ArticleQuantitative imaging in medicine and surgery2026
PSMA-RADS 2.0: clinical validation and technical considerations for prostate-specific membrane antigen positron emission tomography/computed tomography image interpretation.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The updated diagnostic framework prostate-specific membrane antigen Reporting and Data System 2.0 (PSMA-RADS 2.0) has been introduced as a standardized scoring system for PSMA positron emission tomography/computed tomography (PET/CT) structured reporting to enhance the accuracy and clinical utility of prostate cancer (PCa) lesion interpretation. This study aims to evaluate the reliability and identify potential limitations of PSMA-RADS 2.0 in clinical applications. Methods: We conducted a comparative analysis between PSMA-RADS versions 1.0 and 2.0, followed by prospective evaluation of 109 lesions using PSMA-RADS 2.0 criteria. Inter- and intra-reader consistencies were analyzed statistically to evaluate the reliability and practicality of the scoring system. In the context of two independent readings, the inter-reader consistency between experienced readers (ERs) and inexperienced readers (IRs) was evaluated using the intra-class correlation coefficient (ICC). Results: Compared to version 1.0, PSMA-RADS 2.0 simplified primary PSMA-RADS-1 classification for Category I lesions and introduced PSMA-RADS-5T for post-treatment assessment. Inter-reader correlation coefficients values demonstrated excellent consistency (ERs: 0.964-0.969; IRs: 0.929-0.932). Intra-reader correlation coefficients ranged from 0.920 to 0.985 across all readers. However, challenges persisted in lymph node interpretation (ICC: 0.797-0.823) and post-treatment classification. Conclusions: PSMA-RADS 2.0 provides a reliable framework for PSMA PET/CT interpretation, even for IRs. Further refinement is needed for post-treatment categorization and lymph node differentiation. The proposed PSMA-RADS-5T sub-classification complete remission/partial remission/stability disease/progression disease (CR/PR/SD/PD) may enhance clinical utility for treatment monitoring.
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