PI-QUAL version 2: an update of a standardised scoring system for the assessment of image quality of prostate MRI
By
Maarten de Rooij
Clare Allen
Jasper J. Twilt
Linda C. P. Thijssen
Patrick Asbach
Tristan Barrett
Giorgio Brembilla
Mark Emberton
Rajan T. Gupta
Masoom A. Haider
Veeru Kasivisvanathan
Vibeke Løgager
Caroline M. Moore
Anwar R. Padhani
Valeria Panebianco
Philippe Puech
Andrei S. Purysko
Raphaële Renard-Penna
Jonathan Richenberg
Georg Salomon
Francesco Sanguedolce
Ivo G. Schoots
Harriet C. Thöny
Baris Turkbey
Geert Villeirs
Jochen Walz
Jelle Barentsz
Francesco Giganti
May 24, 2024
Clinical Scorecard: Updated Version of PI-QUAL: A Revised Standardized Scoring System for Evaluating Prostate MRI Image Quality
At a Glance
Category Detail
Condition Prostate cancer Key Mechanisms Multiparametric MRI (mpMRI) image quality assessment influencing cancer detection and management Target Population Patients with known or suspected prostate cancer undergoing prostate MRI Care Setting Radiology and urology clinical settings performing prostate MRI
Key Highlights
PI-QUAL v2 provides an updated, standardized 5-point scoring system for prostate MRI image quality applicable with or without intravenous contrast. High-quality prostate MRI images are essential for accurate cancer detection, staging, and biopsy planning. Common artefacts affecting image quality include motion, susceptibility (e.g., rectal gas, metal implants), and chemical shift artefacts. Guideline-Based Recommendations
Diagnosis
Use multiparametric MRI before biopsy to reduce overdiagnosis and unnecessary biopsies. Apply PI-QUAL v2 scoring to objectively assess prostate MRI image quality across clinical scenarios. Management
Ensure adherence to PI-RADS v2.1 technical standards including field strength, b values for DWI, and temporal resolution for DCE sequences. Prefer phased-array surface coils over endorectal coils for signal reception. Monitoring & Follow-up
Regularly evaluate image quality using PI-QUAL v2 to maintain diagnostic accuracy and reproducibility. Monitor for artefacts such as motion, susceptibility, and chemical shift that may impair image interpretation. Risks
Suboptimal image quality can lead to under- or overcalling lesions, indeterminate findings, and inappropriate management decisions. Artefacts from patient motion, rectal gas, or metal implants may distort images and reduce diagnostic confidence. Patient & Prescribing Data
Patients undergoing prostate MRI for cancer detection, staging, screening, or active surveillance
High-quality MRI images assessed by PI-QUAL v2 improve detection of clinically significant prostate cancer and guide biopsy and treatment planning.
Clinical Best Practices
Adhere strictly to PI-RADS v2.1 technical parameters to optimize image acquisition. Use PI-QUAL v2 scoring to standardize and objectively assess image quality in all prostate MRI examinations. Address and minimize common artefacts through patient preparation and optimized scanning protocols. Incorporate image quality assessment into routine clinical workflow to enhance diagnostic accuracy and patient outcomes. References
