Current Medical Imaging - Current Issue

This study aimed to explore the diagnostic value of multiorgan (heart, lungs, blood vessels) point-of-care ultrasound (PoCUS) in patients with high-risk and medium-to-low-risk pulmonary embolism (PE).

Clinical data of 92 patients with suspected PE, admitted to Hangzhou TCM Hospital affiliated with Zhejiang Chinese Medical University from July 2021 to June 2023, were retrospectively analyzed. According to hemodynamic status, patients were divided into the high-risk (n=28) and the medium-to-low-risk groups (n=64). Using computed tomography (CT) and pulmonary angiography (CTPA) as the gold standard, all patients underwent multiorgan PoCUS examination. The sensitivity, specificity, and accuracy of different methods for diagnosing PE, as well as the time difference between multiorgan PoCUS examination and CTPA, were compared. Differences in measurement values of relevant indicators in all groups were analyzed.

In the high-risk group of patients, CTPA identified 15 cases of PE. In contrast, the PoCUS examination confirmed PE diagnosis in 14 cases (true positive), while 10 cases were diagnosed as true negative, one case as false negative, and three cases as false positive. In the medium-to-low-risk group, CTPA identified 50 patients with PE, while multiorgan PoCUS confirmed PE diagnosis in 33 cases (true positive), and identified 9 true negative, 17 false negative, and 5 false positive PE cases. Kappa test of the consistency between the results of multiorgan PoCUS and CTPA showed that multiorgan PoCUS had higher sensitivity, negative predictive value, and accuracy in the high-risk group compared to the medium-to-low-risk group (p<0.05). Cohen's Kappa value of the high-risk group was 0.710, indicating moderate consistency between PoCUS and CTPA results, while Cohen's Kappa value of 0.231 for the medium and low-risk group indicated poor consistency. There was a significant difference in ultrasound parameters between the high-risk and the medium-to-low-risk group (p<0.05). The time required for multiorgan PoCUS in both groups was significantly shorter than that for the CTPA. There was no significant difference in the time required for PoCUS between the two groups (p>0.05).

Multiorgan PoCUS has been found to have higher sensitivity and accuracy in diagnosing patients with high-risk PE compared to those with medium-to-low-risk PE, and a shorter imaging time compared to CTPA.

Pneumocephalus and pneumorrhachis are rare postoperative complications, commonly occurring within a few days to months after spinal surgery. They are very rarely reported after thoracic surgeries. This case highlights a unique presentation in the emergency department involving headache and vomiting caused by late complications following thoracic surgery with a titanium rib implant.

A 64-year-old male presented to the emergency department with headache and vomiting without fever since prior 1 week. He had a history of left lower lobectomy and thoracic wall reconstruction with a titanium rib implant 40 days earlier due to epidermoid lung cancer. Computed tomography imaging of head and thorax revealed bilateral pneumocephalus and extensive pneumorrhachis. After removal of the rib implant and dural repair, the patient fully recovered.

This case underscores the importance of early imaging and diagnosis in patients presenting with neurological symptoms following thoracic surgery and emphasizes the need for enhanced monitoring protocols for patients with titanium implants.

Understanding brain changes in older patients with depression and their relationship with cognitive abilities may aid in the diagnosis of depression in this population. This study aimed to explore the association between brain lesions and cognitive performance in older patients with depression.

We utilized magnetic resonance imaging data from a previous study, which included older adults with and without depression. Smoothed Regional Homogeneity (ReHo) and local brain Amplitude of Low-frequency Fluctuation (ALFF) values were assessed to examine brain activity.

The analysis revealed decreased ReHo in the left middle temporal gyrus, left middle frontal gyrus, and left precuneus, as well as increased local ALFF in the right middle occipital gyrus, left postcentral gyrus, and right precentral gyrus in older patients with depression. These alterations may contribute to behavioral and cognitive changes. However, no significant relationship was found between ReHo values and Montreal Cognitive Assessment (MoCA) scores. In contrast, increased local ALFF in the left postcentral gyrus and right precentral gyrus was negatively correlated with MoCA scores.

This study demonstrated a significant association between regional brain alterations in patients with depression and cognitive behavior. Thus, this work identified functional brain regions and cognitive performance in older adults with depression, highlighting specific brain regions that play a crucial role in cognitive abilities in this population.

