Malignant uveal melanoma and simulating lesions: MR imaging evaluation

Twenty-one patients with intraocular disease were studied by magnetic resonance (MR) imaging and computed tomography (CT). In 13 cases, malignant uveal melanoma was considered the likely diagnosis. Both imaging methods were accurate in determining the location and size of uveal melanomas. MR imaging was superior for the assessment of possible associated retinal detachment, for assessment of vitreous change, and for differentiating uveal melanoma from choroidal hemangioma and choroidal detachment. A case of retinal gliosis could not be differentiated from uveal melanoma by either technique. Uveal melanomas appeared as hyperintense lesions on T1-weighted images and as hypointense lesions on T2-weighted images. High signal intensity of the vitreous was observed in patients with vitritis and in those who were thought to have protein leaking into the vitreous as a result of impairment of the retinal-blood barrier.     

Brain: gadolinium-enhanced fast fluid-attenuated inversion-recovery MR imaging

PURPOSE: To determine the clinical utility of gadolinium-enhanced fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) imaging of the brain by comparing results with those at gadolinium-enhanced T1-weighted MR imaging with magnetization transfer (MT) saturation. MATERIALS AND METHODS: In 105 consecutive patients referred for gadolinium-enhanced brain imaging, FLAIR and T1-weighted MR imaging with MT saturation were performed before and after administration of gadopentetate dimeglumine (0.1 mmol per kilogram of body weight). Pre- and postcontrast images were evaluated to determine the presence of abnormal contrast enhancement and whether enhancement was more conspicuous with the FLAIR or T1-weighted sequences. RESULTS: Thirty-nine studies showed intracranial contrast enhancement. Postcontrast T1-weighted images with MT saturation showed superior enhancement in 14 studies, whereas postcontrast fast FLAIR images showed superior enhancement in 15 studies. Four cases demonstrated approximately equal contrast enhancement with both sequences. Six cases showed some areas of enhancement better with T1-weighted imaging with MT saturation and other areas better with postcontrast fast FLAIR imaging. Superficial enhancement was typically better seen with postcontrast fast FLAIR imaging. CONCLUSION: Fast FLAIR images have noticeable T1 contrast making gadolinium-induced enhancement visible. Gadolinium enhancement in lesions that are hyperintense on precontrast FLAIR images, such as intraparenchymal tumors, may be better seen on T1-weighted images than on postcontrast fast FLAIR images. However, postcontrast fast FLAIR images may be useful for detecting superficial abnormalities, such as meningeal disease, because they do not demonstrate contrast enhancement of vessels with slow flow as do T1-weighted images.     

Choroidal hemangioma: MR findings and differentiation from uveal melanoma.

BACKGROUND AND PURPOSEThe aim of this study was to establish the MR imaging characteristics of choroidal hemangioma and to compare them with those of uveal melanoma.METHODSAmong 41 patients examined at 1.5 T (4-cm surface coil, T1-weighted and fast spin-echo T2-weighted sequences), 25 had uveal melanoma and 16 had circumscribed choroidal hemangioma. After i.v. bolus injection of gadopentetate dimeglumine, dynamic and T1-weighted sequences were acquired.RESULTSIn patients with choroidal hemangioma, uniform signal characteristics were detected on fast T2-weighted images. In 15 of 16 patients with choroidal hemangioma, lesions were isointense with vitreous on fast spin-echo T2-weighted images, whereas lesions in 24 of 25 patients with uveal melanoma were hypointense. Signal characteristics of uveal melanoma and hemangioma did not differ significantly on plain T1-weighted images. Enhancement was earlier and much stronger for circumscribed choroidal hemangioma than for uveal melanoma. After i.v. bolus application of gadopentetate dimeglumine, the increase of signal intensity was higher for circumscribed choroidal hemangioma (signal intensity ratio, 5.8) than for uveal melanoma (signal intensity ratio, 2.2).CONCLUSIONCircumscribed choroidal hemangioma may be difficult to differentiate from melanoma by ophthalmologic examination. Differentiation may not be possible if direct viewing of uveal space-occupying lesions is hampered by opaque vitreous media. The characteristic findings on fast spin-echo T2-weighted MR images and early enhanced images aid in differentiating choroidal hemangioma from uveal melanoma.     

