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Diagnosis of renal artery stenosis: feasibility of combining MR angiography, MR renography, and gadopentetate-based measurements of glomerular filtration rate.

OBJECTIVE: Our aim was to evaluate the feasibility of combining in a single test (1) structural evaluation of renal arteries with MR angiography, (2) functional evaluation of global glomerular filtration rates calculated on the basis of plasma disappearance of gadopentetate dimeglumine, and (3) renographic analysis of individual kidneys based on the dynamic changes in signal intensity that occur after administration of gadopentetate dimeglumine. SUBJECTS AND METHODS: We used unenhanced MR angiography to measure patency of the renal arteries in 10 healthy volunteers and in 10 patients with renal artery stenosis. Calculations of global glomerular filtration rate were based on measurements of plasma disappearance of gadopentetate dimeglumine as shown by MR relaxometry. For renography with gadopentetate dimeglumine, we generated curves that showed changes in signal intensity in both kidneys over time; intrarenal kinetics were studied by measuring the time of arrival of gadopentetate dimeglumine in the cortex and outer medulla of the kidney. Conventional angiograms, measurements of global glomerular filtration rate based on plasma disappearance of 99mTc-DTPA, and 99mTc-DTPA renograms were used as reference standards. We compared the two different methods of determining global glomerular filtration rates by computing the correlation coefficient of the linear regression of rates derived from studies with gadopentetate dimeglumine versus rates derived from studies with 99mTc-DTPA. RESULTS: In all volunteers, renal arteries were well visualized, and global glomerular filtration rates based on plasma clearance of gadopentetate dimeglumine were normal. In nine of 10 patients, correlation was good between findings on MR angiograms and findings on conventional arteriograms. Finding were discordant in one patient because the patient moved during the MR angiography. For all six patients studied, correlation was good between measurements of global glomerular filtration rates based on plasma clearance of gadopentetate dimeglumine and those based on clearance of 99mTc-DTPA (r = 98%). CONCLUSION: Our results suggest the potential of magnetic resonance for a comprehensive approach for detection of renal artery stenosis. This novel approach provides structural evaluation of renal arteries with unenhanced MR angiography. MR renography is done and global glomerular filtration rates are determined by using MR relaxometry after injection of contrast material. Corticomedullary transit times can be determined on the basis of the dynamic changes in signal intensity that occur after administration of gadopentetate dimeglumine.

Adult↗

Half-dose gadolinium-enhanced MR imaging with magnetization transfer technique in brain tumors: comparison with conventional contrast-enhanced MR imaging.

OBJECTIVE: The purpose of this study was to determine whether half-dose enhanced MR imaging with magnetization transfer (MT) saturation can replace standard-dose enhanced MR imaging without MT saturation in patients who have brain tumors. SUBJECTS AND METHODS: Three sets of enhanced T1-weighted MR images were prospectively obtained for each of 25 patients with 32 brain tumors; the first conventional MR images without MT were obtained after administration of standard-dose (0.1-mmol/kg) gadopentetate dimeglumine. Within 1 week, patients underwent administration of one half-dose (0.05 mmol/kg) of the contrast medium, and then two sets of enhanced T1-weighted images were obtained with and then without MT. The degree of contrast enhancement was assessed qualitatively for all 32 tumors and quantitatively for 26 tumors. In the quantitative analysis, we compared mean values for tumor-brain contrast-to-noise ratios in three sets of images. RESULTS: The visual conspicuity of enhancing lesions in half-dose T1-weighted MR images with MT was comparable with that of standard-dose conventional T1-weighted MR images in 43% of cases including most extraaxial tumors. In approximately 75% of cases, the degree of enhancement of the lesions was similar for half-dose T1-weighted images obtained with and without MT. Overall, mean values for tumor-brain contrast-to-noise ratios were significantly lower in half-dose T1-weighted images with MT than in standard-dose T1-weighted images. Also, mean values for tumor-brain contrast-to-noise ratios were significantly higher in half-dose T1-weighted images with MT than in half-dose T1-weighted images without MT. CONCLUSION: Because half-dose enhanced MR imaging with MT yields enhancement comparable with that of standard-dose enhanced conventional MR imaging in less than 50% of cases, the former technique would replace the latter in only limited cases such as selected extraaxial tumors.

