BI-RADS, C-RADS, GI-RADS, LI-RADS, Lu-RADS, TI-RADS, PI-RADS. The long and winding road of standardization

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1 BI-RADS, C-RADS, GI-RADS, LI-RADS, Lu-RADS, TI-RADS, PI-RADS. The long and winding road of standardization Poster No.: C-1928 Congress: ECR 2014 Type: Educational Exhibit Authors: S. Huicochea Castellanos, A. Gonzalez-Aguirre, M. Chapa Ibargüengoitia, S. E. Vazquez, J. Vazquez Lamadrid; Mexico, DF/ MX Keywords: Management, Oncology, CT, MR, Ultrasound, Screening, Cancer DOI: /ecr2014/C-1928 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 21

2 Learning objectives The purpose of this exhibit is: 1.- Review the different classifications created to standardize reporting and data collection; 2.- Ilustrate the imaging findings of the proposed reporting systems; 3.- Discuss the advantages of standardize reports. Page 2 of 21

3 Background The Breast Imaging Reporting and Data System (BI-RADS) is the only validated scoring system that is currently in use in clinical practice. Its utility has been demostrated in research, education, and in quality improvement [1]. In recent years there has been developed multiple, disease oriented systems based in BI-RADS, however their utility has to be proved, effort is being done to validate this score systems and apply them to daily clinical practice. The potential benefits of standardization are to improve communication between radiologist and clinicians, reduce omission of relevant information in reports, reduce variability and error in image interpretation, facilitate outcome monitoring and provide a tool for quality assurance and research. Page 3 of 21

4 Findings and procedure details 1.- BI-RADS (Table 1, Figure 1) The Breast Imaging Reporting and Data System(BI-RADS)was developed by the American College of Radiology to serve as a guide providing standarized breast imaging terminology, a recommended reporting structure including final assessment categories with accompanying management recommendations, and a framework for data collection and auditing. Subsequent validation showed that implementation of BI-RADS reduces inter and intraobserver variability [2]. The first edition was released in 1993 for mammography findings, since then more editions have been released. In 2003 the first edition of the ultrasound and magnetic resonance imaging BIRADS atlas was published [3]. 2.- C-RADS (Table 2, Figure 2) The Working Group on Virtual Colonoscopy published in 2005 a guide to the interpretation of computed tomography (CT) colonography results: the CT Colonography Reporting and Data System, or "C-RADS." It includes a description of terms for reporting the size, morphologic features, and location of polyps and masses, a description of a reporting scheme for colonic and extracolonic lesions with management recommendations [4]. 3.- GI-RADS (Table 3, Figure 3) Amor et al. in 2009 described a reporting system called the Gynecologic Imaging Reporting and Data System (GI-RADS) for reporting findings in adnexal masses based on transvaginal sonography and providing an estimated risk of malignancy according to this classification. The proposed reporting system showed good diagnostic performance and the interobserver agreement was high [5,6]. 4.- LI-RADS (Table 4, Figure 4) In 2008, the American College of Radiology developed a system for standardized interpretation, reporting, and data collection for CT and MRI examinations in patients at risk for HCC. Version 1.0 of the resulting Liver Imaging Reporting and Data System (LIRADS) was released in 2011, the version 2013, includes a lexicon and an imaging atlas [7]. 5.- Lu-RADS (Table 5, Figure 5) Page 4 of 21

5 In the 98th Scientific Assembly and Annual Meeting of Radiological Society of North America, Manos et al. introduced the Lung Reporting and Data System (LuRADS) for CT- screening detected lung nodules to guide management, facilitate communication and provide a framework of data collection and analysis [8]. 6.- TI-RADS (Table 6, Figure 6) There has been suggested several thyroid imaging reporting and data systems since Among these systems there is no consensus concerning the exact format and style for reporting the results of thyroid ultrasound [9-12]. Horvath et alestablished 6 categories and called it Thyroid Imaging Reporting and Data System (TI-RADS) based on 10 sonographic patterns. They suggested that patients with TI-RADS 4 and 5 nodules must be biopsied [9].Interobserver agreement with this classification has been reported fair to moderate, with a high negative predicitive value [13,14]. 7.- PI-RADS (Table 7, Figure 7) The European Society of Urogenital Radiology (ESUR) released in 2012 a standardized system for prostate magnetic resonance imaging (MRI) interpretation and reporting of results: Prostate Imaging Reporting and Data System(PI-RADS). In this scoring system every parameter: T2WI, DWI, DCE-MRI and MRSI (optional) is scored on a five-point scale, Additionally, each lesion is given an overall score, to predict its chance of being a clinically significant cancer, the scoring should include as a minimum requirement division of the prostate 16 regions, as an optimal requirement into 27 regions. [15] It has been reported good to moderate inter-reader agreement for the PI-RADS score [16, 17]. In the study by Schimmöller et al. [16] PI-RADS showed high sensitivity and negative predictive value for biopsied lesions. Roethke et al. evaluated the PI-RADS for detection of prostate cancer in patients with magnetic resonance/transrectal ultrasound fusion-guided biopsy, they concluded the system is beneficial to indicate the likelihood of cancer and it is also valuable to identify locations to be targeted with biopsy [18]. Page 5 of 21

