Extraadrenal pheochromocytoma: detection during pregnancy using MR imaging

This case report demonstrates the usefulness of magnetic resonance (MR) imaging to demonstrate an abdominal mass during pregnancy. A pregnant woman presented in midgestation with symptoms and chemical evidence of a pheochromocytoma. The use of MR imaging permitted early localization of a retrouterine tumor when it would have been undesirable for the woman to undergo computed tomography because of radiation exposure. Evaluation of the MR images formed the basis of the therapeutic strategy used by the patient's physicians.     

Two-dimensional excitation short echo time chemical shift imaging at 0.5 tesla

Detection of short T2 metabolites such as glutamate and glutamine (glx) in the brain can be improved by minimizing the echo time (TE) of the pulse sequence. By combining two dimensions of localization during a single radiofrequency (RF) pulse, an elliptic excitation chemical shift imaging sequence (EECSI) that further reduces TE by a factor of 2 relative to a TE-optimized point resolved spectroscopy sequence chemical shift imaging sequence was developed. An additional set of outer volume saturation pulses is included to minimize the contamination from scalp and marrow space lipids. The sequence runs with conventional gradient hardware (1 G/cm, 17 T/m/s slew rate) at 0.5 T. The increase in the fitted areas of beta,gamma multiplet of glutamate and glx in a brain-mimicking phantom was by a factor of 1.66. In the thalamus of healthy volunteers, glx was increased by 1.44. Combined with the field strength-related improvements in glutamate and glx detection previously demonstrated at 0.5 T, EECSI offers further improvements for imaging glutamate and glx in vivo.     

Coronal nuclear magnetic resonance (NMR) imaging of the abdomen at 0.5 tesla

Coronal nuclear magnetic resonance (NMR) abdominal imaging was performed on a normal volunteer. The scan technique and anatomic features are described. Coronal abdominal scanning optimizes vascular imaging in the abdomen and is helpful in defining the anatomic relationships of a variety of structures.     

Real-time cardiac MRI at 3 tesla.

Real-time cardiac and coronary MRI at 1.5T is relatively "signal starved" and the 3T platform is attractive for its immediate factor of two increase in magnetization. Cardiac imaging at 3T, however, is both subtly and significantly different from imaging at 1.5T because of increased susceptibility artifacts, differences in tissue relaxation, and RF homogeneity issues. New RF excitation and pulse sequence designs are presented which deal with the fat-suppression requirements and off-resonance issues at 3T. Real-time cardiac imaging at 3T is demonstrated with high blood SNR, blood-myocardium CNR, resolution, and image quality, using new spectral-spatial RF pulses and fast spiral gradient echo pulse sequences. The proposed sequence achieves 1.5 mm in-plane resolution over a 20 cm FOV, with a 5.52 mm measured slice thickness and 32 dB of lipid suppression. Complete images are acquired every 120 ms and are reconstructed and displayed at 24 frames/sec using a sliding window. Results from healthy volunteers show improved image quality, a 53% improvement in blood SNR efficiency, and a 232% improvement in blood-myocardium CNR efficiency compared to 1.5T.     

Musculoskeletal MR imaging: turbo (fast) spin-echo versus conventional spin-echo and gradient-echo imaging at 0.5 tesla

The value of T2-weighted fast spin-echo imaging of the musculoskeletal system was assessed in 22 patients with various neoplastic, inflammatory, and traumatic disorders. Images were acquired with high echo number (i.e., echo train length) fast spin-echo (FSE; TR 2000 ms, effective TE 100 ms, echo number 13, lineark-space ordering), conventional spin-echo (SE; TR 2000 ms, TE 100 ms) and gradient-echo (GRE) sequences (TR 600 ms, TE 34 ms, flip angle 25°). Signal intensities, signal-to-noise ratios, contrast, contrast-to-noise ratios, lesion conspicuousness, detail perceptibility, and sensitivity towards image artifacts were compared. The high signal intensity of fat on FSE images resulted in a slightly inferior lesion-to-fat contrast on FSE images. However, on the basis of lesion conspicuity, FSE is able to replace time-consuming conventional T2-weighted SE imaging in musculoskeletal MRI. In contrast, GRE images frequently showed superior lesion conspicuity. One minor disadvantage of FSE in our study was the frequent deterioration of image quality by blurring, black band, and rippling artifacts. Some of these artifacts, however, can be prevented using short echo trains and/or short echo spacings.     

