An Improved 2D Magic-Angle-Turning Pulse Sequence for the Measurement of Chemical-Shift Anisotropy
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Technical challenges of cardiac MRI include minimizing the effects of cardiac and respiratory motion and developing techniques that allow for both high spatial resolution and high SNR given the small size of small structures such as the coronary vessels. Fast imaging techniques provide considerable time savings and increased flexibility which allow to further optimize image quality.
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The combination of fast MR sequences and rapid i.v. injection of paramagnetic contrast media provides information on cerebral perfusion. MR-perfusion imaging primarily depicts the relative cerebral blood volume. The aim of this study was to test whether MR-perfusion imaging with a clinical MR scanner using a standard 2D-FLASH sequence provides clinically relevant information on patients with cerebrovascular diseases and brain tumors. Brain infarctions, lesions in cerebral microangiopathy and occlusions of the carotid artery with very poor collateralization showed definite differences in perfusion imaging compared with normal controls. However, our results show that acceleration of the imaging sequence and optimization of the contrast bolus and data processing are prerequisites for the clinical use of this method, which in principle may provide information on the absolute cerebral blood volume and even blood flow.
PURPOSE: Evaluation of frequency-selective fat saturation (FS) and short-tau inversion recovery (STIR) fat suppression (FU) in MRI of patients with malignant head and neck tumors. METHODS: Forty-five patients with biopsy-proven carcinomas of the extracranial head and neck were examined with MRI at 1.0 T. A T2-weighted TSE sequence with and without STIR-FU and a T1-weighted SE sequence with and without FS were compared in axial slices. RESULTS: STIR-FU was successful in all and FS in 85-88% of the head examinations (nasopharynx, sinuses, oropharynx, and oral cavity) and 33-46% of the neck examinations (hypopharynx and larynx). When visualization and delineation of tumors were ranked on a four-point scale (0-3), respective mean values for images with/without FU or FS were 2.6/1.9 for T2-TSE in all examinations, 2.2/1.7 (nasopharynx and sinuses) and 1.3/1.4-1.6 (oropharynx, oral cavity, hypopharynx, and larynx) for T1-SE without contrast media administration (CM) and 2.3/2.1 (nasopharynx and sinuses) and 2.4-2.5/1.9-2.0 (oropharynx, oral cavity, hypopharynx, and larynx) with CM. CONCLUSIONS: STIR-T2-TSE was a technically reliable pathfinder for localization and extension of both tumors and lymph nodes. FS-T1-SE was technically unreliable in examinations of the hypopharynx and larynx. With CM, FS-T1-SE was most useful for MRI of carcinomas of the oral cavity and oropharynx. In the nasopharynx and sinuses, T1-SE with CM and FS-T1-SE with or without CM were equal for tumor visualization and delineation.
We compared the fluid-attenuated inversion recovery (FLAIR) sequence with conventional spin-echo (SE) imaging for detection of involvement of the central nervous system in five patients with myotonic dystrophy (MD). The diagnosis was made based on clinical features and DNA analysis. All patients showed abnormal high-intensity lesions in the white matter on T2-weighted images, although these were more clearly visible using FLAIR.
We used five MRI sequences in six patients with multiple sclerosis (MS): conventional spin-echo (CSE) with 5-mm slices; 2D fast spin-echo (FSE) with 2-mm slices; multishot T2*-weighted echo-planar imaging (EPI) with 5-mm slices; fast fluid-attenuated inversion recovery (fFLAIR) with 2-mm slices; and 3D fast spin-echo with 1.5-mm-thick slices. A total of 225 lesions were detected on CSE, 274 on 2D FSE, 137 on EPI, 385 on fFLAIR and 320 on 3D FSE. The EPI sequence was clearly the least sensitive and susceptibility artefact was a problem, particularly in the brain stem and temporal lobes. Fast FLAIR displayed a much higher number of supratentorial lesions (380) than 3D FSE (297), 2D FSE (264) or CSE (211). However, in the posterior cranial fossa 3D FSE was the most sensitive sequence (23 lesions), followed by CSE (14) and 2D FSE (10), while fFLAIR (5) was extremely insensitive.