Adult↗

MR imaging and MR arthrography of paraglenoid labral cysts.

OBJECTIVE: We investigated the pathophysiology of paraglenoid labral cysts on the basis of MR imaging, MR arthrography, and cyst aspiration. MATERIALS AND METHODS: From 2211 MR imaging examinations, 51 (2.3%) cysts in 46 patients were identified. MR arthrography (n = 5), cystography (n = 1), arthroscopy (n = 17), percutaneous needle aspiration (n = 4), and medical records were also reviewed (n = 46). RESULTS: On MR imaging and arthrography, cysts were best viewed on T2-weighted images. Mean cyst diameter and volume were 2.2 cm and 2.8 cm3, respectively. Fifty-seven percent of cysts were located adjacent to the posterior labrum. On MR imaging and arthroscopy, a labral tear was identified in 27 (53%) and 15 (88%) patients, respectively. Eight cysts that caused compression neuropathy were large (mean size, 3.1 cm; p = 0.04) and located next to the posterior or inferior labrum. In four of five patients, MR arthrograms showed no intraarticular contrast material in the cyst. Cystograms showed no communication with the glenohumeral joint space, and cyst aspiration resulted in temporary symptom relief; however, cysts recurred in three of four patients. CONCLUSION: Most paralabral cysts are associated with labral tears. Paralabral cysts may be difficult to identify on MR arthrography unless a T2-weighted sequence is performed. Direct communication between a cyst and joint space rarely occurs. A posterior or inferior cyst may cause compression neuropathy of the suprascapular or axillary nerve, respectively. Cyst aspiration may result in temporary relief of symptoms, but an untreated labral tear should be suspected if cysts recur.

Adult↗

MR imaging of the breast in patients with positive margins after lumpectomy: influence of the time interval between lumpectomy and MR imaging.

OBJECTIVE: Postsurgical contrast enhancement resulting from inflammatory changes at the site of surgery limits the accuracy of MR imaging of the breast in diagnosing residual breast cancer. This study was undertaken to evaluate the influence of the time interval between lumpectomy and MR imaging on the diagnosis of residual breast cancer. MATERIALS AND METHODS: Sixty-eight patients who had undergone excisional biopsy with positive resection margins underwent MR imaging for evaluation of residual breast cancer and possible breast conservation. Patients were retrospectively stratified according to the time interval between lumpectomy and MR imaging. Dynamic and morphologic enhancement features were used for lesion characterization. Imaging findings were correlated with results of histopathology. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for patients waiting 7, 14, 21, 28, 35, and 42 days after initial surgery before undergoing MR imaging of the breast. RESULTS: The time interval between lumpectomy and MR imaging of the breast had the greatest influence on the specificity and negative predictive value of MR imaging, increasing progressively over time. A plateau of highest values of 75% specificity and 86% negative predictive value was reached at 28 and 35 days after surgery, respectively. Although the sensitivity and positive predictive value showed smaller variations over time, peak values of 95% sensitivity and 92% positive predictive value were obtained at 35 and 28 days after surgery, respectively. CONCLUSION: We recommend scheduling patients with positive resection margins no earlier than 28 days after initial surgery for evaluation of residual cancer using MR imaging of the breast.

Adult↗

Combined MR lymphangiography and MR imaging-guided needle localization of sentinel lymph nodes using Gadomer-17.

