The Global Reading Room: A Patient With Rectal Gas Artifact on Prostate MRI

Area of Science:

• Radiology
• Urology
• Medical Imaging

Background:

• Multiparametric prostate MRI (mpMRI) is crucial for evaluating elevated prostate-specific antigen (PSA) levels.
• Accurate interpretation of mpMRI can be hindered by artifacts, such as rectal gas.
• Optimal visualization of the prostate gland is essential for detecting potential abnormalities.

Purpose of the Study:

• To address the challenge of suboptimal prostate MRI visualization due to rectal gas.
• To determine the best course of action for a patient with an elevated PSA and artifact-limited mpMRI.
• To ensure accurate prostate cancer diagnosis and staging.

Main Methods:

• A 66-year-old male patient with a PSA of 7.3 ng/mL underwent mpMRI.
• Despite dietary preparation and enema, rectal gas caused significant artifact.
• The anterior prostate was visualized normally, but the posterior prostate was obscured.

Main Results:

• Rectal gas artifact rendered the posterior prostate unevaluable on all MRI sequences.
• The anterior prostate appeared normal, showing no signs of abnormality.
• Diagnostic confidence for the posterior prostate region was compromised.

Conclusions:

• Suboptimal visualization due to rectal gas necessitates further investigation.
• Consideration should be given to repeat mpMRI with improved bowel preparation or alternative diagnostic modalities.
• A definitive recommendation requires addressing the visualization limitations to ensure comprehensive prostate assessment.