Image Quality and Geometric Distortion of Modern Diffusion-Weighted Imaging Sequences in Magnetic Resonance Imaging of the Prostate.

Purpose: The aim of this study was to compare qualitative and quantitative image quality and geometric distortion of 4 magnetic resonance diffusion-weighted imaging (DWI) sequences of the prostate using comparable imaging parameters and similar acquisition times. Methods and Materials: Axial T2-weighted turbo spin echo images and axial DWI echo-planar imaging (EPI) sequences, including single-shot spin-echo (ss-EPI), readout-segmented multishot (rs-EPI), selective excitation-reduced field of view (sTX-EPI), and prototype single-shot technique applying slice-specific shimming (iShim-EPI) sequences, were acquired at 3 T in 10 healthy volunteers (mean age, 26.1 +/- 3.8 years; body mass index, 23.2 +/- 3.0 kg/m2). Two radiologists, blinded to the type of DWI, independently rated DWIs on a 5-point Likert scale regarding subjective image quality features (resolution, demarcation of prostate capsule, zonal anatomy). Interreader agreement was assessed using the intraclass correlation coefficient. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) values were assessed separately in the peripheral and transitional zone. For the analysis of geometric distortion, the diameter of the prostate from left to right and from anterior to posterior was measured at the level of the verumontanum on b-1000 DWIs and on T2-weighted turbo spin echo images. Differences were compared using the Wilcoxon rank sum test for qualitative parameters, analysis of variance, and Friedman test for quantitative parameters. A P value of less than 0.05 was considered significant, with correction for multiple comparisons. Results: Interreader agreement was good to excellent (intraclass correlation coefficient, 0.71-0.79) for all qualitative features. Subjective image quality regarding "resolution" was significantly better for ss-EPI than rs-EPI (mean Likert score, 4.25 vs 3.8; P = 0.031) and sTX-EPI (4.25 vs 3.3; P = 0.046) and for iShim-EPI as compared with rs-EPI (4.4 vs 3.8; P = 0.031) and sTX-EPI (4.4 vs 3.3; P = 0.047). There was no significant difference regarding capsule demarcation and zonal anatomy. Signal-to-noise ratio was significantly higher in iShim-EPI than sTX-EPI (SNR +/- standard deviation [SD], 28.13 +/- 8.21 vs 14.96 +/- 2.4; P = 0.015). The ADC values were lower for the peripheral zone in the sTX-EPI than in the ss-EPI (ADC +/- SD, 1002.94 +/- 83.51 vs 1165.05 +/- 115.64; P = 0.013) and the rs-EPI (1002.94 +/- 83.51 vs 1244.40 +/- 89.95; P = 0.0012) and in the transitional zone in the sTX-EPI compared with the rs-EPI (874.50 +/- 200.72 vs 1261.47 +/- 179.23; P = 0.0021). There were no statistically significant differences in geometric distortion between all DWI sequences. Conclusions: Single-shot spin-echo EPI and iShim-EPI showed a tendency toward superior image quality and SNR compared with rs-EPI and sTX-EPI with no significant differences in geometric distortion. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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