Cartilage disorders: comparison of spin-echo, CHESS, and FLASH sequence MR images

Magnetic resonance (MR) imaging is known to be a suitable modality for the visualization of the hyaline cartilage and the fibrocartilage joint structures. To compare standard spin-echo (SE) images with water images obtained with the chemical shift selective (CHESS) sequence and with the fast low angle shot (FLASH) sequence, examinations were performed with all three sequences in eight volunteers and 28 patients with inflammatory degenerative and traumatic alterations of the knee, hip, and sacroiliac joints. Arthroscopic and/or surgical correlation were available in 16 patients; bone scanning and computed tomography of the sacroiliac joints were performed in four patients. CHESS-water and FLASH images proved superior to SE images in demonstrating hyaline cartilage disorders. There was no difference between SE, CHESS, and FLASH in the detection of fibrocartilage disorders. Short imaging times and satisfactory depiction of cartilage alterations make FLASH a promising method.     

Synthesized MR images: comparison with acquired images

Synthesized and directly acquired spin-echo images were compared in order to assess the validity of magnetic resonance (MR) image synthesis as a method enabling retrospective formation of images by interactive manipulation of scan parameters. Synthetic images subjectively compared favorably in both accuracy and precision with acquired images when formed for the same values of echo (TE) and repetition times (TR) and for interpolated and extrapolated values of both TE and TR. Plots of synthetic and acquired signals within the same pixel sectors quantitatively showed comparable values for several regions of interest in the brain. Percent error and noise-normalized differences between acquired and synthetic images were tested as a quantitative measure of accuracy. Percent error was consistently less than 5% for brain parenchyma, and synthetic signals were accurate to within four times the noise level at acquisition. The apparent signal-to-noise ratio of synthetic images was comparable, superior, or inferior to similar acquired images, depending on the values of TE and TR. Total acquisition time required for synthetic formation of images for arbitrary values of TE and TR was equivalent to that of a single direct acquisition with a TR of 2,500 msec.     

Single-shot turbo spin-echo MR myelography: comparison with 3D-turbo spin-echo MR myelography and T2-turbo spin-echo at 1 T.

In order to reduce the acquisition time, we compared the single-shot-TSE-MR myelography (MRm) and 3D-TSE-MRm. The T2-TSE sequence was the standard of reference. Fifty patients with low back pain, sciatica or cervical radiculopathy were examined at 1.0 T. The shortest AP diameter of the spinal canal, signal-to-noise ratio (SNR) for CSF and cord, contrast-to-noise ratio (CNR) and relative contrast (ReCon) between CSF and cord were calculated. No statistically significant difference was found between the three sequences with regard to the AP diameter of the spinal canal. A significant difference was found in: (i) SNRcord; (ii) SNRCSF; (iii) SS-TSE-MRm (showed the highest CNR) and (iv) SS-TSE-MRm (showed higher ReCon compared to 3D-TSE-MRm). In conclusion, SS-TSE-MRm can be used alternatively to 3D-TSE-MRm reducing the acquisition time down to only 8 s per image.     

Pancreatic cysts: depiction on single-shot fast spin-echo MR images

PURPOSE: To evaluate single-shot fast spin-echo (SE) magnetic resonance (MR) imaging for depiction of pancreatic cysts in a large number of patients and to analyze cyst prevalence with respect to patient age and sex and other clinical information. MATERIALS AND METHODS: Single-shot fast SE images of the pancreas were obtained in 1,444 patients. The images were reviewed for presence of pancreatic cysts, which were classified as simple and nonsimple types, and cyst diameters were measured. kappa statistic, Fisher exact, McNemar Q, and Pearson product moment correlation tests were performed. RESULTS: Two hundred eighty-three (19.6%) patients had at least one pancreatic cyst. The prevalence of pancreatic cysts increased with age (r = 0.96). The percentages of male and female patients with pancreatic cysts (20.4% vs 18.8%) were not significantly different. Two hundred seventy-one (18.8%) patients had simple cysts, and 147 (10.2%) had nonsimple cysts. Of 283 patients with pancreatic cysts, 158 (55.8%) had only one pancreatic cyst. The number of patients with multiple cysts increased with age after 70 years. Four hundred fifteen (83.8%) cysts were 10 mm in diameter or smaller; 56 (11.3%), 11-20 mm in diameter; and 24 (4.9%), 21 mm in diameter or larger. Sixteen (5.7%) patients with pancreatic cysts had malignant pancreatic tumors, and 75 (26.5%) patients had pancreatitis. CONCLUSION: The prevalence of pancreatic cysts at single-shot fast SE MR imaging-especially cysts with a diameter smaller than 10 mm-is similar to that of pancreatic cysts at autopsy and higher than that of pancreatic cysts at transabdominal ultrasonography. Prevalence is especially high in patients with pancreatitis.     

