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J Gieseke

Publications and source records attributed to J Gieseke.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Craniocervical dissections: study strategies in MR imaging and MR angiography].

PURPOSE: To define the diagnostic efficacy of MR imaging, "time of flight" (TOF) and phase contrast (PC) MR angiography in craniocervical arterial dissections. MATERIAL AND METHODS: The MR examinations of 16 patients with proven arterial dissections (n = 20) were retrospectively analysed by three independent readers. The MR protocol included T1w spin echo sequences with and without fat saturation (SPIR), T2w-turbo-spin echo, 2D- and 3D-TOF- and 3D-PC-MRA. The study was undertaken to assess the diagnostic sensitivity of each technique in detecting typical pathological features. RESULTS: The overall sensitivity was best in 3D-PC-MRA; reaching 88% of all possible points. Intramural haematoma could be easily detected with T1W spin echo with fat saturation (100%). Intimal flap and lumen narrowing was best defined with 3D-TOF-MRA in 86% resp. 96% and 3D-PC-MRA in 69% resp. 97%. 3D-PC-MRA was superior to all other sequences in 5 cases of aneurysmal dissection (100%). CONCLUSIONS: An accurate evaluation of craniocervical arterial dissections should rely on a combined protocol including T1w spin echo with fat saturation and an axial 3D-MR angiography (if possible 3D-phase contrast MRA).

Adolescent↗
PubMed1997

Breast neoplasms: T2* susceptibility-contrast, first-pass perfusion MR imaging.

PURPOSE: To evaluate the differentiation of benign from malignant breast tumors with T2*-weighted perfusion magnetic resonance (MR) imaging (blood volume imaging) versus that with dynamic T1-weighted contrast agent-enhanced MR imaging. MATERIALS AND METHODS: Ten healthy adult volunteers and 18 adult patients with benign or malignant lesions underwent both conventional T1-weighted dynamic contrast-enhanced breast MR imaging and repetitive first-pass, single-section, dynamic T2*-weighted perfusion MR imaging. Images were obtained before, during, and after injection of 20 mL of gadopentetate dimeglumine; peak gadopentetate dimeglumine concentrations were calculated from the maximal signal intensity loss on T2*-weighted images. RESULTS: No perfusion effect was detectable in healthy breast parenchyma. A strong susceptibility-mediated signal intensity loss occurred in malignant breast tumors. No or only minor perfusion effects were seen in fibroadenomas, in spite of their rapid enhancement at T1-weighted dynamic imaging. Perfusion imaging was possible after conventional dynamic contrast-enhanced breast MR imaging. CONCLUSION: T2*-weighted perfusion imaging exploits the susceptibility-mediated signal intensity loss of a first-pass bolus of gadopentetate dimeglumine within the capillary bed. First-pass perfusion imaging of breast lesions is feasible. It is promising in the differentiation of benign from malignant, rapidly enhancing lesions.

Adult↗
PubMed1997

Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency.

PURPOSE: To define the range of normal contrast medium enhancement, the variability in contrast medium enhancement patterns in healthy premenopausal breast parenchyma, and the implications for management strategies in cases with incidental contrast medium-enhancing foci on breast magnetic resonance (MR) images. MATERIALS AND METHODS: Twenty healthy volunteers (aged 21-41 years) were examined on a 1.5-T system (dynamic two-dimensional gradient-echo protocol with subtraction postprocessing) during each week of a menstrual cycle (group 1) or over 4 months (group 2). The authors evaluated changes in the number of enhancing foci and the respective enhancement patterns within a cycle and between cycles. RESULTS: Both diffuse and nodular enhancement of breast parenchyma occurred during all phases of the menstrual cycle, especially in weeks 1 and 4. Enhancement was lowest in week 2. A total of 60 enhancing foci (73% of which resolved completely during follow-up) were found in 16 of 20 volunteers. Twenty-six foci demonstrated enhancement velocities beyond the malignancy threshold (>80% increase in the 1st minute). CONCLUSION: Contrast-enhancing foci are normal in healthy premenopausal breasts, even when formal malignancy criteria of enhancement velocity are met. This has to be kept in mind to avoid false-positive results, especially in younger patients.

Adult↗
PubMed1997

Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device.

