Myxoid Chondrosarcoma

This 65-year-old man presented to clinic with a tender mass in the anteromedial portion of his right midthigh which had enlarged over a year’s time. He further complained of nonspecific associated symptoms, including paresthesias and occasional temperature changes in his right leg. Following the illustrated MR examination, the patient was referred for evaluation by surgical oncology. [...]

Nonossifying Fibroma

This 23-year-old woman presented to clinic complaining of right thigh pain over the last year, worse with weightbearing and at night. The subsequent plain film radiograph and MR examination revealed a lesion within the distal femoral metadiaphysis. Biopsy showed findings consistent with a nonossifying fibroma. [...]

Tenosynovial Giant-cell Tumor

This 28-year-old woman presented with an approximately 3 year history of slowly-progressive left ankle pain, worse with movement and at the end of the day. After detection of the illustrated mass, surgery was performed with pathologic examination confirming a tenosynovial giant-cell tumor. [...]

Synovial Sarcoma (monophasic fibrous type)

This 20-year-old man presented with increasing pain and swelling in his left shoulder—an ongoing problem for the prior three months. Physical exam revealed a slightly tender, indurated mass with normal overlying skin. [...]

Technical Considerations in Brain DWI

To provide imaged-guided instruction of technical considerations of diffusion-weighted imaging (DWI) for neuroradiologists. [...]

Ewing Sarcoma

This 15-year-old young boy presented clinically with a complaint of slow onset of a temporal headache, with subsequently vomiting which being serious in the last several weeks. After a physical exam that revealed swelling in the region of the right temporal bone with local tenderness, the patient was referred for a MR exam and received subsequent surgical treatment. [...]

Cerebral Magnetic Resonance Spectroscopy at 1.5T and 3T

MR spectroscopy is a powerful technique that adds metabolic information to routine MRI brain examinations. Through four cases, this article provides tips for performing cerebral MRS. Examples of additional information using this technique include differentiating cerebral neoplasms from abscesses and distinguishing solitary primary cerebral neoplasms from solitary cerebral metastatic deposits. [...]

Introduction to Advanced Techniques in MR Neuroimaging

This article provides a comprehensive introduction to advanced techniques in neuroimaging, including fMRI, DTI, DWI, ASL, SWI. [...]

How Breast MRI Changed the Operative Management

MR diffusion-weighted imaging (DWI) is no longer just for brain applications. Whole body DWI is becoming a standard application in routine imaging. Whole body DWI has become as valuable as T2 contrast in tumor imaging and it allows characterization of tissue properties. This article provides responses to some of the more frequently asked questions including the background, application, and interpretation of whole body DWI and its calculated Apparent Diffusion Coefficient (ADC) images. [...]

Frequently Asked Questions: Diffusion Weighted Imaging (DWI)

MR diffusion-weighted imaging (DWI) is no longer just for brain applications. Whole body DWI is becoming a standard application in routine imaging. Whole body DWI has become as valuable as T2 contrast in tumor imaging and it allows characterization of tissue properties. This article provides responses to some of the more frequently asked questions including the background, application, and interpretation of whole body DWI and its calculated Apparent Diffusion Coefficient (ADC) images. [...]

Assessment and Classification of Peripheral Vascular Anomalies by Time-Resolved MRA using TWIST

Vascular malformations are complex lesions with a variety of clinical manifestations. Time-resolved MRA combined with parallel imaging and echo sharing schemes represents a reasonable alternative to more invasive DSA for the evaluation of VMs. Therefore, time-resolved MRA can play an important role in categorizing these lesions and determining their extent in order to correctly guide treatment. [...]