Mucinous Cystadenocarcinoma (MCA) of the breast remains a relatively rare condition, and to date, there is no systematic summary of its imaging manifestations. Therefore, this report presents a detailed account of the diagnosis and treatment of mucinous cystadenocarcinoma in a 40-year-old woman, with a particular focus on imaging findings. Additionally, we conducted a comprehensive literature review on this disease and summarized its key imaging features. This manuscript provides valuable insights and methodologies for the accurate diagnosis of mucinous cystadenocarcinoma.

We report a 40-year-old premenopausal woman who discovered multiple cysts in her left breast five years ago. Over the past two years, the size of these tumors has increased. Ultrasound examination indicated that the cysts had grown to 27 x 17mm. Following a puncture, the cysts were confirmed to be benign and were not monitored regularly. A year later, the patient's mass in the left breast increased, and an ultrasound exam indicated a suspicious mixed echo area in the upper outer quadrant, suggestive of a malignant lesion. Mammography showed amorphous suspicious calcifications in the lesion area, distributed in segments. Contrast-enhanced magnetic resonance imaging displayed non-mass-type enhancement of the lesion, with a dynamic enhanced imaging time-signal intensity curve (TIC) showing a rapidly rising plateau pattern. Postoperative pathology confirmed invasive carcinoma of the left breast along with mucinous cystadenocarcinoma. Four months after surgery, the patient developed multiple abnormal lymph nodes in the left axilla, which were confirmed to be metastasis upon pathology examination. Following radiotherapy, the patient's condition remained stable during the follow-up period.

Most MCA lesions typically exhibit clear borders and irregular edges, with some displaying expansive growth and compression of surrounding tissues. Mammography can reveal calcified components in lesions. Ultrasound often reveals an isoechoic or hypoechoic mass with well-defined borders but irregular edges. Magnetic resonance imaging (MRI) can show clear boundaries and uneven enhancement of the lesions, and the time-intensity curve (TIC) of the mass area often shows an inflow enhancement pattern.

Cervical cancer is a prevalent malignancy among women, often asymptomatic in early stages, complicating detection.

This study aims to investigate innovative techniques for early cervical cancer detection using a novel U-RCNNS model.

Cervical epithelial cell images stained with hematoxylin and eosin (HE) were analyzed using the U-RCNNS model, which integrates U-Net for segmentation and R-CNN for object detection, incorporating dilated convolution techniques.

The U-RCNNS model significantly improved the accuracy of detecting and segmenting cervical cancer cells, with the enhanced Mask R-CNN showing notable advancements over the baseline model.

The U-RCNNS model presents a promising solution for early cervical cancer detection, offering improved accuracy compared to traditional methods and highlighting its potential for clinical application in early diagnosis.

The aim of this study was to evaluate renal artery embolization in patients with spontaneous renal artery bleeding based on detailed angiographic findings and a comprehensive analysis of its efficacy and clinical outcomes.

This retrospective study evaluated the outcomes of renal artery embolization in 18 cases among 15 patients (11 men and 4 women; mean age: 57.9 years) treated for spontaneous renal bleeding at our institution between March 2017 and October 2023. Data derived from abdominal computed tomography (CT) and arteriography were analyzed to assess the effectiveness of embolization.

Most patients had end-stage renal disease or renal atrophy, with common findings on CT scans, including signs of active bleeding in 66.7% (10/15) and hematoma extending to the retroperitoneal space in 53.3% (8/15). Microcoils were commonly used for embolization (n = 10), with a technical success rate of 100% and primary and final clinical success rates of 80% and 100%, respectively. No major complications were reported during the follow-up, and clinical improvement was observed in all patients who underwent total embolization, with few instances of reduced hematoma size and renal atrophy.

Transarterial embolization is safe and effective for controlling spontaneous renal hemorrhage.

Cytomegalovirus (CMV) infection is common in the digestive and central nervous systems and can infect the entire digestive tract from the mouth to the rectum. In immunocompromised patients, CMV infection is prone to develop into CMV disease, especially in Acquired Immune Deficiency Syndrome (AIDS) patients. Severe cases may accelerate the progression of AIDS patients and form systemic CMV infection. Timely diagnosis and treatment are very important for the prognosis of patients.

In this paper, we report a 36-year-old man with a Human Immunodeficiency Virus (HIV) infection complicated with CMV colitis. Three weeks ago, he developed abdominal pain with fresh blood in the stool, accompanied by anal pain. He was found to be HIV positive 8 years ago. An enhanced CT scan showed edema and irregular thickening of the rectal wall, obvious enhancement of the mucosa, and multiple enlarged lymph nodes around. ¹⁸F-FDG PET/CT imaging displayed diffuse rectum wall thickening and increased glucose metabolism, and the SUV max was 12.7. There were multiple enlarged lymph nodes around the rectum, glucose metabolism was increased, and the SUVmax was 4.6.

