Optimization of Simultaneous Multislice, Readout-Segmented Echo Planar Imaging for Accelerated Diffusion-Weighted Imaging of the Head and Neck: A Preliminary Study

Role of advanced MRI sequences for thyroid lesions assessment. A narrative review

Despite not being the first imaging modality for thyroid gland assessment, Magnetic Resonance Imaging (MRI), thanks to its optimal tissue contrast and spatial resolution, has provided some advancements in detecting and characterizing thyroid abnormalities. Recent research has been focused on improving MRI sequences and employing advanced techniques for a more comprehensive understanding of thyroid pathology. Although not yet standard practice, advanced MRI sequences have shown high accuracy in preliminary studies, correlating well with histopathological results. They particularly show promise in determining malignancy risk in thyroid lesions, which may reduce the need for invasive procedures like biopsies. In this line, functional MRI sequences like Diffusion Weighted Imaging (DWI), Dynamic Contrast-Enhanced MRI (DCE-MRI), and Arterial Spin Labeling (ASL) have demonstrated their potential usefulness in evaluating both diffuse thyroid conditions and focal lesions. Multicompartmental DWI models, such as Intravoxel Incoherent Motion (IVIM) and Diffusion Kurtosis Imaging (DKI), and novel methods like Amide Proton Transfer (APT) imaging or artificial intelligence (AI)-based analyses are being explored for their potential valuable insights into thyroid diseases. This manuscript reviews the critical physical principles and technical requirements for optimal functional MRI sequences of the thyroid and assesses the clinical utility of each technique. It also considers future prospects in the context of advanced MR thyroid imaging and analyzes the current role of advanced MRI sequences in routine practice.

Clinical Applications and Recent Updates of Simultaneous Multi-slice Technique in Accelerated MRI

Simultaneous multi-slice (SMS) is a magnetic resonance imaging (MRI) acceleration technique that utilizes multi-band radio-frequency pulses to simultaneously excite and encode multiple slices. Currently, SMS has been widely studied and applied in the MRI examination to reduce acquisition time, which can significantly improve the examination efficiency and patient throughput. Moreover, SMS technique can improve spatial resolution, which is of great value in disease diagnosis, treatment response monitoring, and prognosis prediction. This review will briefly introduce the technical principles of SMS, and summarize its current clinical applications. More importantly, we will discuss the recent technical progress and future research direction of SMS, hoping to highlight the clinical value and scientific potential of this technique.

Improvement of image quality in diffusion-weighted imaging with model-based deep learning reconstruction for evaluations of the head and neck

OBJECTIVES

To investigate the utility of deep learning (DL)-based image reconstruction using a model-based approach in head and neck diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

We retrospectively analyzed the cases of 41 patients who underwent head/neck DWI. The DWI in 25 patients demonstrated an untreated lesion. We performed qualitative and quantitative assessments in the DWI analyses with both deep learning (DL)- and conventional parallel imaging (PI)-based reconstructions. For the qualitative assessment, we visually evaluated the overall image quality, soft tissue conspicuity, degree of artifact(s), and lesion conspicuity based on a five-point system. In the quantitative assessment, we measured the signal-to-noise ratio (SNR) of the bilateral parotid glands, submandibular gland, the posterior muscle, and the lesion. We then calculated the contrast-to-noise ratio (CNR) between the lesion and the adjacent muscle.

RESULTS

Significant differences were observed in the qualitative analysis between the DWI with PI-based and DL-based reconstructions for all of the evaluation items (p < 0.001). In the quantitative analysis, significant differences in the SNR and CNR between the DWI with PI-based and DL-based reconstructions were observed for all of the evaluation items (p = 0.002 ~ p < 0.001).

DISCUSSION

DL-based image reconstruction with the model-based technique effectively provided sufficient image quality in head/neck DWI.

Simultaneous multislice diffusion-weighted imaging versus standard diffusion-weighted imaging in whole-body PET/MRI

OBJECTIVE

To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection.

METHODS

Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52-71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50-400-800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50-300-800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type.

RESULTS

The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1-16.0) versus 7.0 min (IQR 6.7-7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76-10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10-0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02-2.07, p = 0.038).

CONCLUSIONS

In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions.

KEY POINTS

• Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection.

Improved Readout-Segmented Echo-Planner Diffusion-Weighted Magnetic Resonance Imaging of Nasopharyngeal Carcinoma Using Simultaneous Multislice Acquisitions at 3 T

This study systematically compared the images from readout-segmented echo-planar diffusion-weighted imaging (RESOLVE-DWI [RS-DWI]) and simultaneous multislice accelerated RESOLVE-DWI (SMS-RS-DWI) in patients with nasopharyngeal carcinoma (NPC) in qualitative and quantitative aspects.

Simultaneous multi-slice readout-segmentation of long variable echo-trains for accelerated diffusion-weighted imaging of nasopharyngeal carcinoma: A feasibility and optimization study

OBJECTIVES

We aimed to evaluate the feasibility of simultaneous multi-slice readout segmentation of long variable echo-trains (SMS-RESOLVE) for diffusion-weighted imaging (DWI) of nasopharyngeal carcinoma (NPC) and determine the optimal acceleration factor of SMS-RESOLVE DWI compared with conventional RESOLVE DWI.

MATERIALS AND METHODS

One hundred and five patients with histologically confirmed NPC were enrolled. DWIs including conventional RESOLVE DWI, SMS-RESOLVE DWI with acceleration factors of 2 and 3 (2 × SMS-RESOLVE and 3 × SMS-RESOLVE) were acquired at b-values of 0 and 800 s/mm². The subjective image quality, including overall image quality, lesion conspicuity, and lesion distortion scores, and objective image quality, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast in these three protocols, were assessed and compared. The apparent diffusion coefficients (ADCs) of the primary tumor and right masseter muscle and normalized ADCs in the three protocols were measured and compared.

RESULTS

The 2 × SMS-RESOLVE provided comparable image quality and ADCs with a 48.3% reduction in scan time compared with conventional RESOLVE DWI. The 3 × SMS-RESOLVE showed significantly poorer image quality and the highest ADCs with a 56.9% reduction in scan times compared with conventional RESOLVE DWI.

CONCLUSION

The SMS-RESOLVE DWI with an acceleration factor of 2 yielded the best compromise between image quality and scan time reduction and could be an alternative to conventional RESOLVE DWI for nasopharyngeal carcinoma.