Three series of scout images, to be used for slice positioning in a MR scan of the brain, are illustrated. The first is a typical scout (1), using 2D FLASH technique, with images acquired, as is common today, in the three orthogonal directions. These three directions (sagittal, coronal, and axial) are respective to the main magnetic field, but not to the anatomy of the patient. Note that the patient is less than perfectly positioned, a common occurrence in clinical practice, with the cause multifactorial. The second series of scout images (2) is acquired using a 3D VIBE scan, with the scan time however no longer than for the acquisition of the three scouts shown in (1), approximately 15 seconds. Illustrated are the images already after the initial iteration in slice positioning by the AutoAlign algorithm. The third series of scout images (3) is the final result from AutoAlign, which is produced automatically without user intervention. The axial images have been correctly chosen to span the brain from the vertex to the skull base, the plane of reference (alignment) has been chosen to be the equivalent of the AC-PC line (anterior commissure to posterior commissure), and the images are orthogonal to the coronal plane. [...]

Cerebral amyloid angiography using SWI

Compared to conventional T2*-weighted imaging, a susceptibility-weighted imaging technique is very sensitive in the detection of small bleedings and vascular malformations. This case report shows that SWI is a sensitive tool for the precise assessment of CAA. His findings show that by using SWI, multiple small cortical and subcortical bleedings can be depicted in detail and can show the extent of the severity of CAA better than with conventional T2*-weighted MRI only. [...]

RESOLVE, Multishot Echoplanar Diffusion Weighted Imaging

Scans were acquired at 1.5 T with a typical diffusion weighted echoplanar (EPI) scan sequence (A), and also with a RESOLVE work-in-progress (WIP) scan sequence (B). RESOLVE is a multi-shot technique that uses 2D navigator correction with readout-segmented EPI (ISMRM 2004, p442). Axial scans of the brain in a normal volunteer, at the level of the petrous apices, are presented. The conventional single shot sequence was acquired (with complete coverage of the brain) in 0:54 min:sec. The RESOLVE (multishot) scan was acquired in 3:02 min:sec. A parallel imaging factor of 2 was used for the single shot acquisition, with no parallel imaging employed with the multishot acquisition. Partial Fourier was employed in (A), resulting in a shorter scan time but also some image blurring when compared to (B). [...]

T1 SPACE for Improved Detection of Brain Metastases

T1 SPACE provides in a reasonable scan time a high resolution 3D acquisition of the brain, with improved detection of brain metastases when compared to MP-RAGE, and is advocated as the scan of choice at 3 T [...]

New Non-Contrast MR Techniques (for MR angiography and tissue perfusion)

NATIVE enables excellent non-contrast MR angiographic imaging, with reproducible results. This new software/scan approach is particularly important given that the use of intravenous contrast media has come under recent increased scrutiny. Of relevance, the gadolinium chelates (and specifically the less stable agents in this class), which are used as MR contrast agents, have been linked to a condition called Nephrogenic Systemic Fibrosis (NSF) that can occur in patients with renal insufficiency. [...]


This 41-year-old female presented to clinic with continued pain and swelling in her left fifth finger. She reported an extensive history of injuries to that finger over the last 20 years. The patient’s MRI, illustrated below, revealed a lesion in the proximal phalanx of the left fifth finger which was confirmed as an enchondroma by subsequent surgery. [...]

Improved Workflow and Performance for Contrast-Enhanced MR Angiography Sequences

Recent improvements in TWIST (dynamic contrast enhanced MRA) and more conventional non-dynamic contrast enhanced MRA are discussed. [...]


This 56-year-old female presented to clinic complaining of right foot pain and swelling for the last year, particularly involving the base of the fifth metatarsal and the 3rd toe. A hard, painful nodule involving the base of the patient’s fifth metatarsal was noted on physical exam. [...]

syngo TWIST for Dynamic Time-Resolved MR Angiography

3D dynamic imaging has been available since the late 90s. The speed of dynamic imaging was subsequently improved due to advances in gradient design, for example current 40 mT/m gradients. Since then, dynamic imaging has gone through several changes and improvements, including the implementation of parallel imaging, and more recently, the new k-space coverage now available with TWIST (a 4D MRA application). TWIST achieves significant improvements in temporal and spatial resolution and faster tracking of dynamic processes relative to the other versions of dynamic imaging introduced earlier. TWIST offers a practical, flexible, and elegant way to perform sub-second, time-sequential 3D measurements, both at 1.5 T and 3 T. This can be used in combination with contrast injection to provide dynamic clinical information, including the evaluation of abnormal vascular anatomy as well as vascular hemodynamics, and perfusion measurements. [...]