OBJECTIVE: The goals of our study were to determine the technical feasibility of dynamic MR lymphangiography for detecting sentinel lymph nodes using Gadomer-17 contrast material to compare these results to the clinically standardized blue dye contrast agent, and to show MR imaging-guided needle localization marking of the sentinel nodes. MATERIALS AND METHODS: Six anesthetized swine underwent MR imaging before and for 1 hr after interstitial injection of Gadomer-17 in the posterior tongue and intradermally in the stifle (knee). Using MR imaging guidance, we percutaneously placed a histology needle into the sentinel node or nodes. A standardized intraoperative sentinel node detection procedure was then performed using isosulfan blue contrast agent. Sentinel nodes identified on the MR images were compared with and matched to those identified by biopsy needle localization and the isosulfan blue contrast agent. RESULTS. Interstitial and intradermal injection of Gadomer-17 resulted in a lasting, increased MR signal in the regional lymph nodes. Seven sentinel nodes were identified in both the neck and the groin, with one pig showing two sentinel nodes in the neck and another showing two sentinel nodes in the groin. In all cases, the isosulfan blue contrast agent agreed with the location of the sentinel node determined by Gadomer-17 and marked with the needle. CONCLUSION: In this large animal model, dynamic MR angiography of sentinel lymph nodes is technically feasible using a contrast agent (Gadomer-17) and can be easily combined with MR imaging-guided needle localization.

Animals↗

Effects of coregistration of MR to CT images on MR stereotactic accuracy.

Coregistration of different modality imaging serves to increase the ease and accuracy of stereotactic procedures. In many cases, magnetic resonance (MR) stereotaxis is supplanting computerized tomography (CT). The advantages of increased anatomical detail and multiplanar imaging afforded by MR, however, are offset by its potential inaccuracy as well as the more cumbersome and less available nature of its hardware. A system has been developed by one of the authors by which MR imaging can be performed separately without a stereotactic fiducial headring. Then, immediately prior to surgery, a stereotactic CT scan is obtained and software is used to coregister CT and MR images anatomically by matching cranial landmarks in the two scans. The authors examined this system in six patients as well as with the use of a lucite phantom. After initially coregistering CT and MR images, six separate anatomical (for the patients) and eight artificial (for the phantom) targets were compared. With coregistration, in comparison to CT fiducial scans, errors in each axis are less than or equal to 1 mm using the Cosman-Roberts-Wells system. In fact, the coregistered images are more accurate than MR fiducial images, in the anteroposterior (p = 0.001), lateral (p < 0.05), and vertical (p < 0.03) planes. Three-dimensional error was significantly less in the coregistered scans than the MR fiducial images (p < 0.005). The coregistration procedure therefore not only increases the case of MR stereotaxis but also increases its accuracy.

Brain↗

Various patterns of perfusion-weighted MR imaging and MR angiographic findings in hyperacute ischemic stroke.

BACKGROUND AND PURPOSE: Various clinical subtypes of patients presenting with sudden-onset ischemic stroke have been recognized, but classification of those types is not simple. We identified various patterns of perfusion-weighted MR imaging and MR angiographic findings in hyperacute ischemic stroke with relation to clinical outcomes. METHODS: Twelve patients with symptoms of acute ischemic stroke due to middle cerebral artery occlusion underwent perfusion-weighted MR imaging and MR angiography within 6 hours after the onset of symptoms. Perfusion-weighted imaging was performed with a conventional dynamic contrast-enhanced T2*-weighted sequence, and cerebral blood volume (CBV) maps were then created. CBV maps and MR angiographic findings were compared with 99mTc-HMPAO brain SPECT scans, short-term outcomes, and follow-up imaging findings. RESULTS: The combined CBV and MR angiographic findings were classified into three patterns: arterial occlusion and decreased CBV (n = 8), arterial occlusion and increased CBV (n = 2), and no arterial occlusion and normal CBV (n = 2). These three patterns were strongly related to SPECT findings, short-term outcomes, and follow-up imaging findings. Perfusion on SPECT decreased markedly in the affected regions in all patients with the first pattern, decreased slightly in the second pattern, and was normal in the third pattern. Symptoms were not significantly changed at 24 hours after onset in any of the patients with the first pattern, but resolved completely in all patients with the latter two patterns. Follow-up imaging showed large infarctions in all patients with the first pattern. Initially, no infarction was seen in the second pattern, but watershed infarction developed later in one of these patients. CONCLUSION: Hyperacute ischemic stroke may be differentiated into three imaging patterns with different clinical outcomes. The combined use of perfusion-weighted MR imaging and MR angiography may play a substantial role in guiding the choice of treatment of this disease.

