Clinical applications of high-resolution ocular magnetic resonance imaging

Magnetic resonance imaging (MRI) using fast sequences with subjects staring at a target can provide motion-free ocular images, and small receiver surface coils make it possible to produce ocular images with high spatial resolution. MRI using half-Fourier single-shot rapid acquisition with a relaxation enhancement sequence as a fast T2-weighted imaging yields useful images for the morphologic diagnosis of ocular diseases, and MRI using a fast spoiled gradient-recalled-echo sequence as a T1-weighted imaging yields additional information by the administration of gadolinium-based contrast material for assessing the vascularity of intraocular tumors. These ocular imaging techniques are useful for the evaluation of patients with angle closure glaucoma, congenital abnormality of ocular globes, intraocular tumors and several types of detachments, as well as patients after ocular surgery. In this pictorial essay, we demonstrate the clinical applications of fast high-resolution ocular MRI with fixation of the subjects?? visual foci.     

PACS-based functional magnetic resonance imaging.

The picture archiving and communication system (PACS) technology reaches its 10th anniversary. Retrospectively no one could foresee the impact the PACS would have to the health care enterprise, but it is common consent today, that PACS is the key technology crucial to daily clinical image operations and especially to image related basic and clinical research. During the past 10 years the PACS has been matured from a research and developmental stage into commercial products which are provided by all major modality and health care equipment vendors. The PACS, originally implemented in the Radiology Department, needs to grow and has already carried well beyond departmental limits conquering all image relevant areas inside the hospital. During the past 10 years a dramatic development in imaging techniques especially within MRI emerged. Advanced 3D- and 4D-MR imaging techniques result in much more images and more complex data objects than ever before which need to be implemented into the existing PACS. These new imaging techniques require intensive post-processing apart from the imaging modality which need to be integrated into the image workflow and the PACS implementation. Along with these new imaging techniques new clinical applications, e.g. stroke detection, and research applications, e.g. study of heart and brain function, in Neurology and Cardiology require changes to the traditional PACS concept. Therefore inter-disciplinary image distribution will become the high-water mark for the next 10 years in the PACS endeavor. This paper focuses on one new advanced imaging technique, functional magnetic resonance imaging (fMRI), and discusses how fMRI data is defined, what fMRI requires in terms of clinical and research applications and how to implement fMRI in the existing PACS.     

Extracranial applications of diffusion-weighted magnetic resonance imaging

Diffusion-weighted MRI has become more and more popular in the last couple of years. It is already an accepted diagnostic tool for patients with acute stroke, but is more difficult to use for extracranial applications due to technical challenges mostly related to motion sensitivity and susceptibility variations (e.g., respiration and air-tissue boundaries). However, thanks to the newer technical developments, applications of body DW-MRI are starting to emerge. In this review, we aim to provide an overview of the current status of the published data on DW-MRI in extracranial applications. A short introduction to the physical background of this promising technique is provided, followed by the current status, subdivided into three main topics, the functional evaluation, tissue characterization and therapy monitoring.     

Clinical applications of magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is the most important diagnostic alternative that has been developed in recent years for the evaluation of the biliary and pancreatic ducts. The advantages of this technique are: it does not use contrast media or ionizing radiation; it is noninvasive and complication free; and, the examination is relatively short (approximately 20 to 30 minutes). MRCP has high sensitivity and specificity for diagnosing biliary dilatation and for determining the site and cause of stenosis. Its diagnostic precision for biliary and pancreatic stones is similar to that of endoscopic retrograde cholangiopancreatography (ERCP). MRCP has replaced ERCP in biliary and pancreatic anatomic variants. In unsuccessful ERCP, MRCP is nearly the only diagnostic modality for the evaluation of the biliary tract. Other applications include primary sclerosing cholangitis, stenosis after liver transplantation, and the evaluation of bilioenteric anastomoses. This article reviews the clinical applications of MRCP in the evaluation of biliopancreatic diseases.     

