Diffusion-weighted echo planar MR imaging of the neck at 3 T using integrated shimming: comparison of MR sequence techniques for reducing artifacts caused by magnetic-field inhomogeneities.

OBJECTIVE: Our objective was to compare available techniques reducing artifacts in echo planar imaging (EPI)-based diffusion-weighed magnetic resonance imaging MRI (DWI) of the neck at 3 Tesla caused by B0-field inhomogeneities. MATERIALS AND METHODS: A cylindrical fat-water phantom was equipped with a Maxwell coil allowing for additional linear B0-field variations in z-direction. The effect of increasing strength of this superimposed gradient on image quality was observed using a standard single-shot EPI-based DWI sequence (sEPI), a zoomed single-shot EPI sequence (zEPI), a readout-segmented EPI sequence (rsEPI), and an sEPI sequence with integrated dynamic shimming (intEPI) on a 3-Tesla system. Additionally, ten volunteers were examined over the neck region using these techniques. Image quality was assessed by two radiologists. Scan durations were recorded. RESULTS: With increasing strength of the external gradient, marked distortions, signal loss, and failure of fat suppression were observed using sEPI, zEPI, and rsEPI. These artifacts were markedly reduced using intEPI. Significantly better in vivo image quality was also observed using intEPI compared with the other techniques. Scan time of intEPI was similar to sEPI and zEPI and shorter than rsEPI. CONCLUSION: The use of integrated 2D shim and frequency adjustment for EPI-based DWI results in a significant improvement in image quality of the head/neck region at 3 Tesla. Combining integrated shimming with rsEPI or zEPI can be expected to provide additional improvements.

Technical Note: MR-visualization of interventional devices using transient field alterations and balanced steady-state free precession imaging.

PURPOSE: In interventional magnetic resonance imaging, instruments can be equipped with conducting wires for visualization by current application. The potential of sequence triggered application of transient direct currents in balanced steady-state free precession (bSSFP) imaging is demonstrated. METHODS: A conductor and a modified catheter were examined in water phantoms and in an ex vivo porcine liver. The current was switched by a trigger pulse in the bSSFP sequence in an interval between radiofrequency pulse and signal acquisition. Magnitude and phase images were recorded. Regions with transient field alterations were evaluated by a postprocessing algorithm. A phase mask was computed and overlaid with the magnitude image. RESULTS: Transient field alterations caused continuous phase shifts, which were separated by the postprocessing algorithm from phase jumps due to persistent field alterations. The overlaid images revealed the position of the conductor. The modified catheter generated visible phase offset in all orientations toward the static magnetic field and could be unambiguously localized in the ex vivo porcine liver. CONCLUSIONS: The application of a sequence triggered, direct current in combination with phase imaging allows conspicuous localization of interventional devices with a bSSFP sequence.

Magnetic resonance visualization of conductive structures by sequence-triggered direct currents and spin-echo phase imaging.

PURPOSE: Instrument visualization in interventional magnetic resonance imaging (MRI) is commonly performed via susceptibility artifacts. Unfortunately, this approach suffers from limited conspicuity in inhomogeneous tissue and disturbed spatial encoding. Also, susceptibility artifacts are controllable only by sequence parameters. This work presents the basics of a new visualization method overcoming such problems by applying sequence-triggered direct current (DC) pulses in spin-echo (SE) imaging. SE phase images allow for background free current path localization. METHODS: Application of a sequence-triggered DC pulse in SE imaging, e.g., during a time period between radiofrequency excitation and refocusing, results in transient field inhomogeneities. Dependent on the additional z-magnetic field from the DC, a phase offset results despite the refocusing pulse. False spatial encoding is avoided by DC application during periods when read-out or slice-encoding gradients are inactive. A water phantom containing a brass conductor (water equivalent susceptibility) and a titanium needle (serving as susceptibility source) was used to demonstrate the feasibility. Artifact dependence on current strength and orientation was examined. RESULTS: Without DC, the brass conductor was only visible due to its water displacement. The titanium needle showed typical susceptibility artifacts. Applying triggered DC pulses, the phase offset of spins near the conductor appeared. Because SE phase images are homogenous also in regions of persistent field inhomogeneities, the position of the conductor could be determined with high reliability. Artifact characteristic could be easily controlled by amperage leaving sequence parameters unchanged. For an angle of 30° between current and static field visualization was still possible. CONCLUSIONS: SE phase images display the position of a conductor carrying pulsed DC free from artifacts caused by persistent field inhomogeneities. Magnitude and phase images are acquired simultaneously under the same conditions without the use of extra measurement time. The presented technique offers many advantages for precise instrument localization in interventional MRI.