Focal nodular hyperplasia of the liver on ferumoxides-enhanced MR imaging: features on conventional spin-echo, fast spin-echo and gradient-echo pulse sequences

The aim of this study was to assess the efficacy of a superparamagnetic iron oxide, ferumoxides, in the detection and characterization of focal nodular hyperplasia (FNH) on MR conventional spin-echo (SE), fast spin-echo (FSE) and gradient-echo (GRE) images. Fourteen adults with 27 FNHs were evaluated at 1.5 T before and after injection of ferumoxides. T1-weighted and T2-weighted SE, T2-weighted FSE and T2^*-weighted GRE sequences were used and analysed qualitatively and quantitatively. One hundred percent of FNHs showed a significant postcontrast decrease in signal intensity on T2- and T2*-weighted images. Heavily T2-weighted SE images showed the maximum decrease in FNH signal-to-noise ratio (S/N). Postcontrast GRE T2^*-weighted images improved the detection of the central scar and the delineation of FNHs and demonstrated the best lesion-to-liver contrast-to-noise ratio (C/N). Postcontrast T1-weighted SE images showed the least lesion-to-liver C/N. Ferumoxides-enhanced MR imaging can help detect and characterize FNH. Conventional pre- and postcontrast T2-weighted SE images and postcontrast GRE T2*-weighted images should be used preferentially. Received: 30 November 1998; Revised: 5 April 1999; Accepted: 6 April 1999     

MR imaging of Sturge-Weber syndrome: role of gadopentetate dimeglumine and gradient-echo techniques

Five patients with Sturge-Weber syndrome were evaluated by conventional noncontrast spin-echo MR imaging, a gradient-recalled echo (GRE) technique, and T1-weighted spin-echo imaging after administration of gadopentetate dimeglumine. In four of five cases the full extent of intracranial disease was appreciated only on the postcontrast images. In one patient precontrast and GRE images were entirely normal, while only the postcontrast study demonstrated extensive involvement of both brain and retina. Nevertheless, some abnormal vessels with higher flows were seen better on precontrast T2-weighted images than on postcontrast T1-weighted images. GRE techniques demonstrated calcifications to best advantage, in one case even better than on CT. Contrast enhancement with gadopentetate dimeglumine is necessary for the complete MR evaluation of patients with suspected Sturge-Weber syndrome. Traditional noncontrast T2-weighted and GRE images may provide additional complementary information.     

Intraocular metastases: differential diagnosis from uveal melanomas with high-resolution MRI using a surface coil

Magnetic resonance imaging with dedicated surface coils plays a pivotal role in differential diagnosis and staging of intraocular tumors. The purpose of this study was to establish MRI criteria for the differential diagnosis of uveal melanomas and intraocular metastases. In a prospective study 44 eyes in 36 patients with intraocular metastases and 200 patients with uveal melanomas were investigated with MRI using a 1.5-T scanner and a 5-cm surface coil. Both quantitative and qualitative evaluation of the resulting images was performed. The MR signal intensities typically expected for metastases (slightly hyperintense on non-contrast T1-weighted images and hypointense on T2-weighted images compared to the vitreous body) were seen in only 23.1%. The typical melanoma signal of either moderate or strong hyperintensity on T1-weighted images and hypointensity on T2-weighted images was seen in 69.4% of the proven melanomas. Contrast enhancement was observed in both metastases and melanomas. Morphological differences between metastases and melanomas were detected in tumor size, shape, position, frequency of retinal detachment, and homogeneity of the tumor. Differentiation between intraocular metastases and uveal melanoma is limited by overlap of signal intensities. Some improvement is achieved with morphologic criteria.     

Magnetic resonance imaging in lesions of the eye globe

Magnetic Resonance Imaging (MRI) findings in 22 patients with lesions of the globe were examined. There were 16 cases of malignant uveal melanoma, 2 cases of retinoblastoma, 3 cases of hemorrhagic choroidal detachment and 1 case of senile macula degeneration. MRI adequately depicted the lesions in 20 cases. In two cases MRI findings were unconclusive due to movement artifacts of the eye globe. Fourteen out of 16 uveal melanomas displayed typical T1 and T2 shortening. In the two other cases the hypointense aspect on T2-weighted images was less pronounced due to a lesser amount of melanin in the lesions as demonstrated by subsequent histology. Unlike with CT, the tumoral lesions could clearly be differentiated from subretinal exudate. The case of senile macula degeneration, two retinoblastomas and two cases of hemorrhagic choroidal detachment had the same MRI characteristics as melanomas.     

