The usefulness of a contrast agent and gradient-recalled acquisition in a steady-state imaging sequence for magnetic resonance imaging-guided noninvasive ultrasound surgery.

RATIONALE AND OBJECTIVES: The ability of magnetic resonance imaging to detect small temperature elevations from focused ultrasound surgery beams was studied. In addition, the value of a contrast agent in delineating the necrosed tissue volume was investigated. MATERIALS AND METHODS: Gradient-recalled acquisition in a steady state (GRASS) T1-weighted images were used to follow the temperature elevation and tissue changes during 2-minute sonications in the thigh muscles of 10 rabbits. The effects of the treatment on the vascular network was investigated by injecting a contrast agent bolus before or after the sonication. RESULTS: The signal intensity decreased during the sonication, and the reduction was directly proportional to the applied power and increase in temperature. The signal intensity returned gradually back to baseline after the ultrasound was turned off. Injection of the contrast agent increased the signal intensity in muscle, but not in the necrosed tissue. The dimensions of the delineated tissue volume were the same as measured from the T2-weighted fast-spin-echo images and postmortem tissue examination. CONCLUSIONS: These results indicate that magnetic resonance imaging can be used to detect temperature elevations that do not cause tissue damage and that contrast agent can be used to delineate the necrosed tissue volume.

Orbital magnetic resonance imaging.

Magnetic resonance images of the eye and orbit performed with surface coils at 1.5 tesla showed anatomic details superior to those of conventional third- and fourth-generation computed tomography.

MR imaging of the optic nerve and sheath: correcting the chemical shift misregistration effect.

The interface between soft-tissue structures and adipose tissue may be obscured by the chemical shift misregistration effect on MR images. In the orbit, this effect occurs at the edges at the optic nerve, even on high-resolution local coil images. In both phantom and clinical studies with a 1.5 T local coil imaging system, it was found that the chemical shift misregistration effect can be minimized by positioning the patient so that the optic nerve is parallel to the frequency encoding gradient. Alternatively, the effect can be corrected by using a computer program to combine "lipid" and "water" proton images. The sensitivity of MR for optic nerve lesions should be improved by these technical modifications.

Magnetic resonance imaging of the jugular foramen.

The jugular foramen in normal volunteers was studied with 1.5 T magnetic resonance (MR) systems in 3-mm-thick head- and surface-coil images. Anatomic sections through cadaver heads were correlated with the MR images to identify the jugular bulb and the course of cranial nerves IX-XI. Sagittal images were more useful than coronal or axial to show the course of these nerves through the skull base. MR demonstrates the anatomic relations of the jugular foramen (except its osseous margins) such that its primary use in evaluating this region can be anticipated.

Imaging of brain iron by magnetic resonance: T2 relaxation at different field strengths.

Soon after the advent of magnetic resonance imaging (MRI) as a diagnostic modality in the 1980s, it was recognized that some of the contrast found in brain imaging correlated with patterns of iron deposition. The presence of non-heme iron had previously been established by pathological studies on post-mortem brains. The iron concentration is highest in specific nuclei of the basal ganglia and some associated structures. It is low at birth and increases with age until a relatively constant level is reached at an age of 20-30 years. There is evidence for further increases in very elderly persons. Although iron is ubiquitous in human tissues, only in a few situations is the concentration large enough to affect MRI. Because MRI has the ability to detect, in a noninvasive fashion, the naturally occurring iron in the basal ganglia and related nuclei, it may be used to study the physiology and pathology of these important structures. Magnetic resonance imaging has confirmed the results of earlier post mortem studies of the anatomical localization and age-dependence of brain iron. Initial steps have been toward the use of MRI to study disorders of thought, movement, and behavior that are believed to be related to brain iron. However, additional understanding is required of the physical details of the contrast mechanism, the physiology of the iron accumulation, and the significance of abnormal patterns of iron deposition. In this report, data are presented on the normal variation in MRI parameters and their dependence on magnetic field strength. The potential clinical and basic science applications are briefly reviewed. Information from widely differing fields is relevant to the study of the physical and pathological significance of brain iron, and for this reason, extensive, although not exhaustive, literature references are included.

