Difference in Image Information Between DWI Sequence and DWI Blade for Optimization of Axial Brain

Background: Stroke is a brain disease where an acute nerve function is occurred due to the cerebral vascular disorders. To establish a diagnosis the stroke, it can be identified by employing the Diffusion Weighted Imaging (DWI) sequence in the MRI examination. Artifacts still exist on the MRI image which in turn reduce the resolution when using the DWI sequence. Adding the PROPELLER data acquisition method in the DWI sequence possibly improves the quality of brain images. The purpose of this study is to know the difference on the quality of anatomical image information between the DWI sequences with PROPELLER and without PROPELLER methods, and to determine adequate anatomical image appearance that created in amongst of the two methods, specifically for the stroke disease.Methods: this research is quantitative research with experimental approach. This study was conducted using MRI 1.5 T at Bethesda Hospital Yogyakarta. Data were 16 images from 8 patients using DWI sequences using PROPELLER without PROPELLER on MRI Brain examination with stroke. The results of the image were evaluated on 7 criteria: cortex cerebri, basal ganglia, thalamus, pons, cerebellum, stroke (infarction) and artifacts using questionnaires given to 3 respondents. Data analysis was done by Wilcoxon test to know the difference of anatomical image information on DWI sequence using PROPELLER without PROPELLER and to know better anatomical image information from both sequences seen from mean rank value.Results: The results shown, there is a significant difference on the quality of anatomical image information and the artifacts between the use of DWI sequence with and without PROPELLER methods ( 0.05). Based on the mean rank results, the DWI PROPELLER sequence has a higher mean rank value 4.50 compared to the DWI sequence without PROPELLER 0.00.Conclusions: The DWI PROPELLER sequence has better image results compared to the DWI sequence without PROPELLER.

Background: Diffusion Weighted Imaging (DWI) is a technique that visualizes the movement of water molecules from areas of higher to lower concentration. In DWI sequences, the b-value parameter affects the signal intensity in the images. The objective of this study is to describe the differences in anatomical image information between b-value variations of 1500s/mm2, 2000s/mm2, and 2500s/mm2 in MRI prostate case cancer and to determine the most optimal b-value. Method: This study used a pre-exeachimental approach with a 1.5T Philips MRI machine at a private hospital in South Jakarta from March to April 2023. The sample consisted of 12 Prostate MRI images with DWI sequences and different b-values. Visual grading assessment was eachformed by three radiology specialists, and the data were analyzed using the Friedman test in SPSS. Results: The results showed a significant difference in anatomical image information based on the b-value variations used, with a p-value of 0.05 (0.02). The highest mean rank was obtained from the Friedman test for the b-value of 2000s/mm2. Conclusion: The significant difference in anatomical image information occurred due to differences in signal intensity and noise levels. Prostate cancer tissues appeared more hyperintense with lower noise in images with higher b-values, and vice versa. Additionally, the b-value of 2000s/mm2 resulted in the most optimal signal intensity and noise level. In conclusion, the use of b-value variations in axial DWI images of prostate cancer Prostate MRI to differences in anatomical image information, with the most optimal image information observed at a b-value of 2000s/mm2.

Background: One variation of pulse sequence used in MRI Brain examination is Diffusion Weighted Image (DWI). In the DWI sequence, the value of 'b' which the operator must choose when setting the parameters, affects the signal intensity. In radiology installations, radiographers often use a 'b' value of 1000 s/mm2 with various pathologies. The purpose of this study was to determine the effect of setting the value of 'b' (1000.1500.2000 s/mm2) on image information and to determine the best setting of the three selected 'b' values in generating DWI signals for cases of intracranial tumors.Methods: This research is experimental study. This research uses MR GE 1.5 Tesla. 6 radiographic images were created with three 'b' value settings. Three radiologists then assessed areas of white matter, gray matter, proc. coronoid, basal ganglia and tumor lesions. The results were then analyzed using the Friedman statistical test.Results: The results showed that there were differences in signal intensity and image quality between the three setting values of 'b' with p value 0.005. The mean rank indicates that the best setting 'b' value in producing high signal intensity in Basal ganglia, Proc. coronoid and tumor lesions is 1500 s/mm2 (Mean rank: 2.75 and 2.42). then for white matter and gray matter the best 'b' value setting is 1000 s/mm2 (average rating: 2.50).Conclusion: There is a significant difference in MRI Brain image information with variations in the "b" values of 1000 s/mm2, 1500 s/mm2 and 2000 s/mm2 with pulse sequence Diffusion Weighted Imaging (DWI) using GE 1.5 Tesla MRI modality in patients with intracranial tumors (p 0.05). Keyword : DWI , ‘b’ value, Brain, Tumor, image information