Image-guided radiofrequency ablation of hepatocellular carcinoma (HCC): is MR guidance more effective than CT guidance?

OBJECTIVES: The purpose of the study was to retrospectively compare technique effectiveness of computed tomography (CT)-guided versus magnetic resonance (MR)-guided radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: In 35 consecutive patients 53 CT-guided (n=29) or MR-guided (n=24) ablation procedures were performed in the treatment of 56 (CT: 29; MR: 27) HCC. The entire ablation procedure was performed at a multislice CT-scanner or an interventional 0.2-Tesla MR-scanner. Assessment of treatment response was based on dynamic MR imaging at 1.5Tesla. The mean follow-up was 22.9 months. Primary technique effectiveness was assessed 4 months after ablation therapy. Secondary technique effectiveness was assessed 4 months after a facultative second ablation procedure. Primary and secondary technique effectiveness of CT-guided and MR-guided RF ablation was compared by using Chi-Square (likelihood ratio) test. RESULTS: Primary technique effectiveness after a single session was achieved in 26/27 (96.3%) HCC after MR-guided RF ablation and 23/29 (79.3%) HCC after CT-guided RF ablation (Chi-Square: p=0.04). Secondary technique effectiveness was achieved in 26/27 (96.3%) HCC after MR-guided RF ablation and in 26/29 (89.7%) HCC after CT-guided RF ablation (Chi-Square: p=0.32). A local tumor progression was detected in 8/52 (15.4%) tumors after initial technique effectiveness. Major complications were detected after 3/53 (5.7%) ablation procedures. CONCLUSIONS: CT-guided and MR-guided RF ablations are locally effective therapies in the treatment of HCC. Due to a higher rate of primary technique effectiveness MR-guided RF ablation may reduce the number of required sessions for complete tumor treatment.

Successful Salvage Chemotherapy with FOLFIRINOX for Recurrent Mixed Acinar Cell Carcinoma and Ductal Adenocarcinoma of the Pancreas in an Adolescent Patient.

Pancreatic tumors are rare in children and adolescents. Here, we report the case of a 15-year-old boy who presented with a mixed acinar cell carcinoma/ductal adenocarcinoma with blastomatous components. He received multimodal treatment including various chemotherapy regimens and multistep surgery including liver transplantation. Introduction of FOLFIRINOX after relapse repeatedly achieved a durable metabolic and clinical response with good quality of life.

Resolution adapted finite element modeling of radio frequency interactions on conductive resonant structures in MRI.

Prediction of interactions between the radiofrequency electromagnetic field in magnetic resonance scanners and electrically conductive material surrounded by tissue plays an increasing role for magnetic resonance safety. Testing of conductive implants or instruments is usually performed by standardized experimental setups and temperature measurements at distinct geometrical points, which cannot always reflect worst-case situations. A finite element method based on Matlab (The Mathworks, Natick, MA) and the finite element method program Comsol Multiphysics (Stockholm, Sweden) with a spatially highly variable mesh size solving Maxwell's full-wave equations was applied for a comprehensive simulation of the complete geometrical arrangement of typical birdcage radiofrequency coils loaded with small conductive structures in a homogenous medium. Conductive implants like rods of variable length and closed and open ring structures, partly exhibiting electromagnetic resonance behavior, were modeled and evaluated regarding the distribution of the B(1)- and E-field, induced currents and specific absorption rates. Numerical simulations corresponded well with experiments using a spin-echo sequence for visualization of marked B(1)-field inhomogeneities. Even resonance effects in conductive rods and open rings with suitable geometry were depicted accurately. The proposed method has high potential for complementation or even replacement of common experimental magnetic resonance compatibility measurements.