We compared the sensitivity of a fluid-attenuated inversion-recovery (FLAIR) sequence with that of a conventional dual-echo spin-echo (SE) sequence) to brain lesions in 20 patients with Behçet's syndrome. They underwent 25 MRI examinations. The images were independently analysed for the number, type and anatomical location of lesions shown. There were 18 abnormal studies (13 initial and 5 follow-up). The FLAIR sequence detected significantly more lesions than the SE TE 80 (P < 0.05) and SE TE 20 (P < 0.01) sequences. It was particularly useful for demonstrating lesions in the juxtacortical white matter, which accounted for over half the lesions detected on the FLAIR images. Of patients presenting with nonspecific symptoms such as headache, seven had normal and five had abnormal studies. All patients presenting with focal neurological signs had abnormal imaging. We found supratentorial and, in particular, juxtacortical lesions to be more frequent than previously described.
We report the brain magnetic resonance imaging findings in the case of a 5-year-old boy with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Fluid-attenuation inversion recovery (FLAIR) imaging revealed multifocal abnormal cortical signals which were difficult to see on conventional T1- and T2-weighted images. Although the patient was in an advanced clinical stage of disease and had severe cortical atrophy, FLAIR imaging demonstrated characteristic findings of MELAS.
OBJECTIVE: To determine the usefulness of fat-suppressed gadolinium (Gd)-enhanced MR imaging of the wrist in patients with rheumatoid arthritis (RA). DESIGN AND PATIENTS: Fat-suppressed Gd-enhanced T1-weighted spin-echo (SE) images were obtained and compared with other standard techniques in 38 wrists of 27 patients (22-77 years) with RA. Scoring based on the degree of synovial enhancement of each joint was developed and the total scores (J-score) were correlated with radiographic stage, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and symptomatic change in the follow-up study. RESULTS: Synovial proliferations showed marked enhancement in all the wrists. In addition, contrast enhancement in the bone marrow and tenosynovium was seen in 36 and eight wrists respectively. Fat-suppressed Gd-enhanced T1-weighted images demonstrated these abnormalities better than other techniques. The J-scores correlated well with values of CRP (P = 0.0034), but not with radiographic stages and ESR. CONCLUSION: Fat-suppressed Gd-enhanced T1-weighted SE images can clearly demonstrate most of the essential lesions in RA including the proliferative synovium, bone erosion, bone marrow inflammatory change, and tenosynovitis. Scoring based on the extent of Gd-enhancement of synovium can be useful in the assessment of the inflammatory status.
PURPOSE: To assess the accuracy of different MR sequences for the detection of articular cartilage abnormalities in rheumatoid arthritis. DESIGN AND PATIENTS: Ten metacarpophalangeal joints and 10 metatarsophalangeal joints (specimens from arthritis patients undergoing ablative joint surgery) were examined with a fat-suppressed (FS) 3D FLASH, a FS 3D FISP, a FS 2D fast spin-echo T2-weighted, and a 2D FS spin-echo T1-weighted sequence. Each cartilage lesion and each cortical lesion was graded from 0 to 4 (modified Outerbridge staging system). Subsequently, the results of each sequence were compared with the macroscopic findings and statistically tested against each other. RESULTS: The study shows that 3D gradient-echo sequences with fat suppression were best for imaging and grading of cartilage lesions in arthritis of the small joints of the hands and feet. Using 3D techniques, all grade 2, grade 3, and grade 4 lesions of cartilage or cortical bone were detected. CONCLUSION: FS 3D gradient-echo techniques were best for the detection and grading of hyaline cartilage and subchondral bone lesions in rheumatoid arthritis. MRI has a great potential as an objective method of evaluating cartilage damage and bone erosions in rheumatoid arthritis.