Quality of clinical MR images and the use of contrast agents.

Attempts to optimize the quality of magnetic resonance images must balance the competing needs for high spatial resolution, high signal-to-noise ratio, a large number of sections, and a reasonable imaging time. These factors, which determine the ultimate image quality, are affected by a number of variables, including the field of view, the matrix and pixel size, choice of repetition time and echo time, section thickness, and the number of signals averaged. The manner in which these variables interrelate and their effect on the ultimate image quality are important in order to craft the most appropriate examination for each individual patient. A second major effect on soft-tissue contrast is the use of paramagnetic agents. The spectrum of utility of these agents within the central nervous system and the body is increasing. A large number of new agents are also being investigated, primarily for use outside the central nervous system.

In vivo fluorine-19 MR imaging: relaxation enhancement with Gd-DTPA.

The lack of a naturally occurring background signal from fluorine in magnetic resonance (MR) imaging makes fluorinated compounds potentially attractive candidates for tissue-specific MR contrast agents. Problems associated with the in vivo use of fluorinated compounds are toxicity, which limits the amount of agent that can be used; multiple resonance lines; and an excessively long T1, which leads to long sequence TRs and consequently long imaging times. Many fluorinated agents also possess complex MR spectra that result in chemical shift artifacts if not corrected. The authors demonstrate the use of an extracellular fluorinated agent with a single MR peak for selective imaging of a brain abscess in an animal model and show that the image signal per unit of acquisition time can be enhanced through the use of a T1 relaxation agent, gadolinium diethylenetriamine-pentaacetic acid (DTPA). Trifluoromethylsulfonate was administered at a fluorine-19 dose of 4 mmol/kg, and fluorine images of the induced abscess were acquired before and after the injection of a standard dose of Gd-DTPA (0.1 mmol/kg); non-section-selected projection images were used. Typical imaging times were less than 5 minutes. The signal enhancement factor achieved was approximately four (4.0 +/- 0.8) with use of a 500/12 (TR msec/TE msec) spin-echo sequence.

Magnetic resonance imaging and P-31 magnetic resonance spectroscopy provide unique quantitative data useful in the longitudinal management of patients with dermatomyositis.

OBJECTIVE: To evaluate the utility of magnetic resonance imaging (MRI) and P-31 magnetic resonance spectroscopy (MRS) in the longitudinal management of patients with dermatomyositis (DM). METHODS: The study group consisted of 11 patients, including 3 children, all of whom had a clinical diagnosis of DM. A control group of 8 subjects was studied simultaneously. MRI included images as well as calculations of T1 and T2 relaxation times. The P-31 MRS protocol evaluated metabolic status (i.e., inorganic phosphate/phosphocreatine ratios and phosphocreatine and ATP levels) during rest, exercise, and recovery. RESULTS: T2-weighted images of the thigh muscles showed inflammation even when serum creatine phosphokinase levels were in the normal range. Metabolic abnormalities, which were accentuated with exercise, were found in 10 patients. In some individuals, bioenergetic defects preceded other changes and persisted after resolution of inflammation. In general, clinical impressions correlated with MRI/MRS data. CONCLUSION: MRI and MRS provide unique data which are quantitative and which cannot be obtained from routine laboratory tests. These MR evaluations appear to be of value in assessing the status of DM patients during treatment with steroids and immunosuppressive drugs.

Quantitative imaging of renal blood flow and function.

Noninvasive renal blood flow quantitation has been historically difficult, although radionuclide imaging methods for measuring related parameters of renal function such as glomerular filtration rate and effective renal plasma flow have been successful. Radionuclide methods have long played an important role in the evaluation of renal function, but recent advances in other modalities such as positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging (MRI) have the potential to provide information not available with nuclear medicine techniques. The high spatial resolution provided by these modalities, coupled with dynamic imaging of contrast agents or radioactive tracers, potentially could allow detailed clinical evaluation of regional renal function and blood flow. A specialized MR technique, diffusion-weighted imaging, also shows promise for providing information not otherwise available concerning the renal microcirculation. This report provides a brief review of the available clinical techniques for the evaluation of renal blood flow and function as well as new methods under investigation.

Magnetic resonance angiography techniques.