¹⁸F-FDG-PET imaging technology has potential value in the diagnosis of CMV colitis, especially in immunocompromised patients. Detection of FDG concentrations in the colon wall can help diagnose CMV infection and understand the extent of the lesion, which is essential for the timely initiation of antiviral therapy.

Type 2 diabetes Mellitus (T2DM) increases vulnerability to metabolic dysfunction-associated steatotic liver disease (MASLD). Therefore, this study aims to determine the prevalence and coexistence of MASLD in patients with T2DM using ultrasound.

This cross-sectional retrospective study included 168 patients with T2DM from multiple diabetes clinics in Abha City, Asir region, recruited between August 2023 and December 2023. Adult patients aged 18 and over with T2DM were included, and data was extracted from patient files. All patients were examined by ultrasound to determine the prevalence and coexistence of MASLD in patients with T2DM. Hepatic steatosis on B-mode ultrasound is qualitatively classified on a four-point scale: normal (0), mild (1), moderate (2), and severe (3).

Out of 168 patients, 68.4% were identified with MASLD, mostly with diffuse liver (97.4%) diagnosed through ultrasound. MASLD was significantly higher in individuals with uncontrolled diabetes (72.5%) than those with controlled diabetes (46.2%), with a significant difference (p=0.015) and an odds ratio (OR) of 3.081, indicating uncontrolled diabetics are over three times more likely to develop MASLD. The uncontrolled group had a statistically significant larger liver size than the control group (13.6cm ±1.43 vs. 13.0cm ±1.20, respectively: [p=0.032, 95%CI 0.053-1.12]). Furthermore, a notable association was observed between increased BMI and the prevalence of MASLD in individuals with T2DM. Furthermore, no significant association was found between the duration of diabetes and the severity of MASLD, nor between the grading of MASLD and gender.

This study highlights a crucial association between uncontrolled diabetes and increased MASLD prevalence, emphasizing the importance of diabetes management in reducing MASLD risk.

Primary intracranial Ewing Sarcoma/peripheral Primitive Neuroectodermal Tumor (EWS/pPNET) is exceedingly rare and easy to misdiagnose.

We present a case involving a 23-year-old male who presented with headaches and vomiting. The preoperative brain imaging revealed an irregular mass in the left parietal lobe, initially misdiagnosed as meningioma. However, the surgical specimen was ultimately diagnosed as primary intracranial EWS/pPNET. The patient underwent a total tumor resection, followed by adjuvant chemotherapy and radiotherapy. No recurrence or distant metastasis was observed 18 months after the surgery.

When the imaging features of young patients’ lesions are solid, aggressive, and unevenly enhanced masses, physicians should be aware of the possibility of primary intracranial EWS/pPNET, and if possible, Gross Total Resection (GTR) and intensive chemotherapy and radiotherapy are recommended.

The purpose of this study was to establish the efficacy of ultrasound (US)-guided hydrodilatation of the glenohumeral joint, in conjunction with corticosteroid injection, in alleviating pain and improving shoulder joint adhesion among patients with primary frozen shoulder (FS).

FS, also known as adhesive capsulitis, is a pathological condition characterized by pain and potential functional impairment. The natural progression of FS involves three distinct stages: freezing, frozen, and thawing. Chronic pain in FS patients can lead to aseptic inflammation, thickening of fibroblasts, and an abundance of type I and III collagen fibers in the vicinity of the glenohumeral joint, ligaments, and tendons. This condition significantly impacts patients' quality of life.

A total of 200 FS patients were enrolled in this study. All participants underwent US-guided hydrodilatation of the glenohumeral joint, combined with corticosteroid injection, at our department. Pre- and post-treatment (1 year) ultrasound measurements were recorded for the thickness of the axillary recess capsule (ARC), coracohumeral ligament (CHL), and subacromial bursa. Additionally, the numerical rating scale (NRS) and Constant-Murley score (CMS) were assessed to evaluate pain intensity and shoulder function, respectively.

