Superior diagnostic strength of combined contrast enhanced MR-angiography and MR-imaging compared to intra-arterial DSA in liver transplantation candidates.

To evaluate the diagnostic value of combined contrast enhanced MRA (ce-MRA) and MRI compared to that of intra-arterial DSA (i.a.DSA) in liver transplantation, transjugular porto-systemic (TIPSS) and spleno-renal shunt candidates. 50 patients in the workup for liver transplantation underwent ce-MRA/MRI and i.a.DSA within a three days interval. Both examinations were assessed with respect to vessel anatomy and patency of the arterial, portal venous, porto-systemic collateral and systemic venous system. The results were compared with the intra-operative findings when available. Malignancy detection in ce-MRA/MRI and i.a.DSA were compared. There are no significant differences for the arterial part of the vascular supply to the liver that is important for transplantation. Although the differences for the portal system are not significant, the difference between the two techniques is of clinical importance because i.a.DSA failed to detect portal vein occlusion in 4 patients. Ce-MRA is significantly better for the detection of collaterals (p < 0.001) and the assessment of the inferior vena cava, the hepatic and the renal veins (p < 0.001). Although the detection of liver malignancy is poor in both techniques, ce-MRA/MRI is superior to i.a.DSA. This study shows that a one step diagnostic approach with a combination of ce-MRA and MRI is a valuable radiological tool with a superior diagnostic strength compared to i.a.DSA in the liver transplantation and shunt candidate. Therefore, ce-MRA/MRI should replace i.a.DSA in these patients groups.     

Comparison of contrast enhanced MR-angiography-MRI and digital subtraction angiography in the evaluation of pancreas and/or kidney transplantation patients: initial experience.

To evaluate whether combined contrast enhanced MRA and MRI (ce-MRA-MRI) has the potential to replace intra-arterial DSA (i.a.DSA) in patients with impaired graft function or suspected of vascular complications after pancreas and/or kidney transplantation. 7 patients after combined pancreas-kidney and 22 patients after kidney transplantation underwent ce-MRA-MRI and i.a.DSA within a 3 days interval. Qualitative and quantitative comparison of the arterial and venous supply, the parenchyma and urinary collecting system was made. Both ce-MRA and i.a.DSA showed good results in the detection of arterial stenoses. However, ce-MRA falsely suggested stenoses if vascular clips were used; on the other hand, i.a.DSA was less informative if the graft arteries were very tortuous. Ce-MRA was superior in depicting the venous anatomy (p < 0.001) and the parenchymal enhancement of the pancreatic grafts. For the assessment of the contrast excretion, the pyelocalyceal system and the ureter of the renal graft ce-MRA-MRI was superior (p < 0.001), for small caliber arteries in the renal grafts i.a.DSA was of greater value (p < 0.001). The combination of ce-MRA and MRI is reliable for evaluating the vascular anatomy and has several advantages over i.a.DSA after pancreas and/or kidney transplantation. It can replace i.a.DSA in patients with impaired graft function or suspected of vascular complications after pancreas and/or kidney transplantation.     

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.     

Usefulness of MRI for the pre-operative evaluation of the pulmonary arteries in Tetralogy of Fallot

Adequate pre-operative evaluation of patients with Tetralogy of Fallot (TF) includes cine-angiography to delineate the pulmonary vasculature and the coronary artery anatomy and to demonstrate the presence of multiple ventricular septal defects (VSDs). All other information is obtained from color-Doppler-echocardiography. Magnetic resonance imaging (MRI), using the spin-echo sequence and cine-angiography was employed on 18 patients with TF, four of whom had aorto-pulmonary shunts. Mean age at MRI was 12.9 m (SD 2.3 m) and 14.3 m (SD 2.8 m) at cine-angiography. To compare MRI and cine-angiography we measured the ascending aorta, the main, the left and right pulmonary arteries and each structure at three levels. Diagnostic agreement between the two imaging methods was found if, for each modality, one of the three measurements in one structure differed by more than 40% from the other two measured in case of a local stenosis, and the diameter of the main pulmonary artery was less than 60% of the aorta to diagnose hypoplasia of the main pulmonary artery. There was close agreement between cine-angiography and MRI. With regard to the intracardiac anatomy, MRI was superior to color-Doppler-echocardiography in the depiction of aortic override and of right ventricular hypertrophy. In three cases local stenoses in the pulmonary arteries were detected by MRI and cine-angiography. Hypoplasia of the main pulmonary artery was detected by MRI in six patients and by cine-angiography in five patients. Cine-angiography missed one case of hypoplasia. In the remaining 11 patients normal findings were found by MRI and cine-angiography. For the demonstration of shunts, gradient-recalled-echo MRI is expected to give better results than the spin-echo sequence which depicted two out of four shunts in this series. Cine-angiography can be substituted by MRI in delineating the pulmonary arteries. New developments in MRI indicate the feasibility of delineating the coronary arteries.     

