A new vascular coupling device: Assessment of MRI issues at 3-tesla

Objective

Vascular grafting frequently involves a time-consuming operation. A new vascular coupling device (VCD) made from metallic material was recently developed that may be advantageous because of the reduced operative time and decreased patient risks. Because of the metal, there are safety concerns related to MRI. Therefore, the purpose of this investigation was to use standardized testing techniques to evaluate MRI issues for this VCD in association with a 3-Tesla MR system.

Methods

The VCD (corlife oHG, Hannover, Germany) was evaluated for magnetic field interactions (translational attraction and torque), MRI-related heating, and artifacts at 3-Tesla. MRI-related heating was assessed with the VCD in a gelled-saline-filled phantom with MRI performed at a whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were assessed using T1-weighted, spin echo, and gradient echo pulse sequences.

Results

The VCD exhibited minor magnetic field interactions and minimal heating (maximum temperature elevation, 1.8 °C). Artifacts were relatively small in relation to the size and shape of this implant. The lumen of the VCD could not be visualized using the gradient echo pulse sequence.

Conclusions

The metallic VCD that underwent evaluation is MR conditional for a patient undergoing an MRI procedure at 3-Tesla or less.     

In vitro assessment of 3-T MRI issues for a bioabsorbable,coronary artery scaffold with metallic markers

Objective

Coronary artery stents are made from metallic mesh and, therefore, to ensure patient safety, these implants must be evaluated to determine risks associated with MRI. Recently, bioabsorbable scaffolds, which have metallic markers, have been developed for use in the coronary arteries. Because of the metallic materials, these implants may present issues for patients undergoing MRI. Therefore, the objective of this investigation was to assess MRI issues (i.e., magnetic field interactions, MRI-related heating, and artifacts at 3 T) for a new bioabsorbable, coronary artery scaffold with metallic markers.

Methods

A bioabsorbable, coronary artery scaffold (Mirage Microfiber Scaffold) underwent assessments for magnetic field interactions, MRI-related heating, and artifacts at 3-Tesla using standard techniques. MRI-related heating was evaluated with the scaffold placed in a gelled-saline-filled phantom and MRI was performed at an MR system reported, whole body averaged SAR of 2.9 W/kg for 15 minutes. Artifacts were characterized using T1-weighted spin echo and gradient echo, pulse sequences.

Results

There were no magnetic field interactions. The highest temperature rise was 1.6 °C (highest background temperature rise, 1.6 °C). Artifacts were relatively small in relation to the size and shape of this coronary artery scaffold. Notably, the lumen of the scaffold could be visualized on the GRE pulse sequence.

Conclusion

The results demonstrated that the coronary artery scaffold is acceptable (or “MR conditional,” using current MRI labeling terminology) for a patient undergoing an MRI procedure at 3 T or less. To our knowledge, this is the first bioabsorbable, coronary artery scaffold that has been evaluated for MRI issues.     

Feasibility of post-gadolinium three-dimensional gradient-echo sequence to evaluate the pulmonary arterial vasculature

Purpose

To determine the feasibility of post-gadolinium three-dimensional gradient-echo (3D-GE) sequence for the evaluation of the pulmonary arterial vasculature in patients with suspected pulmonary embolism (PE) and in patients with a variety of other disease processes.

Materials and Methods

Twenty-six consecutive patients (18 females, 8 males; mean age±S.D., 46.6±21.1 years) who underwent chest magnetic resonance imaging (MRI) including post-gadolinium 3D-GE sequence for the evaluation of PE (Group A, n=13) and a variety of other disease processes (Group B, n=13) were included in the study. Post-gadolinium 3D-GE MR sequences were retrospectively, independently and blindly evaluated by two reviewers for the image quality of pulmonary arterial vasculature, and findings of PE and other disease processes. Clinical and imaging follow-up data for all patients were obtained. Interobserver agreement was calculated by kappa statistics.

Results

All central and lobar pulmonary arteries, 71.4–89.6% of segmental arteries and 46.7–52.7% of subsegmental arterial units in both groups were visualized with sufficient diagnostic image quality on post-gadolinium 3D-GE sequences. PE involving lobar and segmental arteries was diagnosed in two patients in each group. Other disease processes including pneumonia, lung nodules, superior vena cava stenosis, lung metastases, chronic lymphocytic leukemia and aortic aneurysm were detected in 10 of 26 patients. There was good to excellent interobserver agreement (0.73 to 1.00) for all findings.

