# Comparison of the Image Quality of Turbo Spin Echo and Echo-Planar Diffusion-Weighted Imaging of the Head and Neck Region

## TL;DR

This study compares two MRI techniques for the head and neck, finding that turbo spin echo provides clearer images and better lesion detection than echo-planar diffusion-weighted imaging.

## Contribution

The study provides a direct comparison of TSE and EP-DWI image quality in the head and neck region using SNR, CNR, and lesion detection metrics.

## Key findings

- TSE had significantly higher SNR and CNR than EP-DWI, indicating better image clarity and tissue differentiation.
- EP-DWI showed more artifacts and detected fewer lesions compared to TSE.
- Both techniques showed excellent inter-observer agreement, but TSE was more effective for anatomical assessment.

## Abstract

Background: Magnetic resonance imaging (MRI) of the head and neck region is notably challenging due to the complex anatomy and the critical need for high-resolution imaging to accurately diagnose various pathologies. The two prominent MRI techniques used in this context are turbo spin echo (TSE) and echo-planar diffusion-weighted imaging (EP-DWI). TSE is recognized for providing high-resolution anatomical images, whereas EP-DWI offers functional imaging that highlights the diffusion of water molecules, essential for detecting early pathological changes. This study aims to compare the image quality of TSE and EP-DWI in the head and neck region to assess their diagnostic efficacy and clinical utility.

Methods: This retrospective study was conducted at Saveetha Medical College and Hospital over six months. A total of 100 patients (50 males and 50 females, aged 18-65 years) with various head and neck pathologies were included. Patients underwent both TSE and EP-DWI sequences using a Philips MULTIVA 1.5 T scanner. Image quality was assessed based on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), artifact presence, and lesion detection. Two experienced radiologists independently reviewed the images, with inter-observer agreement calculated using Cohen's kappa coefficient.

Results: The mean SNR for TSE was significantly higher than EP-DWI (45.2 vs. 28.7, p<0.01), indicating superior image clarity and detail in TSE images. TSE demonstrated a higher mean CNR compared to EP-DWI (25.4 vs. 15.8, p<0.01), suggesting better differentiation between different tissue types and pathologies. Artifacts were more frequent in EP-DWI images (45% vs. 15%), with motion artifacts being the most common. TSE detected more lesions (120 vs. 95), with more precise delineation of lesions. The inter-observer agreement was excellent for both TSE and EP-DWI, with kappa values of 0.85 and 0.80, respectively.

Conclusion: TSE MRI provides superior image quality compared to EP-DWI for evaluating the head and neck region. The enhanced SNR and CNR in TSE images result in clearer and more detailed visualizations of anatomical structures and pathological changes, with fewer artifacts. While EP-DWI is valuable for functional imaging, its role should be complementary to TSE. The study suggests that TSE should be the preferred modality for detailed anatomical assessment in the head and neck region. Further studies with larger sample sizes and advanced imaging techniques may provide additional insights into optimizing MRI protocols for head and neck imaging.