Pulmonary resorption of inhaled gadobutrol in an animal model: usage to determine lung diffusion in MRI examinations

The aim of this study was to examine a pulmonary gadobutrol resorption after inhalation. An examination of 16 young swine, which were given different amounts of gadobutrol through inhalation, was performed. A measurement of the signal elevation in peripheral lung tissue as well as in the thoracic aorta was made using a T(1)-weighted FLASH-3D sequence in a 1.5 T magnetic resonance imaging (MRI) machine. Twenty minutes after gadobutrol application, a steep signal elevation in the aorta was reported, as well as a plateau phase after 45 min. The signal elevation in peripheral lung tissue after inhalation increased to a mean of 33.9%. The concurrent signal elevation of the abdominal aorta was 137.4%. The evaluation of an intravascular signal elevation after gadobutrol inhalation opens the possibility to evaluate and obtain lung diffusion with MRI.     

Pulse wave velocity with 4D flow MRI: Systematic differences and age-related regional vascular stiffness

Purpose

The objective of this study was to compare multiple methods for estimation of PWV from 4D flow MRI velocity data and to investigate if 4D flow MRI-based PWV estimation with piecewise linear regression modeling of travel-distance vs. travel time is sufficient to discern age-related regional differences in PWV.

Methods

4D flow MRI velocity data were acquired in 8 young and 8 older (age: 23 ± 2 vs. 58 ± 2 years old) normal volunteers. Travel-time and travel-distance were measured throughout the aorta and piecewise linear regression was used to measure global PWV in the descending aorta and regional PWV in three equally sized segments between the top of the aortic arch and the renal arteries. Six different methods for extracting travel-time were compared.

Results

Methods for estimation of travel-time that use information about the whole flow waveform systematically overestimate PWV when compared to methods restricted to the upslope-portion of the waveforms (p < 0.05). In terms of regional PWV, a significant interaction was found between age and location (p < 0.05). The age-related differences in regional PWV were greater in the proximal compared to distal descending aorta.

Conclusion

Care must be taken as different classes of methods for the estimation of travel-time produce different results. 4D flow MRI-based PWV estimation with piecewise linear regression modeling of travel-distance vs. travel time can discern age-related differences in regional PWV well in line with previously reported data.     

MRI postoperative monitoring in patients surgically treated for aortic dissection

In most cases, surgery of aortic dissections repairs only the ascending portion of the aorta, leaving a residual dissection in the arch and descending aorta. We studied 17 patients operated upon for type A aortic dissection. A total of 42 magnetic resonance imaging (MRI) examinations were performed, with two to five studies per patient (mean 2.47). The studies were done between 5 weeks and 47 months (mean 17.5 months) after surgery. The patients were evaluated by MRI using gated spin-echo and gradient-echo sequences on axial and oblique sagittal views, and in selected cases, coronal views. A high incidence of abnormalities was observed. Pericardial hematoma was observed in 11% of cases, aortic and branch involvement in 41%, abdominal aortic branch involvement in 47%, dilatation of native aorta in 58%, and extension of dissection in 10%. New complications were detected during follow-up in 53% of patients. MRI was helpful in the follow-up of patients operated upon for aortic dissections, owing to its noninvasiveness and multiplanarity. By means of this technique, it was possible to obtain information about the natural history of the disease, as well as information useful for subsequent treatment.     

