Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Nov 28, 2019; 11(11): 134-143
Published online Nov 28, 2019. doi: 10.4329/wjr.v11.i11.134
Comparison of free breathing and respiratory triggered diffusion-weighted imaging sequences for liver imaging
Janio Szklaruk, Jong Bum Son, Wei Wei, Priya Bhosale, Sanaz Javadi, Jingfei Ma
Janio Szklaruk, Priya Bhosale, Sanaz Javadi, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Jong Bum Son, Jingfei Ma, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Wei Wei, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: All authors contributed to the manuscript preparation, study design and data analysis; Wei W performed all statistical analyses; Bhosale P, Javadi S, Son JB and Szklaruk J acquired the data; Ma J and Szklaruk J contributed to the overall study design and implementation, data analysis.
Institutional review board statement: This study was approved by the University of Texas MD Anderson Cancer Center Institutional Review Board.
Conflict-of-interest statement: All authors declare that they have nothing to disclose except for Ma J. Ma J has ongoing financial relationships with GE Healthcare, Siemens Healthineers, and C4 Imaging. There are no family members who present a potential conflict of interest.
Data sharing statement: Not applicable
STROBE statement: The authors have read the STROBE checklist, and the manuscript was prepared and revised according to the STROBE checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Janio Szklaruk, MD, PhD, Doctor, Professor, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030, United States. jszklaru@mdanderson.org
Telephone: +1-713-7453230
Received: June 25, 2019
Peer-review started: June 29, 2019
First decision: August 2, 2019
Revised: August 26, 2019
Accepted: September 25, 2019
Article in press: September 25, 2019
Published online: November 28, 2019
ARTICLE HIGHLIGHTS
Research background

Diffusion-weighted imaging (DWI) in the body has several technical challenges. This include ghosting artifacts, mis-registration and susceptibility artifacts.

Research motivation

New DWI sequences have been developed to overcome some of these challenges. Our goal is to evaluate 3 new DWI sequences for liver imaging.

Research objectives

To compare the image quality and quantitative apparent diffusion coefficients (ADC) of 3 DWI sequences for in vivo liver imaging: Free-breathing (FB)-DWI, simultaneous multislice (SMS)-DWI, and prospective acquisition correction (PACE)-DWI.

Research methods

Magnetic resonance imaging (MRI) of the abdomen was performed at 1.5 T on 20 patients with liver lesions in this Institutional Review Board-approved prospective study. The MR study included 3 separate DWI sequences: FB-DWI, SMS-DWI, and PACE-DWI. The image quality, mean ADC values, standard deviations (SD) of the ADC, and quality of the ADC histogram were compared. Wilcoxon signed-rank tests were used to compare qualitative image quality scores. A linear mixed model was used to compare the mean ADC values and the SDs of the ADC values. All tests were 2-sided and P values of 0.05 or less were considered statistically significant.

Research results

PACE-DWI had the highest mean image quality score (4.48), followed by SMS-DWI (4.22) and FB-DWI (3.15). The image quality of PACE-DWI was rated superior to that of SMS-DWI and FB- DWI (P < 0.03). The quality of the PACE-DWI ADC histograms were better than the SMS-DWI and FB-DWI. The SD of the ADC values was not statistically significant in terms of difference for PACE-DWI and SMS-DWI (P = 0.18), whereas FB-DWI had significantly more variation in the SD of its ADC.

Research conclusions

PACE-DWI and SMS-DWI are equivalent in their ability to measure ADC. Compared to FB-DWI, both PACE-DWI and SMS-DWI provide better image quality and decreased variability in the quantitative diffusion measurement of liver lesions.

Research perspectives

Therefore, this technique may provide a better characterization of the intrinsic diffusion characteristics of the tumor than that provided by FB-DWI and SMS-DWI. However, both PACE-DWI and SMS-DWI provided better image quality with fewer artifacts and less variability in the ADC values. These are valuable in assessing tumor treatment response and comparably better than the FB-DWI technique.