Contrast Enhanced MRI

Contrast Enhanced MRI. Research Imaging Seminar. MD Anderson Center, June 21, 2012, Houston, Texas [...]

Gadolinium Contrast Agent Safety

Gadolinium Contrast Agent Safety. MR 2015 Garmisch (Germany), 16th International MRI Symposium. January 31, 2015 [...]

MAGNETOM Aera – Combining Throughput and Highest Quality MR Angiography in an Optimized Clinical Workflow

This paper shows how the simultaneous use of multipurpose loop coils in MRI allows high-resolution musculoskeletal studies with increased contrast and specificity for assessing muscles, tendons, ligaments, joints, and cartilage. Dr. Ferrer presents a number of different daily patient routine examinations, including specifically evaluation of the carpal bones, the thumb metacarpals, the metacarpals, the distal inter-phalangeal joints, the elbow and ankle. [...]

MRI Assessment of Articular Cartilage Repair

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. [...]

Clinical Application of Diffusion Tensor Imaging in Radiation Planning for Brain Tumors

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. [...]

Comprehensive MRI-Based Staging of Rectal Cancer. Beneficial Combination of Local High- Resolution Imaging and a Moving-Table Platform for Simultaneous Detection of Metastasis

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. [...]

MSK Imaging Tips and Tricks

Mark Lourensz from the MRI Department at St. Vincent’s Hospital in Melbourne, Australia shares tips and tricks on a broad range of musculoskeletal topics extending from standard joint MRI to whole limb tumor evaluation. Some of these may be common sense, but it doesn’t hurt to revisit the basics occasionally. [...]

Job’s Syndrome

Contrast-enhanced MR imaging is a particularly sensitive method for detecting soft-tissue masses, providing as well precise localization and definition of extent. In his case report, G. Hadjidekov et al. (Sofia, Bulgaria) presents a rare immunodeficiency disorder known as Job’s syndrome. The case shows the usefulness of MRI to analyze skin disorders and deeper soft-tissue masses in various locations. [...]

Bone and Soft Tissue Tumor Imaging: An Overview

Tumor imaging can be daunting, given the high stakes involved with a missed diagnosis or mis-diagnosis resulting in unnecessary further investigations, biopsies or even surgeries. In their article Marcus Pianta, Mark Lourensz et al. (St. Vincent’s Hospital, Fitzroy, Australia) describe their routine imaging protocol targeted to bone and soft tissue lesions, describe reporting and what the referring physicians need to know. [...]

MR Neurography – Diagnostic Criteria to Determine Lesions of Peripheral Nerves

MR Neurography is an excellent technique for visualization and evaluation of peripheral nerve disorders. In their article Philipp Bäumer et al. (Heidelberg University Hospital, Heidelberg, Germany) show high resolution intra-neural fascicular detail in both normal and abnormal states and cover different aspects including clinical indications, protocols, pitfalls, and useful applications. [...]

Sinding-Larsen-Johansson Disease

An 11-year-old female patient presented with pain in the left knee during extension and flexion manoeuvres of the knee following horseback exercises. Based on physical examination, a partial rupture of the left patellar ligament was suspected. In his case report, Axel Goldmann, MD (Orthopedic Center, Erlangen, Germany) describes the MRI findings of rarely seen SLJ disease. [...]

Brain Perfusion; How & Why

Pathologic perfusion is sometimes the reason and often the consequence of brain pathologies. Evaluation of perfusion with dynamic susceptibility-weighted imaging is a well understood and established method to evaluate these changes. In this article, Binesh et al. (Cedars Sinai Medical Center, Los Angeles) show step-by-step how they apply this method and present four case reports illustrating the usefulness of perfusion imaging in clinical practice. [...]

MRI of the Shoulder: Utilizing the Glenoid Clockface Orientation

Orthopedic surgeons describe the glenoid fossa as the face of a clock, with the longitudinal axis defined by the supraglenoid tubercle at the 12:00 position and the inferior margin of the glenoid at the 6:00 position. Orienting the shoulder MRI exam relative to this clockface is ideal as it results in images which consistently correspond with the arthroscopists’ perspective and optimally profiles the major anatomic structures of the glenohumeral joint. In this article, Steven D. Needell, M.D. describes how to use the technique and shows its advantages in clinical cases. [...]

