Medical Institutions' Adherence to the PI-RADS v2Minimum Technical Standards for Prostate MRI in Korea

Youngwoo Kwon; Moon Hyung Choi; Seung Eun Jung

doi:10.3348/jksr.2019.80.2.306

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Kwon, Choi, and Jung: Medical Institutions' Adherence to the PI-RADS v2Minimum Technical Standards for Prostate MRI in Korea

Original Article

J Korean Soc Radiol 2019;80(2):306-317.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.2.306

Medical Institutions' Adherence to the PI-RADS v2Minimum Technical Standards for Prostate MRI in Korea

Youngwoo Kwon, MD, Moon Hyung Choi, MD^∗, Seung Eun Jung, MD

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

^∗Corresponding author Moon Hyung Choi, MD Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel 82-2-2258-1459 Fax 82-2-599-6771 E-mail cmh@catholic.ac.kr

Received 7 June 2018 Revised 12 July 2018 Accepted 4 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the adherence rate to Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) minimum technical standards of prostate magnetic resonance imaging (MRI) in Korean medical institutions.

Materials and Methods

This study included 103 prostate MRI examinations from 85 outside medical institutions performed from March 2015 to January 2018. The difference in adherence rate to minimal technical standards of PI-RADS v2 was compared using a Fisher's exact test between subgroups divided by the magnetic strength of MRI machine, type of medical institution and presence of genitourinary radiologist.

Results

Diffusion-weighted imaging (DWI) was obtained frequently in examinations performed in a 3-T machine, in university hospitals and in medical institutions where genitourinary radiologist work in than the others (p < 0.001,p < 0.001,p = 0.003). Many minimum technical standards of PI-RADS v2 showed significantly lower adherence rate in a 1.5-T machine, in a non-university hospital and in a medical institution without genitourinary radiologist than the others.

Conclusion

The frequency of obtaining DWI and the adherent rate to some of the PI-RADS v2 minimum technical standards were significantly higher in 3-T machines, university hospitals and medical institutions with a genitourinary radiologist.

References

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Table 1.

Characteristics of Medical Institutions and Machines in This Study

	Number (Percentage)
Types of medical institutions
Clinic	6 (5.8)
Hospital	3 (2.9)
General hospital	29 (28.2)
University hospital	65 (63.1)
Number of radiologists
1	15 (14.6)
2–8	30 (29.1)
9–16	28 (27.2)
≥ 17	30 (29.1)
Genitourinary radiologist
Absence	62 (60.2)
Presence	41 (39.8)
Number of machines per institution
1	74 (87.1)
2	5 (5.9)
3	5 (5.9)
4	1 (1.1)
Vendor
Philips healthcare	45 (43.7)
Siemens healthineers	38 (36.9)
GE healthcare	13 (12.6)
Canon medical systems	7 (6.8)
Magnetic field strength
1.5T	31 (30.1)
3.0T	72 (69.9)
Contrast-enhancement
No contrast-enhancement	10 (9.7)
Dynamic contrast-enhancement	53 (51.5)
Multiphase contrast-enhancement	28 (27.2)
Single phase contrast-enhancement	12 (11.7)

Table 2.

Differences in Proportion of MRIs Obtaining Essential Sequences

	Magnetic Strength			University Hospital			GU Radiologist
	3.0T (n = 72)	1.5T (n = 31)	p-Value	Yes (n = 65)	No (n = 38)	p-Value	Presence (n = 41)	Absence (n = 62)	p-Value
T2WI, three plane	68 (94.4)	29 (93.5)	1.000	62 (95.4)	35 (92.1)	0.667	39 (95.1)	58 (93.5)	1.000
DWI	71 (98.6)	20 (64.5)	< 0.001	65 (100)	26 (68.4)	< 0.001	41 (100.0)	50 (80.6)	0.003
DCEI	42 (58.3)	11 (35.5)	0.052	36 (55.4)	17 (44.7)	0.315	27 (65.9)	26 (41.9)	0.026

Data is presented as number (percentage).

DCEI = dynamic contrast-enhanced imaging, DWI = diffusion-weighted imaging, GU = genitourinary, MRI = magnetic resonance imaging, T2WI = T2-weighted imaging

Table 3.

