Prostate: simplified MRI anatomy recognition and training—the P-SMART study: a novel approach to defining prostatic apex, mid-gland and base

@article{withey2026prostate,
  title = {{Prostate: simplified MRI anatomy recognition and training—the P-SMART study: a novel approach to defining prostatic apex, mid-gland and base}},
  author = {Samuel J. Withey and Patricia Gutierrez and Alfonso M. Ponsiglione and Arnaldo Stanzione and Jeries P. Zawaideh and Giorgio Brembilla and Giacomo Avesani and Charlie A. Hamm and Adriano B. Dias and Sungmin Woo and Anwar R. Padhani and Vibeke Løgager and Andrea Ponsiglione and P-SMART Collaborators and Jorge Abreu-Gomez and Georgios Agrotis and Francesco Alessandrino and Fahd Alkhalifah and Yuki Arita and Aishah Azam and Tristan Barrett and Mariem Bensalah-Faria and Rodrigo Borrero-Leon and Silvia Bottazzi and Donato Bressi and Iztok Caglic and Charlotte Charbel and Emil Colliander and Renato Cuocolo and Maarten De Rooij and Nando De Vulder and Margot Delrue and Sofia A. N. Fialho and Maria G. Freda and Matilde L. R. R. Gonçalves and Jonathan Hernández-Mancera and Ilias Karvounis and Iman Kiani and Fredrik Langkilde and Nicolas A. Litardo and Ashley Luckyram and Luigi Mannacio and Ricardo S. Martins and Sandra P. Mazzini and Ana Sofia L. Moreira and Shakiba Mosadegh and Jina Pakpoor and Pavel Radu and Giorgio Raia and Guillaume Ramette and Luca Russo and Daniel A. Sandoval and Alicia R. Silberbrandt and William Weston and Chen Jiang Wu and Lili Xu and Yu Hang Yang},
  journal = {Insights into Imaging},
  year = {2026},
  month = nov,
  doi = {10.1186/s13244-026-02459-2},
  url = {https://link.springer.com/article/10.1186/s13244-026-02459-2},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Prostate: simplified MRI anatomy recognition and training—the P-SMART study: a novel approach to defining prostatic apex, mid-gland and base
AU  - Samuel J. Withey
AU  - Patricia Gutierrez
AU  - Alfonso M. Ponsiglione
AU  - Arnaldo Stanzione
AU  - Jeries P. Zawaideh
AU  - Giorgio Brembilla
AU  - Giacomo Avesani
AU  - Charlie A. Hamm
AU  - Adriano B. Dias
AU  - Sungmin Woo
AU  - Anwar R. Padhani
AU  - Vibeke Løgager
AU  - Andrea Ponsiglione
AU  - P-SMART Collaborators
AU  - Jorge Abreu-Gomez
AU  - Georgios Agrotis
AU  - Francesco Alessandrino
AU  - Fahd Alkhalifah
AU  - Yuki Arita
AU  - Aishah Azam
AU  - Tristan Barrett
AU  - Mariem Bensalah-Faria
AU  - Rodrigo Borrero-Leon
AU  - Silvia Bottazzi
AU  - Donato Bressi
AU  - Iztok Caglic
AU  - Charlotte Charbel
AU  - Emil Colliander
AU  - Renato Cuocolo
AU  - Maarten De Rooij
AU  - Nando De Vulder
AU  - Margot Delrue
AU  - Sofia A. N. Fialho
AU  - Maria G. Freda
AU  - Matilde L. R. R. Gonçalves
AU  - Jonathan Hernández-Mancera
AU  - Ilias Karvounis
AU  - Iman Kiani
AU  - Fredrik Langkilde
AU  - Nicolas A. Litardo
AU  - Ashley Luckyram
AU  - Luigi Mannacio
AU  - Ricardo S. Martins
AU  - Sandra P. Mazzini
AU  - Ana Sofia L. Moreira
AU  - Shakiba Mosadegh
AU  - Jina Pakpoor
AU  - Pavel Radu
AU  - Giorgio Raia
AU  - Guillaume Ramette
AU  - Luca Russo
AU  - Daniel A. Sandoval
AU  - Alicia R. Silberbrandt
AU  - William Weston
AU  - Chen Jiang Wu
AU  - Lili Xu
AU  - Yu Hang Yang
PY  - 2026
DA  - 2026/11/05
JO  - Insights into Imaging
DO  - 10.1186/s13244-026-02459-2
UR  - https://link.springer.com/article/10.1186/s13244-026-02459-2
AB  - Objectives: Precise lesion localisation on prostate MRI—specifically, identification of whether at the apex, mid-gland, or base—is essential for effective communication and clinical management. This study aimed to assess interobserver agreement of current practice using the Prostate Imaging-Reporting and Data System (PI-RADS) against a novel anatomy-based approach, P-SMART (Prostate Simplified MRI Anatomy Recognition and Training).  Materials and methods: This multi-reader, two-phase agreement study, used axial and sagittal T2-weighted MRI from a publicly available dataset. Forty MRI cases were annotated with four regions of interest (ROIs). Readers were asked to document ROI location—apex, mid-gland, or base—first using the PI-RADS method, then following a 3-week washout period and short educational intervention, using the P-SMART method. Interobserver agreement was evaluated using Fleiss’ kappa (κ) statistics and compared following bootstrap resampling using a paired t -test. Subgroup analyses were performed by reader expertise and prostate size.  Results: Following quality assurance, 156 ROIs were evaluated by 43 readers in each phase of the study. Overall interobserver agreement improved with P-SMART vs PI-RADS (κ = 0.571 vs 0.399; p < 0.001). In subgroup analyses, improvements were consistent for experts (0.663 vs 0.435; p < 0.001), non-experts (0.530 vs 0.393; p < 0.001), large prostates (0.518 vs 0.325; p < 0.001), and small prostates (0.620 vs 0.461; p < 0.001).  Conclusion: The P-SMART approach, designed to align with the PI-RADS sector map, yielded significantly higher interobserver agreement for prostate lesion-level localisation than the PI-RADS method, across reader experience and gland size, though overall agreement was only moderate. Improved reproducibility may support biopsy targeting, active surveillance monitoring, and treatment planning.  Key Points: Question Can a novel method of dividing the prostate into apex, mid-gland, and base improve reader agreement compared to current practice?  Findings The P-SMART method to divide the prostate outperformed PI-RADS (Fleiss’ kappa 0.571 vs 0.399), improving consistency across experience levels and prostate sizes.  Relevance statement : More reproducible prostate level assignment supports accurate lesion localisation for biopsy planning, active surveillance, and treatment planning. If validated, P-SMART may improve communication and could be integrated into reporting workflows and software tools.
SN  - 1869-4101
ER  -