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Updated: Dec 11, 2025
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
Near-Silent and Distortion-Free Diffusion MRI in Pediatric Musculoskeletal Disorders: Comparison With Echo Planar
Jesse K Sandberg1, Victoria A Young1, Ali B Syed1
1Department of Radiology, Stanford University, Stanford, California, USA.
Background:
Diffusion-weighted imaging (DWI) is common for evaluating pediatric musculoskeletal lesions, but suffers from geometric distortion and intense acoustic noise.
Purpose:
To investigate the performance of a near-silent and distortion-free DWI sequence (DW-SD) relative to standard echo-planar DWI (DW-EPI) in pediatric extremity MRI.
Study Type:
Prospective validation study.
Subjects:
Thirty-nine children referred for extremity MRI.
Field Strength/Sequence:
DW-EPI and DW-SD, based on a rotating ultrafast sequence modified with sinusoidal diffusion preparation gradients, at 3T.
Assessment:
DW-SD image quality (Sanat ) was assessed from 0 (nondiagnostic) to 5 (outstanding) and comparative image quality (Scomp ) (from -2 = DW-EPI more delineated to +2 = DW-SD more delineated, 0 = same). ADC measured by DW-SD and DW-EPI were compared in bone marrow, muscle, and lesions.
Statistical Tests:
Wilcoxon rank-sum test and confidence interval of proportions (CIOP) were calculated for Scomp , Student's t-test, coefficient of variation (COV), and Bland-Altman analysis for ADC values, and intraclass correlation coefficient (ICC) for interreader agreement.
Results:
DW-SD and DW-EPI ADC values for bone marrow, muscle, and lesions were not significantly different (P = 0.3, P = 0.2, and P = 0.27, respectively) and had an overall ADC COV of 14.8% (95% confidence interval: 12.3%, 16.9%) and no significant proportional bias on Bland-Altman analysis. Sanat CIOP was rated diagnostic or better (score of 3, 4, or 5) in 72-98% of cases for bone marrow, muscle, and soft tissues. DW-SD was equivalent to or preferred over DW-EPI in muscles and soft tissues, with CIOP 86-93% and 93%, respectively. Lesions were equally visualized on DW-SD and DW-EPI in 40-51%, with DW-SD preferred in 44-56% of cases. DW-SD was rated significantly better than DW-EPI across all comparative variables that included bone marrow, muscle, soft tissue, cartilage, and lesions (P < 0.05). Readers had moderate to near-perfect (ICC range = 0.45-0.85).
Data Conclusion:
DW-SD of the extremities provided similar ADC values and improved image quality compared with conventional DW-EPI. Level of Evidence 2 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:504-513.
Insights
A new near-silent, distortion-free diffusion-weighted imaging (DWI) sequence improved image quality in pediatric extremity MRI. This advanced DWI technique provided similar apparent diffusion coefficient (ADC) values compared to standard echo-planar DWI (DW-EPI).
Area of Science:
- Medical Imaging
- Radiology
- Pediatric Imaging
Background:
- Diffusion-weighted imaging (DWI) is crucial for evaluating pediatric musculoskeletal lesions.
- Standard echo-planar DWI (DW-EPI) is limited by geometric distortion and acoustic noise.
Purpose of the Study:
- To evaluate a novel, near-silent, and distortion-free DWI sequence (DW-SD).
- To compare the performance of DW-SD against conventional DW-EPI in pediatric extremity MRI.
Main Methods:
- A prospective validation study involving 39 children undergoing extremity MRI at 3T.
- Utilized DW-EPI and DW-SD sequences, with DW-SD based on a modified rotating ultrafast sequence.
- Assessed image quality (Sanat, Scomp) and compared apparent diffusion coefficient (ADC) values in bone marrow, muscle, and lesions.
Main Results:
- DW-SD demonstrated significantly improved image quality compared to DW-EPI across various tissues and lesions (P < 0.05).
- ADC values derived from DW-SD and DW-EPI were comparable and showed no significant proportional bias.
- Image quality was rated diagnostic or better in 72-98% of cases, with DW-SD often preferred over DW-EPI.
Conclusions:
- The near-silent, distortion-free DW-SD sequence offers comparable ADC values to DW-EPI.
- DW-SD provides superior image quality, making it a promising alternative for pediatric extremity MRI.
- This technique addresses the limitations of conventional DWI, enhancing diagnostic accuracy and patient comfort.
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