基于优化后流动敏感黑血序列的豆纹动脉3 T磁共振成像

豆纹动脉是大脑内部的重要动脉,其阻塞往往会导致腔隙性脑梗死.现在在临床上主要利用数字减影血管造影(Digital Subtraction Angiography,DSA)技术实现豆纹动脉成像,然而DSA的有创性是其重要的限制因素.有研究表明,在高场磁共振系统(7 T)下,时间飞跃法(Time-Of-Flight,TOF)已经能够得到较好的豆纹动脉影像,但是在临床使用的1.5 T或3 T磁共振系统下,由于豆纹动脉的管腔直径非常小(大约为0.3~0.7 mm)、血流速度比较慢,对其成像仍然是个挑战.该文主要研究了在3 T磁共振系统下使用流动敏感黑血(Flow-Sensitive Black-Blood,FSBB)序列对豆纹动脉进行成像的方法,并对该成像序列中流动敏感梯度的设计进行了优化,使其在扫描时间和图像分辨率、对比度、信噪比等方面都能够基本满足临床使用的要求.     

A general dual-bolus approach for quantitative DCE-MRI

Purpose

To present a dual-bolus technique for quantitative dynamic contrast-enhanced MRI (DCE-MRI) and show that it can give an arterial input function (AIF) measurement equivalent to that from a single-bolus protocol.

Methods

Five rabbits were imaged using a dual-bolus technique applicable for high-resolution DCE-MRI, incorporating a time resolved imaging of contrast kinetics (TRICKS) sequence for rapid temporal sampling. AIFs were measured from both the low-dose prebolus and the high-dose main bolus in the abdominal aorta. In one animal, TRICKS and fast spoiled gradient echo (FSPGR) acquisitions were compared.

Results

The scaled prebolus AIF was shown to match the main bolus AIF, with 95% confidence intervals overlapping for fits of gamma-variate functions to the first pass and linear fits to the washout phase, with the exception of one case. The AIFs measured using TRICKS and FSPGR were shown to be equivalent in one animal.

Conclusion

The proposed technique can capture even the rapid circulation kinetics in the rabbit aorta, and the scaled prebolus AIF is equivalent to the AIF from a high-dose injection. This allows separate measurements of the AIF and tissue uptake curves, meaning that each curve can then be acquired using a protocol tailored to its specific requirements.     

Spin echo MRI in the evaluation of hearts with a double outlet right ventricle: usefulness and limitations

The surgical approach to a double outlet right ventricle (DORV) is dependent on the spatial relationship of the semilunar valves, outflow tracts and ventricular septal defect (VSD). The purpose of the study was to assess the value of MRI for the evaluation of cardiovascular anatomy in patients before and after surgery for DORV. Spin echo MRI was performed in 12 patients with DORV (eight preoperative and four postoperative patients). Thin-section MRI was performed in three orthogonal planes and selected angulated views were obtained. Conventional imaging by color Doppler echocardiography and cine-angiocardiography and surgical findings, when present, served as the reference standards. The results found that the spatial relationship between semilunar valves and VSD was accurately assessed by MRI in eight out of eight preoperative patients. In the four postoperative cases MRI depicted the morphology of both outflow tracts and provided adequate information on their patency. Of the eight preoperative patients, five have undergone corrective surgery and the MRI findings were confirmed. MRI provided additional information to conventional imaging preoperatively in three cases in which the VSD opened into the outlet portion of the DORV, without there being a direct relation to a semilunar valve. In two preoperative cases in which the VSD was directly committed to the aorta, conventional imaging was conclusive. MRI was unable to depict aberrant chordae tendineae in four out of four cases. We conclude that MRI provides accurate additional anatomic information in patients with DORV, which is helpful in presurgical planning as well as during follow-up. Spin echo MRI does not visualize aberrant chordae tendineae.     

