Group Advancing Prostate MRI Guidelines

Advances in MRI technology hold great promise for more accurate diagnosis and treatment of prostate cancers. But the advent of new, complex technologies comes with a need to standardize the technical requirements involved in performing these exams and reporting them out.

“I think there is a widespread recognition that the approach to managing and diagnosing this disease needs to change, because it hasn’t been as good, efficient and cost-effective as it should be,” said Jeffrey Weinreb, MD, professor of diagnostic radiology at Yale School of Medicine.

Now, the American College of Radiology (ACR) along with AdMeTech Foundation and the European Society of Urogenital Radiologists (ESUR) have joined together to develop standards for the Magnetic Resonance Prostate Imaging Reporting and Data System (MR PI-RADS), modeled after the Breast Imaging Reporting and Data System (BI-RADS).

A working group has been set up, co-chaired by Weinreb, who is also director of medical imaging and chief of body imaging and magnetic resonance imaging at Yale, and Jelle Barentsz, MD, a professor of radiology at the department of radiology, Radboud University Medical Center in Nijmegen, the Netherlands. This group will build upon prostate MRI guidelines developed by the ESUR and the work already done by the AdMeTech Foundation's International Prostate MRI Working Group.

One of the areas the working group will be looking at is the standardization of MRI acquisition approaches and protocols. The way in which prostate MRI has been performed over the years has been “variable,” said Weinreb, “in that everyone has done it differently. It’s only recently that experts have reached a consensus on how this exam should be performed and what the technical requirements for performing it are.”

The working group will also work on standardizing the lexicon and terminology used to report out prostate MR.

Another member of the working group, Clare Tempany, MD, Ferenc Jolesz Chair of Radiology Research, Brigham and Women's Hospital and professor of radiology Harvard Medical School Department of Radiology, said her interest in this project has been informed by her experience with multi-center trials such as ACRIN trial for MR spectroscopy, which she said demonstrated a need for the standardization of the lexicon and terminology used to report out prostate MR.

“The interpretive questions are very challenging,” said Tempany, who pointed out that that prostate MR has become so advanced that it presents a “dizzying array of data” for interpretation.

“How does the radiologist who doesn’t do 100 prostate MRs a day assimilate the data,” she asked. “How do they present that report and what are the requirements of the report necessary to meet the needs of the referring physician? What do the surgeons radiation oncologists, medical oncologists, and patients themselves want in these reports, and what should we medically be required to report?”

The variations and inconsistencies in reports was a common theme in complaints Tempany heard in meetings with referring physicians, “and became a major motivation for what we are doing,” she said.

“It’s essentially a tool to enhance communication between radiologists performing the exam, and the physician,” said Weinreb. “It will facilitate the quality of clinical care and research, and hopefully in the end result in fewer unnecessary biopsies, more information from biopsies and better treatment for patients.”

Weinreb said the plan is for MR PI-RADS to be completed and ready for distribution by the beginning of 2013, a quick turnaround when compared to the amount of time it took to develop BI-RADS and the time it is taking to complete another ACR-sponsored program, the Liver Imaging Reporting and Data System (LI-RADS). Once completed, MR PI-RADS will be available either electronically or in hard copy format through the ACR.

“We’re optimistic we can do this quickly because this [prostate MR] is now a mature technology and among the experts there is already a good consensus on how to do and report these exams,” said Weinreb. “And the European group has already formed a good foundation on which we can build.”