Conclusion

Post-gadolinium 3D-GE sequence may be an alternative technique for the visualization of central, lobar and segmental arteries, and may diagnose PE and other pathologies involving the chest in different patient populations.     

3D high-resolution contrast enhanced MRI of carotid atheroma — a technical update

Objective

Development of a fast 3D high-resolution magnetic resonance imaging (MRI) protocol for improved carotid artery plaque imaging.

Methods

Two patients with carotid atherosclerosis disease underwent 3D high-resolution MRI which included time-of-flight and T₁-weighted variable flip angle, fast-spin-echo (FSE) imaging, pre- and post-intravenous gadolinium-based contrast agent administration.

Results

Good quality images with intrinsic blood suppression were obtained pre- and post-contrast administration using a 3D FSE sequence. The plaque burden, lipid core volume, hemorrhage volume and fibrous cap thickness were well determined.

Conclusions

3D high-resolution MR imaging of carotid plaque using TOF and 3D FSE can achieve high isotropic resolution, large coverage, and excellent image quality within a short acquisition time.     

The use of T2*-weighted multi-echo GRE imaging as a novel method to diagnose hepatocellular carcinoma compared with gadolinium-enhanced MRI: a feasibility study

Background

The goal of the study was to assess a T2*-weighted MRI sequence for the ability to identify hepatocellular carcinoma (HCC).

Methods

Hepatic iron deposition, which is common in chronic liver disease (CLD), may increase the conspicuity of HCC on GRE imaging due to increased T2* signal decay in liver parenchyma. In this study, a breath-hold T2*-weighted MRI sequence was evaluated by a blinded observer for HCC and the results compared to a reference standard of gadolinium-enhanced MRI in these same patients. Forty-one patients (mean age 56.2 years; 17 females) were included in this approved, retrospective study.

Results

By the reference standard, 14 of 41 patients had a total of 25 HCCs. The sensitivity of the T2*-weighted MR sequence for identifying HCC, per lesion, was 60%, while the specificity was 100%. There was a significantly lower T2* value of liver parenchyma in patients with HCC identified by the T2*-weighted sequence than in those with HCCs which were not identified by the T2*-weighted sequence (27.8±2.2 vs. 21.9±2.1 ms; P=.02).

Conclusions

A T2*-weighted MRI sequence can identify HCC in patients with CLD. This technique may be beneficial for imaging of patients contraindicated for gadolinium.     

Ultrasmall superparamagnetic iron oxides enhanced MR imaging in rats with experimentally induced endometriosis

Purpose

The purpose of our study was to evaluate the feasibility of magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxides (USPIO) in the detection of experimentally induced endometriosis.

Materials and methods

Endometriosis was surgically induced in rats by transplanting an autologous fragment of uterine tissue onto the inner surface of the abdominal wall, the posterior surface of the uterine body and the arterial cascades of the small intestines adjacent to mesenteric blood vessels. Six weeks later, MRI using Gd-DTPA and USPIO was performed for the evaluation of the ectopic uterine tissue (EUT). A scoring system was developed for image interpretation (0=absence, 1=probably absence, 2=probably presence and 3=presence). We defined MR index (MRIx) as the sum of T1-weighted and enhanced T1-weighted and T2-weighted image scores, and USPIO MRIx (MRIx^+USPIO) as the MRIx score plus the score of USPIO-enhanced T2-weighted image.

Results

The MRIx^+USPIO was also higher in the successfully autotransplanted group than in the failed group (6.19±1.72 versus 3.94±1.20, P<.001). There was also a significant linear relationship between MRIx^+USPIO and pathologic status (R²=0.494, P<.001). Thirty-one (64.6%) of the 48 implanted uterine tissues were histologically confirmed on pathologic review. The area of MRIx and MRIx^+USPIO in the detection of EUT more than 3 mm in size was 0.739 and 0.913, respectively.

Conclusion

Our results suggest that USPIO-enhanced MRI could be a novel diagnostic tool for diagnosis in experimentally induced peritoneal endometriosis.     

