Prostatic urethral lift with UroLift® is a minimally invasive approach to treat symptomatic benign prostatic hypertrophy. This device causes artifacts on prostate MR images. Our aim was to evaluate the impact of artifact on prostate MR image quality.
Single-center, retrospective review of patients with UroLift® who subsequently had prostate MRI. Two readers graded UroLift® artifact on each pulse sequence using a 5-point scale (1. Non-diagnostic; 5. No artifact). Prostate Imaging Quality scores were assigned for the whole dataset. The volume of gland obscured by artifact was measured. Linear and logistic regression models were used to identify predictors of poor image quality.
37 patients were included. Poor image quality occurs more in the transition zone than the peripheral zone (15% vs 3%), at base/mid regions vs the apex (13%, 9% and 5%, respectively) and on diffusion-weighted images (DWI) vs T2-weighted (T2WI) and dynamic contrast-enhanced (DCE) sequences (27%, 0.3%, 0%, respectively) (p < 0.001). Suboptimal image quality (i.e., PI-QUAL score < 2) was found in 16-24% of exams. The percentage of gland obscured by the UroLift® artifact was higher on DWI and DCE sequences than T2WI (32%, 9%, and 6%, respectively;p<0.001).
UroLift® artifact negatively affects prostate MR image quality with greater impact in the mid-basal transition zone, obscuring a third of the gland on DWI. Patients considering this procedure should be counseled on the impact of this device on image quality and its potential implications for any image-guided prostate cancer workup.
The Journal of urology. 2023 Jan 11 [Epub ahead of print]
Tarik Benidir, Ethan Austhof, Ryan D Ward, Justin Ream, Jenifer Bullen, Baris Turkbey, Peter A Pinto, Francesco Giganti, Eric A Klein, Andrei S Purysko
Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio USA., Case Western Reserve University School of Medicine, Cleveland, Ohio USA., Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, Cleveland, Ohio USA., Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio USA., Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland USA., Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.