RF tissue-heating near metallic implants during magnetic resonance examinations: an approach in the ac limit.

PURPOSE: State of the art to access radiofrequency (RF) heating near implants is computer modeling of the devices and solving Maxwell's equations for the specific setup. For a set of input parameters, a fixed result is obtained. This work presents a theoretical approach in the alternating current (ac) limit, which can potentially render closed formulas for the basic behavior of tissue heating near metallic structures. Dedicated experiments were performed to support the theory. METHODS: For the ac calculations, the implant was modeled as an RLC parallel circuit, with L being the secondary of a transformer and the RF transmission coil being its primary. Parameters influencing coupling, power matching, and specific absorption rate (SAR) were determined and formula relations were established. Experiments on a copper ring with a radial gap as capacitor for inductive coupling (at 1.5 T) and on needles for capacitive coupling (at 3 T) were carried out. The temperature rise in the embedding dielectric was observed as a function of its specific resistance using an infrared (IR) camera. RESULTS: Closed formulas containing the parameters of the setup were obtained for the frequency dependence of the transmitted power at fixed load resistance, for the calculation of the resistance for optimum power transfer, and for the calculation of the transmitted power in dependence of the load resistance. Good qualitative agreement was found between the course of the experimentally obtained heating curves and the theoretically determined power curves. Power matching revealed as critical parameter especially if the sample was resonant close to the Larmor frequency. CONCLUSIONS: The presented ac approach to RF heating near an implant, which mimics specific values for R, L, and C, allows for closed formulas to estimate the potential of RF energy transfer. A first reference point for worst-case determination in MR testing procedures can be obtained. Numerical approaches, necessary to determine spatially resolved heating maps, can be supported.

Quantification of direct current in electrically active implants using MRI methods.

The aim of this study was to evaluate a variety of phase- and magnitude-based MRI methods at 1.5 T and 3 T regarding their sensitivity and accuracy with respect to the quantification of electrical direct current via the induced magnetic field inhomogeneity. For this, a phantom was constructed which was specially designed to reduce RF effects and which provided a one-dimensional electrical direct current in a thin copper conductor perpendicular to the static magnetic field of the scanner. The current was varied between 4 mA and 472 mA. The analysis of FLASH phase images as well as trueFISP and MAGSUS images revealed that the accuracy of the MR current measurement depended on the method and the field strength: the mean of the absolute deviations of the measured current values from the adjusted current values varied between 9% and 21%. The phase measurement with a FLASH sequence was found to be more sensitive than the trueFISP and MAGSUS measurements. In FLASH magnitude images as well as in images of spin echo sequences with on- and off-resonant frequency selective saturation pulses the extension of the artifact increased with the electrical current. MRI methods for the quantification of electrical direct current might e.g. play a role in functional testing of electrically active devices in the human body in terms of measuring the present current. One-dimensional electrical direct current in a thin, straight conductor could also be applied to the visualization of instruments in interventional MRI procedures. Currents below 100 mA would be sufficient to create distinct artifacts, at least under simplified conditions (homogeneous background etc.).

Magnetic resonance perfusion imaging without contrast media.

PURPOSE: Principles of magnetic resonance imaging techniques providing perfusion-related contrast weighting without administration of contrast media are reported and analysed systematically. Especially common approaches to arterial spin labelling (ASL) perfusion imaging allowing quantitative assessment of specific perfusion rates are described in detail. The potential of ASL for perfusion imaging was tested in several types of tissue. METHODS: After a systematic comparison of technical aspects of continuous and pulsed ASL techniques the standard kinetic model and tissue properties of influence to quantitative measurements of perfusion are reported. For the applications demonstrated in this paper a flow-sensitive alternating inversion recovery (FAIR) ASL perfusion preparation approach followed by true fast imaging with steady precession (true FISP) data recording was developed and implemented on whole-body scanners operating at 0.2, 1.5 and 3 T for quantitative perfusion measurement in various types of tissue. RESULTS: ASL imaging provides a non-invasive tool for assessment of tissue perfusion rates in vivo. Images recorded from kidney, lung, brain, salivary gland and thyroid gland provide a spatial resolution of a few millimetres and sufficient signal to noise ratio in perfusion maps after 2-5 min of examination time. CONCLUSIONS: Newly developed ASL techniques provide especially high image quality and quantitative perfusion maps in tissues with relatively high perfusion rates (as also present in many tumours). Averaging of acquisitions and image subtraction procedures are mandatory, leading to the necessity of synchronization of data recording to breathing in abdominal and thoracic organs.

