ArticleInvestigative radiology2026
Diffusion-weighted Imaging Distortion in Prostate MRI: A Cross-sectional Study Comparing Supine and Prone Positioning.
Article in Investigative radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesDiffusion weighted imaging (DWI) is a key component of multiparametric (mp) prostate MRI. DWI using echo-planar techniques is susceptible to distortion at the recto-prostatic air-tissue interface. This study was to determine whether prone patient positioning reduces adjacent rectal air and DW image distortion when compared with standard-of-care supine positioning. MATERIALS AND
methodsThis prospective study included consecutive patients undergoing mpMRI for suspected PCa between 2023 and 2024. Prostate segmentation was performed on DW and contrast-enhanced images. DWI distortion was measured quantitatively. Qualitative image quality of DWI and T2-weighted imaging (T2WI) was evaluated using PI-QUAL version 2; a separate 5-point clinically based Likert scale was employed to evaluate the volume of rectal air adjacent to the prostate.
resultsFifty-two patients were enrolled. In total, 58% of patients expressed a preference for supine imaging versus 20% for prone imaging. Qualitative DWI image quality improved significantly in the prone position [median: 4 (3 to 4)] versus supine [3 (1 to 4)]; P < 0.001. In contrast, prone T2WI quality [1 (1 to 1)] was significantly inferior than supine T2WI [3 (3-4)]; P < 0.001. Quantitative measures of rectal air were significantly lower for prone [1.13 cm 3 (0.34-2.43)] compared with supine imaging [1.96 cm 3 (0.47 to 5.81); P = 0.005]. There was no significant difference in distortion between prone [3.21 mm (2.42 to 3.82) and supine [2.95 mm (2.25 to 4.21)] positioning across all patients ( P = 0.80); however, in patients with >4 cm 3 of supine rectal air (n = 19), distortion was significantly reduced by prone imaging [3.49 mm (2.84 to 4.03)] compared with supine [4.60 mm (3.17 to 5.95)]; P = 0.02. The mean additional scanning time for the necessary prone imaging was 8 minutes 18 seconds.
conclusionsProne positioning significantly reduces DWI distortion artefact when rectal air is present, but consistently results in degraded T2WI quality.
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