Fat-suppressed MR images of both hands obtained using CHESS can be improved by rice pads

When chemical shift selective (CHESS) imaging is used with magnetic resonance imaging (MRI) for simultaneous imaging of both hands for the evaluation of rheumatoid arthritis, the fat suppression effect is poor. We investigated whether these fat-suppressed images using CHESS could be improved with the use of rice pads. T1-weighted images were obtained with CHESS and the same imaging parameters were used with and without rice pads on the coronal plane of both hands in 10 healthy volunteers. Patients were placed in a prone position with both hands extended overhead. The fat-suppression effect was classified into four categories and scored for both sets of images, and visual assessments were made by one radiologist and one radiologic technologist. The evaluation score was 1.1 for the images made without rice pads, and 3.2 for the images made with rice pads. The fat suppression effect was thus significantly better in the images made using rice pads (P<0.0001). Lingering fat signals disappeared almost completely in images of both hands using CHESS with rice pads, and it was confirmed that the images were improved and had good fat suppression. More accurate evaluation of inflammatory sites that occur in rheumatoid arthritis may thus be possible, promising better diagnostic accuracy.     

Lingering fat signals with CHESS in simultaneous imaging of both hands can be improved with rice pads in both 1.5 T and 3.0 T

Objectives

To investigate whether rice pads can eliminate lingering fat signals of the complex surface shape of both hands that occur with chemical shift selective (CHESS) at 1.5 T and 3.0 T.

Materials and methods

T1-weighted images were obtained with CHESS using 1.5 T and 3.0 T systems. The same imaging parameters were used with and without rice pads on the coronal plane of both hands in 10 healthy volunteers. The fat-suppression effects were classified into four categories and scored for images, and visual evaluations were performed by one radiologist and one radiologic technologist.

Results

At 1.5 T, the mean evaluation score was 1.55 for images obtained without rice pads and 3.50 for images obtained with rice pads. At 3.0 T, the mean evaluation score was 1.10 for images obtained without rice pads and 3.20 for images obtained with rice pads. With both systems, images obtained with the rice pads showed significantly better fat suppression effects than images obtained without rice pads (P < 0.0001, P < 0.0001).

Conclusions

It was confirmed that lingering fat signals are eliminated and good fat-suppressed images are obtained with the use of rice pads at 1.5 T and 3.0 T. Rice pads are therefore useful with at 1.5 T and 3.0 T, which are currently becoming more widely used.     

Improved fat suppression using multipeak reconstruction for IDEAL chemical shift fat‐water separation: Application with fast spin echo imaging

Purpose

To evaluate and quantify improvements in the quality of fat suppression for fast spin‐echo imaging of the knee using multipeak fat spectral modeling and IDEAL fat‐water separation.

Materials and Methods

T₁‐weighted and T₂‐weighted fast spin‐echo sequences with IDEAL fat‐water separation and two frequency‐selective fat‐saturation methods (fat‐selective saturation and fat‐selective partial inversion) were performed on 10 knees of five asymptomatic volunteers. The IDEAL images were reconstructed using a conventional single‐peak method and precalibrated and self‐calibrated multipeak methods that more accurately model the NMR spectrum of fat. The signal‐to‐noise ratio (SNR) was measured in various tissues for all sequences. Student t‐tests were used to compare SNR values.

Results

Precalibrated and self‐calibrated multipeak IDEAL had significantly greater suppression of signal (P < 0.05) within subcutaneous fat and bone marrow than fat‐selective saturation, fat‐selective partial inversion, and single‐peak IDEAL for both T₁‐weighted and T₂‐weighted fast spin‐echo sequences. For T₁‐weighted fast spin‐echo sequences, the improvement in the suppression of signal within subcutaneous fat and bone marrow for multipeak IDEAL ranged between 65% when compared to fat‐selective partial inversion to 86% when compared to fat‐selectivesaturation. For T2‐weighted fast spin‐echo sequences, the improvement for multipeak IDEAL ranged between 21% when compared to fat‐selective partial inversion to 81% when compared to fat‐selective saturation.

Conclusion

Multipeak IDEAL fat‐water separation provides improved fat suppression for T₁‐weighted and T₂‐weighted fast spin‐echo imaging of the knee when compared to single‐peak IDEAL and two widely used frequency‐selected fat‐saturation methods. J. Magn. Reson. Imaging 2009;29:436–442. © 2009 Wiley‐Liss, Inc.     

Improved fat water separation with water selective inversion pulse for inversion recovery imaging in cardiac MRI

Purpose:

To develop an improved chemical shift‐based water‐fat separation sequence using a water‐selective inversion pulse for inversion recovery 3D contrast‐enhanced cardiac magnetic resonance imaging (MRI).

