Primary lymphoma of the cervix: MRI findings with gadolinium

MRI evaluation of primary cervical lymphoma has not been reported. We report such a case of primary cervical lymphoma, a lesion well seen and well delineated from normal tissue by MRI. Although primary lymphoma of the cervix is a rare entity, the disease does exist and can be well demonstrated by MRI. We evaluated the MR appearance of this lesion with both nonenhanced and gadolinium-enhanced imaging.     

Evaluation of two new gadolinium chelates as contrast agents for MRI

Two new gadolinium chelates were investigated for potential use as tissue-specific contrast agents for magnetic resonance imaging. In vitro measurements of stability constants, octanol/water partition coefficients and relaxation times in solutions of water and human serum albumin (HSA) were performed with each new chelate and compared with gadolinium-diethylenetriamine pentaacetic acid, Gd(DTPA). Biodistribution studies and magnetic resonance imaging in rats were used to evaluate the new chelates in vivo. The stability constants (log K) of gadolinium-N,N″-bis(3-hydroxy-6-methyl-2-pyridylmethyl)diethylenetriamine-N,N′,N″-triacetic acid, Gd(DTTA-HP), and gadolinium-1,7-13-triaza-4,10-16-trioxacyclooctadecane-N,N′,N″-triacetic acid, Gd(TTCT), were determined to be 23.65 and 18.07, respectively. These can be compared to a literature value of 22.46 for Gd(DTPA). Octanol/water partition coefficients for both complexes showed they were more lipophilic than Gd(DTPA). Gd(DTTA-HP) exhibited a smaller relaxivity in water but a larger relaxivity in 4% HSA than Gd(DTPA). Gd(TTCT) exhibited a lower relaxivity than Gd(DTPA) in both water and 4% HSA. Both complexes showed similar biodistributions to Gd(DTPA) no carrier-added concentrations. Gd(DTTA-HP) had a greater percent change in signal intensity than Gd(DTPA) on T₁-weighted spin-echo images in the heart, liver, and kidney. Percent change in signal intensity for Gd(TTCT) was lower than Gd(DTPA) in heart, liver, and kidney.     

Gadolinium-DTPA-enhanced MRI of intraocular tumors

The value of gadolinium-enhanced MRI in 30 patients with intraocular lesions has been evaluated. Seventeen patients had a uveal melanoma, two a ciliary body melanoma, three had uveal metastases, one lymphoma, four had senile macula degenerations, and three uveal nevi. Twelve of 17 patients with melanoma were followed up by MRI after ruthenium plaque therapy on 2–4 occasions. Melanomas showed high precontrast signal intensities and only a slight enhancement after intravenous Gd-DTPA was given. After ruthenium plaque therapy precontrast signal intensities (SI) decreased while a moderate signal increase on postcontrast scans was noted. Scars or tumor residues were better delineated on enhanced images. All other tumors than melanotic melanomas showed low SI on precontrast scans and a high signal increase after Gd-DTPA administration. Small amelanotic tumors were better delineated on postcontrast scans. In addition Gd-DTPA-enhanced MRI allowed differentiation between tumor and hemorrhage. No signal increase after Gd-DTPA application was seen in subretinal or vitreous hemorrhages of varying ages.     

Absolute quantification of the hepatic glycogen content in a patient with glycogen storage disease by C magnetic resonance spectroscopy

Using natural-abundance ¹³C magnetic resonance spectroscopy (MRS) on a conventional whole-body system operating at 1.5 T, the absolute hepatic glycogen concentration was noninvasively determined in a patient with type Ia glycogen storage disease. Furthermore, to assess the reliability of glycogen determination, hepatic glycogen content was assessed after an overnight fasting period in 35 healthy volunteers divided into two groups, one with a carbohydrate-rich diet, the other without any particular dietary preparation. In the patient, the glycogen concentration was found to be 458 mM. In the healthy subjects, average glycogen concentrations were 229 ± 34 mM (mean ± standard deviation) and 257 ± 31 mM for the group without and with dietary preparation, respectively. The ¹³C-MRS results are in agreement with those obtained by conventional liver biopsy. ¹³C MRS in natural abundance may thus serve as a straightforward, fast, and noninvasive tool for quantification of the liver glycogen content in patients.     

