PI-QUAL Assistant PI-QUAL quality assessment icon

PI-QUAL v2 image-quality assessment for prostate MRI with or without IV contrast. Overall PI-QUAL v2 scores are 1 inadequate, 2 acceptable, and 3 optimal.

PI-QUAL v2, 2024 scoring sheet
PI-QUAL incomplete. Choose a protocol to begin.

Choose the protocol first

Choose the protocol used for this examination. The applicable questions remain visible so answers can be reviewed and revised at any time.

T2-WI

Answer the technical prerequisite first. If it is not met, the T2-WI formal sequence points are 0/4.

0/5 complete

Technical prerequisite

T2-WI slice thickness: 3 mm.

Required before scoring the four T2-WI image-quality criteria.

Image-quality criteria

T2-WI has sufficient signal-to-noise ratio.

T2-WI criterion 1 of 4.

Required prostate and periprostatic structures are clearly delineated on T2-WI.

T2-WI criterion 2 of 4.

T2-WI is free of artifacts that impair interpretation.

T2-WI criterion 3 of 4.

Sagittal or coronal T2-WI sequence is adequate.

T2-WI criterion 4 of 4.

DWI/ADC

All DWI/ADC prerequisites must be met before the four DWI/ADC image-quality criteria are scored.

0/7 complete

Technical prerequisites

DWI slice thickness: 4 mm or less.

Technical prerequisite 1 of 3.

High b-value DWI sequence is available: b value 1400 s/mm2 or greater.

Technical prerequisite 2 of 3.

ADC map was generated

Calculated using at least two b-values ≤1,000 s/mm².

Image-quality criteria

High b-value images have sufficient contrast and signal-to-noise ratio.

DWI/ADC criterion 1 of 4.

ADC shows sufficient contrast between TZ/BPH and PZ.

DWI/ADC criterion 2 of 4.

DWI/ADC is free of artifacts that impair interpretation.

DWI/ADC criterion 3 of 4.

DWI/ADC anatomically matches the T2-WI sequence.

DWI/ADC criterion 4 of 4.

How PI-QUAL v2 is calculated

T2-WI and DWI/ADC are each scored from their four sequence-specific criteria after the required technical prerequisites are met. DCE is assessed only when contrast was administered and is DCE plus only when both DCE quality criteria are met.

  • MRI without IV contrast: PI-QUAL 1 if T2-WI or DWI is 2/4 or lower, PI-QUAL 2 if both are at least 3/4, and PI-QUAL 3 only when both are 4/4.
  • MRI with DCE: DCE can downgrade a T2-WI 4/4 plus DWI 4/4 examination to PI-QUAL 2 if DCE is minus.
  • MRI with DCE: DCE plus can upgrade to PI-QUAL 2 when one dominant sequence is 4/4 and the other is 2/4 or lower.
  • No sum score: Sequence points are not added into an overall total. The final overall score is derived from the published decision table.
Source: de Rooij M, Allen C, Twilt JJ, et al. PI-QUAL version 2: an update of a standardised scoring system for the assessment of image quality of prostate MRI. European Radiology. 2024;34:7068-7079. doi:10.1007/s00330-024-10795-4.

PI-QUAL v2 FAQ

What does an overall PI-QUAL v2 score of 2 mean?
Overall PI-QUAL v2 score 2 means acceptable image quality. It is not the same as a markedly limited overall score. It indicates that the examination is usable but not optimal, and the limiting sequence should be documented.
Are T2-WI and DWI sequence points the same as overall PI-QUAL?
No. T2-WI and DWI/ADC each have a sequence score out of 4. The overall PI-QUAL v2 score is a separate 1 to 3 category derived from the decision table.
Is DCE quality scored like T2-WI and DWI?
No. DCE is dichotomized as plus or minus. DCE plus requires both DCE image-quality criteria to be met after all DCE technical prerequisites are satisfied.
Does a low-quality scan always require repeat imaging?
No. PI-QUAL v2 should inform clinical decision-making rather than determine it by itself. The publication notes that repeat imaging is advised when the scan remains doubtful or is deemed insufficient to make a diagnosis.

Reviewed by Nick Shaheen, MD, board-certified radiologist