Background: MRI examination of the brain using 3D CISS and 3D SPACE sequences is often used for cranial nerve-related diagnosis. MRI can show images of cranial nerves, subtentorial masses, and neurovascular compression. In this study, the Radiology Installation of RSPON Prof. Dr. Mahar Mardjono Jakarta used 3D SPACE sequences, but there were differences in the selection of sequences used in several other hospitals. The purpose of this study is to determine the difference in anatomical image information and the most optimal sequence in displaying image information between 3D CISS and 3D SPACE sequences with trigeminal neuralgia. Methods: This study was conducted on 10 patients with trigeminal neuralgia in the range of 40 - 75 years. The image assessment was carried out by three radiology specialists by assessing the clarity of CN V, root entry zone, Meckel's cave, SCA, and AICA. Anatomical information which was assessed with a score range of 1-3. The resulting data was ordinal data. Data analysis was carried out using the Wilcoxon statistical test. Results: The results of this study showed that there was a difference in anatomical image information between 3D CISS and 3D SPACE sequences which showed a p-value of 0.00 (p < 0.05). This study also shows that there was a difference in information from each anatomy assessed, so that the more optimal sequence in providing an overview of anatomical information on MRI examination of axial brain with trigeminal neuralgia is the 3D SPACE sequence with a mean rank value 25.00. Conclusions: There was a difference in anatomical image information between 3D CISS and 3D SPACE. 3D SPACE can provide a more optimal image of anatomical information and sharper image results when compared to 3D CISS and a shorter scanning time.

Diffusion Weighted Imaging (DWI) is a sequence used in brain tumor cases to assess molecular movement (diffusion). DWI is influenced by the selection of the b-value parameter which results in differences in the generated signal. The aim of this study is to determine the differences in b-value variations of 500, 1000, 1500 s/mm2 in brain tumor cases and identify the most optimal variation. This study is a pre-experimental study conducted using a 1.5 Tesla Philips MRI machine at a private hospital in South Jakarta from March to April 2023. The sample consisted of twelve DWI MRI images with different b-value variations. Visual grading analysis was performed by three radiology specialists, and the data were analyzed using the Friedman test in SPSS. The results showed a significant difference in image information based on the use of different b-value variations, with a p-value of 0.05 (2.36). The use of a b-value of 1000 s/mm had the highest mean rank in the basal ganglia, cerebellum, thalamus, pons, gray matter, and lesions. The difference in image information with b-value variations visualized different brain tumor representations due to increased noise with higher b-values and suboptimal image sharpness with lower b-values due to low signal intensity. The use of b-value variations of 500, 1000, 1500 s/mm2 resulted in differences in anatomical image information in sequences DWI MRI brain axial of brain cases tumor due to differences in image noise and signal intensity, with a b-value of 1000 s/mm being the most optimal variation.

To compare image quality (IQ) of reduced field-of-view (rFOV) and full FOV (fFOV) diffusion-weighted imaging (DWI) sequences at 3T, with histological T staging of rectal cancer as a reference standard. In all, 81 patients with rectal cancer received magnetic resonance (MR) scans (3.0T), including both rFOV and fFOV DWI sequences. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were quantitatively evaluated using the paired t-test. Two radiologists independently assessed subjective IQ parameters, including image sharpness, distortion, artifacts, lesion conspicuity, and overall subjective IQ of both sequences. The Wilcoxon signed rank test was used to compare subjective IQ scores and tumor apparent diffusion coefficients (ADCs) between DWI sequences. Spearman correlation analysis was used to correlate ADC values and corresponding T staging of rectal cancer. CNR was significantly higher in rFOV DWI than in fFOV DWI (7.15 ± 2.77 vs. 5.39 ± 2.08, P < 0.001). SNR was significantly higher in rFOV DWI than in fFOV DWI (44.17 ± 11.01 vs. 34.76 ± 13.30, P < 0.001). The subjective IQ parameters of rFOV DWI sequence were rated superior to those of fFOV DWI sequence by both readers (P < 0.001). No significant differences between mean tumor ADC values of both sequences (0.991 ± 0.121 vs. 0.100 ± 0.126 × 10-3 mm2 /s, P = 0.617) were noted. Apart from T1 stage, T staging of rectal cancer was inversely correlated with ADC values of rFOV DWI (r = -0.688, P < 0.001) and fFOV DWI sequences (r = -0.641, P < 0.001). The rFOV DWI sequence provided significantly better IQ and lesion conspicuity than the fFOV DWI sequence. In addition, rFOV and fFOV DWI sequences can be used in evaluation of histological T staging of rectal cancer. 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:967-975.