Half-fourier acquisition single-shot turbo spin-echo (HASTE) MR: comparison with fast spin-echo MR in diseases of the brain.

PURPOSETo compare an ultrafast T2-weighted (half-Fourier acquisition single-shot turbo spin-echo [HASTE]) pulse sequence with fast spin-echo T2-weighted sequences in MR imaging of brain lesions.METHODSFast spin-echo and HASTE images of 34 consecutive patients over the age of 50 years or with suspected demyelinating disease were reviewed independently by two neuroradiologists for the number of lesions less than 5 mm and greater than or equal to 5 mm, and for lesion conspicuity, gray-white matter differentiation, and extent of periventricular confluent signal abnormality. The reviewers also assessed for the presence of hemosiderin and extent of motion artifacts.RESULTSPer patient, the mean number of 5-mm or larger lesions detected on fast spin-echo images (1.4) relative to the number detected on HASTE images (0.8) was not statistically significant. For lesions less than 5 mm, fast spin-echo images showed more lesions (7.5) than HASTE images did (2.4). The fast spin-echo images were better at depicting gray-white matter differentiation, conspicuity of lesions, and periventricular signal abnormality. Of four T2 hypointense lesions seen on fast spin-echo images, none was detected on HASTE images.CONCLUSIONAlthough the HASTE technique might be useful for rapid imaging of the brain, our study shows a diminished sensitivity for the detection of lesions less than 5 mm in diameter and for T2 hypointense lesions.     

Cardiac T1 calculations from MR spin-echo images

Normally, cardiac triggering in MR spin-echo imaging restricts repetition times (TR) to integral values of the cardiac period (TC), and introduces irregularities in TR due to variations in TC. We have investigated how much these restrictions decrease the accuracy and precision of spin-lattice relaxation (T1) values of the myocardium calculated from two cardiac-triggered spin-echo images. By introducing additional excitation pulses, TR can effectively be reduced to a fractional value of TC and considerable improvement in T1 precision is possible. For TC = 800 ms, the improvement in T1 precision is 30% when two spin-echo images of TR = 1/2 X TC and TR = 2 X TC are used to calculate T1 instead of two images with TR = TC and TR = 2 X TC. The irregularities in TR decrease both T1 precision and accuracy. Irregularities of the order of 15% in a mean TR of 800 ms produce a fourfold decrease in precision. Since irregularities in TC easily exceed 15%, MRI data should be acquired when individual TR values are approximately within +/- 15% of the subject's mean TC.     

High-contrast visualization of uterine three-layer structure by fast spin-echo T2-weighted MR images: comparison with different parameters

We performed experimental and clinical MR studies to determine the optimal imaging conditions for the uterine three-layer structure on fast spin-echo T2-weighted imaging. In the experimental study, we used our original phantom. Imaging studies were carried out with different TRs, TEs, and ETLs, and the contrast-to-noise ratio (CNR) was evaluated. TR was the most important factor for contrast in both the phantom and clinical studies. The longer TR was, the better the contrast became. In the clinical study, TRs of 5500-6000 msec provided clear visualization of the uterine three-layer structure. Longer TRs would be useful for the detection of disease, differential diagnosis, and grading in patients with uterine diseases.     

Gradient-echo MR imaging of the lumbar spine: comparison with spin-echo technique

Gradient-echo (GRE) magnetic resonance (MR) imaging has been advocated as the imaging modality of choice for evaluating radiculopathy in the cervical spine. Axial GRE images of the lumbar spine in 50 patients were compared with similar images obtained using spin-echo (SE) technique on a 1.5 T MR system. The SE images were superior to GRE images in the evaluation of the neural foramina, epidural fat, and disk herniation. The GRE images obtained were inadequate for lumbar spine imaging due to an unacceptable level of chemical shift artifacts. The GRE technique does provide the advantages of rapid acquisition of T2* images and decreased motion artifact. Axial GRE images may play an increasingly important role in lumbar spine imaging with continued changes in software and improvements in technology.     

