Comparison of prostate distortion by inflatable and rigid endorectal MRI coils in permanent prostate brachytherapy imaging

Purpose: To study the deformation of the prostate by a rigid reusable endorectal coil and a balloon-type endorectal coil (BTC) during MRI of the prostate in brachytherapy imaging. Methods and Materials: The prostate gland was contoured on 157 MRI scans from 52 prostate cancer patients undergoing brachytherapy. The curvature of the posterior prostate surface deformation was computed as a measure of prostate distortion and compared between scans with a BTC, rigid endorectal coil (REC), or no endorectal coil. For the nine patients who had MRIs with all three endorectal scenarios, a mean prostate deformation vector was also calculated between scenarios using deformable image registration. These measures of prostate distortion were compared with the prostate anterior-to-posterior to left-to-right ratio (AP/LR) on the largest prostate axial slice. Results: Significant differences in prostate curvature were found between scans without an endorectal coil versus a REC versus a BTC (p < 0.001). The mean prostate deformation was 3.9 mm due to the BTC and 2.0 mm for the REC (p = 0.012). The mean AP/LR ratio was 0.62 with a BTC versus 0.76 without a coil or 0.73 with a REC (p < 0.001), but no difference existed between scans with a REC versus no coil (p = 0.7). The AP/LR ratio showed moderate correlation with prostate curvature (r = 0.48), and with mean prostate deformation (r = −0.64 to 0.68). Conclusions: The REC caused minimal deformation of the prostate compared with a BTC with adequate MR image quality, and calculation of the cross-sectional AP/LR ratio on the largest axial prostate slice can serve as a simple measure of prostate distortion.