FOCUS-DWI improves prostate cancer detection through deep learning reconstruction with IQMR technology

This study explored the effects of using Intelligent Quick Magnetic Resonance (IQMR) image post-processing on image quality in Field of View Optimized and Constrained Single-Shot Diffusion-Weighted Imaging (FOCUS-DWI) sequences for prostate cancer detection, and assessed its efficacy in distinguishing malignant from benign lesions. The clinical data and MRI images from 62 patients with prostate masses (31 benign and 31 malignant) were retrospectively analyzed. Axial T2-weighted imaging with fat saturation (T2WI-FS) and FOCUS-DWI sequences were acquired, and the FOCUS-DWI images were processed using the IQMR post-processing system to generate IQMR-FOCUS-DWI images. Two independent radiologists undertook subjective scoring, grading using the Prostate Imaging Reporting and Data System (PI-RADS), diagnosis of benign and malignant lesions, and diagnostic confidence scoring for images from the FOCUS-DWI and IQMR-FOCUS-DWI sequences. Additionally, quantitative analyses, specifically, the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM), were conducted using T2WI-FS as the reference standard. The apparent diffusion coefficients (ADCs) of malignant and benign lesions were compared between the two imaging sequences. Spearman correlation coefficients were calculated to evaluate the associations between diagnostic confidence scores and diagnostic accuracy rates of the two sequence groups, as well as between the ADC values of malignant lesions and Gleason grading in the two sequence groups. Receiver operating characteristic (ROC) curves were utilized to assess the efficacy of ADC in distinguishing lesions. The qualitative analysis revealed that IQMR-FOCUS-DWI images showed significantly better noise suppression, reduced geometric distortion, and enhanced overall quality relative to the FOCUS-DWI images (P < 0.001). There was no significant difference in the PI-RADS scores between IQMR-FOCUS-DWI and FOCUS-DWI images (P = 0.0875), while the diagnostic confidence scores of IQMR-FOCUS-DWI sequences were markedly higher than those of FOCUS-DWI sequences (P = 0.0002). The diagnostic results of the FOCUS-DWI sequences for benign and malignant prostate lesions were consistent with those of the pathological results (P < 0.05), as were those of the IQMR-FOCUS-DWI sequences (P < 0.05). The quantitative analysis indicated that the PSNR, SSIM, and ADC values were markedly greater in IQMR-FOCUS-DWI images relative to FOCUS-DWI images (P < 0.01). In both imaging sequences, benign lesions exhibited ADC values markedly greater than those of malignant lesions (P < 0.001). The diagnostic confidence scores of both groups of sequences were significantly positively correlated with the diagnostic accuracy rate. In malignant lesions, the ADC values of the FOCUS-DWI sequences showed moderate negative correlations with the Gleason grading, while the ADC values of the IQMR-FOCUS-DWI sequences were strongly negatively associated with the Gleason grading. ROC curves indicated the superior diagnostic performance of IQMR-FOCUS-DWI (AUC = 0.941) compared to FOCUS-DWI (AUC = 0.832) for differentiating prostate lesions (P = 0.0487). IQMR-FOCUS-DWI significantly enhances image quality and improves diagnostic accuracy for benign and malignant prostate lesions compared to conventional FOCUS-DWI.