Investigation of uterine peristalsis diurnal variation

BACKGROUND: In women of reproductive age, wavelike movements of the subendometrial myometrium, which is called uterine peristalsis, is considered to be related with fertility and menstrual problems. This is because the direction and frequency of peristalsis is known to be different among menstrual cycle phases. However, nothing is known as regarding diurnal variations. This study was designed to evaluate for the presence of a diurnal variation in uterine peristalsis. MATERIALS AND METHODS: MR studies were performed on 12 volunteers of reproductive age using a 1.5-T magnet, four times per day (at 0800, 1300, 1800 and 2300 h) during three (periovulatory, luteal and menstrual) phases of one menstrual cycle. Sixty images were obtained by half-Fourier acquisition single-shot turbo spin echo every 2 s and displayed on cine mode. Semiautomated software was utilized to discern the presence of peristaltic waves, as well as peristaltic frequency and direction. The presence of sustained contractions was visually determined. RESULTS: There was no statistically significant difference during the daytime for frequency and direction of uterine peristalsis for all menstrual cycle phases. Nonetheless, peristaltic frequency and direction fluctuated during each cycle. Statistically significant peristaltic suppression was observed in association with sustained contractions during the periovulatory phase. CONCLUSIONS: A diurnal variation was not observed for uterine peristalsis. Sporadic changes in peristaltic frequency were observed and appear to be closely related to sustained uterine contractions.     

Perfusion of the uterine junctional zone in nulliparous and primiparous women assessed by DCE-MRI,as a function of menstrual cycle and hormonal contraception

PurposeTo evaluate the perfusion parameters of inner and outer myometrium in healthy nulliparous and primiparous women who are and who are not currently using hormonal contraceptives by means of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Material and methodsWe performed pelvic 1.5 T DCE-MRI on 98 women: 18 nulliparous non-users, 30 nulliparous users, 12 primiparous non-users and 38 primiparous users of hormonal contraception (mean age respectively 26.4, 25.8, 30.23 and 28.18 years). The nulliparous non-users underwent DCE-MRI investigations during their follicular, ovulatory and luteal phase. Perfusion parameters (iAUC/volume, Ktrans, Kep and Ve) were assessed in the anterior and posterior junctional zone (JZ), outer myometrium and cervix.ResultsIn nulliparous non-users, the mean Ktrans and iAUC/volume showed a decrease from follicular to luteal phase (0.82 vs 0.55 min^− 1 for Ktrans, p = 0/027 and 1.28 vs 0.68 for iAUC/volume, p < 0.001). The anterior JZ demonstrated lower Ktrans (p = 0.050) and higher Kep (p = 0.012), in nulliparous non-users, lower Ktrans in nulliparous users (p < 0.001) and lower Ve in primiparous users (p = 0.012) than the anterior outer myometrium. Ktrans at the anterior and posterior JZ wall in nulliparous users was lower than in non-users (p = 0.001 and p = 0.013) and Ve at the anterior JZ wall in primiparous users was lower than in non-users (p = 0.044).ConclusionThis study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.     

Inter-rater and intra-rater reliability of subchondral bone and cartilage thickness measurement from MRI

MRI is often used to visualize and quantify the articular cartilage layer of load bearing joints affected by degenerative diseases, such as osteoarthritis (OA). Although the role played by the subchondral bone in the etiology and/or progression of OA may be important, the ability to visualize and quantify subchondral bone with MRI has received little attention. In this report we examined the inter-rater and intra-rater reliability of subchondral bone and cartilage thickness measurements from MR images of cadaver femoral head specimens. A 3D-SPGR pulse sequence tuned to eliminate chemical shift artifact through phase cancellation was used to image the specimens. Three raters manually segmented four specimens on two different occasions. Subchondral bone and cartilage thickness measurements were calculated from the segmented images. Inter-rater and intra-rater reliabilities were very high (>.98) for both cartilage and subchondral bone thickness measurements. We conclude that subchondral bone thickness can be measured as reliably as cartilage thickness from MR images.     

