Fast MR imaging of liver metastasis using FLASH and FISP--optimal sequences for T1- and T2*-weighted images

This paper deals with a study to obtain the optimal sequence of gradient echo (GE) for T1- and T2*-weighted images similar to T1- and T2-weighted images of spin echo (SE). Two GE sequences, fast low angle shot (FLASH) and fast imaging with steady-state precession (FISP), were performed in 15 cases of liver metastasis in various combination of flip angle (FA), repetition time (TR), and echo time (TE). The optimal combinations were summarized as follows: 1) T1-weighted FLASH image with FA of 40 degrees, TR of 22 msec and TE of 10 msec, 2) T1-weighted FISP image with FA of 70 degrees, TR of 100 msec, TE of 10 msec, 3) both T2*-weighted FLASH and FISP images with FA of 10 degrees, TR of 100 msec and TE of 30 msec. Not only to provide the adequate T1- and T2*-weighted images but also to enable breath-holding MR imaging, GE sequences can optionally take place SE in cases of deteriorated images caused by moving artifacts. Other applications support the re-examination and further detailing when required, conveniently rather in short time.     

Contrast media in MR arthrography of the glenohumeral joint: intra-articular gadopentetate vs saline: preliminary results

The purpose of this investigation was to compare gadopentetate and saline as contrast media in MR arthrograms of the glenohumeral joint. In 60 consecutive patients MR arthrograms with either gadopentetate (n = 26) or saline (n = 34) were performed. After injection of gadopentate, 3D gradient-echo (GE) images were obtained (TR 32 ms, TE 10 ms, flip angle 40 °). With saline, double-echo steady-state images (heavily T2-weighted 3D GE images) were obtained (TR 40 ms, TE 9/45 ms, flip angle 40 °). In the last 14 of these patients T2-weighted turbo spin-echo (SE) images were added (TR 2900 ms, TE 96 ms). Contrast-to-noise ratios standardized for imaging times proved to be superior for the gadolinium arthrograms compared with GE and SE saline arthrograms (intra-articular fluid vs subacromial fat: p = 0.0001 and 0.0008; intra-articular fluid vs supraspinatus tendon: p = 0.0001 and 0.046). Using a qualitative scoring system gadolinium arthrograms were superior to saline arthrograms (p < 0.0001 and p < 0.0001). Saline arthrograms in combination with GE and SE sequences are inferior to gadopentetate arthrograms with GE sequences. Received 24 May 1996; Accepted 30 August 1996     

Preliminary clinical results with low flip angle spin-echo MR imaging of the head and neck

A new approach for producing primarily T2- and proton-density-weighted MR images in less time than the conventional long TR, long TE imaging is to reduce the TR of a double spin-echo pulse sequence and to also reduce the RF excitation flip angle to minimize the resulting T1 sensitivity. In preliminary studies with a human volunteer and five patients with various diseases of the head and neck, conventional long TR, long TE and short TR, short TE images were compared with short TR, long TE images with reduced flip angles (45 degrees, 30 degrees), which required only 40% of the imaging time of the long TR images. The latter images showed a similar contrast pattern to the conventional T2-weighted image, and contrast-to-noise measurements indicated an increase in contrast between the lesion and nearby tissue when the flip angle was reduced. Furthermore, the maximum contrast/noise per unit imaging time on the short TR, long TE image was comparable to that on the long TR, long TE image. Optimization of the flip angle with short TR allows a substantial reduction in imaging time but with a reduction in multislice capability. This technique will be most useful in areas of complex anatomy where two or more orthogonal imaging planes are required, such as the head and neck.     

Detection and characterization of metastatic cervical adenopathy by MR imaging: comparison of different MR techniques

Thirty-five patients scheduled to undergo a neck dissection for squamous cell carcinoma of the head and neck were evaluated preoperatively by magnetic resonance (MR) imaging. Axial and occasionally sagittal and coronal images were obtained. To define the most reliable technique to detect cervical lymph node metastasis, we compared several MR pulse sequences with and without Gd-DTPA administration to histopathologic findings in the neck dissection specimens. T1-weighted spin echo combined with T2-weighted gradient recalled echo (GE) sequences were found to be more useful than any other combination of pulse sequences in localizing lymph nodes. On T2-weighted GE images, lymph nodes were depicted with intermediate to high signal intensity in contrast to low signal muscular and fatty tissue. Gadolinium DTPA enhanced T1-weighted GE images reliably depict central lymph node necrosis, the most specific criterion for lymph node metastasis.     

