Superparamagnetic iron oxide-enhanced MR imaging: pulse sequence optimization for detection of liver cancer

The effects of magnetic resonance (MR) pulse sequences and timing parameters on tumor-liver contrast were studied in an animal model of metastatic liver cancer. Six spin-echo (SE), three inversion-recovery (IR), and four gradient-echo (GRE) sequences were evaluated at 0.6 T before and after injection of super-paramagnetic iron oxide. GRE techniques, irrespective of echo time and flip angle, showed the greatest change in signal intensity (enhancement) of the liver after administration of iron oxide. Single-acquisition GRE sequences (16 seconds) matched the contrast-to-noise ratio (C/N) performance of the most effective 6.4-minute SE sequences. Multiexcitation GRE sequences showed tumor-liver C/Ns per unit time that were significantly (P less than .05) higher than those achieved with SE and IR sequences. GRE sequences, which recruit intravoxel dephasing as an additional source of transverse relaxation enhancement (T2*), show a higher C/N per unit time and in this respect seem superior to SE and IR sequences for MR imaging with superparamagnetic iron oxide.     

Breast and axillary tissue MR imaging: correlation of signal intensities and relaxation times with pathologic findings

We tested a variety of inversion-recovery (IR) and spin-echo (SE) sequences by imaging the breast masses of 22 patients before surgery and 23 tissue specimens with magnetic resonance (MR) imaging at 0.6 T to determine the most effective pulse sequences to evaluate breast disease. An SE pulse sequence using a long repetition time (TR) of 1,600 msec and a long echo time (TE) of 90 msec was found to be the most sensitive in depicting carcinoma in the excised tissue specimens, with all of the carcinomas (n = 15) demonstrating irregular areas of higher signal intensity (SI) than that of the adjacent fat. However, only five of 11 breast carcinomas present in the preoperative patients produced a higher SI than that produced by fat on the same T2-weighted sequence. Five of the remaining six carcinomas in the preoperative patients appeared as localized distortions of fibroductular architecture on both T2-weighted SE and IR sequences. In axillary tissue specimens, both metastatic carcinoma and hyperplastic lymph nodes produced a high SI on T2-weighted SE sequences. However, metastatic carcinoma had a significantly longer T2 relaxation time than did hyperplastic lymph nodes.     

Hepatic metastases: randomized, controlled comparison of detection with MR imaging and CT

To determine the accuracy of magnetic resonance (MR) imaging relative to computed tomography (CT) in the diagnosis of liver metastases, a randomized, controlled study was conducted of 135 subjects, including 57 with cancer metastatic to the liver, 27 with benign cysts or hemangiomas, and 51 without focal liver disease. The sensitivity of MR imaging for detecting individual metastatic deposits was 64%, significantly greater than 51% for CT (P less than .001); the difference in sensitivity for identifying patients with one or more hepatic metastases was less (82% for MR imaging vs. 80% for CT). In patients without hepatic metastases, the specificity of MR imaging was 99% versus 94% for CT. Significant differences were found between individual MR pulse sequences in detection of individual lesions. The sensitivity of both T1-weighted spin-echo (SE) (64%) and inversion-recovery (IR) (65%) pulse sequences was significantly (P less than .001) greater than either the TE (echo time) 60 msec (43%) or TE 120 msec (43%) T2-weighted pulse sequences. Overall, the accuracy of a single T1-weighted (10-minute) pulse sequence was superior to that of contrast-enhanced CT.     

Initial feasibility studies using single-shot EPI for the detection of focal liver lesions

Echo planar MR imaging (EPI) has been developed to completely eliminate motion artifacts and is currently being prepared for implementation into clinical MR systems. Thus, the purpose of this study was to evaluate the clinical utility of EPI in the detection of focal liver lesions and to compare EPI with contrast-enhanced CT. EPI studies were performed on an experimental 1.0 Tesla whole body system using fat-suppressed single-shot spin echo (SE) and inversion recovery (IR) pulse sequences. A total of 26 liver tumors in 12 patients scheduled for liver resection were prospectively examined and correlated with intraoperative ultrasound, surgery, and pathology as the gold standard. Quantitative analysis of EPI was performed by means of liver signal-to-noise and tumorliver contrast-to-noise calculations. Diagnostic performance compared with contrast-enhanced CT was assessed by means of ROC analysis. Lesion-liver contrast was highest with EPI SE at a TE-time of 70 ms and this technique showed best lesion detectability as measured by area under curve (AUC) values. Among EPI techniques, the IR sequence with an inversion time of 300 ms to null the liver signal showed high lesion-liver contrast but all four reviewers reported problems assessing liver anatomy. Improved EPI techniques may prove useful for screening of focal liver lesions.     

