PSF-EPI与TGSE-BLADE DWI对颅内肿瘤成像质量的比较
本研究前瞻性纳入37例颅内肿瘤患者，在3T MRI上比较PSF-EPI与TGSE-BLADE两种无变形DWI序列的图像质量与ADC参数。结果显示PSF-EPI的肿瘤显示和整体图像质量更优，SNR更高，而两种序列间ADC测量无显著差异。
要点
- PSF-EPI显示颅内肿瘤的肿瘤描绘和整体图像质量优于TGSE-BLADE。
- 两种序列的肿瘤ADC值无显著差异，日常报告中可参照使用。
- TGSE-BLADE肿瘤对比度略高于PSF-EPI，但伪影和变形评分无显著差别。
核心结论
- 两种序列均可提供无变形成像，但PSF-EPI图像质量更好且实测SNR显著更高。
- PSF-EPI与TGSE-BLADE的ADC测量具有可比性。
- 当临床优先考虑病灶显著性和解剖轮廓时可优先选用PSF-EPI。
研究设计与样本
- 前瞻性研究，纳入37例颅内肿瘤患者，其中男性18例、女性19例，中位年龄11岁。
- 所有患者在3T MRI上均接受PSF-EPI和TGSE-BLADE两种DWI序列扫描。
- 由两名放射科医生独立评价定性指标，统计方法包括配对检验、Cohen's Kappa和Bland-Altman分析。
关键影像表现/征象
- PSF-EPI的肿瘤描绘评分显著优于TGSE-BLADE。
- 两种序列在伪影评分和几何变形评分上无显著差异。
- 肿瘤对比度在TGSE-BLADE上略高于PSF-EPI。
诊断标准与关键数值
- 肿瘤描绘评分PSF-EPI显著优于TGSE-BLADE，整体图像质量评分PSF-EPI显著更高。
- PSF-EPI的SNR显著高于TGSE-BLADE，而CNR在两种序列间无显著差异。
- 正常表现白质ADC在两种序列间无显著差异，平均差异小、一致性好。
- 肿瘤ADC在两种序列间无显著差异，但Bland-Altman分析显示肿瘤ADC差异离散度大于正常表现白质。
临床应用与阅片要点
- 当阅片重点为病灶显著性和解剖边界时，可优先选择PSF-EPI序列观察颅内肿瘤。
- 两种序列的ADC测量可互换参考，但肿瘤区域ADC一致性波动较正常白质更大。
- TGSE-BLADE的肿瘤对比度略高，在需要突出肿瘤与周围组织对比时可作为补充观察。
局限性
- 原文未报告本研究为单中心或样本量较小的局限性。
- 本研究纳入患者中位年龄为11岁，结果对成人颅内肿瘤的适用性可能有限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: To compare the image quality and quantitative parameters of point spread function-encoded echo planar imaging (PSF-EPI) and turbo gradient spin echo BLADE (TGSE-BLADE) for distortion-free diffusion-weighted imaging (DWI) of intracranial tumors.
MATERIALS AND METHODS: This prospective study included 37 patients (18 males, 19 females, median age: 11 years) with intracranial tumors who underwent 3 T MRI using both PSF-EPI and TGSE-BLADE DWI sequences. Two radiologists independently evaluated qualitative parameters, including tumor depiction, artifacts, geometric distortion, and overall image quality on a 5-point scale. Quantitative metrics, including signal-to-noise ratio (SNR), contrast, contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC), were measured. Statistical methods included paired tests, Cohen's Kappa statistics, and Bland-Altman analysis for assessing ADC agreement in normal-appearing white matter and tumors.
RESULTS: PSF-EPI demonstrated significantly better tumor depiction (p<0.01) and overall image quality (p<0.01) than TGSE-BLADE, with no significant difference in artifact (p=0.256) or distortion scores (p=0.389). Inter-rater agreement was substantial to almost perfect. Quantitatively, PSF-EPI yielded significantly higher SNR (p<0.001), whereas CNR was comparable between the two sequences (p=0.988). Tumor contrast was slightly higher in TGSE-BLADE than in PSF-EPI (p=0.034). In normal-appearing white matter, ADC measurements showed good agreement with only a small mean difference and no significant inter-sequence difference (p=0.097). Likewise, no significant inter-sequence difference in lesion ADC was observed (p=0.195), although ADC differences in tumors showed wider dispersion than those in normal-appearing white matter on Bland-Altman analysis.
CONCLUSION: While both sequences provide distortion-free imaging, PSF-EPI offers superior image quality and significantly higher measured SNR. ADC measurements were comparable between PSF-EPI and TGSE-BLADE. These findings support the use of PSF-EPI as a robust technique for intracranial tumor imaging, particularly when lesion conspicuity and anatomical delineation are clinically prioritized.
引用
- Zhong, Huang, Zhou, et al. Comparison of Point Spread Function Encoding EPI DWI and Turbo Gradient Spin Echo BLADE DWI for Imaging Intracranial Tumors. Acad Radiol. 2026. PMID: 42242995. doi:10.1016/j.acra.2026.05.009
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。