High-resolution deep learning reconstructed T2-weighted imaging for improvement of image quality and extraprostatic extension assessment in prostate MRI

Sebastian Gassenmaier^1*Franziska Katharina Staber¹Stephan Ursprung¹Judith Herrmann¹Sebastian Werner¹Andreas Lingg¹Lisa C Adams²Haidara Almansour¹Konstantin Nikolaou¹Saif Afat¹

• ¹Eberhard Karls Universitat Tubingen, Tübingen, Germany
• ²Klinikum rechts der Isar der Technischen Universitat Munchen, Munich, Germany

Purpose: To evaluate the impact of high-resolution T2-weighted imaging (T2HR) including deep learning image reconstruction (DLR), on image quality, lesion delineation, and extraprostatic extension (EPE) assessment in prostate multiparametric MRI (mpMRI). Materials and Methods: This retrospective study included 69 patients who underwent mpMRI of the prostate on a 3T scanner with DLR between April 2023 and March 2024. Routine mpMRI protocols adhering to PI-RADS v2.1 were used, including additionally a T2HR sequence (2 mm slice thickness, 4:31 min versus 4:12 min for standard T2 (T2S)). Image datasets were evaluated by two radiologists using a Likert scale ranging from 1 – 5 with 5 being the best for sharpness, lesion contours, motion artifacts, prostate border delineation, overall image quality, and diagnostic confidence. PI-RADS scoring and EPE suspicion were analyzed. Statistical methods included Wilcoxon signed-rank tests and Cohen's kappa for inter-reader agreement. Results: T2HR significantly improved lesion contours (median 5 vs. 4, p<0.001), prostate border delineation (median 5 vs. 4, p<0.001) and overall image quality (median 5 vs. 4, p<0.001) compared to T2S. However, motion artifacts were significantly worse in T2HR. Substantial inter-reader agreement was observed for PI-RADS scoring. EPE detection was marginally increased with T2HR, though histopathological validation was limited. Conclusion: T2HR imaging with DLR enhances image quality, lesion delineation, and diagnostic confidence without significant prolongation of acquisition time. It shows potential for improving EPE assessment in prostate cancer but requires further validation in larger studies.