PI-RADS-Klassifikation: Strukturiertes Befundungsschema für die MRT der Prostata

Zusammenfassung

Ziel: Konkretisierung der ESUR-Leitlinien zur standardisierten Befundung der multiparametrischen MRT zur Detektion des Prostatakarzinoms und Vorstellung eines grafischen Befundschemas zur Vereinfachung der Befundübermittlung an den Urologen.

Material und Methoden: Kürzlich wurde von der ESUR ein strukturiertes Befundungsschema für die multiparametrische MRT der Prostata beschrieben (PI-RADS). Hierbei wurden die Ausprägungen der einzelnen Methoden, bestehend aus der T2-gewichteten, der diffusionsgewichteten, der dynamischen kontrastmittelgestützten MRT und MR-Spektroskopie auf einer Likert-Skala von 1 – 5 angegeben. Die Grundlagen der technischen Durchführung unter Berücksichtigung der Gegebenheiten des deutschsprachigen Raumes wurden im Konsensus ermittelt sowie repräsentative Bildbeispiele auf Grundlage von Untersuchungen der 3 Institute im Konsensverfahren ausgewählt. Scoring-Intervalle für einen aggregierten PI-RADS-Score wurden ebenfalls im Konsensus festgelegt.

Ergebnisse: Die multiparametrischen Methoden wurden hinsichtlich Durchführung und aktuellem Stellenwert kritisch erörtert. Ebenso wurden die beschriebenen Kriterien der einzelnen multiparametrischen Ausprägungen der PI-RADS-Klassifikation anhand einer schematischen Übersicht konkretisiert. Für die klinische Arbeit wird empfohlen, anhand der erstellten Scoringtabelle ab einem PI-RADS-Score von 4 (≥ 10 Punkte bei Vorliegen von 3 Methoden und ≥ 13 Punkte bei Vorliegen von 4 Methoden) den Verdacht auf ein Prostatakarzinom zu stellen. Abschließend wurde eine grafische Befundvorlage zur Befundübermittlung erarbeitet.

Schlussfolgerung: Die strukturierte Befundung anhand der ESUR-Leitlinie trägt durch Standardisierung und Vereinheitlichung zur Qualitätssicherung eines radiologischen Verfahrens bei und vereinfacht die Befundübermittlung an den Urologen.

Abstract

Purpose: To flesh out the ESUR guidelines for the standardized interpretation of multiparametric magnetic resonance imaging (mMRI) for the detection of prostate cancer and to present a graphic reporting scheme for improved communication of findings to urologists.

Materials and Methods: The ESUR has recently published a structured reporting system for mMRI of the prostate (PI-RADS). This system involves the use of 5-point Likert scales for grading the findings obtained with different MRI techniques. The mMRI includes T2-weighted MRI, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and MR spectroscopy. In a first step, the fundamentals of technical implementation were determined by consensus, taking into account in particular the German-speaking community. Then, representative images were selected by consensus on the basis of examinations of the three institutions. In addition, scoring intervals for an aggregated PI-RADS score were determined in consensus.

Results: The multiparametric methods were discussed critically with regard to implementation and the current status. Criteria used for grading mMRI findings with the PI-RADS classification were concretized by succinct examples. Using the consensus table for aggregated scoring in a clinical setting, a diagnosis of suspected prostate cancer should be made if the PI-RADS score is 4 or higher (≥ 10 points if 3 techniques are used or ≥ 13 points if 4 techniques are used). Finally, a graphic scheme was developed for communicating mMRI prostate findings.

Conclusion: Structured reporting according to the ESUR guidelines contributes to quality assurance by standardizing prostate mMRI, and it facilities the communication of findings to urologists.

Key words

prostate - MR imaging - MR diffusion/perfusion - MR spectroscopy

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