MRI in cerebral developmental malformations and epilepsy

Cerebral developmental malformations are increasingly recognized as a major cause of developmental delay and epilepsy. The incidence of these developmental malformations in patients with epilepsy is not known, but epilepsy surgery data suggest that this pathology is commonly seen in children who undergo epilepsy surgery for intractable epilepsy. These malformations can be diagnosed by a combination of clinical, neurophysiological, and imaging techniques. However, imaging techniques such as MRI have been able to provide in vivo recognition of many of these malformations and have contributed to the recognition of specific syndromes. These malformations can be classified on an anatomical basis either into diffuse, unilateral, or generalized. However, a combination of imaging data in conjunction with genetics and embryology may be more appropriate in the future. Further technical developments promise to increase the sensitivity of MRI in detecting these malformations and may help to delineate the possible biology of these disorders.     

Investigation of cerebral ischemia using magnetization transfer contrast (MTC) MR imaging

The effects of cerebral ischemia in rat brain were monitored as a function of time using proton MR imaging. Spinspin relaxation time (T₂), proton density, and magnetization transfer contrast (MTC) were measured by MR imaging at various time intervals during a 1-week period following the induction of ischemic damage. Ischemic injury was characterized by a maximization of both T₂ value and MTC appearance at 24 hr postischemic injury. These changes were accompanied by a gradual increase in MR observable water density over the first few days of ischemia. A reduction in the magnetization exchange rate between “free” and “bound” water protons as measured by MTC imaging is at least partially responsible for the elevation in T₂ values observed during ischemia, and may accompany breakdown of cellular structure.     

Diffusion-weighted imaging versus superparamagnetic iron oxide (SPIO)-enhanced MRI: exclusive and combined values in the assessment of hepatic metastases

Purpose

The purpose was to validate diffusion-weighted imaging (DWI) in the assessment of hepatic metastases compared with superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging.

Materials and Methods

For 21 consecutive patients with 160 metastases from extrahepatic malignancy and 25 benign focal lesions, two radiologists evaluated four separate review sessions (I, SPIO-enhanced T2?-weighted images; II, precontrast DWI; III, SPIO-enhanced T2?-weighted images and precontrast DWI; IV, SPIO-enhanced T2?-weighted images plus precontrast and SPIO-enhanced DWI) and assigned confidence levels using a five-grade scale for each hepatic lesion.

Results

The A_z values after receiver operating characteristic curve analysis for Reader 1 and Reader 2 were 0.80 and 0.75 on session I, 0.91 and 0.91 on session II, 0.97 and 0.96 on session III and 0.96 and 0.96 on session IV, respectively. The A_z value of session II was significantly higher than that of session I (Reader 1, P=.004; Reader 2, P<.001), and that of session III was significantly higher than that of session I (P<.001 for each reader) or session II (Reader 1, P=.004; Reader 2, P=.003). Although there was no significant difference of A_z value between session III and session IV (Reader 1, P=.231; Reader 2, P=.878), the sensitivity improved for session IV compared with that for session III (Reader 1, P=.031; Reader 2, P=.039).

Conclusion

In the assessment of hepatic metastases, DWI can provide more accurate information than can SPIO-enhanced images. Diagnostic accuracy can be increased even more through the combination of both techniques.     

RF interference suppression in a cardiac synchronization system operating in a high magnetic field NMR imaging system

An electrocardiographic (ECG) unit suitable for cardiac-synchronized nuclear magnetic resonance imaging in high magnetic fields is presented. The unit includes lossy transmission lines as ECG leads in order to supress radio frequency (RF) interference in the electrocardiogram. The unit's immunity to RF interference is demonstrated.     