The role of magnetic susceptibility in magnetic resonance imaging: MRI magnetic compatibility of the first and second kinds.

The concept of magnetic susceptibility is central to many current research and development activities in magnetic resonance imaging (MRI); for example, the development of MR-guided surgery has created a need for surgical instruments and other devices with susceptibility tailored to the MR environment; susceptibility effects can lead to position errors of up to several millimeters in MR-guided stereotactic surgery; and the variation of magnetic susceptibility on a microscopic scale within tissues contributes to MR contrast and is the basis of functional MRI. The magnetic aspects of MR compatibility are discussed in terms of two levels of acceptability: Materials with the first kind of magnetic field compatibility are such that magnetic forces and torques do not interfere significantly when the materials are used within the magnetic field of the scanner; materials with the second kind of magnetic field compatibility meet the more demanding requirement that they produce only negligible artifacts within the MR image and their effect on the positional accuracy of features within the image is negligible or can readily be corrected. Several materials exhibiting magnetic field compatibility of the second kind have been studied and a group of materials that produce essentially no image distortion, even when located directly within the imaging field of view, is identified. Because of demagnetizing effects, the shape and orientation, as well as the susceptibility, of objects within and adjacent to the imaging region is important in MRI. The quantitative use of susceptibility data is important to MRI, but the use of literature values for the susceptibility of materials is often difficult because of inconsistent traditions in the definitions and units used for magnetic parameters-particularly susceptibility. The uniform use of SI units for magnetic susceptibility and related quantities would help to achieve consistency and avoid confusion in MRI.

MRI-guided noninvasive ultrasound surgery.

In this study, the feasibility of using magnetic resonance imaging (MRI) to detect tissue necrosis induced by focussed ultrasound beams was investigated. It was shown that lesions produced in dog's thigh muscle in vivo were clearly visible in T2-weighted images and that the lesion dimensions measured from the images correlated with the postmortem measurements of the visible tissue damage. It was also shown that the sonications can be done in the magnet and that the lesions are visible immediately after the sonications with increasing image contrast as a function of time. These results showed that MRI can be used to direct and monitor on-line noninvasive ultrasound surgery. This may have a major impact in future patient treatments.

Human exposure to 4.0-Tesla magnetic fields in a whole-body scanner.

Details are given for the design, construction, properties, and performance of a large, highly homogeneous magnet designed to permit whole-body magnetic resonance imaging and spectroscopy at 4 T. The magnet has an inductance of 1289 H and a stored energy of 33.4 MJ at rated field. The health of a group of 11 volunteers who had varying degrees of exposure to this field was followed over a 12-month period and no change that could be associated with this exposure was detected. A mild level of sensory experiences, apparently associated with motion within the field of the magnet, was reported by some of the volunteers during some of their exposures. A questionnaire regarding sensory effects associated with magnetic resonance scanners and possibly caused by the static magnetic field of these instruments, was given to nine respondents who had experience within both 1.5-T scanners and this 4-T scanner and to another group of 24 respondents who had experience only within 1.5-T scanners. For the sensations of vertigo, nausea, and metallic taste there was statistically significant (p less than 0.05) evidence for a field-dependent effect that was greater at 4 T. In addition, there was evidence for motion-induced magnetophosphenes caused by motion of the eyes within the static field. These results indicate the practicality of experimental whole-body body scanners operating at 4 T and the possibility of mild sensory effects in humans associated with motion within a static magnetic field. The results also indicate the likelihood of a wide margin of safety for the exposure of noncompromised patients to the static fields of conventional magnetic resonance scanners operated at 1.5 to 2 T and below.

Very-high-field magnetic resonance imaging: instrumentation and safety issues.

