{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:06:45Z","timestamp":1790068005824,"version":"4.0.1"},"reference-count":37,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction: Multiparametric MRI (mpMRI) interpreted using Prostate Imaging Reporting and Data System (PI-RADS) v2.1 is central to prostate cancer (PCa) assessment, but inter-reader variability remains a concern. This study evaluated inter-reader agreement, diagnostic performance, the utility of prostate-specific antigen density (PSA-D), and imaging predictors of biopsy-detected PCa. Methods: We conducted a retrospective study of 102 patients who underwent prostate mpMRI followed by transrectal ultrasound (TRUS)-guided biopsy. Three experienced radiologists independently scored examinations using PI-RADS v2.1. Agreement was assessed using intraclass correlation coefficients (ICC) and weighted \u03ba statistics. Diagnostic performance was evaluated at a PI-RADS \u22653 threshold. Patients were stratified by PSA-D, and logistic regression identified imaging predictors of biopsy outcomes. Reader confidence was scored on a 10-point scale. Results: PCa was detected in 60\/102 patients (58.8%) and csPCa in 46\/102 (45.1%). Overall agreement was moderate to good (ICC, 0.749; \u03ba, 0.748), with higher agreement in the transitional compared to the peripheral zone (ICC, 0.822 vs. 0.662). Averaged PI-RADS scores yielded 100% sensitivity for both PCa and csPCa, with specificities of 47.6% and 35.7%, respectively. PSA-D stratification showed higher PPVs at PSA-D \u22650.15 ng\/mL2, while sensitivity and NPV were 100% in both strata; specificity remained relatively low. Reader confidence correlated with PI-RADS category and interpretation accuracy. In multivariable patient-level analyses, DWI hyperintensity was independently associated with biopsy-detected PCa and csPCa. Conclusions: PI-RADS v2.1 showed moderate to good inter-reader agreement and high sensitivity but modest specificity for PCa and csPCa. Agreement was higher for transitional-zone lesions, and DWI hyperintensity was independently associated with PCa and csPCa. PSA-D subgroup estimates were imprecise, and its incremental value requires confirmation in larger prospective cohorts.<\/jats:p>","DOI":"10.3390\/diagnostics16183056","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3056","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Assessment of PI-RADS v2.1: Inter-Reader Agreement, Diagnostic Accuracy, and the Added Value of PSA Density in Prostate Cancer Prediction"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6603-6319","authenticated-orcid":false,"given":"Mohammad","family":"Abufaraj","sequence":"first","affiliation":[{"name":"Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan"},{"name":"Department of Urology, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Sarah B.","family":"Al-Qalalweh","sequence":"additional","affiliation":[{"name":"Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Ahmad S.","family":"Kreishan","sequence":"additional","affiliation":[{"name":"Department of Radiology, King Hussein Medical Center, Jordanian Royal Medical Services, Amman 11733, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2726-2684","authenticated-orcid":false,"given":"Rama M.","family":"Abbadi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3774-337X","authenticated-orcid":false,"given":"Omar","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jordan University Hospital, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Abdelrhman","family":"Labib","sequence":"additional","affiliation":[{"name":"Department of Radiology, Abdali Hospital, Amman 11191, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7551-6239","authenticated-orcid":false,"given":"Mohammad","family":"Abu Shattal","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Diana A.","family":"Bawi","sequence":"additional","affiliation":[{"name":"University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Osama","family":"Samara","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Yazeed E.","family":"Alhanbali","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Salma N.","family":"Farah","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mousa A.","family":"Al-Abbadi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Forensic Medicine, College of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6627-6179","authenticated-orcid":false,"given":"Shahrokh F.","family":"Shariat","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan"},{"name":"Department of Urology, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Department of Urology, Weill Cornell Medical College, New York, NY 10065, 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