Mapping of left ventricle wall thickness in mice using 11.7-T magnetic resonance imaging

BackgroundThe left ventricle (LV) wall thickness is an important and routinely measured cardiologic parameter. Here we introduce three-dimensional (3D) mapping of LV wall thickness and function using a self-gated magnetic resonance (MR) sequence for ultra-high-field 11.7-T MR cine imaging of mouse hearts.Methods and resultsSix male C57BL/6-j mice were subjected to 11.7-T MR imaging (MRI). Three standard views—short axis, long axis four-chamber, and long axis two-chamber—and eight consecutive short axis scans from the apex to base were performed for each mouse. The resulting 11 self-gated cine images were used for fast low-angle shot analysis with a navigator echo over an observation period of approximately 35 min. The right ventricle (RV) and LV were identified in the short axis and four-chamber views. On 3D color-coded maps, the interventricular septum wall (diastole: 0.94 ± 0.05 mm, systole: 1.20 ± 0.09 mm) and LV free wall (diastole: 1.07 ± 0.15 mm, systole: 1.79 ± 0.11 mm) thicknesses were measured.ConclusionThis 3D wall thickness mapping technique can be used to observe regional wall thickness at the end-diastole and end-systole. Self-gated cine imaging based on ultra-high-field MRI can be used to accurately and easily measure cardiac function and wall thickness in normal mouse hearts. As in the preclinical study, this versatile and simple method will be clinically useful for the high-field-MRI evaluation of cardiac function and wall thickness.     

Initial attempts at directly detecting alpha wave activity in the brain using MRI

The “direct detection” of neuronal activity by MRI could offer improved spatial and temporal resolution compared to the blood oxygenation level-dependent (BOLD) effect. Here we describe initial attempts to use MRI to detect directly the neuronal currents resulting from spontaneous alpha wave activity, which have previously been shown to generate the largest extracranial magnetic fields. Experiments were successfully carried out on four subjects at 3 T. A single slice was imaged at a rate of 25 images per second under two conditions. The first (in darkness with eyes-closed) was chosen to promote alpha wave activity, while the second (eyes-open viewing a visual stimulus) was chosen to suppress it. The fluctuations of the phase and magnitude of the resulting MR image data were frequency analysed, and tested for the signature of both alpha wave activity and neuronal activity evoked by the visual stimulus.

Regions were found that consistently showed elevated power in fluctuations of the phase of the MR signal, in the frequency range of alpha waves, during the eyes-closed condition. It was conservatively assumed that if oscillations occurred at the same frequency in the magnitude signal from the same region or at the same frequency in the phase or magnitude signal from other regions overlying large vessels or cerebrospinal fluid (CSF), then the phase changes were not due to neuronal activity related to alpha waves. Using these criteria the data obtained were consistent with direct detection of alpha wave activity in three of the four volunteers. No significant MR signal fluctuations due to evoked activity were identified.     

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.     

Motion correction based reconstruction method for compressively sampled cardiac MR imaging

Respiratory motion during Magnetic Resonance (MR) acquisition causes strong blurring artifacts in the reconstructed images. These artifacts become more pronounced when used with the fast imaging reconstruction techniques like compressed sensing (CS). Recently, an MR reconstruction technique has been done with the help of compressed sensing (CS), to provide good quality sparse images from the highly under-sampled k-space data. In order to maximize the benefits of CS, it is obvious to use CS with the motion corrected samples. In this paper, we propose a novel CS based motion corrected image reconstruction technique. First, k-space data have been assigned to different respiratory state with the help of frequency domain phase correlation method. Then, multiple sparsity constraints has been used to provide good quality reconstructed cardiac cine images with the highly under-sampled k-space data. The proposed method exploits the multiple sparsity constraints, in combination with demon based registration technique and a novel reconstruction technique to provide the final motion free images. The proposed method is very simple to implement in clinical settings as compared to existing motion corrected methods. The performance of the proposed method is examined using simulated data and clinical data. Results show that this method performs better than the reconstruction of CS based method of cardiac cine images. Different acceleration rates have been used to show the performance of the proposed method.     