Gd-DTPA enhanced MR for detecting intracranial extension of sinonasal malignancies

Magnetic resonance imaging is frequently used for evaluating the extent of malignant tumor in the paranasal sinuses and nasal fossa. Detection of the intracranial extension of a tumor is important in the initial staging of disease. The epidural component of a sinonasal tumor frequently displays signal intensity at or near that of the adjacent brain on standard T1- and T2-weighted scanning sequences. In six of eight malignant sinonasal tumors with intracranial involvement, gadopentetate dimeglumine (Gd-DTPA) enhanced MR was significantly better than the noncontrast scans for demonstrating the intracranial extension. This finding is in contradistinction to the superiority of unenhanced T2-weighted scans for determining the extent of disease within the sinonasal region itself. Tangential Gd-DTPA MR scanning of the skull base compensates for the difficulty of recognizing areas of bone destruction on noncontrast images. Postcontrast sequences should be added to the scanning protocol for sinonasal lesions near the skull base.     

Contrast-enhanced magnetization transfer MR of the brain: importance of precontrast images.

PURPOSETo determine the importance of obtaining precontrast T1-weighted magnetization transfer (MT) MR images for better interpretation contrast-enhanced T1-weighted MT images.METHODSOne hundred fifty-five patients referred for MR imaging of the brain were examined prospectively with noncontrast T1-weighted imaging, noncontrast T1-weighted imaging with MT, contrast-enhanced T1-weighted imaging, and contrast-enhanced T1-weighted imaging with MT. In the patients who had abnormally increased signal intensity on postcontrast images (with or without MT), the four imaging sequences were evaluated with regard to number of lesions and lesional signal intensity. For each of the sequences, two experienced neuroradiologists subjectively graded the lesions on a scale of 1 to 4 (4 being the most conspicuous) with regard to abnormally increased signal intensity.RESULTSTwenty-two of the 155 patients had increased signal intensity on one or more of the postcontrast sequences. Eight of these 22 patients had increased signal intensity of one or more lesions on images without MT. All these lesions were seen better on images obtained with MT. An additional six of the 22 patients had increased signal intensity of one or more lesions on images obtained with MT that was not detected on images obtained without MT. Eight of the 22 patients had no high signal intensity on noncontrast images with or without MT. One of the eight had increased number and conspicuity of lesions on postcontrast MT images.CONCLUSIONSA significant number of patients had increased signal intensity on noncontrast T1-weighted images with MT that was not seen on noncontrast T1-weighted images without MT. This high signal intensity was also visible on postcontrast MT images, and would have been mistaken for pathologic enhancement if noncontrast MT images had not been available for comparison.     

Intraocular tumors: evaluation with MR imaging

Sixty-seven ocular tumors were studied with magnetic resonance (MR) imaging and computed tomography (CT). These tumors included primary uveal melanoma (n = 55), circumscribed choroidal hemangioma (n = 3), diffuse choroidal hemangioma (n = 1), retinal capillary hemangioma (n = 1), medulloepithelioma (n = 1), choroidal nevus (n = 1), retinoblastoma (n = 1), and choroidal metastases (n = 4). MR imaging demonstrated all these lesions, while CT demonstrated 88%. Associated retinal detachment was more easily distinguished from the neoplasms with MR imaging. Extrascleral extension of melanoma and hemorrhagic cystic necrosis within the melanoma were clearly demonstrated with MR imaging, but not with CT. Ninety-three percent of melanomas were markedly hyperintense, compared with the intensity of the vitreous body, on T1-weighted images and hypointense on T2-weighted images. All metastatic lesions were isointense on T1-weighted images and hypointense on T2-weighted images. The circumscribed choroidal hemangiomas were hyperintense on T1-weighted images and isointense on T2-weighted images. MR imaging is superior to CT in detection of intraocular tumors and may be more specific in diagnosis.     

