Fig. 1

Synthetic flowchart for practical setup and radiological assessment of DWI data in clinical practice. Critical steps include assessment of image quality and artefact mitigation (e.g., eddy current compensation/correction, fat suppression, non-EPI sequences to avoid severe distortion artefacts). For highly anisotropic tissues, employ ≥ 6 diffusion directions and DTI to avoid bias due to residual anisotropy in ADC maps. Cross-validate hyperintense DWI signals with ADC values to distinguish true restriction (low ADC, e.g., in acute ischaemic stroke) from T2-shine-through (high ADC, caused by prolonged T2 relaxation, e.g., in subacute cerebral infarction). In oncology (e.g., prostate or breast), use DWIBS to enhance tumour detectability and optionally combine high b-value DWI (e.g., b = 1500 s/mm²) with ADC maps to assess cellularity. DWI, diffusion-weighted imaging; b-value, diffusion weighting; DW-SE, diffusion-weighted spin echo; EPI, echo planar imaging; DWIBS, diffusion-weighted imaging with background body signal suppression; DTI, diffusion tensor imaging; TE, echo time; TR, repetition time; ADC, apparent diffusion coefficient; 4-scan trace image, average of diffusion measurements along 4 different directions