Deep Learning-Based Distortion Correction for Brain Diffusion-weighted Imaging: A Prospective Comparison With Single-shot and Readout-segmented Echo-planar Imaging.

BACKGROUND: Single-shot echo-planar imaging DWI (ss-EPI DWI) is susceptible to geometric distortions near air-tissue interfaces, limiting diagnostic accuracy. Multishot readout-segmented DWI (RESOLVE DWI) mitigates these artifacts but requires longer acquisition times. This study evaluated whether ss-EPI DWI with a deep learning-enabled correction of static field inhomogeneities (DL DWI) can achieve effective distortion correction while preserving diagnostic reliability and reducing scan time. OBJECTIVES: To compare image quality, geometric distortion, lesion detectability, and diagnostic confidence of ss-EPI DWI with DL-enabled correction of static field inhomogeneities (DL DWI) against conventional ss-EPI DWI (without correction) and RESOLVE DWI. MATERIALS AND METHODS: In this prospective single-center study (April 2025 to August 2025), 100 patients undergoing clinically indicated brain MRI were enrolled following written informed consent. All patients underwent DL ss-EPI DWI with DL correction (1 min 29 s) and RESOLVE DWI (3 min 17 s); ss-EPI DWI was reconstructed by disabling DL correction for all patients. Qualitative and quantitative analyses were performed. Three board-certified radiologists rated image quality, lesion detectability, distortion, and diagnostic confidence on a 5-point Likert Scale. Two quantitative measures of distortion were applied: geometric conformity with anatomic 3D T1-weighted data through coregistration methods and gray-value distributions within volumes of interest in susceptibility-affected regions (temporal lobe, cerebellum, and brainstem). RESULTS: DL DWI significantly outperformed ss-EPI DWI across all qualitative parameters, including diagnostic confidence (median, 4.0 vs. 3.0; P < 0.001), overall image quality (median, 4.0 vs. 3.0; P < 0.001), and geometric distortion (median, 4.0 vs. 3.0; P < 0.001). RESOLVE DWI achieved the highest ratings overall (median, 5.0). Lesion detectability was comparable between DL DWI and RESOLVE DWI (median, 4.0 for both; P > 0.08), while both significantly outperformed ss-EPI DWI (P < 0.001). Quantitative analysis confirmed superior geometric accuracy of DL DWI over ss-EPI DWI, with lower coregistration cost-function values and normalization of gray-value distributions in susceptibility-affected regions. CONCLUSION: DL DWI improved image quality and geometric accuracy compared with uncorrected ss-EPI DWI. Subjective lesion-detectability ratings were similar between DL DWI and RESOLVE DWI, while DL DWI required less than half the acquisition time. These findings support DL-based distortion correction as a promising, time-efficient approach for brain diffusion-weighted imaging that warrants confirmation in a predefined noninferiority design.