Improving prostate MRI diagnosis

A review of PI-QUAL: standardising prostate MRI image quality for improved diagnostic accuracy

Published on June 1, 2026

Improving prostate MRI diagnosis

Multiparametric magnetic resonance imaging (mpMRI) plays a significant role in the detection, characterisation and management of prostate cancer (PCa). Its diagnostic accuracy, however, depends on consistent high-quality imaging. 


Variability in scanner protocols, patient-related artefacts and operator expertise can compromise reliability, leading to inaccurate staging and suboptimal biopsy targeting. 


To address these challenges, the Prostate Imaging Quality (PI-QUAL) scoring system was introduced as an objective, standardised framework for assessing prostate MRI quality. This review aims to strengthen awareness of PI-QUAL by outlining its rationale, scoring criteria and key updates in the revised version 2. 


Practical examples are included to demonstrate how PI-QUAL can be applied in clinical practice. Wider adoption of PI-QUAL has the potential to standardise prostate MRI image quality, enhance diagnostic confidence and support more consistent, evidence-based management of prostate cancer, ultimately improving patient outcomes.


Background


The integration of pre-biopsy MRI into the prostate...

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