Sathiadoss Paul, Haroon Mohammad, Osman Heba, Ahmad Faraz, Papadatos Philip, Schieda Nicola
Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.
Can Assoc Radiol J. 2022 May;73(2):346-354. doi: 10.1177/08465371211033753. Epub 2021 Aug 17.
To compare 5 different rectal preparation strategies for prostate MRI.
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.
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).
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.
比较5种不同的直肠准备策略用于前列腺MRI检查的效果。
这项五组对照的质量保证研究每组评估56例患者（共280例患者），包括：不做准备、在MRI当天00:00开始的清流饮食（CFD）、福静清灌肠剂灌肠、灌肠+CFD、灌肠+CFD+静脉注射抗痉挛药物。该研究的检验效能设定为0.80，α错误率为0.05。三名盲法放射科医生独立使用5级李克特量表对T2加权（T2W）和扩散加权成像（DWI）进行评估，评估内容包括：直肠直径（前后径最大值）、直肠内容物（粪便、液体、气体）、直肠运动、T2W/DWI图像质量、T2W图像清晰度和DWI磁敏感伪影。总体比较采用方差分析（ANOVA）和克鲁斯卡尔-沃利斯检验，两两比较采用配对t检验和威尔科克森符号秩检验。
与未灌肠组相比，灌肠组的直肠直径和气体量更低（p<0.001），灌肠+CFD+静脉注射抗痉挛药物组的直径最小且气体最少（p=0.022至<0.001）。灌肠+CFD组的T2W图像质量和清晰度最高（p<0.001），灌肠+CFD组与使用/未使用静脉注射抗痉挛药物组之间无差异（p=0.064，0.084）。与所有其他组相比，灌肠+CFD+静脉注射抗痉挛药物组的运动伪影最少（p<0.001），其次是灌肠+CFD组（p=0.008至<0.001）。灌肠+CFD组的DWI图像质量最高（p<0.001），DWI磁敏感伪影最低（p<0.001），且灌肠+CFD组与使用/未使用抗痉挛药物组之间无差异（p=0.058至0.202）。
在前列腺MRI检查前使用灌肠+清流饮食可获得最高的T2W和DWI图像质量，且DWI伪影最少。与灌肠+清流饮食相比，使用静脉注射抗痉挛药物可减少T2W上的运动，但不能改善T2W或DWI的图像质量，也不能减轻DWI伪影。
