FLAIR Fusion in Multiple Sclerosis Follow-up: An Indispensable Tool in Clinical Routine

MS follow-up leads to millions of brain MRI scans around the world. Depending on the number and size of inflammatory lesions, comparing successive exams to assess dissemination in time can be a challenging and lengthy process. Stéphane Cantin et al. (Grenoble, France) describes FLAIR image fusion with syngo.via, an easy to implement and cost-effective technique that allows faster and improved patient care compared to conventional frame-by-frame 3D FLAIR comparison. [...]

To Add Myelin Detection to Your Neuro Protocol Without Additional Scan Time

The article describes the experiences with REMyDI (Rapid Estimation of Myelin for Diagnostic Imaging), a method of myelin detection in the brain, using a scan time of approximately 6 minutes. [...]

Optimizing Fiducial Markers for MRI-based Radiotherapy

Fiducial markers need to fulfill many, sometimes competing, criteria when used for MRI based radiotherapy treatment planning. This article covers the development and optimization of markers. [...]

First Experiences with the World’s First MAGNETOM Vida

This review focuses on 8 critical questions regarding gadolinium deposition in the brain and body, with the answers and discussion therein important for future regulatory decisions and clinical practice. [...]

Performing Gynecologic Brachytherapy in the Medical Innovation Technical Expert Center

Houda Bahig et al. describe their intensity modulated radiotherapy planning workflow with MRI for locally advanced head-and-neck cancer (HNC) and discuss the current role of MRI in HNC treatment planning. [...]

MRI in Head and Neck Radiotherapy Planning

Houda Bahig et al. describe their intensity modulated radiotherapy planning workflow with MRI for locally advanced head-and-neck cancer (HNC) and discuss the current role of MRI in HNC treatment planning. [...]

Assessing Brain Volumes Using MorphoBox Prototype

This review focuses on 8 critical questions regarding gadolinium deposition in the brain and body, with the answers and discussion therein important for future regulatory decisions and clinical practice. [...]

High-resolution, Anatomically-accurate Diffusion-weighted Imaging of Orbital and Sinonasal Lesions with RESOLVE

This paper reviews four recently published studies where RESOLVE was shown to be clinically effective in the diffusion-weighted imaging of sinonasal and optic pathologies. It also demonstrates the clinical value that RESOLVE brings to the detection and characterization of the diseases in these regions. [...]

Overview of Magnetic Resonance Fingerprinting

This overview of Magnetic Resonance Fingerprinting describes the basic concepts of MRF and illustrates some clinical applications. [...]

New ‘ADC & b-value’ Tool in syngo.via

This article describes the feature ‘ADC & computed b-value’ available on Siemens’ syngo.via VB10. This new tool provides an increased degree of freedom in the choice of the b-value for disease detection and characterization. [...]

Pediatric Pathologies that have Leukocoria as Presenting Sign: the Podium

The article features the clinical and imaging signs and differential diagnosis of Retinoblastoma, persistent fetal vasculature and Coats’ disease. View/Download [...]

Safety of the Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging, Focusing in Part on Their Accumulation in the Brain and Especially the Dentate Nucleus

The established class of intravenous contrast media for magnetic resonance imaging is the gadolinium chelates, more generally referred to as the gadolinium-based contrast agents (GBCAs). [...]

Launch of the world’s first 7 T MR platform intended for clinical use (Siemens)

Erlangen, Germany, May 31, 2015 — Siemens announced at the Toronto ISMRM (International Society for Magnetic Resonance in Medicine) meeting the launch of the world’s first 7 T MR platform intended for clinical use. Important advances include a new, light, actively shielded magnet with zero helium boil-off and dual operating modes, enabling rapid switching between research […] [...]

CAIPIRINHA – Revisited

The development ofmulti coil receiver hardware as well as dedicated parallel acquisition techniques (PAT) and respective reconstruction methods allowed for a significant decrease of acquisition times in almost all clinical applications. This article provides a brief overview of 2D- and MS-CAIPIRINHA. [...]

