). Readers with more experience showed greater interreader reproducibility than readers with intermediate experience in the whole prostate (P = 0.026) and peripheral zone (P = 0.002). Sequence-specific interreader agreement for all readers was similar to the overall PI-RADSv2 score, with κ = 0.24, 0.24, and 0.23 and Po  = 0.47, 0.44, and 0.54 in T2 -weighted, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE), respectively. Overall intrareader and interreader ICC for lesion measurement was 0.82 and 0.71, respectively.Data ConclusionPI-RADSv2 provides moderate intrareader reproducibility, poor interreader reproducibility, and moderate interreader lesion measurement reproducibility. These findings suggest a need for more standardized reader training in prostate MRI.Level Of Evidence2 Technical Efficacy: Stage 2.© 2018 International Society for Magnetic Resonance in Medicine.

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