Improving prostate MRI quality and its diagnostic impact: a prospective quality improvement initiative.

PURPOSE: High-quality imaging is critical for accurate prostate cancer assessment using MRI. This study describes a quality improvement (QI) initiative for prostate MRI and evaluates the impact of image quality on diagnostic performance.

METHODS

In this prospective study, 1328 patients underwent prostate MRI between March 2023 and March 2024. The QI initiative focused on patient preparation, protocol standardization, technologist education, and quality control. Image quality was prospectively scored using the Prostate Imaging Quality (PI-QUAL) system. Diagnostic performance was assessed by comparing the positive predictive value (PPV) of PI-RADS ≥ 3 lesions before and after the intervention and between exams with optimal (PI-QUAL ≥ 4) and suboptimal quality. Fisher's exact test was used for comparisons. Clinically significant prostate cancer (csPCa) was defined as Gleason Grade Group ≥ 2.

RESULTS

The proportion of PI-QUAL ≥ 4 exams increased from 67 to 84% after the intervention (p < 0.001). The PPV for any prostate cancer improved from 65 to 78% (p = 0.03), though the increase for csPCa (from 42 to 46%) was not statistically significant (p = 0.5). No significant difference in PPV was observed between optimal and suboptimal exams for any cancer (76% vs. 77%, p = 0.9) or csPCa (45% vs. 48%, p = 0.7).

CONCLUSION

The QI initiative significantly improved image quality and overall cancer detection rates. However, the association between image quality and csPCa detection was not statistically significant, possibly due to greater improvements in T2-weighted images vs. diffusion weighted images and high reader expertise.