Vessel boundary extraction based on a global and local deformable physical model with variable stiffness

Reliable and efficient vessel cross-sectional boundary extraction is very important for many medical magnetic resonance (MR) image studies. General purpose edge detection algorithms often fail for medical MR images processing due to fuzzy boundaries, inconsistent image contrast, missing edge features, and the complicated background of MR images. In this regard, we present a vessel cross-sectional boundary extraction algorithm based on a global and local deformable model with variable stiffness. With the global model, the algorithm can handle relatively large vessel position shifts and size changes. The local deformation with variable stiffness parameters enable the model to stay right on edge points at the location where edge features are strong and at the same time, fit a smooth contour at the location where edge features are missing. Directional gradient information is used to help the model to pick correct edge segments. The algorithm was used to process MR cine phase-contrast images of the aorta from 20 volunteers (over 500 images) with excellent results.     

Selective F MR imaging of 5-fluorouracil and α-fluoro-β-alanine

A ¹⁹F MR chemical shift imaging (CSI) technique is presented which enables selective imaging of the antineoplastic drug 5-fluorouracil (5-FU) and its major catabolite α-fluoro-β-alanine (FBAL). The CSI sequence employs a chemical shift selective (CHESS) saturation pulse to suppress either the 5-FU or the FBAL resonance before the other component of the two-line ¹⁹F MR spectrum is measured. Because the transmitter frequency can always be set to the Larmor frequency of the ¹⁹F resonance to be imaged, this approach yields 5-FU and FBAL MR images free of chemical shift artifacts in read-out and slice-selection direction. In phantom experiments, selective 5-FU and FBAL images with a spatial resolution of 15 × 15 × 20 mm³ (4.5 ml) were obtained in 30 min from a model solution, whose drug and catabolite concentrations were similar to those estimated in the liver of tumor patients undergoing IV chemotherapy with 5-FU. The drug-specific MR imaging technique developed is, therefore, well-suited for the direct and noninvasive monitoring of the up-take and trapping of 5-FU in liver tumors in vivo.     

Initial in vivo rodent sodium and proton MR imaging at 21.1 T

The first in vivo sodium and proton magnetic resonance (MR) images and localized spectra of rodents were attained using the wide bore (105 mm) high resolution 21.1-T magnet, built and operated at the National High Magnetic Field Laboratory (Tallahassee, FL, USA). Head images of normal mice (C57BL/6J) and Fisher rats (∼250 g) were acquired with custom designed radiofrequency probes at frequencies of 237/900 MHz for sodium and proton, respectively. Sodium MR imaging resolutions of ∼0.125 μl for mouse and rat heads were achieved by using a 3D back-projection pulse sequence. A gain in SNR of ∼3 for sodium and ∼2 times for proton were found relative to corresponding MR images acquired at 9.4 T. 3D Fast Low Angle Shot (FLASH) proton mouse images (50×50×50 μm³) were acquired in 90 min and corresponding rat images (100×100×100 μm³) within a total time of 120 min. Both in vivo large rodent MR imaging and localized spectroscopy at the extremely high field of 21.1 T are feasible and demonstrate improved resolution and sensitivity valuable for structural and functional brain analysis.     

Measuring tongue motion from tagged cine-MRI using harmonic phase (HARP) processing

A cine series of tagged magnetic resonance (MR) images of the tongue is used to measure tongue motion and its internal deformation during speech. Tagged images are collected in three slice orientations (sagittal, coronal, and axial) during repetitions of the utterance "disouk" (/disuk/). A new technique called harmonic phase MRI (HARP-MRI) is used to process the tagged MR images to measure the internal deformation of the tongue. The measurements include displacement and velocity of tissue points, principal strains, and strain in the line-of-action of specific muscles. These measurements are not restricted to tag intersections, but can be calculated at every pixel in the image. The different motion measurements complement each other in understanding the tongue kinematics and in hypothesizing the internal muscle activity of the tongue.     

