Factors influencing variability in interpretation of prostate MRI

Motivation: Multiparametric MRI is crucial for prostate cancer detection, but false positives and variability in interpretation remain challenges. Goal(s): Investigate factors influencing the PPV of PI-RADSv2 in prostate mpMRI interpretation. Approach: Evaluated 1,388 PI-RADS ≥3 lesions from 958 individuals interpreted by 22 fellowship-trained radiologists. Analyzed clinical factors, imaging characteristics, and radiologist experience impacting PPV, including ADC value, PSA density, lesion size, and case volume. Results: ADC values and PSA density significantly influenced PPV, while radiologist experience and lesion size did not. No significant PPV variability was observed across radiologists. Combining ADC value and PSA density with PI-RADS improved classification accuracy. Impact: Incorporating ADC value and PSA density into PI-RADS scoring could improve diagnostic accuracy of prostate mpMRI interpretation, ultimately enhancing patient care.