Prior to the commencement of treatment, the measurements indicated a thickness of 4.8±2.3 mm for the ARC, 4.2±1.7 mm for the CHL, and 3.9±1.4 mm for the subacromial bursa. Additionally, the preoperative assessment using the NRS scale for pain yielded a score of 6.4±2.0, while the CMS score for the joint function was 35.8±8.5. Following one year of treatment, a notable decrease was observed in the thickness of ARC, CHL, and subacromial bursa. Furthermore, significant improvements were recorded in both the pain NRS score and the CMS score.

US-guided hydrodilatation of the glenohumeral joint, in combination with corticosteroid injection, may help improve the symptom and function of FS.

Perforation is one of the rarest effects of Meckel's diverticulum and may clinically resemble acute appendicitis.

A 34-year-old woman with pain in the right iliac fossa, nausea, and vomiting for three days was brought to the emergency department. An abdominal examination indicated rebound tenderness in the area of the right iliac fossa. Abdominal ultrasound showed a heterogeneous lesion in the left iliac fossa measuring 5 cm × 3.5 cm × 4 cm with no internal vascularity. Abdominal Computed Tomography (CT) demonstrated a hypodense lesion located left of the midline of the abdomen, which was inseparable from the small bowel at the antimesenteric border. Laparoscopic exploration was performed, and an intraoperative diagnosis of perforated Meckel’s diverticulum with phlegmon formation was made. The patient had an uneventful recovery.

Radiologists should be aware of the possibility of complicated Merkel's diverticulum when encountering cases of acute abdominal pain. If there is a lower abdominal inflammatory process and a normal appendix is identified, there should be a high degree of suspicion when examining the CT scan.

Retroperitoneal nerve sheath tumors are uncommon, representing a small fraction of all primary retroperitoneal neoplasms. Accurate differentiation between benign and malignant forms is essential for optimal clinical management. This study assessed the clinical profiles and sonographic traits of retroperitoneal nerve sheath tumors with the goal of enhancing diagnostic precision and developing therapeutic strategies.

A retrospective analysis of patients diagnosed with retroperitoneal nerve sheath tumors who completed surgical treatment and underwent ultrasound imaging was carried out. Tumors were classified based on sonographic features and blood flow characteristics as per Adler's grading system. Statistical analysis was performed using SPSS 25.0. ROC curve analysis was carried out to determine the optimal diagnostic cutoff values.

A total of 57 patients were included in the study. There were no significant variances in age, gender, or tumor localization among the groups. However, pronounced disparities were observed in tumor number, size, shape, definition of borders, internal echo pattern, structural composition, presence of calcification, and blood flow signals between the classic and malignant groups. Notably, malignant tumors tended to manifest as larger masses with indistinct margins and irregular shapes. The maximum tumor diameter emerged as a discriminating factor for malignancy, with a diagnostic cutoff of 9.9 cm, yielding an AUC of 0.754 from the ROC curve analysis.

This study outlines the distinctive clinical and sonographic features of retroperitoneal nerve sheath tumors, with a particular focus on malignant subtypes. Ultrasonography emerges as a valuable diagnostic tool, contributing to the differentiation of tumor categories and potentially to the development of targeted treatment strategies. The identification of specific sonographic markers may facilitate the early detection and detailed characterization of these tumors, which could contribute to improved patient outcomes.

Lung cancer remains a leading cause of cancer-related mortality worldwide, necessitating early and accurate detection methods. Our study aims to enhance lung cancer detection by integrating VGGNet-16 form of Convolutional Neural Networks (CNNs) and Support Vector Machines (SVM) into a hybrid model (SVMVGGNet-16), leveraging the strengths of both models for high accuracy and reliability in classifying lung cancer types in different 4 classes such as adenocarcinoma (ADC), large cell carcinoma (LCC), Normal, and squamous cell carcinoma (SCC).

Using the LIDC-IDRI dataset, we pre-processed images with a median filter and histogram equalization, segmented lung tumors through thresholding and edge detection, and extracted geometric features such as area, perimeter, eccentricity, compactness, and circularity. VGGNet-16 and SVM employed for feature extraction and classification, respectively. Performance matrices were evaluated using accuracy, AUC, recall, precision, and F1-score. Both VGGNet-16 and SVM underwent comparative analysis during the training, validation, and testing phases.

The SVMVGGNet-16 model outperformed both, with a training accuracy (97.22%), AUC (99.42%), recall (94.22%), precision (95.28%), and F1-score (94.68%). In testing, our SVMVGGNet-16 model maintained high accuracy (96.72%), with an AUC (96.87%), recall (84.67%), precision (87.40%), and F1-score (85.73%).