Because of their advantage in terms of signal-to-noise ratio, high-field magnetic resonance imaging systems have become favored in the last few years for functional magnetic resonance imaging (fMRI) applications. In many ways the conceptual development of these high-field scanners has involved more-or-less straightforward extensions of practices at lower field strengths. However, in other ways specific engineering challenges have been encountered and largely overcome in the quest for scanners capable of realizing the advantages of high-field systems. An understanding of the technical trade-offs that can be made in terms of hardware performance is useful in deciding on the optimum system for a given fMRI application. In this article the technical issues surrounding high-field scanning are reviewed in the context of a typical brain mapping protocol. In addition there is a discussion of the safety issues related to the use of these systems.

Head and body imaging by hydrogen nuclear magnetic resonance.

A hydrogen (1H) nuclear magnetic resonance (NMR) imaging study of the normal head, thorax, and limbs is reported. The images are 10 to 15 mm thick transverse slices obtained in 2 to 4 min using a two-dimensional Fourier transform technique. Spatial resolution in the imaging plane is about 2 mm, enabling the optic nerve and many small blood vessels to be observed. Thorax scans show details of the cardiac chambers, aorta wall, and lungs without artefacts arising from physiological motion.

Noninvasive imaging of the normal temporal bone. Comparison of sagittal surface coil magnetic imaging and high-resolution computed tomography.

High-resolution computed tomography (HRCT) is a noninvasive technique for evaluating the middle ear for primary and recurrent cholesteatoma. However, a limitation of HRCT is that it cannot differentiate between cholesteatoma and granulation tissue. Magnetic resonance imaging (MRI) is a noninvasive, nonradiologic technique that has been effective in demonstrating histochemical differences between various soft tissues. We present images from a normal living subject's temporal bone in the sagittal plane obtained with both HRCT and MRI. Anatomic correlates in the same cut planes are presented. The HRCT provided excellent detail of the bony landmarks within the temporal bone and was used as the reference for the MRI. The soft-tissue structures such as cranial nerves, cochlea, vestibule, and semicircular canals were identified.

MR safety at high magnetic fields.

MR imaging requires the exposure of human patients to magnetic fields that are much more intense than ever occur naturally. Under most circumstances, however, these fields do not appear to pose a health or safety risk even at levels well above those currently in clinical use. This margin of safety results from the extreme weakness of the diamagnetic interaction between human tissues and magnetic fields. Ferromagnetic materials, however, present either as implants within the patient or inadvertently introduced into the scanner environment, pose significant risks and must be scrupulously avoided. At very high field strengths, there is evidence for mild sensory effects, such as vertigo and metallic tastes, which do not appear to be harmful.

Experience with MR-guided therapy.

The use of magnetic resonance imaging (MRI) for the real time guidance of surgical procedures is now undergoing clinical trials. Among the many procedures explored, open craniotomy neurosurgery appears to be among the most promising. Over 50 such cases have been done at the Brigham and Women's Hospital (BWH) in Boston. We review the technical approach used in these and related procedures. We consider the way in which imaging is used to augment and improve the procedures. As well, the implications of these protocols for remote diagnosis and telesurgery are explored. Finally, the implications of this experience for the insertion of new technology into medicine are discussed.

Safety of strong, static magnetic fields.

Issues associated with the exposure of patients to strong, static magnetic fields during magnetic resonance imaging (MRI) are reviewed and discussed. The history of human exposure to magnetic fields is reviewed, and the contradictory nature of the literature regarding effects on human health is described. In the absence of ferromagnetic foreign bodies, there is no replicated scientific study showing a health hazard associated with magnetic field exposure and no evidence for hazards associated with cumulative exposure to these fields. The very high degree of patient safety in strong magnetic fields is attributed to the small value of the magnetic susceptibility of human tissues and to the lack of ferromagnetic components in these tissues. The wide range of susceptibility values between magnetic materials and human tissues is shown to lead to qualitatively differing behaviors of these materials when they are exposed to magnetic fields. Mathematical expressions are provided for the calculation of forces and torques.