Optimal pulse sequence for imaging hepatic metastases

For magnetic resonance (MR) imaging studies in which the diagnosis is dependent on image contrast, it is essential that an optimized imaging technique be used. Using detection of hepatic metastases as an example, the authors describe a rational strategy for optimizing MR imaging technique. First, for a single patient with proved hepatic metastases, a variety of imaging sequences is discussed and evaluated, leading to characterization of the patient's hepatic tissues. Then the characteristics of the tissues of a representative patient population are presented. These are used to determine two optimal pulse sequences that maximize the achievable signal difference-to-noise ratio achievable in a fixed imaging time. The recommended imaging sequence for detection of hepatic metastases at 0.15 T is either a three-dimensional volume spin-echo (SE) sequence with echo time (TE) = 12 msec and repetition time (TR) = 184 msec or a multisection inversion recovery sequence with TE = 22 msec, inversion time = 250 msec, and TR = 1,375 msec. The variation of this optimum pulse sequence with field strength is also presented.     

Detection of hepatic metastases: analysis of pulse sequence performance in MR imaging

Forty-three patients with liver metastases were imaged using 14 different pulse sequences (average, 7.5 sequences per patient) to allow direct comparison of their performance. "T2-weighted" spin-echo (SE) images, "T1-weighted" inversion recovery (IR) images, and "T1-weighted" SE images were obtained using a wide range of timing parameters. Pulse sequence performance was quantitated by measuring liver signal-to-noise (S/N) ratios and cancer-liver signal difference-to-noise (SD/N) ratios. Data were standardized to reflect a constant imaging time of 9 minutes for all pulse sequences. The SE 2,000/120 (TR [repetition time]/TE [echo time]) sequence resulted in the greatest SD/N ratio of the T2-weighted SE sequences but also yielded the low S/N ratios, poor anatomic resolution, and motion artifacts common to all T2-weighted SE images. IR sequence images were also sensitive to motion artifacts because of the use of a long TR (1,500 msec). Short TR/TE T1-weighted SE sequences (SE 260/18) had the greatest SD/N ratio (P less than .05), S/N ratio, and anatomic resolution. Furthermore, extensive signal averaging appears to be a powerful solution to all types of motion artifacts in the abdomen.     

Multisection FLASH: method for breath-hold MR imaging of the entire liver.

One hundred ten patients with various focal liver lesions were imaged with a multisection fast low-angle shot (FLASH) gradient-echo sequence with an echo time of 4.6 msec. This sequence enabled the acquisition of 19 T1-weighted magnetic resonance (MR) images of the liver within a single 26-second breath hold. Patients were also examined with standard T1- and T2-weighted spin-echo (SE) sequences. The multisection FLASH sequence provided significantly higher (P less than .01) liver-spleen contrast, liver-spleen signal-difference-to-noise ratio (SD/N), liver-tumor contrast, and liver-tumor SD/N than the T1-weighted SE sequence but lower values than the T2-weighted SE sequence. Motion artifacts were reduced with the multisection FLASH sequence compared with both SE sequences (P less than .01). The overall image quality of the multisection FLASH images was similar to that of the T1-weighted SE images and superior to that of T2-weighted SE images. The most important characteristics of the multisection FLASH technique in MR imaging of the liver are the high T1 contrast, the prevention of motion artifacts, and a dramatic reduction in imaging time.     

Multiple-slice spin lock imaging of head and neck tumors at 0.1 Tesla: exploring appropriate imaging parameters with reference to T2-weighted spin-echo technique

RATIONALE AND OBJECTIVES: Spin lock imaging has been shown to be useful in characterizing head and neck tumors. The purposes of this study were to explore and develop multiple-slice spin lock gradient-echo (SL-GRE) sequences for head and neck imaging and to compare the tumor contrast on SL images to spin-echo (SE) T2-weighted images at 0.1 T. METHODS: On the basis of measured relaxation times of tumors and head and neck tissues, the authors evaluated with signal equations the effect of imaging parameters on tissue contrast produced by the SL-GRE sequence. In the clinical study, 34 patients with pathologically verified head and neck tumors were imaged with multiple-slice SL-GRE (repetition time 1500 ms/echo time 30 ms) out-of-phase fat/water sequences and compared with T2-weighted SE (repetition time 1500 ms/echo time 120 ms) sequences. The conspicuity of tumors was evaluated by calculating the contrast-to-noise ratios (CNRs). RESULTS: The combination of a short echo time of 30 ms and the length of locking pulses in the range of 10 to 35 ms produced optimal CNRs for head and neck tumor imaging. The measured CNRs and subjective evaluation for tumor detection were satisfactory with both imaging sequences. However, the CNRs between tumors and salivary gland tissues were significantly greater with the SL sequence than with the T2-weighted sequence. CONCLUSIONS: The multiple-slice SL-GRE technique provides image contrast comparable to that of SE T2-weighted imaging for head and neck tumors at 0.1 T. With short locking pulse lengths and echo times, wide anatomic coverage and reduced motion and susceptibility artifacts can be achieved. The out-of-phase SL technique is useful in imaging salivary gland tumors.     