MR digital subtraction angiography with three-dimensional data acquisition in the diagnosis of brain tumors: preliminary experience

MR digital subtraction angiography (DSA) visualizes intracranial vasculature using a rapid T1-weighted sequence and a bolus injection of gadolinium. Although two-dimensional sequences are most frequently used, we applied a three-dimensional technique in combination with a fast method of k-space filling to improve both the temporal and spatial resolutions. In this preliminary study, we assessed the feasibility of using this technique for the diagnosis of brain tumors in 21 patients by reviewing the obtained images and, in 10 patients, comparing the images with conventional angiograms. MR DSA visualized a tumor stain in 11 patients, a tumor mass effect in 9, and tumor-related vessels in 5. In 9 of the 10 patients for whom conventional angiograms were available, the two kinds of angiograms corresponded well. Three-dimensional MR DSA using our technique is a useful adjunct to conventional MR imaging for the visualization of tumor hemodynamics and, in some cases, tumor-related vessels and mass effects.     

Magnetic resonance imaging of intraductal papilloma of the breast

To describe the appearance of isolated intraductal papilloma on contrast-enhanced water-specific, high spatial-resolution and rapid dynamic breast MRI, a retrospective review of unilateral breast images of 15 pathologically proven papilloma was performed. MRI revealed three patterns: Four papillomas were small, smooth, enhancing masses at the posterior end of an enlarged duct, corresponding to the "small lumenal mass" appearance of papilloma known from galactography. MRI detected two of these "small lumenal mass" papillomas in patients with abnormal nipple discharge even when galactography was unsuccessful. Seven papillomas were irregular enhancing masses detected in patients without nipple discharge. None of these papillomas had specifically benign findings. All seven demonstrated rapid enhancement and three showed rim enhancement or spiculation. These "tumor-like" papillomas mimicked invasive breast cancer on MRI. Four papillomas were occult on MRI, not revealed by either contrast-enhanced MRI or fat-suppressed T(2)-weighted MRI. Intraductal papillomas present with a variable appearance on MRI ranging from occult to "small lumenal mass" papillomas to irregular rapidly enhancing lesions that cannot be distinguished from invasive cancers.     

MRI dynamic range and its compatibility with signal transmission media

As the number of MRI phased array coil elements grows, interactions among cables connecting them to the system receiver become increasingly problematic. Fiber optic or wireless links would reduce electromagnetic interference, but their dynamic range (DR) is generally less than that of coaxial cables. Raw MRI signals, however, have a large DR because of the high signal amplitude near the center of k-space. Here, we study DR in MRI in order to determine the compatibility of MRI multicoil imaging with non-coaxial cable signal transmission. Since raw signal data are routinely discarded, we have developed an improved method for estimating the DR of MRI signals from conventional magnitude images. Our results indicate that the DR of typical surface coil signals at 3 T for human subjects is less than 88 dB, even for three-dimensional acquisition protocols. Cardiac and spine coil arrays had a maximum DR of less than 75 dB and head coil arrays less than 88 dB. The DR derived from magnitude images is in good agreement with that measured from raw data. The results suggest that current analog fiber optic links, with a spurious-free DR of 60–70 dB at 500 kHz bandwidth, are not by themselves adequate for transmitting MRI data from volume or array coils with DR 90 dB. However, combining analog links with signal compression might make non-coaxial cable signal transmission viable.     

Dynamic imaging with MRI contrast agents: quantitative considerations

Time-resolved MRI has had enormous impact in cognitive science and may become a significant tool in basic biological research with the application of new molecular imaging agents. In this paper, we examine the temporal characteristics of MRI contrast agents that could be used in dynamic studies. We consider "smart" T1 contrast agents, T2 agents based on reversible aggregation of superparamagnetic nanoparticles and sensors that produce changes in saturation transfer effects (chemical exchange saturation transfer, CEST). We discuss response properties of several agents with reference to available experimental data, and we develop a new theoretical model that predicts the response rates and relaxivity changes of aggregation-based sensors. We also perform calculations to define the extent to which constraints on temporal resolution are imposed by the imaging methods themselves. Our analysis confirms that some small T1 agents may be compatible with MRI temporal resolution on the order of 100 ms. Nanoparticle aggregation T2 sensors are applicable at much lower concentrations, but are likely to respond on a single second or slower timescale. CEST agents work at high concentrations and temporal resolutions of 1-10 s, limited by a requirement for long presaturation periods in the MRI pulse sequence.     

