DOI:10.1001/jamaoncol.2025.1594
-MRI-screening reduces unnecessary Bx.
-Aggressive PCa detection increase with MRI.
-Overdiagnosis of insign PCa drops
-Benefit/harm improves with each screening round.
-MRI sustains efficiency+safety over repeated rounds.
-Fewer Bx’s in subsequent screening rounds.
3 Papers about PI-QUAL v2
(Prostate MR Image Quality Assessment)
The original paper (1st image) is open access. Please find images from the other 2: Eur Rad and Eur Urol
Original
de Rooij et al. European Radiology (2024) 34:7068–7079
doi.org/10.1007/s003...
#QualityMatters #Prostate #ProstateMRI
Image Quality in Radiology
Giorgio Bembrilla @ECR2025
- Always do a PI-QUAL check in a prostate MRI
- Adhere to PI-RADS technical standards
Voor mijn podcast #TegenHetLicht over #ProstaatMRI luister: open.spotify.com/episode/5sxs...
Biopsy result:
65 yrs, PSA 21, PSAD 0.54, cT2 --> PI-RADS 5, mT3a, DCE ++
Pathology:
- GS: 4+3, with invasive cribriform growth
Answer to yesterday's case:
- PI-RADS 5: internal invasive growth, >15 mm
Score: T2W/DWI/DCE: 5/5/+ PI-RADS 5
- MRI stage T3a (mT3a): bulge, broad contact, invasive
- Value of DCE: early enhancement, arterial curve-like
high probability of Gleason 4 component
65 yrs, PSA 21, PSAD 0.54, cT2
PI-RADS assessment?
MRI stage (mT?)
Value of DCE?
• PI-QUALv2 standardized system for prostate MRI quality
• High quality is essential: 30% mp and 50% of bpMR are not adequate in NL
• Certified radiologists key for PI-QUALv2 standards
• Implementing PI-QUALv2 in research (papers) and clinics is crucial
rdcu.be/d8NBe
www.linkedin.com/posts/jelle-...
Important Update on Prostate MRI Quality!
Push for higher-quality prostate MRI is essential for accurate diagnosis and patient care!
✅ Include PI-QUAL in all reports
✅ Quality Control should in the guidelines
✅ Scientific papers should mention PI-QUAL
83 yr
PSA 13,2
PSAD 0,29
DRE T2R
Answer:
PI-RADS 5 in d.d.: granulomatous prostatitis (GP)
Always biopsy to exclude sign-PCa
T2W: Patchy organized chaos + some erased charcoal
DWI: Patchy areas of low ADC (minimal 467)
DCE: areas of central lack of enhancement
Diagnosis: GP + central necrosis
Diagnosis?
Male 83 yrs; PSA 13,2; PSAD 0,29; DRE: T2R
What are your thoughts?
- significant cancer?
- something else?
- must a biopsy be performed?
It’s inverted!
Sadly, many of us exhibit high Ego, high Euro, and low Empathy.
Let’s strive to restore the pyramid to its proper orientation
By doing so, we’ll create a far better world for all.
The Three E’s:
- Ego
- Euro
- Empathy
(Human = E3)
We’re all unique due to our varying proportions of these traits.
What’s wrong with this pyramid?
The experts are right for PSA based screening, but wrong for risk adapted PSA-MRI screening.
Evidence is piling up that risk adapted-MRI screening significantly decreases overdiagnosis and has at least equal detection of significant PCa.
Furthermore, this screening approach is cost-effective.
Summary of recent literature on AI in PCa:
• AI improves less experienced radiologist
• AI models reduce unnecessary biopsies by better identifying low-risk PCa.
• Challenges are standardization, and clinical integration of AI
• Prospective clinical validation of AI is needed
Our 3-day PI-RADS workshop in South Africa was a big success! Passionate participants learned to use prostate MRI.
We’re proud to have trained half of all radiologists here. Big thank you to everyone who made this possible!
Bring this course to your region, just contact me:
j.barentsz@andros.nl