Accelerated Diffusion Tensor Imaging of Skeletal Muscle Using Simultaneous Multi-Slice Acquisition

Simultaneous multi-slice acquisition with CAIPIRINHA reduces the scan time in diffusion-weighted MRI. In this article, early experience with this technique for accelerated DTI of skeletal muscle is shown. [...]

Simultaneous Multi-Slice (SMS) Imaging for Pre-Surgical BOLD fMRI and Diffusion Tractography: Case Illustrations

The presented case studies illustrate that SMS can increase the statistical confidence of fMRI and diffusion tractography results. These gains may be used to increase spatial image resolution and coverage, to improve spatial coregistration to high-resolution anatomical scans for intra-operative neuro-navigation, and / or to shorten acquisition times. [...]

Quiescent Interval Single-Shot (QISS) Lower Extremity MRA for the Diagnosis of Peripheral Artery Disease: Case Presentations

Case presentation of non-contrast QISS MRA providing high diagnostic accuracy for the detection of hemodynamically significant arterial stenosis of the lower extremities at both 1.5 and 3T. [...]

Point-of-Care MR Imaging and How We can Learn from Other Imaging Modalities. Thoughts on a Potential New Strategy

The article introduces point-of-care MRI, an extremely focused and goal-directed examinations strategy, that could reduce examination time and patient comfort. [...]

Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI: Early Experience for Brain Ischemia and Cervical Lymphadenopathy

In single shot EPI, the entirety of k-space is traversed after one shot (excitation). Readout-segmentation acquires k-space in multiple shots for reduced TE and encoding time. Real-time reacquisition of unusable shots is also supported. [...]

Clinical Case: 3 Tesla MR Neurography-Guided Posterior Femoral Cutaneous Nerve Block

The high SNR available at 3T provides the ability to perform high-resolution MR neurography-guided perineural injections for highly accurate visualization of small nerve as well as needle targeting and perineural injection. This case report demonstrates how this techniques facilitates accurate targeting of the PFCN.  Download/View PDF [...]

syngo MR XA10 – Your New Work Environment for More Comfortable Scanning and Intuitive Image Processing

In this article we share some of our experiences over the last few years with MR upgrades. [...]

Case Series: Utilization of the Pediatric 16 Coil for 1.5T and 3T Systems

In this article we share some of our experiences over the last few years with MR upgrades. [...]

Long-term Experience with MR Upgrades

In this article we share some of our experiences over the last few years with MR upgrades. [...]

Rapid Estimation of Myelin for Diagnostic Imaging (REMyDI)

The article describes a new MRI myelin detection model to measure the presence of myelin by its effect on the surrounding cellular water, and discusses clinical applications of this technique. Download/View PDF [...]

Val M. Runge, MD – ASNR 2015 – Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease – The Essentials with MR and CT

This educational exhibit was presented at the ASNR 2015 meeting, with imaging performed on a 3 T Siemens Skyra MR system. The full reference for the exhibit is given below. Runge V, Smoker W, Valavanis A. Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease – The Essentials with MR and CT. ASNR 53rd Annual Meeting, […] [...]

Val M. Runge, MD – ASNR 2015 – Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI

This educational exhibit was presented at the ASNR 2015 meeting, with imaging performed on a 3 T Siemens Skyra MR system. The full reference for the exhibit is given below. Runge V, Richter J, Beck T, Piccirelli M, Valavanis A. Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI. ASNR 53rd Annual Meeting, April 25-30, 2015, Chicago, Illinois […] [...]

Subarachnoid hemorrhage

subarachnoid hemorrhage well seen on T2 fl2d coronal GRE, subarachnoid hemorrhage of unknown reason, may have small thrombosed cortical vein – very small, on pre-contrast T1, also likely small adjacent skull hemangioma, seen on both CT and MR Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

ACOM aneurysm

A flow void is noted in the region of the anterior communicating artery (ACOM) on an axial T2-weighted image, with signal intensity corresponding to arterial flow on an axial source image from a 3D TOF MRA. CE MRA images further confirm the aneurysm, with the right A1 segment of the ACA noted to be very […] [...]

