Deep Resolve Boost in 2D MRI for Neuroradiology: A Comparative Evaluation of Diagnostic Gains and Potential Risks

Deep Resolve Boost (DRB) applied to accelerated acquisition (ACC) offers the potential to reduce MRI acquisition time and improve image quality. However, studies on the potential impact on artifacts, anatomic delineation, and the depiction of imaging findings are scarce. This study aims to fill this gap and evaluates the clinical performance of DRB-ACC in 2D MRI sequences.

In this prospective observational study, 256 paired 2D sequences (T2/turbo inversion recovery magnitude, and FLAIR) were acquired from 200 patients undergoing routine neuroradiologic MRI on a 3T scanner. For each examination, both standard and DRB-ACC (predominantly high strength) were acquired in the same session using identical scanner settings, except for acceleration factor; same surface coil, sequence orientation, and slice thickness. Image quality, anatomic structure delineation, artifact presence, and lesion conspicuity were independently assessed by 2 readers using standardized scoring.

DRB-ACC sequences demonstrated good or fair image quality in 94.5% of cases, with improved or unchanged quality compared with standard acquisition in 95.7% of sequences. However, anatomic delineation was inferior in key regions such as the hippocampus, brainstem, and cerebellum. Artifacts were more pronounced in 27.3% and newly introduced in 84.8% of the accelerated DRB sequences, commonly affecting the brainstem and deep gray matter. Lesion depiction was equivalent to standard images in 91.6% of cases, with limited instances of improved (7.2%) or degraded (1.2%) delineation.

DRB-ACC enables acceleration of 2D MRI while maintaining image quality and lesion visibility. At the same time, the presence of artifacts and reduced delineation of certain anatomic structures underscores the need for caution in the interpretation of image findings and selective use in clinical routine, particularly in clinical scenarios requiring high anatomic detail such as for epilepsy screening, or in cases with suspected brainstem pathology.