Comparison of simultaneous multi-slice single-shot DWI to readout-segmented DWI for evaluation of breast lesions at 3T MRI.

Abstract Purpose To compare diffusion-weighted imaging of the breast performed with a conventional readout-segmented echo-planar imaging (rs-EPI) sequence to when using a prototype simultaneous multi-slice single-shot EPI (SMS-ss-EPI) acquisition. Method From September 2017 to December 2018, 26 women with histologically proven breast cancer were scanned with the conventional rs-EPI and the SMS-ss-EPI at 3 T during the same imaging examination. Four breast radiologists (4-13 years of experience) independently scored both acquired series of 25 women (one case was used for training) for overall image quality (1: extremely poor to 9: excellent) and artifacts (1: very disturbing to 5: not present). All lesions (n = 52; 40 malignant, 12 benign) were also evaluated for visibility (1: not visible, 2: visible if location is given, 3: visible). In addition, lesion characteristics were rated, and a BI-RADS score was given. Results were analyzed using visual grading characteristics and the resulting area under the curve (AUCVGC), weighted kappa, McNemar test, and dependent-samples t-test when appropriate. Results Overall, radiologists significantly preferred the image quality in rs-EPI over that of SMS-ss-EPI (AUCVGC: 0.698, P = 0.002). Infolding and ghosting, and distortion artifacts were significantly less apparent in the rs-EPI (AUCVGC: 0.660, P = 0.022 and AUCVGC: 0.700 P = 0.002, respectively). Lesions were, however, significantly better visible on the SMS-ss-EPI images (AUCVGC: 0.427, P = 0.016). Malignant lesions had significantly higher visibility with SMS-ss-EPI (P = 0.035). Sensitivity and specificity were comparable between both sequences (P = 0.760 and P = 0.549, respectively). Conclusions Despite the perceived lower image quality and the increased presence of artifacts in the SMS-ss-EPI sequence, malignant lesions are better visualized using this sequence.