"Ivy sign" in childhood moyamoya disease: depiction on FLAIR and contrast-enhanced T1-weighted MR images

PURPOSE: To compare contrast material-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images with or without gadolinium in depicting the leptomeningeal ivy sign in children with moyamoya disease. MATERIALS AND METHODS: Twenty-nine sets of FLAIR and postcontrast T1-weighted MR images were available in 19 consecutive children with primary moyamoya disease confirmed with conventional and MR angiography. Contrast-enhanced FLAIR MR images also were available in 15 sets. Two pediatric radiologists reviewed FLAIR and postcontrast T1-weighted images in separate sessions for the leptomeningeal ivy sign and assigned a rating of "present," "absent," or "equivocal" by consensus. Unenhanced and contrast-enhanced FLAIR MR images were compared side by side to determine which better depicted leptomeningeal high signal intensities. RESULTS: Postcontrast T1-weighted MR images revealed the leptomeningeal ivy sign in 40 hemispheres (frequency of visualization, 71% [40 of 56 hemispheres]), whereas unenhanced FLAIR MR images depicted it in 26 hemispheres (frequency of visualization, 46% [26 of 56 hemispheres]). An equivocal rating was given in 21 hemispheres versus in 11 on FLAIR and postcontrast T1-weighted images, respectively. FLAIR and postcontrast T1-weighted images agreed in 40 hemispheres. There was no case with a positive rating on FLAIR images when postcontrast T1-weighted images were negative. Unenhanced FLAIR MR imaging was superior to contrast-enhanced FLAIR imaging in seven hemispheres, whereas enhanced FLAIR was better in four of 28 hemispheres. In the remaining 17, findings with each sequence were similar. CONCLUSION: Contrast-enhanced T1-weighted images are better than FLAIR images for depicting the leptomeningeal ivy sign in moyamoya disease.     

MR增强后液体衰减反转恢复序列对脑转移瘤的诊断价值

目的 分析MR增强后液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列对脑转移瘤的诊断价值. 资料与方法 确诊恶性肿瘤可疑有脑转移患者159例.MR检查除常规平扫和增强外,在增强后加扫FLAIR序列,图像由3名有经验的放射科医师评估. 结果 58例有脑内转移,6例增强后FLAIR脑实质病灶数目显示较增强T1WI多,11例病灶强化较T1WI明显;在11例柔脑膜转移者中,7例病灶强化程度优于增强后T1WI. 结论 增强后FLAIR是增强后T1WI的有效补充,对脑内小病灶和脑膜病灶更敏感.     

Improved detection and delineation of head and neck lesions with fat suppression spin-echo MR imaging.

To compare conventional and fat suppression MR imaging in their ability to detect head and neck lesions, we prospectively studied 17 patients with head and neck tumors and one normal volunteer. Five patients had benign tumors (one mixed cell tumor, one hemangioma, one lipoma, and two plexiform neurofibromas), 10 had malignant tumors (six squamous cell carcinomas, two minor salivary gland carcinomas, one lymphoma, and one malignant fibrous histiocytoma), and two had nonspecific lymphadenopathy. All subjects were studied with standard spin-echo T1- and T2-weighted images (T2-weighted imaging was done with and without fat suppression technique). In addition, T1-weighted images with contrast enhancement and fat suppression were obtained in nine patients. A four-point grading system was used for comparison of the conventional and fat suppression images. Grades ranged from 0 (unsatisfactory, the lesion cannot be seen) to 3 (excellent, the lesion and its margins can be seen clearly with sharp contrast from surrounding normal tissue). We found that postcontrast fat suppression T1-weighted images and fat suppression T2-weighted images were most useful; these sequences obtained an average score close to grade 3 (2.77 and 2.85, respectively). On the other hand, the conventional T2-weighted images had an average score of about 2 (1.82) and the conventional T1-weighted image had a score of about 1 (1.33). Fat suppression T2-weighted sequences generally were superior in cases of lymphadenopathies. Postcontrast T1-weighted images were most useful in a case of plexiform neurofibroma, owing to their fibrous component and lower proton density.(ABSTRACT TRUNCATED AT 250 WORDS)     

Human peripheral arteries: feasibility of transvenous intravascular MR imaging of the arterial wall

