A Comparison of Methods for High-Spatial-Resolution Diffusion-weighted Imaging in Breast MRI.

Background Diffusion-weighted imaging (DWI) shows promise in detecting and monitoring breast cancer, but standard spin-echo (SE) echo-planar DWI methods often have poor image quality and low spatial resolution. Proposed alternatives include readout-segmented (RS) echo-planar imaging and axially reformatted (AR)-simultaneous multislice (SMS) imaging. Purpose To compare the resolution and image quality of standard SE echo-planar imaging DWI with two high-spatial-resolution alternatives, RS echo-planar and AR-SMS imaging, for breast imaging. Materials and Methods In a prospective study (2016-2018), three 5-minute DWI protocols were acquired at 3.0 T, including standard SE echo-planar imaging, RS echo-planar imaging with five segments, and AR-SMS imaging with four times slice acceleration. Participants were women undergoing breast MRI either as part of a treatment response clinical trial or undergoing breast MRI for screening or suspected cancer. A commercial breast phantom was imaged for resolution comparison. Three breast radiologists reviewed images in random order, including clinical images indicating the lesion, images with b value of 800 sec/mm2, and apparent diffusion coefficient (ADC) maps from the three randomly labeled DWI methods. Readers measured the longest dimension and lesion-average ADC on three DWI methods, reported measurement confidence, and rated or ranked the quality of each image. The scores were fit to a linear mixed-effects model with intercepts for reader and subject. Results The smallest feature (1 mm) was only detectible in a phantom on images from AR-SMS DWI. Thirty lesions from 28 women (mean age, 50 years ± 13 [standard deviation]) were evaluated. On the five-point Likert scale for image quality, AR-SMS imaging scored 1.31 points higher than SE echo-planar imaging and 0.74 points higher than RS echo-planar imaging, whereas RS echo-planar imaging scored 0.57 points higher than SE echo-planar imaging (all P < .001). Conclusion The axially reformatted simultaneous multislice protocol was rated highest for image quality, followed by the readout-segmented echo-planar imaging protocol. Both were rated higher than the standard spin-echo echo-planar imaging. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Partridge in this issue.

Nyquist ghost correction of breast diffusion weighted imaging using referenceless methods.

PURPOSE: Correction of Nyquist ghosts for single-shot spin-echo EPI using the standard 3-line navigator often fails in breast DWI because of incomplete fat suppression, respiration, and greater B0 inhomogeneity. The purpose of this work is to compare the performance of the 3-line navigator with 4 data-driven methods termed "referenceless methods," including 2 previously proposed in literature, 1 introduced in this work, and finally a combination of all 3, in breast DWI. METHODS: Breast DWI was acquired for 41 patients with SS SE-EPI. Raw data was corrected offline with the standard 3-line navigator and 4 referenceless methods, which modeled the ghost as a linear phase error and minimized 3 unique cost functions as well as the median solution of all 3. Ghost levels were evaluated based on the signal intensity in the background region, defined by a mask auto-generated from a T1 -weighted anatomical image. Ghost intensity measurements were fit to a linear mixed model including ghost correction method and b-value as covariates. RESULTS: All 4 referenceless methods outperformed the standard 3-line navigator with statistical significance at all 4 b-values tested (b = 0, 100, 600, and 800 s/mm2 ). CONCLUSIONS: Referenceless methods provide a robust way to reduce Nyquist ghosts in breast DWI without the need for any additional calibration scan.