Ultrasmall superparamagnetic iron-oxide-enhanced MR imaging of normal bone marrow in rodents: original research original research

RATIONALE AND OBJECTIVES: The objective is to compare three different ultrasmall superparamagnetic iron oxides (USPIOs) for magnetic resonance (MR) imaging of normal bone marrow in rodents. MATERIALS AND METHODS: Femoral bone marrow in 18 Sprague-Dawley rats was examined by using MR imaging before and up to 2 and 24 hours postinjection (PI) of 200 mumol of Fe/kg of SHU555C (n = 6), ferumoxtran-10 (n = 6), or ferumoxytol (n = 6), using T1-weighted (50 ms/1.7 ms/60 degrees = repetition time [TR]/echo time [TE]/flip angle) and T2*-weighted (100 ms/15 ms/38 degrees = TR/TE/flip angle) three-dimensional spoiled gradient recalled echo sequences. USPIO-induced bone marrow was evaluated qualitatively and quantified as signal-to-noise ratio (SNR) and change in signal intensity (DeltaSI) values. A mixed-effect model was fitted to the SNR and DeltaSI values, and differences among USPIOs were tested for significance by using F tests. RESULTS: At 2 hours PI, all three USPIOs showed marked positive signal enhancement on T1-weighted images and a corresponding marked signal loss on T2*-weighted images. At 24 hours PI, the T1 effect of all three USPIOs disappeared, whereas T2*-weighted images showed persistent signal loss on SHU555C and ferumoxytol-enhanced MR images, but not ferumoxtran-10-enhanced MR images. Corresponding SNR and DeltaSI values on T2*-weighted MR images at 24 hours PI were significantly different from baseline for SHU555C and ferumoxytol, but not ferumoxtran-10. CONCLUSION: All three USPIO contrast agents, ferumoxtran-10, ferumoxytol, and SHU555C, can be applied for MR imaging of bone marrow. Ferumoxtran-10 apparently reveals a different kinetic behavior in bone marrow than ferumoxytol and SHU555C.     

MR imaging of hyaline cartilage at 0.5 T: a quantitative and qualitative in vitro evaluation of three types of sequences

Objective. To identify an optimal pulse sequence for in vitro imaging of hyaline cartilage at 0.5 T. Materials and methods. Twelve holes of varying diameter and depth were drilled in cartilage of two pig knees. These were submerged in saline and scanned with a 0.5-T MR system. Sixteen T1-weighted gradient echo (GE), two T2-weighted GE, and 16 fast spin echo sequences were used, by varying repetition time (TR), echo time (TE), flip angle (FA), echo train length, profile order, and by use of fat saturation. Contrast-to-noise ratios (CNR) of cartilage versus saline solution and cartilage versus subchondral bone were measured. Cartilaginous lesions were evaluated separately by three independent observers. Interobserver variability and correlation between the quantitative and qualitative analyses were calculated. Results. The mean CNRs of two specimens of cartilage versus saline solution ranged from 6.3 (±2.1) to 27.7 (±2.5), and those of cartilage versus subchondral bone from 0.3 (±0.2) to 22.5 (±1.4). The highest CNR was obtained with a T1-weighted spoiled 3D-GE technique (TR 65 ms, TE 11.5 ms, FA 45°). The number of lesions observed per sequence varied from 35 to 69. Observer agreement was fair to good. The T1-weighted spoiled GE sequences with a TR of 65 ms, TE of 11.5 ms and FA of 30° and 45° were significantly superior to the other 34 sequences in the qualitative analysis. Conclusion. T1-weighted spoiled 3D-GE sequences with a TR of 65 ms, a TE of 11.5 ms, and a FA of 30–45° were found to be optimal for in vitro imaging of cartilage at 0.5 T.     