Feasibility of in vivo transvenous intravascular magnetic resonance (MR) imaging of the human arterial wall was determined. All subjects provided written informed consent, and institutional review board approved the study. Six arteries in six patients were imaged with a guidewire placed in the iliac vein (n = 5) or left renal vein (n = 1). Pre- and postcontrast T1-weighted and T2-weighted transvenous MR imaging were performed. An atherosclerotic plaque with a fibrous cap was identified on 27 (42%) of 64 images of veins without stents; intimal hyperplasia in a renal artery with a stent was identified on 12 images. Contrast-to-noise ratios (CNRs) on arterial wall postcontrast T1-weighted images were superior to those on images obtained with other sequences (P < .001), and the postcontrast images demonstrated the greatest number of plaques with a low-signal intensity core and fibrous cap. Preliminary results show that transvenous MR imaging is feasible for high-spatial-resolution imaging of the arterial wall and atherosclerotic plaque. Postcontrast T1-weighted imaging affords greatest CNR for the arterial wall.     

Relationship between contrast enhancement on fluid-attenuated inversion recovery MR sequences and signal intensity on T2-weighted MR images: visual evaluation of brain tumors

PURPOSE: To investigate the relationship between the degree of contrast enhancement in fluid-attenuated inversion recovery (FLAIR) sequences and tumor signal intensity on T2-weighted images. MATERIALS AND METHODS: A total of 96 patients suspected of having brain tumors were examined by MR imaging, and whenever a brain tumor with an enhancing part larger than the slice thickness was demonstrated on postcontrast T1-weighted images, postcontrast FLAIR images were additionally acquired. The tumor signal intensity on the T2-weighted images was visually classified as follows: equal or lower compared with normal cerebral cortex (group 1), higher than normal cortex (group 2), and as high as cerebrospinal fluid (CSF) (group 3). When a lesion contained several parts with different signal intensities on T2-weighted images, we assessed each part separately. In each group, we visually compared pre- and postcontrast FLAIR images and assessed whether tumor contrast enhancement was present. When contrast enhancement was present on FLAIR sequence, the degree of contrast enhancement in T1-weighted and FLAIR sequences was visually compared. RESULTS: Postcontrast T1-weighted images showed 46 enhancing lesions, including 48 parts, in 31 MR examinations. FLAIR images of the lesion-parts in group 1 (N=18) did not show significant contrast enhancement. In group 2 (N=12), all the parts were enhanced in FLAIR sequences, and three parts were enhanced more clearly in the FLAIR sequences than in the T1-weighted sequences. In group 3 (N=18), all the parts were enhanced equally or more clearly in the FLAIR sequences than in the T1-weighted sequences. CONCLUSION: The signal intensity in FLAIR sequences is largely influenced by both T1 and T2 relaxation time; there is a close relationship between the signal intensity of brain tumors on T2-weighted images and the degree of contrast enhancement on FLAIR sequences. When tumors have higher signal intensity than normal cortex on T2-weighted images, additional postcontrast FLAIR imaging may improve their depiction.     

Spinal angiolipomas: MR features.

PURPOSETo determine the MR features of spinal angiolipomas and to compare these findings with their histologic appearance.METHODSThe MR examinations of three patients with surgically proved angiolipomas were reviewed for tumor location and extent, signal characteristics, and pattern of contrast enhancement, and were then compared with the histologic findings.RESULTSFour tumors were found in the three patients, all located in the posterior epidural compartment, averaging about 2.5 vertebral bodies in length. On noncontrast T1-weighted images, all lesions were inhomogeneous and hypointense relative to epidural fat. Inhomogeneous enhancement was seen in three lesions on postcontrast T1-weighted images obtained with fat-saturation techniques. Angiolipomas were least conspicuous on T2-weighted images. A high vascular content correlated with the presence of large hypointense regions on T1-weighted images.CONCLUSIONSpinal angiolipomas are typically hyperintense on noncontrast T-1-weighted images relative to other tumors. Angiolipomas that contain large hypointense foci on noncontrast T1-weighted images can be expected to have a high degree of vascularity.     