Acute Disease↗

MR-cholangiopancreaticography (MRCP) and MR-angiography: morphologic changes with magnetic resonance imaging.

Since 1997 we have prospectively tried to assess/confirm the diagnostic value of MR-Cholangiopancreaticography (MRCP) and MR-Angiography in patients suffering from pancreatic carcinoma. Till today we have studied 116 adult patients with two 1,5 Tesla MRT scanners using a body phased-array coil: 27 patients with benign diseases of the pancreas, 58 with carcinoma of the pancreas, 15 with no disorder of the pancreatobiliary system, 14 with hepatic abnormalities and 2 with other tumors. MR examinations included routinely T1-weighted (TSE, SE), T1-weighted fat-suppressed (TSE, SE), T2 weighted fast turbo spin-echo (UTSE, Haste), T2-weighted fat-suppressed fast turbo spin-echo (SPIR), 2D-cholangiopancreaticography (images were obtained with breath-held) or 3D-cholangiopancreaticography (images were obtained in coronal and axial plane with respiratory triggering). In cases with pancreatic cancer we added MR-angiography. MR images were retrospectively compared with CT, ERCP amd sonography data. Summarizing the results confirm that MRCP is a safe and non-invasive technique for studying pancreatic and biliary diseases which yields information in many cases complemontory to ERCP and PTC. MRCP images can also be used as a guide for subsequent interventional procedures. MRCP will, therefore, allow the restriction of ERCP and PTC to more therapeutical indications and cases offering special problems. Considering staging and follow-up of pancreatic cancer, MRCP cross-sectional images and MR-angiography should be performed, allowing the visualization of the extraductal anatomy/pathology. These techniques may provide the clinicians with complementary information compared to other conventional imaging methods like US and CT. Clinicians engaged in pancreatic oncology, therefore, should have MRCP, MR-angiography and MR imaging available in addition to the conventional diagnostic tools.

Adenocarcinoma↗

Dynamic contrast-enhanced MR angiography and MR imaging of the carotid artery: high-resolution sequences in different acquisition planes.

BACKGROUND AND PURPOSE: First-pass contrast-enhanced MR angiography has become the technique of choice for studying the carotid bifurcation, but this method has some limitations. We evaluated the clinical utility of performing 3D contrast-enhanced MR angiography in the axial plane immediately after performing angiography in the coronal plane. METHODS: Cervical carotid arteries of 80 consecutive patients were studied on a 1.5-T MR imager with phased-array coils. Coronal 3D MR angiography was performed after administering a bolus injection of contrast material (20 mL) with automatic triggering. This was immediately followed by an axial acquisition. We measured carotid diameters on the contrast-enhanced MR angiograms as well as on intra-arterial digital subtraction angiograms according to established criteria. We also evaluated original source MR angiograms. RESULTS: Angiograms obtained in the axial plane correlated better with the intra-arterial digital subtraction angiograms than did the coronal angiograms. When first-pass contrast-enhanced MR angiography was incomplete because of a failure of triggering, the second-phase acquisition provided sufficient image quality. Original source images suffered from ring artifacts, low axial resolution, and a low level of soft-tissue visualization. Axial-based source images showed flow-independent contrast filling to the patent lumen with sufficient visualization of plaque morphology, thickened arterial wall, and surrounding disease processes, such as tumors. CONCLUSION: With the addition of a 1-minute second-phase 3D acquisition in a different plane immediately after first-pass contrast-enhanced MR angiography, one can obtain a more accurate depiction of the carotid bifurcation, insurance against failure of triggering, and diagnostic source images.