ACA aneurysm

Note the prominent pulsation artifact in the first image (a FSE T1-weighted scan at 3 T), seen propagating in the left-right dimension. On the post-contrast image (a short TE GRE scan), the aneurysm is well depicted, other than partial volume effects (due to the 4 mm slice thickness). This 2D scan is relatively immune to […] [...]

Acute cerebellar hemorrhage

Acute cerebellar hemorrhage, hypertensive. A large acute parenchymal hemorrhage is seen in the left cerebellar hemisphere, on sagittal, axial, and coronal reformatted images from a non-contrast CT exam. Note the vasogenic edema circumferential to this hematoma. Hemorrhage is also seen in the fourth ventricle on the axial image, with interstitial edema and ventricular enlargement noted […] [...]

Acute infarction of the caudate head and lentiform nucleus

Both structures are supplied by the lateral lenticulostriate arteries, which originate from the MCA. The caudate nucleus is also supplied by the medial lenticulostriate arteries, which arise from the ACA. The recurrent artery of Heubner, which supplies the anteromedial caudate nucleus and the anteroinferior internal capsule, is the largest of the medial lenticulostriate arteries, and […] [...]

Acute lacunar infarction, posterior limb of the internal capsule

The patient was hypertensive, and presented for CT (which was negative) with acute hypoesthesia involving the left side of the body. The MR was obtained 15 hours later, and reveals a small acute lacunar infarct in the internal capsule on the right. Due to the ability to detect cytotoxic edema, with diffusion weighted imaging, MR […] [...]

Acute medial medullary infarct

Abnormal hyperintensity is noted in the right medial medulla on both T2- and diffusion-weighted scans, which corresponds to vasogenic and cytotoxic edema, respectively. The medial medulla is most often described as being supplied by the anterior spinal artery. The medial medullary syndrome, also known as Dejerine syndrome, is caused by infarction of this region. It […] [...]

Acute parenchymal hemorrhage, due to an underlying AVM

Acute parenchymal hemorrhage, due to an underlying AVM. A large acute parenchymal hematoma is noted in the right frontal lobe. Post-contrast, there is tubular like enhancement within and immediately posterior to the hemorrhage, most consistent with acute extravasation of blood. The coronal thick MIP from the CTA study reveals a small nidus of arterial enhancement […] [...]

Acute subarachnoid hemorrhage from a small ACOM aneurysm

The images presented include an axial unenhanced CT, a coronal MIP from the CTA, and a 3D magnified view of the aneurysm from the CTA, obtained using volume rendering technique (VRT). The latter shows the distal internal carotid artery, the two anterior cerebral arteries, and the small multi-lobulated aneurysm originating from the ACOM, near its […] [...]

Acute superior cerebellar artery (SCA) infarction

Acute superior cerebellar artery (SCA) infarction, with an accompanying small unilateral pontine infarct. Hypodensity is seen on CT in a portion of the SCA territory, with hyperintensity on axial T2-weighted MR (and sagittal FLAIR), both due to vasogenic edema. The presence of restricted diffusion is confirmed on the ADC map, reconstructed from the diffusion scans. […] [...]

Acute subdural and parenchymal hemorrhage, from an underlying AVM

Acute subdural and parenchymal hemorrhage, from an underlying AVM, in a patient with fibromuscular dysplasia (FMD). Intracranial aneurysms are a well known associated finding in FMD, with the occurrence of intracranial arteriovenous malformations less common. On axial CT, both the acute subdural and parenchymal hematomas are well demonstrated, together with midline shift and compression of […] [...]

