Single shot echo planar imaging (ssEPI) vs single shot turbo spin echo (ssTSE) DWI of the orbit in patients with ocular melanoma.

Abstract

Diffusion weighted imaging (DWI) has become important for orbital imaging. However, the echoplanar imaging (EPI) DWI has inherent obstacles due to susceptibility to magnetic field inhomogeneities. We conducted a comparative study assessing the image quality of orbits in a patient cohort with uveal melanoma (UM). We hypothesized that single shot turbo spin echo (ssTSE) DWI would have better image quality in terms of less distortion and artifacts and yield better tissue evaluation compared to ssEPI-DWI. ssEPI-DWI and ssTSE-DWI of orbits were obtained from 50 patients with uveal melanoma who were prospectively enrolled in the study. Distortion ratio (DR), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diffusion signal properties, and apparent diffusion coefficient (ADC) values were collected and compared between ssEPI-DWI and ssTSE-DWI. Two reviewers evaluated and compared the geometric distortion, susceptibility and ghosting artifacts, resolution, demarcation of ocular mass, and overall quality. A higher DR was found in ssEPI-DWI compared to ssTSE-DWI (p < 0.001). SNR and CNR were lower for the temporal lobe cortex (p ≤ 0.004), but higher for melanoma in ssEPI-DWI than ssTSE-DWI (p ≤ 0.037). Geometric distortion and artifacts were more common in ssEPI-DWI (p < 0.001). Resolution (p ≤ 0.013) and overall quality (p < 0.001) were better in ssTSE-DWI. Ocular masses were demarcated better on ssEPI-DWI (p ≤ 0.002). Significant negative correlations between T1 and T2 signal intensities (r = -0.369, p ≤ 0.008) and positive correlations between T2 and both DWI signal intensities (r = 0.686 and p < 0.001 for ssEPI-DWI, r = 0.747 and p < 0.001 for ssTSE-DWI) were revealed. With less geometric distortion and susceptibility artifacts, better resolution, and overall quality, ssTSE-DWI can serve as an alternative to ssEPI-DWI for orbital DWI. ssTSE-DWI can be a better alternative of diffusion imaging of orbits with less susceptibility artifact and geometric distortion compared to ssEPI-DWI.