PURPOSE: To evaluate the usefulness of preoperative magnetic resonance (MR) imaging-guided stereotactic localization and core biopsy of suspicious breast lesions that are visible at breast MR imaging alone (ie, that are clinically, mammographically, and ultrasonographically occult), with the goal of integrating this technique into the diagnostic and therapeutic work-up of MR-suspicious lesions in a clinical setting. MATERIALS AND METHODS: A stereotactic breast biopsy device was used for needle placement in and guide wire localization of 97 lesions in 66 patients or core biopsy of five lesions in five patients; all lesions were visible at MR imaging. Interventions were performed with MR guidance on a 0.5- or 1.5-T system. RESULTS: Lesion localization and resection were successful in 95 of the 97 lesions; two of the lesions were not resected in spite of correct guide wire localization. In this series, 53 (55%) of 97 lesions proved malignant (11 [21%] in situ; 42 [79%] invasive). Lesions were 4-19 mm (mean, 8.7 mm); all invasive cancers corresponded to a pT1 tumor stage. Location of the lesion in the parenchyma (retroareolar or prepectoral) did not interfere with accessibility. CONCLUSION: MR imaging-guided stereotactic hook-wire placement and excisional biopsy are accurate and effective in managing lesions identified at only breast MR imaging. MR imaging-guided core biopsy holds promise for allowing a definite work-up of these lesions.

Adult↗
PubMed1997

[Incidence of lesions described by magnetic resonance imaging in the clarification of focal epilepsy of frontal and temporal origin].

AIM: Today, MRI is an integral part of the presurgical evaluation of patients suffering from partial epilepsy. These patients frequently show focal morphological abnormalities with potential epileptogenic character and surgical resection of these lesions is associated with superior postsurgical outcome as to seizure frequency. Apart from easily detectable defects, such as post-traumatic lesions or cerebral infarction, as wide variety of mainly small abnormalities can be detected using MRI. METHODS: In this study, 484 patients suffering from partial epilepsy of temporal or frontal onset were evaluated for the incidence of different lesions in this population. RESULTS: All lesions found were included without evaluating their potential epileptogenicity, which remains to be proven using other procedures (EEG, SPECT, PET, etc.). Involvement of the hippocampal formation was a major finding in temporal lobe epilepsy, which could be detected as sclerosis (T2w-images), atrophy (T2w-TSE or T1w-IR-images) or both (15%). In addition and in declining frequency various tumors (14%), post-traumatic lesion (-5%), and focal cortical dysplasia or other disturbances of cortical integrity (-4%) were found. These lesions are detectable with best contrast on different sequences. As a consequence it is suggested to acquire sequences in 3 dimensions including a T1w-SE, two (coronal and axial) double-echo-SE sequences and similarly two T1w-IR-sequences. The application of contrast media can be restricted to special questions, derived either from the first imaging results or from the patients history. CONCLUSION: Using qualitative data for interpretation, the sensitivity as to the detection of any focal pathology of a recent-generation MRI in this population was 75%, with 79% for temporal lobe epilepsies and 67% for frontal lobe epilepsies. Quantitative measurements of hippocampal volume or signal seem to be able to increase the sensitivity of the method.

Atrophy↗
PubMed1996

[MRI of the pancreas: value of standard versus fat-suppressed pulse sequence at 0.5 T].

PURPOSE: To compare five pulse sequences in 60 patients with pancreatic disease by means of MRI at 0.5 T. METHODS: T1 weighted Spin-Echo sequences (T1W SE) before and after i.v. contrast medium administration, fat-suppressed T1W SE sequences after i.v. contrast medium administration, T2 weighted Turbo-Spin-Echo sequences (T2W TSE), and fat-suppressed T2W TSE were evaluated within an ROC study. RESULTS: The standard sequences (T1W SE before and after i.v. contrast medium administration, T2W TSE) were superior to the fat-suppressed T1W and T2W (T)SE sequences in delineating the anatomy and for correct diagnosis. The T1W sequence with and without i.v. contrast media detected all anatomic structures best. In most instances the correct diagnosis and coexistent findings in the diseased pancreas were obtained with the T2W sequence. CONCLUSION: Fat-suppressed sequences are less useful in the diagnosis of pancreatic disease by MRI at medium field strength compared to the standard sequences.

Diagnosis, Differential↗
PubMed1996

[A new application of MR tomography of the lung using ultra-short turbo spin echo sequences].

PURPOSE: Development of an improved MR sequence for examining the lung. METHOD: T2 weighted ultra-short turbo spin echo sequences were used in five individuals with variations in echo times, delayed triggering and echo intervals. To reduce movement artifacts all examinations were carried out with ECG and respiratory triggering. The sequences giving optimal image quality were then employed in 19 patients having various pulmonary abnormalities. Image resolutions, artifacts, image contrasts and diagnostic value were then judged by two observers and compared with CT. RESULTS: In the first study, a diastole-triggered UTSE sequence with the shortest echo proved optimal (TE = 90 ms, TR = 2-4 s, echo = 9 ms, turbo factor = 19). In the patient series studied, MRT was inferior to CT with regard to resolution and number of artifacts, but better in respect of contrast and diagnostic value. CONCLUSION: Using UTSE of the lung, MRT can produce images of good quality. Compared with CT, contrast is better with MRT, offering diagnostic advantages for MRT.

