ESR Essentials: diffusion-weighted MRI - Practice recommendations by the European Society for Magnetic Resonance in Medicine and Biology

Palombo, Marco ORCID: https://orcid.org/0000-0003-4892-7967, Bodini, Benedetta, Grussu, Francesco, Le Bihan, Denis, Nilsson, Markus, Perez-Lopez, Raquel, Oei, Edwin H. G., Schoots, Ivo G., Smits, Marion and Jelescu, Ileana O. 2025. ESR Essentials: diffusion-weighted MRI - Practice recommendations by the European Society for Magnetic Resonance in Medicine and Biology. European Radiology 10.1007/s00330-025-12033-x

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Abstract

Diffusion-weighted imaging (DWI) offers critical insights into tissue microstructure through the assessment of water molecule random displacements and plays a central role in the assessment of neoplastic and non-neoplastic diseases. To successfully implement and use DWI in clinical practice, guidelines for acquisition, interpretation of image contrast and of artefacts should be followed, taking the disease process and body part into account. We recommend covering a b-value range of 0–1000 s/mm2 in the brain (along at least six directions for white matter), and 50–800 s/mm2 in the body. Available acquisition acceleration options should be used to reduce repetition time (TR), echo time (TE), and echo-planar imaging (EPI) distortions, while considering the penalty in signal-to-noise ratio (SNR) and image sharpness. DW images and the apparent diffusion coefficient (ADC) map should be read jointly for the clinical interpretation. Areas of slower diffusion are hyperintense on DW images and hypointense on the ADC map, and vice versa. Magnetic susceptibility distortions and signal drop-outs or pile-ups are particularly pronounced at air-tissue or metal-tissue interfaces and may obscure areas of interest or hinder the co-localisation with structural scans. By following these guidelines and recommendations, radiologists and imaging professionals can enhance diagnostic accuracy, reduce variability, and maximise the clinical value of DWI across diverse applications.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Computer Science & Informatics Schools > Psychology Research Institutes & Centres > Cardiff University Brain Research Imaging Centre (CUBRIC)
Publisher:	Springer
ISSN:	0938-7994
Date of First Compliant Deposit:	2 October 2025
Date of Acceptance:	27 August 2025
Last Modified:	03 Oct 2025 09:30
URI:	https://orca.cardiff.ac.uk/id/eprint/181457

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