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Characterizing indeterminate (Likert-scored 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multi-parametric MRI

Brizmohun Appayya, Mrishta, Sidhu, Harbir S, Dikaios, Nikolaos, Johnston, Edward W, Simmons, Lucy AM, Freeman, Alex, Kirkham, Alexander PS, Ahmed, Hashim U and Punwani, Shonit (2017) Characterizing indeterminate (Likert-scored 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multi-parametric MRI The British Journal of Radiology, 91 (1083).

Characterizing indeterminate (Likert-scored 3-5) peripheral zone prostate lesions.pdf - Accepted version Manuscript

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To determine whether indeterminate (Likert-score 3/5) peripheral zone (PZ) multi-parametric MRI (mpMRI) studies are classifiable by Prostate-Specific Antigen (PSA), PSA density (PSAD), PI-RADS_v2 rescoring and morphological MRI features.


Men with maximum Likert-score 3/5 within their PZ were retrospectively selected from 330 men who prospectively underwent prostate mpMRI (3T) without an endorectal coil, followed by twenty-zone trans-perineal template prostate mapping biopsies ± focal lesion-targeted biopsy. PSAD was calculated using pre-biopsy PSA and MRI-derived volume. Two readers A and B independently assessed included men with both subjective Likert-score and PI-RADS_v2. Both readers then classified mpMRI morphological features in consensus. Men were divided into two groups: significant cancer (≥Gleason 3+4) or insignificant cancer (≤Gleason 3+3)/no cancer. Comparisons between groups were made separately for PSA&PSAD using Mann-Whitney test and morphological descriptors with Fisher's exact test. PI-RADS_v2 and subjective Likert assessment were descriptively compared and percentage inter-reader agreement calculated.


76 men were eligible for PSA&PSAD analyses, 71 for PI-RADS scoring, and 67 for morphological assessment (excluding significant image artefacts). Unlike PSA (p=0.915), PSAD was statistically different (p=0.004) between the significant 0.19 ng/ml2 (IQR: 0.13-0.29) and non-significant/no cancer 0.13 ng/ml2 (IQR: 0.10-0.17) groups. Presence of mpMRI morphological features wasn't significantly different between groups. Subjective Likert assessment discriminated patients with significant cancer better than PI-RADS_v2. Inter-reader percentage agreement was 83% for subjective Likert-scoring and 56% for PI-RADS_v2.


PSAD may categorize presence of significant cancer in patients with Likert-scored 3/5 PZ mpMRI findings.


PSAD may be used in indeterminate PZ mpMRI to guide decisions between biopsy versus monitoring.

Item Type: Article
Divisions : Faculty of Engineering and Physical Sciences > Electronic Engineering
Authors :
Brizmohun Appayya, Mrishta
Sidhu, Harbir S
Johnston, Edward W
Simmons, Lucy AM
Freeman, Alex
Kirkham, Alexander PS
Ahmed, Hashim U
Punwani, Shonit
Date : 30 November 2017
DOI : 10.1259/bjr.20170645
Copyright Disclaimer : © 2017 The Authors. Published by the British Institute of Radiology.
Depositing User : Clive Harris
Date Deposited : 11 Dec 2017 16:02
Last Modified : 01 Dec 2018 02:08

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