Technical and Care-Related Determinants of Quality in Multiparametric Prostate MRI.

Abstract

Background: Prostate cancer is one of the most prevalent malignancies among the male population, and multiparametric magnetic resonance imaging (mpMRI) has become a cornerstone of its diagnostic pathway, enabling improved detection and characterization of clinically significant lesions. However, the diagnostic performance of mpMRI is highly dependent on both technical and patient-related factors, including patient preparation, which may significantly affect the occurrence of artifacts and overall image interpretability. Methods: The aim of this study was to evaluate the impact of patient preparation on the diagnostic quality of prostate mpMRI performed on a 3-Tesla MRI system. A single-center retrospective observational study was conducted using prostate mpMRI examinations retrieved from the institutional PACS database. Examinations including complete T2-weighted sequences, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps, and radiological reports containing PI-RADS classification were included. Patient preparation was assessed according to three parameters: presence of rectal gas, degree of bladder distension, and presence of bowel motion artifacts. Each parameter was scored using an ordinal scale ranging from 0 to 2. A composite preparation score (range 0–6) was subsequently calculated and categorized into three levels: good, moderate, and poor preparation. Diagnostic image quality was classified as either diagnostic or limited/non-diagnostic. The association between patient preparation and examination quality was evaluated using Pearson’s chi-square test. Results: Patient preparation was expected to have a significant impact on the diagnostic quality of prostate mpMRI. Lower levels of rectal gas, adequate bladder filling, and reduced bowel motion artifacts were associated with improved image quality and a higher proportion of diagnostically adequate examinations. Conversely, suboptimal preparation was associated with an increased incidence of artifacts and reduced diagnostic confidence. Conclusions: This study highlights the crucial role of the Radiographer (Medical Imaging Technologist) in patient management and artifact prevention during prostate mpMRI examinations. The findings emphasize the importance of implementing standardized patient preparation protocols to enhance image quality, optimize diagnostic performance, and improve the overall effectiveness of prostate mpMRI in clinical practice.