Magnetic resonance imaging (MRI) of the abdomen increasingly incorporates diffusion-weighted imaging (DWI) sequences. Whereas DWI can substantially aid in detecting and characterizing suspicious findings, it remains unclear to what extent the use of ultra-high b-value DWI might further be of aid for the radiologist especially when using DWI sequences with advanced processing. The target of this study was therefore to compare high and ultra-high b-value DWI in abdominal MRI examinations. This institutional review board-approved, prospective study included abdominal MRI examinations of 70 oncologic patients (mean age, 58 years; range, 21-90 years) examined with a clinical 1.5 T MRI scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) with an advanced echo planar DWI sequence (b = 0, 50, 900, and 1500 s/mm) after ex vivo phantom and in vivo volunteer investigations. High b900 and ultra-high b1500 DWIs were compared by a qualitative reading for image quality and lesion conspicuity using a 5-point Likert scale with 2 radiologists as readers. The ratios of apparent signal intensities of suspicious lesions/normal tissue of the same organ (LNTRs) were calculated. Appropriate methods were used for statistical analysis, including Wilcoxon signed-rank test and κ statistic for interreader agreement analysis (P < 0.05/0.0125/0.005 after Bonferroni correction). Image quality was significantly increased with b900 as compared with b1500 DWI (P < 0.001) despite using an advanced DWI sequence. A total of 153 suspicious lesions were analyzed. Overall reader confidence for characterization/detection of malignant lesions and, correspondingly, the LNTR (mean, 2.7 ± 1.8 vs 2.4 ± 1.6) were significantly higher with b900 than with b1500 DWI (P < 0.001 and P < 0.001). The increased confidence of lesion recognition and LNTR in the b900 DWI remained significant qualitatively in lymphatic and hepatic lesions and quantitatively in lymphatic, pulmonal, and osseous lesions. Using high b-value DWI (900 s/mm) provided an improved image quality and also lesion conspicuity as compared with ultra-high b-value DWI (1500 s/mm) in oncologic abdominal examinations despite using advanced processing. Consequently, the value for additional ultra-high b-value DWI in oncologic examinations should be critically evaluated in future studies.

Recent publications have suggested incorporating coronal diffusion-weighted imaging (DWI) sequences and axial DWI sequences to enhance the detection of posterior fossa infarcts (PFIs). This study evaluated the utility of coronal DWIs compared with axial DWIs for assessing PFIs in the emergency department (ED). A retrospective, institutional review board-approved study was conducted at a level I stroke center, including 118 patients who presented to the ED between 2016 and 2023 with suspected PFI. Inclusion criteria involved patients who underwent emergent 1.5 T magnetic resonance imaging (MRI) and had axial and coronal DWI sequences. Two neuroradiologists independently evaluated the DWI sequences for PFI detection in 2 rounds, with a 4-week interval between rounds. The neuroradiologists assessed the quality of axial and coronal DWIs using a 5-point Likert scale. Descriptive statistics, interrater reliability, and marginal homogeneity tests were performed. Among the 118 MRI scans, 23 (19%) showed PFI on axial and coronal DWI sequences. All 23 cases were identified on axial DWI, whereas 8 cases of PFI (35%) were not detected on coronal DWI ( P value = 0.013). No PFIs were observed on coronal DWI that was not identified on axial DWI. The quality scores for both raters were significantly higher for axial DWIs than coronal DWIs ( P value <0.00001). Despite recent recommendations advocating for the inclusion of coronal DWI in PFI detection, this study's findings indicate no improvement in PFI detection or image quality using coronal DWI. Further research is necessary to validate these results and explore the potential benefits of incorporating coronal DWI in assessing posterior fossa strokes.

The purpose of this study was to determine whether MRE performed with diffusion-weighted imaging (DWI) sequences is comparable to contrast-enhanced MRE in the detection of active small-bowel inflammation in pediatric patients with Crohn's disease (CD). We included in our study 68 patients with diagnosis of CD between April 2015 and June 2018 that underwent MRE examination. Examination protocol includes coronal and axial FISP, T2-w half-Fourier RARE and DWI sequences, a baseline coronal T1-w fat-saturated ultrafast (GRE) sequence followed by contrast 3D T1-w GRE. All images were assessed by two radiologists who graded each of bowel segments for the presence of inflammation on a four-point confidence scale on the basis of wall thickening and wall signal on DWI and ADC maps and comparing their results with post-contrast images. When considering all bowel segments, we found 41 true positive and 25 true negative on DWI. One false positive case corresponded to the absence of inflammatory histopathology changes at the level of the terminal ileum in a 15-year-old male, and one false negative case was in a 10-year-old female with only jejunal lesion. The corresponding sensitivity, specificity, PPV, NPV and accuracy were 97.6% (95% CI 67.7-99.7), 96.1% (95% CI 66.7-98.5), 97.6% (95% CI 70.8-98.4), 96.1% (95% CI 64.2-90.6) and 97% (95% CI 84.2-97.5), respectively. Analyzing the gadolinium-enhanced set, 35 true positive and 25 true negative results were found. One false positive case was found, and it was the same as with DWI. The corresponding sensitivity, specificity, PPV, NPV and accuracy were 83.3% (95% CI 65.9-86.7), 96.1% (95% CI 68.7-88.9), 97.2% (95% CI 84.3-98.7), 78.1% (95% CI 27.9-72.1) and 88.2% (95% CI 41.2-85.6), respectively. Sensitivity for the detection of active IBD lesion was significantly better with DWI than with CE-T1-w imaging (p = 0.002), whereas the specificity was similar (p = 0.743). Our study has shown that DWI sequences have a high accuracy in detecting the bowel segment affected by CD. These results emphasize the utility to include the DWI/ADC in standard MR enterography protocols and suggest that DWI could replace T1-weighted post-contrast sequences.