Magnetic resonance imaging of the uterus in vivo and in vitro at an ultra low magnetic field (0.02 T): Assessment of its normal structure and of leiomyomas

The purpose of this investigation was to analyze the normal anatomy and leiomyomas of the uterus with an ultra low field (0.02 T) magnetic resonance imaging (MRI) device. MR imaging was performed on 18 uteri, 11 of which were imaged both preoperatively (in vivo) and as an operative specimen (in vitro), 6 only as an operative specimen, and 1 only preoperatively. All uteri were examined histologically after imaging. The junctional zone was much better delineated in vivo than in vitro, indicating that its appearance on MR is partly due to blood flow. No structures contributing to its visibility in vitro could be demonstrated histologically. Twenty leiomyomas (size range 7–79 mm) in 12 uteri were found with MRI. They were slightly better discerned in vivo than in vitro. The leiomyomas, having no degenerative changes, had a signal intensity which was the same or lower than that of the myometrium. On images obtained in vitro the signal intensity of these leiomyomas relative to that of myometrium correlated directly with their muscular content (R = 0.74, p = .002). The authors conclude that the junctional zone is a sum of physiological and structural factors, the latter being responsible for its in vitro delineation. MR imaging of the uterus in vitro did not give more information than MR imaging in vivo. All leiomyomas larger than 10 mm could be detected, indicating that MR imaging at 0.02 T is an accurate method for the imaging of the uterine leiomyomas.     

Abnormal uterine cavity: differential diagnosis with MR imaging

The objective of the study was to assess the usefulness of magnetic resonance (MR) imaging in distinguishing malignant from benign conditions in patients with an abnormal uterine cavity. Fifty-four patients that were suspected of having abnormal uterine cavities were retrospectively evaluated by using MR imaging. The diagnosis of an abnormal uterine cavity included a thickened endometrium, and/or a endometrial mass, and/or a submucosal mass. Threshold values to classify the uterine cavity as abnormal on sagittal T₂-weighted images were >10 mm for premenopausal women and >5 mm for postmenopausal women. Malignancy was diagnosed when lesions invaded the myometrial/junctional zone, and/or lesion enhancement was lower than that of the adjacent myometrium. The results found that histology confirmed 18 malignant and 37 benign lesions. Twelve of 15 endometrial carcinomas and 3 malignant mixed mesodermal tumors (MMMT) were correctly characterized as malignant on enhanced T₁-weighted images; whereas 6 of 15 endometrial carcinomas and 3 MMMT were correctly characterized on T₂-weighted images. Thirty-four of 37 benign cases were correctly characterized as not malignant on enhanced T₁-weighted images. One of 14 submucosal leiomyomas, one endometrial stromal metaplasia, and one of ten pathologically normal endometria were misdiagnosed on enhanced T₁-weighted images but were correctly diagnosed on T₂-weighted images. The overall sensitivity, specificity, and accuracy for distinguishing malignant from benign central uterine masses were 83%, 92%, and 89% for enhanced T₁-weighted image, and 50%, 97%, and 82% for T₂-weighted image, respectively. We came to the conclusion that in diagnosing patients with abnormal uterine cavity, MR imaging may help differentiate malignant from benign disorders.     

Sentence recognition in noise promoting or suppressing masking release by normal-hearing and cochlear-implant listeners

Normal-hearing (NH) listeners maintain robust speech understanding in modulated noise by "glimpsing" portions of speech from a partially masked waveform--a phenomenon known as masking release (MR). Cochlear implant (CI) users, however, generally lack such resiliency. In previous studies, temporal masking of speech by noise occurred randomly, obscuring to what degree MR is attributable to the temporal overlap of speech and masker. In the present study, masker conditions were constructed to either promote (+MR) or suppress (-MR) masking release by controlling the degree of temporal overlap. Sentence recognition was measured in 14 CI subjects and 22 young-adult NH subjects. Normal-hearing subjects showed large amounts of masking release in the +MR condition and a marked difference between +MR and -MR conditions. In contrast, CI subjects demonstrated less effect of MR overall, and some displayed modulation interference as reflected by poorer performance in modulated maskers. These results suggest that the poor performance of typical CI users in noise might be accounted for by factors that extend beyond peripheral masking, such as reduced segmental boundaries between syllables or words. Encouragingly, the best CI users tested here could take advantage of masker fluctuations to better segregate the speech from the background.     

