Echo-planar DWI variants: A comparative study in vertebral marrow pathology

• Published in: Journal of clinical ultrasound
• Main Authors: Kesen, Sevcihan, Tokgöz, Nil
• Format: Journal Article
• Language: English
• Published: United States 28.08.2024
• Subjects: Modic type I; metastasis; DWI; vertebra; single‐shot echo‐planar imaging; spondylodiscitis; bone marrow edema; readout‐segmented echo‐planar imaging
• ISSN: 0091-2751; 1097-0096; 1097-0096
• DOI: 10.1002/jcu.23779

Single-shot echo-planar imaging (ss-EPI) has limited application in vertebral column imaging due to numerous artifacts. Therefore, we aimed to compare readout-segmented echo-planar imaging (rs-EPI) to ss-EPI and assess its value in the differential diagnosis of vertebral infectious, tumoral infiltrative, and degenerative disorders. Sixty-six adult patients with spondylodiscitis (SD, n = 26), tumoral infiltration (TI, n = 20), or Modic type I degeneration (DE, n = 20) findings on spinal magnetic resonance imaging (MRI) included in this retrospective study. Two radiologists scored images for quality on a 4-point scale (image resolution, degree of geometric distortion, lesion selectivity, and diagnostic reliability) and measured signal intensity (SI), apparent diffusion coefficient (ADC), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). DE and SD groups also united to form the benign group. In all groups, rs-EPI performed better than ss-EPI in image quality, SNR, and CNR (p < .05). The difference between mean pathological ADC (ADC ) in the two sequences was statistically significant (p < .05). There was no significant difference between the groups in terms of ADC in rs-EPI (p = .229), unlike ss-EPI (p = .025). Pathological SI (SI ) and CNR in rs-EPI were significantly higher in the malignant group than benign group (p = .002, p < .001). In rs-EPI, no significant difference was found between malignant and benign groups' ADC (p = .13). The rs-EPI is a diffusion-weighted imaging (DWI) method with higher image quality that diminishes motion-induced phase errors and increases resolution through phase corrections. However, the distinction of malignant and benign vertebral bone marrow pathologies is unsatisfactory for rs-EPI compared with ss-EPI.