Differences in Adherence Rate to PI-RADS v2 according to Magnetic Strength of MRI Machines

Parameters	Recommendation	3.0T (n = 72)	1.5T (n = 31)	p-Value
T2WI
Thickness	3 mm	56 (77.8)	20 (64.5)	0.221
Interslice gap	No gap	67 (93.1)	30 (96.8)	0.665
FOV (frequency)	12–20 cm	56 (77.8)	20 (64.5)	0.221
FOV (phase)	12–20 cm	58 (80.6)	21 (67.7)	0.204
In plane resolution (frequency)	≤ 0.4 mm	63 (87.5)	30 (96.8)	0.275
In plane resolution (phase)	≤ 0.7 mm	51 (70.8)	6 (19.4)	< 0.001
Diffusion-weighted imaging
Location of slice	Match or similar to T2W	41 (58.6)	5 (25.0)	0.011
TR	≥ 3000 msec	66 (94.3)	17 (85.0)	0.181
TE	≤ 90 msec	61 (87.1)	16 (80.0)	0.475
Thickness	≤ 4 mm	64 (91.4)	16 (80.0)	0.220
Thickness Interslice gap	≤ 4 mm No gap	64 (91.4) 32 (45.7)	16 (80.0) 5 (25.0)	0.220 0.125
Interslice gap FOV (frequency)	No gap 16–22 cm	32 (45.7) 50 (71.4)	5 (25.0) 4 (20.0)	0.125 < 0.001
FOV (phase)	16–22 cm	51 (72.9)	5 (25.0)	< 0.001
In plane resolution (frequency)	≤ 2.5 mm	67 (95.7)	16 (80.0)	0.041
In plane resolution (phase)	≤ 2.5 mm	66 (94.3)	14 (70.0)	0.007
High b-value	800–1000 sec/mm²	64 (91.4)	15 (75.0)	0.062
Additional high b-value	≥ 1400 sec/mm²	6 (8.6)	0 (0)	0.331
Low b-value	50–100 sec/mm²	27 (38.6)	7 (35.0)	1.000
Dynamic contrast-enhanced imaging
Location of slice	Match or similar to T2W	13 (31.0)	6 (54.5)	0.173
TR	< 100 msec	42 (100)	11 (100)	–
TR TE	< 100 msec < 5 msec	42 (100) 38 (90.5)	11 (100) 4 (36.4)	– 0.001
Thickness	3 mm	37 (88.1)	3 (27.3)	< 0.001
Interslice gap	No gap	14 (33.3)	6 (54.5)	0.296
In plane resolution	≤ 2 mm × ≤ 2 mm	42 (100)	11 (100)	–

Data is presented as number (percentage). FOV = field of view, MRI = magnetic resonance imaging, PI-RADS v2 = Prostate Imaging-Reporting and Data System version 2, TE = echo time, TR = repetition time, T2WI = T2-weighted imaging

Table 4.

Differences in Adherence Rate to PI-RADS v2 between University and Non-University Hospital

Parameters	Recommendation	University Hospital (n = 65)	Non-University Hospital (n = 38)	p-Value
T2WI
Thickness	3 mm	48 (73.8)	28 (73.7)	1.000
Thickness Interslice gap	3 mm No gap	48 (73.8) 60 (92.3)	28 (73.7) 37 (97.4)	1.000 0.409
FOV (frequency)	12–20 cm	51 (78.5)	25 (65.8)	0.171
FOV (phase)	12–20 cm	54 (83.1)	25 (65.8)	0.056
In plane resolution (frequency)	≤ 0.4 mm	58 (89.2)	35 (92.1)	0.742
In plane resolution (phase)	≤ 0.7 mm	45 (69.2)	12 (31.6)	< 0.001
Diffusion-weighted imaging
Location of slice	Match or similar to T2WI	36 (56.3)	10 (38.5)	0.164
TR	≥ 3000 msec	59 (92.2)	24 (92.3)	1.000
TE	≤ 90 msec	56 (87.5)	21 (80.8)	0.510
^Thickness	≤ 4 mm	57 (89.1)	23 (88.5)	1.000
Interslice gap	No gap	28 (42.2)	10 (38.5)	0.816
FOV (frequency)	16–22 cm	43 (67.2)	11 (42.3)	0.035
FOV (phase)	16–22 cm	44 (68.8)	12 (46.2)	0.057
In plane resolution (frequency)	≤ 2.5 mm	61 (95.3)	22 (84.6)	0.186
In plane resolution (phase)	≤ 2.5 mm	59 (92.2)	21 (80.8)	0.145
High b-value	800–1000 sec/mm²	59 (92.2)	20 (76.9)	0.072
Additiaonl high b-value	≥ 1400 sec/mm²	5 (7.8)	1 (3.8)	0.668
Low b-value	50–100 sec/mm²	24 (37.5)	10 (38.5)	1.000
Dynamic contrast-enhanced imaging
Location of slice	Match or similar to T2WI	10 (27.8)	9 (2.9)	0.124
TR	< 100 msec	36 (100)	17 (100)	–
TE	< 5 msec	32 (88.9)	10 (58.8)	0.025
^Thickness	3 mm	30 (83.3)	10 (58.8)	0.086
Interslice gap	No gap	12 (33.3)	8 (47.1)	0.375
Interslice gap^In plane resolution	No gap ≤ 2 mm × ≤ 2 mm	12 (33.3) 36 (100)	8 (47.1) 17 (100)	0.375 −

