![]() With the goal of standardizing the acquisition and reporting of prostatic mpMRI imaging examinations, the European Society of Urogenital Radiology (ESUR) developed the Prostate Imaging-Reporting and Data System (PI-RADS) in 2013 and then updated it in 2015 (PI-RADS v2) and 2019 (PI-RADS v2.1) 4. Multiparametric Magnetic Resonance Imaging (mpMRI) has gradually gained in importance for both a timely diagnosis and an accurate characterization of PCa lesions, which play a key-role in all PCa patient management steps 2, 3. Prostate cancer (PCa) is one of the most commonly diagnosed malignant neoplasms among men 1. Radiomics models showed high diagnostic efficacy in classify PI-RADS 3 and upPI-RADS 4 lesions, outperforming PI-RADS v2.1 performance. ![]() Our results support the significant role of T2 and ADC radiomic features for PCa detection in lesions scored as PI-RADS 3 and upPI-RADS 4. For PI-RADS 3 stratification, second order model showed higher performances (Area Under the Receiver Operating Characteristic Curve-AUC- = 80%), while for upPI-RADS 4 stratification, first order model showed higher performances respect to superior order models (AUC = 89%). Among 293 radiomic features, the top selected features derived from T2 and ADC. 41 PI-RADS 3 and 32 upPI-RADS 4 lesions were analyzed. Predictive models were constructed for PCa detection in PI-RADS 3 and upPI-RADS 4 lesions using at each step an imbalance-adjusted bootstrap resampling (IABR) on 1000 samples. Feature selection was performed using Wilcoxon-ranksum test and Minimum Redundancy Maximum Relevance (mRMR). Radiomic features were extracted from T2-weighted MRI (T2), Apparent diffusion Coefficient (ADC) map and DCE-MRI subtracted images using PyRadiomics. PI-RADS 3 and PI-RADS 4 lesions were re-scored according to the PI-RADS v2.1 before and after DCE-MRI evaluation. Biopsy results were used as gold standard. Multiparametric MRI (mpMRI) data of patients who underwent prostatic mpMRI between April 2013 and September 2018 were retrospectively evaluated. ![]() We aimed at investigating the usefulness of radiomics for detection of PCa lesions (Gleason Score ≥ 6) in PI-RADS 3 lesions and in peripheral PI-RADS 3 upgraded to PI-RADS 4 lesions (upPI-RADS 4). Despite the key-role of the Prostate Imaging and Reporting and Data System (PI-RADS) in the diagnosis and characterization of prostate cancer (PCa), this system remains to be affected by several limitations, primarily associated with the interpretation of equivocal PI-RADS 3 lesions and with the debated role of Dynamic Contrast Enhanced-Magnetic Resonance Imaging (DCE-MRI), which is only used to upgrade peripheral PI-RADS category 3 lesions to PI-RADS category 4 if enhancement is focal. ![]()
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