Related Experiment Video
Updated: Dec 1, 2025
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Influence of Enema and Dietary Restrictions on Prostate MR Image Quality: A Multireader Study
Andrei S Purysko1, Nathan Mielke2, Jennifer Bullen3
1Imaging institute, Cleveland Clinic, 9500 Euclid Avenue, JB-322, Cleveland, OH 44145; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Purpose:
To evaluate the effect of enema and dietary restrictions on prostate MR image quality metrics and to assess inter-reader agreement for these metrics.
Methods:
This retrospective study included 195 men divided into groups based on their compliance with preparation instructions before prostate MRI (Enema + Diet, n = 98; Enema, n = 42; Diet, n = 35; Control [no compliance], n = 20). Four readers independently assessed six image quality metrics on a 5-point scale. Between-group comparisons were made using Wilcoxon rank sum test. Inter-reader agreement was calculated using Fleiss' kappa.
Results:
Compared with the Control group, image quality with respect to rectal stool/gas, distortion of diffusion-weighted images, overall image quality, and confidence in assessment was higher in the Enema + Diet, Enema, and Diet groups (p < 0.05 for all comparisons). The Enema + Diet and Enema groups had significantly higher scores than the Diet group for rectal stool/gas (p < 0.001 and 0.005, respectively). The Enema + Diet and Diet groups had higher scores than the Control group for rectal peristalsis (p = 0.027 and 0.009, respectively), but there were no significant differences in motion artifacts on T2-weighted images. Agreement among readers was fair, with kappa values ranging from 0.25 to 0.37.
Conclusion:
Enema and dietary restriction can improve the quality of prostate MRI by decreasing rectal distension and distortion of diffusion-weighted images and by increasing reader confidence in image assessment. Inter-reader agreement using subjective criteria for analysis of MRI quality is fair.
Insights
Preparing for prostate MRI with enema and dietary changes significantly improves image quality by reducing rectal artifacts and enhancing diagnostic confidence. Reader agreement on these quality metrics was fair.
Area of Science:
- Radiology
- Medical Imaging
Background:
- Prostate MRI quality is crucial for accurate diagnosis and treatment planning.
- Rectal distension and stool can significantly degrade image quality.
- Standardized preparation protocols are essential for optimal MRI outcomes.
Purpose of the Study:
- To evaluate the impact of enema and dietary restrictions on prostate MRI image quality metrics.
- To assess the inter-reader agreement for subjective MRI quality assessments.
Main Methods:
- Retrospective analysis of 195 men undergoing prostate MRI.
- Patients were grouped based on adherence to preparation: Enema + Diet, Enema only, Diet only, and Control (no preparation).
- Four readers independently scored six image quality metrics; inter-reader agreement was calculated using Fleiss' kappa.
Main Results:
- Enema and/or dietary preparation significantly improved image quality compared to the control group, specifically for rectal stool/gas and diffusion-weighted image distortion.
- The combined Enema + Diet and Enema-only groups showed superior results for rectal stool/gas compared to the Diet-only group.
- While rectal peristalsis improved with preparation, motion artifacts on T2-weighted images showed no significant difference. Inter-reader agreement was fair (kappa 0.25–0.37).
Conclusions:
- Enema and dietary restrictions are effective in enhancing prostate MRI quality by minimizing rectal distension and improving diffusion-weighted image clarity.
- These preparations increase reader confidence in image assessment.
- Subjective assessment of MRI quality shows fair inter-reader agreement.
Related Concept Videos
01:27Imaging Studies IV: Magnetic Resonance Imaging
01:23Lower GI Series: Barium Enema
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:27Imaging Studies III: Computed Tomography
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
01:24Imaging Studies II: Ultrasonography