Phantoms for diffusion-weighted imaging and diffusion tensor imaging quality control: A review and new perspectives

Introduction: Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) combine magnetic resonance imaging (MRI) techniques and diffusion measures. In DWI, the contrast is defined by microscopic motion of water protons. Nowadays, DWI has become important for early diagnostic of acute stroke. DTI images are calculated from DWI images acquired in at least six directions, which give information of diffusion directionality, making it possible to reconstruct axonal or muscle fiber images. Both techniques have been applied to study body structures in healthy and pathological conditions. Currently, it is known that these images and derived parameters are quite sensitive to factors related to acquisition and processing. Magnetic field inhomogeneity, susceptibility, chemical shift, radiofrequency (RF) interference, eddy currents and low signal-to-noise ratio (SNR) can have a more harmful effect in diffusion data than in T1or T2-weighted image data. However, even today there are not reference phantoms and guidelines for DWI or DTI quality control (QC). Review: Proposals for construction and use of DWI and DTI QC phantoms can be found in literature. DWI have been evaluated using containers filled by gel or liquid with tissue-like MRI properties, as well as using microfabricated devices. DTI acquisitions also have been checked with these devices or using natural or artificial fiber structures. The head phantom from American College of Radiology (ACR) is also pointed out as an alternative for DTI QC. This article brings a discussion about proposed DWI and DTI phantoms, challenges involved and future perspectives for standardization of DWI and DTI QC.