Cardiac lipoma: Six-year follow-up with MRI characteristics, and a review of the literature

A total of 63 cardiac lipomas have been reported to date. Although most of these rare tumors cause no symptoms, a few can have a detrimental effect on myocardial function as well as displacing and encasing the coronary arteries. This case of a cardiac lipoma was initially seen in 1982. The lipoma was found to be nonresectable at surgery due to involvement of the coronary arteries. This neoplasm was characterized with magnetic resonance imaging in 1989 on a follow-up visit. Magnetic resonance imaging is shown to be superior to computed tomography for identifying the relationship of the lipoma to the coronary arteries. This is a significant factor in determining resectability.     

Small hyperintense hepatic lesions on T1-weighted images in patients with cirrhosis: evaluation with serial MRI and imaging features for clinical benignity

PURPOSE: The aim of this study was to evaluate the frequency and magnetic resonance imaging (MRI) features of clinically benign, small (<2 cm) hyperintense hepatic lesions in the cirrhotic liver on T1-weighted MR images seen at serial MRI. MATERIALS AND METHODS: This study included 189 patients with cirrhosis, who underwent hepatic MRI more than twice with an interval of at least 12 months. The initial MR images were reviewed for the presence of small hyperintense lesions on T1-weighted images. The size, location and signal intensity on T2-weighted images as well as enhancement patterns of the corresponding lesions were recorded. RESULTS: On the initial T1-weighted MR images, 43 small hyperintense hepatic lesions were detected in 23 (12%) of 189 patients. Twelve (28%) of 43 lesions showed early enhancement and were pathologically diagnosed as hepatocellular carcinoma (HCC) during the follow-up period. Thirty-one (72%) of 43 lesions showed no early enhancement with various signal intensity on T2-weighted images (hyperintensity=4, isointensity=20, hypointensity=7). Among these 31 lesions, 12 showed no interval change, while 11 disappeared (n=10) or decreased in size (n=1). In the remaining eight lesions, seven were diagnosed as HCC on the basis of pathologic confirmation or the interval growth. CONCLUSION: Small hyperintense hepatic lesions on T1-weighted magnetic resonance (MR) images without early enhancement on the arterial-phase contrast-enhanced dynamic studies in patients with cirrhosis usually showed no interval growth or disappeared during the serial MRI. These lesions with additional findings of iso- or hypointensity on the T2-weighted MR images without "washout effect" on the contrast-enhanced equilibrium-phase images may more frequently be clinically benign or hyperplastic nodules than HCCs.     

Slice profile improvement for a clinical MRI system

Optimal control methods have been recently introduced to improve the design of selective radio frequency pulses and several optimized selective pulses that can produce excellent slice profiles have been reported. These pulses usually require high peak rf amplitudes to implement and thus can not be widely utilized because of the limitations of the specific absorption rate and the rf power amplifier of a clinical system. We have a Siemens 1.5 T MRI clinical system. Several pulse files which consist of the bandwith matched 90° and 180° selective pulses are provided. Some of these can produce excellent slice profiles. However, they can only be used in the pulse sequences with the pulse length of 5.12 msec. The purpose of this paper is to improve the slice profiles produced by the pulse file in the pulse sequences with the shorter 2.56 msec pulse length. A pulse file optimized by the conjugate gradient method is proposed to substitute the 2.56 msec Siemens pulse file. Our experimental results confirm that the slice profiles and images are improved by the optimized pulse file with a lower peak voltage. The proposed pulse file can also be applied in other clinical MRI systems.     

Signal-to-noise improvement in mid-field MRI surface coils: A degree in plumbing?

From a series of standard SE imaging sequences, performed on a Bruker 0.28 T imaging system, with the assistance of a healthy volunteer, the image signal-to-noise (S/N) ratio obtained from a 23-cm square surface coil has been shown to increase by up to 38% as the tube gauge is increased from 4 to 18 mm. The reason did not lie solely in the much improved Q factor of the unloaded coils. Despite a more than twofold increase in the unloaded Q factor, the loaded coil Q values only increased by 8%. It would appear, however, that the resistive, dielectric and inductive noise components are all reduced, and hence contribute to the observed improved S/N. The reduction in pure ohmic losses accounts for a quarter of the improved S/N, while the reduced inductive and dielectric losses provide the remaining three quarters. No independent quantification of the two latter noise sources was attempted, although a reduced dielectric contribution is confirmed qualitatively by a reduction in the negative frequency shift of the resonance frequency as a function of increasing coil gauge when the coil is loaded.     

