Jakob Weiss1, Jana Taron1, Ahmed E. Othman1, Petros Martirosian1, Sascha Kaufmann1, Ulrich Kramer1, Konstantin Nikolaou1, and Mike Notohamiprodjo1
1Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
Synopsis
To
evaluate the clinical performance of simultaneous multi-slice (sms)
diffusion-weighted imaging (DWI) of the prostate. A prototype sms-DWI sequence
was utilized and compared to conventional DWI sequences. Sms acquisition is
based on the recently introduced principle of simultaneously exciting and
acquiring multiple slices by a single radiofrequency (RF) pulse, thus
accelerating image acquisition directly by the number of simultaneously excited
slices (MB-factor). Image analyses revealed similar image quality and lesion
detection as compared to conventional DWI sequences at a substantially
decreased acquisition time. Sms-DWI seems a valuable alternative to
conventional DWI sequences for prostate imaging.Purpose
To assess the clinical impact of simultaneous
multi-slice (sms) single-shot echo-planar-imaging (EPI) for accelerated
diffusion-weighted imaging (DWI) of the prostate.
Material and Methods
43 patients with suspected prostate cancer (PC) were
consecutively included in this study. All examinations were performed at 3T (MAGNETOM, Skyra, Siemens Healthcare, Erlangen,
Germany). In all patients three DWI sequences with b-values of 50 and 800 s/mm
2
were acquired: 1) A prototype sms-DW-EPI sequence (Multi-Band EPI,
Release 012, Center for Magnetic Resonance Research, University of Minnesota,
MN, USA) was utilized. It is based on the recently introduced principle of
simultaneously exciting and acquiring multiple slices by a single
radiofrequency (RF) pulse and subsequently unaliasing those using parallel
imaging principles [1-3]. Thus, TR can be
reduced directly by the number of simultaneously excited slices (MB-factor).
Further improvement of this technique could be achieved by introducing the
blipped controlled aliasing in parallel imaging technique (blipped CAIPI) and
by using time-shifted RF pulses to reduce peak RF power [4, 5]. In this study
sms-DW-EPI sequence with MB-factor of 2 and blipped CAIPI with slice shift of
FOV phase/4 was utilized. Acquisition time for an average of 28 slices was 1:38
min. 2) Multi-shot-DW-EPI (ms-DW-EPI) sequence is based on dividing the k-space
trajectory into multiple readout segments and thus allowing time reduction for
TE and encoding-time. Average acquisition time was 6:02 min. 3) Conventional
single-shot EPI (ss-DW-EPI); acquisition time 3:29 min. A T2-weigthed turbo-spin-echo sequence in transversal and sagittal
planes served as standard of reference for adequate anatomic representation. In
all sequences the bipolar diffusion preparation scheme was used to compensate
for residual eddy currents and partially reduce the consequent image distortions.
All DWI measurements were
performed using diffusion gradients applied in three orthogonal directions
(three-scan trace) and parallel imaging using GRAPPA technique with an acceleration
factor of 2.
Diagnostic image quality (overall, anatomic
differentiability, lesion detection) and artifacts (noise, distortion) of
sms-DW-EPI were assessed qualitatively (5-point Likert scale, 5 = excellent,
two independent readers) and quantitatively (signal-to-noise-ratios, ADC
values) and compared to ms-DW-EPI and ss-DW-EPI.
Statistical
analyses were performed using SPSS (Version 22, IMB, Armonk/NY, USA).
ANOVA-analysis was calculated for normally distributed data. For qualitative
analysis non-parametric Friedman´s ANOVA was performed. Multiple comparisons
were accounted by using Bonferroni correction. P-values
< 0.05 were assumed to indicate significance.
Results
Scores for overall image quality (p=0.15) and lesion
detection (p=0.59) revealed no significant differences among the sequences. See Figure 1 and 2. Anatomic
differentiability of the central vs. the peripheral gland was rated significantly
higher for sms-DW-EPI as compared to ss-DW-EPI (p<0.01) whereas no
differences could be found between sms-DW-EPI and ms-DW-EPI (p=0.08). Noise
impairment was rated significantly higher in ms-DW-EPI than in sms-DW-EPI and
ss-DW-EPI respectively (p<0.0001). No significant difference could be found
regarding distortion artifacts (p=0.24). ADC values for prostate parenchyma and
histologically confirmed PC were lowest in sms-DW-EPI and highest in ss-DW-EPI
with significant differences between the sequences (p<0.0001). Sms-DW-EPI
showed comparable SNR to ss-DW-EPI and significantly higher SNR values than
ms-DW-EPI (p<0.05).
Discussion
In this study we demonstrated that sms acquisition is
a valuable new technique for diffusion weighted-MRI of the prostate. The main advantage
of sms-DWI is the dramatically decreased acquisition time. This is important,
because the number of prostate MRI will increase, resulting in the demand of a
higher patient throughput due to the recent implementation of prostate MRI into
clinical guidelines [6]. This is
reasonable since DWI of the prostate significantly increases sensitivity of PC
detection compared to T2-weigthed imaging alone and plays an important role in
suspect lesion stratification using the PI-RADS classification system [7, 8].
Usually three b-values are acquired (0, 50 and 800
s/mm
2) in standard DW imaging. Recently published studies could even
demonstrate the benefit of higher b-values (1000, 1500 or 2000 s/mm
2)
for improved tumor detection due to higher contrast ratios of tumor to healthy
tissue [9]. However, these
findings have not yet been implemented into the revised PI-RADS version [8]. Therefore, we
acquired our data guideline-conform at the standard b-values. Nevertheless, in
preliminary examinations we also acquired images with b-values of 1000 s/mm
2
and higher, however the resulting SNR was too low for adequate image
interpretation. One possibility to overcome this problem is to use accelerated
sms-DW-EPI at standard protocol acquisition time to gain higher SNR.
Conclusion
Simultaneous
multi-slice DWI of the prostate is a promising new acquisition technique
allowing for substantially reduced examination time with no significant
differences in image quality and similar lesion detection compared to
conventional DWI sequences.
Acknowledgements
The
authors kindly acknowledge the receipt of the multi-slice DW-EPI sequence used
in this study from the University of Minnesota, Center for Magnetic Resonance
Imaging. Furthermore, the authors acknowledge Christina Schraml for her helpful
comments in the preparation of this study.References
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