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JU INSIGHT Impact of Prostate Urethral Lift Device on Prostate Magnetic Resonance Image Quality

By: Tarik Benidir, MD, Glickman Urological Kidney Institute, Cleveland Clinic, Ohio; Ethan Austhof, MD, Glickman Urological Kidney Institute, Cleveland Clinic, Ohio; Ryan D. Ward, MD, Imaging Institute, Cleveland Clinic, Ohio; Justin Ream, MS, Imaging Institute, Cleveland Clinic, Ohio; Jenifer Bullen, MD, Quantitative Health Sciences, Cleveland Clinic, Ohio; Baris Turkbey, MD, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Peter A. Pinto, MD, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Francesco Giganti, MD, PhD, University College London Hospital NHS Foundation Trust, United Kingdom, University College London, United Kingdom; Eric A. Klein, MD, Glickman Urological Kidney Institute, Cleveland Clinic, Ohio; Andrei S. Purysko, MD, Glickman Urological Kidney Institute, Cleveland Clinic, Ohio, Imaging Institute, Cleveland Clinic, Ohio | Posted on: 20 Apr 2023

Benidir T, Austhof E, Ward RD, et al. Impact of prostate urethral lift device on prostate magnetic resonance image quality. J Urol. 2023;209(4)752-761.

Study Need and Importance

Prostatic urethral lift (UroLift) is a minimally invasive treatment option for men with lower urinary tract symptoms secondary to benign prostatic hypertrophy. This device causes artifacts on prostate MRI. As prostate MRI is increasingly utilized in the workup of men with suspected or confirmed prostate cancer, understanding the impact of UroLift in terms of MRI readability and interpretation remains highly important. Our aim was thus to evaluate the impact of UroLift on prostate MRI quality.

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Figure. Example of the impact of UroLift device on magnetic resonance image quality. On T2-weighted images (T2WI) and dynamic contrast-enhanced (DCE) images, the artifact is seen as small areas of signal void in the transition zone. On diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) map, the susceptibility artifact results in a larger area of signal void with distortion of the image, obscuring a focal lesion in the right anterior peripheral/transition zone seen on T2WI and DCE. MRI-guided biopsy of the lesion revealed prostate cancer grade group 3. PCa indicates prostate cancer.

What We Found

On qualitative assessment, 19% of graded areas had at least moderate UroLift artifact and poor image quality in 9% of graded areas. The transitional zone was more affected than the peripheral zone (15% vs 3%), the base and mid regions were more affected than the apex (13%, 9%, and 5%, respectively), and diffusion-weighted images were more affected than T2-weighted images (27% vs 0.3%; all P values < .001). Overall, readers scored poor diagnostic quality (Prostate Image Quality <3) for 20.3% of exams. On quantitative assessment, a higher proportion of the gland was obscured by UroLift artifact on the apparent diffusion coefficient maps (mean 32%) and dynamic contrast-enhanced images (mean 9%) than T2-weighted images (mean 6%; P < .001)

Limitations

This study was limited by its single-center retrospective nature. Furthermore, we did not evaluate the correlation between the severity of the artifact and the MRI accuracy for prostate cancer diagnosis or staging. Our sample size was modest.

Interpretation for Patient Care

The UroLift device causes significant artifacts on prostate MRI, which can result in poor image quality and limit the diagnostic capabilities. Patients should be counseled about this correlation and its potential implications for subsequent prostate cancer workup using MRI.

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