E2158. Comparative Effectiveness of Sublingual Hyoscyamine vs. Parenteral Glucagon on the Diagnostic Performance of Multiparametric Prostate MRI
MD Anderson Cancer Center
The purpose of this study was to compare the effectiveness of sublingual antispasmotic hyoscyamine versus parenteral antispasmotic glucagon in reducing the image blur and motion artifact that would significantly impact the ability of radiologists to accurately diagnose prostate adenocarcinoma on high-quality multiparametric magnetic resonance imaging (mpMRI). The primary outcome was image blur on the T2-weighted imaging (T2WI), diffusion-weighted imagine (DWI) and dynamic contrast enhancement (DCE) sequences. The secondary outcomes included motion artifacts and diagnostic accuracy for detecting clinically significant intraprostatic lesion.
Materials and Methods:
This was a single-center retrospective study consisting of 200 participants selected from a database consisting of all patients within the 7-year period (2014–2021). Inclusion criteria included men older than 18 years having undergone prostate MRI for suspected prostate cancer based on elevated PSA, abnormal digital rectal exam, and/or positive biopsy. Exclusion criteria included those with contraindications to having MRI or medical conditions preventing antispasmotic pretreatment, and those with pelvic metallic implants. One hundred patients with sublingual hyoscyamine pretreatment and 100 patients with parenteral glucagon pretreatment were then randomly chosen. These two groups were compared with respect to image quality based on primary and secondary outcomes. Along with basic demographic data, comparisons were also made controlling for such factors such as basal metabolic index (BMI), usage of endorectal coil, and presence of orthopedic hardware. Statistical analyses were performed to determine if there was any statistically significant difference between the use of sublingual hyoscyamine and parenteral glucagon in reducing image blur and motion artifact. SAS (version 9.4) was used for all statistical analyses and a p-value of < 0.05 was considered as statistically significant.
Overall, there was no statistically significant difference in the effectiveness of sublingual hyoscyamine versus parenteral glucagon in reducing the image blur and motion artifact that would impact the accurate diagnosis of prostate adenocarcinoma on high-quality mpMRI; however, there was statistically significant difference in image blur and motion artifact between the two groups during the later sequences of DCE. Of note, there was no statistically significant differences between the two groups in terms of demographic data, BMI, usage of endorectal coil, and presence of orthopedic hardware.
This study compared the effectiveness of sublingual hyoscyamine versus parenteral glucagon in reducing image blur and motion artifact of prostate MRIs. Because there was no statistically significant difference in the effectiveness of these two antispasmotics with different routes of administration in promoting accurate prostate MRI interpretation, patients may have a choice in selecting the appropriate agent based on their medical profiles, their desire for the less invasive route of administration and potential savings in health care cost.