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. [...]

Practical Considerations for the Evaluation of the Neuroforamina in Routine Spine Imaging at 3T. A Case Series

Pathologies of the neuroforamina are one of the most frequent indications for spine surgery. However, in standard MRI with axial and sagittal planes and relatively thick slices (>3 mm) the diagnostic information may be limited for proper evaluation of the nerve roots. Prof. Marc-André Weber et al. (University Hospital Heidelberg, Germany) share practical tips on […] [...]

Ankylosing spondylitis, chronic disease

There is marked irregularity and sclerosis of the sacroiliac joints bilaterally. Fatty changes are noted as well, in the sacrum, bordering the joint. There is little edema within the bone adjacent to the sacroiliac joints. All are findings consistent with long standing disease. Part of the on-line supplement to Neuroradiology – The Essentials with MR […] [...]

Ankylosing spondylitis, hip disease

One-third of individuals with AS develop hip and shoulder involvement. Bilateral disease, with joint effusions and synovial enhancement are characteristic. Additional less common findings include subchondral bone marrow edema, erosive destruction, and fatty accumulation. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – […] [...]

Ankylosing spondylitis, sacroiliac joint disease

In this patient with long standing disease, joint space irregularity and adjacent fatty changes predominate. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Ankylosing spondylitis, with bony ankylosis of the sacroiliac joints

In this 44-year-old patient, coronal images of the pelvis reveal fusion of the sacroiliac joints bilaterally. Sagittal images of the lumbar spine show vertebral body squaring and a bamboo like appearance due to diffuse ankylosis (and syndesmophytes). There is vertebral body fusion at multiple levels, with loss of disk space height and abnormal signal intensity […] [...]

Anterior and posterior fusion defects of C1

Note the well corticated margins and absence of a discrete fracture line. Such fusion defects are congenital in nature, and are primarily incidental findings. Incomplete posterior fusion can be seen in normal children up to the age of 10, with bony fusion typically occurring by age 5. Clefts of the posterior arch occur in 5% […] [...]

Cervical cord hemangioblastoma

Cervical cord hemangioblastoma, in a patient with von Hippel Lindau syndrome. A small enhancing intramedullary lesion is noted at C4, with mild accompanying vasogenic edema. 75% of spinal cord hemangioblastomas are sporadic, 25% occur in association with von Hippel Lindau syndrome. Spinal cord hemangioblastomas most commonly occur posteriorly within the cord, as in this patient. […] [...]

Chondrosarcoma of the cervical spine

The left lamina of C2 is involved by a focal mass lesion, which is slightly expansile in nature. A somewhat characteristic feature of the histologic diagnosis, reflecting hyaline cartilage, is the marked hyperintensity on the T2-weighted scan. There is moderate enhancement post-contrast, which as with the other findings (with the exception of the appearance on […] [...]

Chronic dens fracture

A type II odontoid fracture is present, with non-union (pseudoarthosis). (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

DISH (diffuse idiopathic skeletal hyperostosis) in the cervical spine

In DISH (also known as Forestier disease) there is calcification and ossification of ligaments and entheses (the connective tissue between bone and a tendon or ligament) involving the vertebral column. Ossification of the anterior longitudinal ligament is common (and often marked), and may occur in conjunction with ossification of the posterior longitudinal ligament (OPLL). Both […] [...]

Epidural hematoma, spine, illustrating image composition

Composed sagittal T2-weighted, T1-weighted, and post-contrast T1-weighted images are presented. Each image is an automatically generated composition of two high-resolution independent cervicothoracic and thoracolumbar image acquisitions. The patient was on aspirin and Plavix, and presented with urinary retention and poor anal sphincter tone, consistent with a lesion compressing the conus medullaris. A predominantly deoxyhemoglobin epidural […] [...]

Hydatid cysts of the sacrum, ileum and L5

In the spine, with hydatid disease, there is typically slow resorption of trabeculae, without bony expansion, with a conglomeration of daughter cysts. This accounts for the multilocular appearance on MR, with high signal intensity on T2-weighted sequences. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement […] [...]

Hyperflexion injury with a clay-shoveler fracture

CT depicts an avulsion fracture of the spinous process of C6. MR reveals additional important findings, including the extensive posterior paraspinal muscular injury (edema), disruption of the interspinous ligament, compression fractures (marrow edema) involving multiple contiguous cervical and thoracic vertebral bodies, and extensive prevertebral edema as well as fluid (hemorrhage). Note that the cord appears […] [...]