MR of the head and neck: comparison of fast spin-echo and conventional spin-echo sequences.

PURPOSETo compare conspicuousness of head and neck lesions on fast spin-echo sequences and conventional spin-echo sequences.METHODSForty consecutive patients with 61 head and neck lesions were evaluated. Lesion conspicuousness was qualitatively compared on conventional spin-echo and fast spin-echo sequences, using both spin-density and T2-weighted images. Thirty-six lesions had surgical or pathologic confirmation, and 25 were assigned a presumptive diagnosis based on clinical evaluation and imaging findings seen on conventional spin-echo T1- and T2-weighted sequences. Forty lesions were related to neoplasms; 21 lesions consisted of infectious, vascular, or inflammatory abnormalities.RESULTSFast spin-echo sequences provided improved lesion conspicuousness in 91% of spin-density images, in 77% of T2-weighted images, and in 84% of the combined spin-density and T2-weighted images.CONCLUSIONBy providing shorter imaging times and equal or superior lesion conspicuousness, long-repetition-time fast spin-echo sequences can replace long-repetition-time conventional spin-echo sequences in evaluation of the head and neck.     

MR cholangiopancreatography: comparison of 2D single-shot fast spin-echo and 3D fast spin-echo sequences

PURPOSE: To compare 2D single-shot Fast Spin-Echo (FSE) and two 3D FSE MR cholangiopancreatography (MRCP) sequences with different slice thickness in the evaluation of normal and abnormal biliary and pancreatic duct systems. MATERIALS AND METHODS: Thirty-two consecutive patients, both with normal biliary and pancreatic ducts (n=14) and with different biliary and/or pancreatic duct disease (n=18) underwent MRCP with a 1.5 T superconductive magnet. One 2D single-shot FSE and two 3D FSE MRCP sequences with different slice thickness (1.6 mm and 3 mm) were performed in each patient. Images were analysed with regards to: artefacts (0=none, 1=minimal, 2=present but not affecting the diagnostic evaluation, 3=present and affecting the diagnostic evaluation), image quality (0=non-diagnostic, 1=poor, 2=fair, 3=good, 4=excellent), duct conspicuity (0=not-visible, 1=poor, 2=good, 3=excellent), diagnostic confidence (possible presence of dilatations, stones and stenoses). RESULTS: Artefacts were rarely present, without significant differences among the three sequences. The 2D single-shot FSE sequence provided a significantly better image quality and significantly better conspicuity of the intrahepatic and pancreatic ducts in comparison to both the 1.6-mm and 3-mm thickness 3D FSE sequences. The three sequences yielded identical results in the detection of 17 cases of dilatation and 10 cases of stenosis as well as in the evaluation of their degree. Stones in the biliary tree were detected in 6 cases with the 2D single-shot FSE sequence, in 5 cases in the MIP images of the 3D FSE sequence with slice thickness of 1.6 mm and in 4 cases in the MIP images of the 3D FSE sequence with slice thickness of 3 mm. The diagnostic confidence did not show statistically significant differences among the three sequences. CONCLUSIONS: The 2D single-shot FSE sequence proved to be superior to the 3D FSE sequences in the evaluation of normal and abnormal biliary and pancreatic duct systems.     

Chemical shift-based true water and fat images: regional phase correction of modified spin-echo MR images

The process of separating water and fat signal in magnetic resonance images with the Dixon pulse sequence is hindered by phase errors in the water-fat opposed image. These errors arise from static field inhomogeneities, varying magnetic susceptibilities of different body tissues, and other causes. Phase correction performed with data from phantom imaging can compensate for static field inhomogeneities but not for the other effects. A regional phase-correction algorithm is presented that removes non-chemical-shift phase effects and produces true water and fat images. The technique has been applied with good results to 21 patients and healthy volunteers. The images include ones of the abdomen, knees, hips, spine, and head. This method of regional phase correction is an efficacious way of producing separate water and fat images with the Dixon pulse sequence.     