MRI of acute cholecystitis: Comparison with the normal gallbladder and other entities

Our purpose was to prospectively compare MRI findings with histopathologic findings in the evaluation of suspected acute cholecystitis. Fourteen patients with clinically suspected acute cholecystitis were entered into the study. MR sequences included T₁-weighted fat-suppression and breath-hold spoiled gradient echo (SGE) before and after intravenous gadolinium chelate administration. Percent contrast enhancement (%CE) of the gallbladder wall and gallbladder wall thickness (WT) were measured and liver enhancement patterns determined prospectively on MR images. Correlation was obtained with pathological findings at cholecytectomy in all patients. In a second phase of the study MR images on 10 additional subjects who underwent MR examination for reasons other than hepatobiliary disease were analyzed to determine normal values for %CE and gallbladder wall thickness. Mean %CE was 124.0% in patients with acute cholecystitis (10 patients), 58.0% in patients with chronic cholecystitis (2 patients), and 73.0% in patients with gallbladder malignancy (2 patients). Mean gallbladder WT was 6.1 mm in acute cholecystitis, 4.5 mm in chronic cholecystitis, and 6.0 mm in malignant disease. There was a significant difference in %CE between acute and chronic cholecystitis (p = 0.03); no other significant differences in %CE or WT were observed among the patients with gallbladder disease. Patients without biliary disease had %CE of 37.3% and WT of 2.9 mm, which were both significantly less (p < 0.001) than in patients with acute cholecystitis. Transient enhancement of pericholecystic hepatic parenchyma on immediate postgadolinium SGE images was seen in 7 of 10 patients with acute cholecystitis, and not observed in other patients. Patients with acute cholecystitis had increased %CE and WT on MR images that were significantly greater than normal and %CE that was significantly greater than in patients with chronic cholecystitis. Transient increased pericholecystic hepatic enhancement was observed in 70% of acute cholecystitis patients and in no other patient groups.     

Whistler mode based explanation for the fast reconnection rate measured in the mit versatile toroidal facility

Despite the widely discussed role of whistler waves in mediating magnetic reconnection (MR), the direct connection between such waves and the MR has not been demonstrated by comparing the characteristic temporal and spatial features of the waves and the MR process. Using the whistler wave dispersion relation, we theoretically predict the experimentally measured rise time (τ(rise)) of a few microseconds for the fast rising MR rate in the Versatile Toroidal Facility at MIT. The rise time is closely given by the inverse of the frequency bandwidth of the whistler waves generated in the evolving current sheet. The wave frequencies lie much above the ion cyclotron frequency, but they are limited to less than 0.1% of the electron cyclotron frequency in the argon plasma. The maximum normalized MR rate R=0.35 measured experimentally is precisely predicted by the angular dispersion of the whistler waves.     

Breathhold cine MRI of left ventricular function in patients with obstructive sleep apnea: work-in-progress

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that can cause left ventricular (LV) dysfunction. In patients with OSA, the LV dysfunction is usually evaluated by echocardiography. The purpose of this study was to evaluate whether the use of breathhold cine MRI for the study of LV dysfunction would be feasible and well tolerated by patients with OSA. Six volunteers and five patients underwent a breathhold cine MRI study of the LV using a 1.5 Tesla MR imager. Cine MRI was performed using a breathhold k-space segmented TurboFLASH technique during end-expiration. Systolic thickening of the LV septal wall was 49% +/- 16% in normals vs. 25% +/- 10.5% in patients (p < 0.05). Systolic thickening of the LV free wall was 42% +/- 12% in normals vs. 22% +/- 9% in patients (p < 0.05). There was a significant difference in end-diastolic wall thickness between the two groups. All patients tolerated the procedure well. The total duration of each study was relatively short (less than 11 min). Breathhold MRI techniques can be used to study LV dysfunction in patients with respiratory disability such as OSA.     