Ivory vertebra, metastatic prostate carcinoma

The ivory vertebra describes a dense sclerotic vertebral body on plain film or CT, with the correlate on MR being very low signal intensity on both T1- and T2-weighted sequences. L2 and S2 are involved in this fashion in the presented case, with additional metastatic lesions noted posteriorly in L1 and L3, together with mild […] [...]

Klippel-Feil

There is vertebral nonsegmentation at two levels, one involving a hemivertebra, together with a prominent scoliosis of the cervical spine. Also present is an anterior fusion defect of C1. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and […] [...]

Lipoma, tethered cord, hydromyelia, block vertebrae

The cord extends at least to the S1 level, with dilatation of the central canal within that portion visualized (hydromyelia). A small lipoma is noted within the bony spinal canal posteriorly at the S1 level. The axial scan at this level reveals the cord near its termination/posterior tethering, with the lipoma immediately contiguous bilaterally. Fusion […] [...]

Meningioma (WHO grade I, meningotheliomatous in type), cervical spine

A large, homogeneously enhancing, intradural extramedullary mass lesion is noted anteriorly within the thecal sac at the C2 level. There is prominent deformity and compression of the cord, long standing in nature, without evidence of edema or gliosis. Note the characteristic flat margin of the lesion along the dura. Part of the on-line supplement to […] [...]

Migrated disk fragment

There is mild loss of disk space height (and thus substance) at L5-S1. A left paracentral disk herniation is noted, at this level, together with superior migration. Note the slight hyperintensity of the superiorly migrated portion of the disk on the T2-weighted scan, consistent with a free fragment (which is also suggested by the extent […] [...]

Multiple sclerosis, cervical and thoracic cord lesions

An enhancing cervical cord lesion is noted on sagittal and axial images, located at the C2 level, with an additional thoracic lesion (which did not enhance) depicted on a lower axial T2-weighted section. Neither lesion respects gray-white matter boundaries, as seen on the axial T2-weighted scans, a common finding for MR lesions of the cord. […] [...]

Neurofibromatosis type 1

Dural ectasia and a lateral meningocele are present. Also noted are scalloped vertebrae and scoliosis. All are characteristic findings. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Paget disease of the lumbar spine and pelvis

Both the L1 and L2 vertebral bodies (together with their respective posterior elements) are involved, with the vertebral bodies expanded in the antero-posterior dimension and L2 a characteristic “picture frame” vertebra. There is involvement as well of the pelvis together with the sacral vertebral bodies. Coarse and thickened trabeculae are particularly evident in the iliac […] [...]

Pancoast tumor

An apical soft tissue mass is present, with invasion of the adjacent vertebral body (visualized by the lucent defect therein). (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Scheuermann disease

Only a sagittal midline T2-weighted scan is presented. However this is sufficient to visualize the characteristic thoracic kyphosis, with involvement of 3 contiguous vertebrae. There is anterior wedging of the vertebral bodies and disk space narrowing, the latter greatest anteriorly. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of […] [...]

Schwannoma (WHO grade I)

A lobulated uniformly enhancing mass lesion is noted with the bulk of the mass paraspinal in location, extending into the foramen at the T4-5 level on the right, with epidural extent and mild displacement of the cord to the left. The intervertebral foramen is enlarged. The well-circumscribed nature of the lesion, and location, favor the […] [...]

Schwannoma at C3-4 on the left, within the neural foramen and compressing the cord

An enhancing mass lesion is seen, centered within the neural foramen – the latter is enlarged, indicating that the lesion is long standing in nature. There is marked cord compression, with abnormal high signal intensity within the cord on the T2-weighted exam, indicative of either gliosis or edema. The patient presented clinically with numbness in […] [...]

Tethered cord

The cord extends to the sacral region, without a change in caliber or distinct conus. The cord ends in a lipoma, with tethering posteriorly. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Thoracic spine schwannoma

  Clinical History: 28-year old woman with chest and upper back pain for 3 months Diagnosis: Thoracic spine schwannoma  MR Technique: Imaging of the thoracic spine was performed on a 3T MR system. (A) Sagittal T1-weighted TSE (TR/TE 650/8.1ms), (B) sagittal T2-weighted TSE (TR/TE 2000/97), (C) sagittal T2-weighted TSE images with Dixon fat suppression (TR/TE2500/101), […] [...]

Eosinophilic granuloma

Clinical History: 12 year old boy with back pain limiting activities of daily living Diagnosis: Thoracic vertebral eosinophilic granuloma MR Technique: Thoracic spine imaging was performed on a 3T MR system (Skyra, Siemens). (A) Sagittal T1-weighted TSE (TR/TE 650/8.1ms) and (B) T2-weighted TSE (TR/TE 2000/97ms) images were acquired. Contrast-enhanced sagittal T1-weighted (C) and coronal T1-weighted […] [...]

