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Advanced Diffusion-Weighted Abdominal Imaging: Qualitative and Quantitative Comparison of High and Ultra-High
Constantin Dreher, Tristan Anselm Kuder1, Franziska König2
1Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Introduction:
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.
Methods:
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).
Results:
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.
Conclusions:
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.
Insights
High b-value diffusion-weighted imaging (DWI) at 900 s/mm improves image quality and lesion detection in abdominal MRI for cancer patients compared to ultra-high b-values of 1500 s/mm. Further evaluation of ultra-high b-value DWI in oncologic imaging is recommended.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Diffusion-weighted imaging (DWI) is increasingly used in abdominal MRI for detecting and characterizing suspicious findings.
- The utility of ultra-high b-value DWI, especially with advanced processing, requires further investigation.
Purpose of the Study:
- To compare the effectiveness of high (b=900 s/mm²) versus ultra-high (b=1500 s/mm²) b-value DWI in abdominal MRI for oncologic patients.
Main Methods:
- A prospective study of 70 oncologic patients using a 1.5 T MRI scanner with an advanced echo planar DWI sequence.
- Comparison of b=900 and b=1500 s/mm² DWI by two radiologists using a 5-point Likert scale for image quality and lesion conspicuity.
- Calculation of lesion-to-normal tissue ratios (LNTRs) and statistical analysis.
Main Results:
- Image quality was significantly higher with b=900 s/mm² DWI compared to b=1500 s/mm² DWI (P < 0.001).
- Reader confidence for lesion characterization/detection and LNTRs were significantly higher with b=900 s/mm² DWI (P < 0.001).
- Improved lesion recognition and LNTRs with b=900 s/mm² DWI were significant in lymphatic, hepatic, pulmonal, and osseous lesions.
Conclusions:
- High b-value DWI (900 s/mm²) offers superior image quality and lesion conspicuity over ultra-high b-value DWI (1500 s/mm²) in abdominal oncologic MRI.
- The clinical value of additional ultra-high b-value DWI in oncologic examinations warrants critical evaluation in future research.