Data is presented as number (percentage). FOV = field of view, PI-RADS v2 = Prostate Imaging-Reporting and Data System version 2, TE = echo time, TR = repetition time, T2WI = T2-weighted imaging

Table 5.

Differences in Adherence Rate to PI-RADS v2 according to whether GU Radiologist Is Present or Absent

Parameters	Recommendation	Presence (n = 41)	Absence (n = 62)	p-Value
T2WI
Thickness	3 mm	32 (78.0)	44 (71.0)	0.497
Interslice gap	No gap	39 (95.1)	58 (93.5)	1.000
FOV (frequency)	12–20 cm	35 (85.4)	41 (66.1)	0.039
FOV (phase)	12–20 cm	35 (85.4)	44 (71.0)	0.102
In plane resolution (frequency)	≤ 0.4 mm	36 (87.8)	57 (91.9)	0.514
In plane resolution (phase)	≤ 0.7 mm	29 (70.7)	28 (45.2)	0.015
Diffusion-weighted imaging
Location of slice	Match or similar to T2WI	27 (67.5)	19 (38.0)	0.006
TR	≥ 3000 msec	36 (90.0)	47 (94.0)	0.695
TE	≤ 90 msec	37 (92.5)	40 (80.0)	0.113
Thickness	≤ 4 mm	36 (90.0)	44 (88.0)	1.000
Thickness Interslice gap	≤ 4 mm No gap	36 (90.0) 21 (52.5)	44 (88.0) 16 (32.0)	1.000 0.056
Interslice gap FOV (frequency)	No gap 16–22 cm	21 (52.5) 31 (77.5)	16 (32.0) 23 (46.0)	0.056 0.003
FOV (phase)	16–22 cm	31 (77.5)	25 (50.0)	0.009
In plane resolution (frequency)	≤ 2.5 mm	39 (97.5)	44 (88.0)	0.127
In plane resolution (phase)	≤ 2.5 mm	38 (95.0)	42 (84.0)	0.175
High b-value	800–1000 sec/mm²	3 (7.5)	3 (6.0)	1.000
Additional high b-value	≥ 1400 sec/mm²	³5 (87.5)	44 (88.0)	1.000
Low b-value	50–100 sec/mm²	21 (52.5)	13 (26.0)	0.016
Dynamic contrast-enhanced imaging
Location of slice	Match or similar to T2WI	10 (37.0)	9 (34.6)	1.000
TR	< 100 msec	27 (100)	26 (100)	–
TE	< 5 msec	25 (92.6)	17 (65.4)	0.019
Thickness	3 mm	24 (88.9)	16 (61.5)	0.028
Interslice gap	No gap	7 (25.9)	13 (50.0)	0.093
In plane resolution	≤ 2 mm × ≤ 2 mm	27 (100)	26 (100)	–

Data is presented as number (percentage). FOV = field of view, GU = genitourinary, PI-RADS v2 = Prostate Imaging-Reporting and Data System version 2, TE = echo time, TR = repetition time, T2WI = T2-weighted imaging

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