Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality. Issue 2 (May 2022)

• Record Type: Journal Article
• Authors: Sathiadoss, Paul; Haroon, Mohammad; Osman, Heba; Ahmad, Faraz; Papadatos, Philip; Schieda, Nicola
• Is Part Of: Canadian Association of Radiologists journal. Volume 73:Issue 2(2022)
• Page Start: 346
• Page End: 354
• Publication Date: 2022-05
• Subjects: prostatic neoplasms -- magnetic resonance imaging -- enema -- diet -- peristalsis -- antispasmodic; Radiology, Medical -- Periodicals; Radiology, Medical -- Canada -- Periodicals; 616.0757
• DOI: 10.1177/08465371211033753
• Languages: English
• ISSNs: 0846-5371

Abstract

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.