• Lin Cheng, Matthew D Blackledge, David J Collins, Matthew R Orton, Neil P Jerome, Thorsten Feiweier, Mihaela Rata, Veronica Morgan, Nina Tunariu, Martin O Leach, and Dow-Mu Koh.
• Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
• Comput. Biol. Med. 2016 Dec 1; 79: 92-98.

PurposeTo introduce T2-adjusted computed DWI (T2-cDWI), a method that provides synthetic images at arbitrary b-values and echo times (TEs) that improve tissue contrast by removing or increasing T2 contrast in diffusion-weighted images.Materials And MethodsIn addition to the standard DWI acquisition protocol T2-weighted echo-planar images at multiple (≥2) echo times were acquired. This allows voxelwise estimation of apparent diffusion coefficient (ADC) and T2 values, permitting synthetic images to be generated at any chosen b-value and echo time. An analytical model is derived for the noise properties in T2-cDWI, and validated using a diffusion test-object. Furthermore, we present T2-cDWI in two example clinical case studies: (i) a patient with mesothelioma demonstrating multiple disease tissue compartments and (ii) a patient with primary ovarian cancer demonstrating solid and cystic disease compartments.ResultsMeasured image noise in T2-cDWI from phantom experiments conformed to the analytical model and demonstrated that T2-cDWI at high computed b-value/TE combinations achieves lower noise compared with conventional DWI. In patients, T2-cDWI with low b-value and long TE enhanced fluid signal while suppressing solid tumour components. Conversely, large b-values and short TEs overcome T2 shine-through effects and increase the contrast between tumour and fluid compared with conventional high-b-value DW images.ConclusionT2-cDWI is a promising clinical tool for improving image signal-to-noise, image contrast, and tumour detection through suppression of T2 shine-through effects.Copyright © 2016. Published by Elsevier Ltd.

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