Let’s TWIST again: Temporal and Spatial High-Resolution 3D MR-Angiography of the Hand

Compared to conventional contrastenhanced MR angiography (MRA), which provides a spatial high-resolution threedimensional (3D) MRA data set of the vascular target region, MRA with TWIST (time-resolved angiography with stochastic trajectories) with its high temporal resolution offers an additional dynamic component. It presents a broad range of advantages for all vascular diagnostic questions where blood flow dynamics play a role. [...]

Whole-Body Oncologic Imaging with syngo TimCT

The article shows that the addition of syngo TimCT functionality makes whole-body MR oncologic evaluation a viable reality. Extended, whole-body anatomic coverage is now possible without off-isocenter artifacts or signal loss. In-plane image quality with the TimCT application is maintained in comparison to conventional MR. Non-breathhold technique did not limit diagnostic quality in the presented patients. Skull-base to upper thigh coverage was achieved in standard imaging times of 30–40 minutes. With the addition of DWI to conventional sequences, functional-anatomic information correlation is possible through the whole-body field of view. TimCT has removed the barriers to whole-body MR evaluation. [...]


This 56 year old man presented to clinic complaining of a mass within the musculature of his medial right thigh that had appeared approximately 5 months ago. The patient denied any associated pain or tenderness. On the illustrated MR examination, a mass was found which was confirmed as a liposarcoma by pathologic evaluation following its surgical removal [...]

Fat Suppression in the Abdomen

Due to the different chemical environment, hydrogen nuclei in water- and in fat-tissue have different values for some MRI-relevant parameters, mainly being the relaxation time and the resonance frequency (chemical shift). These differences can be used to selectively suppress/reduce the signal of fat bound protons.Thus relaxation-dependant and chemical shift-dependant methods can be used for fat suppression. [...]


This 35-year-old female presented to clinic complaining of pain and swelling posterior to her right knee of approximately 3 months duration. Physical examination confirmed the presence of a soft tissue mass in the patient’s right posterior lower leg. An MRI scan demonstrated a well-defined oval lesion, confirmed to be a neurofibroma by subsequent surgery. [...]

Ollier Disease

This 17-year-old girl initially presented as a toddler and has since suffered from multiple complications related to Ollier disease, particularly in regard to her left femur. Disease involvement initially also included the left hemipelvis. The patient subsequently underwent multiple procedures involving the femur for the correction of pathologic fractures and leg-length discrepancies. Her most recent surgery, one year ago, consisted of curettage and bone grafting of lesions in her left iliac wing and proximal femur. [...]

Spectral Adiabatic Inversion Recovery (SPAIR) MR imaging of the Abdomen

SPAIR (Spectral Adiabatic Inversion Recovery) is a powerful technique for fat suppression which offers advantages over conventional fat suppression techniques. The technique is insensitive to B1 inhomogenities and only fat spins are suppressed/inverted. [...]

Osseous Lymphoma

This 92-year-old female presented to clinic with chronic right shoulder swelling and pain of several months duration which had become more severe in last 10 days. Her past history includes a diagnosis of lymphoma in the early 1980’s—a non-Hodgkin stage IIE variety with favorable histologic status. She underwent 4 cycles of CHOP therapy followed by radiation treatment. Lymphomatous involvement was initially found in her right salivary gland, right submandibular gland, and left inner cheek. Plain film radiographs and the illustrated MR examination of the patient’s right arm revealed an ill-defined mass involving right humeral metaphysis. [...]

Low-grade malignant fibrous histiocytoma

This 9-year-old boy presented with vision loss in the left eye for more than one year. Ophthalmologic exam revealed no organic lesion and the patient was referred for an MRI. The lesion was subsequently resected. [...]


This 28-year-old man presented with increasing pain and swelling in his right shoulder for more than four months. Physical exam revealed an obvious swelling, with overlying normal skin, involving the right shoulder. Because of the swelling and pain, movement of the joint was restricted. [...]