Materials and Methods:

In inversion recovery sequences the fat signal is substantially reduced due to the application of a nonselective inversion pulse. Therefore, for simultaneous visualization of water, fat, and myocardial enhancement in inversion recovery‐based sequences such as late gadolinium enhancement imaging, two separate scans are used. To overcome this, the nonselective inversion pulse is replaced with a water‐selective inversion pulse. Imaging was performed in phantoms, nine healthy subjects, and nine patients with suspected arrhythmogenic right ventricular cardiomyopathy plus one patient for tumor/mass imaging. In patients, images with conventional turbo‐spin echo (TSE) with and without fat saturation were acquired prior to contrast injection for fat assessment. Subjective image scores (1 = poor, 4 = excellent) were used for image assessment.

Results:

Phantom experiments showed a fat signal‐to‐noise ratio (SNR) increase between 1.7 to 5.9 times for inversion times of 150 and 300 msec, respectively. The water‐selective inversion pulse retains the fat signal in contrast‐enhanced cardiac MR, allowing improved visualization of fat in the water‐fat separated images of healthy subjects with a score of 3.7 ± 0.6. Patient images acquired with the proposed sequence were scored higher when compared with a TSE sequence (3.5 ± 0.7 vs. 2.2 ± 0.5, P < 0.05).

Conclusion:

The water‐selective inversion pulse retains the fat signal in inversion recovery‐based contrast‐enhanced cardiac MR, allowing simultaneous visualization of water and fat. J. Magn. Reson. Imaging 2013;37:484–490. © 2012 Wiley Periodicals, Inc.     

4D radial coronary artery imaging within a single breath-hold: cine angiography with phase-sensitive fat suppression (CAPS).

Coronary artery data acquisition with steady-state free precession (SSFP) is typically performed in a single frame in mid-diastole with a spectrally selective pulse to suppress epicardial fat signal. Data are acquired while the signal approaches steady state, which may lead to artifacts from the SSFP transient response. To avoid sensitivity to cardiac motion, an accurate trigger delay and data acquisition window must be determined. Cine data acquisition is an alternative approach for resolving these limitations. However, it is challenging to use conventional fat saturation with cine imaging because it interrupts the steady-state condition. The purpose of this study was to develop a 4D coronary artery imaging technique, termed "cine angiography with phase-sensitive fat suppression" (CAPS), that would result in high temporal and spatial resolution simultaneously. A 3D radial stacked k-space was acquired over the entire cardiac cycle and then interleaved with a sliding window. Sensitivity-encoded (SENSE) reconstruction with rescaling was developed to reduce streak artifact and noise. Phase-sensitive SSFP was employed for fat suppression using phase detection. Experimental studies were performed on volunteers. The proposed technique provides high-resolution coronary artery imaging for all cardiac phases, and allows multiple images at mid-diastole to be averaged, thus enhancing the signal-to-noise ratio (SNR) and vessel delineation.     

Rapid fat suppression in MRI of the breast with short binomial pulses

PURPOSE: To develop a faster method of fat suppression for use in dynamic contrast enhanced MRI of the breast. MATERIALS AND METHODS: A method of fast fat suppression is presented using spatially nonselective rapid binomial pulses. In contrast to conventional binomial frequency-selective pulses, these short pulses are applied without interpulse delay, allowing for very rapid spectrally selective excitation. RESULTS: Effective water excitation and fat suppression were achieved in breast MRI at 3.0 Tesla with total excitation time as low as 160 microsec, which is several times shorter than the excitation time of currently used fat suppression techniques. Rapid fat suppression comes at the expense of increased specific absorption rate (SAR) and mildly degraded quality of suppression. A flexible tradeoff of short imaging time vs. SAR can be made to optimize imaging speed for fat-suppressed breast MRI. CONCLUSION: Rapid binomial pulses can be used for dynamic contrast enhanced breast MRI with excitation times significantly shorter than currently used fat suppression pulses. Shorter excitation time allows more rapid imaging, allowing greater temporal and spatial resolution for characterization of breast lesions.     

Fat suppression with short inversion time inversion‐recovery and chemical‐shift selective saturation: A dual STIR‐CHESS combination prepulse for turbo spin echo pulse sequences

Purpose:

To test a newly developed fat suppression magnetic resonance imaging (MRI) prepulse that synergistically uses the principles of fat suppression via inversion recovery (STIR) and spectral fat saturation (CHESS), relative to pure CHESS and STIR. This new technique is termed dual fat suppression (Dual‐FS).

