Objective To compare the image quality and diagnostic value of field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding diffusion-weighted imaging (FOCUS-MUSE DWI) with single-shot echo-planar imaging (SS-EPI) DWI in gastric cancer. Materials and methods Patients with biopsy-proven gastric cancer who underwent FOCUS-MUSE and SS-EPI DWI were enrolled in this prospective study between February and October 2024. Qualitative image quality was evaluated by two radiologists using a standardized five-point scale. Quantitative comparisons of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) were conducted for all measurable lesions. Preoperative T-staging accuracy was compared between the two techniques, with pathological or surgical findings as the reference. Agreement between estimations was evaluated using weighted kappa values and Bland–Altman plots. Pairwise differences between sequences were assessed using the Wilcoxon signed-rank and McNemar tests. Results Among 177 patients (age 65.4 ± 9.8 years, mean ± standard deviation; 133 males), FOCUS-MUSE DWI outperformed SS-EPI DWI in lesion conspicuity and overall image quality (median scores, 5 versus 4; both p < 0.001). For 148 patients with measurable lesions, FOCUS-MUSE yielded higher SNR (33.6 and 34.6 versus 26.9 and 26.9) and CNR (7.1 and 7.7 versus 5.3 and 5.9; all p < 0.001). Among 128 patients with pathologically T1–4a (pT1–T4a), surgically T4b (sT4b), or pathologically T4b (pT4b), T-staging accuracy was higher with FOCUS-MUSE (64.8% and 63.3%) than SS-EPI (44.5% and 47.7%; both p < 0.001). Intra- and inter-reader agreement was good to excellent. Conclusions FOCUS-MUSE DWI demonstrated higher image quality and T-staging accuracy than SS-EPI DWI in gastric cancer. Relevance statement FOCUS-MUSE DWI provides improved image quality compared with conventional SS-EPI DWI and enables more accurate preoperative T staging in gastric cancer. These findings support the potential role of advanced DWI techniques in improving local tumor assessment. Key Points <UnorderedList Mark="Bullet"> <ItemContent> FOCUS-MUSE DWI demonstrated higher image quality compared to SS-EPI DWI in gastric cancer. </ItemContent> <ItemContent> FOCUS-MUSE DWI significantly improved preoperative T-staging accuracy over SS-EPI DWI. </ItemContent> <ItemContent> This advanced DWI technique shows potential to enhance preoperative risk stratification and surgical planning. </ItemContent> </UnorderedList> Graphical Abstract

Improved image quality and T-staging accuracy using FOCUS-MUSE DWI in gastric cancer: a prospective comparison with SS-EPI

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2026年6月17日

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Qiong Li,
Ya-Jun Hou,
Qian-Yun Jiang,
Jie Xu,
Qiu-Xia Feng,
Lei Yuan,
Pu-Yeh Wu,
Chen-Jiang Wu,
Xi-Sheng Liu,
Na-Na Sun

摘要

Objective

To compare the image quality and diagnostic value of field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding diffusion-weighted imaging (FOCUS-MUSE DWI) with single-shot echo-planar imaging (SS-EPI) DWI in gastric cancer.

Materials and methods

Patients with biopsy-proven gastric cancer who underwent FOCUS-MUSE and SS-EPI DWI were enrolled in this prospective study between February and October 2024. Qualitative image quality was evaluated by two radiologists using a standardized five-point scale. Quantitative comparisons of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) were conducted for all measurable lesions. Preoperative T-staging accuracy was compared between the two techniques, with pathological or surgical findings as the reference. Agreement between estimations was evaluated using weighted kappa values and Bland–Altman plots. Pairwise differences between sequences were assessed using the Wilcoxon signed-rank and McNemar tests.

Results

Among 177 patients (age 65.4 ± 9.8 years, mean ± standard deviation; 133 males), FOCUS-MUSE DWI outperformed SS-EPI DWI in lesion conspicuity and overall image quality (median scores, 5 versus 4; both p < 0.001). For 148 patients with measurable lesions, FOCUS-MUSE yielded higher SNR (33.6 and 34.6 versus 26.9 and 26.9) and CNR (7.1 and 7.7 versus 5.3 and 5.9; all p < 0.001). Among 128 patients with pathologically T1–4a (pT1–T4a), surgically T4b (sT4b), or pathologically T4b (pT4b), T-staging accuracy was higher with FOCUS-MUSE (64.8% and 63.3%) than SS-EPI (44.5% and 47.7%; both p < 0.001). Intra- and inter-reader agreement was good to excellent.

Conclusions

FOCUS-MUSE DWI demonstrated higher image quality and T-staging accuracy than SS-EPI DWI in gastric cancer.

Relevance statement

FOCUS-MUSE DWI provides improved image quality compared with conventional SS-EPI DWI and enables more accurate preoperative T staging in gastric cancer. These findings support the potential role of advanced DWI techniques in improving local tumor assessment.

Key Points

FOCUS-MUSE DWI demonstrated higher image quality compared to SS-EPI DWI in gastric cancer.

FOCUS-MUSE DWI significantly improved preoperative T-staging accuracy over SS-EPI DWI.

This advanced DWI technique shows potential to enhance preoperative risk stratification and surgical planning.

Graphical Abstract