MR Imaging of total hip arthroplasty: comparison among sequences to study the sciatic nerve at 1.5 T

Purpose

This study was done to test a series of MR sequences for evaluating the sciatic nerve after total hip arthroplasty (THA).

Material and Methods

The study protocol was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-five patients (11 men and 14 women mean age: 62.3±5.7 years) with THA were included in this prospective study. MRI protocol included sequences that were preliminarily tailored for nerve imaging in patients with THA: proton density (PD)-weighted turbo SE, T1-weighted turbo SE (TSE) 3 mm thickness, T1-weighted turbo SE (TSE) 6 mm thickness, T1-weighted turbo SE with high bandwidth (TSE hBW), T2- weighted TSE, T2-weighted with fat saturation and short-tau inversion recovery (STIR). For each sequence, we evaluated the visibility of the sciatic nerve using a semiquantitative score (0=total masking; 1=insufficient visibility; 2=sufficient visibility; 3=optimal visibility). The sum of the scores given to each sequence was divided by the maximal sum, obtaining a percentage visibility index. Friedman and sign tests were used for statistical analysis.

Results

MR examination time was approximately 40 min. No patients reported pain, heat or symptoms related to nerve stimulation. The visibility index ranged between 88% and 70% for the first four sequences. The T1-weighted TSE hBW sequence had the best visibility index (P<.05). The visibility indexes of the first four sequences were significantly higher (P<.004, sign test) than those of the remaining three sequences.

Conclusion

The sciatic nerve could be studied at 1.5 T in patients following THA. The nerve is better visualized with T1-weighted TSE hBW sequences. On T2-weighted sequences and STIR, the visibility of the nerve is low.     

Unfolding the long-term pathophysiological processes following an acute inflammatory demyelinating lesion of multiple sclerosis

Background

Acute symptomatic inflammation is a main feature of multiple sclerosis but pathophysiological processes underlying total or partial recovery are poorly understood.

Objective

To characterize in vivo these processes at molecular, structural and functional levels using multimodal MR methods.

Methods

A neuroimaging 3-year follow-up (Weeks 0, 3, 11, 29, 59 and 169) was conducted on a 41-year-old woman presenting at baseline with a large acute demyelinating lesion of multiple sclerosis. Conventional magnetic resonance imaging (MRI), magnetization transfer imaging, diffusion-weighted imaging, functional MRI and magnetic resonance spectroscopy were conducted at 1.5 T.

Results

Patient presenting with subacute left hemiplegia recovered progressively (expended disability status scale 7 to 5.5). The MR exploration demonstrated structural functional and metabolic impairments at baseline. Despite restoration of the blood brain barrier integrity, high lactate levels persisted for several weeks concomitant with glial activation. Slow and progressive structural and metabolic restorations occurred from baseline to W169 (lesion volume −64%; apparent diffusion coefficient −14.7%, magnetization transfer ratio +14%, choline −51%, lipids −78%, N-acetylaspartate +77%) while functionality of the motor system recovered.

Conclusions

Multimodal MRI/MRS evidenced long-term dynamics recovery processes involving tissue repair, glial activation, recovery of neuronal function and functional systems. This may impact on customized rehabilitation strategies generally focused on the first months following the onset of symptoms.     

Quantitative MR imaging of targeted SPIO particles on the cell surface and comparison to flow cytometry

Purpose

To detect anti-CEACAM5 targeted superparamagnetic iron oxide (SPIO) particles in vitro on the cell surface by quantitative magnetic resonance (MR) imaging and to compare with flow cytometry.

Materials and Methods

The monoclonal mouse antibody T84.1 and an appropriate IgG isotype antibody were conjugated to dextran-coated SPIO particles. HT29 cells expressing carcinoembryonic antigen (CEACAM5) were treated with antibody-conjugated SPIO particles. Purified cell samples were examined on a 3.0-T MR scanner using a multi-echo spin-echo sequence for MR relaxometry. Aliquots of the cell samples were further treated with a fluorescein isothiocyanate (FITC) anti-dextran antibody and an Alexa Fluor 488 anti-mouse antibody for the corresponding flow cytometry.