6 Images for this section: Table 1: Breast Imaging and Data Report System (BI-RADS) Page 6 of 21

7 Fig. 1: BI-RADS Page 7 of 21

8 Table 2: CT Colonography Reporting and Data System (C-RADS) Page 8 of 21

9 Fig. 2: C-RADS Page 9 of 21

10 Table 3: Gynecologic Imaging Reporting and Data System (GI-RADS) Fig. 3: GI-RADS Page 10 of 21

11 Table 4: Liver Imaging Reporting and Data System (LI-RADS) Page 11 of 21

12 Fig. 4: LI-RADS Page 12 of 21

13 Table 5: Thyroid Imaging Reporting and Data System (TI-RADS) Page 13 of 21

14 Fig. 5: Lu-RADS Page 14 of 21

15 Table 6: Lung Reporting and Data System (Lu-RADS) Page 15 of 21

16 Fig. 6: TI-RADS Page 16 of 21

17 Table 7: Prostate Imaging Reporting and Data System (PI-RADS) scoring system Fig. 7: Prostate cancer with Gleason score of 4+3=7 in a 81-year old man. A T2WI demonstrates homogeneous low signal intensity focus with extra-capsular extension (score 5). B ADC map demonstrates corresponding focal reduced ADC (arrow). There was no increased signal intensity on DW image using high b value (not shown) (score 4). C Maximum slope parametric perfusion map show rapid enhancement, D Type 2 enhancement curve (score 3) PI-RADS total score: 12/15 PI-RADS overall score for probability of being a significant cancer: 5 Page 17 of 21

18 Conclusion These systems provide an organized approach to image interpretation and reporting, also a framework for data collection and analysis, including quality assurance. The standardize imaging reports facilitate patient management and communication between clinicians and radiologists. Page 18 of 21

19 Personal information S. Huicochea Castellanos, Department of Radiology, INCMNSZ, Vasco de Quiroga 15, Tlalpan 14000, Mexico, DF. A. Gonzalez-Aguirre, Department of Radiology, INCMNSZ, Vasco de Quiroga 15, Tlalpan 14000, Mexico, DF. M. Chapa Ibargüengoitia, Department of Radiology, INCMNSZ, Vasco de Quiroga 15, Tlalpan 14000, Mexico City, DF. S. E. Vazquez, Department of Radiology, INCMNSZ, Vasco de Quiroga 15, Tlalpan 14000, Mexico, DF. J. Vazquez Lamadrid, Department of Radiology, INCMNSZ, Vasco de Quiroga 15, Tlalpan 14000, Mexico, DF. Page 19 of 21

20 References 1. Burnside ES, Sickles EA, Bassett LW, et al. The ACR BI-RADS experience: learning from history. J Am Coll Radiol 2009;6(12): Baker JA, Kornguth PJ, Floyd CE Jr. Breast imaging reporting and data system standardized mammography lexicon: observer variability in lesion description. AJR Am J Roentgenol 1996;166: D'Orsi CJ, Mendelson, EB, Ikeda DM, et al: Breast Imaging Reporting and Data System: ACR BI-RADS - Breast Imaging Atlas, Reston, VA, American College of Radiology, Zalis ME, Barish MA, Choi JR,et al; Working Group on Virtual Colonoscopy. CT colonography reporting and data system: a consensus proposal. Radiology Jul;236(1): Amor F, Vaccaro H, Alcázar JL, León M, Craig JM, Martinez J. Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings. J Ultrasound Med Mar;28(3): Amor F, Alcázar JL, Vaccaro H, León M, Iturra A. GI-RADS reporting system for ultrasound evaluation of adnexal masses in clinical practice: a prospective multicenter study. Ultrasound Obstet Gynecol Oct;38(4): American College of Radiology. Liver Imaging Reporting and Data System version American College of Radiology website. Safety/Resources/ LIRADS. Published March Updated Accessed November 24, Manos,D, Borgaonkar,J, Seely,J, Roberts,H, Mayo,J. Guidance for Reporting Screening CT: Introducing the Lung Reporting and Data System (LuRADS). Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; November 25- November 30, 2012 Chicago IL. rsna2012.rsna.org/search/event_display.cfm? em_id= Accessed December 3, Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009; 94(5): Park JY, Lee HJ, Jang HW, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid 2009;19(11): Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011;260(3): Page 20 of 21

21 12. Russ G, Bigorgne C, Royer B, Rouxel A, Bienvenu-Perrard M. The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid J Radiol. 2011;92(7-8): Friedrich-Rust M, Meyer G, Dauth N, et al. Interobserver Agreement of Thyroid Imaging Reporting and Data System (TIRADS) and Strain Elastography for the Assessment of Thyroid Nodules. Plos one ;8(10):e Cheng SP, Lee JJ, Lin JL, Chuang SM, Chien MN, Liu CL. Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head Neck 2013;35(4): Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines Eur Radiol 2012; 22: Schimmöller L, Quentin M, Arsov C, et al. Inter-reader agreement of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard. Eur Radiol. 2013; 23: Rosenkrantz AB, Kim S, Lim RP, et al. Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales. Radiology 2013;269(2): Roethke MC, Kuru TH, Schultze S, et al. Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla. Eur Radiol Page 21 of 21