Comparison of Echo Planar and Turbo Spin Echo Diffusion‐Weighted Imaging in Intraoperative MRI

Thorpe, James C.; Thust, Stefanie C.; Gillon, Claire H.M.; Rowe, Selene; Swain, Charlotte E.; MacArthur, Donald C.; Howarth, Simon P.; Avula, Shivaram; Morgan, Paul S.; Dineen, Rob A.

Abstract

Background
Diffusion-weighted imaging (DWI) is routinely used in brain tumor surgery guided by intraoperative MRI (IoMRI). However, conventional echo planar imaging DWI (EPI-DWI) is susceptible to distortion and artifacts that affect image quality. Turbo spin echo DWI (TSE-DWI) is an alternative technique with minimal spatial distortions that has the potential to be the radiologically preferred sequence.

Purpose
To compare via single- and multisequence assessment EPI-DWI and TSE-DWI in the IoMRI setting to determine whether there is a radiological preference for either sequence.

Study Type
Retrospective.

Population
Thirty-four patients (22 female) aged 2–61 years (24 under 18 years) undergoing IoMRI during surgical resection of intracranial tumors.

Field Strength/Sequence
3-T, EPI-DWI, and TSE-DWI.

Assessment
Patients were scanned with EPI- and TSE-DWI as part of the standard IoMRI scanning protocol. A single-sequence assessment of spatial distortion and image artifact was performed by three neuroradiologists blinded to the sequence type. Images were scored regarding distortion and artifacts, around and remote to the resection cavity. A multisequence radiological assessment was performed by three neuroradiologists in full radiological context including all other IoMRI sequences from each case. The DWI images were directly compared with scorings of the radiologists on which they preferred with respect to anatomy, abnormality, artifact, and overall preference.

Statistical Tests
Wilcoxon signed-rank tests for single-sequence assessment, weighted kappa for single and multisequence assessment. A P-value <0.001 was considered statistically significant.

Results
For the blinded single-sequence assessment, the TSE-DWI sequence was scored equal to or superior to the EPI-DWI sequence for distortion and artifacts, around and remote to the resection cavity for every case. In the multisequence assessment, all radiologists independently expressed a preference for TSE-DWI over EPI-DWI sequences on viewing brain anatomy, abnormalities, and artifacts.

Data Conclusion
The TSE-DWI sequences may be favored over EPI-DWI for IoMRI in patients with intracranial tumors.

Citation

Thorpe, J. C., Thust, S. C., Gillon, C. H., Rowe, S., Swain, C. E., MacArthur, D. C., Howarth, S. P., Avula, S., Morgan, P. S., & Dineen, R. A. (2024). Comparison of Echo Planar and Turbo Spin Echo Diffusion‐Weighted Imaging in Intraoperative MRI. Journal of Magnetic Resonance Imaging, https://doi.org/10.1002/jmri.29614

• Journal Article Type: Article
• Acceptance Date: Sep 5, 2024
• Online Publication Date: Oct 10, 2024
• Publication Date: Oct 10, 2024
• Deposit Date: Sep 10, 2024
• Publicly Available Date: Oct 11, 2025
• Journal: Journal of Magnetic Resonance Imaging
• Print ISSN: 1053-1807
• Electronic ISSN: 1522-2586
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1002/jmri.29614
• Keywords: diffusion, TSE diffusion, intraoperative MRI, neurosurgery, EPI diffusion
• Public URL: https://nottingham-repository.worktribe.com/output/39454350
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/jmri.29614