MR safety considerations for patients undergoing prostate MRI
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SPECIAL SECTION: PROSTATE CANCER
MR safety considerations for patients undergoing prostate MRI Varaha S. Tammisetti1 Received: 6 June 2020 / Revised: 15 August 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Over the past decade, there has been a dramatic increase in the number of patients undergoing prostate MRI scans. Patients presenting for prostate MRI are an ageing population and may present with a variety of passive or active implants and devices. These implants and devices can be MR safe or MR conditional or MR unsafe. Patients with certain MR-conditional active implants and devices can safely obtain prostate MRI in a specified MR environment within specific MR imaging parameters. Prostate MRI and PET-MRI in patients with passive implants such as hip prostheses, fiducial markers for SBRT, brachytherapy seeds and prostatectomy bed clips have unique concerns for image optimization that can cause geometric distortion of the diffusion-weighted imaging (DWI) sequence. We discuss strategies to overcome these susceptibility artifacts. Prostate MRI in patients with MR conditional active implants such as cardiac implantable electronic devices (CIED) also require modification of imaging parameters and magnet strength. In this setting, a diagnostic quality prostate MRI can be performed at a lower magnet strength (1.5 T) along with modification of imaging parameters to ensure patient safety. Imaging strategies to minimize susceptibility artifact and decrease the specific absorption rate (SAR) in both settings are described. Knowledge of MR safety considerations and imaging strategies specific to prostate MRI and PET-MRI in patients with implants and devices is essential to ensure diagnostic-quality MR images and patient safety. Keywords Prostate MR · MR safety · Hip prosthesis · CIED
Introduction Prostate cancer is the most common non-cutaneous malignancy and the second most common cause of mortality in men [1]. With PI-RADS standardization, the use of prostate MRI to provide actionable information to guide MR-directed prostate biopsies in the detection of clinically significant prostate cancer has increased [1]. High-quality multiparametric prostate MRI is typically performed at either 3 T or 1.5 T magnet strengths. The 3 T magnet strength is preferred over 1.5 T [2]; however, a proportion of patients undergoing prostate MRI, especially those who are older, present with a variety of MR image quality and patient safety issues from passive implants such as hip prostheses or brachytherapy seeds and from active devices such as cardiac implantable electronic devices (CIED) [3, 4]. Passive implants in the * Varaha S. Tammisetti [email protected] 1
pelvis, including hip prostheses and brachytherapy seeds cause geometric distortion and artifact on the diffusionweighted (DWI) sequence, limiting the clinical interpretation and accurate PI-RADS categorization [3]. Patients with MR-conditional active implants or devices require modification of MRI
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