Biopsy needle tips with markers--MR compatible needles for high-precision needle tip positioning.

Needle tip visualization is of high importance in magnetic resonance imaging (MRI) guided interventional procedures, for example for taking biopsies from suspicious lesions in the liver or kidney. The exact position of the needle tip is often obscured by image artifacts arising from the magnetic properties of the needle. The authors investigated two special biopsy needle tip designs using diamagnetic coatings. For common interventional MR sequences, the needle tip can be identified in the MR image by several equidistant dark spots arranged along a straight line. A dotted instead of a solid line allows for an improved control of the movement of the needle, not only if the needle is tilted toward the imaging plane, but also if the needle leaves an empty canal with signal extinction, which cannot be distinguished from the needle material itself. With the proposed design the position of the needle tip can be estimated with a precision of approximately 1 mm using conventional FLASH, FISP, and TSE sequences, as used for interventional MR. Furthermore, the size of the biopsy probe can be estimated from the artifact. In using needles with a properly designed tip coating, taking biopsies under MR control is beginning to be greatly simplified. The approach to design artifacts using diamagnetic material in combination with paramagnetic material paves the way toward new instruments and implants, suitably tailored to the needs of the interventional radiologist.

Heating of metallic implants and instruments induced by gradient switching in a 1.5-Tesla whole-body unit.

PURPOSE: To examine gradient switching-induced heating of metallic parts. MATERIALS AND METHODS: Copper and titanium frames and sheets ( approximately 50 x 50 mm(2), 1.5 mm thick, frame width = 3 mm) surrounded by air were positioned in the scanner perpendicular to the static field horizontally 20 cm off-center. During the execution of a sequence (three-dimensional [3D] true fast imaging with steady precession [True-FISP], TR = 6.4 msec) exploiting the gradient capabilities (maximum gradient = 40 mT/m, maximum slew rate = 200 T/m/second), heating was measured with an infrared camera. Radio frequency (RF) amplitude was set to zero volts. Heating of a copper frame with a narrowing to 1 mm over 20 mm at one side was examined in air and in addition surrounded by several liters of gelled saline using fiber-optic thermography. Further heating studies were performed using an artificial hip made of titanium, and an aluminum replica of the hip prosthesis with the same geometry. RESULTS: For the copper specimens, considerable heating (>10 degrees C) in air and in gelled saline (>1.2 degrees C) could be observed. Heating of the titanium specimens was markedly less ( approximately 1 degrees C in air). For the titanium artificial hip no heating could be detected, while the rise in temperature for the aluminum replica was approximately 2.2 degrees C. CONCLUSION: Heating of more than 10 degrees C solely due to gradient switching without any RF irradiation was demonstrated in isolated copper wire frames. Under specific conditions (high gradient duty cycle, metallic loop of sufficient inductance and low resistance, power matching) gradient switching-induced heating of conductive specimens must be considered.

Tissue warming and regulatory responses induced by radio frequency energy deposition on a whole-body 3-Tesla magnetic resonance imager.

