Cancer Detection Rate and Abnormal Interpretation Rate of Prostate MRI in Patients with Low-grade Cancer.

To evaluate the utility of cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI for patients with low-grade prostate cancer (PCa). This three-center retrospective study included patients who underwent prostate MRI from 2017 to 2021 with known low-grade PCa (Gleason score 6) without prior treatment. Patient-level highest PI-RADS score and pathological diagnosis within 1 year after MRI were used to evaluate the diagnostic performance of prostate MRI in detecting clinically significant PCa (csPCa: Gleason score ≥7). The metrics AIR, CDR, and CDR adjusted for pathological confirmation rate (aCDR) were calculated. Radiologist-level AIR-CDR plots were shown. Simulation AIR-CDR lines were created to assess the effects of different diagnostic performances of prostate MRI and the prevalence of csPCa. A total of 3207 exams were interpreted by 33 radiologists. Overall AIR, CDR, and aCDR at PI-RADS 3-5 (4-5) were 51.7% (36.5%), 22.1% (18.8%), and 30.7% (24.6%), respectively. Radiologist-level AIR and CDR at PI-RADS 3-5 (4-5) were in the 36.8-75.6% (21.9-57.5%) range and the 16.3-28.7% (10.9-26.5%) range. In the simulation, changing parameters of diagnostic performance or csPCa prevalence shifted the AIR-CDR line. We proposed CDR and AIR as performance metrics in prostate MRI and reported reference performance values in patients with known low-grade PCa. There was variability in radiologist-level AIR and CDR. Combined use of AIR and CDR could provide meaningful feedback for radiologists to improve their performance by showing relative performance to other radiologists.

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