Simultaneous multislice readout-segmented echo planar imaging for accelerated diffusion tensor imaging of the mandibular nerve: A feasibility study.

PURPOSE To assess the feasibility of diffusion tensor imaging (DTI) using simultaneous multislice (SMS) acquisition with blipped controlled aliasing in parallel imaging (CAIPI) for accelerated readout-segmented echo planar imaging (rs-EPI) of the mandibular nerves. DTI of the mandibular nerves using EPI is challenging due to susceptibility artifacts. Rs-EPI is less prone to artifacts but associated with longer scan durations. MATERIALS AND METHODS Eight asymptomatic volunteers were imaged at 3T using a 64-channel head/neck coil. Conventional, 2-fold (2xSMS) and 3-fold (3xSMS) slice-accelerated rs-EPI sequences were acquired. Tractography of the mandibular nerves was performed. Signal-to-noise ratio (SNR), fractional anisotropy (FA), mean diffusivity (MD), and number of tracts were calculated. Artifacts were evaluated qualitatively on Likert scales. Parameters were compared statistically. Clinical feasibility of 2xSMS rs-EPI was tested in four patients. RESULTS SNR was similar for conventional (mean ± SD; 8.55 ± 3.90) and 2xSMS rs-EPI (7.83 ± 3.15) but lower for 3xSMS rs-EPI (5.42 ± 2.93; analysis of variance, P = 0.004). FA was similar for all sequences (rs-EPI, 0.42 ± 0.08; 2xSMS rs-EPI, 0.43 ± 0.08; 3xSMS rs-EPI, 0.44 ± 0.06), while 3xSMS rs-EPI showed lower MD (rs-EPI, 0.0015 ± 0.0003; 2xSMS rs-EPI, 0.0014 ± 0.0001; 3xSMS rs-EPI, 0.0013 ± 0.0003) and lower number of tracts (rs-EPI, 66.56 ± 51.31; 2xSMS rs-EPI, 65.75 ± 55.40; 3xSMS rs-EPI, 37.93 ± 52.42) compared to rs-EPI and 2xSMS rs-EPI. Additionally, 2xSMS rs-EPI was feasible in four clinical patients and provided robust imaging results. CONCLUSION 2xSMS rs-EPI yielded similar SNR, FA, and MD values compared to conventional rs-EPI at reduced scan time and is feasible in clinical patients. These findings suggest the potential clinical applicability of rs-EPI for DTI of the mandibular nerve. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:663-677.