Materials and Methods:

To determine if Dual‐FS could be chemically specific for fat, the phantom consisted of the fat‐mimicking NiCl₂ aqueous solution, porcine fat, porcine muscle, and water was imaged with the three fat‐suppression techniques. For Dual‐FS and STIR, several inversion times were used. Signal intensities of each image obtained with each technique were compared. To determine if Dual‐FS could be robust to magnetic field inhomogeneities, the phantom consisting of different NiCl₂ aqueous solutions, porcine fat, porcine muscle, and water was imaged with Dual‐FS and CHESS at the several off‐resonance frequencies. To compare fat suppression efficiency in vivo, 10 volunteer subjects were also imaged with the three fat‐suppression techniques.

Results:

Dual‐FS could suppress fat sufficiently within the inversion time of 110–140 msec, thus enabling differentiation between fat and fat‐mimicking aqueous structures. Dual‐FS was as robust to magnetic field inhomogeneities as STIR and less vulnerable than CHESS. The same results for fat suppression were obtained in volunteers.

Conclusion:

The Dual‐FS‐STIR‐CHESS is an alternative and promising fat suppression technique for turbo spin echo MRI. J. Magn. Reson. Imaging 2010;31:1277–1281. ©2010 Wiley‐Liss, Inc.     

Quantitative assessment of the effects of high‐permittivity pads in 7 Tesla MRI of the brain

The use of high‐permittivity materials has been shown to be an effective method for increasing transmit and receive sensitivity in areas of low‐signal intensity in the brain at high field. Results in this article show that the use of these materials does not increase the intercoil coupling for a phased array receive coil, does not have any detrimental effects on the B₀ homogeneity within the brain, and does not affect the specific absorption rate distribution within the head. Areas of the brain close to the pads exhibit significant increases (>100%) in transmit field efficiency, but areas further away show a less pronounced (～10%) decrease due to the homogenization of the transmit field and the loss introduced by the dielectric pads. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

Magnetic resonance (MR) imaging of the shoulder, elbow, and wrist

Thorough knowledge of small structures in the joints is becoming important as the resolution of magnetic resonance (MR) imaging has improved during the past decade. The author discusses the MR anatomy and pathology of three representative structures in the joints of the upper extremities: the labral-ligamentous complex of the shoulder, ulnar collateral ligament(UCL) of the elbow, and triangular fibrocartilage complex(TFCC) of the wrist. The labral-ligamentous complex is composed of the anterior labrum and three glenohumeral ligaments. Because of their similar MR appearance, the labral sulcus is difficult to differentiate from traumatic detachment of the labrum, even with the aid of MR arthrography. Insertion of the UCL to the medial condyle in the growing elbow presents different MR appearances according to age. Acute and chronic UCL tears are commonly seen in elbows with medial tension overload and are well depicted with three-dimensional Fourier transform(3DFT) gradient-echo images. 3DFT images are the most suitable for observation of the TFCC as well. Since abnormally high signals of the articular disc suggestive of tear are often seen in asymptomatic subjects, MR imaging may not reliably be used to differentiate clinically significant tears from asymptomatic defects. In this review article, the author emphasizes developmental anatomy and normal variations in the interpretation of MR images.     

Magnetic resonance imaging of the elbow in athletes

Acute and chronic elbow pain is common, particularly in athletes. Although plain radiographs, ultrasound, and computed tomography all have a role to play in the investigation of elbow pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for diagnosis of soft tissue disease and osteochondral injury around the elbow. The high spatial resolution, excellent soft-tissue contrast, and multiplanar imaging capabilities of MRI make it ideal for evaluating the complex joint anatomy of the elbow. This article reviews imaging of common disease conditions occurring around the elbow in athletes, with an emphasis on MRI.     

MR imaging of the head and neck

The purpose of this paper is to describe current imaging protocols for MR imaging of the head and neck region and to define results and clinical impact. Depending on the clinical question, different MRI protocols are presented for imaging of the head and neck. The appearance of different pathologic findings on imaging studies and how adapted imaging protocols help to improve differential diagnosis is discussed. In summary, MRI is the method of choice for imaging of the head and neck.     

