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Improved image quality and detection of acute cerebral infarction with PROPELLER diffusion-weighted MR imaging
Kirsten P Forbes1, James G Pipe, John P Karis
1Division of Neuroradiology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013, USA.
Purpose:
To compare periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) multishot fast spin-echo diffusion-weighted magnetic resonance (MR) imaging with single-shot echo-planar diffusion-weighted MR imaging for image quality and visualization of acute cerebral infarction.
Materials And Methods:
Seventy subjects (35 men, 35 women; mean age, 55 years +/- 24 [SD]) who were suspected of having acute cerebral infarction (symptom duration, 2.8 days +/- 2.7) underwent PROPELLER and echo-planar MR imaging (b = 1,000 sec/mm(2)). Two neuroradiologists compared unlabeled images for presence of artifacts, visualization of infarction, and their preference of images. Interobserver agreement and image comparison were assessed by using the kappa statistic and the chi(2) test, respectively.
Results:
PROPELLER MR imaging reduced susceptibility artifacts (n = 70 subjects), which limited visualization of temporal (echo-planar, n = 64; PROPELLER, n = 0; P <.01, chi(2) test), frontal (echo-planar, n = 58; PROPELLER, n = 1; P <.01), and parietal lobes (echo-planar, n = 5; PROPELLER, n = 0; P <.05) and cerebellum (echo-planar, n = 36; PROPELLER, n = 0; P <.01) and brainstem (echo-planar, n = 23; PROPELLER, n = 0; P <.01). Acute infarction (n = 31 subjects) was better demonstrated at PROPELLER MR imaging (PROPELLER better, n = 18; echo-planar better, n = 1; PROPELLER and echo-planar equal, n = 12; P <.01, chi(2) test). PROPELLER MR imaging was preferred in all (n = 70) but one case in which the lesion lay within the intersection gap (PROPELLER preferred, n = 69; echo-planar preferred, n = 1; P <.01, chi(2) test).
Conclusion:
With a short increase in imaging time, PROPELLER MR imaging offers better image quality and detection of acute cerebral infarction than does echo-planar MR imaging.
Insights
Periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) MRI significantly reduces artifacts and improves visualization of acute cerebral infarction compared to echo-planar MRI. This advanced technique offers superior image quality for detecting early stroke.
Area of Science:
- Radiology
- Neuroimaging
- Medical Imaging
Background:
- Acute cerebral infarction detection is critical for timely treatment.
- Diffusion-weighted magnetic resonance imaging (DW-MRI) is essential for diagnosing acute stroke.
- Single-shot echo-planar imaging (EPI) is a common DW-MRI technique but is prone to artifacts.
Purpose of the Study:
- To compare the image quality and visualization of acute cerebral infarction using PROPELLER multishot fast spin-echo DW-MRI versus single-shot EPI DW-MRI.
- To evaluate the reduction of artifacts and the enhancement of infarction detection with PROPELLER imaging.
Main Methods:
- Seventy subjects with suspected acute cerebral infarction underwent both PROPELLER and EPI DW-MRI (b = 1,000 sec/mm(2)).
- Two neuroradiologists assessed images for artifacts, infarction visualization, and preference, using kappa statistics and chi(2) tests for analysis.
Main Results:
- PROPELLER imaging significantly reduced susceptibility artifacts across all brain lobes and the brainstem compared to EPI (P <.01).
- Acute infarction was better visualized with PROPELLER imaging (18 cases) than with EPI (1 case), with 12 cases rated equal (P <.01).
- PROPELLER imaging was overwhelmingly preferred by radiologists (69 of 70 cases).
Conclusions:
- PROPELLER DW-MRI provides superior image quality and artifact reduction compared to EPI DW-MRI.
- This technique enhances the detection of acute cerebral infarction, offering a valuable improvement for stroke diagnosis.
- Despite a slight increase in imaging time, PROPELLER imaging is recommended for its diagnostic advantages.