Spatially filtering functional magnetic resonance imaging data

When constructing MR images from acquired spatial frequency data, it can be beneficial to apply a low-pass filter to remove high frequency noise from the resulting images. This amounts to attenuating high spatial frequency fluctuations that can affect detected MR signal. A study is presented of spatially filtering MR data and possible ramifications on detecting regionally specific activation signal. It is shown that absolute activation levels are strongly dependent on the parameters of the filter used in image construction and that significance of an activation signal can be enhanced through appropriate filter selection. A comparison is made between spatially filtering MR image data and applying a Gaussian convolution kernel to statistical parametric maps.     

The clinical potential of functional magnetic resonance imaging

Functional magnetic resonance imaging (fMRI) has had a huge impact on understanding the healthy human brain. To date it has had much less impact in clinical neuroscience or clinical practice. The reasons for this are in part that the image acquisition, paradigm design, and data analysis strategies used presently are not sufficiently standardized. This makes the comparison of results across individuals, scanning sessions, and centers difficult. Nevertheless, there are emerging applications for clinical fMRI, and as the field matures the number of applications is likely to grow. It seems certain that fMRI has an important role to play in helping us understand the mechanisms of neuropsychiatric diseases and in helping to identify effective therapeutic strategies.     

Probabilistic analysis of functional magnetic resonance imaging data

Probability theory is applied to the analysis of fMRI data. The posterior distribution of the parameters is shown to incorporate all the information available from the data, the hypotheses, and the prior information. Under appropriate simplifying conditions, the theory reduces to the standard statistical test, including the general linear model. The theory is particularly suited to handle the spatial variations in the noise present in fMRI, allowing the comparison of activated voxels that have different, and unknown, noise. The theory also explicitly includes prior information, which is shown to be critical in the attainment of reliable activation maps.     

Applications of functional magnetic resonance imaging in psychiatry

While the use of MRI techniques has become a cornerstone of the neurology clinic, the application of such methods in psychiatry was rather limited until the advent of functional magnetic resonance imaging (fMRI). Over the past decade fMRI has superseded radionuclide-imaging techniques and blossomed into a widely used psychiatric research tool. This review focuses on the neurobiological findings from fMRI research in three less well-documented psychiatric disorders: attention deficit hyperactivity disorder (ADHD), depression, and obsessive-compulsive disorder (OCD). Although there was some disparity in early findings, greater standardization of image acquisition, analysis, and paradigms, and improved clinical classification are leading to a greater convergence of observations from different laboratories. fMRI is also beginning to realize its potential as an important mediator between genes and phenotypes, and may thus contribute to a better understanding of the pathophysiology of major neuropsychiatric diseases. The role of fMRI in the objective assessment of therapeutic intervention and early prediction of response to treatment is also discussed.     

Clinical impact of shoulder magnetic resonance imaging

The clinical impact of magnetic resonance imaging (MRI) of the shoulder is dependent upon the clinical diagnosisand clinical indications for surgical management. MRI of the shoulder is very useful in defining the anatomic pathology associated with shoulder pain and disability. The clinical impact of MRI is improved when it is obtained under well defined criteria which should be based upon clinical treatment algorithms. Shoulder MRI is best used to define the anatomic pathology associated with rotator cuff tears and traumatic glenohumeral instability.     

Clinical impact of elbow magnetic resonance imaging

The elbow and its articulations are subject to tremendous forces during overhead sports. The elbow joint is vulnerable to a variety of injuries as a result of either acute traumatic events or chronic repetitive overuse. Elbow pathology in throwing athletes has been classified according to the mechanism of injury: medial tension overload, lateral compression, extension overload, and posterolateral rotatory instability. Given the complexity of these injuries, complete diagnosis and treatment requires a thorough evaluation of the elbow. This evaluation begins with a history and physical examination, an understanding of pathomechanics, and an assessment of normal and pathological anatomy. Imaging studies may be of assistance in defining this anatomy. The correlation of these imaging studies with clinical information is essential in the proper diagnosis and management of these complex injuries. This article presents the impact of elbow magnetic resonance imaging (MRI) for the clinical diagnosis of the three most common elbow disorders for which MRI has diagnostic efficacy in the athlete.     

