Abstract
Objective This study is aimed at comparing the image quality and diagnostic performance of mean apparent diffusion coefficient (ADC) and lesion-to-spinal cord signal intensity ratio (LSR) derived from turbo spin-echo diffusion-weighted imaging (TSE-DWI) and echo-planar imaging- (EPI-) DWI in patients with a solitary pulmonary lesion (SPL). Methods 33 patients with SPL underwent chest imaging using EPI-DWI and TSE-DWI with b = 600 s/mm2 in free breathing. A comparison of the distortion ratio (DR), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) was drawn between the two techniques using a Wilcoxon signed-rank test. The interprotocol reproducibility between quantitative parameters of EPI-DWI and TSE-DWI was evaluated using a Bland-Altman plot. ADCs and LSRs derived from EPI-DWI and TSE-DWI were calculated and compared between malignant and benign groups using the Mann–Whitney test. Results TSE-DWI had similar SNR and CNR compared with EPI-DWI. DR was significantly lower on TSE-DWI than EPI-DWI. ADC and LSR showed slightly higher values with TSE-DWI, while the Bland-Altman analysis showed unacceptable limits of agreement between the two sequences. ADC and LSR of both DWI techniques differed significantly between lung cancer and benign lesions (P < 0.05). The LSR(EPI-DWI) showed the highest area under the curve (AUC = 0.818), followed by ADC(EPI-DWI) (AUC = 0.789), ADC(TSE-DWI) (AUC = 0.781), and LSR(TSE-DWI) (AUC = 0.748), respectively. Among these parameters, the difference in diagnostic accuracy was not statistically significant. Conclusions TSE-DWI provides significantly improved image quality in patients with SPL as compared with EPI-DWI. However, there was no difference in diagnostic efficacy between these two techniques, according to ADC and LSR.
Highlights
Diffusion-weighted imaging (DWI) is an essential magnetic resonance imaging (MRI) technique to assess water molecule diffusivity in living tissues
The mean signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were slightly lower in turbo spin-echo diffusion-weighted imaging (TSE-DWI) than those in echo-planar imaging- (EPI-)DWI; no significant difference was detected between the two sequences
We found that Turbo spinecho (TSE-)DWI provides distortion-free images with similar SNR and CNR compared with EPI-DWI
Summary
This study is aimed at comparing the image quality and diagnostic performance of mean apparent diffusion coefficient (ADC) and lesion-to-spinal cord signal intensity ratio (LSR) derived from turbo spin-echo diffusion-weighted imaging (TSE-DWI) and echo-planar imaging- (EPI-) DWI in patients with a solitary pulmonary lesion (SPL). ADCs and LSRs derived from EPI-DWI and TSE-DWI were calculated and compared between malignant and benign groups using the Mann–Whitney test. ADC and LSR of both DWI techniques differed significantly between lung cancer and benign lesions (P < 0:05). The LSR(EPI-DWI) showed the highest area under the curve (AUC = 0:818), followed by ADC(EPI-DWI) (AUC = 0:789), ADC(TSE-DWI) (AUC = 0:781), and LSR(TSE-DWI) (AUC = 0:748), respectively. Among these parameters, the difference in diagnostic accuracy was not statistically significant. TSE-DWI provides significantly improved image quality in patients with SPL as compared with EPI-DWI. There was no difference in diagnostic efficacy between these two techniques, according to ADC and LSR
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