Adolescent↗

Bithalamic hyperintensity on T2-weighted MR: vascular causes and evaluation with MR angiography.

PURPOSE: To determine whether MR angiography can be used to differentiate between the two vascular causes of bithalamic hyperintensity on T2-weighted MR images: "top of the basilar" artery occlusion and deep cerebral vein thrombosis. METHODS: A retrospective review identified six patients with bithalamic T2 hyperintensity of vascular causes. MR angiography was performed in four patients, MR angiography and conventional angiography in one patient, and conventional angiography in one patient. Data pertaining to clinical presentation and hospital course were collected. MR angiographic techniques were multislab overlapping three-dimensional time-of-flight, 2-D time-of-flight, and 2-D phase-contrast. RESULTS: Three cases of top of the basilar artery occlusion and three cases of deep cerebral vein thrombosis were recognized. In all cases, T2 hyperintensity in a vascular distribution suggested cerebral occlusive disease. Infarction involving the thalami and basal ganglia was present in two cases of deep cerebral vein thrombosis. Infarction of the thalami, mesodiencephalic region, and cerebellar hemispheres was present in two cases of basilar artery occlusion. Bithalamic infarction alone was seen in one case of deep cerebral vein thrombosis and one case of basilar artery occlusion. In the five cases in which MR angiography was used, this technique accurately distinguished the vessels involved (arterial or venous). CONCLUSION: MR angiography is a useful adjunct to MR imaging in the evaluation of bithalamic T2 hyperintensity. It does help distinguish between the two vascular causes: top of basilar artery occlusion and deep cerebral vein thrombosis.

Adult↗

[A clinical phase III trial of MR-20 in gynecologic nephrotoxicity of cisplatin--a comparative study in MR-20-treated and control patients on cyclical intermittent cisplatin treatment].

UNLABELLED: MR-20 was administered to 52 gynecological cancer patients who presented with nephrotoxicity from cisplatin (CDDP) treatment over 3 courses at 33 institutions throughout Japan during the period from July 1992 through March 1994, in order to study its suppressive effect on the nephrotoxicity as well as its safety; and the results are reported in this paper. METHODS: The efficacy and usefulness of MR-20 were studied by a MR-20-untreated-controlled, non-double-blind manner. An efficacy rate of 72.0% was achieved in the MR-20 group, and 37.0% in the untreated group: MR-20 was significantly more effective for nephrotoxicity than the MR-20-untreated group. Ccr was prevented from significant variations in the MR-20 group, compared with the untreated group. It was considered that MR-20 is a safe drug, and that it is useful in suppressing the nephrotoxicity of CDDP treatment.

Adult↗

Simultaneous radiofrequency (RF) heating and magnetic resonance (MR) thermal mapping using an intravascular MR imaging/RF heating system.

Previous studies have confirmed the possibility of using an intravascular MR imaging guidewire (MRIG) as a heating source to enhance vascular gene transfection/expression. This motivated us to develop a new intravascular system that can perform MR imaging, radiofrequncy (RF) heating, and MR temperature monitoring simultaneously in an MR scanner. To validate this concept, a series of mathematical simulations of RF power loss along a 0.032-inch MRIG and RF energy spatial distribution were performed to determine the optimum RF heating frequency. Then, an RF generator/amplifier and a filter box were built. The possibility for simultaneous RF heating and MR thermal mapping of the system was confirmed in vitro using a phantom, and the obtained thermal mapping profile was compared with the simulated RF power distribution. Subsequently, the feasibility of simultaneous RF heating and temperature monitoring was successfully validated in vivo in the aorta of living rabbits. This MR imaging/RF heating system offers a potential tool for intravascular MR-mediated, RF-enhanced vascular gene therapy.

Animals↗

Interactive MR-guided biopsies of maxillary and skull-base lesions in an open-MR system: first clinical results.