CMR Imaging of Profound Macrovascular Obstruction

Cardiac cine imaging of the myocardium, dynamic first pass myocardial perfusion imaging, and delayed myocardial enhancement imaging are presented in a patient with macrovascular obstruction. [...]

Clinical Lung Imaging

MRI of the lung can be applied in a variety of clinical scenarios. It is a feasible alternative to CT– as it avoids unnecessary radiation in young patients and provides additional physiological information such as perfusion or respiratory dynamics. Diffusion-weighted imaging can even add biological information about cell density. In this report, Professor Biederer (University Hospital Kiel, Germany) gives a detailed review on lung imaging protocols and an insight into typical applications for lung MRI. [...]

Cerebral Amyloid Angiopathy (CAA) using Susceptibility-Weighted Imaging (syngo SWI)

Susceptibility weighted imaging well demonstrates microhemorrhages within the brain. In CAA, these involve the cortex and subcortical white matter within the frontal and parietal lobes. This is in distinction to hypertensive microangiopathy, where microhemorrhages occur in deep white matter as well as infratentorially. [...]

3T MR Imaging of Peripheral Nerves Using 3D Diffusion-Weighted PSIF Technique

High-resolution magnetic resonance (MR) Neurography is a novel imaging technique, which enables multiplanar imaging of peripheral nerves, as well as diagnosis and localization of entrapment and non-entrapment peripheral neuropathies related to etiologies, such as inflammation, tumor and trauma. [...]

MR Tumor Staging for Treatment Decision in Case of Wilms Tumor

Nephroblastoma – also known as Wilms tumor – is the most frequent renal malignancy in childhood with the highest incidence of this tumor within the fourth year of life. 80% of patients are less than 5 years old, however it is a rare condition in neonates ([...]

Imaging of Diseases of the Cranial Nerves: Tips and Tricks

This article focuses on common problems and pitfalls in MRI of pathologies of cranial nerves. It provides an introduction to helpful sequences and post processing techniques. To familiarize the reader with cranial nerve imaging, examples of the normal anatomy as well as typical pathological cases are shown. [...]

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

Vascular malformations (VM) are complex lesions present in various anatomical locations with a variety of clinical manifestations. Time-resolved MRA combined with parallel imaging and echo sharing schemes offer a reasonable alternative to more invasive diagnostic methods such as digital subtraction angiography (DSA) in evaluation of VMs. MRI is becoming the imaging modality of choice in assessing morphological issues regarding VMs. Time-resolved MRA can play an important role in characterizing these lesions and can influence therapeutic decision-making. [...]

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. [...]

Technical Considerations in Brain DWI

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

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. [...]

syngo NATIVE TrueFISP in the Assessment of the Transplanted Kidney

When imaging patients with impaired renal function that have recently undergone transplant surgery, one approach is to use a completely non- invasive method, without the use of a gadolinium chelate, and thus without the potential risk of NSF. In this article the effectiveness of TrueFISP with selective inversion recovery preparation, now known as syngo NATIVE TrueFISP, is shown. This technique from a diagnostic point of view appears equivalent to low dose contrast-enhanced angiography, providing a low-risk method for the initial evaluation of the transplanted kidney. [...]

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. [...]

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. [...]

Case Report: syngo TimCT – MR Angiography in Clinical Routine

Studies at the University Medical Center in Mannheim, Germany show that the continuous moving table MRA approach is a major improvement in imaging the lower extremities in a clinical setting as it combines an easy, fast and robust workflow with good clinical results and is applicable to a broad range of patients. [...]

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) [...]

MR Safety

There are two types of forces exerted on a ferrous (iron) object when brought in close proximity to an MR magnet: rotational and translational. The rotational force (torque) is that which causes a ferrous object to turn and align with the direction of the magnetic field. Rotational forces are strongest at the isocenter of the magnet. [...]