Reduced Field-of-view Diffusion-Weighted Magnetic Resonance Imaging for Detecting Early Gastric Cancer: A Pilot Study Comparing Diagnostic Performance with MDCT and fFOV DWI

Introduction: Early detection of gastric cancer remains challenging for many of the current imaging techniques. Recent advancements in reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) have shown promise in improving the visualization of small anatomical structures. This study aimed to evaluate and compare the diagnostic performance of rFOV DWI with multi-detector computed tomography (MDCT) and conventional full field of view (fFOV) DWI for detecting early gastric cancer (EGC). Methods: This retrospective study included 43 patients with pathologically confirmed EGC. All participants underwent pre-treatment imaging, including CT scans and MRI with a prototype rFOV DWI and conventional fFOV DWI at 3 Tesla. Quantitative (signal-to-noise ratio SNR, contrast-to-noise ratio CNR) and qualitative (subjective image quality) assessments were performed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves and area-under-the-curve (AUC) analysis. Results: rFOV DWI demonstrated significantly higher SNR and CNR compared with fFOV DWI (P < 0.05). Subjective image quality scores were also superior for rFOV DWI (P < 0.05). In lesion detection, rFOV DWI showed higher sensitivity (0.705) than CT (0.636) and fFOV DWI (0.523). ROC analysis revealed that rFOV DWI had a higher AUC (0.829, 95% CI 0.764, 0.882) than fFOV DWI (0.734, 95% CI 0.661, 0.798, P = 0.02) and a modest improvement over CT (0.799, 95% CI 0.731, 0.856, P = 0.51). Discussion: The findings suggest that rFOV DWI provides superior image quality and diagnostic accuracy for EGC detection compared with conventional fFOV DWI. While it showed a trend toward better performance than CT, further studies with larger cohorts are needed to validate these results. Conclusion: rFOV DWI offers improved image quality and diagnostic performance for early gastric cancer detection compared with fFOV DWI, with a potential advantage over CT. This technique may enhance early diagnosis and clinical decision-making in gastric cancer management.