Malignant lesions of the liver identified on T1- but not T2-weighted MR images at 1.5 T

The authors reviewed their 21/2-year experience with a magnetic resonance (MR) imaging protocol for a 1.5-T MR imager that included T2-weighted fat-suppressed spin-echo, T1-weighted breath-hold gradient-echo, and serial dynamic gadolinium-enhanced T1-weighted gradient-echo imaging to identify histologic types of malignant liver lesions more apparent on T1- than on T2-weighted images. MR images of 212 consecutive patients with malignant liver lesions were reviewed. T2-weighted, T1-weighted, and dynamic contrast-enhanced T1-weighted images were examined separately in a blinded fashion. Seven patients demonstrated liver lesions (lymphoma [two patients] and carcinoid, hepatocellular carcinoma, colon adenocarcinoma, transitional cell carcinoma, and melanoma [one patient each]) on T1-weighted images that were inconspicuous on T2-weighted images. In all cases, the lesions were most conspicuous on T1-weighted images obtained immediately after administration of contrast agent. Histologic confirmation was present for all seven patients. The consistent feature among these lesions was that they were hypovascular, due either to a fibrous stroma or to dense monoclonal cellularity. These results suggest that in some patients with hypovascular primary neoplasms, the lesions may be identified only on T1-weighted images, and that immediate postcontrast T1-weighted images are of particular value in demonstrating lesions.     

葡萄膜黑色素瘤的MRI诊断

目的探讨MRI对葡萄膜黑色素瘤的诊断价值。资料与方法对35例葡萄膜黑色素瘤患者行MRI横断面、冠状面、斜矢状面平扫及增强扫描。结果35例黑色素瘤患者中27例在T1WI表现为高信号,8例为等信号,T2WI上均为低信号,增强后为中度至明显强化。21例继发的视网膜脱离在T1WI上为高信号,T2WI上为等或高信号,无强化。结论MRI可对肿瘤进行精确定位,同时能显示肿瘤的大小和信号特征,有助于对葡萄膜黑色素瘤的诊断及鉴别诊断。     

Pre- and postcontrast FLAIR MR imaging in the diagnosis of intracranial meningeal pathology

PURPOSE: Few reports address the use of fluid-attenuated inversion-recovery (FLAIR) images of the brain in the diagnosis of extraaxial lesions. Our purpose was to assess the value of FLAIR images, including postcontrast ones, in the diagnosis of intracranial meningeal diseases. METHODS: We reviewed precontrast (n=24) and postcontrast (n=20) FLAIR images obtained from 25 patients with infectious meningitis (n=13), carcinomatous meningitis or dissemination of primary brain tumor (n=7), dural metastasis (n=3), and others (n=2) in comparison with fast spin-echo T2-weighted and postcontrast T1-weighted images. RESULTS: In lesion detectability, precontrast FLAIR images were significantly superior to fast spin-echo T2-weighted images but inferior to postcontrast T1-weighted images. There was no significant difference between postcontrast T1-weighted and FLAIR images. CONCLUSION: Precontrast FLAIR images can substitute for conventional fast spin-echo T2-weighted images. Postcontrast FLAIR images have diagnostic potential equivalent to conventional postcontrast T1-weighted images.     

Preliminary results of MR imaging with superparamagnetic iron oxide in pancreatic and retroperitoneal disorders

The authors conducted a preliminary evaluation of the potential of superparamagnetic iron oxide as contrast material for delineation of the bowel. Ten patients with various pancreatic diseases and 18 patients with suspected retroperitoneal disease underwent T1- and T2-weighted MR imaging before and after contrast material was administered. Two radiologists reviewed randomized images and scored them for depiction of anatomic structures and abnormalities. In most patients, postcontrast T1-weighted images showed improved delineation of the retroperitoneal small bowel (duodenum), stomach, and pancreas. Postcontrast T2-weighted images showed improved delineation of retroperitoneal small bowel, para-aortic region, peripancreatic fat, and renal veins. There was no improvement in delineation of retroperitoneal diseases, except for lymphadenopathy, which was better seen on both T1- and T2-weighted postcontrast images. Preliminary results suggest that superparamagnetic iron oxide is a useful contrast agent for delineating some normal retroperitoneal structures, lymphadenopathy, and pancreatic disease and that it is less useful in evaluating other retroperitoneal masses.