Fibroepithelial papilloma

This 46-year-old woman presented clinically with a complaint of gradual hearing impairment in the right ear for three years. Physical examination revealed the right parotid gland region to be swollen, with a medium-hard palpable mass. [...]

Metastatic Vertebral Disease

This 56-year-old male with a history of renal cell carcinoma presented to his primary care physician complaining of intractable back pain for one week. The MR examination performed for further assessment is given. [...]

Revisiting Liver Imaging with VIBE

Volume Interpolated Breath-hold Examination (VIBE) offers three-dimensional multiphase image acquisition before and following contrast administration on a breath-hold time scale. The dynamic behavior of liver lesions and structures during the precontrast, arterial, portal venous, early equilibrium and 5-minute delayed equilibrium phases of enhancement allows more accurate characterization than static pre- and postcontrast analysis. [...]

Detection and Characterization of Focal Liver Lesions using Respiratory-Triggered Diffusion- Weighted MR Imaging (DWI)

Due to a number of technical challenges, the use of DWI was initially confined to the brain with its low incidence of movement artifacts and the high homogeneity and signal-to-noise ratio (SNR) of brain tissue. Physiological motion artifacts (e.g. motility of the bowel, cardiac pulsation, respiratory motions) and the heterogeneous composition of many extracranial organs had precluded the application of DWI in body imaging until a series of technologic advances such as the development of echo-planar imaging (EPI), high-gradient amplitudes, multichannel coils and parallel imaging techniques enabled the acquisition of high quality diffusion-weighted images of the body. [...]

Evaluation of a Modified Stejskal-Tanner Pulsing Scheme for DWI Allowing a Marked Reduction in Echo Time at 3 T

To evaluate a modified Stejskal-Tanner diffusion gradient pulsing scheme that achieves a markedly shorter TE, by applying diffusion encoding during the entire time between the two requisite radiofrequency pulses, with respect to SNR, overall diagnostic image quality, bulk susceptibility artifact, and resulting spatial distortions (which were quantified). [...]

syngo BLADE Motion Correction from Head to Toe

BLADE measures and corrects in-plane motion through periodically rotated overlapping parallel lines with enhanced reconstruction. syngo BLADE acquires multiple low resolution data sets and combines them to make one motion free, high quality image. This provides clear images in all slice orientations and body regions such as the head, spine, liver or knee. [...]

Diagnostic Relevant Reduction of Motion Artifacts in the Posterior Fossa by syngo BLADE Imaging

Although movement and pulsation artifacts are a frequent problem in daily routine, especially in the evaluation of pediatric patients, few articles on this topic can be found in the literature. Experience from Stuttgart shows that MR images of the posterior fossa, cerebellum and brain stem may be significantly impaired by artifacts from pulsatile flow of blood or cerebrospinal fluid even without inadvertent patient head movement. Sedation or general anesthesia rarely influence these pulsation or flow artifacts. However, accurate assessment of small brain lesions is essential in many pediatric patients, especially those with malignant brain tumors. BLADE reduces movement and pulsation artifacts in T2w FLAIR images without relevant loss of image quality. It therefore markedly improves depiction of small and low contrast brain lesions in the posterior fossa of pediatric patients. This can be crucial especially following surgery of malignant brain tumors. In the absence of major artifacts, in this study, lesions of all sizes were depicted with comparable quality by both techniques (BLADE vs conventional FSE technique). [...]

3D High Resolution MRI of the Knee at 3T Using a Moderately T2-weighted 3D-TSE-fs (syngo SPACE) sequence – Useful or Not?

3D High Resolution MRI of the Knee at 3T SPACE is a new approach to MRI of the knee at 3T. It allows high spatial resolution isotropic true 3-dimensional acquisition and subsequent reconstruction. Overall acquisition time is shorter than that of three separate 2-dimensional datasets and SNR for 1 mm reconstructions is similar to conventional 2D-TSE-fs. The identification of anatomical structures is in general equal or superior to conventional scans, with superior discrimination of relevant small ligamentous structures. A simple protocol comprising 1 mm SPACE reconstructions in all three orientations is extremely useful for clinical evaluation. The additional possibility of free 3- dimensional reconstruction depending on the specific clinical need may become useful for diagnosis in difficult cases or with complex anatomy, and in particular for presurgical planning, i.e. for traumatic ligamentous lesions or complex meniscal tears. [...]

