European journal of radiology · 2026
Simultaneous multi-slice diffusion weighted imaging of hepatocellular carcinoma at 3.0 T: Comparison of breath-hold, free-breathing, and respiratory-triggered techniques.
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Zhang Meng, Li Hanyu, Yang Ting, Yin Ting, Li Zhenlin, Ye Zheng
Аннотация
PURPOSE: This study aimed to evaluate the performance of simultaneous multi-slice diffusion weighted imaging (SMS-DWI) using breath-hold (BH), free-breathing (FB), and respiratory-triggered (RT) breathing schemes in patients with hepatocellular carcinoma (HCC), focusing on image quality and apparent diffusion coefficient (ADC) repeatability.
METHODS: This prospective study consecutively enrolled HCC patients between October 2020 and March 2023, based on specific inclusion and exclusion criteria. The patients underwent BH-SMS-DWI, FB-SMS-DWI and RT-SMS-DWI at b-values of 50, 400, and 800 s/mm2. Image quality was assessed qualitatively using a 5-point Likert scale. Besides, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC values were quantitatively measured. To evaluate the ADC repeatability, SMS-DWI scans were performed twice for each breathing scheme. The intraclass correlation coefficient (ICC) and test-retest variability (TRV) were used for assessment.
RESULTS: A total of 172 HCC patients with 189 HCC lesions were included for analysis. BH-SMS-DWI showed the shortest scan time but reduced image quality at high b-values (b = 800 s/mm2) compared to RT-SMS-DWI and FB-SMS-DWI. At b = 800 s/mm2, BH-SMS-DWI exhibited significantly lower overall image quality (3.37 ± 0.67, P < 0.001) compared to both RT-SMS-DWI (3.65 ± 0.69) and FB-SMS-DWI (3.63 ± 0.65), with no significant difference between them (P > 0.990). In addition, it also demonstrated inferior SNRs for both liver and tumor compared to RT-SMS-DWI (liver: 118.36 vs. 183.08, P < 0.001; tumor: 247.41 vs. 389.23, P < 0.001) and FB-SMS-DWI (liver: 118.36 vs. 161.52, P < 0.001; tumor: 247.41 vs. 323.48, P < 0.001). There were no significant differences in tumor ADC values across three breathing schemes. BH-SMS-DWI demonstrated the highest ADC repeatability (ICC: 0.86, 95% CI: 0.84-0.91; TRV: 9.17, 95% CI: 7.21-16.23), followed by FB-SMS-DWI (ICC: 0.83, 95% CI: 0.76-0.87; TRV: 14.27, 95% CI: 11.34-21.17), and RT-SMS-DWI (ICC: 0.80, 95% CI: 0.75-0.86; TRV: 14.36, 95% CI: 12.57-23.31).
CONCLUSION: FB-SMS-DWI is recommended as the most reliable and efficient option for clinical HCC imaging. BH-SMS-DWI, with superior ADC repeatability, is preferred for treatment monitoring and longitudinal follow-up in patients with sufficient breath-holding capability.
METHODS: This prospective study consecutively enrolled HCC patients between October 2020 and March 2023, based on specific inclusion and exclusion criteria. The patients underwent BH-SMS-DWI, FB-SMS-DWI and RT-SMS-DWI at b-values of 50, 400, and 800 s/mm2. Image quality was assessed qualitatively using a 5-point Likert scale. Besides, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC values were quantitatively measured. To evaluate the ADC repeatability, SMS-DWI scans were performed twice for each breathing scheme. The intraclass correlation coefficient (ICC) and test-retest variability (TRV) were used for assessment.
RESULTS: A total of 172 HCC patients with 189 HCC lesions were included for analysis. BH-SMS-DWI showed the shortest scan time but reduced image quality at high b-values (b = 800 s/mm2) compared to RT-SMS-DWI and FB-SMS-DWI. At b = 800 s/mm2, BH-SMS-DWI exhibited significantly lower overall image quality (3.37 ± 0.67, P < 0.001) compared to both RT-SMS-DWI (3.65 ± 0.69) and FB-SMS-DWI (3.63 ± 0.65), with no significant difference between them (P > 0.990). In addition, it also demonstrated inferior SNRs for both liver and tumor compared to RT-SMS-DWI (liver: 118.36 vs. 183.08, P < 0.001; tumor: 247.41 vs. 389.23, P < 0.001) and FB-SMS-DWI (liver: 118.36 vs. 161.52, P < 0.001; tumor: 247.41 vs. 323.48, P < 0.001). There were no significant differences in tumor ADC values across three breathing schemes. BH-SMS-DWI demonstrated the highest ADC repeatability (ICC: 0.86, 95% CI: 0.84-0.91; TRV: 9.17, 95% CI: 7.21-16.23), followed by FB-SMS-DWI (ICC: 0.83, 95% CI: 0.76-0.87; TRV: 14.27, 95% CI: 11.34-21.17), and RT-SMS-DWI (ICC: 0.80, 95% CI: 0.75-0.86; TRV: 14.36, 95% CI: 12.57-23.31).
CONCLUSION: FB-SMS-DWI is recommended as the most reliable and efficient option for clinical HCC imaging. BH-SMS-DWI, with superior ADC repeatability, is preferred for treatment monitoring and longitudinal follow-up in patients with sufficient breath-holding capability.