不同MRI序列在显示颞叶内侧硬化的对照研究

目的比较各序列在颞叶内侧硬化病人显示海马信号强度增加的作用。材料与方法对３０例临床及脑电图或脑地形图诊断为颞叶癫痫的病人采用双回波常规自旋回波（ＳＥ）序列、快速自旋回波（ＦＳＥ）序列和液体衰减反转恢复（ＦＬＡＩＲ）序列进行ＭＲＩ检查，并通过目测观察和信号强度测量等方法对图像进行处理。结果ＳＥ序列质子密度加权像判别海马信号强度增加的准确度最差（４３．３％）；ＦＳＥ序列次之（６２．２％）；ＳＥ序列Ｔ２加权像和ＦＬＡＩＲ序列判别海马信号强度增加的准确度很高，且ＦＬＡＩＲ序列（８８．９％）较ＳＥ序列Ｔ２加权像（７７．８％）更为准确。结论在诊断颞叶内侧硬化方面ＦＬＡＩＲ序列有可能成为常规ＳＥ序列的替代者     

Manganese dipyridoxyl diphosphate. Effect of dose, time, and pulse sequence on hepatic enhancement in rats

We used an animal model to investigate the hepatic enhancement characteristics of manganese dipyridoxyl diphosphate (MnDPDP) related to time, dose, and pulse sequence. The contrast doses selected were in the human tolerance range. Using an SE 300/15 pulse sequence, maximum mean hepatic enhancement of 45% (8 mumols/kg) and 58% (12 mumols/kg) over baseline was seen during a plateau maintained between 5 and 50 minutes postinjection in the 8 mumols/kg group, and between 10 and 90 minutes in the 12 mumols/kg group. This plateau was followed by a very gradual decline in hepatic enhancement. Using either 4 or 8 mumols/kg, there was a significant increase in postcontrast hepatic intensity on all relatively T1-weighted pulse sequences (spin echo [SE] 300/15, inversion recovery [IR] 1400/20/400, gradient echo [GE] 47/13/80 degrees, and GE 60/20/30 degrees) except GE 47/13/80 degrees at 4 mumols/kg. At 8 mumols/kg there was superior enhancement, with IR 1400/20/400 and SE 300/15, but at 4 mumols/kg there was no consistently superior sequence. None of the relatively T2-weighted pulse sequences (SE 2000/50, SE 2000/100, or GE 100/30/20 degrees) demonstrated a significant change in hepatic intensity using either dose of contrast. The data suggest that the best combination of dose, pulse sequence, and time for hepatic imaging with MnDPDP is 8 mumols/kg using heavily T1-weighted sequences 5 to 60 minutes following contrast administration.     

Chronic subdural hematoma: demonstration by magnetic resonance

The ability of magnetic resonance (MR) to identify intracranial hematomas was tested in five patients with clinical and computed tomographic signs of chronic subdural hematoma. The extracerebral collections were displayed as a zone of bright intensity using the T1-weighted inversion recovery (IR 1,500/400) sequence, reflecting the lesions' short T1 relaxation times. The collections also showed high intensity using the spin echo (SE) sequence, with a longer delay of 100 ms and 160 ms, reflecting the long T2 relaxation time. The spin echo sequence with a repetition time of 500 ms and an echo delay of 160 ms (SE 500/160) almost effaced other structures in the image, thus increasing the specificity of this pulse scheme for detection of chronic blood collections. Although in two of the five patients the subdural hematomas were in the isodense CT phase, all were easily visualized with MR.     