Detection of glutamate/glutamine resonances by 1H magnetic resonance spectroscopy at 0.5 tesla

Midfield proton magnetic resonance spectroscopy (MRS) provides a noninvasive method to monitor glutamate and glutamine (Glx) levels in vivo. Experiments to detect the γ and β resonances of Glx have been performed by using commercial 0.5 T and 1.5 T MR scanners on seven patients with elevated blood ammonia and eight normal volunteers. Compared with the spectral sensitivity obtained on an otherwise identical system operating at 1.5 T, the singlet resonance of N-acetyl aspartate (NAA) was decreased by a factor of 1.48, which is significantly less than expected using the ratio of Boltzman populations at the two field strengths. However, the resonances of Glx at 0.5 T increased in signal-to-noise ratio (SNR) by a factor of 2. The increased SNR of Glx is principally due to improved B ₀ main-field homogeneity and collapse of the strongly J -coupled Glx resonances. Our preliminary results suggest that midfield proton MRS will provide significant clinical utility in the detection of Glx levels in human brain.     

MR demonstration of a cystic pheochromocytoma

Cystic pheochromocytoma is a rare tumor of the adrenal gland that can pose a diagnostic challenge. We report a case of a 14 year-old boy who had an adrenal lesion that appeared cystic by both sonography and CT, but that demonstrated hemorrhage into the lesion at MR Imaging, and proved to be a cystic pheochromocytoma. We emphasize the importance of considering the diagnosis of pheochromocytoma when faced with a cystic lesion of the adrenal gland.     

Experimental focal cerebral ischaemia assessed with IVIM*-MRI in the acute phase at 0.5 tesla

Summary Intravoxel incoherent motion (IVIM^*)-MRI has been performed on a clinical system at 0.5 tesla with a b gradient factor of 100 s/mm², in a feline focal model of cerebral ischaemia. Images were obtained in 26 cats from less than 1 hour and up to 7–12 hours after stroke. The apparent diffusion coefficient (ADC) was decreased at the site of injury when compared to the contralateral normal side, by 30% in the first, 33% in 1–2 h and 27% in 2–4 h; it increased at 7–12 h, when vasogenic oedema occurred. IVIM^*-MRI demonstrated early changes, due to cytotoxic oedema, during the acute phase of cerebral ischaemia to which conventional T2-weighted spin-echo imaging was not sensitive.     

Depiction of the normal adrenal gland evaluation with 0.5 tesla MRI

MR studies of the abdomen in 128 patients were reviewed in order to evaluate the normal adrenal glands. The studies were performed on a 0.5-Tesla superconducting unit. T1-weighted spin-echo (T1WI), T2-weighted spin-echo (T2WI) and T2*-weighted gradient-echo (T2*-WI) images were obtained. T1WI demonstrated the normal adrenal glands in 90% of the patients. T2*WI identified the glands in 86%, a higher rate than the 73% for T2WI. On both T1WI and T2WI, the right adrenal gland was demonstrated of a lower rate than the left adrenal gland, because the right retroperitoneal fat layer was narrow in patients with hepatic tumors. T2*WI depicted both adrenal glands equally, because the intensity of the left adrenal gland was the same as that of collateral veins from portal hypertension. It is suggested that both T1WI and T2WI with a gradient echo pulse sequence are more useful in depicting the adrenal glands than both T1WI and T2WI.     

MR characteristics of meningioma subtypes at 1.5 tesla.

Analysis of MR signal characteristics and histopathologic findings confirms the strong correlation between meningioma subtype and observed signal intensity (SI) changes in 24 patients imaged at 1.5 T. On T2-weighted images, 90% of fibroblastic and transitional tumors were hypointense relative to cerebral cortex (SI intermediate greater than SI T2-weighted images); conversely, 66% of meningothelial subtypes displayed persistent hyperintensity (SI intermediate less than or equal to SI T2-weighted images), and the remaining one-third demonstrated mixed high-signal changes. Subtype specific differences in collagen distribution and cellularity, i.e., tumor geometry, appeared to account for these signal trends. Based solely on SI characteristics, correct histologic subgrouping of tumors as either fibroblastic/transitional or meningothelial/angioblastic was possible in 80% (19 of 24) of patients. Utilization of adjunctive imaging features (i.e., mass effect, peritumoral edema, intratumoral cyst formation) in conjunction with signal changes permitted a correct histologic pattern in 96% (23 of 24) of patients.     

