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: 10.1594/ecr2014/C-1928

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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.

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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.

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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 (LI-
RADS) was released in 2011, the version 2013, includes a lexicon and an imaging atlas
[7].

5.- Lu-RADS (Table 5, Figure 5)

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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
2009. 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].

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Images for this section:

Table 1: Breast Imaging and Data Report System (BI-RADS)

© Radiology, INCMNSZ, Mexico, DF/MX

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Fig. 1: BI-RADS

© Radiology, INCMNSZ, Mexico, DF/MX

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Table 2: CT Colonography Reporting and Data System (C-RADS)

© Radiology, INCMNSZ, Mexico, DF/MX

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Fig. 2: C-RADS

© Radiology, INCMNSZ, Mexico, DF/MX

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Table 3: Gynecologic Imaging Reporting and Data System (GI-RADS)

© Radiology, INCMNSZ, Mexico, DF/MX

Fig. 3: GI-RADS

© Radiology, INCMNSZ, Mexico, DF/MX

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Table 4: Liver Imaging Reporting and Data System (LI-RADS)

© Radiology, INCMNSZ, Mexico, DF/MX

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Fig. 4: LI-RADS

© Radiology, INCMNSZ, Mexico, DF/MX

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Table 5: Thyroid Imaging Reporting and Data System (TI-RADS)

© Radiology, INCMNSZ, Mexico, DF/MX

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Fig. 5: Lu-RADS

© Radiology, INCMNSZ, Mexico, DF/MX

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Table 6: Lung Reporting and Data System (Lu-RADS)

© Radiology, INCMNSZ, Mexico, DF/MX

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Fig. 6: TI-RADS

© Radiology, INCMNSZ, Mexico, DF/MX

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Table 7: Prostate Imaging Reporting and Data System (PI-RADS) scoring system

© Radiology, INCMNSZ, Mexico, DF/MX

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

© Radiology, INCMNSZ, Mexico, DF/MX

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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.

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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.

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References

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from history. J Am Coll Radiol 2009;6(12):851-60

2. Baker JA, Kornguth PJ, Floyd CE Jr. Breast imaging reporting and data system
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3. 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, 2003

4. Zalis ME, Barish MA, Choi JR,et al; Working Group on Virtual Colonoscopy. CT
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5. 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. 2009 Mar;28(3):285-91.

6. 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
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7. American College of Radiology. Liver Imaging Reporting and Data System version
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15. Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012.
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16. 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; 23:3185-3190

17. Rosenkrantz AB, Kim S, Lim RP, et al. Prostate cancer localization using
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18. Roethke MC, Kuru TH, Schultze S, et al. Evaluation of the ESUR PI-RADS scoring
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