Dual dynamic contrast-enhanced MR imaging

A method was devised for obtaining dynamic contrast-enhanced T1-weighted and relaxation rate (ΔR2*) images simultaneously to evaluate regional hemodyn-amics of the brain tumors. On a 1.5-T MR system, dual dynamic contrast-enhanced images were obtained using a gradient echo (dual echo fast field echo) pulse sequence with the keyhole technique to improve temporal and spatial resolution during a rapid bolus injection of gadopentetate dimeglumine. The dynamic T1 contrast images were obtained from the first echo; moreover. ∫ ΔR2*dt values were calculated from the first and the second echo images. The dynamic T1 contrast images provided information about characteristic enhancement pattern (vascularization and disruption of bloodbrain barrier), and the f ΔR2*dt values provided a map of regional blood pool in tumor site, peritumoral edema, and other surrounding regions of the brain. The ability to obtain dynamic contrast-enhanced T1 contrast and ΔR2* imaging at the same time allows optimization of the advantages of each and thereby more information about the microvascular circulation of the brain lesions.     

Detection of hepatic metastases: comparison of contrast-enhanced CT, unenhanced MR imaging, and iron oxide-enhanced MR imaging

Diagnostic accuracy of contrast-enhanced CT, unenhanced MR imaging, and MR images enhanced with superparamagnetic iron oxide was evaluated in 10 patients with histologically proved hepatic metastases. First, diagnostic performance of the imaging technique with respect to the ability of radiologists to recognize the presence or absence of a metastasis was measured by using receiver-operating-characteristic (ROC) analysis of single images. Second, the total number of lesions (N = 108) detected by "complete" CT and MR examinations was counted. Finally, lesion-liver contrast-to-noise ratios (CNR) were measured in all MR sequences. The area under the ROC curve was .67 +/- .03 for contrast-enhanced CT, .81 +/- .07 for the unenhanced SE 260/14 sequence, and .92 +/- .01 for the iron oxide-enhanced SE 1500/40 sequence. The enhanced SE 1500/40 sequence yielded significantly (p less than .005) greater accuracy than did contrast-enhanced CT. The same sequence detected significantly (p less than .05) more lesions than all other imaging techniques (19% more than the best unenhanced MR sequence and 36% more than contrast-enhanced CT). The enhanced SE 1500/40 sequence also yielded the highest CNR value (19.5 +/- 10.2) of all MR sequences. These results indicate that iron oxide-enhanced MR imaging is a superior imaging technique for the detection of hepatic lesions.     

Signal-to-noise and contrast in fast spin echo (FSE) and inversion recovery FSE imaging.

Fast spin echo (FSE) imaging has recently experienced a renewed enthusiasm in the clinical setting for its ability to provide high contrast T2-weighted images in short imaging times. This article evaluates the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) properties of the FSE sequence, inversion recovery (IR) FSE sequence, and conventional SE imaging. The results indicate that FSE imaging displays similar contrast properties to SE imaging, but that the SNR and CNR are improved secondary to the longer TRs and longer effective TEs that may be used. The SNR per unit time of the FSE sequence, and hence its efficiency, is at least a factor of 8 better than the SE sequence when 16 echoes are acquired for each excitation. The addition of a slice selective inversion pulse in IR-FSE allows rapid generation of IR images with image contrast similar to that of conventional IR sequences. When used with a multicoil array for abdominal, pelvic, and spine imaging, the IR-FSE sequence produces images that are virtually free of motion artifact from the subcutaneous fat immediately adjacent to the coils. Both FSE and IR-FSE, when compared with SE imaging, provide superior image contrast and SNR in reduced imaging time.     

Conventional and rapid MR imaging of the liver with Gd-DTPA

Twenty-three patients with malignant hepatic tumors underwent magnetic resonance (MR) imaging before and after intravenous administration of gadolinium-diethylene-triaminepentaacetic acid (DTPA). Two different doses were used, 0.1 mmol/kg and 0.2 mmol/kg. The larger dose proved to be more effective than the smaller dose. The signal-enhancement-to-noise ratio was significantly larger in the tumor than in the liver (2 alpha less than or equal to .05). In a moderately T1-weighted spin echo (SE) sequence (SE 400/30) (repetition time [TR] msec/echo time [TE] msec), the tumor was better defined 6 minutes after administration of Gd-DTPA. More strongly T1-weighted sequences--that is, SE 200/20 and inversion recovery 1,500/35/400 (TR msec/TE msec/inversion time, msec)--showed significantly worse contrast between tumor and liver (signal-difference-to-noise ratio [SD/N]) 10 and 15 minutes after administration (2 alpha less than or equal to .05). On the other hand, the low SD/N in the rapid MR imaging sequence was significantly improved (2 alpha less than or equal to .05). The most important indications for administration of Gd-DTPA in diagnosing hepatic tumors are the presentation of perfusion conditions and contrast optimization in rapid MR images.     

