3 Papers about PI-QUAL v2
(Prostate MR Image Quality Assessment)

The original paper (1st image) is open access. Please find images from the other 2: Eur Rad and Eur Urol

Original
de Rooij et al. European Radiology (2024) 34:7068–7079
doi.org/10.1007/s003...

#QualityMatters #Prostate #ProstateMRI

Image Quality in Radiology

Giorgio Bembrilla @ECR2025

- Always do a PI-QUAL check in a prostate MRI
- Adhere to PI-RADS technical standards

Answer to yesterday's case:

- PI-RADS 5: internal invasive growth, >15 mm
Score: T2W/DWI/DCE: 5/5/+  PI-RADS 5

- MRI stage T3a (mT3a): bulge, broad contact, invasive

- Value of DCE: early enhancement, arterial curve-like
 high probability of Gleason 4 component

65 yrs, PSA 21, PSAD 0.54, cT2

PI-RADS assessment?
MRI stage (mT?)
Value of DCE?

83 yr
PSA 13,2
PSAD 0,29
DRE T2R

Answer:
PI-RADS 5 in d.d.: granulomatous prostatitis (GP)
Always biopsy to exclude sign-PCa

T2W: Patchy organized chaos + some erased charcoal
DWI: Patchy areas of low ADC (minimal 467)
DCE: areas of central lack of enhancement

Diagnosis: GP + central necrosis

Diagnosis?

Male 83 yrs; PSA 13,2; PSAD 0,29; DRE: T2R

What are your thoughts?

- significant cancer?
- something else?
- must a biopsy be performed?

It’s inverted!

Sadly, many of us exhibit high Ego, high Euro, and low Empathy.

Let’s strive to restore the pyramid to its proper orientation
By doing so, we’ll create a far better world for all.

The Three E’s:

- Ego
- Euro
- Empathy

(Human = E3)

We’re all unique due to our varying proportions of these traits.

What’s wrong with this pyramid?

Our 3-day PI-RADS workshop in South Africa was a big success! Passionate participants learned to use prostate MRI.
We’re proud to have trained half of all radiologists here. Big thank you to everyone who made this possible!

Bring this course to your region, just contact me:
j.barentsz@andros.nl