MR/PET – Hybrid Imaging for the Next Decade

The clinical potential of combining information derived from MR and PET is evident and has resulted in the development of the world’s first whole-body molecular MR system. Thomas Beyer et al. (Tubingen University Hospital, Germany) describe in their article the history of combining PET with MRI, the rationale to do so, and the challenges that had to be overcome. [...]

32-Channel Head Coil Imaging at 3T

Advanced head coil design with 3T imaging substantially improves the available signal-to-noise ratio (SNR), making possible a substantial reduction in scan time, the use of advanced parallel imaging, high spatial resolution imaging (reduced voxel size in 3D acquisitions, whether for imaging of the brain itself or the vasculature) and implementation of innovative imaging techniques. [...]


SNR and Parallel Imaging Improvements Offered by a 32 Channel Head Coil Design Advanced head coil design with 3 T imaging substantially improves the available signal-to-noise ratio (SNR), making possible a significant reduction in scan time, the use of advanced parallel imaging, high spatial resolution imaging (reduced voxel size in 3D acquisitions, whether for imaging of the brain itself or the vasculature) and implementation of innovative imaging techniques. The use of higher parallel imaging factors in conventional diffusion-weighted echoplanar imaging (EPI), together with the implementation of a fast spin echo (FSE) based BLADE diffusion-weighted scan is illustrated in patients with acute infarction (the latter free of bulk susceptibility artifact and geometric image distortion). [...]

Case Report: Cortical Dysplasia

This clinical case report details the use of a 32 channel head coil and 3 T for improved visualization of presumed cortical dysplasia in a pediatric patient. [...]

Large FOV Imaging at 3T with a 32-Channel Body Array Coil

This article shows the benefits of a 32-channel body coil for large field-of-view imaging in the abdomen and pelvis, including MR Angiography. The evolution of parallel imaging techniques has been very rapid, with realization of their full potential requiring development and utilization of MR systems with up to 32 receiver channels. [...]

Clinical Neurological Imaging on an Open Bore MRI System (MAGNETOM Espree)

An open bore MRI has the practical advantage of accommodating large or claustrophobic patients. Unfortunately, until the advent of the 1.5T MAGNETOM Espree, “open” was often synonymous with inferior image quality. However, in addition to the large 70 centimeter bore, the Espree system offers advanced coil combinations using the Total imaging matrix (Tim) and isocenter imaging technology. Together, these features allow for performance of advanced neuroimaging protocols in new clinical populations. [...]

TrueForm™ Technology (MAGNETOM Espree)

TrueForm magnet design is an innovation that produces a cylindrically optimized homogeneity volume instead of the conventional elliptical volume. TrueForm RF design includes innovative hardware technology as well as new application and processing features, which ensure uniform RF distribution in all body regions. [...]

Case Report: Fast Joint Imaging at 1.5 Tesla with a Combination of the Quadrature Knee and Body Matrix Coil in Case of Severe Knee Pain of an Obese Patient

Knee MRI is challenging in both obese patients and patients in pain, requiring in some cases special coil setups as imaging is impossible with a conventional closed knee coil. In the presented case, a flexible coil setup is demonstrated in combination with open-bore MR technology. This illustrates the benefit of such setups in the diagnosis of knee pain in obese patients. [...]

Case Report: Knee MR Imaging of Haemarthrosis in a Case of Haemophilia A

Imaging pediatric joints is often still a domain of x-ray and ultrasound. However, the application of MRI is of growing importance, not only because of its excellent soft tissue contrast but also because of its capability to early and precisely detect bone destruction. In this case, Prof. Marc-André Weber (University of Heidelberg, Germany) reports on the imaging findings of a 14-year-old male with known hemophilia A. [...]