Regional differences in rat brain displayed by fast MRI with superparamagnetic contrast agents

Gradient echo images of coronal sections through the brains of normal rats have been recorded at 2.0 T both before and at various times after intravenous bolus administrations of a superparamagnetic iron oxide suspension. The decrease in NMR signal due to the transit of the contrast agent has been quantified as a function of time. The image immediately following the injection can be subtracted from that pre-contrast to reveal regional differences related to blood flow.     

MRI and diabetic foot infections

The role of magnetic resonance imaging and plain radiographs in evaluating osteomyelitis in the diabetic foot was studied. Fifty patients were prospectively examined by magnetic resonance imaging and plain radiographs to determine the extent of infection. Thirty-seven patients had positive MRI for osteomyelitis and 19 were positive with conventional radiography. Thirteen patients had negative MRI healed with short course of antibiotics. Five patients with positive MRI received four weeks' course of intravenous antibiotics with two still having persistent infection in the six weeks follow-up. Thirty-two patients underwent surgery with favorable results. Sixty-two bone specimens were obtained for histologic evaluation of osteomyelitis. In cases with histologic proof of diagnosis, magnetic resonance sensitivity was 99%, specificity was 81%, and accuracy was 94%. Thus magnetic resonance imaging was shown to have a high sensitivity, specificity, and accuracy in detecting osteomyelitis.     

Magnetic resonance imaging of the thoracic cavity using a paused 3DFT acquisition technique

A new pulse sequence designed for magnetic resonance imaging of the entire thoracic cavity is described. This sequence, called 3DPAUSE, is a rapid three-dimensional Fourier transform (3DFT) sequence with periodic pauses for breathing and additional rf pulses after each pause to restore the magnetization to steady-state before data acquisition resumes. Cardiac motion artifacts are effectively removed by signal averaging. Respiratory motion artifacts are removed by breath hold. Image artifacts caused by an inadequate number of pauses or by inappropriate placement of the pauses within a scan are shown, and ways to avoid these artifacts are discussed. 3DPAUSE provides the ability to acquire three-dimensional arrays in the thoracic cavity with minimal artifacts from respiratory and cardiac motions in a clinically reasonable time.     

Increasing the yield from volumetric MRI in patients with epilepsy

Volumetric magnetic resonance imaging has become a routine investigation in the management of patients with chronic partial epilepsy. However, even with the use of reformatted images, an underlying cause for epileps can-not be found in many of these patients. We show that further processing of the data, including three-dimensional reconstruction and quantitative analysis of the volume and complexity of the images in three dimensions, reveals additional positive information in up to 75% of patients. This may be useful for surgical planning, prognostication, and understanding of the structure and development of the human brain.     

A study of T1-weighted 31phosphorus MR-spectroscopy from patients with focal and diffuse liver disease.

³¹P-MR-Spectroscopy was performed in 28 patients with focal (n = 23) and diffuse (n = 5) liver disease and in 18 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T by using a surface coil. To get T₁-weighted ³¹P-spectra a short TR of 600 msec was taken, because T₁-weighted spectra of focal liver disease were more significantly different from spectra from healthy volunteers than density weighted ones. The VOI from patients with focal superficial alterations showed a mean volume of 172 ml, with diffuse liver disease 196 ml, and from volunteers 158 ml. Focal tumors filled up the VOI on an average of 70%. This investigation demonstrated that PME/β-ATP- and PDE/β-ATP-ratios were sensitive indicators for focal liver disease. As a result of this study we could establish a significant increase of PME/β-ATP- (0.75 ± 0.30) and PDE/β-ATP-ratios (1.68 ± 0.62) in patients with superficial focal liver metastases (n = 19) compared to the control group (PME/β-ATP: 0.49 ± 0.17, PDE/β-ATP: 1.24 ± 0.24; t-test: p < 0.02). Patients with a hemangioma (n = 1), liver infarction (n = 1), empyema of gallbladder (n = 1) and a hepatic involvement by a malignant lymphoma (n = 1) showed a similar increase of PME/β-ATP and/or PDE/β-ATP. Up to now spectral changes seemed to be non-specific. The ratios of ³¹P metabolites of the cirrhoses (n = 4) and the fatty liver (n = 1) did not show any characteristic changes versus the volunteers.     