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.     

STIR MR imaging of the orbit

Fifteen patients with CT-documented orbital lesions were evaluated with MR imaging at 1.5 T with both conventional spin-echo (SE) and short inversion time inversion recovery (STIR) sequences. Fat signal was reliably nulled at inversion times of approximately 120-200 msec in all cases, thereby allowing clear detection of all retrobulbar lesions and normal structures on STIR images as markedly hyperintense relative to fat. All lesions were also clearly depicted on SE images; in fact, short repetition time/short echo time SE sequences were at least as useful as STIR images for illustrating anatomic structures and mass lesions, and in a much shorter scanning time. Separation of optic nerve from perioptic subarachnoid space was clear on SE images, but often difficult or impossible on STIR images owing to the relatively high intensity of normal optic nerves on STIR images. The synergism of relaxation prolongation with STIR actually resulted in loss of information, as any ability to separate the effects of T1 from T2 on signal intensity was impossible when STIR was the sole pulse sequence. We believe that more information is obtained with standard SE sequences than with STIR sequences, and therefore SE remains the method of choice for orbital MR imaging.     

STIR MR Imaging of the Orbit

Fifteen patients with CT-documented orbital lesions were evaluated with MR imaging at 1.5 T with both conventional spin-echo (SE) and short inversion time inversion recovery (STIR) sequences. Fat signal was reliably nulled at inversion times of approximately 120–200 msec in all cases, thereby allowing clear detection of all retrobulbar lesions and normal structures on STIR images as markedly hyperintense relative to fat. All lesions were also clearly depicted on SE images; in fact, short repetition time/short echo time SE sequences were at least as useful as STIR images for illustrating anatomic structures and mass lesions, and in a much shorter scanning time. Separation of optic nerve from perioptic subarachnoid space was clear on SE images, but often difficult or impossible on STIR images owing to the relatively high intensity of normal optic nerves on STIR images. The synergism of relaxation prolongation with STIR actually resulted in loss of information, as any ability to separate the effects of T1 from T2 on signal intensity was impossible when STIR was the sole pulse sequence.We believe that more information is obtained with standard SE sequences than with STIR sequences, and therefore SE remains the method of choice for orbital MR imaging.     

Small hepatocellular carcinoma versus small cavernous hemangioma: differentiation with MR imaging at 2.0 T

Eighteen small hepatocellular carcinomas (HCCs) and 38 hemangiomas less than 5 cm in diameter were studied with magnetic resonance (MR) imaging at 2.0 T. Relatively T1-weighted spin-echo (SE) 500/30 (repetition time msec/echo time msec) images and proton-density 2,000/30 images showed nonspecific contrast-to-noise ratios (C/Ns) and intensity ratios in HCCs and hemangiomas. On T2-weighted 2,000/60, 90, 120, 150, and 180 images, hemangiomas had significantly greater C/N and intensity ratios than HCCs (P less than .05). The SE 2,000/180 sequence showed the greatest difference in tumor-liver intensity ratios between small HCCs and hemangiomas, followed by the SE 2,000/150 sequence, but there was no statistically significant difference between the two pulse sequences. However, the SE 2,000/180 sequence is limited in the number of sections obtainable for routine clinical liver imaging. The findings indicate that the SE 2,000/60 sequence is optimal for the detection of small HCCs and hemangiomas and that the SE 2,000/150 sequence is optimal for distinguishing small HCCs from hemangiomas at 2.0 T.     

Liver metastases: detection by phase-contrast MR imaging

Forty patients with biopsy-proved metastatic liver cancers were studied by magnetic resonance (MR) imaging using one or more conventional (in-phase) pulse sequences and a corresponding phase-contrast (opposed-phase) pulse sequence. Pulse-sequence performance was quantitated by measuring signal-difference-to-noise (SD/N) ratios between cancerous tissue and liver. The SD/N performance of T2-weighted spin-echo (SE) pulse sequences improved when used with the phase-contrast technique. SE 2,000/30 opposed-phase images showed improved (P less than .001) SD/N in 72% of patients over in-phase images. The SD/N of T1-weighted SE or inversion recovery pulse sequences deteriorated when used with the phase-contrast technique. Changes in measured SD/N correlated well with image appearance and actual lesion detectability in individual cases. Phase-contrast imaging should be employed routinely when T2-weighted SE pulse sequences are relied on to detect liver cancer.