Anaplastic astrocytoma (WHO grade III), CT and MR

A focal, mildly hyperdense, lesion is noted on CT in the right centrum semiovale, with restricted diffusion and no abnormal contrast enhancement. rCBV is mildly elevated. The hyperdensity on CT is unusual, with the diffusion restriction (confirmed on the ADC map, not shown) correctly suggesting a higher-grade lesion, with the lesion appearing on other scans […] [...]

Anaplastic ependymoma (WHO grade III), in an 18 month old infant

There is a large enhancing extra-axial mass lying within the 4th ventricle and extending into the foramen of Luschka on the left. Heterogeneity of the lesion with cystic and necrotic areas is characteristic, along with the previously described findings. Most patients are one to five years in age, and present – as this child – […] [...]

Aneurysm, cavernous carotid artery

A small mass lesion is noted within the left cavernous sinus on both CT and MR (axial imaging), with CT revealing enhancement therein. MRA confirms this to be an aneurysm, with the DSA provided for comparison (from an initial balloon test occlusion study). This 12 mm aneurysm of the cavernous segment of the internal carotid […] [...]

B cell lymphoma

A hyperintense periventricular mass lesion with accompanying vasogenic edema is noted in the right occipital lobe. The mass is hyperintense on DWI, with disruption of the blood-brain barrier (enhancement) demonstrated post-contrast. The mass had restricted diffusion (reflected by the high SI on DWI), which is compatible with primary CNS lymphoma, a diagnosis confirmed at surgery. […] [...]

Brain metastases, melanoma

Pre- and post-contrast axial T1-weighted scans are illustrated. Pre-contrast, several small lesions in the frontal lobes, in particular on the left, demonstrate hyperintensity. Numerous small nodular enhancing lesions are noted post-contrast, all at the gray-white matter junction. Hemorrhagic metastases are seen in up to 15% of brain metastases. A mnemonic for the primary tumors that […] [...]

Calvarial metastasis from breast carcinoma, with hyperostosis frontalis interna

A large lytic skull lesion is noted on CT, along with benign thickening along the inner table of the frontal bone (an incidental finding). MR depicts well the soft tissue mass within the skull, which is slightly expansile and easily distinguished pre-contrast from the adjacent fatty marrow, with enhancement post-contrast. Part of the on-line supplement […] [...]

Cavernous malformation, with an associated developmental venous anomaly

On CT, a small, well delineated, hyperdense, round, focal lesion is seen pre-contrast, to the right and posterior to the fourth ventricle. On axial T2-weighted scans, a complete hemosiderin rim is demonstrated, together a “popcorn ball” appearance centrally, with mixed high and low signal intensity – all characteristic for a cavernous malformation. Just lateral and […] [...]

Cerebellar hemangioblastoma

Cerebellar hemangioblastoma on MR, von Hippel Lindau syndrome. Well seen on axial T2- and sagittal post-contrast T1-weighted scans is a cystic cerebellar lesion with an enhancing mural nodule. This lesion is also illustrated on CT in an accompanying figure. A solid enhancing nodule (along the periphery of the cyst) would be the most characteristic imaging […] [...]

Cerebellar hemangioblastoma on CT

Cerebellar hemangioblastoma on CT, von Hippel Lindau syndrome. Post-contrast scans in all three orthogonal planes reveal a cystic cerebellar lesion, with an enhancing mural nodule, the most common imaging presentation for a hemangioblastoma. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Cerebral abscess

A small lesion with a thin, uniform rim of contrast enhancement and moderate associated vasogenic edema is noted in the left postcentral gyrus. Note that the periphery of the lesion is slightly hypointense on the coronal FLAIR scan, which is characteristic of an abscess, together with restricted diffusion (well seen in this patient, but with […] [...]