Our experimental results demonstrate the potential of SVMVGGNet-16 in improving diagnostic performance, leading to earlier detection and better treatment outcomes. Future work includes refining the model, expanding datasets, conducting clinical trials, and integrating the system into clinical practice to ensure practical usability.

Axitinib is a selective inhibitor of vascular endothelial growth factor receptors and is used in the treatment of many malignancies. Herein, we reported a rare case with axitinib-induced retinal changesand associated toxicity.

A forty-five-year-old female presented with blurred vision who had been taking 7 mg of Axitinib bid for 5 months. Initial Best Corrected Visual Acuity (BCVA) was 20/32 at the right and counting fingers at the left eye. Funduscopic examination revealed bilaterally widespread intraretinal hemorrhages, cotton-wool spots, and hard exudates with a star-like appearance at the macula. The optical coherence tomography revealed central macular edema. There was hyperreflective edema in the inner layers, exudates in the middle retinal layers, and subfoveal subretinal fluid. Fundus fluorescein angiography revealed localized ischaemic findings in the early phase and multifocal perivascular ink-blot fluorescein leakage in the middle and late phases. Axitinib treatment was discontinued immediately, and at the third month of follow-up, the macular edema and fundus findings improved with a final BCVA of 20/20 at the right and 20/32 at the left eye.

Considering the ocular side effects of the patients receiving axitinib is crucial to prevent any potentially persistent visual loss.

Spinal image denoising plays a vital role in the accurate diagnosis of disc herniation (DH).

Traditional denoising algorithms perform less due Limited Directional Selectivity problem and do not adequately capture directional information in pixels. Traditional algorithms' edge representation and texture details are insufficient for the earlier detection of DH. Limited Directional Selectivity leads to inaccurate diagnosis and classification of Disc Herniation (DH) stages. The DH stages are (i) Degeneration (ii) Prolapse (iii) Extrusion and (iv) Sequestration. Moreover, detection of DH size below 2mm using MR image is the major problem.

To solve the above problem, spinal cord MR images fed to the proposed Parrot optimization tuned Denoising Convolutional Neural Network (Po-DnCNN) algorithm for perspective enhancement of nucleus pulposus region in the spinal cord, vertebrae. The perspective enhancement of Spinal cord image led to the accurate classification of stages and earlier detection of DH by using the proposed Hippopotamus optimization- Fast Hybrid Vision Transformer (Ho–FastViT) algorithm. For this study, spinal cord MR images are obtained from the Grand Challenge website – SPIDER dataset.

The proposed Po-DnCNN method and Ho-FastViT results are analysed quantitatively and qualitatively based on the edge, contrast, classification of the stage, and enhancement of the projected nucleus pulposus region in the spinal cord and vertebrae. The predicted DH results using the proposed method are compared with the manual Pfirrman Grade value of the spinal card method.

Proposed method is better than traditional methods for earlier detection of DH. Po-DnCNN and Ho-FastViat methods give high accuracy of about 98% and 97% compared to traditional methods.

Patients with Turner syndrome need hormone replacement therapy for puberty induction. However, it is not known whether inadequate hormone replacement therapy affects the pituitary.

Patients with Turner syndrome (n=35) and healthy control (n=20) (age/gender matched) subjects were included. MRI imaging of the pituitary was used to calculate pituitary volumes. According to the estradiol regimen, patients were divided into two groups; (i) those treated with low-dose conjugated oestrogen (CE, 0.625 mg) and (ii) those treated with combination therapy (ethinyl estradiol+sipropterone acetate; 35 mcg/2 mg). Pituitary measurements were calculated according to pituitary borders and their distances to each other via pituitary MRI.

Pituitary hyperplasia (0.58±0.15 cm³vs. 0.40±0.17 cm³) was determined in patients with low dose conjugated estrogen compared to the other patients or healthy control subjects (0.42±0.16 cm³) (p=0.005). Serum FSH levels of the patients treated with low dose CE were also higher compared to the patients who received combination therapy (p=0.001).

Inadequate hormone replacement therapy can cause devastating effects on the bones and uterine health and disrupts the pituitary structure.

Hypoxic-ischemic encephalopathy (HIE) is a brain injury that is caused by improper oxygen/blood flow. None of the existing works have concentrated on detecting HIE based on the sub-acute injury in the brain.

To enhance the accuracy and specificity of HIE detection, a comprehensive approach that includes SAI identification, BGT segmentation, and volume calculation will be utilized.

