A comprehensive quantitative and qualitative assessment of TGSE-BLADE DWI in postoperative imaging following intracranial tumor resection

Abstract

Purpose: Postoperative MRI plays a pivotal role in assessing residual disease and planning therapy after intracranial tumor resection. As acute perioperative infarction may mimic enhancing and non-enhancing tumor tissue in follow-up imaging, the initial postoperative MRI examination is essential for this purpose. However, conventional DWI techniques like RESOLVE are often impaired by artifacts from intracranial air. This study compares RESOLVE DWI with TGSE-BLADE DWI within early postoperative scans to improve diagnostic confidence in identifying ischemic changes.

Method: In a retrospective, institutional review board-approved study, 33 patients (mean age 52.3 ± 25.1 years) underwent a 1.5-Tesla MRI within 48 h of resection. RESOLVE and TGSE-BLADE DWI sequences were acquired in the same orientation and slice thickness of 5 mm. Two neuroradiologists blindly evaluated geometric distortion, susceptibility artifacts, overall image quality, and diagnostic confidence. Quantitative analysis included measuring signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC) values, image quality metrics and resection defect dimensions against T1-weighted images.

Results: TGSE-BLADE DWI exhibited significantly reduced geometric distortions and susceptibility artifacts near the resection site compared with RESOLVE DWI, producing superior qualitative image quality and diagnostic confidence (p < 0.001). Conversely, RESOLVE DWI yielded slightly higher SNR and CNR. Measurements of the resection defect on TGSE-BLADE DWI closely matched those on T1-weighted images (p = 0.974), while RESOLVE DWI showed a significant discrepancy (p < 0.001).

Conclusions: TGSE-BLADE DWI significantly minimizes artifacts and geometric distortions in intracranial postoperative imaging, thereby improving the detection of perioperative ischemic changes. This robust technique serves as an effective alternative to conventional EPI-based sequences in challenging settings with pronounced B₀ inhomogeneities, ultimately enhancing diagnostic confidence and patient care.

Keywords: Diffusion-weighted imaging; Intracranial tumors; Magnetic resonance imaging; Postoperative imaging.