Near-SilentandDistortion-FreeDiffusionMRIin Pediatric Musculoskeletal Disorders: Comparison With Echo Planar Imaging Diffusion

摘要

Background Diffusion-weighted imaging (DWI) is common for evaluating pediatric musculoskeletal lesions, but suffers from geometric distortion and intense acoustic noise. Purpose To investigate the performance of a near-silent and distortion-free DWI sequence (DW-SD) relative to standard echo-planar DWI (DW-EPI) in pediatric extremity MRI. Study Type Prospective validation study. Subjects Thirty-nine children referred for extremity MRI. Field Strength/Sequence DW-EPI and DW-SD, based on a rotating ultrafast sequence modified with sinusoidal diffusion preparation gradients, at 3T. Assessment DW-SD image quality (S-anat) was assessed from 0 (nondiagnostic) to 5 (outstanding) and comparative image quality (S-comp) (from -2 = DW-EPI more delineated to +2 = DW-SD more delineated, 0 = same). ADC measured by DW-SD and DW-EPI were compared in bone marrow, muscle, and lesions. Statistical Tests Wilcoxon rank-sum test and confidence interval of proportions (CIOP) were calculated for S-comp, Student'st-test, coefficient of variation (COV), and Bland-Altman analysis for ADC values, and intraclass correlation coefficient (ICC) for interreader agreement. Results DW-SD and DW-EPI ADC values for bone marrow, muscle, and lesions were not significantly different (P= 0.3,P= 0.2, andP= 0.27, respectively) and had an overall ADC COV of 14.8% (95% confidence interval: 12.3%, 16.9%) and no significant proportional bias on Bland-Altman analysis. SanatCIOP was rated diagnostic or better (score of 3, 4, or 5) in 72-98% of cases for bone marrow, muscle, and soft tissues. DW-SD was equivalent to or preferred over DW-EPI in muscles and soft tissues, with CIOP 86-93% and 93%, respectively. Lesions were equally visualized on DW-SD and DW-EPI in 40-51%, with DW-SD preferred in 44-56% of cases. DW-SD was rated significantly better than DW-EPI across all comparative variables that included bone marrow, muscle, soft tissue, cartilage, and lesions (P < 0.05). Readers had moderate to near-perfect (ICC range = 0.45-0.85). Data Conclusion DW-SD of the extremities provided similar ADC values and improved image quality compared with conventional DW-EPI. Level of Evidence 2 Technical Efficacy Stage 2