Clinical Scorecard: Fundamentals of ESR: Implementing Appropriate Scoring Systems in Prostate MRI—Guidelines from ESUR
At a Glance
Category
Detail
Condition
Prostate cancer (PCa) and related clinical scenarios
Key Mechanisms
Use of standardized MRI scoring systems (PI-QUAL, PI-RADS v2.1, PRECISE, PI-RR) to assess image quality, detect clinically significant cancer, monitor active surveillance, and evaluate local recurrence
Target Population
Men with clinical suspicion of prostate cancer, patients under active surveillance, and post-treatment patients
Care Setting
Radiology departments performing prostate MRI in diagnostic and follow-up settings
PI-RADS v2.1 is the recommended scoring system for detecting and localizing clinically significant prostate cancer in biopsy-naïve men.
PRECISE and PI-RR scores are used respectively for monitoring radiological changes during active surveillance and assessing local recurrence after curative treatments.
Guideline-Based Recommendations
Diagnosis
Use prostate MRI as a triage test before biopsy in men with clinical suspicion of prostate cancer.
Adhere strictly to PI-RADS v2.1 recommendations for acquisition, interpretation, and reporting of prostate MRI in treatment-naïve patients.
Limit description to no more than four lesions per PI-RADS v2.1 and report them with standardized diagrams and measurements.
Management
Apply PRECISE scoring to predict clinically significant radiological changes during active surveillance.
Use PI-RR scoring to estimate the likelihood of local recurrence after primary whole-gland treatments such as radical surgery or radiotherapy.
Monitoring & Follow-up
Employ PRECISE assessments for serial imaging evaluation in active surveillance protocols.
Utilize consistent scoring systems to facilitate effective communication and standardized follow-up.
Risks
Avoid incorrect application of PI-RADS scoring in post-treatment settings to prevent misinterpretation.
Recognize limitations and current evidence gaps regarding the role of dynamic contrast-enhanced imaging and consider biparametric MRI cautiously.
Patient & Prescribing Data
Men suspected of prostate cancer, patients undergoing active surveillance, and post-treatment patients
Prostate MRI guided by appropriate scoring systems reduces unnecessary biopsies, improves detection of clinically significant cancer, and supports tailored patient management.
Clinical Best Practices
Perform image quality assessment using the PI-QUAL score before interpreting prostate MRI.
Use PI-RADS v2.1 for lesion detection and localization in biopsy-naïve men, considering zone-specific dominant sequences (DWI for peripheral zone, T2W for transition zone).
Report lesions with standardized graphical diagrams and explicit size measurements to enhance multidisciplinary communication.
Consider biparametric MRI protocols only in biopsy-naïve patients with high-quality imaging and expert interpretation.
Apply PRECISE and PI-RR scores appropriately according to clinical context to monitor disease progression and recurrence.
by Andrea Ponsiglione, Giorgio Brembilla, Renato Cuocolo, Patricia Gutierrez, Ana Sofia Moreira, Martina Pecoraro, Jeries Zawaideh, Jelle Barentsz, Francesco Giganti, Anwar R. Padhani, Valeria Panebianco, Philippe Puech, Geert Villeirs
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