Evaluating the Application of MUSE Diffusion-Weighted Imaging in Esophageal Cancer in Comparison with HR and Single-Shot DWIs

Background/Objectives: To evaluate and compare the qualitative and quantitative image performance of multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) against conventional single-shot (ss-DWI) and high-resolution single-shot (HR-ssDWI) sequences in patients with esophageal cancer. Methods: Twenty patients who underwent esophagus MRI, including ss-DWI, HR-ssDWI and MUSE-DWI, were retrospectively enrolled. Image quality, esophageal contour, lesion conspicuity and image distortion were independently graded by two radiologists using a five-point scale and compared between the three sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of esophageal tissue were measured and compared between the three sequences. Results: After Bonferroni correction (p < 0.017), MUSE-DWI had significantly higher scores than HR-ssDWI in image quality, esophageal contour delineation and lesion conspicuity, and all three sequences had statistically significant differences in image distortion scores with MUSE-DWI performing the best. Quantitative analysis revealed that MUSE-DWI had the highest SNR and CNR values; significant differences were found in SNR between ss-DWI and HR-ssDWI (p < 0.001), and in both SNR and CNR between HR-ssDWI and MUSE-DWI (p < 0.001), while no significant differences were observed in SNR and CNR between ss-DWI and MUSE-DWI (p > 0.017). Conclusions: MUSE-DWI outperforms ss-DWI and HR-ssDWI in reducing image distortion, with comparable quantitative image quality metrics to ss-DWI. It represents a valuable optimized DWI technique for esophageal clinical imaging.