The optic pathways: a magnetic resonance study at 1.5 tesla. I. Anatomy

The authors retrospectively examined one hundred and twenty-nine patients who had undergone MR examination of the sellar, parasellar and orbital regions, to evaluate MR capabilities in demonstrating the optic pathways and their relationship to the most important anatomical structures nearby. T1-weighted images allowed a very good evaluation not only of the optic pathways as a whole, but also of the intracanalicular and intracranial segments of the optic nerve; the optic tracts and geniculate bodies were also clearly demonstrated. Optic radiations were clearly visible on both T1- and T2-weighted images. The orbital portion of the optic nerve could be evaluated with T1-weighted images, which showed its external profile. However, only multi-echo T2-weighted images allowed the nerve to be differentiated from perineural spaces, filled with cerebrospinal fluid, thus giving a true cisternographic effect.     

Magnetic resonance imaging of the pancreas at 3.0 tesla: qualitative and quantitative comparison with 1.5 tesla

OBJECTIVES: We sought to perform a preliminary comparison of signal-to-noise ratio (SNR) and image quality for magnetic resonance imaging (MRI) of the pancreas at 1.5 and 3 T. MATERIALS AND METHODS: Two imaging cohorts were studied using a T2-weighted, single-shot fast spin-echo pulse sequence and a T1-weighted, fat-suppressed 3D gradient-echo pulse sequence. In the first cohort, 4 subjects were imaged using identical imaging parameters before and after contrast administration at 1.5 and 3.0 T. The SNR was quantified for the pancreas as well as for the liver, spleen, and muscle. In a second cohort of 12 subjects in whom the receiver bandwidth was adjusted for field strength, SNR measurements and qualitative rankings of image quality were performed. RESULTS: In the study cohort using identical imaging parameters at both magnetic field strengths, the mean (SD) ratios of SNR at 3.0 to 1.5 T of the single-shot fast spin-echo images for the pancreas, liver, spleen, and muscle were 1.63 (0.39), 1.82 (0.39), 1.45 (0.18), 2.01 (0.16), respectively. For the precontrast fat-suppressed 3D gradient-echo sequence, the corresponding ratios were 1.28 (0.29), 1.26 (0.30), 1.16 (0.27), and 1.76 (0.45), respectively; for the arterial phase, the corresponding ratios were 2.02 (0.28), 1.60 (0.42), 1.47 (0.26), and 1.94 (0.32), respectively; and for the delayed postcontrast phase, the corresponding ratios were 1.63 (0.51), 2.01 (0.25), 1.66 (0.06), and 2.31 (0.47), respectively. The SNR benefit of 3.0 T was significantly greater on contrast-enhanced as compared with noncontrast T1-weighted 3D gradient-echo images. In the second study cohort, SNR was superior at 3.0 T, although the use of a reduced readout bandwidth at 1.5 T substantially diminished the advantage of the higher field system. With qualitative comparison of images obtained at the 2 magnetic field strengths, the fat-suppressed 3D gradient-echo images obtained at 3.0 T were preferred, whereas the single shot fast spin-echo images obtained at 1.5 T were preferred because of better signal homogeneity. CONCLUSIONS: Our results in a small cohort of volunteers and patients demonstrate a marked improvement in SNR at 3.0 T compared with 1.5 T (by a factor of 2 in some cases) when identical imaging parameters were used. The SNR advantage at 3.0 T is diminished but persists when the receiver bandwidth is adjusted for magnetic field strength. The results suggest that 3.0 T may offer promise for improved body MRI, although further technical development to optimize SNR and improve signal homogeneity will be needed before its full potential can be achieved.     

Magnetic resonance imaging at 3.0 tesla detects more lesions in acute optic neuritis than at 1.5 tesla

OBJECTIVE: We sought to assess whether magnetic resonance imaging (MRI) at 3.0 T detects more brain lesions in acute optic neuritis (ON) than MRI at 1.5 T. MATERIALS AND METHODS: Twenty-eight patients with acute ON were scanned at both field-strengths using fast-fluid-attenuated inversion recovery (FLAIR), proton density and T2-weighted turbo spin echo, and T1-weighted spin echo after contrast. In addition, magnetization-prepared rapid acquisition gradient echo (MPRAGE) was obtained after contrast at 3.0 T. Lesion number and volumes were assessed by an observer blind to patient identity and field strength. RESULTS: Scans at 3.0 T showed a significantly increase in number of lesions detected on FLAIR images (P = 0.002) relative to scanning at 1.5 T. MPRAGE proved to be suitable for detecting enhancing lesions in ON. CONCLUSION: The MRI protocol at 3.0 T was more sensitive to hyperintense brain lesions in ON than the standard MRI protocol at 1.5 T.     