Choroidal fissure cyst

These are considered a normal variant, and occur in the medial temporal lobe. They have a characteristic spindle shape on sagittal images (not illustrated), demonstrate CSF signal intensity, and expand slightly the choroidal fissure of the temporal lobe. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Convexity meningioma

Axial, sagittal, and coronal images reveal a round extra-axial lesion, with a broad base along the dura of the convexity, and a small associated dural tail. Additional typical findings for the diagnosis include relative isointensity to brain on the T1-weighted scan, slight hyperintensity on T2-weighted scans, and homogeneous contrast enhancement. Part of the on-line supplement […] [...]

Brain abscess

Clinical History: This 5-year old boy presented with an acute headache and vomiting for 12 hours. The patient had a clinical history of cholesteatoma surgery in the recent past, involving the right mastoid.   Diagnosis: Brain abscess   MR Technique: Contrast-enhanced brain MR imaging was performed on a 3T system following an unenhanced CT scan […] [...]

Convexity meningioma with invasion of the superior sagittal sinus and the calvarium,CT

An enhancing lesion is identified along and to the left of the falx posteriorly, with occlusion of the superior sagittal sinus (diagnosed by the lack of enhancement). A portion of the sinus and adjacent draining cortical veins are identified along the anterior margin of the lesion. The calvarium is focally involved, with expansion, osteolysis and […] [...]

Convexity meningioma with invasion of the superior sagittal sinus and the calvarium,MR

In an accompanying figure, the CT findings in this case are presented. An extra-axial mass lesion is noted, adjacent to and to the left of the falx. The superior sagittal sinus is occluded. Meningiomas with restricted diffusion (hyperintensity on DWI), as in this example, tend to be malignant or highly atypical. The sagittal post-contrast exam […] [...]


CT reveals a normal right coronal suture, with bony bridging of the suture on the left. The result is an abnormal shape to the skull, which is asymmetrical, and termed plagiocephaly (which can involve either the coronal suture, as in this patient, or the lambdoid suture). No gross structural abnormalities are noted involving the brain. […] [...]

Early subacute infarct along the lateral ventricle, in a patient with extensive chronic small vessel white matter ischemic disease

A large lacunar infarct is seen in the white matter of the corona radiata, immediately adjacent to the left lateral ventricle. The infarct demonstrates both vasogenic edema, seen with abnormal high signal intensity on the T2-weighted scan, and cytotoxic edema, seen as restricted diffusion (low intensity) on the ADC map. Thus, the lesion is early […] [...]

Early subacute pinpoint cortical infarct, left precentral gyrus

The patient presented 6 days prior to the MR exam with right arm and facial paralysis. NIHSS=3 (minor stroke), which improved to 0 (no stroke symptoms). CT at the time of symptom onset was negative. Multiple small focal areas of gliosis or edema (with high signal intensity) are seen on the coronal FLAIR, with a […] [...]

Falx meningioma, with interval growth

The first post-contrast coronal T1-weighted scan was obtained six years prior to the second exam, with coronal FLAIR and post-contrast T1-weighted scans illustrated from the second exam. There has been interval growth of the lesion, substantial when viewed from a volume perspective. The lesion was electively removed, prior to possible involvement of the superior sagittal […] [...]

Focal cortical dysplasia

There is focal cortical thickening and a relatively poorly defined transition between gray and white matter, seen in the left frontal lobe on axial and coronal scans, in this 18 month old with intractable seizures. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Ganglioglioma (cystic)

Presenting with seizure,a small intra-axial mass lesion is noted in the posterior temporal lobe in this young adult male. There is a small amount of associated vasogenic edema. Post contrast, the enhancement is predominantly rim-like in character, with likely both a solid (posteriorly) and a cystic component to the lesion. Part of the on-line supplement […] [...]

Ganglioglioma (solid)

A relatively well defined intraaxial mass lesion is noted in the right temporal lobe, with low- and high signal intensity respectively on T1- and T2-weighted scans, and prominent enhancement. There is only mild accompanying vasogenic edema. Location in the temporal lobe is characteristic for this diagnosis, as was the patient’s age (13 years), with this […] [...]

