Objective New magnetic resonance imaging (MRI) gradient technology enables the acquisition of ultrahigh b-value diffusion-weighted imaging (DWI). We assessed its impact on image quality and Prostate Imaging Reporting and Data System (PI-RADS) scores in prostate MRI. Materials and methods Participants with cancer suspicion prospectively underwent 3-T prostate MRI (maximum gradient strength 200 mT/m). Sequences with b-values of 0/800, 1,500, 2,500, 3,500, and 4,500 s/mm² were acquired. Lesion conspicuity was rated from 1 (non-diagnostic) to 5 (excellent). Apparent signal-to-noise ratios (aSNR) and acquisition times were determined. Cumulative link mixed-effects models, repeated measures ANOVA, and Cohen/Fleiss κ statistics were used. Results A total of 107 participants, aged 67 ± 8 years (mean ± standard deviation), were included. Compared to DWI(b1500), the DWI(b2500), DWI(b3500), and DWI(b4500) acquisitions were worse regarding both lesion conspicuity (median score, 5 [interquartile interval 4–5] versus 4 [3–4] versus 2 [2–3] versus 2 [1–2], respectively; all p < 0.001) and aSNR (19.0 ± 7.5 versus 12.7 ± 4.8 versus 11.8 ± 4.1 versus 11.4 ± 2.6, respectively; all p < 0.001). Acquisition times increased from DWI(b1500) (107 ± 9 s) to DWI(b4500) (329 ± 26 s). Cohen κ for PI-RADS score agreement was good to moderate (DWI(b2500): 0.87 [confidence interval 0.81, 0.94]; DWI(b3500): 0.75 [0.65, 0.84]; DWI(4500): 0.61 [0.49, 0.72]). Conclusion Acquired ultrahigh gradient DWI sequences with ultrahigh b-values in prostate MRI had worse image quality than standard b-values, while PI-RADS agreement between DWI(b1500) and DWI(b2500) was good. However, diagnostic estimates for clinically significant prostate carcinoma remained limited due to a small biopsy sample size (50/107 patients). Relevance statement Ultrahigh b-value DWI showed no improved diagnostic performance in comparison to standard b-value DWI regarding the identification of potential prostate cancer. Ultrahigh b-value should not replace standard high b-values (1,500 s/mm²) for imaging workup of patients with suspicion for prostate cancer. Key Points <UnorderedList Mark="Bullet"> <ItemContent> Acquired ultrahigh b-values (b2500–4500) using ultrahigh gradients of up to 140 T/m were utilized for prostate DWI. </ItemContent> <ItemContent> Both, overall image quality and diagnostic confidence decreased from good for DWI(b1500) to non-diagnostic for DWI(b4500). </ItemContent> <ItemContent> PI-RADS agreement between DWI(b1500) and DWI(b2500) was good, while it was only moderate between DWI(b1500) and DWI(b4500). </ItemContent> </UnorderedList> Graphical Abstract

Acquisition, image quality, and PI-RADS agreement of ultrahigh-gradient DWI in prostate 3-T MRI

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2026年2月23日

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Leon M. Bischoff,
Christoph Endler,
Philipp Krausewitz,
Joerg Ellinger,
Niklas Klümper,
Alexander Isaak,
Narine Mesropyan,
Dmitrij Kravchenko,
Daniel Kuetting,
Alois M. Sprinkart,
Petra Mürtz,
Claus C. Pieper,
Julian A. Luetkens

摘要

Objective

New magnetic resonance imaging (MRI) gradient technology enables the acquisition of ultrahigh b-value diffusion-weighted imaging (DWI). We assessed its impact on image quality and Prostate Imaging Reporting and Data System (PI-RADS) scores in prostate MRI.

Materials and methods

Participants with cancer suspicion prospectively underwent 3-T prostate MRI (maximum gradient strength 200 mT/m). Sequences with b-values of 0/800, 1,500, 2,500, 3,500, and 4,500 s/mm² were acquired. Lesion conspicuity was rated from 1 (non-diagnostic) to 5 (excellent). Apparent signal-to-noise ratios (aSNR) and acquisition times were determined. Cumulative link mixed-effects models, repeated measures ANOVA, and Cohen/Fleiss κ statistics were used.

Results

A total of 107 participants, aged 67 ± 8 years (mean ± standard deviation), were included. Compared to DWI(b1500), the DWI(b2500), DWI(b3500), and DWI(b4500) acquisitions were worse regarding both lesion conspicuity (median score, 5 [interquartile interval 4–5] versus 4 [3–4] versus 2 [2–3] versus 2 [1–2], respectively; all p < 0.001) and aSNR (19.0 ± 7.5 versus 12.7 ± 4.8 versus 11.8 ± 4.1 versus 11.4 ± 2.6, respectively; all p < 0.001). Acquisition times increased from DWI(b1500) (107 ± 9 s) to DWI(b4500) (329 ± 26 s). Cohen κ for PI-RADS score agreement was good to moderate (DWI(b2500): 0.87 [confidence interval 0.81, 0.94]; DWI(b3500): 0.75 [0.65, 0.84]; DWI(4500): 0.61 [0.49, 0.72]).

Conclusion

Acquired ultrahigh gradient DWI sequences with ultrahigh b-values in prostate MRI had worse image quality than standard b-values, while PI-RADS agreement between DWI(b1500) and DWI(b2500) was good. However, diagnostic estimates for clinically significant prostate carcinoma remained limited due to a small biopsy sample size (50/107 patients).

Relevance statement

Ultrahigh b-value DWI showed no improved diagnostic performance in comparison to standard b-value DWI regarding the identification of potential prostate cancer. Ultrahigh b-value should not replace standard high b-values (1,500 s/mm²) for imaging workup of patients with suspicion for prostate cancer.

Key Points

Acquired ultrahigh b-values (b2500–4500) using ultrahigh gradients of up to 140 T/m were utilized for prostate DWI.

Both, overall image quality and diagnostic confidence decreased from good for DWI(b1500) to non-diagnostic for DWI(b4500).

PI-RADS agreement between DWI(b1500) and DWI(b2500) was good, while it was only moderate between DWI(b1500) and DWI(b4500).

Graphical Abstract