Faculty Bibliography

OBJECTIVE: A retrospective review of the MR examinations in 21 patients with idiopathic synovial osteochondromatosis (ISO) was performed to determine its MRI characteristics. MATERIALS AND METHODS: Twenty-one patients diagnosed with ISO had undergone MRI prior to surgery. The MR images were retrospectively evaluated for configuration and extent of lesion as well as for signal characteristics. RESULTS: Three distinct MR patterns were seen in ISO: A--lobulated homogeneous intraarticular signal isointense to slightly hyperintense to muscle on T1-weighted images and hyperintense on T2-weighted images (n = 3); B--pattern A plus foci of signal void on all pulse sequences (n = 17); and C--features of pattern A and B plus foci of peripheral low signal surrounding central fat-like signal (n = 2). The foci of signal void in pattern B and C corresponded to areas of calcification and the foci of peripheral low signal surrounding central fat-like signal in pattern C corresponded to areas of ossification. CONCLUSION: The MR appearance of ISO appears sufficiently unique to allow its differentiation from other causes of intraarticular pathology

In an attempt to improve the detection of chondral abnormalities with magnetic resonance imaging, a fat-suppressed three-dimensional gradient-recalled acquisition in the steady state (GRASS) and spoiled GRASS (SPGR) sequence was optimized by study of five cadaveric knee specimens. Results with this optimized sequence then were compared with results with three spin-echo (T1-, proton-density-, and T2-weighted) and two three-dimensional gradient-recalled echo sequences (GRASS and non-fat-suppressed SPGR) in the assessment of naturally occurring abnormalities of the patellofemoral compartment in 10 cadaveric knees. Results with the optimized fat-suppressed SPGR sequence were significantly better (P < .02) than results with the other five sequences and had a sensitivity of 96%, a specificity of 95%, and an accuracy of 95%. In addition, normal cartilage consistently appeared as a trilaminar structure with the fat-suppressed SPGR sequence, a feature that appeared to help in identification of chondral lesions

Quantitative phase-contrast magnetic resonance (MR) angiography of the portal vein was prospectively evaluated in 79 fasting patients and 23 healthy volunteers. Images were obtained during a 12-second breath-hold acquisition in the coronal (n = 102) and axial (n = 11) planes. Pathologic correlation was available in 55 of 79 patients and included findings of cholangiocarcinoma, cirrhosis, hepatocellular carcinoma, hepatitis, and metastatic disease. Forty-one patients had correlative Doppler ultrasound (US) findings. MR and US findings correlated as to flow direction in all cases. In nine patients, Doppler US velocity measurements were available and closely correlated with MR findings. A comparison of axial and coronal portal venous phase-contrast measurements in 11 patients revealed no substantial difference with regard to the plane used. Quantitative phase-contrast MR angiography is a simple and rapid technique for the assessment of portal venous patency, flow direction, and flow velocity and, combined with high-resolution conventional MR imaging, may obviate the current use of both computed tomographic and US examinations

T2-weighted images are considered the most sensitive for lesion detection at high field; however, long imaging time is problematic. Accordingly, the authors compared four breath-hold T2 or T2* weighted sequences comprising T2*-weighted FLASH, T2*-weighted PSIF, T2-weighted rapid spin echo (RASE), and T2-weighted Turbo-FLASH (Turbo) in 20 different healthy volunteers, 10 at 1.0 T and 10 at 1.5 T with reference to regular T2-weighted spin echo. Images were evaluated quantitatively by liver signal to noise (S/N) and spleen-liver signal difference to noise (SD/N) ratios and qualitatively for presence of artifacts and image quality. Data were evaluated for 1.0 T and 1.5 T separately and combined. In the combined evaluation, T2*-FLASH had good S/N (23.1 + 5.1) but low SD/N (2.9 + 1.7) and suffered from susceptibility artifacts. T2* PSIF had good S/N (28.1 + 10.0) and moderate SD/N (6.0 + 2.4), but occasionally had heterogeneous signal intensity. Flow signal void was an attractive feature. T2 RASE had very low S/N (4.4 + 1.9) and low SD/N (2.3 + 1.1) and suffered from flow artifacts. T2-Turbo had good S/N (24.6 + 8.6) and SD/N (8.9 + 2.5). Flow signal void was present, but small matrix size decreased image quality. The results of our study suggest that T2*-PSIF and T2-Turbo have good S/N and SD/N and fair image quality which may be clinically useful for breath-hold T2-weighted sequences of the liver

The authors compared six MR sequences comprising conventional breath-hold [rapid spin echo (RASE) repetition time (TR) 240 ms/echo time (TE) 8 ms/90 degrees, fast low angle shot (FLASH) 130/4.5/80 degrees, TurboFLASH 6.5/3.5/8 degrees], fat suppressed regular spin echo (FS SE 330/15/90 degrees), and two combined fat suppressed breath-hold sequences (FS FLASH 130/8/80 degrees, FS RASE 240/10/90 degrees) for studying the normal pancreas. Sequences were selected on the basis of features desirable for demonstrating the pancreas, particularly absence or decrease in artifacts and improved dynamic range of intraabdominal tissue signal intensities. Ten normal volunteers were studied, six at 1.5 T and four at 1.0 T, and comparison was made to regular short TR/TE SE. Quantitative pancreas signal-to-noise (S/N) and pancreas fat-to-noise (SD/N) measurements and qualitative evaluation of overall resolution and artifacts were determined. Fat suppressed FLASH had the highest S/N (44.1 +/- 10.8, p less than 0.0001) and SD/N (35.0 +/- 11.9, p less than 0.0001), and seven studies were considered good or very good. Fat suppressed SE had good S/N (32.6 +/- 7.7) and SD/N (19.0 +/- 3.6), and eight FS SE studies were considered good or very good. Among the nonsuppressed sequences, FLASH had the best combination of quantitative and qualitative measurements. Our results suggest that fat suppression may be important for studying the pancreas and that nonsuppressed FLASH may be a reasonable alternative

The authors compared three T1-weighted magnetic resonance imaging techniques that acquire images encompassing the entire liver in one breath hold. Twenty healthy volunteers were imaged--10 at 1.0 T and 10 at 1.5 T--and the results compared with those of regular short repetition time/echo time spin-echo imaging. Rapid acquisition spin echo was resistant to artifacts and had good image quality but had the lowest liver signal-to-noise (S/N) and spleen-liver signal-difference-to-noise (SD/N) values. Fast low-angle shot (FLASH) had the highest S/N and SD/N, very good image quality, and only mild artifacts. TurboFLASH had good S/N and SD/N, but reduced matrix size decreased image quality. All three sequences had better SD/N than regular spin echo, and FLASH and TurboFLASH had higher S/N. On the basis of this study, the FLASH sequence appears the most attractive for T1-weighted breath-hold imaging

Three cases of surgical implantation of esophageal carcinoma during esophagogastrectomy are presented. The CT and radiographic appearance is demonstrated. A possible etiology and method for decreasing the risk of surgical spread of tumor are discussed