Glioblastoma, right parietal in location

A relatively well-defined enhancing mass lesion is seen, with prominent accompanying vasogenic edema. Despite the absence of gross central necrosis, the abnormal high signal intensity on FLAIR extends within the splenium of the corpus callosum, and extended (on images not presented) to the left as well. This finding is consistent with infiltration of the corpus […] [...]

Gyriform hyperdensity in a large left MCA and watershed territory infarction, due to prior DSA and not hemorrhage

The patient presented with signs of a large acute left MCA infarct, and proceeded to DSA. The images on the top row were acquired within hours following DSA, and show gyriform hyperdensity in the left MCA and watershed distributions, including the left caudate head. By imaging appearance alone, this could represent either hemorrhage or residual […] [...]

Hemangioblastoma (WHO grade I)

A cerebellar mass lesion is seen on the axial T2-weighted scan, with mild accompanying vasogenic edema. A distinctive additional finding is the many prominent associated vascular structures (flow voids). TOF MRA performed with contrast administration reveals a highly vascular lesion, with prominent early enhancement, and tortuous feeding vessels both anteriorly and posteriorly. There is prominent […] [...]

Late subacute, enhancing PICA infarct

There is slight hyperintensity on DWI, which proved to be T2-shine through (not true restricted diffusion) in a portion of the arterial territory of PICA on the right. Hyperintensity is noted on the axial FSE T2-weighted scan in this region, with only subtle increased signal intensity on the coronal FLAIR. On the post-contrast coronal scan […] [...]

Late subacute, enhancing PCA distribution infarcts, secondary to dissection of the right vertebral artery

Edema is seen in the thalamus, high signal intensity in the hippocampus on DWI (principally T2 shine through), and abnormal enhancement post-contrast in these regions together with the medial occipital lobe (all on the right). CE-MRA reveals the right vertebral artery to be narrowed in its midportion, with a small pseudoaneurysm at the level of […] [...]

Macroadenoma of the pituitary gland, with intra-operative MR

Coronal and sagittal T1-weighted post-contrast scans are presented in a patient with a small macroadenoma, both prior to surgery (upper row) and intraoperatively (lower row). Note that the adenoma enhances less than the normal pituitary, and is located inferiorly within the sella. There is cavernous sinus invasion on the right. On the intra-operative scan, near […] [...]

MCA bifurcation aneurysm

A small multilobulated aneurysm is noted on the left, visualized both on planar imaging post-contrast as well as on MRA. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

MCA bifurcation aneurysm, T2 flow void

On the axial T2-weighted scan, a flow void is noted in the region of the MCA bifurcation on the right. Coronal post-contrast imaging reveals enhancement of this aneurysm, which is well visualized on TOF MRA. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

MCA with accompanying ACA infarcts

At presentation (upper two images), on the unenhanced CT only a small chronic white matter infarct is noted in the left frontal lobe. CTA (thick MIP) reveals a paucity of vessels in the left ACA and MCA distributions. The CT one day later (lower two images) reveals abnormal low density in both the ACA and […] [...]

Metastatic melanoma

A large left frontal metastasis, with prominent enhancement and surrounding vasogenic edema is noted on pre- and post-contrast T1-weighted scans. There are small areas of hemorrhage (methemoglobin) and cystic change (with low signal intensity) therein. The 4 mm coronal post-contrast T1-weighted image raises the question of a small pinpoint cerebellar metastasis on the left. Reformatting […] [...]

Multiple cerebellar hemangioblastomas

Multiple cerebellar hemangioblastomas on MR, perfusion imaging (ASL). Two small nodular enhancing lesions, with mild accompanying vasogenic edema, are noted within the cerebellum in this patient with von Hippel Lindau syndrome. Arterial spin labeling (ASL) is an alternative technique to first pass perfusion MR, the latter acquired during bolus gadolinium chelate administration typically using echoplanar […] [...]