MRI protocol optimization for quantitative DCE-MRI of the spine

PurposeIn this study we systematically investigated different Dynamic Contrast Enhancement (DCE)-MRI protocols in the spine, with the goal of finding an optimal protocol that provides data suitable for quantitative pharmacokinetic modelling (PKM).Materials and methodsIn 13 patients referred for MRI of the spine, DCE-MRI of the spine was performed with 2D and 3D MRI protocols on a 3T Philips Ingenuity MR system. A standard bolus of contrast agent (Dotarem - 0.2 ml/kg body weight) was injected intravenously at a speed of 3 ml/s. Different techniques for acceleration and motion compensation were tested: parallel imaging, partial-Fourier imaging and flow compensation. The quality of the DCE MRI images was scored on the basis of SNR, motion artefacts due to flow and respiration, signal enhancement, quality of the T₁ map and of the arterial input function, and quality of pharmacokinetic model fitting to the extended Tofts model.ResultsSagittal 3D sequences are to be preferred for PKM of the spine. Acceleration techniques were unsuccessful due to increased flow or motion artefacts. Motion compensating gradients failed to improve the DCE scans due to the longer echo time and the T₂* decay which becomes more dominant and leads to signal loss, especially in the aorta. The quality scoring revealed that the best method was a conventional 3D gradient–echo acquisition without any acceleration or motion compensation technique. The priority in the choice of sequence parameters should be given to reducing echo time and keeping the dynamic temporal resolution below 5 s. Increasing the number of acquisition, when possible, helps towards reducing flow artefacts. In our setting we achieved this with a sagittal 3D slab with 5 slices with a thickness of 4.5 mm and two acquisitions.ConclusionThe proposed DCE protocol, encompassing the spine and the descending aorta, produces a realistic arterial input function and dynamic data suitable for PKM.     

Molecular imaging contrast media for visualization of liver function

Background and Aims

Diagnosis of liver disease has improved because of progress in imaging technology. Among the imaging methods, magnetic resonance imaging (MRI) has the advantage of a lack of radiation exposure, but the basis of the method (imaging of hydrogen atoms in water molecules) makes it hard to detect changes in tissue or the location of the diseased tissue in the liver. The aims of this study are to develop new contrast media for visualization of functional changes in the liver and to check the effectiveness of the media.

Methods

We developed a new molecular imaging contrast media that targets the asialoglycoprotein receptor (ASGP-R), a membrane protein that is specific to hepatocytes. We first checked the contrast media diameter and the cytotoxicity. Next, we examined the interaction of the media with ASGP-R through observation of fluorescein isothiocyanate (FITC)-labeled molecular imaging contrast media bound to normal hepatocellular ASGP-R using confocal laser scanning microscopy. Finally, we used MRI to observe hepatocyte interactions with the molecular imaging contrast media.

Results

The contrast media forms a nanoparticle of about 30 nm diameter in aqueous solution and the cytotoxicity is low. In vitro, the media has high specificity for ASGP-R in normal rat hepatocyte RLN-8 cells and this interaction was blocked by lactose (which has a similar molecular structure to that of galactose) and by an anti-ASGP-R antibody. The contrast media markedly enhanced T1-weighted images in MRI of normal rat hepatocytes compared to the signal strength for rat liver cancer cells.

Conclusions

We have shown that our new contrast media for molecular imaging of hepatocytes by MRI is effective in vitro.     

