An international survey of diffusion and perfusion magnetic resonance imaging implementation in the head and neck

The goal of this international survey was to understand how diffusion (DWI) and perfusion imaging (PWI) are being applied to clinical head and neck imaging.

An online questionnaire focusing on acquisition, clinical indications, analysis, and reporting of qualitative DWI (QlDWI), quantitative DWI (QnDWI) and dynamic contrast-enhanced PWI (DCE-PWI) in the head and neck was circulated to members of the American Society of Head and Neck Radiology (ASHNR) and European Society of Head and Neck Radiology (ESHNR) over a 3-month period. Descriptive statistics and group comparisons were calculated with SPSS® v27.

There were 294 unique respondents (17.6% response rate) from 256 institutions (182 ESHNR, 74 ASHNR). DWI was routinely acquired for some head and neck indications at 95.7% of the respondents' institutions, with 92.5% of radiologists interpreting QlDWI but only 36.7% analysing QnDWI. QlDWI was most frequently applied to primary mucosal masses or the middle ear, whilst QnDWI was routinely used to distinguish tumour histologies, and primary or recurrent carcinoma. DCE-PWI was routinely acquired at 53.6% of institutions and used by 40.8% of respondents, however, there was no clinical scenario in which it was routinely applied by most users. DCE-PWI analysis methods varied, with time-intensity curve classifications being the most frequently reported. Lack of standardisation was identified as a key reason for not implementing QnDWI, whilst numerous factors prevented the adoption of DCE-PWI.

There is widespread routine interpretation of QlDWI by head and neck radiologists, but there is considerable variation in the application and analysis of head and neck QnDWI and DCE-PWI.

Question How are diffusion (DWI) and dynamic contrast-enhanced perfusion imaging (DCE-PWI) being utilised by head and neck radiologists across a wide range of practices? Findings An international survey demonstrated widespread routine interpretation of qualitative DWI but variable application and analysis of quantitative DWI and DCE-PWI with numerous barriers to implementation. Clinical relevance The survey results will aid discussion on how to standardise and optimally disseminate these MRI techniques in day-to-day practice. More focused education and resource allocation may be required to accelerate the adoption of quantitative DWI and DCE-PWI.