Efficiency and Accuracy Evaluation of Multiple Diffusion‐Weighted MRI Techniques Across Different Scanners

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Background The choice between different diffusion‐weighted imaging (DWI) techniques is difficult as each comes with tradeoffs for efficient clinical routine imaging and apparent diffusion coefficient (ADC) accuracy. Purpose To quantify signal‐to‐noise‐ratio (SNR) efficiency, ADC accuracy, artifacts, and distortions for different DWI acquisition techniques, coils, and scanners. Study Type Phantom, in vivo intraindividual biomarker accuracy between DWI techniques and independent ratings. Population/Phantoms NIST diffusion phantom. 51 Patients: 40 with prostate cancer and 11 with head‐and‐neck cancer at 1.5 T Field Strength/Sequence Echo planar imaging (EPI): 1.5 T and 3 T Siemens; 3 T Philips. Distortion‐reducing: RESOLVE (1.5 and 3 T Siemens); Turbo Spin Echo (TSE)‐SPLICE (3 T Philips). Small field‐of‐view (FOV): ZoomitPro (1.5 T Siemens); IRIS (3 T Philips). Head‐and‐neck and flexible coils. Assessment SNR Efficiency, geometrical distortions, and susceptibility artifacts were quantified for different b‐values in a phantom. ADC accuracy/agreement was quantified in phantom and for 51 patients. In vivo image quality was independently rated by four experts. Statistical Tests QIBA methodology for accuracy: trueness, repeatability, reproducibility, Bland–Altman 95% Limits‐of‐Agreement (LOA) for ADC. Wilcoxon Signed‐Rank and student tests on P < 0.05 level. Results The ZoomitPro small FOV sequence improved b‐image efficiency by 8%–14%, reduced artifacts and observer scoring for most raters at the cost of smaller FOV compared to EPI. The TSE‐SPLICE technique reduced artifacts almost completely at a 24% efficiency cost compared to EPI for b‐values ≤500 sec/mm2. Phantom ADC 95% LOA trueness were within ±0.03 × 10−3 mm2/sec except for small FOV IRIS. The in vivo ADC agreement between techniques, however, resulted in 95% LOAs in the order of ±0.3 × 10−3 mm2/sec with up to 0.2 × 10−3 mm2/sec of bias. Data Conclusion ZoomitPro for Siemens and TSE SPLICE for Philips resulted in a trade‐off between efficiency and artifacts. Phantom ADC quality control largely underestimated in vivo accuracy: significant ADC bias and variability was found between techniques in vivo. Level of Evidence 3 Technical Efficacy Stage 2

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