Feasibility of Simultaneous Multislice Acceleration Technique in Readout-Segmented Echo-Planar Diffusion-Weighted Imaging for Assessing Rectal Cancer

Background: Readout-segmented echo-planar imaging (rs-EPI) with simultaneous multislice (SMS) technology has been successfully applied to tumor research in many organs, but no feasibility study in rectal cancer has been reported, and the optimal acceleration of SMS with rs-EPI in rectal cancer has not been well determined yet. Objective: To investigate the feasibility of SMS rs-EPI of rectal cancer with different acceleration factors (AF(s)) and its influence on image quality, acquisition time and apparent diffusion coefficients (ADC(s)) in comparison to conventional sequences. Methods: All patients underwent rs-EPI and SMS rs-EPI with AF(s) of 2 and 3 (2 x SMS rs-EPI and 3 x SMS rs-EPI, respectively) using a 3T scanner. Acquisition times of the three rs-EPI sequences were measured. Image qualitative parameters (5-point Likert scale), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), geometric distortion, and apparent diffusion coefficient (ADC) values of the three sequences were compared. Results: A total of eighty-three patients were enrolled in our study. rs-EPI and 2 x SMS rs-EPI offered equivalently high overall image quality with a scan time reduction to nearly half (rs-EPI: 137 s, 2 x SM rs-EPI: 60 s). 3 x SMS rs-EPI showed significantly poorer image quality (p < 0.05). ADC values were significantly lower in 3 x SMS rs-EPI compared to rs-EPI in rectal tumors and normal tissue (tumor tissue: rs-EPI 1.19 +/- 0.21 x 10(-3) mm(2)/s, 3 x SMS rs-EPI 1.10 +/- 0.26 x 10(-3) mm(2)/s, p < 0.001; normal tissue: rs-EPI 1.68 +/- 0.13 x 10(-3) mm(2)/s, 3 x SMS rs-EPI 1.54 +/- 0.20 x 10(-3) mm(2)/s, p < 0.001). Conclusions: SMS rs-EPI using an AF of 2 is feasible for rectal MRI resulting in substantial reductions in acquisition time while maintaining diagnostic image quality and similar ADC values to those of rs-EPI when the slice distance and number of shots are the same among three rs-EPI sequences.