ArticleEuropean radiology2025
Multi-orientation and prone-position ZOOMit diffusion-weighted imaging for predicting T stage in distal gastric cancer.
Article in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo compare the image quality of ZOOMit diffusion-weighted imaging (ZOOMit DWI) of distal gastric cancer in prone vs supine positioning and to determine whether multi-orientation ZOOMit DWI (M-ZOOMit) offers additional diagnostic value over axial ZOOMit DWI (A-ZOOMit). METHODS AND MATERIALS: This two-phase study enrolled patients with biopsy-confirmed distal gastric cancer who underwent pre-treatment MRI. In phase 1 (November 2021 to February 2022), participants underwent ZOOMit DWI in both standard supine and prone positions. Two radiologists independently evaluated image quality on supine and prone ZOOMit DWI using a 5-point Likert scale. In phase 2 (March 2022 to September 2023), participants were imaged solely in the prone position; they subsequently underwent radical surgery. Histopathological findings served as the reference standard. The accuracy of T staging based on uni-orientation (axial, coronal, and sagittal) vs M-ZOOMit was assessed by four additional radiologists. Reader consistency and agreement on image quality scores were evaluated using κ-agreement and Kendall W analyses.
resultsPhase 1 enrolled 30 patients (mean age, 62.0 years ± 11.5 [standard deviation]; 19 men); phase 2 enrolled 134 patients (mean age, 60.9 years ± 11.7; 81 men). Image quality scores assigned by both readers were significantly higher for prone ZOOMit DWI than for supine ZOOMit DWI (p < 0.001). Regarding overall T staging, M-ZOOMit and coronal ZOOMit DWI (C-ZOOMit) demonstrated significantly better performance relative to A-ZOOMit (both p < 0.05).
conclusionZOOMit DWI in the prone position provides superior image quality. M-ZOOMit and C-ZOOMit enhance T staging accuracy compared to A-ZOOMit for distal gastric cancer. KEY POINTS: Question DWI is a powerful technique, but poor image quality has remained a key limitation, hindering diagnostic accuracy for distal gastric cancer. Findings The prone-position ZOOMit DWI improved the image quality. Besides, multi-orientation and coronal ZOOMit DWI demonstrated superior performance relative to A-ZOOMit DWI for T staging. Clinical relevance The prone-position and M-ZOOMit DWI is a better imaging protocol for the T staging assessment of distal gastric cancer patients, replacing the conventional supine-position and axial DWI.
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