This study addresses the critical challenge of detecting hypoxic-schemic encephalopathy (HIE) through advanced image processing techniques applied to brain MRI data. The primary research questions focus on the effectiveness of the proposed CO-GW-RNN method in accurately identifying HIE and the impact of incorporating segmentation and clustering processes on detection performance.

The proposed method achieved remarkable results, demonstrating an accuracy of 98.98% and a specificity of 98.17%, significantly outperforming existing techniques such as the RUB classifier (84.6% accuracy) and the DTL method (94.00% accuracy).

These findings validate the effectiveness of the proposed methodology in improving HIE detection in brain MRI images.

This study aimed to compare automated three-dimensional Intrapulmonary Vessel Volume (IPVV) differences between lung and mediastinal windows in healthy individuals using quantitative measurements obtained from chest Computed Tomography (CT) plain scans.

A total of 258 participants (aged 21–83 years) with negative chest CT scans from routine physical examinations conducted between January to November 2023 were retrospectively enrolled. For each healthy participant, an algorithm was used to automatically extract total lung IPVVs as well as IPVVs for vessels of specific diameter. Differences in IPVVs were then compared between those extracted using the lung window and those extracted using the mediastinal window.

The IPVVs for the entire lung, intrapulmonary arteries, intrapulmonary veins, and small pulmonary vessels (categorized by different diameters) extracted from the lung window were significantly higher than those extracted from the mediastinal window (p<0.01). No significant sex-based differences in IPVV were observed for pulmonary arteries and veins with diameters between 0.8 and 1.6 mm, as well as pulmonary veins with diameters between 2.4 and 3.2 mm. However, in pulmonary arteries and veins with diameters between 1.6 and 2.4 mm, females had significantly higher IPVVs than males. In all other cases, IPVVs were larger in males than in females.

This method of automatic IPVV extraction and quantitative assessment has been proven to be feasible. Automated IPVV expression effectively identified morphological characteristics of intrapulmonary vessels. The study has concluded IPVVs extracted from the lung window to be generally larger than those extracted from the mediastinal window.

Early diagnosis of prostate cancer can improve the survival rate of patients on the premise of high-quality images. The prerequisite for early diagnosis is high-quality images. ZOOMit is a method for high-resolution, zoomed FOV imaging, allowing diffusion-weighted images with high contrast and resolution in short acquisition times. RESOLVE DWI is an advanced MRI technique developed to obtain high-resolution diffusion-weighted images with reduced susceptibility-related artifacts.

This study aimed to compare the image quality of conventional single-shot Echo-planar Imaging (ss-EPI) Diffusion-weighted Imaging (DWI), zoomed FOV imaging (ZOOMit) DWI, and readout segmentation of long variable echo-trains (RESOLVE) DWI sequences for prostate imaging, and optimize the strategy to obtain high-quality Magnetic Resonance Imaging (MRI) in order to discriminate malignant and benign prostate diseases.

Fifty-one patients were enrolled, including 31 with prostate cancer, 11 with prostate benign disease, and 9 with bladder cancer. Patients underwent MRI scans using T2-weighted (T2W), ss-EPI DWI, ZOOMit DWI, and RESOLVE DWI (b = 0, 50, 1400 s/mm²) sequences using a 3.0T MRI scanner. Subjective scores of image quality were evaluated by two independent radiologists. Differences in the subjective scores and objective parameters among the three sequences were compared. The agreement and consistency between the findings of the two raters were evaluated with Kappa or Intra-class Correlation Coefficient (ICC). Receiver Operating Characteristic (ROC) curves were used to distinguish malignant and benign prostate disease.

The agreement of subjective scores of 51 patients was high or moderate between the two radiologists (kappa: 0.529–0.880). ZOOMit displayed the highest clarity and the lowest distortion and artifacts compared to ss-EPI and RESOLVE. The two radiologic technicians obtained moderate or high consistency of objective measurement (ICC: 0.527–0.924). In the ROC analysis, ADCmean and Prostate Imaging Reporting and Data System (PI-RADS) scores for three sequences were comparable in differentiating prostate cancer from benign prostate disease (all p>0.05), in which ZOOMit indicated the highest Area Under the Curve (AUC) (0.930 and 0.790, respectively).

Compared to the other two sequences, ZOOMit can be deemed preferable to improve prostate MRI diffusion imaging as it has exhibited the highest AUC in identifying prostate cancer.