An international survey of diffusion and perfusion magnetic resonance imaging implementation in the head and neck

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OBJECTIVE: The goal of this international survey was to understand how diffusion (DWI) and perfusion imaging (PWI) are being applied to clinical head and neck imaging. METHODS AND MATERIALS: An online questionnaire focusing on acquisition, clinical indications, analysis, and reporting of qualitative DWI (QlDWI), quantitative DWI (QnDWI) and dynamic contrast-enhanced PWI (DCE-PWI) in the head and neck was circulated to members of the American Society of Head and Neck Radiology (ASHNR) and European Society of Head and Neck Radiology (ESHNR) over a 3-month period. Descriptive statistics and group comparisons were calculated with SPSS® v27. RESULTS: There were 294 unique respondents (17.6% response rate) from 256 institutions (182 ESHNR, 74 ASHNR). DWI was routinely acquired for some head and neck indications at 95.7% of the respondents' institutions, with 92.5% of radiologists interpreting QlDWI but only 36.7% analysing QnDWI. QlDWI was most frequently applied to primary mucosal masses or the middle ear, whilst QnDWI was routinely used to distinguish tumour histologies, and primary or recurrent carcinoma. DCE-PWI was routinely acquired at 53.6% of institutions and used by 40.8% of respondents, however, there was no clinical scenario in which it was routinely applied by most users. DCE-PWI analysis methods varied, with time-intensity curve classifications being the most frequently reported. Lack of standardisation was identified as a key reason for not implementing QnDWI, whilst numerous factors prevented the adoption of DCE-PWI. CONCLUSION: There is widespread routine interpretation of QlDWI by head and neck radiologists, but there is considerable variation in the application and analysis of head and neck QnDWI and DCE-PWI. KEY POINTS: Question How are diffusion (DWI) and dynamic contrast-enhanced perfusion imaging (DCE-PWI) being utilised by head and neck radiologists across a wide range of practices? Findings An international survey demonstrated widespread routine interpretation of qualitative DWI but variable application and analysis of quantitative DWI and DCE-PWI with numerous barriers to implementation. Clinical relevance The survey results will aid discussion on how to standardise and optimally disseminate these MRI techniques in day-to-day practice. More focused education and resource allocation may be required to accelerate the adoption of quantitative DWI and DCE-PWI.

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