Editorial for “One‐Minute Multi‐Contrast Echo Planar Brain MRI in Ischemic Stroke ‐ A Retrospective Observational Study of Diagnostic Performance”

Editorial for “One-Minute Multi-Contrast Echo Planar Brain MRI in Ischemic Stroke A Retrospective Observational Study of Diagnostic Performance” Despite magnetic resonance imaging (MRI) has a higher sensitivity to detect cerebral infarction and provide more useful information on stroke compared to computed tomography (CT), CT remains the primary modality for stroke imaging due to its wider availability and shorter acquisition time. Nevertheless, we have been making efforts on the exploration of fast sequences, which has never stopped. Supada Prakkamakul et al used an ultrafast MRI protocol to decrease the total scan time from 10 minutes 32 seconds to 4 minutes 59 seconds. In this issue of JMRI, Kits et al. demonstrated a fast multicontrast echo planar imaging-based sequence (EPIMix) for brain applications, which generates six MRI contrasts—DWI, apparent diffusion contrast (ADC), T2*weighted (T2*WI), T2-weighted (T2WI), T2-FLAIR and T1-FLAIR images with a total acquisition time of only 78 seconds—and showed a high but marginally lower diagnostic performance compared to standard MRI for the detection and characterization of acute brain infarct. The EPIMix realizes multiple different sequences in one scan in just 78 seconds. It is well known that MRI is the preferred modality for stroke patients if the required time is short because multiparameter imaging of MRI can provide rich pathophysiological information. First, DWI could detect hyperacute infarction. Second, DWI-T2-FLAIR mismatch indicates the extent of ischemic penumbra. Third, hyperintensity vessel sign on T2-FLAIR images often reflects the status of leptomeningeal collateral circulation. Finally, T2*WI or SWI is sensitive to detect cerebral microbleed, and even draining venous, such as asymmetric deep medullary veins that may demonstrate misery perfusion or brain tissue at risk of ischemia. These useful and important information can be acquired by EPIMix in just 78 seconds. EPIMix is an exciting sequence for neuroradiologists, neurologists, and stroke patients. However, we assume EPIMix has a long way to go to approve the diagnosis performance for various information from EPIMix on different stages of stroke in clinical practice. One limitation of the study is that only non-hyperacute cases are included, which just focus on the detection of cerebral infarction. Further studies are needed to evaluate the diagnostic performance of EPIMix in early time windows, and assessment of ischemic penumbra, collaterals, and oxygen extraction fraction should take into account because tissue window is proposed by a lot of studies, which determine the clinical decision-making and prognosis in patients with acute cerebral infarction. Moreover, if the sequence of EPIMix could provide information about cerebral perfusion, it would be better. However, the publication by Kits et al is an important step in that direction. We hope that advancement in relative research and clinical application can improve this fast multicontrast echo planar imaging-based sequence (EPIMix).