Results

MR relaxometry revealed a dose-dependent binding of T84.1-conjugated SPIO particles with a positive correlation between R₂ relaxation rate of cell samples and SPIO particle concentration during incubation (r=0.993, P<.01). Positive correlations were also observed between R₂ relaxation rate and flow cytometry (geometric mean) with both fluorescent antibodies (r=0.972 and r=0.953, both P<.01), respectively.

Conclusion

The study revealed the feasibility of quantitative MR imaging of targeted SPIO particles on the cell surface comparable to flow cytometry.     

Assessment of normal flow patterns in the pulmonary circulation by using 4D magnetic resonance velocity mapping

Objective

The purpose of this study was to analyze flow patterns in the pulmonary circulation of healthy volunteers by using 4D flow magnetic resonance imaging.

Materials and Methods

The study was approved by the local ethics committee and all subjects gave written informed consent. Eighteen volunteers underwent a 4D flow scan of the whole-heart. Two patients with congenital heart disease were also included to detect possible patterns of flow abnormalities (Patient 1: corrected transposition of great arteries (TGA); Patient 2: partial anomalous pulmonary venous return and atrial septal defect). To analyze flow patterns, 2D planes were placed on the main pulmonary artery (PA), left and right PA. Flow patterns were assessed manually by two independent viewers using vector fields, streamlines and particle traces, and semi-automatically by vorticity quantification.

Results

Two counter-rotating helices were found in the main PA of volunteers. Right-handed helical flow was detected in the right PA of 15 volunteers. Analysis of the helical flow by particles traces revealed that both helices contributed mainly to the flow in the right PA. In the patient with corrected TGA helical flow was not detected. Abnormal vortical flow was visualized in the main PA of patient 2, suggesting elevated mean PA pressure.

Conclusions

Helical flow is normally present in the main PA and right PA. 4D flow is an excellent tool to evaluate noninvasively complex blood flow patterns in the pulmonary circulation. Knowledge of normal and abnormal flow patterns might help to evaluate patients with congenital heart disease adding functional information undetectable with other imaging modalities.     

Evaluation of Marfan patients status post valve-sparing aortic root replacement with 4D flow

Background

Over the past two decades elective valve-sparing aortic root replacement (V-SARR) has become more common in the treatment of patients with aortic root and ascending aortic aneurysms. Currently there are little data available to predict complications in the post-operative population. The study goal was to determine if altered flow patterns in the thoracic aorta, as measured by MRI, are associated with complications after V-SARR.

Methods

Time-resolved three-dimensional phase-contrast MRI (4D flow) was used to image 12 patients with Marfan syndrome after V-SARR. The patients were followed up for an average of 5.8 years after imaging and 8.2 years after surgery. Additionally 5 volunteers were imaged for comparison. Flow profiles were visualized during peak systole using streamlines. Wall shear stress estimates and normalized flow displacement were evaluated at multiple planes in the thoracic aorta.

Results

During the follow-up period, a single patient developed a Stanford Type B aortic dissection. At initial imaging, prior to the development of the dissection, the patient had altered flow patterns, wall shear stress estimates, and increased normalized flow displacement in the thoracic aorta in comparison to the remaining V-SARR patients and volunteers.

Conclusions

This is the first follow-up study of patients after 4D flow imaging. An aortic dissection developed in one patient with altered flow patterns and hemodynamic stresses in the thoracic aorta. These results suggest that flow and altered hemodynamics may play a role in the development of post-operative intramural hematomas and dissections.     

Detection of diminished response to cold pressor test in smokers: Assessment using phase-contrast cine magnetic resonance imaging of the coronary sinus

Purpose

The purposes of this study were to evaluate the reproducibility for measuring the cold pressor test (CPT)-induced myocardial blood flow (MBF) alteration using phase-contrast (PC) cine MRI, and to determine if this approach could detect altered MBF response to CPT in smokers.

Materials and methods

After obtaining informed consent, ten healthy male non-smokers (mean age: 28 ± 5 years) and ten age-matched male smokers (smoking duration ≥ 5 years, mean age: 28 ± 3 years) were examined in this institutional review board approved study. Breath-hold PC cine MR images of the coronary sinus were obtained with a 3 T MR imager with 32 channel coils at rest and during a CPT performed after immersing one foot in ice water. MBF was calculated as coronary sinus flow divided by the left ventricular (LV) mass which was given as a total LV myocardial volume measured on cine MRI multiplied by the specific gravity (1.05 g/mL).

