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?

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

methods114 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).

resultsSignificantly 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).

conclusionThe 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.