Diagnosis, Differential↗
PubMed1996

[Comparison of fast turbo-spin-echo and gradient- and spin-echo sequences as well as echo planar imaging with conventional spin-echo sequences in MRI of focal liver lesions at 1.0 tesla].

PURPOSE: To evaluate the value of rapid T2-weighted turbo-spin sequences (TSE), turbo-spin-echo sequences with shortened echo spacing (UTSE), gradient-and-spin-echo sequences (GraSE) and T1-weighted echo-planar imaging (EPI) in comparison with conventional spin-echo sequences (SE) in the diagnosis of focal liver lesions. METHODS: 20 patients with malignant focal liver lesions underwent magnetic resonance imaging at 1.0 tesla. RESULTS: The use of fast T2-sequences (TSE, UTSE, GraSE) reduced the examination time to about 35-50%. Artifacts were reduced compared with the conventional T2-SE sequence. Quantitative analysis demonstrated that UTSE imaging had the highest tumor/liver contrast-to-noise ratio (CNR) followed by TSE, T2-SE and GraSE sequences. CNR with EPI was lower than with the T1-SE sequence (p < 0.05). CONCLUSION: Turbo-spin-echo sequences with shortened echo spacing yield a shorter imaging time and improved image quality without loss of signal intensity in tumor/liver-CNR, compared with conventional T2-pulse sequences in liver imaging at 1.OT.

Adult↗
PubMed1996

Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging.

PURPOSE: To compare the usefulness of spiral computed tomography (CT), multiplanar transesophageal echocardiography (TEE), and magnetic resonance (MR) imaging in the diagnosis of thoracic aortic dissection and arch vessel involvement. MATERIALS AND METHODS: Forty-nine symptomatic patients with clinically suspected aortic dissection were examined with contrast material-enhanced spiral CT, multiplanar TEE, and 0.5-T MR imaging (T1-weighted, cardiac-gated, spin-echo sequences). Imaging results were confirmed at autopsy (five patients), intraoperative exploration (23 patients), angiography (nine patients), and follow-up (12 patients). RESULTS: Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 100%, 94%, and 94% for spiral CT, multiplanar TEE, and MR imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 93%, 60%, and 67%, respectively, and specificity was 97%, 85%, and 88%, respectively. CONCLUSION: Spinal CT and multiplanar TEE are as valuable as MR imaging in the detection of thoracic aortic dissection. In the assessment of the supraaortic branches, spiral CT is superior (P<.05).

Adult↗
PubMed1995

[Spiral computerized tomography, multiplane transesophageal echocardiography and magnetic resonance imaging in the diagnosis of thoracic aortic dissection].

The aim of this study was the evaluation of spiral computed tomography (Spiral-CT), multiplane transesophageal echocardiography (multiplane TEE) and magnetic resonance imaging (MRI) in the diagnosis of thoracic aortic dissection. 41 patients were examined: 30 with clinically suspected acute aortic dissection (14 Stanford A, 7 Stanford B), 11 with aortic repair (7/11 with persisting distal dissection). In 14 patients there was involvement of the supraaortic vessels. Sensitivity of Spiral-CT, multiplane TEE and MRI in the detection of aortic dissection was 100%, specificity was 100, 92, and 91%. In the assessment of involvement of aortic arch vessels sensitivity was 100, 67, and 60%, specificity was 100, 95, and 90%. The new imaging modalities Spiral-CT and multiplane TEE are equal to MRI in the detection of aortic dissection. In the assessment of the supraaortic branches Spiral-CT is superior to multiplane TEE and MRI and might become the method of choice.

Adult↗
PubMed1995

[Static and dynamic MR tomography of the pancreas: contrast media kinetics of the normal pancreatic parenchyma in pancreatic carcinoma and chronic pancreatitis].