Fibrous dysplasia: magnetic resonance imaging appearance at 1.5 tesla

Fibrous dysplasia has been described in a small number of cases in the literature as showing low signal intensity on T1- and T2-weighted magnetic resonance images. We reviewed magnetic resonance scans of 13 patients with fibrous dysplasia to determine if there might be a characteristic appearance. All lesions had sharply defined borders and were of intermediate signal intensity on T1-weighted images. With T2 weighting, six lesions (46%) showed high signal intensity, four (31%) showed persistent intermediate signal intensity, and three (23%) showed mixed intermediate and high signal intensity. Ten lesions (77%) had inhomogeneous signal intensity and three (23%) had homogeneous signal intensity. We concluded that fibrous dysplasia does not have a characteristic appearance on magnetic resonance imaging. However, magnetic resonance may be helpful in establishing the diagnosis of fibrous dysplasia if low to intermediate signal intensity is seen on both T1- and T2-weighted images. This situation occurred in 54% of our cases, whereas the other 46% had nonspecific signal characteristics indistinguishable from many other bone lesions.     

1H spectroscopic imaging of rat brain at 7 tesla.

1H magnetic resonance spectroscopic imaging has been used to obtain metabolite maps of the rat brain. The spin-echo-based technique has been evaluated with respect to water and lipid suppression and sensitivity. Metabolite maps were constructed for choline, creatine + phosphocreatine, amino acids, N-acetyl aspartate, and lactate. A spatial resolution of 3 x 3 mm (in plane) with 7-mm-thick slices was achieved routinely in 60-min (16 x 16 phase encodings) acquisitions. For higher intensity resonances, metabolite maps could be constructed in as little as 10 min. Results from phantoms and from rats under normal and focal ischemia conditions are presented.     

Magnetic resonance imaging contrast enhancement of brain tumors at 3 tesla versus 1.5 tesla

RATIONALE AND OBJECTIVES: To compare the diagnostic efficacy of a standard dose of MRI contrast agent in the evaluation of primary brain tumors and metastases using a high-field 3 tesla MR unit versus a 1.5 tesla MR unit. METHODS: Sixteen patients with brain tumors were examined at both field strengths using identical axial T1-SE protocols pre- and postcontrast (0.1 mmol/kg gadolinium), and postcontrast coronal 3D GRE with magnetization preparation (MP-RAGE), which was adjusted separately for each field strength. Evaluation of the images was performed quantitatively and, in the case of T1-SE images, also by visual assessment. RESULTS: Tumor-to-brain-contrast after gadolinium administration using statistical evaluation of MP-RAGE scans was significantly higher at 3 tesla (97.5) than at 1.5 tesla (46.3). The same was true for T1-SE sequences (93.0 vs. 72.1). Signal enhancement of the lesions in T1-SE sequences was not significantly different between both field strengths. CONCLUSIONS: Administration of a gadolinium contrast agent produces higher contrast between tumor and normal brain at 3 tesla than at 1.5 tesla.     

MRI at 7 tesla and above: Demonstrated and potential capabilities

With more than 40 installed MR systems worldwide operating at 7 Tesla or higher, ultra‐high‐field (UHF) imaging has been established as a platform for clinically oriented research in recent years. Along with technical developments that, in part, have also been successfully transferred to lower field strengths, MR imaging and spectroscopy at UHF have demonstrated capabilities and potentials for clinical diagnostics in a variety of studies. In terms of applications, this overview article focuses on already achieved advantages for in vivo imaging, i.e., in imaging the brain and joints of the musculoskeletal system, but also considers developments in body imaging, which is particularly challenging. Furthermore, new applications for clinical diagnostics such as X‐nuclei imaging and spectroscopy, which only really become feasible at ultra‐high magnetic fields, will be presented. J. Magn. Reson. Imaging 2015;41:13–33. © 2014 Wiley Periodicals, Inc .