The purpose of this study was to explore the potential of interactive MR-guided biopsies in the maxillary and skull base region using a 0.5-T open-configuration scanner in patients with tumours affecting the maxilla or skull base. Ten patients with cystic or solid tumours affecting the maxillary and skull base regions underwent MR-guided biopsy in a superconducting, open 0.5-T MR system equipped with an optical frameless stereotaxic system. T2-weighted spin-echo images were acquired prior to and following biopsy, which was performed with 18- or 22-G needles using an enoral or percutaneous approach following infiltration of the skin, mucosa and periosteum with local anaesthetics. The position of the needle tip was continuously updated on fast T1-weighted gradient-recalled-echo images (TR 19 ms, TE 7.1 ms, flip angle 30 degrees, slice thickness 1 cm, field of view 24 x 24 cm) using the frameless stereotaxic system. In addition, the needle was identified based on the associated susceptibility artefact in all three planes. Once the target lesion had been reached, cytology material was aspirated. All ten patients tolerated the interactive MR-guided biopsies well without complications. Vital structures, including the brain, neurovascular bundles, vessels and eyes, were visualized on MR imaging and could be spared. There was no difference in the use of 18- or 22-G non-ferromagnetic needles concerning the susceptibility artefact. Sufficient material for cytological analysis was obtained in nine of ten cases. The mean biopsy time was 15 min. Interactive MR-guided biopsies of the head and neck in an open system are technically feasible and safe. Monitoring of the needle path in multiple planes permits the interactive adjustment of the needle course in near real time. Interactive MR-guided biopsies may well replace open surgical procedures in the maxillary region in selected patients.

Adult↗

MR imaging and 1H-MR spectroscopy in a case of cerebral infarction with transient cerebral arteriopathy.

A case of cerebral infarction with transient cerebral arteriopathy in a 12-year-old female is described. The child showed with an acute onset of left hemiplegia, central facial palsy and aphasia. She was diagnosed with right internal carotid artery obstruction with no predisposing factors for cerebral infarction. A serial MR image and MR spectroscopy of the brain was performed. MR angiography revealed reversible vascular changes in the right middle cerebral artery after several months. The ratio of choline/creatine was elevated and that of N-acetylaspartate (NAA)/creatine was depressed in the cerebral lesion, however, they were normalized during the remission phase with long echo time-MR spectroscopy. The elevation of the lactate peak was clarified with short echo time-MR spectroscopy. The longitudinal follow up using MR angiography, and MR spectroscopy with long and short echo time was useful for the evaluation of reversible vascular change with cerebral infarction in children.

Aspartic Acid↗

Does high-resolution MR imaging have better accuracy than standard MR imaging for evaluation of the triangular fibrocartilage complex?

We compared the findings of high-resolution MR imaging and standard MR imaging in the detection of tears of the triangular fibrocartilage in 33 patients with chronic wrist pain on the ulnar side. With arthroscopy as the standard of reference, sensitivity was 100%, specificity 53%, and accuracy 79% with the high-resolution MR imaging, against 83%, 67%, and 76% with the standard MR imaging. High-resolution MR imaging showed a higher sensitivity, but a decreased specificity in the assessment of the triangular fibrocartilage. The results showed that diagnosis of tears in the triangular fibrocartilage by MR imaging, even high-resolution MR imaging, is unsatisfactory, although further technological advances may well improve the accuracy.

Adult↗

[Gadolinium-enhanced T(1)-weighted MR urography versus T(2)-weighted (HASTE) MR urography in children].