Cerebrovascular enhancement in spoiled GRASS (SPGR) images: comparison with spin-echo technique.

The signals and artifacts in cerebral blood vessels were systematically studied using a new three-dimensional Fourier transform (3DFT) technique, spoiled gradient recalled acquisition in steady state (SPGR), with parameters optimized for T1-weighted brain imaging. Twenty consecutive patients referred for routine cranial MR imaging were prospectively studied before and after the intravenous administration of Gd-DTPA using both 3DFT SPGR and conventional 2DFT SE imaging. A significant difference between the two techniques was noted in regard to the appearance of cerebral blood vessels and the degree of vascular pulsation artifact. Precontrast SPGR images demonstrated high signal in all (100%) internal carotid arteries and in nearly all (85-95%) vertebral, basilar, and proximal posterior, middle, and anterior cerebral arteries. High signal was variably present (5-50%) in more distal arterial branches. High signal from venous structures was not seen except in the superior sagittal sinus, which was bright in 75% of cases. Postcontrast SPGR images reliably demonstrated uniform high signal in all (100%) major arterial branches, up to fourth-order branches in the middle cerebral artery, diminishing toward the vertex. All (100%) major deep and superficial venous structures were of uniformly high signal, diminishing slightly as they exited the skull base. Flow related artifacts were found to be significantly (p = 0.001) reduced in contrast enhanced SPGR compared to SE images. As implemented in this study, SPGR and SE images demonstrate significantly different patterns of vascular signal that must be recognized for the proper interpretation of MR images.     

Fat-suppressed fast spin-echo mid-TE (TE[effective]=34) MR images: comparison with fast spin-echo T2-weighted images for the diagnosis of tears and anatomic variants of the glenoid labrum

Objective. To compare the sensitivity, specificity, and accuracy of fat-suppressed fast spin-echo (FSE) mid-TE (TE[effective]=34) images with fat-suppressed FSE T2-weighted images for the diagnosis of labral abnormalities. Design and patients. The study included 27 consecutive patients who had axial fat-suppressed FSE T2-weighted and fat-suppressed FSE mid-TE MR images, and had labral abnormalities diagnosed at arthroscopy. The acquisition time was about 5 min for each sequence, but the mid-TE sequence allowed a higher spatial resolution than the T2-weighted images (256×256 versus 256×192). Twenty-eight age-matched patients with arthroscopically normal labra were included as a control group. The labrum was graded on the MR images as normal or abnormal separately by two musculoskeletal radiologists who were masked to the history and arthroscopic results. The surgical findings were used as the gold standard for calculating the sensitivity, specificity, and accuracy for interpreting the correct location of a labral abnormality. The sensitivity, specificity, and accuracy for the two sequences were compared with a McNemar test, and significance defined as P<0.05. Results. For observer 1, the sensitivity for labral abnormalities was 0.59 on the T2-weighted images, and 0.78 on the mid-TE images (P=0.12). The specificity was 0.54 for the T2-weighted, and 0.64 for the mid-TE images (P=0.51). The accuracy was 0.56 for the T2-weighted, and 0.71 for the mid-TE images (P=0.08). For observer 2, the sensitivity/specificity/accuracy was 0.67/0.93/0.80 for the T2-weighted, and 0.70/0.86/0.78 for the mid-TE images (all P>0.5). Conclusion. In this small study there is no statistically significant difference for demonstrating labral abnormalities between FSE T2-weighted images, and higher-resolution fat-suppressed FSE mid-TE (TE[effective]=34) images obtained with a similar acquisition time. Although there was a general trend toward higher sensitivity and accuracy with the mid-TE sequence, particularly for one of the two observers, a larger study is needed to determine whether this is the preferred single axial pulse sequence for conventional MR imaging of the labrum. Received: 28 June 1999 Revision requested: 9 September 1999 Revision received: 20 September 1999 Accepted: 28 September 1999     

Determination of left ventricular volume and mass with use of biphasic spin-echo MR imaging: comparison with cine MR