PURPOSE: To quantify the B1-field induced tissue warming on a 3T-whole-body scanner, to test whether the patient is able to sense the temperature change, and to evaluate whether the imaging procedure constitutes a significant cardiovascular stress. MATERIALS AND METHODS: A total of 18 volunteers were divided into three equal groups for 3.0T MRI of the pelvis, the head, or the knee. An imaging protocol operating at first level mode was applied, allowing radio frequency (RF) irradiation up to the legal specific absorption rate (SAR) limits. An identical placebo protocol with active gradient switching but without RF transmission was used. Temperature changes were measured with a fiber-optic thermometer (FO) and an infrared camera (IR). RESULTS: Temperature differences to the placebo were highest for imaging of the pelvis (FO: DeltaT = 0.88 +/- 0.13 degrees C, IR: DeltaT = 1.01 +/- 0.15 degrees C) as compared to the head (FO: DeltaT = 0.46 +/- 0.12 degrees C, IR: DeltaT = 0.47 +/- 0.10 degrees C) and the knee (FO: DeltaT = 0.33 +/- 0.11 degrees C, IR: DeltaT = 0.37 +/- 0.09 degrees C). The volunteers were able to discriminate between imaging and placebo for pelvic (P < 0.0001) and head (P = 0.0005) imaging but not for knee imaging (P = 0.209). No changes in heart rate or blood pressure were detected. CONCLUSION: The 3.0T MRI in the first operational mode may lead to measurable and perceptible thermal energy deposition. However, it may be regarded as safe concerning the thermoregulatory cardiovascular stress.

Numerical simulations of intra-voxel dephasing effects and signal voids in gradient echo MR imaging using different sub-grid sizes.

Signal void artifacts in gradient echo imaging are caused by the intra-voxel dephasing of the spins. Intra-voxel dephasing can be estimated by computing the field distribution on a sub-grid inside each picture element, followed by integration of all magnetization components. The strategy of computing the artifacts based on the integration of the sub-voxel signal components is presented here for different sub-grids. The coarseness of the sub-grid is directly related to computational effort. The possibility to save memory space and computing time for the dipole model by computing the field only on a sub-grid is addressed in the presented article. It is investigated as to how far computational time and memory space can be reduced by using an appropriate sub-grid. Numerical results for a model of a partially diamagnetically coated needle shaft are compared to experimental findings. In the case of a pure titanium needle, it is shown as being sufficient to compute the field distribution on a sub-grid that is at least four times coarser in each direction than the grid used to discretize the object in the related MR image. Due to three nested loops over the 3D grid, the need for memory space and time is saved by a factor 64. Deviations between measurements and simulations for the broad side of the artifact (uncompensated) and for the small side of the artifact (compensated) were 15.5%, respectively, 19.1% for orientation parallel to the exterior field, and 22.7%, respectively, 23.1% for orientation perpendicular to the exterior field.

Eddy-current induction in extended metallic parts as a source of considerable torsional moment.

PURPOSE: To examine eddy-current-provoked torque on conductive parts due to current induction from movement through the fringe field of the MR scanner and from gradient switching. MATERIALS AND METHODS: For both cases, torque was calculated for frames of copper, aluminum, and titanium, inclined to 45 degrees to B0 (maximum torque case). Conditions were analyzed in which torque from gravity (legal limit, ASTM F2213-02) was exceeded. Experiments were carried out on a 1.5 T and a 3 T scanner for copper and titanium frames and plates (approximately 50 x 50 mm2). Movement-induced torque was measured at patient table velocity (20 cm/second). Alternating torque from gradient switching was investigated by holding the specimens in different locations in the scanner while executing sequences that exploited the gradient capabilities (40 mT/m). RESULTS: The calculations predicted that movement-induced torque could exceed torque from gravity (depending on the part size, electric resistance, and velocity). Two experiments on moving conductive frames in the fringe fields of the scanners confirmed the calculations. For maximum torque case parameters, gradient-switching-induced torque was calculated to be nearly 100 times greater than the movement-induced torque. Well-conducting metal parts located off center vibrated significantly due to impulse-like fast alternating torque characteristics. CONCLUSION: Torque on metal parts from movement in the fringe field is weak under standard conditions, but for larger parts the acceptable limit can be reached with a high static field and increased velocity. Vibrations due to gradient switching were confirmed and may explain the sensations occasionally reported by patients with implants.

Relaxivity of Gadopentetate Dimeglumine (Magnevist), Gadobutrol (Gadovist), and Gadobenate Dimeglumine (MultiHance) in human blood plasma at 0.2, 1.5, and 3 Tesla.