Advances in cardiac applications of subsecond flash MRI

Flow-suppressed, subsecond FLASH MR images of the normal human heart have been obtained from single cardiac cycles using a 2.0-T whole-body MRI/MRS system (Siemens Magnetom) equipped with conventional 10 mT m⁻¹ gradients. The present results demonstrate further technical improvements as compared to a previous report on the same subject (Magn. Reson. Med. 13:150–157; 1990). Measuring times of 139 msec and 209 msec were achieved by reducing the repetition time to TR = 4.36 msec (TE = 2.8 msec) and the spatial resolution to 32 × 128 or 48 × 128 measured data points, respectively. The flip angle was optimized to 12°. Spatial pre-saturation of 60 mm thick sections adjacent to the imaging plane resulted in a suppression of the blood signal and a clear delineation of the myocardium. Oblique rotation of the imaging slice provides convenient access to the anatomical long axis and short axis views of the heart. EKG-triggered images from separate heartbeats but at different cardiac phases demonstrate that the effective time resolution is considerably less than the actual imaging time.     

Remotely detected high-field MRI of porous samples

Remote detection of NMR is a novel technique in which an NMR-active sensor surveys an environment of interest and retains memory of that environment to be recovered at a later time in a different location. The NMR or MRI information about the sensor nucleus is encoded and stored as spin polarization at the first location and subsequently moved to a different physical location for optimized detection. A dedicated probe incorporating two separate radio frequency (RF)-circuits was built for this purpose. The encoding solenoid coil was large enough to fit around the bulky sample matrix, while the smaller detection solenoid coil had not only a higher quality factor, but also an enhanced filling factor since the coil volume comprised purely the sensor nuclei. We obtained two-dimensional (2D) void space images of two model porous samples with resolution less than 1.4 mm2. The remotely reconstructed images demonstrate the ability to determine fine structure with image quality superior to their directly detected counterparts and show the great potential of NMR remote detection for imaging applications that suffer from low sensitivity due to low concentrations and filling factor.     

Magnetic resonance imaging and epilepsy: Neurosurgical decision making

Advances in magnetic resonance imaging (MRI) techniques have had an important impact on the decision-making process leading to surgical resection for chronic seizures. The MRI is now obtained relatively early in the work-up, and, when it shows abnormality, it assumes a crucial role in the detection of specific surgically remediable syndromes. These syndromes, when diagnosed by MR and other confirmatory studies such as electroencephalography (EEG), positron emission tomography (PET), magnetoencephalography (MEG), and neuropsychological testing, define the essential part of the surgical plan; that is, removal of the disease substrate. The availability of a host of MR techniques enable us to investigate epilepsy not only as a structural pathology but as physiological pathology reflected in abnormal blood flow, metabolism, and synaptic transmission. The mainstay of surgical treatment is the removal of the anatomic pathology, but other MR techniques may be helpful in the delineation of dual pathology in lesional cases, in appreciation of the full extent of microscopic pathology in developmental lesions, and in the imposition of restrictions on the resection based upon functional mapping. Finally, functional and anatomic maps obtained preoperatively can be related directly to the spatial coordinates of the exposed brain in the operating room using MRI-based frameless stereotactic methods. The final outcome, then, is the removal of the disease substrate without injury to adjacent, functionally salient cortical regions.