Degeneration (Lumbar)

A 76 year old man with advanced degenerative spine disease [...]

Lipoma

A 53-year-old woman complaining of severe left leg pain for several months [...]

Metastasis (carcinoma of prostate)

This 64 year old man is status post prostatectomy with positive margins and subsequent local regional recurrence, treated with external beam radiation therapy, with further recurrence and subsequent development of disseminated disease. [...]

Multiple chronic compression deformities

An unfortunate 83-year-old lady with severe degenerative spine disease, a history of multiple compression fractures and prior vertebroplasty of L2, presenting once again with intractable back pain [...]

Acute and chronic vertebral compression fractures

An 83 year old woman with back pain. [...]

C3 burst fracture

A 77 year-old woman seen in the emergency room, following trauma, with cervical pain but no neurologic deficit. [...]

Disk space infection (L2-3)

A 70 year-old woman with chronic kidney disease, on IV antibiotics for osteomyelitis. [...]

Metastases (renal cell, lumbar)

A 56 year-old man with back pain [...]

Standardized Quality and Process Efficiency with High-Throughput MR Exams

Standardized Quality and Process Efficiency with High-Throughput MR Exams. MR 2015 Garmisch (Germany), 16th International MRI Symposium. January 30, 2015. [...]

‘White Dots’ on Cranial MRI: MS and Differential Diagnosis

The article discusses technical considerations and various clinical applications of the DESS sequence. 3D DESS techniques have advantages in assessment of pediatric cartilage pathology including higher SNR, increased cartilage-to-fluid contrast and isotropic resolution, which helps to reduce partial volume effects. 3D DESS techniques are also of essential importance in the pediatric population due to the lack of ionizing radiation. [...]

T1-weighted Phase Sensitive Inversion Recovery for Imaging Multiple Sclerosis Lesions in the Cervical Spinal Cord

The evolution of sophisticated surgical repair procedures for the treatment of isolated, focal traumatic or degenerative cartialge lesions has created the need for accurate, non-invasive assessment of the repair tissue. MRI depicts well subchondral bone and bone marrow, allowing examination of repair tissue and its interface with parent cartilage and complications of repair surgeries such as graft hypertrophy and delamination. [...]

MAGNETOM Aera – Combining Throughput and Highest Quality Spine Imaging in an Optimized Clinical Workflow

The term WARP summarizes methods to minimize the impact of metal implants on MR image quality. This article introduces different techniques such as high bandwidth, VAT and SEMAC. [...]

RESOLVE: A Powerful Tool for Imaging the Pediatric Spine

The term WARP summarizes methods to minimize the impact of metal implants on MR image quality. This article introduces different techniques such as high bandwidth, VAT and SEMAC. [...]

Advantages of MSK Imaging at 3 Tesla with special focus on Spine and Tumor Imaging.

The clinical advantages of upgrading to higher field strength (3T) magnets, improving coil technology, and using larger bore-sizes are proving to be significant. Through 10 case studies, it is suggested that the use of 3T open bore system with TrueForm technology can improve the diagnostic potential, as well as widen the indications, of MRI. The cases illustrate advantages of musculoskeletal imaging with a special focus on spine and tumor imaging. [...]

Multiple myeloma

Back pain in a 58 year old woman [...]

Synovial cyst

Back pain in a 58 year old woman [...]

Tethered cord

Back pain in a 58 year old woman [...]

Lumbar vertebral metastases

A 61 year old man with small cell carcinoma of the lung [...]

Multiple sclerosis (cervical spinal cord)

A 28 year old woman [...]

OPLL (Ossification of the posterior longitudinal ligament)

A 57 year old male with numbness of the hands. [...]

Sacral spinal dysraphism with a meningocele.

A 40 year old female with history of spina bifida. [...]

Plasmacytoma (biopsy proven)

64 year old man with past medical history of HTN with complaint of abdominal pain and migratory rib, sternal and back pain for 1 year. [...]

Thoracic dural AV fistula

58 yr old woman presented with back pain. An MRI of the thoracic and lumbar spine was obtained. [...]

Tethered spinal cord

This 6-year-old girl was referred to physical therapy for baseline evaluation in the spina bifida clinic and for assessment of neurogenic bowel and bladder dysfunction. At birth, this patient was diagnosed with sacral dysgenesis along with tethered cord and a lipoma within the sacral spinal canal. [...]

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. [...]

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. [...]