PURPOSE: We aimed both at improving image quality and diagnostic value of pancreatic MRI by using fast multislice imaging techniques and at demonstrating normal and pathologic signal enhancement in the pancreas after i.v. gadopentate-dimeglumine. METHODS: MR imaging at was performed in 30 patients with suspicion of pancreatic neoplasm or chronic disease and in 15 patients without pancreatic abnormalities. RESULTS: SNR, CNR, mean signal enhancement, and time/signal-intensity curves were calculated. Signal enhancement after i.v. Gd-DTPA averaged 34.4% in neoplasms (n = 14) vs 58.8% in pancreatic tissue not involved by tumour (p < 0.05) in T1-w SE and was also significant in the T1-w GE sequence (p < 0.005). CNR (pancreas vs lesion) and SNR improved significantly (p < 0.005; pancreas: p < 0.001; lesion: p < 0.05) after i.v. Gd-DTPA administration. In patients without pancreatic disease enhancement curves of pancreas demonstrate a rapid signal increase (79.0% after 34 s). Patients with adenocarcinoma or chronic pancreatitis demonstrated flattened signal intensity curves and higher peak signal intensity values (90.1, 111.3% after 68 s). The slope of signal increase of neoplastic tissue was significantly different (p < 0.01) from unaffected parenchyma (48.3% after 51 s, 90.1% after 68 s). CONCLUSION: MR imaging with fast T2-w SE and T1-w SE sequences provides excellent visualisation of the pancreas and adequate conspicuity of pancreatic adenocarcinoma. Following i.v. Gd-DTPA significant enhancement of tumour/parenchyma contrast is found.

Adenocarcinoma↗
PubMed1995

[MR mammography at 0.5 tesla. II. The capacity to differentiate malignant and benign lesions in MR mammography at 0.5 and 1.5 T].

PURPOSE: To determine whether medium field strength (0.5 T) MR mammography is able to differentiate between benign and malignant lesions in the same way as a 1.5 T standard technique. MATERIAL: In 40 consecutive female patients with nodular lesions, examinations were carried out at 1.5 T (2D-FFE, TR/TE/FA 200/3.9/80) and 0.5 T (3D-FFE, 24/3.4/40). RESULTS: There was wide spread of the speed of enhancement of malignant tumours for both techniques (44%-145% with signal increase in the first minute of 42%-189%). In 15 out of 17 carcinomas, the rapidity of uptake and final degree of enhancement after contrast was higher during 0.5 T/3D measurements than it was for 1.5 T/2D images. Fibroadenomas and mastopathies showed similar enhancement characteristics for both techniques. Sharply defined "wash-out" was seen only in malignant lesions; it appeared ten times more frequently in the 0.5 T/3D examinations than at 1.5 T/2D. CONCLUSIONS: The distinction between benign and malignant lesions can be made with more certainty using medium field strength and 3D-FFE sequence than using the 2D high-field standard technique.

Breast↗
PubMed1995

[Value of turbo-spin-echo sequences in cerebral magnetic resonance tomography in children].

AIM: The value of turbo-spin-echo (TSE) sequences was compared with conventional spin-echo (SE) and inversion-recovery (IR) sequences for cerebral MRT in 70 children at 0.5 T and 1.5 T. In addition we evaluated whether proton weighted sequences (PD) were diagnostically important and in what proportion of cases. METHOD: Conventional T1 and T2 weighted SE and T2 weighted TSE sequences were used in all children. An IR sequence was performed in 39 patients. The various sequences were analysed semiquantitatively with regard to image quality, artifacts and the demonstration of normal and anatomical structures and pathological findings. RESULTS: By any criteria, TSE sequences were superior to conventional T2 weighted SE sequences at 0.5T and 1.5 T, requiring a shorter examination time (35-53%). In 8.6% the pathological finding was best seen on PD-SE sequences (5 glial scars, 1 tumor). CONCLUSION: Although TSE sequences are better than T2 SE sequences with regard to image quality and the demonstration of abnormalities, conventional double-echo SE sequences (with PD and T2 weighted images) cannot be entirely replaced by T2 weighted TSE sequences in children.

Adolescent↗
PubMed1995

[Focal and diffuse lesions in dynamic MR-mammography of healthy probands].

PURPOSE: To evaluate the range of normal contrast enhancement behaviour in dynamic MR mammography of healthy breast parenchyma, and to reduce false-positive results caused by incidental contrast enhancing lesions. MATERIALS AND METHODS: We performed a prospective two-armed study on 20 healthy premenopausal volunteers who were examined four times within one month (Group 1) or during four consecutive months (Group 2). Incidence, prevalence, morphology, and contrast enhancement pattern of lesions were evaluated. RESULTS: 82% (9/11 of Group 1) and 78% (7/9 of Group 2) showed at least one of a total of 60 contrast enhancing lesions. In 54% or 33% (Group 1 or 2), lesions with enhancement velocity beyond the malignancy threshold were found. 72% or 75% of lesions resolved completely during follow-ups. 69% of lesions were focal with irregular border. Time/signal intensity diagrams were almost always not suspicious; no wash-out phenomenon was seen. CONCLUSION: In MR mammography of premenopausal breast parenchyma, focal contrast enhancing lesions-even with enhancement beyond the malignancy threshold-may occur without any underlying pathology.

