Comparison of the quality of prostate images from different diffusion-weighted imaging sequences: Single-shot echo-planar, reduced field-of-view, readout-segmented multi-shot

Objectives: The objectives of the study are to compare the prostate image quality (IQ) obtained with single-shot echo-planar diffusion-weighted imaging (ss-DWI), reduced field-of-view diffusion-weighted imaging (rf-DWI), and readout-segmented multi-shot diffusion-weighted imaging (rs-DWI), along with their diagnostic efficacy for clinically significant prostate cancer (csPCa), to optimize prostate magnetic resonance diffusion-weighted imaging sequences. Material and Methods: We have analyzed prostate images from 72 patients who underwent ss-DWI, rs-DWI, and rf-DWI magnetic resonance imaging (MRI) scans from March 2023 to September 2024. Two radiologists qualitatively evaluated the IQ of three diffusion-weighted imaging (DWI) sequences and corresponding apparent diffusion coefficient (ADC) images as well as Prostate Imaging Reporting and Data System Version 2.1 (PI-RADS v2.1) category of prostate nodules and measured the anterior-posterior diameter and right-left (RL) diameters of the prostate on both types of images and ADC values of prostate nodules. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Qualitative and quantitative differences across DWI techniques were statistically compared. Results: The rf-DWI images demonstrated optimal clarity, minimal distortion/artifacts, and the highest CNR and lowest SNR. The RL diameter of the prostate measured on T2-weighted images was larger than those on ss-DWI images, and the RL diameter measured on ss-DWI images was smaller than those measured on rf-DWI images ( P < 0.05). The rf-DWI-based PI-RADS v2.1 categorization and ADC values showed higher diagnostic accuracy for csPCa versus ss-DWI/rs-DWI, with optimal ADC cutoffs of 0.958 × 10 3 mm 2 /s (transition zone) and 0.769 × 10 3 mm 2 /s (peripheral zone). Conclusion: Compared to ss-DWI and rs-DWI, the rf-DWI sequence demonstrates optimal IQ and quantitative parameters with the optimum diagnostic performance for csPCa, making it the best choice for prostate scans.