Time-reduced T2-weighted celebral MRI with optimized flip angles

This study was set up to see whether lowering the flip angle in proton density- and T2-weighted double-spin echo sequences allows for shortening of repetition time (TR) and imaging time without significant change of image quality. Ten patients with celebral white matter lesions were investigated with an 1.5 T MR scanner using a conventional long- TR double-spin echo sequence (TR = 2500 ms, TE = 15 and 70 ms) and reduced-TR double-spin echo sequences (TR = 1900 ms, TE = 15 and 70 ms) at flip angles of 90°, 80°, 70°, 60°, and 50°. Lowering the flip angle resulted in less T1-contrast and a relative increase of T2-contrast. At a flip angle of 70°, contrast-to noise ratios (NNRs) between lesions and brain, as well as image artifacts of the reduced-TR sequence (CNR: 22.4) were similar to the conventional long-TR sequence (CNR:21.1), while imaging time was shortened by about 25%. Offprint requests to: Peter Schubeus     

Optimization of sequence parameters in fast MR imaging of the brain with FLASH

Owing to the intrinsically complex behavior of the signal intensity of fast gradient-refocusing MR sequences, agreement as to the clinically most useful sequence parameters has not yet been reached. This study evaluates the FLASH (fast low-angle shot) sequence for gray-white matter differentiation on normal volunteers at 1.5 T. The FLASH gradient-echo sequence is essentially T1-dependent. For very fast imaging and T1 weighting, the following parameters yield the best results: a flip angle of 30-50 degrees with TR = 20 and TE = 10. To replace T1-weighted SE by the faster FLASH sequence, the best results are achieved by a flip angle of 70-120 degrees with TR = 150-300 and TE = 10 (or shorter, if possible). The most valuable proton-density aspect is achieved by a flip angle of 30 degrees with TR = 300 and TE = 16.     

MR imaging evaluation of plica synoviallis mediopatellaris of the knee joint]

To evaluate the diagnostic ability of MR imaging for plica synoviallis mediopatellaris (PSM), we retrospectively reviewed the MR imaging findings of patellofemoral space in 20 knee joints of 11 patients. In all 20 knee joints, arthroscopy and MR imaging were available. MR imaging was performed with a 1.5 Tesla Magnetom (Siemens) using a round surface coil. Pulse sequences were SE (TR 600 ms/TE 26 ms), SE (TR 200 ms/TE 26, 70 ms) and FLASH (TR 450 ms/TE 15 ms/FA 90 degrees). In six of the 20 knees with PSM proved by arthroscopy, a low intensity band was shown above the medial condyle of the femur on both T1- and T2-weighted MR images, and on FLASH images this band was shown as intermediate intensity. In the other 14 knees with no PSM observed by arthroscopy, the low intensity band was not shown on MR imaging. In all 20 knees, a similar low intensity band was shown about 1 cm cranial to the medial condyle of the femur. This should not be diagnosed as PSM. The low intensity band seen on T1- and T2-weighted MR images and its anatomical relation to the medial condyle are important in diagnosing PSM.     

Hyaline articular cartilage: relaxation times,pulse-sequence parameters and MR appearance at 1.5 T

In order to optimize the parameters for the best visualization of the internal architecture of the hyaline articular cartilage a study both ex vivo and in vivo was performed. Accurate T1 and T2 relaxation times of articular cartilage were obtained with a particular mixed sequence and then used for the creation of isocontrast intensity graphs. These graphs subsequently allowed in all pulse sequences (spin echo, SE and gradient time (TR), echo time (TE) and flip angle (FA) for optimization of signal differences between MR cartilage zones. For SE sequences maximum contrast between cartilage zones can be obtained by using a long TR (> 1,500 ms) with a short TE (< 30 ms), whereas for GRE sequences maximum contrast is obtained with th shortest TE (< 15 ms) combined with a relatively long TR (> 400 ms) and an FA greater than 40°. A trilaminar appearance was demonstrated with a superficial and deep hypointense ozne in all sequences and an intermediate zone that was moderately hyperintense on SET1-weighted images, slightly more hyperintense on proton density Rho and SE T2-weighted images and even more hyperintense on GRE images.     