Adult↗
PubMed1995

[Turbo-spin-echo sequences with selective fat suppression (SPIR) in the MRI of focal liver lesions at 0.5 tesla].

PURPOSE: The value of T2 weighted turbo-spin-echo sequences with selective fat suppression (TSE-SPIR) in the detection and differential diagnosis of focal liver lesions was compared to TSE sequences and conventional T1 weighted spin-echo (T1 SE) sequences at 0.5T. METHODS: In 50 patients with focal liver lesions T1 SE-TSE-, and TSE-SPIR sequences were performed. Two independent readers evaluated the sequences with regard to the image quality, fat suppression, and the number and conspicuity of liver lesions. Quantitative analysis was performed by tumour-liver contrast-to-noise (CNR) measurements. RESULTS: From a total of 118 liver lesions the T1 SE sequence, the TSE sequence, and the TSE-SPIR sequence showed 85.6%, 83.9%, and 91.5%, respectively (p < 0.05). The tumour-liver CNR of malignant liver lesions was 30.2-46.6% higher on the TSE-SPIR sequence compared to the TSE sequence (p < 0.01). With the exception of fat-containing lesions there was no significant difference of CNR in benign lesions on both TSE sequences. CONCLUSION: With regard to lesion detection the TSE-SPIR sequence is superior to the TSE sequence without fat suppression, whereas it is inferior to the TSE sequence in the differential diagnosis of benign and malignant lesions.

Adipose Tissue↗
PubMed1995

[Value of Turbo-FLAIR sequence in the diagnosis of brain diseases at 0.5 tesla].

PURPOSE: Aim of the study was to evaluate FLAIR combined with Turbo-Spin-Echo (Turbo-FLAIR) at 0.5 tesla in comparison to conventional T1- and T2-weighted spin-echo images (SE) in MRI of the brain. MATERIAL AND METHODS: A Turbo-FLAIR sequence was optimised for 0.5 Tesla (Philips Gyroscan T5-II) that provided seventeen 5 mm sections in 4:21 minutes (TR = 6075 ms, T1 = 1600 ms, TE = 120 ms and a turbofactor = 17). Images were compared with T1- (TR = 500 ms, TE = 15 ms) proton density and T2-weighted spin-echo (TR = 2500 ms, TE = 20/90 ms) studies in 10 healthy volunteers and 30 patients with various brain pathologies. RESULTS: Turbo-FLAIR could effectively eliminate the CSF signal in all studies except ventricular areas with CSF inflow. Contrast-to-noise ratios (C/N) for the contrast between lesions and CSF was superior in Turbo-FLAIR. C/N between lesions and grey matter was significantly higher in Turbo-FLAIR than in proton density (PD)-weighted SE. C/N between lesions and white matter was equal to PD-weighted SE but significantly smaller than on T2-weighted SE. Visual analysis showed greater lesions conspicuity with Turbo-FLAIR and a higher frequency of detection of cortical and subcortical lesions. CONCLUSIONS: Turbo-FLAIR is a reliable and practical technique on 0.5 Tesla, that is more sensitive than SE sequences especially for the detection of cortical, subcortical lesions and lesions surrounded by CSF.

Adolescent↗
PubMed1995

[Turbo-spin-echo MR imaging of the brain at 0.5 T].

Turbo-spin-echo (TSE) imaging is a fast technique, which provides true spin-echo contrast in a definitely shorter scan time than conventional spin-echo (SE). Clinical studies at 1.5 T show that TSE is a valuable alternative to SE and will ultimately replace time-consuming T2-weighted SE imaging for examinations of the brain and brainstem. Besides the reduction of scan time, TSE is less sensitive to motion artefacts. A slight decrease of susceptibility effects of 1.5 T can be a disadvantage in the detection of old haemorrhagic lesions and calcifications. In these cases the gradient-echo sequence will remain the most sensitive. TSE allows a greater flexibility of examination strategies, including several orientations, strongly T2-weighted images and high spatial resolution (HR) MRI. HR MRI using thin slices (1-3 mm), a small field of view and a 512 image matrix yields detailed information about small anatomical regions (e.g. the pituitary fossa, cavernous sinus, internal auditory canal and brainstem) and permits the delineation of specific cranial nerves. In this study TSE was utilized at 0.5 T field strength in order to assess whether the advantages of TSE hold for midfield systems. Preliminary results in imaging of the brain and brainstem are very promising.

Adolescent↗