Multishot cartesian turbo spin-echo diffusion imaging using iterative POCSMUSE Reconstruction

Purpose To report a diffusion imaging technique insensitive to off-resonance artifacts and motion-induced ghost artifacts using multishot Cartesian turbo spin-echo (TSE) acquisition and iterative POCS-based reconstruction of multiplexed sensitivity encoded magnetic resonance imaging (MRI) (POCSMUSE) for phase correction. Materials and Methods Phase insensitive diffusion preparation was used to deal with the violation of the Carr–Purcell–Meiboom–Gill (CPMG) conditions of TSE diffusion-weighted imaging (DWI), followed by a multishot Cartesian TSE readout for data acquisition. An iterative diffusion phase correction method, iterative POCSMUSE, was developed and implemented to eliminate the ghost artifacts in multishot TSE DWI. The in vivo human brain diffusion images (from one healthy volunteer and 10 patients) using multishot Cartesian TSE were acquired at 3T and reconstructed using iterative POCSMUSE, and compared with single-shot and multishot echo-planar imaging (EPI) results. These images were evaluated by two radiologists using visual scores (considering both image quality and distortion levels) from 1 to 5. Results The proposed iterative POCSMUSE reconstruction was able to correct the ghost artifacts in multishot DWI. The ghost-to-signal ratio of TSE DWI using iterative POCSMUSE (0.0174 ± 0.0024) was significantly (P < 0.0005) smaller than using POCSMUSE (0.0253 ± 0.0040). The image scores of multishot TSE DWI were significantly higher than single-shot (P = 0.004 and 0.006 from two reviewers) and multishot (P = 0.008 and 0.004 from two reviewers) EPI-based methods. Conclusion The proposed multishot Cartesian TSE DWI using iterative POCSMUSE reconstruction can provide high-quality diffusion images insensitive to motion-induced ghost artifacts and off-resonance related artifacts such as chemical shifts and susceptibility-induced image distortions. Level of Evidence: 1 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:167–174