Detection of hepatic VX2 carcinomas with ferucarbotran-enhanced magnetic resonance imaging in rabbits: Comparison of nine pulse sequences

OBJECTIVE: To compare the diagnostic performance of a variety of magnetic resonance imaging (MRI) sequences, in order to identify the most effective ferucarbotran-enhanced sequence for the detection of multiple small hepatic VX2 carcinomas in rabbits. METHODS: Fifteen rabbits with experimentally induced 135 VX2 carcinomas in the liver underwent ferucarbotran-enhanced MRI using the following nine pulse sequences: a fat-suppressed fast spin-echo (FSE) sequence with two echo times (TE) (proton density- and T2-weighted images), four different T2*-weighted fast multiplanar GRASS (gradient-recalled acquisition in the steady state) (FMPGR) with the combination of three TEs (9, 12, 15 ms, respectively) and two flip angles (20 degrees , 80 degrees, respectively), T2*-weighted fast multiplanar spoiled GRASS (FMPSPGR), T1-weighted FMPSPGR, and dynamic T1-weighted FMPSPGR. All images were reviewed by three radiologists with quantitative and qualitative analysis. RESULTS: Tumor-to-liver contrast-to-noise ratio of the proton density-weighted FSE sequence was significantly higher than those of the others (p<0.05). The lesion conspicuities of proton density- and T2-weighted FSE and T2*-weighted FMPGR (TE/flip angle, 9/20 degrees and 12/20 degrees ) images were better and the image artifacts of T2*-weighted FMPGR (TE/flip angle, 15/20 degrees and 12/80 degrees ) and T2*-weighted FMPSPGR images were more prominent than those of the others (p<0.05). The lesion detection in T2- and proton density-weighted FSE and T2*-weighted FMPGR (TE/flip angle, 12/20 degrees ) images were superior to those of the others and for the detection of very small hepatic tumors of less than 5 mm, the sensitivities of these sequences were less than 30%. CONCLUSION: Ferucarbotran-enhanced T2- and proton density-weighted FSE and T2*-weighed FMPGR (TE/flip angle, 12/20 degrees ) images were found to be the most effective pulse sequences for the detection of multiple small hepatic VX2 carcinomas but these sequences were limited in the detection of very small hepatic tumors of less than 5 mm in size.     

Superparamagnetic iron oxide-enhanced MR imaging of head and neck lymph nodes.

PURPOSE: To compare findings on superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) images of the head and neck with those from resected lymph node specimens and to determine the effect of such imaging on surgical planning in patients with histopathologically proved squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: Thirty patients underwent MR imaging with nonenhanced and SPIO-enhanced (2.6 mg Fe/kg intravenously) T1-weighted (500/15 [repetition time msec/echo time msec]) and T2-weighted (1,900/80) spin-echo and T2-weighted gradient-echo (GRE) (500/15, 15 degrees flip angle) sequences. Signal intensity decrease was measured, and visual analysis was performed. Surgical plans were modified, if necessary, according to MR findings. Histopathologic and MR findings were compared. RESULTS: Histopathologic evaluation of 1,029 lymph nodes revealed 69 were metastatic. MR imaging enabled detection of 59 metastases. Regarding lymph node levels, MR diagnosis was correct in 26 of 27 patients who underwent surgery: Only one metastasis was localized in level II with MR imaging, whereas histopathologic evaluation placed it at level III. Extent of surgery was changed in seven patients. SPIO-enhanced T2-weighted GRE was the best sequence for differentiating between benign and malignant lymph nodes. CONCLUSION: SPIO-enhanced MR imaging has an important effect on planning the extent of surgery. On a patient basis, SPIO-enhanced MR images compared well with resected specimens.     