Chest applications of magnetic resonance imaging: an update

Accumulated experience with MR applications in the chest has helped to define its role relative to other modalities. Technical advances improving image quality, newer fast scans, and cine methods are expanding the information available from MR. This discussion reviews the useful applications and limitations of MR in evaluating thoracic disorders. Physicians should be knowledgeable and selective in their utilization of this modality.     

眼外肌功能MRI研究进展

眼外肌病变多样,既往多注重研究形态学变化,随着MR设备及新技术的不断开发和进展,功能磁共振成像已成为显示眼外肌运动功能及病理变化的无创性影像学检查方法。就功能磁共振技术在眼外肌成像中的发展及应用予以综述。     

眼外肌功能MRI研究进展

眼外肌病变多样,既往多注重研究形态学变化,随着MR设备及新技术的不断开发和进展,功能磁共振成像已成为显示眼外肌运动功能及病理变化的无创性影像学检查方法。就功能磁共振技术在眼外肌成像中的发展及应用予以综述。     

Nuclear magnetic resonance imaging: applications for neurological abnormalities

In recent clinical trials, nuclear magnetic resonance (NMR) imagers have demonstrated their ability to generate images with superb contrast and spatial detail in multiple planes. Blood vessels are especially well defined without the use of contrast agents. Although NMR is highly sensitive to changes in tissue composition, the potential of NMR to differentiate among different pathologic entities remains to be fully elucidated.     

Clinical and experimental sodium magnetic resonance imaging

In conclusion, sodium MR imaging has potential for providing physiologic information relevant to cell mitosis, cell energy state, rCBV, and seizures. Considerable technical and experimental development is necessary, however, before sodium MRI becomes a routine examination in the clinical setting.     

Artifacts in functional magnetic resonance imaging from gaseous oxygen

Unexpectedly large fluctuations in signal intensity wen identified in the functional MRI (FMRI) of normal subjects breathing pure oxygen intermittently. To test the hypothesis that the signal changes were due to fluctuating concentrations of gaseous (paramagnetic) oxygen in the magnetic field, echo planar gradient echo images were acquired of a phantom contiguous to an oxygen mask through which pure oxygen was administered intermittently via plastic tubing. As a control, room air was administered intermittently or oxygen continuously in the same experimental protocol. Signal intensity changes of up to 60% temporally correlated with the administration of oxygen were produced in the phantom. In functional images prepared from the echo planar images, the signal intensity changes resulted in artifacts especially at interfaces in the phantom. The intermittent administration of pure oxygen during acquisition of data for FMRI may produce signal intensity changes that simulate or obscure function.     

Clinical use of urinary tract magnetic resonance imaging

MR imaging should not be used to evaluate the majority of the lesions described herein but should be reserved for specific clinical situations. The detection and differential diagnosis of adrenal masses is a legitimate application of this technique. The staging of renal tumors in patients in whom CT fails to do so may be accomplished by MR imaging. Establishment of patency of the renal veins and of surgical shunts involving these veins may be performed by MR imaging if Doppler ultrasonography proves unsatisfactory. MR imaging may differentiate between stable retroperitoneal fibrosis and malignant disease in patients in whom this differential is a problem. Hematomas may be distinguished from nonhemorrhagic fluid collections anywhere in the abdomen or pelvis. In selected patients, the local extent of certain bladder tumors may be evaluated by MR imaging when CT and biopsy fail to do so. In testicular disease, MR imaging may aid in the differential diagnosis of abnormalities that are not sufficiently characterized by ultrasonography, and MR imaging may detect undescended testes in some patients in whom ultrasonography fails to do so. In the future, wider application of fast scanning with bolus administration of soluble paramagnetic contrast agents may refine the differential diagnosis of adrenal masses and aid in the detection of renal masses. MR angiographic techniques ultimately may constitute a screening procedure for renal arteriostenosis. A subset of patients with prostate carcinoma may prove to benefit from local staging of the disease by MR imaging.