Deep Resolve Boost in 2D MRI for Neuroradiology: A Comparative Evaluation of Diagnostic Gains and Potential Risks.

Background And Purpose Deep Resolve Boost applied to accelerated acquisition (DRB-ACC) offers the potential to reduce MRI acquisition time and improve image quality. However, studies on the potential impact on artifacts, anatomical delineation, and the depiction of imaging findings are scarce. This study aims to fill this gap and evaluates the clinical performance of DRB-ACC in 2D MRI sequences.Materials And Methods In this prospective observational study, 256 paired 2D sequences (T2/TIRM, and FLAIR) were acquired from 200 patients undergoing routine neuroradiological MRI on a 3T scanner. For each examination, both standard and DRB-ACC (predominantly high strength) were acquired in the same session using identical scanner settings, except for acceleration factor; same surface coil, sequence orientation and slice thickness. Image quality, anatomical structure delineation, artifact presence, and lesion conspicuity were independently assessed by two readers using standardized scoring.Results DRB-ACC sequences demonstrated good or fair image quality in 94.5% of cases, with improved or unchanged quality compared to standard acquisition in 95.7% of sequences. However, anatomical delineation was inferior in key regions such as the hippocampus, brainstem, and cerebellum. Artifacts were more pronounced in 27.3% and newly introduced in 84.8% of the accelerated DRB sequences, commonly affecting the brainstem and deep gray matter. Lesion depiction was equivalent to standard images in 91.6% of cases, with limited instances of improved (7.2%) or degraded (1.2%) delineation.Conclusions DRB-ACC enables acceleration of 2D MRI while maintaining image quality and lesion visibility. At the same time, the presence of artifacts and reduced delineation of certain anatomical structures underscores the need for caution in the interpretation of image findings and selective use in clinical routine, particularly in clinical scenarios requiring high anatomical detail such as for epilepsy screening or in cases with suspected brainstem pathology.Abbreviations ACC＝ accelerated acquisition; DRB＝ Deep Resolve Boost.