• He An, Xiaodong Ma, Ziyi Pan, Hua Guo, and LeeElaine Yuen PhinEYPhttp://orcid.org/0000-0002-0627-5297Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong, China. eyplee77@hku.hk..
• Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong, China.
• Eur Radiol. 2020 Apr 1; 30 (4): 1876-1884.

ObjectivesTo qualitatively and quantitatively compare the image quality between single-shot echo-planar (SS-EPI) and multi-shot echo-planar (IMS-EPI) diffusion-weighted imaging (DWI) in female pelvis METHODS: This was a prospective study involving 80 females who underwent 3.0T pelvic magnetic resonance imaging (MRI). SS-EPI and IMS-EPI DWI were acquired with 3 b values (0, 400, 800 s/mm2). Two independent reviewers assessed the overall image quality, artifacts, sharpness, and lesion conspicuity based on a 5-point Likert scale. Regions of interest (ROI) were placed on the endometrium and the gluteus muscles to quantify the signal intensities and apparent diffusion coefficient (ADC). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and geometric distortion were quantified on both sequences. Inter-rater agreement was assessed using κ statistics and Kendall test. Qualitative scores were compared using Wilcoxon signed-rank test and quantitative parameters were compared with paired t test and Bland-Altman analysis.ResultsIMS-EPI demonstrated better image quality than SS-EPI for all aspects evaluated (SS-EPI vs. IMS-EPI: overall quality 3.04 vs. 4.17, artifacts 3.09 vs. 3.99, sharpness 2.40 vs. 4.32, lesion conspicuity 3.20 vs. 4.25; p < 0.001). Good agreement and correlation were observed between two reviewers (SS-EPI κ 0.699, r 0.742; IMS-EPI κ 0.702, r 0.789). IMS-EPI showed lower geometric distortion, SNR, and CNR than SS-EPI (p < 0.050). There was no significant difference in the mean ADC between the two sequences.ConclusionIMS-EPI showed better image quality with lower geometric distortion without affecting the quantification of ADC, though the SNR and CNR decreased due to post-processing limitations.Key Points• IMS-EPI showed better image quality than SS-EPI. • IMS-EPI showed lower geometric distortion without affecting ADC compared with SS-EPI. • The SNR and CNR of IMS-EPI decreased due to post-processing limitations.

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