Results

In non-smokers, MBF was 0.86 ± 0.25 mL/min/g at rest, with a significant increase to 1.20 ± 0.36 mL/min/g seen during CPT (percentage change of MBF (?MBF (%)); 39.2% ± 14.4%, p < 0.001). Inter-study reproducibility for ?MBF (%) measurements by different MR technologist was good, as indicated by the intraclass correlation coefficient of 0.93 and reproducibility coefficient of 10.5%. There was no significant difference between smokers and non-smokers for resting MBF (0.85 ± 0.32 mL/min/g, p = 0.91). However, ?MBF (%) in smokers was significantly reduced (-4.0 ± 32.2% vs. 39.2 ± 14.4%, p = 0.011).

Conclusion

PC cine MRI can be used to reproducibly quantify MBF response to CPT and to detect impaired flow response in smokers. This MR approach may be useful for monitoring the sequential change of coronary blood flow in various potentially pathologic conditions and for investigating its relationship with cardiovascular risk.     

Evaluation of MRI issues at 3-Tesla for a hospital identification (ID) wristband

Background and Purpose

A recent report suggested that a serious burn injury was due to the presence of the identification (ID) wristband. As such, in lieu of removing or padding hospital ID wristbands in all patients prior to magnetic resonance imaging (MRI), testing may be performed to characterize risks for ID wristbands. Therefore, the purpose of this investigation was to evaluate the magnetic field interactions, heating and artifacts at 3 T for a hospital ID wristband.

Materials and Methods

Standardized test methods were used to evaluate magnetic field interactions, MRI-related heating, and artifacts at 3 T for a hospital ID wristband.

Results

There were no magnetic field interactions. MRI-related heating evaluated at a relatively high, MR system-reported, whole body-averaged specific absorption rate (2.9 W/kg) did not increase above the background level. The artifacts related to the ink used for printing were “small” for one toner and “large” for the other in relation to the dimensions of the printing.

Conclusions

Based on the tests performed, this particular hospital ID wristband is considered MR safe and will not pose a hazard to a patient undergoing an MRI examination. Importantly, it is not necessary to remove this item for a patient referred for MRI.     

Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T

Purpose

The purpose of the study was to validate the diagnostic performance of high-resolution isovolumetric magnetic resonance arthrography (MRA) for intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist as compared to conventional MR imaging (MRI).

Materials and methods

Forty-eight patients with traumatic TFCC tears at arthroscopy were enrolled. All patients had underwent proton-density- and T2-weighted MRI before arthrography and three-dimensional T1 high-resolution isovolumetric examination (3D-THRIVE) MRA on a 3-T MR. We assessed the presence of scapholunate interosseous ligament (SLIL)/lunotriquetral interosseous ligament (LTIL) or TFCC tears using the arthroscopy as a gold standard.

Results

Arthroscopy revealed 37 TFCC central tears, 15 TFCC peripheral tears, 20 SLIL tears and 13 LTIL tears. Sensitivities of MRI and MRA were 70.3% and 94.6% for detection of TFCC central tears, 60.0% and 93.3% for detection of TFCC peripheral tears, 65.0% and 85.0% for SLIL tears, and 61.5% and 84.6% for LTIL tears. The specificity of the MRI was 100% for the detection of ligaments and TFCC tears. The specificities of the MRA for detection of TFCC central tears, TFCC peripheral tears, SLIL tears and LTIL tears were 100%, 97%, 96.4% and 100%, respectively.

Conclusion

Isovolumetric 3D-THRIVE wrist MRA provided better results for depiction of intrinsic ligament and TFCC tears than wrist MRI.     

Isotropic proton-density-weighted high-resolution MRI for volume measurement of reconstructed orbital fractures--a comparison with multislice CT

Objective

The cause of enophthalmos as a late complication after orbital reconstruction is poorly investigated. Multislice CT (MSCT) is usually employed for its assessment, in spite of limitations regarding soft tissue depiction/imaging, as well as the implication of radiation and production of artifacts. Magnetic resonance imaging (MRI) has been shown to be a valuable alternative. The aim of this study was to establish a bony and soft tissue orbital volume calculation method based on different high-resolution MRI sequences compared to MSCT.

