Patient preparation and image quality in female pelvic MRI: recommendations revisited
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Patient preparation and image quality in female pelvic MRI: recommendations revisited Mahshid Sheikh-Sarraf 1 & Stephanie Nougaret 2,3 & Rosemarie Forstner 4 & Rahel A. Kubik-Huch 1 Received: 13 March 2020 / Accepted: 6 April 2020 # European Society of Radiology 2020
Abstract Objectives To assess whether with recent MR technology current patient preparation literature recommendations for female pelvic MRI are still valid and how they are influencing the position of the female pelvic organs, image quality, and diagnostic confidence. Methods This prospective study was performed in two centres. The effects of bladder filling (empty, moderate, full; n = 26), fasting, saturation band (n = 25), and menstrual cycle (n = 25) were assessed in healthy subjects in centre 1, while the effect of intravenous glucagon application was evaluated in 20 patients with benign conditions in centre 2. Images of the pelvis were acquired using 1.5-T MRI with T2-weighted turbo spin echo imaging in sagittal and (angulated) transaxial planes. The analysis was conducted hierarchically using paired Wilcoxon tests with an alpha significance level of 0.05. Results Urinary bladder filling influenced the cervix-to-uterine angle (p < 0.001) but had no clear effect on image quality (p > 0.05). A moderately full bladder provided the best delineation of fat between the bladder and uterus (p = 0.0009). A full bladder resulted in highest ovarian displacement (p = 0.0059). Timing within the menstrual cycle did not influence the depiction of zonal anatomy (p > 0.05). Fasting (p < 0.02) and saturation bands (p < 0.001) had a positive effect on image quality. Glucagon was associated with decreased MRI artefacts (p = 0.002). Conclusion Fasting, antispasmodic agents, and saturation bands improved MR image quality and are recommended for female pelvic MRI. Urinary bladder filling influenced the cervix-to-uterine angle, but had no clear effect on image quality. Key Points • Fasting, saturation band, and glucagon injection significantly reduced bowel movement artefacts. • Depiction of the anatomical details of the uterus was not influenced by the timing of MRI within the menstrual cycle. • Although bladder filling did not impact diagnostic capabilities in healthy volunteers, in clinical practice, it may be useful to examine patients with a moderately full bladder, to reduce diagnostic inaccuracies. Keywords Magnetic resonance imaging . Artefacts . Guidelines . Pelvis
Mahshid Sheikh-Sarraf and Stephanie Nougaret shared first authorship. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-06869-8) contains supplementary material, which is available to authorized users. * Stephanie Nougaret [email protected] 1
Department of Radiology, Kantonsspital Baden, Im Ergel 5, 5404 Baden, Switzerland
3
Department of Radiology, Montpellier Cancer Institute, 208 Ave des Apothicaires, 34295 Montpellier, France
2
Montpellier Cancer Research Institute, IRCM, INSERM, U1194, University of Montpellier, 20
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