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Advancing free-breathing liver diffusion-weighted imaging with Propeller-EPI: Improved image quality and ADC
Liyuan Liang1,2,3, Lu Wang4,5, Qiting Wu1
1Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China.
Medical Physics
|December 4, 2025
Summary
A new free-breathing liver diffusion-weighted imaging (DWI) technique using Propeller echo-planar imaging (DW-Propeller-EPI) significantly improves image quality and apparent diffusion coefficient (ADC) repeatability compared to standard methods.
Area of Science:
- Magnetic Resonance Imaging (MRI)
- Medical Imaging
- Hepatology
Background:
- Liver diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement is crucial for diagnosing liver diseases.
- Free-breathing (FB) liver DWI enhances patient comfort but faces challenges in maintaining image quality and ADC repeatability with standard diffusion-weighted single-shot echo-planar imaging (DW-ss-EPI).
Purpose of the Study:
- To develop an advanced FB liver DWI technique using diffusion-weighted Propeller echo-planar imaging (DW-Propeller-EPI) with motion compensation.
- To prospectively evaluate the performance of DW-Propeller-EPI against standard DW-ss-EPI regarding image quality and ADC repeatability.
Main Methods:
- Developed a DW-Propeller-EPI sequence and reconstruction pipeline with reference-free Nyquist ghost correction and motion compensation.
- Conducted in vivo evaluation comparing four techniques: three routine DW-ss-EPI (breath-holding, respiratory-triggering, FB) and one FB DW-Propeller-EPI.
- Assessed image quality via radiologist scoring and ADC repeatability using Bland-Altman analysis and ANOVA.
Main Results:
- FB DW-Propeller-EPI achieved significantly higher image quality ratings across all aspects compared to routine DW-ss-EPI (P < 0.001).
- FB DW-Propeller-EPI demonstrated superior ADC repeatability (LOA: 0.212 × 10⁻³ mm²/s) versus standard FB DW-ss-EPI (LOA: 0.255 × 10⁻³ mm²/s).
- ADC measurements were comparable between FB DW-Propeller-EPI and both respiratory-triggering and FB DW-ss-EPI techniques.
Conclusions:
- The proposed FB DW-Propeller-EPI technique provides high-quality free-breathing liver DWI with excellent ADC repeatability.
- This advanced technique surpasses conventional DW-ss-EPI in both image quality and ADC repeatability for FB liver DWI.
- FB DW-Propeller-EPI offers a promising solution for clinical applications, especially in patient populations requiring free-breathing MRI.