After a radio frequency pulse, the decay of the magnetic resonance (MR) signal is described by two relaxation processes, T1 and T2. T1 describes the rate at which the magnetization realigns itself along the external magnetic field direction (ML), and T2 describes the rate of decay of the magnetization component along the transverse axis (MT). Magnetic resonance angiography (MRA) sequences have been developed that encode flow as changes in the apparent T1 or T2 of the moving blood relative to stationary tissues. MRA sequences typically use either time-of-flight (TOF) techniques to encode T1 or phase-contrast techniques to encode T2. TOF techniques encode flow as an apparent T1 shortening through the wash-in of fully relaxed blood from outside the image volume. The shorter T1 produces an enhancement of vascular structures relative to stationary tissues. TOF methods may use either sequential two-dimensional, three-dimensional, or multi-slab three-dimensional imaging sequences to produce a three-dimensional MRA data set. Phase-contrast methods use additional magnetic field gradients to encode flow as shifts in the phase of MT. Both TOF and phase-contrast methods use maximum intensity projection (MIP) images displayed in a cine format to aid in the visualization of three-dimensional vascular structures.

Clinical impact of picture archiving and communication systems: evaluation of a prototype system.

Opinion surveys were gathered before and 6 months after installation of a prototype picture archiving and communication system (PACS) (PACS/1, Siemens Medical Systems, Iselin, NJ). Median turnaround times and the percent of delayed or missing reports were calculated for 1,026 baseline and 8,438 follow-up studies at 6 months. Neuroradiological (neuro) computed tomography (CT) used PACS, while neuro magnetic resonance (MR), body CT, and body MR served as controls. The opinion surveys showed improved service in all categories, including those not directly affected by PACS. PACS images favorably impressed 86% of respondents, but most considered the system too slow, unreliable, and the storage capacity too low. A majority of 81% recommended against purchase of PACS now. There was an overall increase in the median report turnaround time for both neuro CT and the controls. Neuro CT showed a 41% decrease in delayed or missing reports, but controls also showed similar decreases. The effects of this prototype PACS on turnaround time or on report delivery could not be distinguished from section-wide changes in CT and MR services. Future improvements in PACS should vigorously address increased speed, reliability, and storage capacity.

Dermatomyositis: correlative MR imaging and P-31 MR spectroscopy for quantitative characterization of inflammatory disease.

Magnetic resonance (MR) imaging and phosphorus-31 MR spectroscopy were used to examine four patients with dermatomyositis and five control subjects. T2-weighted images of the thigh muscles of patients showed increased signal intensity, with focal and inhomogeneous involvement predominantly in the vastus lateralis and secondarily in the vastus intermedius and vastus medialis. T1 and T2 values of the vastus lateralis in patients were significantly higher than those of the control subjects. T1 values of the rectus femoris and biceps femoris with more generalized inflammation were moderately elevated but still significantly higher than those of the control subjects. P-31 MR spectra of the quadriceps muscles were obtained during rest, during exercise at two graded levels, and in recovery. Concentrations of adenosine triphosphate and phosphocreatine (PCr) in the diseased muscles were 30% below normal values, and the inorganic phosphate/PCr ratios were increased in the patients' muscles at rest and throughout exercise. The T1 and T2 values as well as the P-31 metabolite data correlated with symptoms and clinical assessment.

Gadolinium-enhanced MR angiography.

Experience in three patients (one each with meningioma, pineal tumor, and prominent jugular bulb) illustrates that magnetic resonance (MR) angiography can benefit from the administration of gadolinium diethylenetriaminepentaacetic acid. Data were acquired with a three-dimensional velocity-compensated (fast imaging with steady-state precession) sequence. MR angiograms were obtained with a ray projection algorithm by using maximum intensity values. Portions of the vascular anatomy--particularly venous structures and smaller arteries--were better portrayed on the postcontrast than on the precontrast angiograms. Enhancing lesions were also seen on the projection images. Enhancement of dura and extracranial tissues (sinus and nasal mucosa) can obscure vascular detail.

AUR memorial award--1988. MRI enhancement of perfused tissues using chromium labeled red blood cells as an intravascular contrast agent.