Determination of normal regional left ventricular function from cine-MR images using a semi-automated edge detection method

A semi-automated edge detection method for the delineation of the endo- and epicardial borders of the left ventricle from cine MR images has been developed. The feasibility of this was demonstrated by processing end diastolic and end systolic ECG-gated images of four short axis images in 10 healthy subjects. The first derivative method combined with a 2D weighted polynomial fitting procedure was used to determine the endo- and epicardial borders, which then allowed determination of the wall motion, wall thickening, and ejection fraction, of the left ventricle. The results show that the end-systolic radial wall motion varies from (32 ± 8)% to (76 ± 12)%, and wall thickening from (0.60 ± 0.46) cm to (1.26 ± 0.50) cm. An average ejection fraction of (69 ± 6)% was found which agrees well with literature values. The method described, for the delineation of the borders, reduces considerably the long and tedious operator time inherent in manual measurement and greatly increases the reproducibility of the measurements.     

Wavelet-based characterization of vertebral trabecular bone structure from magnetic resonance images at 3 T compared with micro-computed tomographic measurements

Trabecular bone structure and bone density contribute to the strength of bone and are important in the study of osteoporosis. Wavelets are a powerful tool in characterizing and quantifying texture in an image. The purpose of this study was to validate wavelets as a tool in computing trabecular bone thickness directly from gray-level images. To this end, eight cylindrical cores of vertebral trabecular bone were imaged using 3-T magnetic resonance imaging (MRI) and micro-computed tomography (microCT). Thickness measurements of the trabecular bone from the wavelet-based analysis were compared with standard 2D structural parameters analogous to bone histomorphometry (MR images) and direct 3D distance transformation methods (microCT images). Additionally, bone volume fraction was determined using each method. The average difference in trabecular thickness between the wavelet and standard methods was less than the size of 1 pixel size for both MRI and microCT analysis. A correlation (R) of .94 for microCT measurements and that of .52 for MRI were found for the bone volume fraction. Based on these results, we conclude that wavelet-based methods deliver results comparable with those from established MR histomorphometric measurements. Because the wavelet transform is more robust with respect to image noise and operates directly on gray-level images, it could be a powerful tool for computing structural bone parameters from MR images acquired using high resolution and thus limited signal scenarios.     

Fast spoiled gradient-recalled MR imaging of thoracic aortic dissection: Preliminary clinical experience at 1.5 T

The purpose of this study was to evaluate fast spoiled gradient-recalled (FSPGR) magnetic resonance (MR) imaging in the diagnosis of thoracic aortic dissection (TAD). Twenty-eight patients with suspected TAD underwent MR imaging with FSPGR and either cine or cardiac-gated spin-echo MR techniques. The average scanning time for the FSPGR images was approximately 1 min. Three readers interpreted the FSPGR images for the presence or absence of TAD. An ROC analysis was done. At a specificity of 90%, the sensitivity ranged from 52% to 90% for the three readers. Pulsatility artifacts and mural thrombus were causes of false-positive and false-negative readings. The areas under the ROC curves (A_z) ranged from 0.85 to 0.97 for the three readers. There was a statistically significant difference in the A_z values for two of the experienced readers (p = .02). The correct type of dissection was determined in only 65% of the true-positive diagnoses. FSPGR has a very limited role in screening and for rapid evaluation of the unstable patient. The results are reader dependent and susceptible to pulsatility artifacts. Determination of the type of dissection is limited. With a suspected thoracic aortic dissection, therefore, additional imaging sequences should be obtained to maximize accuracy.