Abstract
ObjectivesTo qualitatively and quantitatively compare the image quality between single-shot echo-planar (SS-EPI) and multi-shot echo-planar (IMS-EPI) diffusion-weighted imaging (DWI) in female pelvisMethodsThis was a prospective study involving 80 females who underwent 3.0T pelvic magnetic resonance imaging (MRI). SS-EPI and IMS-EPI DWI were acquired with 3 b values (0, 400, 800 s/mm2). Two independent reviewers assessed the overall image quality, artifacts, sharpness, and lesion conspicuity based on a 5-point Likert scale. Regions of interest (ROI) were placed on the endometrium and the gluteus muscles to quantify the signal intensities and apparent diffusion coefficient (ADC). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and geometric distortion were quantified on both sequences. Inter-rater agreement was assessed using κ statistics and Kendall test. Qualitative scores were compared using Wilcoxon signed-rank test and quantitative parameters were compared with paired t test and Bland-Altman analysis.ResultsIMS-EPI demonstrated better image quality than SS-EPI for all aspects evaluated (SS-EPI vs. IMS-EPI: overall quality 3.04 vs. 4.17, artifacts 3.09 vs. 3.99, sharpness 2.40 vs. 4.32, lesion conspicuity 3.20 vs. 4.25; p < 0.001). Good agreement and correlation were observed between two reviewers (SS-EPI κ 0.699, r 0.742; IMS-EPI κ 0.702, r 0.789). IMS-EPI showed lower geometric distortion, SNR, and CNR than SS-EPI (p < 0.050). There was no significant difference in the mean ADC between the two sequences.ConclusionIMS-EPI showed better image quality with lower geometric distortion without affecting the quantification of ADC, though the SNR and CNR decreased due to post-processing limitations.Key Points• IMS-EPI showed better image quality than SS-EPI.• IMS-EPI showed lower geometric distortion without affecting ADC compared with SS-EPI.• The SNR and CNR of IMS-EPI decreased due to post-processing limitations.
Highlights
Magnetic resonance imaging (MRI) is used in the evaluation of malignant and benign diseases of the female pelvis due to its exquisite soft tissue resolution and anatomical details
Among the 68 patients who were included in the quantitative analysis, there were endometrial cancer (n = 37), benign diseases, uterine congenital anomalies (n = 2), other gynecological malignancies, and 4 cases with no structural abnormality found
We showed that interleaved multi-shot echo-planar imaging (IMS-EPI) had superior image quality and decrease geometric distortion compared with SSEPI without affecting apparent diffusion coefficient (ADC) quantification
Summary
Magnetic resonance imaging (MRI) is used in the evaluation of malignant and benign diseases of the female pelvis due to its exquisite soft tissue resolution and anatomical details. The DWI signal varies according to the tissue microarchitecture or cellularity, reflecting the proportion of intracellular and extracellular water molecules. The log of the slope of the signal decay on DWI is quantified by the apparent diffusion coefficient (ADC), a measure of the diffusion ability of the tissue under investigation [3]. SS-EPI can suffer from geometric distortion along tissue boundaries with different susceptibilities since it usually has low bandwidth along the phase-encoding direction [5]. SSEPI gives rise to low-resolution images and encounters difficulty with large field of view (FOV) [6]
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