Quantitation of atherosclerosis by magnetic resonance imaging and 3-D morphology operators

The objective was to ascertain whether MRI and image processing can be used to quantify atherosclerosis by measuring wall thickness in rabbit aorta. The abdominal aortas of 2 healthy and 5 atherosclerotic rabbits were examined with a gradient-echo inflow angiography sequence (2DI) and a proton density weighted turbo-spin-echo sequence (PDW). Using thresholding by four observers and 3D morphology operators, segmentation of the artery and vein lumina was performed from the 2DI sequence, and of surrounding fat and muscle from the PDW sequence. Remaining voxels adjacent to the aortic lumen were classified as vessel wall. By measuring the vessel wall volume and the lumen volume, the wall percentage was calculated. The values were significantly higher for the diseased animals than for unaffected individuals (p < 0.01). It is concluded that aortic wall thickening in atherosclerotic rabbits can be measured quantitatively by using MRI combined with 3D morphology image processing operators.     

Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration

Objectives

Endometriosis is the ectopic localization of endometrial glands. Symptoms include a wide variety of chronic pelvic pain. Ovarian endometriosis represents the most frequent site of implantation followed by the Douglas pouch which is undepicted unless peritoneal fluid is present. Pelvic exams may be reported as normal in 40% of evaluations, although multiple nodularities are located in this region. Nowadays, laparoscopy represents the standard technique for endometriosis evaluation. However, magnetic resonance imaging (MRI) remains the best noninvasive technique for the evaluation of pelvic lesions. According to the importance of a precise preoperative diagnosis of deep infiltrative endometriosis involving the Douglas pouch, we evaluated feasibility of a 3-T system in the evaluation of this particular region.

Methods

We enrolled 19 women coming with either ultrasound or anamnestic suspicion of endometriosis. Pelvic MRI examination was performed on the 3-T system. We applied a standard exam protocol including pulse sequences [single-shot fast spin echo (FSE)] and high-resolution T2W and T1W FSE sequences with and without FS.

Results

MRI diagnosed posterior cul-de-sac obliteration in 15/19 patients. MRI findings were compared with laparoscopy, thus obtaining the following statistical values: mean sensitivity, specificity, positive predictive value and negative predictive value, respectively, of 93%, 75%, 93% and 75%. Moreover, we calculated an interobserver agreement k value of 0.72 with a substantial degree of agreement between two radiologists of a sensitivity value of 93% and specificity value of 75%.

Conclusions

Precise preoperative mapping of posterior cul-de-sac region is essential for a preoperative planning. In our work, the 3-T MRI was shown to be excellent in the evaluation of posterior cul-de-sac obliteration associated to an optimal evaluation of the uterosacral ligaments due to the higher contrast spatial resolution.     

MR imaging of the ischiopubic synchondrosis

The ischiopubic synchondrosis (IPS) is a temporary joint, occurring in childhood prior to fusion of the ischial and pubic bones. On conventional radiographs this tumor-like appearance is a well known normal anatomic variant, however, there are no reports in the literature of the appearance of IPS on MRI. Therefore the purpose of this study was to evaluate typical magnetic resonance features of the IPS. All pelvic MRIs from 1/1992 to 4/1998 of children ranging in age from 4 to 16 years, who were scanned for reasons other than bone disorders, were retrospectively investigated. Twenty-eight children were included and the morphologic appearance of IPS on MRI was evaluated. Seventeen (61%) of these 28 children had the following findings of IPS on MRI. Listed in order of frequency we found signal alteration of the ischiopubic fusion zone [hyperintense on T(2) with fat-saturation (89%) or STIR (74%), hypointense on T(1) (71%)], fibrous "bridging" (68%) [hypointense band on all sequences in perpendicular orientation to the axis of the inferior pubic ramus], fusiform swelling (68%), signal alteration of the adjacent soft tissue (57%) and irregular margins (56%). In 10 children contrast enhanced scans were available for evaluation, showing contrast enhancement of the bone marrow in 83.3% and of the adjacent soft tissue in 66.7%. Fusiform swelling of the ischiopubic fusion zone, signal alteration and contrast enhancement of both the bone marrow and the adjacent soft-tissue are characteristic features of the IPS on MRI, which may be due to mechanical stress at this temporary joint. These features are nonspecific and may resemble tumor, infection or trauma. Fibrous "bridging" was the only finding on MRI, which has not been described for any other entity and thus, it seems to be a characteristic MRI-feature.