Comparison of multiplexed sensitivity encoding and single-shot echo-planar imaging for diffusion-weighted imaging in meningiomas: imaging quality, grading accuracy and proliferative activity prediction

Abstract

Background Diffusion-Weighted Imaging (DWI) is of key importance in evaluating biological behaviors of meningiomas, but the image quality of conventional single-shot echo-planar imaging DWI (ssEPI-DWI) is unsatisfactory due to susceptibility artifact near the skull. Our aim was to compare multiplexed sensitivity encoding DWI (MUSE-DWI) with ssEPI-DWI for the image quality, grading accuracy and proliferative activity prediction in meningiomas. Methods Consecutive 73 patients with pathologically proven meningiomas were included in this prospective study. Three neuroradiologists independently assessed the image quality using a 5-point Likert scale, while two other neuroradiologists calculated the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Inter-rater agreement was assessed using Intra-class correlation coefficient (ICC). Image quality scores, SNR and CNR were compared using the Wilcoxon signed-rank test. Histogram metrics of ADC values were extracted from the whole tumor. ROC curve, Delong test, and logistic regression analyses were performed to evaluate the diagnostic performance of single histogram parameters and combined models for tumor grading. The Spearman rank correlation method was applied to assess the correlation between histogram parameters and the Ki-67 labelling index (LI). Results Sharpness, distortion, susceptibility artifact, lesion conspicuity and overall image quality were significantly better in MUSE-DWI with good inter-rater agreement (p < 0.05; ICC: 0.83–0.90). Both SNR and CNR were significantly higher in MUSE-DWI (p < 0.05; ICC: 0.82–0.92). The best diagnostic accuracy was obtained by combining the 10th percentile (C10) and interquartile range (IQR) of ADC (An AUC of 0.774 for MUSE-DWI; 0.713 for ssEPI-DWI). The Delong test showed significant differences in diagnostic accuracy (p = 0.045). For MUSE-DWI, ADC IQR (p = 0.007) and variance (p = 0.040) were significantly positively correlated with Ki-67 LI. For ssEPI-DWI, only ADC IQR (p = 0.047) was significantly positively correlated with Ki-67 LI. Conclusion Compared with ssEPI-DWI, MUSE-DWI improves the image quality, enhancing the accuracy of meningioma grading and proliferative activity prediction.