Estimating radiofrequency power deposition in body NMR imaging.

Simple theoretical estimates of the average, maximum, and spatial variation of the radiofrequency power deposition (specific absorption rate) during hydrogen nuclear magnetic resonance imaging are deduced for homogeneous spheres and for cylinders of biological tissue with a uniformly penetrating linear rf field directed axially and transverse to the cylindrical axis. These are all simple scalar multiples of the expression for the cylinder in an axial field published earlier (Med. Phys. 8, 510 (1981]. Exact solutions for the power deposition in the cylinder with axial (Phys. Med. Biol. 23, 630 (1978] and transversely directed rf field are also presented, and the spatial variation of power deposition in head and body models is examined. In the exact models, the specific absorption rates decrease rapidly and monotonically with decreasing radius despite local increases in rf field amplitude. Conversion factors are provided for calculating the power deposited by Gaussian and sinc-modulated rf pulses used for slice selection in NMR imaging, relative to rectangular profiled pulses. Theoretical estimates are compared with direct measurements of the total power deposited in the bodies of nine adult males by a 63-MHz body-imaging system with transversely directed field, taking account of cable and NMR coil losses. The results for the average power deposition agree within about 20% for the exact model of the cylinder with axial field, when applied to the exposed torso volume enclosed by the rf coil. The average values predicted by the simple spherical and cylindrical models with axial fields, the exact cylindrical model with transverse field, and the simple truncated cylinder model with transverse field were about two to three times that measured, while the simple model consisting of an infinitely long cylinder with transverse field gave results about six times that measured. The surface power deposition measured by observing the incremental power as a function of external torso radius was comparable to the average value. This is consistent with the presence of a variable thickness peripheral adipose layer which does not substantially increase surface power deposition with increasing torso radius. The absence of highly localized intensity artifacts in 63-MHz body images does not suggest anomalously intense power deposition at localized internal sites, although peak power is difficult to measure.

On-line monitoring of ultrasonic surgery with MR imaging.

Ultrasonic surgery was performed in rabbits and dogs under the guidance of magnetic resonance (MR) imaging. Two different MR techniques were used to guide the ultrasound beam. T2-weighted images showed lesion formation within a few minutes after sonication. T1-weighted GRASS (gradient-recalled acquisition in the steady state) images were sensitive to temperature elevations, permitting monitoring of lesion creation with MR imaging. Short TR T1-weighted GRASS images were not as helpful in detecting temperature elevation because of a reduction in signal-to-noise ratio. T2-weighted fast spin-echo images were compared with conventional T2-weighted spin-echo images. The former produced high-quality images in a fraction of the imaging time. This study shows that it is possible to monitor and guide ultrasonic surgery with MR imaging.

Magnetic resonance-guided thermal surgery.

A demonstration of MR guided thermal surgery involved experiments with imaging of focused ultrasound in an MRI system, measurements of the thermal transients and a thermal analysis of the resulting images. Both the heat distribution and the creation of focused ultrasound lesions in gel phantoms, in vitro bovine muscle and in vivo rabbit muscle were monitored with magnetic resonance imaging. Thermal surgical procedures were modeled by an elongated gaussian heat source where heat flow is controlled by tissue thermal properties and tissue perfusion. Temperature profiles were measured with thermocouples or calculated from magnetic resonance imaging in agreement with the model. A 2-s T1-weighted gradient-refocused acquisition provided thermal profiles needed to localize the heat distribution produced by a 4-s focused ultrasound pulse. Thermal analysis of the images give an effective thermal diffusion coefficient of 0.0015 cm2/s in gel and 0.0033 cm2/s in muscle. The lesions were detected using a T2-weighted spin-echo or fast spin-echo pulse sequence in agreement with muscle tissue sections. Potential thermal surgery applications are in the prostate, liver, kidney, bladder, breast, eye and brain.