OBJECTIVES: We sought to determine the relaxivity and accurate relaxation rates of Gd-DTPA, Gd-BT-DO3A, and Gd-BOPTA at 0.2, 1.5, and 3 T in human blood plasma. MATERIALS AND METHODS: Contrast media concentrations between 0.01 and 16 mM in human plasma were used for relaxation measurements. The R1 and R2 relaxation rates and r1 and r2 relaxivities were determined. RESULTS: Gd-BOPTA produced the highest relaxation rates and relaxivities at all field strengths. The r1 and r2 values for Gd-BOPTA were 107-131% and 91-244% higher than for Gd-DTPA, respectively, and 72-98% and 82-166% higher than for Gd-BT-DO3A. Higher field strengths resulted in lower values of R1, R2, and r1 for all contrast agents tested and of r2 for Gd-DTPA and Gd-BT-DO3A. A linear dependence of R1 and R2 on concentration was found for Gd-DTPA and Gd-BT-DO3A and a nonlinear dependence for Gd-BOPTA for concentrations larger than 1 mM. The r1 and r2 relaxivity of Gd-BOPTA increased with decreasing concentration. CONCLUSIONS: Gd-BOPTA demonstrates the highest longitudinal r1 at all field strengths, which is ascribable to weak protein interaction. The R2/R1 ratio increases at higher field strength only for Gd-BOPTA, hence very short echo times are required for Gd-BOPTA to benefit from the higher longitudinal relaxivity.

Effects on MRI due to altered rf polarization near conductive implants or instruments.

In magnetic resonance imaging near metal parts variations in radio frequency (rf)-amplitude and of receive sensitivity must be considered. For loop structures, e.g., vascular stents, B1 produces rf eddy currents in accordance to Faraday's law; the B1-related electrical rf field E1 injects directly to elongated structures (e.g., wires). Locally, the rf magnetic field Bl,ind (induced B1) is superimposed onto the rf field from the transmitter coil, which near the metal can dominate spin excitation. Geometry and arrangement of the parts determine the polarization of B(1,ind). Components parallel to B0 are of special interest. A copper sheet (100 mm x 15 mm, 3 mm thick) and a 27 cm long copper wire were examined in a water phantom using the spin-echo (SE) technique. In addition to rf-amplitude amplification, rf-phase shift due to z components of B(1,ind) could be detected near the metallic objects. Periodic rf-amplitude instabilities had an amplified effect for phase-shifted regions. Phase-encoding artifacts occurred as distinct ghosts (TR=200 ms) or band-like smearing (TR=201 ms) from affected spin ensembles. SE phase imaging can potentially be used in interventional magnetic resonance imaging for background-free localization of metallic markers.

Interaction between grounding pads used for RF ablation therapy and magnetic resonance imaging.

OBJECTIVES: To characterize artifacts and imaging problems in the presence of conductive grounding pads for RF ablation therapy as well as potential heating problems due to induction of eddy currents in the pads. Strategies for avoidance of those problems are developed. MATERIALS AND METHODS: Underlying principles of interactions between grounding pads and MR imaging are reported. Influential parameters, e.g., orientation in relation to the magnetic field, shape of the grounding pad, sequence type (spin-echo versus gradient echo) and magnetic field strength (0.2 T, 1.5 T, 3 T) were varied in systematic phantom studies. Heating effects due to induced eddy currents were estimated theoretically and measured by infrared imaging in an adapted set-up. RESULTS: MR imaging artifacts are markedly dependent on the orientation and geometrical shape of the grounding pads. Visible signal extinction artifacts were more pronounced using spin-echo techniques than in gradient echo images and increased for higher field strengths. Suitable incisions in the grounding pad reduced eddy currents markedly and minimized image artifacts. Heating problems due to induced eddy currents by the RF transmitted for MR imaging were excluded by phantom measurements. CONCLUSIONS: Suitable positioning of the grounding pads and adaptation of their geometry provide clearly reduced artifacts in MR imaging.

Magnetic susceptibility effects on the accuracy of MR temperature monitoring by the proton resonance frequency method.