Materials and Methods

Thirty-seven patients were included in this prospective study investigating the origin of enophthalmos present 3–4 months after complex orbital reconstruction. Morphological and dimensional changes of the orbit, eye globes, extraocular muscles and fat content were investigated 3–4 months after surgery. To assess the site and size of bony and soft tissue changes in the traumatized orbits, we used MSCT and MR images as well as corresponding 3-D reconstructions.

Results

All enophthalmic orbits revealed a significant bony volume increase compared to the contralateral side as well as a reduced sagittal eye projection. Mean orbital volume enlargements of 1.0 cm³ lead to 0.93 mm enophthalmos (P<.05). Hardly any fatty atrophy could be depicted by the different MRI techniques.

Conclusions

For soft tissue depiction of the orbit, MRI was superior to MSCT. Particularly, proton density weighting proved to be the best sequence for soft tissue volume segmentation, allowing determination of the cause and degree of posttraumatic enophthalmos in reconstructed orbits.     

RF-related heating assessment of extracranial neurosurgical implants at 7 T

Purpose

The purpose was to evaluate radiofrequency (RF)-related heating of commonly used extracranial neurosurgical implants in 7-T magnetic resonance imaging (MRI).

Materials and methods

Experiments were performed using a 7-T MR system equipped with a transmit/receive RF head coil. Four commonly used titanium neurosurgical implants were studied using a test procedure adapted from the American Society for Testing and Materials Standard F2182-11a. Implants (n = 4) were tested with an MRI turbo spin echo pulse sequence designed to achieve maximum RF exposure [specific absorption rate (SAR) level = 9.9 W/kg], which was further validated by performing calorimetry. Maximum temperature increases near each implant's surface were measured using fiberoptic temperature probes in a gelled-saline-filled phantom that mimicked the conductive properties of soft tissue. Measurement results were compared to literature data for patient safety.

Results

The highest achievable phantom averaged SAR was determined by calorimetry to be 2.0 ± 0.1 W/kg due to the highly conservative SAR estimation model used by this 7-T MR system. The maximum temperature increase at this SAR level was below 1.0 °C for all extracranial neurosurgical implants that underwent testing.

Conclusion

The findings indicated that RF-related heating under the conditions used in this investigation is not a significant safety concern for patients with the particular extracranial neurosurgical implants evaluated in this study.     

Focal nodular hyperplasia of the liver: diffusion and perfusion MRI characteristics

Purpose

To present diffusion and perfusion magnetic resonance imaging (MRI) characteristics of focal nodular hyperplasia (FNH) of the liver.

Materials and Methods

Thirty-five patients with 52 FNHs (21 were pathologically-confirmed) underwent MRI at 1.5-T device. MR diffusion [diffusion-weighted imaging (DWI)] was performed using a free-breathing single-shot, spin-echo, echo-planar sequence with b gradient factor value of 500 s/mm². MR perfusion [perfusion-weighted imaging (PWI)] consisted of a 3D free-breathing LAVA sequence repeated up to 5 minutes after injection of 7 mL Gd-BOPTA (MultiHance, Bracco, Italy) and 20 mL saline flush at a flow rate of 4 mL/s. Apparent diffusion coefficient (ADC) and time-signal intensity curve (TSIC) were obtained for both normal liver and each FNH by two reviewers in conference; maximum enhancement (ME) percentage, time to peak enhancement (TTP), and maximal slope (MS) were also calculated.

Results

On DWI mean ADC value was 1.624×10^− 3 mm²/s for normal liver and 1.629×10^− 3 mm²/s for FNH. ADC value for each FNH and the normal liver was not statistically different (P= .936). On PWI, TSIC-Type 1 (quick and marked enhancement and quick decay followed by slowly decaying) was observed in all 52 FNHs, and TSIC-Type 2 (fast enhancement followed by slowly decaying plateau) in all normal livers. The mean ME, TTP and MS values were significantly different for FNH and normal liver (P= .005).

Conclusion

FNHs of the liver showed typical diffusion and perfusion MRI characteristics in all cases. On the ADC map, we could get similar value between the FNHs and the background parenchyma. On the perfusion imaging, FNHs showed a different pattern distinguished from the background liver.     