PURPOSE: To evaluate gadolinium-enhanced T(1)-weighted excretory MR urography (EMRU) versus T(2)-weighted (HASTE) MR urography in children with upper urinary tract abnormalities. PATIENTS AND METHODS: In a prospective study 63 children, aged from 3 weeks to 15 years, underwent MR urography in a 1.5-T scanner. Before and after an intravenous injection of 0.05 mg/kg body weight of furosemide, respiratory-triggered HASTE images were obtained for T(2)-weighted MR urography. EMRU was performed subsequent to i. v. gadolinium injection with respiratory-gated, coronal 3 D-gradient-echo sequences. RESULTS: Compared to T(2)-weighted (HASTE) MR urography, gadolinium-enhanced MR urography revealed a superior diagnostic accuracy in non-dilated collecting systems (horseshoe kidneys, ectopic kidneys, duplex systems, single ectopic ureters, ureteroceles). EMRU and T(2)-weighted (HASTE) MRU turned out to be equivalent in the assessment of obstructed but normal functioning upper urinary tracts (UPJ obstructions, megaureters). Non-functioning dilated collecting systems and multicystic dysplastic kidneys were best visualized with use of T(2)-weighted (HASTE) MR urography. CONCLUSION: Respiratory-gated gadolinium-enhanced T(1)-weighted MRU allows accurate evaluation of most upper urinary tract abnormalities. T(2)-weighted (HASTE) MRU complements GMRU in the evaluation of non-functioning renal units and cystic disease of the kidneys.

Adolescent↗

Analysis of patellar cartilage. Comparison of conventional MR imaging and MR and CT arthrography in cadavers.

OBJECTIVE: To compare the sensitivity of conventional MR sequences, MR arthrography, and CT arthrography for the detection of cartilage lesions of the patella in cadavers. MATERIAL AND METHODS: Cartilage lesions in 10 cadaveric specimens were evaluated by MR imaging, including T1-weighted, proton density-weighted and T2-weighted sequences, and fat-suppressed spoiled gradient recalled acquisition in the steady state (SPGR), MR arthrography including T1-weighted and SPGR sequences, and double-contrast CT arthrography including conventional and subtracted images. The sensitivities with regard to detection of lesions were compared to results from morphologic and histologic investigations of sectioned specimens. RESULTS: Twenty-one lesions were detected morphologically. For the detection of these lesions, sensitivities were as follows: T1-weighted images 33.3%; proton density-weighted images 85.7%; T2-weighted images 85.7%; SPGR images 80.9%; MR arthrography with T1-SE sequences 57.1%; MR arthrography with SPGR sequence 90.5%; and CT arthrography, both regular and subtracted images 85.7%. CONCLUSION: For noninvasive techniques, T2-weighted images revealed the highest sensitivity for the detection of patellar cartilage lesions, which was surpassed only by MR arthrography using the SPGR sequence. CT arthrography delineated surface irregularities but failed to demonstrate intrachondral lesions.

Aged↗

Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee. Correlation of MR and arthroscopic findings.

PURPOSE: The objective was to assess the efficacy of fast spin-echo (FSE) imaging in the detection of articular cartilage abnormality in osteoarthrosis of the knee. MATERIAL AND METHODS: We studied 356 articular surfaces in 73 knees that had been examined by both MR imaging and arthroscopy. The MR images were obtained with FSE imaging (TR/TE 4200/100) on a 0.5 T unit. The surface abnormalities of the articular cartilage that were detected by MR imaging were compared with the arthroscopic findings. RESULTS: The overall sensitivity and specificity of MR in detecting chondral abnormalities were 60.5% (158/261) and 93.7% (89/95) respectively. MR imaging was more sensitive to the higher grade lesions: 31.8% (34/107) in grade 1; 72.4% (71/98) in grade 2; 93.5% (43/46) in grade 3; and 100% (10/10) in grade 4. The MR and arthroscopic grades were the same in 46.9% (167/356), and differed by no more than 1 grade in 90.2% (321/356) and 2 grades in 99.2% (353/356). The correlation between arthroscopic and MR grading scores was highly significant with a correlation coefficient of 0.705 (p < 0.0001). CONCLUSION: FSE sequence was less sensitive to mild cartilage abnormality but useful in detecting moderate to severe abnormality and in evaluating the degree of articular cartilage abnormality.

Adult↗