Gradient-echo MR imaging of the cervical spine: evaluation of extradural disease

A prospective study was undertaken on 204 consecutive patients comparing low flip angle gradient-echo and T1-weighted spin-echo techniques in the MR evaluation of cervical extradural disease. Four patient groups were studied with varying gradient-echo TEs (6 or 13 msec) and flip angles (10 degrees or 60 degrees). Images were evaluated independently for contrast behavior and anatomy, then directly compared for conspicuity of lesions. The FLASH sequences (especially with a 10 degrees flip angle) produced better conspicuity of disease in half the imaging time. T1-weighted spin-echo sequences were more sensitive to marrow changes and intradural disease. The short TE sequence (6 msec) did not produce any diagnostic advantage over the longer TE sequence (13 msec). A fast and sensitive MR examination for cervical extradural disease combines a sagittal T1-weighted spin-echo acquisition with sagittal and axial FLASH 10 degrees sequences.     

Magnetic resonance in the evaluation of parametrial involvement in carcinoma of the cervix uteri]

Cervical carcinoma is one of the most frequent gynecologic malignancies. Its prognosis depends on both tumor volume at diagnosis and its stage. Staging accuracy is important not only for prognosis but also for optimal treatment planning. According to FIGO criteria, carcinomas without parametrial involvement (stage I and limited stage IIA disease) can be surgically treated. For more advanced stages, treatment, in most cases, consists of radiation therapy or chemotherapy alone. The authors evaluated MR accuracy in the diagnosis of parametrial involvement; to this purpose, 32 patients with histologically proven lesions were referred for MR imaging, which was performed with a 0.5 T superconductive magnet. Transverse and sagittal SE images were obtained with T2 weighting (TR 1800 ms, TE 30-100 ms); transverse and sometimes sagittal images were obtained with T1 weighting (TR 450/300 ms, TE 20/30). T1-weighted images distinguished neoplasm from cervical stroma or dense parametrial connective tissue in 40% of cases only. T2-weighted images, instead, demonstrated the difference in all cases, showing tumor as a hyperintense area in 90% of patients. Neoplastic involvement of pericervical connective tissue was diagnosed, with those sequences, on the basis of focal disruptions of the outer hypointense fibrous cervical stroma; findings were correlated with those from a previous clinical staging and in 26/32 patients with pathologic findings. MR accuracy in demonstrating parametrial involvement was 88%, sensitivity was 77% and specificity was 94%. Clinical staging accuracy in the evaluation of this parameter was 66%. In 6 cases with no surgical findings, MR confirmed extensive parametrial and vesical or rectal neoplastic involvement, as diagnosed at clinics. MR imaging, thanks to its multiplanar and multiparametric imaging capabilities is a very reliable technique in the preoperative staging of cervical carcinoma. Moreover, since clinical staging can sometimes underestimate pericervical connective spread, the higher accuracy of MR imaging can help avoid useless interventional procedures.     

Staging of spinal metastasis using special techniques of magnetic resonance imaging

The diagnosis of spine metastasis is a problem of great interest which leaves many questions unanswered. In this field MR imaging plays a fundamental role, as the only technique able to directly demonstrate the changes in bone marrow tissue, bound to tumoral activity. The introduction of gradient-echo (GE) sequences has helped reduce examination time. Moreover, with the accurate choice of pulse-sequence parameters (TR, TE, flip angle) additional information is acquired which is not yielded by conventional spin-echo (SE) sequences. Our study was aimed at evaluating MR sensitivity in the different stages of bone metastatic evolution. The comparative adequacy was evaluated of combined bone scintigraphy and conventional radiology versus MR imaging in 62 patients with vertebral metastases. Time interval between bone scan and/or radiological study and MR exam ranged from 10 days to 8 months. SE and GE T1-weighted images, and SE and GE T2-weighted images on the sagittal plane were employed, and axial images; coronal images were rarely acquired. Metastases were demonstrated by MR imaging at 122 vertebral levels, versus 88 true positives of combined scintigraphy and conventional radiology. Scintigraphic false-positives were observed at 15 vertebral levels, versus 9 with radiography. GE sequences were superior to SE ones in detecting vertebral morphologic lesions and bone marrow involvement thanks to their improved resolution and sensitivity. Moreover, GE sequences demonstrated tumoral bone marrow spread and persistent tumoral activity in the follow-up of spine metastases. Our results point to GE sequences as those of choice because of their higher resolution and sensitivity, which also allow response to treatment to be evaluated.     

Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT.

Computed tomographic (CT) scans and magnetic resonance (MR) images obtained in 24 patients with cervical lymphadenopathy were retrospectively and blindly evaluated by two readers for the presence of central nodal necrosis (CNN) and extracapsular nodal spread (ENS). The CT studies were all enhanced, and the MR images were obtained with short repetition time (TR)/echo time (TE), long TR/double echo, and enhanced short TR/TE fat-suppressed sequences. Each MR imaging sequence was interpreted separately and then collectively. Sixty lymph nodes were identified with CT. Sensitivity for CNN was 16%-67% with the unenhanced MR pulse sequences, 50% with enhanced sequences, and 83%-100% with CT. The most accurate reading of MR images for CNN was with the unenhanced T1-weighted and T2-weighted images (86%-87%); the accuracy of CT was 91%-96%. The accuracy of MR imaging for detecting ENS was maximal with T1-weighted images (78%-90%). Gadolinium-enhanced, fat-suppressed images did not improve accuracy in evaluating CNN or ENS. CT is currently more accurate than unenhanced or enhanced MR imaging in detecting CNN or ENS.     

Incidence of adrenal masses in patients referred for renal artery stenosis screening MR

RATIONALE AND OBJECTIVES: Prior work has shown the efficacy of magnetic resonance (MR) in renal artery stenosis evaluation. The increasing role of renal artery stenosis in the differential diagnostic evaluation of hypertension raises the question of whether MR should be used as a screening modality. This project evaluated the additional potential benefits of MR by determining the incidence of adrenal masses in this selected population. METHODS: A 2-year retrospective study analysis of patients who failed to respond to antihypertensive medical management and were referred for renal MR for hypertension amassed 77 subjects ranging in age from 18 to 88 years. A masked analysis for adrenal masses was performed on this data set. Magnetic resonance techniques included T2-weighted turbo spin-echo (repetition time [TR] 2000-4000 ms, echo time [TE] 80-100 ms, turbo factor 2-16), T1-weighted spin-echo (TR 200-500 ms, TE 10-30 ms), gradient-echo time-of-flight (TR 26 ms, TE 6.9 ms, 40 degrees flip angle, 2 excitations), and dynamic gadopentetate dimeglumine-enhanced MR angiography (three-dimensional gradient recalled echo, TR 10 ms, TE 3 ms, 40 degrees flip angle, 1 excitation). RESULTS: Thirty-three patients had renal artery disease, 44 had normal renal arteries, and 7 had adrenal masses. Forty-three percent of patients who underwent renal MR had disease of the renal arteries detected, and 9% of patients referred for MR had adrenal masses that would have been missed with scintigraphy and/or angiography, of which 57% were responsible for hypertension. CONCLUSIONS: The ability to evaluate renal artery and adrenal anatomy globally can be useful, as exemplified in the current series, and the adrenals should be examined carefully in any renal MR in a hypertensive patient.     

Low flip angle spin-echo MR imaging to obtain better Gd-DTPA enhanced imaging with ECG gating]

ECG-gated spin-echo imaging (ECG-SE) can reduce physiological motion artifacts. However, ECG-SE does not provide strong T1-weighted images because repetition time (TR) depends on heart rate (HR). We investigated the usefulness of low flip angle spin-echo imaging (LFSE) in obtaining more T1-dependent contrast with ECG gating. in computer simulation, the predicted image contrast and signal-to-noise ratio (SNR) obtained for each flip angle (0-180 degrees) and each TR (300 msec-1200 msec) were compared with those obtained by conventional T1-weighted spin-echo imaging (CSE: TR = 500 msec, TE = 20 msec). In clinical evaluation, tissue contrast [contrast index (CI): (SI of lesion-SI of muscle)2*100/SI of muscle] obtained by CSE and LFSE were compared in 17 patients. At a TR of 1,000 msec, T1-dependent contrast increased with decreasing flip angle and that at 38 degrees was identical to that with T1-weighted spin-echo. SNR increased with the flip angle until 100 degrees, and that at 53 degrees was identical to that with T1-weighted spin-echo. CI on LFSE (74.0 +/- 52.0) was significantly higher than CI on CSE (40.9 +/- 35.9). ECG-gated LFSE imaging provides better T1-dependent contrast than conventional ECG-SE. This method was especially useful for Gd-DTPA enhanced MR imaging.     