In this study, the authors compared a new rapid spin-echo magnetic resonance (MR) imaging method, biphasic MR, with cine MR in the determination of left ventricular volume and mass in healthy volunteers. Biphasic spin-echo MR images covering the entire heart were obtained with use of the electrocardiogram R wave and the downslope of the T wave at both end diastole and end systole, respectively. Biphasic MR-determined values correlated well with small standard errors of the estimate (end-diastolic volume = 7.82 cm3, end-diastolic mass = 10.20 g, end-systolic mass = 10.08 g, ejection fraction = 2.62%) and were more reproducible. Cine MR-defined end-systolic volume was significantly larger (P less than .01) and ejection fraction was significantly smaller (P less than .005) than biphasic MR-determined values probably because of the uncertainty in isolating end systole with cine MR. Left ventricular volumes, mass, and ejection fraction are more accurately and reproducibly quantified in a more time-efficient manner with use of biphasic MR than with cine MR because of its significantly shorter image acquisition and reconstruction times.     

Improved precision in calculated T1 MR images using multiple spin-echo acquisition

Calculated T1 images require that magnetic resonance signals be detected at several inversion or repetition times (TR). Multiple spin-echo (SE) acquisitions provide several measurements of the magnetization at each TR, the signal size diminishing according to T2 decay. In this work we review one method (Case 1) for estimating T1 from single echoes and present four new methods (Cases 2-5) in which multiple acquired echoes are used. For Case 2 a fit is performed using the first echo at each TR, repeated using second echoes, etc., and the final T1 estimate is the simple average of the individual fits at each echo time (TE). For Case 3 the optimum weighted average is performed. For Cases 4 and 5 synthetic SE images are generated at each TR prior to the T1 fit, Case 4 using a synthetic TE of zero, and Case 5 using a TE providing maximum signal-to-noise ratio in the synthetic image. The relative precision in T1 provided by each method is calculated rigorously. It is proven that Cases 3 and 5 are optimum and equivalent and can theoretically reduce the noise in T1 images by as much as 40% over Case 1 with no increase in scanning time. Approximations are proposed that enable the optimum methods to be implemented in a practical fashion. Experimental images are presented that verify the relative predicted behavior.     

Fat-suppressed MR of the orbit and cavernous sinus: comparison of fast spin-echo and conventional spin-echo.

PURPOSETo compare T2-weighted fat-suppressed fast spin-echo imaging with fat-suppressed conventional spin-echo imaging in the detection of normal intraorbital and pericavernous anatomy and orbital disease, and to determine the efficacy of fat saturation with T2-weighted fast spin-echo imaging of the cavernous sinus.METHODSContrast-to-noise ratios of normal intraorbital anatomy were calculated and compared in 10 consecutive patients using fat-suppressed fast spin-echo and conventional spin-echo T2-weighted images. Contrast-to-noise ratios of common intraorbital lesions were calculated and compared using fat-suppressed fast spin-echo and fat-suppressed conventional spin-echo. Qualitative evaluation was performed and compared for normal intraorbital anatomy using both fat-suppressed fast spin-echo and fat-suppressed conventional spin-echo in 16 patients. Qualitative evaluation for the detection of normal anatomic structures of the pericavernous region was performed and compared using fast spin-echo with and without fat suppression and fat-suppressed conventional spin-echo T2-weighted images in 16 patients. Fat saturation was performed using standard commercially available chemical saturation technique.RESULTSReduced imaging time allowed more acquisitions for fat-suppressed fast spin-echo images, which significantly improved visibility of intraorbital and pericavernous anatomy over fat-suppressed conventional spin-echo. Anatomic visibility was also improved because of reduced motion, phase encoding, and susceptibility artifacts. There was no significant difference between contrast-to-noise ratios for fat-suppressed fast spin-echo and fat-suppressed conventional spin-echo imaging of the lateral and medial rectus muscles. Contrast-to-noise ratios of fat suppressed fast spin-echo of orbital disease was significantly greater than contrast-to-noise ratios of fat-suppressed conventional spin-echo. Detection of several normal anatomic structures of the pericavernous region was significantly improved with non-fat-suppressed fast spin-echo over fat-suppressed fast spin-echo because of significantly reduced magnetic susceptibility artifact.CONCLUSIONSFat-suppressed fast spin-echo is superior to fat-suppressed conventional spin-echo for T2-weighted orbital imaging. Non-fat-suppressed fast spin-echo is the preferred pulse sequence for T2-weighted imaging of the cavernous sinus because of the minimal susceptibility artifact.