Rectal gas-induced susceptibility artefacts on prostate diffusion-weighted MRI with epi read-out at 3.0 T: does a preparatory micro-enema improve image quality?

Abstract

Purpose

To assess whether the application of a preparatory micro-enema reduces gas-induced susceptibility artefacts on diffusion-weighted MRI of the prostate.

Methods

114 consecutive patients who received multiparametric 3 T MRI of the prostate at our institution were retrospectively enrolled. 63 patients self-administered a preparatory micro-enema prior to imaging, and 51 patients underwent MRI without bowel preparation. Two blinded readers independently reviewed the diffusion-weighted sequences regarding gas-induced artefacts. The presence/severity of artefacts was scored ranging from 0 (no artefact) to 3 (severe artefact). A score ≥ 2 was considered a clinically relevant artefact. Maximum rectal width at the level of the prostate was correlated with the administration of a micro-enema. Scores were compared between the scans performed with and without bowel preparation using univariable and multivariable logistic regression, taking into account potential confounding factors (age and prostate volume).

Results

Significantly less artefacts were found on diffusion-weighted sequences after the administration of a micro-enema shortly prior to MR imaging. Clinically relevant artefacts were found in 10% in the patient group after enema, in 41% without enema. If present, artefacts were also significantly less severe. Mean severity score was 0.3 (enema administered) and 1.2 (no enema), and odds ratio was 0.137 (p < 0.0001) in univariable ordinal logistic regression. Inter-observer agreement was excellent (κ 0.801).

Conclusion

The use of a preparatory micro-enema prior to 3 T multiparametric prostate MRI significantly reduces both the incidence and severity of gas-induced artefacts on diffusion-weighted sequences and thus improves image quality.

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Data availability

All data and material are available from the corresponding author.

Abbreviations

PSA:

Prostate specific antigen

DRE:

Digital rectal examination

TRUS:

Transrectal ultrasound

mpMRI:

Multiparametric MRI

EPI:

Echo planar imaging

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Acknowledgements

Preiss-Daimler Stiftung Medical Equipment and Research.

Funding

The corresponding author received a research grant from the Preiss-Daimler Stiftung Medical Equipment and Research.

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Authors

Contributions

VP: Corresponding author; CGR: Substantial contribution to the design, analysis and interpretation of the data; H-MH: Substantial contribution to the design, acquisition and interpretation of the data; CB: Substantial contribution to the design, acquisition and interpretation of the data. AB: Substantial contribution to the analysis and interpretation of the data as well as critical revision. CT: Substantial contribution to the analysis and interpretation of the data as well as critical revision; J-PK: Substantial contribution to the analysis and interpretation of the data as well as critical revision; ML: Substantial contribution to the analysis and interpretation of the data as well as critical revision; R-TH: Substantial contribution to the analysis and interpretation of the data as well as critical revision; IP: Substantial contribution to the analysis and interpretation of the data as well as critical revision. All authors reviewed and approved the work to be published and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Verena Plodeck.

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The corresponding author owns 5 Siemens shares (not Siemens Healthineers).

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This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval of the local ethics committee at the Technical University Dresden was granted prior to the study.

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Due to the retrospective nature of the study informed consent was waived by the local ethics committee.

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Plodeck, V., Radosa, C.G., Hübner, H. et al. Rectal gas-induced susceptibility artefacts on prostate diffusion-weighted MRI with epi read-out at 3.0 T: does a preparatory micro-enema improve image quality?. Abdom Radiol (2020). https://doi.org/10.1007/s00261-020-02600-9

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Keywords

  • Multiparametric magnetic resonance imaging
  • Prostate cancer
  • Diffusion weighted
  • Enema
  • Artefacts