Tips for T2-weighted TSE Shoulder Imaging with Spectral Fat Saturation

Robust fat saturation can be achieved by different approaches including the application of inversion recovery sequences or advanced fat suppression pulses such as SPAIR. However, in some cases, such as the musculoskeletal imaging of the shoulder, the combination of a T2- weighted turbo spin echo (TSE) sequence with a conventional spectral fat saturation pulse is needed. When imaging obese or very tall patients, the shoulder has to be positioned off-center in many MR exams and therefore several factors will affect image quality with spectral fat saturation. This article provides tips on patient positioning and sequence set-up that will help you to achieve high quality spectral fat saturation. [...]

Traumatic Lesion of the Left Brachial Plexus

To diagnose peripheral neurologic deficits, imaging of the vertebral disks alone may not be sufficient. Depending on the clinical symptoms, the nerve roots themselves need to be evaluated in detail. In the presented case of a traumatic lesion of the brachial plexus, Markus Lentschig, MD (MR and PET/CT Center, Bremen, Germany) presents his 1.5 T imaging protocol for the evaluation of the cervical nerve roots and brachial plexus. [...]

Assessment of Tumor Extension and Improved Localization for Planning and Nerve Sparing Radical Prostatectomy

The potential of state-of-the-art MRI at 3 T, in prostate imaging without the use of an endorectal coil, is discussed in this article. Two clinical cases are presented, with MRI in each instance able to improve both therapy planning and surgical outcome. [...]

Nonsecretory Multiple Myeloma MRI Monitoring of Therapy Response

Multiple myeloma is a malignant hematologic disorder characterized by the infiltration of neoplastic plasma cells into bone marrow. Detection of medullary involvement is best accomplished with the aid of MRI. Visualization of myeloma burden at baseline and during therapy is beneficial for improved patient management and accurate prognostic evaluation. Therefore, whole-body imaging protocols are mandatory, especially for assessment of myeloma infiltration in all bone marrow cavities (medullary involvement) as well as for diagnosis of extramedullary involvement. [...]

Whole-Body MRI for Accurate Assessment of Tumor Load of Bone Metastases Originating from Breast Carcinoma

With breast carcinoma, detection of metastases and estimation of tumor load is of high relevance for patient-individualized therapy regimes. This article presents two cases that show the advantages of MRI for imaging bone metastases originating from breast cancer. In both cases, there was the high clinical suspicion of tumor recurrence with metastastic spread. The patients underwent therefore combined whole- body 18F FDG PET/CT and whole-body MRI for tumor staging with special focus on the brain, liver and bone marrow. [...]

Case Reports: Tumor Detection by Diffusion-Weighted MRI and ADC-Mapping with Correlation to PET/CT Results

Early and accurate estimation of metastatic spread is essential for a patient-adapted, efficient therapy regime. In this context, whole-body and multi-step MRI have already helped to improve the diagnostic accuracy of staging examinations. As a further step, it is known that cancer is also often characterized by higher cellularity and therefore restriction of water diffusion. Diffusion-weighted imaging (DWI) with high b-values has therefore been applied to image metastases in order to help improve the diagnostic accuracy of MRI. The working-group of Schlemmer et al., Department of Radiology, University of Tuebingen, Germany, have compared the findings with results of 18F-FDG PET/CT exams. [...]

Case Report: Metastases from Neuroendocrine Carcinoma: Value of Diffusion-Weighted MR Imaging Compared to 68Ga-DOTATOC PET-CT

Neuroendocrine tumors may be challenging to diagnose. Diffusion-weighted MR imaging (DWI) plays an important role in the accurate detection of liver lesions, which may be occult onconventional MRI and especially CT. In the presented case, the suspicion of diffuse hepatic spread is also supported by the additionally performed 68Ga-DOTATOC PET. The article shows, that DWI […] [...]

Nodular Lesions in Diffuse Liver Disease

Richard C. Semelka, MD Professor University of North Carolina Department of Radiology   *Video: latest on nephrogenic systemic fibrosis (nsf) [...]

Compressed Sensing: A Great Opportunity to Shift the Paradigm of Cardiac MRI to Real-Time

Cardiac MRI is particularly well suited to benefit from a group of novel image reconstruction methods known as compressed sensing that promise to speed up data acquisition. This article provides a brief introduction to the topic. [...]