PURPOSE: To evaluate the error of MR temperature assessment based on the temperature-dependent Larmor frequency shift of water protons, which can result from susceptibility effects caused by the radiofrequency (RF) applicator. MATERIALS AND METHODS: Local frequency shifts due to RF applicator displacements were simulated numerically by means of a three-dimensional elementary dipole model. Experimental examinations using a water tank phantom equipped with a high-precision screw thread were applied to examine temperature and movement effects for five commercially available, MR-compatible RF applicators. Measurements were performed at 1.5 Tesla. RESULTS: For single-needle electrodes perpendicular to the external field, a distortion of 0.1 ppm and 0.2 ppm was recorded at a distance of 17.5 mm and 12.5 mm, respectively, to the needle shaft. Cluster applicators and umbrella-shaped applicators caused distortions of 0.1 ppm up to distances of 36 mm. Sinusoidal dependence on applicator orientation was found with the highest values for perpendicular orientation and the lowest values for orientation parallel to the magnetic field. With a single electrode oriented perpendicular to the field at a distance of 1.5 cm and 2.0 cm, a needle displacement of 5 mm led to an error in temperature measurement of 16.3 degrees C and 7.5 degrees C, respectively. CONCLUSION: In MR temperature measurement, displacement of the RF applicator by patient movement or breathing leads to significant errors that have to be taken into account when PRF temperature maps are used to monitor tumor ablation in the presence of paramagnetic applicators.

Magnetic resonance-guided percutaneous radiofrequency ablation of renal cell carcinomas: a pilot clinical study.

OBJECTIVE: The objective of this study was to assess the feasibility and efficacy of magnetic resonance imaging-(MRI) guided percutaneous radiofrequency (RF) ablation of renal cell carcinomas (RCC). SUBJECTS AND METHODS: Twelve patients with RCC (63 to 82 years old) were treated with RF ablation in an interventional 0.2-Tesla open MR unit. Tumor sizes varied from 1.6 cm to 3.9 cm in maximum diameter (tumor volumes 1.9 cm3 to 28.7 cm3). RF procedures were entirely performed in the MR suite. For positioning of the MR-compatible RF-electrode, near real-time MR fluoroscopy by means of rapid gradient echo sequences (acquisition time approximately 2 seconds) was used. Monitoring of ablation was obtained by intermittent imaging with T1- and T2-weighted spin echo sequences. RESULTS: Accurate placement of the RF electrodes was possible in all cases using near real-time MR fluoroscopy. Eleven of 12 patients were successfully treated within 1 single session; 1 patient had to be retreated for tumor relapse at 13 months follow up. Mean number of electrode repositionings under MR guidance during 1 session was 1.7; ablation time ranged between 12 and 28 minutes. Mean duration of 1 treatment session was 5 hours. Coagulation volumes ranged from 7.3 cm3 up to 30.2 cm3. All patients now appear to be disease-free with a mean follow up of 10.3 months (range, 3-23 months). CONCLUSION: MRI-guided RF ablation of RCC in an interventional MR unit is safe and feasible. Fast MR imaging is a convenient method for rapid positioning of MR-compatible RF electrodes. MR monitoring of ablation procedure with T2-weighted imaging allows for immediate assessment of coagulation extent.

Metal artifacts caused by gradient switching.

In metal parts, e.g., implants or instruments, eddy currents can be induced from gradient switching if positioned off-center inside the MR scanner. For the first time, a systematic analysis of related artifacts was performed. Current strength increases in conjunction with increasing size of the part, increasing electrical conductivity, distance from isocenter, and increasing gradient strengths. A xy-plane oriented copper ring (d(o) = 20 mm, d(i) = 15 mm, 2 mm thick) was examined at isocenter and at x = 15 cm, y = z = 0. Comparisons of xy-, xz-, and yz-slices, recorded for both possibilities to select encoding directions, revealed effects from ramp-down of the slice-selection and ramp-up of the read-out gradient. Near the metal part, temporary inhomogeneities were superimposed to the static field and spin-dephasing signal loss resulted, despite using spin-echo technique. Artifacts depended on excitation and read-out bandwidth. For an equivalent titanium ring, conductivity related effects could not be ascertained but distinct susceptibility effects occurred. MR compatibility of implants/instruments therefore requires both low susceptibility and low conductivity.