Prospective Comparison of Reduced Field-of-View (rFOV) and Full FOV (fFOV) Diffusion-Weighted Imaging (DWI) in the Assessment of Insulinoma: Image Quality and Lesion Detection

Usefulness of high b-value diffusion-weighted MRI in the diagnosis of Creutzfeldt-Jakob disease

Utilidad de la resonancia magnética cerebral con secuencia de difusión y valor b alto en el diagnóstico de la enfermedad de Creutzfeldt-Jakob

To obtain the optimal simultaneous-multislice (SMS)-accelerated diffusion-weighted imaging (DWI) of the liver at 3.0T MRI by systematically estimating the repeatability of apparent diffusion coefficient (ADC), signal-to-noise ratio (SNR) and image quality of different breathing schemes in comparison to standard DWI (STD) and other SMS sequences. In this institutional review board-approved prospective study, hepatic DWIs (b = 50, 300, 600s/mm2) were performed in 23 volunteers on 3.0T MRI using SMS and STD with breath-hold (BH-SMS, BH-STD), free-breathing (FB-SMS, FB-STD) and respiratory-triggered (RT-SMS, RT-STD). Reduction of scan time with SMS-acceleration was calculated. ADC and SNR were measured in nine anatomic locations and image quality was assessed on all SMS and STD sequences. An optimal SMS-DWI was decided by systematically comparing the ADC repeatability, SNR and image quality among above DWIs. SMS-DWI reduced scan time significantly by comparison with corresponding STD-DWI (27 vs. 42s for BH, 54 vs. 78s for FB and 42 vs. 97s for RT). In all DWIs, BH-SMS had the greatest intraobserver agreement (intraclass correlation coefficient (ICC): 0.920-0.944) and good interobserver agreement (ICC: 0.831-0.886) for ADC measurements, and had the best ADC repeatability (mean ADC absolute differences: 0.046-0.058 × 10-3mm2/s, limits of agreement (LOA): 0.010-0.013 × 10-3mm2/s) in nine locations. BH-SMS had the highest SNR in three representative sections except for RT-STD. There were no significant differences in image quality between BH-SMS and other DWI sequences (median BH-SMS: 4.75, other DWI: 4.5-5.0; P > 0.0.5). BH-SMS provides considerable scan time reduction with good image quality, sufficient SNR and highest ADC repeatability on 3.0T MRI, which is thus recommended as the optimal hepatic DWI sequence for those subjects with adequate breath-holding capability.

Clinical feasibility of accelerated diffusion weighted imaging of the abdomen with deep learning reconstruction: Comparison with conventional diffusion weighted imaging

Cervical cancer is the second most common gynecologic malignancy in Asia and is the leading cause of death in women in developing countries. The cervical cancer stage will significantly affect the prognosis and management. Based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 classification of cervical cancer, magnetic resonance imaging (MRI) has a crucial role in determining cervical cancer staging. This study aimed to evaluate the role of T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences in assessing cervical carcinoma, with the pathological diagnosis being taken as the standard for cervical cancer diagnosis. This study was conducted on seven patients diagnosed with cervical cancer from pathological examination in January 2020 to March 2021 in the Department of Radiology Dr. Hasan Sadikin General Hospital Bandung. We detect the presence of locoregional lesions and extensions of cervical carcinoma using MRI with T2WI and DWI sequences in patients who have previously been diagnosed histopathologically. This study involved seven cervical cancer patients. Pelvic MRI with T2WI and DWI sequences was performed. The imaging results in these patients show that one patient has stage IB1 cervical cancer, four patients have stage IIB, one patient has stage IIIA, and one has stage IIIC1 cervical cancer. This study concluded that T2WI and DWI sequences in MRI are essential and sufficient for diagnosing cervical cancer.