Abstract
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p> New magnetic resonance imaging (MRI) gradient technology enables the acquisition of ultrahigh <jats:italic>b-</jats:italic> value diffusion-weighted imaging (DWI). We assessed its impact on image quality and Prostate Imaging Reporting and Data System (PI-RADS) scores in prostate MRI. </jats:p> </jats:sec> <jats:sec> <jats:title>Materials and methods</jats:title> <jats:p> Participants with cancer suspicion prospectively underwent 3-T prostate MRI (maximum gradient strength 200 mT/m). Sequences with <jats:italic>b-</jats:italic> values of 0/800, 1,500, 2,500, 3,500, and 4,500 s/mm² were acquired. Lesion conspicuity was rated from 1 (non-diagnostic) to 5 (excellent). Apparent signal-to-noise ratios (aSNR) and acquisition times were determined. Cumulative link mixed-effects models, repeated measures ANOVA, and Cohen/Fleiss κ statistics were used. </jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> A total of 107 participants, aged 67 ± 8 years (mean ± standard deviation), were included. Compared to DWI(b1500), the DWI(b2500), DWI(b3500), and DWI(b4500) acquisitions were worse regarding both lesion conspicuity (median score, 5 [interquartile interval 4–5] <jats:italic>versus</jats:italic> 4 [3–4] <jats:italic>versus</jats:italic> 2 [2–3] <jats:italic>versus</jats:italic> 2 [1–2], respectively; all <jats:italic>p</jats:italic> < 0.001) and aSNR (19.0 ± 7.5 <jats:italic>versus</jats:italic> 12.7 ± 4.8 <jats:italic>versus</jats:italic> 11.8 ± 4.1 <jats:italic>versus</jats:italic> 11.4 ± 2.6, respectively; all <jats:italic>p</jats:italic> < 0.001). Acquisition times increased from DWI(b1500) (107 ± 9 s) to DWI(b4500) (329 ± 26 s). Cohen κ for PI-RADS score agreement was good to moderate (DWI(b2500): 0.87 [confidence interval 0.81, 0.94]; DWI(b3500): 0.75 [0.65, 0.84]; DWI(4500): 0.61 [0.49, 0.72]). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p> Acquired ultrahigh gradient DWI sequences with ultrahigh <jats:italic>b-</jats:italic> values in prostate MRI had worse image quality than standard <jats:italic>b-</jats:italic> values, while PI-RADS agreement between DWI(b1500) and DWI(b2500) was good. However, diagnostic estimates for clinically significant prostate carcinoma remained limited due to a small biopsy sample size (50/107 patients). </jats:p> </jats:sec> <jats:sec> <jats:title>Relevance statement</jats:title> <jats:p> Ultrahigh <jats:italic>b-</jats:italic> value DWI showed no improved diagnostic performance in comparison to standard <jats:italic>b-</jats:italic> value DWI regarding the identification of potential prostate cancer. Ultrahigh <jats:italic>b-</jats:italic> value should not replace standard high <jats:italic>b-</jats:italic> values (1,500 s/mm²) for imaging workup of patients with suspicion for prostate cancer. </jats:p> </jats:sec> <jats:sec> <jats:title>Key Points</jats:title> <jats:p> <jats:list list-type="bullet"> <jats:list-item> <jats:p> <jats:italic>Acquired ultrahigh b-values (b2500–4500) using ultrahigh gradients of up to 140 T/m were utilized for prostate DWI</jats:italic> . </jats:p> </jats:list-item> <jats:list-item> <jats:p> <jats:italic>Both, overall image quality and diagnostic confidence decreased from good for DWI(b1500) to non-diagnostic for DWI(b4500)</jats:italic> . </jats:p> </jats:list-item> <jats:list-item> <jats:p> <jats:italic>PI-RADS agreement between DWI(b1500) and DWI(b2500) was good, while it was only moderate between DWI(b1500) and DWI(b4500)</jats:italic> . </jats:p> </jats:list-item> </jats:list> </jats:p> </jats:sec> <jats:sec> <jats:title>Graphical Abstract</jats:title> </jats:sec>