Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality
Paul Sathiadoss1, Mohammad Haroon1, Heba Osman1
1Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada.
Purpose:
To compare 5 different rectal preparation strategies for prostate MRI.
Methods:
This 5-arm quality-assurance study evaluated 56 patients per arm (280 patients) including: no preparation, clear-fluids diet (CFD) beginning at 00:00 hours on the day of MRI, Fleet®-enema, enema + CFD, enema + CFD + IV-antispasmodic agent. The study was powered to 0.80 with alpha-error of 0.05. Three blinded radiologists independently evaluated T2-Weighted (T2W) and Diffusion Weighed Imaging (DWI) for: rectal diameter (maximal AP diameter), rectal content (stool, fluid, gas), rectal motion, T2W/DWI image quality, T2W image sharpness and DWI susceptibility artifact using 5-point Likert scales. Overall comparisons were performed using analysis of variance (ANOVA) and Kruskal-Wallis, with pair-wise comparisons using paired t-tests and Wilcoxon sign-rank tests.
Results:
Rectal diameter and amount of gas were lower in enema compared to non-enema groups (p < 0.001), with smallest diameter and least gas in the enema + CFD + IV-antispasmodic group (p = 0.022-<0.001). T2W image quality and sharpness were highest in the enema + CFD groups (p < 0.001) with no difference comparing enema + CFD with/without IV-antispasmodic (p = 0.064, 0.084). Motion artifact was least in enema + CFD + IV-antispasmodic group compared to all other groups (p < 0.001), followed by the enema + CFD group (p = 0.008-<0.001). DWI image quality was highest (p < 0.001) and DWI susceptibility artifact lowest (p < 0.001) in the enema + CFD groups (p < 0.001) and did not differ comparing enema + CFD with/without anti-spasmodic (p = 0.058-0.202).
Conclusions:
Use of enema + clear-fluids diet before prostate MRI yields the highest T2W and DWI image quality with the least DWI artifact. IV-antispasmodic use reduces motion on T2W but does not improve image quality on T2W or DWI, or lessen DWI artifact compared to enema + clear-fluids diet.
Insights
For prostate MRI, an enema combined with a clear-fluids diet (CFD) significantly improves T2-weighted and diffusion-weighted imaging quality. This preparation strategy minimizes rectal diameter and gas, leading to clearer diagnostic images.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Context:
- Prostate MRI requires optimal rectal preparation for accurate imaging.
- Previous methods lack standardized efficacy.
- Evaluating novel preparation techniques is crucial for diagnostic yield.
Purpose:
- To compare five distinct rectal preparation regimens for prostate MRI.
- To assess the impact of enema, clear-fluids diet (CFD), and antispasmodics on image quality.
- To determine the optimal strategy for minimizing artifacts and maximizing diagnostic information.
Summary:
- A quality-assurance study involving 280 patients evaluated no preparation, CFD, enema, enema + CFD, and enema + CFD + IV-antispasmodic.
- Enema + CFD significantly reduced rectal diameter and gas compared to other groups.
- Enema + CFD yielded the highest T2-weighted and DWI image quality with the least artifact.
Impact:
- The enema + CFD regimen is recommended for superior prostate MRI quality.
- This preparation strategy enhances diagnostic accuracy by reducing motion and artifacts.
- Findings provide evidence-based guidelines for optimizing prostate MRI protocols.
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