Abstract
Diffusion-weighted imaging (DWI) is widely utilized for evaluating uterine diseases. However, the prevalent technique, single-shot echo planar imaging (ssEPI), is hindered by notable image distortion and low spatial resolution. Therefore, optimizing uterine DWI sequences is vital for improving image quality. To investigate the efficacy of multiplexed sensitivity encoding (MUSE) combined with reverse polarity gradient (RPG) in enhancing uterine DWI quality and assessing local invasion in endometrial and cervical cancer, we included 149 patients. Each patient underwent DWI of the uterus using ssEPI, MUSE, and RPG-MUSE techniques. We compared these three sequences regarding image quality, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), geometric distortion rate (GDR), ADC values, accuracy in determining the extent of cancer invasion, and the Area Under the Curve (AUC) for identifying endometrial cancer and benign endometrial lesions using ADC values. The results indicated that RPG-MUSE DWI had less artifacts than MUSE and ssEPI (P < 0.05). Lesions were more apparent in MUSE and RPG-MUSE sequences compared to ssEPI (P < 0.05), with RPG-MUSE providing clearer lesion edges (P < 0.05). Additionally, RPG-MUSE DWI demonstrated higher SNR and CNR than ssEPI and MUSE (P < 0.05), along with a lower GDR (P < 0.05). The ADC values did not show significant differences among the three sequences (P > 0.05). Furthermore, the AUC of the ROC for detecting endometrial cancer and benign endometrial lesions using ADC values showed no significant differences across the sequences (P = 0.7609, 0.7186, and 0.8706, respectively). When combining each DWI sequence with T2WI for FIGO staging, RPG-MUSE and MUSE exhibited better alignment with pathology findings compared to ssEPI (P < 0.05). Overall, RPG-MUSE DWI showed fewer artifacts, higher SNR and CNR, reduced geometric distortion, and clearer lesion visualization compared to ssEPI and MUSE, leading to a more precise assessment of endometrial and cervical cancer invasion extent.