Qualitative image evaluation criteria.

<div><p>Purpose</p><p>This study compared field-of-view (FOV) optimized and constrained undistorted single-shot diffusion-weighted imaging (FOCUS DWI) with deep-learning-based reconstruction (DLR) to conventional DWI for breast imaging.</p><p>Methods</p><p>This study prospectively enrolled 49 female patients suspected of breast cancer from July to December 2023. The patients underwent conventional and FOCUS breast DWI and data were reconstructed with and without DLR. Two radiologists independently evaluated three images per patient using a 5-point Likert scale. Objective evaluations, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC), were conducted using manual region of interest-based analysis. The subjective and objective evaluations were compared using the Friedman test.</p><p>Results</p><p>The scores for the overall image quality, anatomical details, lesion conspicuity, artifacts, and distortion in FOCUS-DLR DWI were higher than in conventional DWI (all <i>P</i> < 0.001). The SNR of FOCUS-DLR DWI was higher than that of conventional and FOCUS DWI (both <i>P</i> < 0.001), while FOCUS and conventional DWI were similar (<i>P</i> = 0.096). Conventional, FOCUS, and FOCUS-DLR DWI had similar CNR and ADC values.</p><p>Conclusion</p><p>Our findings indicate that images produced by FOCUS-DLR DWI were superior to conventional DWI, supporting the applicability of this technique in clinical practice. DLR provides a new approach to optimize breast DWI.</p></div>