Assessment of MRI issues for the Argus II retinal prosthesis

Objective

The objective was to evaluate magnetic resonance imaging (MRI) issues (magnetic field interactions, heating, artifacts and functional alterations) at 1.5 T and 3 T for the Argus II Retinal Prosthesis (Second Sight Medical Products, Sylmar, CA, USA).

Materials and Methods

Standardized protocols were used to assess magnetic field interactions (translational attraction and torque; 3 T, worst case), MRI-related heating (1.5 and 3 T), artifacts (3 T; worst case) and functional changes (1.5 and 3 T) associated with MRI.

Results

The magnetic field interactions were acceptable. MRI-related heating, which was studied at a relatively high, MR system-reported whole body averaged specific absorption rates, will not pose a hazard to the patient under the conditions used for testing. While artifacts were “moderate” in relation to the dimensions of the Argus II Retinal Prosthesis, optimization of MRI parameters can reduce the size of the artifacts. Exposures to MRI conditions at 1.5 and 3 T did not damage or alter the functional aspects of the Argus II Retinal Prosthesis.

Conclusions

In consideration of the test results, a patient with the Argus II Retinal Prosthesis may undergo MRI at 1.5 T or 3 T when specific guidelines and MRI conditions are followed, including those advised by the manufacturer.     

Effects of blood ΔR2* non-linearity on absolute perfusion quantification using DSC-MRI: Comparison with Xe-133 SPECT

Purpose

To evaluate whether a non-linear blood ΔR₂*-versus-concentration relationship improves quantitative cerebral blood flow (CBF) estimates obtained by dynamic susceptibility contrast (DSC) MRI in a comparison with Xe-133 SPECT CBF in healthy volunteers.

Material and Methods

Linear as well as non-linear relationships between ΔR₂* and contrast agent concentration in blood were applied to the arterial input function (AIF) and the venous output function (VOF) from DSC-MRI. To reduce partial volume effects in the AIF, the arterial time integral was rescaled using a corrected VOF scheme.

Results

Under the assumption of proportionality between the two modalities, the relationship CBF(MRI) = 0.58CBF(SPECT) (r = 0.64) was observed using the linear relationship and CBF(MRI) = 0.51CBF(SPECT) (r = 0.71) using the non-linear relationship.

Discussion

A smaller ratio of the VOF time integral to the AIF time integral and a somewhat better correlation between global DSC-MRI and Xe-133 SPECT CBF estimates were observed using the non-linear relationship. The results did not, however, confirm the superiority of one model over the other, potentially because realistic AIF signal data may well originate from a combination of blood and surrounding tissue.     

Management of branch-duct intraductal papillary mucinous neoplasms of the pancreas: observation with MR imaging

Purpose

To evaluate the clinical outcomes of conservative management by observation with MRI of patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs).

Materials and Methods

Twenty-three consecutive patients, who were followed up by MRI with magnetic resonance cholangiopancreatography (MRCP) over a period of more than 9 months after initial MRI examinations, were enrolled in this study. On MRI, number of lesions, the maximum diameter of BD-IPMNs, lesion location, the presence of associated dilatation of main pancreatic duct (MPD), the presence of enhancing mural nodules within the lesion and the presence of interval change were retrospectively reviewed on initial and follow-up MR images in consensus by two radiologists. All patients were evaluated to search for evidence of malignant progression of disease.

Results

The follow-up period ranged from 10 to 96 months (mean, 37 months). On initial MRI with MRCP, a total of 39 lesions were found in 23 patients. The maximum diameter of BD-IPMNs ranged between 6 and 32 mm, with a mean of 12 mm. Thirty-four lesions (87%) of 19 patients remained unchanged in the maximum diameter. Five lesions (13%) of four patients showed an increase in the maximum diameter. Enhancing mural nodules were not found in any individual, neither on the initial MRI study nor on the follow-up studies. There was no patient who had evidence of local aggressive growth of tumor or evidence of metastases to distant sites.

Conclusion

Our study suggests that branch-duct IPMNs without enhancing mural nodules are essentially benign and should be managed nonoperatively through observation by MRI.