It has been demonstrated that chromium (Cr) labeling significantly decreases the relaxation times of packed red blood cells (RBCs). In this study, the spin-lattice relaxation time (T1) of human red cells was shortened from 836 ms to 29 ms and the spin-spin relaxation time (T2) shortened from 134 ms to 18 ms, when the cells were labeled at a Cr incubation concentration of 50 mM. Labeling of canine cells at 50 mM resulted in a T1 of 36 ms and a T2 of 26 ms. A labeling concentration of 10 mM produced similar relaxation enhancement, with uptake of 47% of the available Cr, and was determined to be optimal. The enhancement of longitudinal and transverse relaxation rates (1/T1,-1/T2) per amount of hemoglobin-bound Cr are 6.9 s-1 mM-1 and 9.8 s-1 mM-1 respectively, different from those of a pure Cr+3 solution. Labeling cells at 10 mM decreased the survival half-time in vivo from 16.6 days to 4.7 days in dogs. No difference in red cell survival was found with the use of hetero-transfusion versus auto-transfusion of labeled RBCs. Significant shortening of the T1 (912 ms to 266 ms, P = .03) and T2 (90 ms to 70 ms, P = .006) of spleen and the T1 (764 ms to 282 ms, P = .005) and the T2 (128 ms to 86 ms, P = .005) of liver occurred when 10% of the RBC mass of dogs was exchanged with Cr labeled cells. Liver and spleen spin density changes (P greater than 0.23) and muscle spin density and relaxation changes (P greater than 0.4) were insignificant. The in vivo T1 of a canine spleen which had been infarcted did not change following transfusion with labeled cells, where the T1 of liver did shorten. We believe this preliminary study suggests that Cr labeled red cells may have the potential to become an intravascular magnetic resonance imaging contrast agent.

Preoperative assessment of myometrial invasion of endometrial adenocarcinoma by sonography (US) and magnetic resonance imaging (MRI).

The presence and/or depth of myometrial invasion of endometrial adenocarcinoma has important prognostic and therapeutic implications. Fifteen patients with histologically proven endometrial cancer underwent preoperative evaluation with sonography (US) and magnetic resonance imaging (MRI) to assess depth of invasion. Using criteria of greater than or equal to 50% of myometrial wall involvement as representing deep invasion, and less than 50% as superficial invasion, US was more accurate than MRI in five cases; in three MRI was more accurate than US; both MRI and US were equally accurate in four; neither was accurate in three. Polypoid lesions caused the greatest number of false positive reports of deep invasion with both MRI and US. Preliminary results indicate that US and MRI have promise as preoperative tests to assess the extent of myometrial invasion.

Central nervous system lesions in pediatric patients: Gd-DTPA-enhanced MR imaging.

Twenty pediatric patients, aged 2-18 years, with known or suspected masses in the brain and/or spinal cord were studied with magnetic resonance imaging at 0.6T with and without use of 0.1 mmol/kg gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). The multisection, multiecho imaging mode was utilized. Surgically proved mass lesions included astrocytoma (n = 6), medulloblastoma (n = 2), ependymoma (n = 1), craniopharyngioma (n = 1), oligodendroglioma (n = 1), germinoma (n = 1) and fibrosarcoma (n = 1). Presumptive diagnoses included astrocytoma (n = 3), arachnoid cyst (n = 1), tuberous sclerosis (n = 1), cryptic vascular malformation (n = 1), and normal (n = 1). There was dramatic enhancement in 11 of 20 patients, with improved definition of the presence and extent of lesions in six patients. No adverse effects were noted in any of the 20 patients. It is concluded that Gd-DTPA is useful in delineating the presence, extent, and number of certain lesions of the central nervous system in children.

Liver volume measurements and three-dimensional display from MR images.

A method was investigated for measuring the volumes of human livers in vivo from magnetic resonance images and subsequently displaying these livers in three dimensions. Volumetric image sets of phantoms, healthy volunteers, and patients with cirrhotic livers were processed. Two image-processing approaches were compared for accuracy of liver measurements, intrasubject and interobserver variation, and speed of processing. Results indicated that both processing methods had a high degree of volume-measuring accuracy (within 8%), the interobserver measurements had a high coefficient of correlation (r = .9994), the intrasubject measurements had a low coefficient of variation (1.8%), and one method was four to five times faster than the other. The faster and easier of the two image-processing approaches provided satisfactory results for measuring liver volumes, but the slower approach provided more realistic-looking three-dimensional images of the liver.

Differential diagnosis of severe back pain using MRI.

Back pain, despite its prevalence, often presents a diagnostic dilemma. Infection, degeneration, and neoplasm comprise major etiologic categories of severe nonspecific back pain. Diagnostic evaluation includes plain roentgenograms, computerized tomography, and radionuclide studies, all of which are often equivocal or misleading. We retrospectively analyzed 21 presentations of severe back pain of various causes evaluated by magnetic resonance imaging (MRI) in addition to conventional diagnostic imaging modes. A characteristic MRI pattern of both the lesions's distribution and its signal intensity was observed that delineated each etiologic category. MRI was found to be particularly suited for use in the differential diagnosis of nonspecific back pain.