Low flip-angle spin-echo imaging of the liver. Basic study and its application to hepatic space-occupying lesions]

Dependence on T1 contrast can be reduced by changing the excitation flip angle. Low flip-angle spin-echo imaging can reduce imaging time because repetition time (TR) is reduced. The authors assessed the efficacy of low flip-angle spin-echo images in phantoms and in liver. MR phantoms made from polyvinyl alcohol gel to model the properties of normal liver, HCC, and hemangioma were scanned with various flip angles at TR 2400 and 1200 msec. Measured signal intensities fitted well with theoretical values. The T1 contrast of signal intensity decreased as the flip angle was reduced, accompanied by a decrease in signal-to-noise ratio (S/N). Thirty patients with hepatic space-occupying lesions (23 with HCC, three with metastases and four with hemangioma) were studied by conventional SE (CSE) at 2400/60/2 (TR/TE/NEX [number of excitations]) (10 min 46 sec imaging time) and low flip-angle SE (LFSE) at 1200/60/30 degrees/2 (TR/TE/FA/NEX) (5:20) and/or 1200/60/30 degrees/4 (10:18). The sensitivity of CSE in detecting lesions was 93% (44/47). It was 92% (35/38) for LFSE with two NEX and 94% (34/36) for LFSE with four NEX pulse sequences. The contrast-to-noise ratio (C/N) for images (HCC/liver, hemangioma/liver) obtained by LFSE with four NEX was significantly higher than that for those obtained by CSE (4.8 vs 3.5, p less than 0.01; 13.4 vs 9.7, p less than 0.01, respectively). Although the C/N (lesion/liver) for LFSE with two NEX sequences was lower than that of CSE for any type of lesion (3.0 vs 3.5 for HCC; 5.1 vs 6.3 for metastases; 8.3 vs 9.7 for hemangioma), the difference was not significant. Although reducing the flip angle from 90 degrees to 30 degrees with two NEX resulted in a decrease in S/N (10.7 to 8.9 for HCC; 15.3 to 11.9 for metastases; 20.0 to 18.1 for hemangioma; 7.4 to 6.3 for normal liver; 10.7 to 10.1 for spleen), the difference was not significant. For hepatic space-occupying lesions, low flip-angle spin-echo imaging is useful to obtain T2-weighted images in a shorter imaging time without sacrificing lesion detectability.     

MR Detection of microhemorrhages in neurologically healthy adults

T2*-weighted gradient-echo (GE) magnetic resonance images frequently demonstrate small hypointense lesions in patients with systemic hypertension and spontaneous hematomas. These lesions have been suspected to represent subclinical microhemorrhages. We examined the incidence of these lesions in neurologically healthy adults, and the factors associated with them. Axial T2*-weighted GE images (TR = 1,000 ms, TE = 30 ms, flip angle = 20 degrees) were obtained in addition to conventional T1- and T2-weighted spin echo images in 450 neurologically healthy Japanese adults (289 men and 161 women; age 52.9 +/- 7.7 years, range 24-84). The overall incidence of small hypointense lesions was 3.1% (14/450), and these lesions were closely related to systemic hypertension (P < 0.0001) and heavy cigarette smoking (>20 cigarettes per day; P=0.003). Although the incidence of hypointense lesions was lower in neurologically healthy adults than in the reported incidence in patients with a hemorrhagic history, the presence of these lesions was related to the risk factors for primary intracerebral hemorrhage even in the neurologically healthy adults.