All over the map: An interobserver agreement study of tumor location based on the PI-RADSv2 sector map

Document Type

Journal Article

Publication Date



Journal of Magnetic Resonance Imaging








interobserver agreement; PI-RADSv2; prostate mpMRI


© 2018 International Society for Magnetic Resonance in Medicine Background: Prostate imaging reporting and data system version 2 (PI-RADSv2) recommends a sector map for reporting findings of prostate cancer mulitparametric MRI (mpMRI). Anecdotally, radiologists may demonstrate inconsistent reproducibility with this map. Purpose: To evaluate interobserver agreement in defining prostate tumor location on mpMRI using the PI-RADSv2 sector map. Study Type: Retrospective. Population: Thirty consecutive patients who underwent mpMRI between October, 2013 and March, 2015 and who subsequently underwent prostatectomy with whole-mount processing. Field Strength: 3T mpMRI with T 2 W, diffusion-weighted imaging (DWI) (apparent diffusion coefficient [ADC] and b-2000), dynamic contrast-enhanced (DCE). Assessment: Six radiologists (two high, two intermediate, and two low experience) from six institutions participated. Readers were blinded to lesion location and detected up to four lesions as per PI-RADSv2 guidelines. Readers marked the long-axis of lesions, saved screen-shots of each lesion, and then marked the lesion location on the PI-RADSv2 sector map. Whole-mount prostatectomy specimens registered to the MRI served as ground truth. Index lesions were defined as the highest grade lesion or largest lesion if grades were equivalent. Statistical Test: Agreement was calculated for the exact, overlap, and proportion of agreement. Results: Readers detected an average of 1.9 lesions per patient (range 1.6–2.3). 96.3% (335/348) of all lesions for all readers were scored PI-RADS ≥3. Readers defined a median of 2 (range 1–18) sectors per lesion. Agreement for detecting index lesions by screen shots was 83.7% (76.1%–89.9%) vs. 71.0% (63.1–78.3%) overlap agreement on the PI-RADS sector map (P < 0.001). Exact agreement for defining sectors of detected index lesions was only 21.2% (95% confidence interval [CI]: 14.4–27.7%) and rose to 49.0% (42.4–55.3%) when overlap was considered. Agreement on defining the same level of disease (ie, apex, mid, base) was 61.4% (95% CI 50.2–71.8%). Data Conclusion: Readers are highly likely to detect the same index lesion on mpMRI, but exhibit poor reproducibility when attempting to define tumor location on the PI-RADSv2 sector map. The poor agreement of the PI-RADSv2 sector map raises concerns its utility in clinical practice. Level of Evidence: 3. Technical Efficacy: Stage 2. J. MAGN. RESON. IMAGING 2018;48:482–490.

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