Fat suppression at 2D MR imaging of the hands: Dixon method versus CHESS technique and STIR sequence

ObjectiveTo compare the effectiveness of fat suppression and the signal-to-noise ratio (SNR) of the Dixon method with those of the CHESS (Chemical Shift-Selective) technique and STIR (Short Tau Inversion Recovery) sequence in hands of normal subjects at 2D MR imaging.Material and methods14 healthy volunteers (mean age of 29.4 years) consented to have both hands prospectively imaged with SE T1 Dixon, T1 CHESS, T2 Dixon, T2 CHESS and STIR sequences in a 1.5T MR scanner. Three radiologists scored the effectiveness of fat suppression in bone marrow (EFS^BM) and soft tissues (EFS^ST) in 20 joints per subject. One radiologist measured the SNR in 10 bones per subject. Statistical analysis used two-way ANOVA with random effects, paired t-test and observed agreement to assess differences in effectiveness of fat suppression, differences in SNR and inter-observer agreement.ResultsEFS^BM was statistically significantly higher for T1 Dixon than for T1 CHESS and for T2 Dixon than for T2 CHESS (p < 0.0001). EFS^BM was significantly higher for T2 Dixon than for STIR in the coronal plane (p = 0.0020). The SNR was significantly higher for T1 Dixon than for T1 CHESS and for T2 Dixon than for STIR (p  <  0.0001). The SNR was significantly lower for T2 Dixon than for T2 CHESS (p < 0.0001).ConclusionThe Dixon method yields more effective fat suppression and higher SNR than the CHESS technique at 2D T1-weighted MR imaging of the hands. At T2-weighted MR imaging, fat suppression is more effective with the Dixon method while SNR is higher with the CHESS technique.     

Three‐point dixon method enables whole‐body water and fat imaging of obese subjects

Dixon imaging techniques derive chemical shift‐separated water and fat images, enabling the quantification of fat content and forming an alternative to fat suppression. Whole‐body Dixon imaging is of interest in studies of obesity and the metabolic syndrome, and possibly in oncology. A three‐point Dixon method is proposed where two solutions are found analytically in each voxel. The true solution is identified by a multiseed three‐dimensional region‐growing scheme with a dynamic path, allowing confident regions to be solved before unconfident regions, such as background noise. 2π‐Phase unwrapping is not required. Whole‐body datasets (256 × 184 × 252 voxels) were collected from 39 subjects (body mass index 19.8‐45.4 kg/m²), in a mean scan time of 5 min 15 sec. Water and fat images were reconstructed offline, using the proposed method and two reference methods. The resulting images were subjectively graded on a four‐grade scale by two radiologists, blinded to the method used. The proposed method was found superior to the reference methods. It exclusively received the two highest grades, implying that only mild reconstruction failures were found. The computation time for a whole‐body dataset was 1 min 51.5 sec ± 3.0 sec. It was concluded that whole‐body water and fat imaging is feasible even for obese subjects, using the proposed method. Magn Reson Med 63:1659–1668, 2010. © 2010 Wiley‐Liss, Inc.     

Hoffa's recess: incidence, morphology and differential diagnosis of the globular-shaped cleft in the infrapatellar fat pad of the knee on MRI and cadaver dissections

We frequently observed a fluid-like indentation at the inferior posterior margin of Hoffa's fat pad of the knee and sought to establish the incidence and differential diagnostic criteria of this cleft. In total, 133 MRI studies and 35 cadaver specimens were analyzed for the location, size, and shape of clefts at the inferior posterior margin of Hoffa's fat pad. The incidence of a fluid-like ovoid cleft on MR images was 13.5% and in cadavers 14.3%. The cleft was located just below the insertion of the infrapatellar synovial fold (plica synovialis infrapatellaris, ligamentum mucosum). More linear-shaped indentations at the posterior margin were visible in all patients and cadavers due to the horizontal course of the alar folds. A fluid-filled indentation within the inferior posterior margin of Hoffa's fat pad has to be expected in more than 10% of knee studies and should not be confused with tumors like ganglion cysts. We term this cleft the infrahoffatic recess. One hypothesis of its origin concerns the embryological regression process of the infrapatellar membrane into the infrapatellar synovial fold. It should not be confused with linear clefts due to the alar folds.     

Improved homogeneity of the transmit field by simultaneous transmission with phased array and volume coil

Purpose:

To improve the homogeneity of transmit volume coils at high magnetic fields (≥4 T). Due to radiofrequency (RF) field/tissue interactions at high fields, 4 T to 8 T, the transmit profile from head‐sized volume coils shows a distinctive pattern with relatively strong RF magnetic field B₁ in the center of the brain.

Materials and Methods:

In contrast to conventional volume coils at high field strengths, surface coil phased arrays can provide increased RF field strength peripherally. In theory, simultaneous transmission from these two devices could produce a more homogeneous transmission field. To minimize interactions between the phased array and the volume coil, counter rotating current (CRC) surface coils consisting of two parallel rings carrying opposite currents were used for the phased array.

Results:

Numerical simulations and experimental data demonstrate that substantial improvements in transmit field homogeneity can be obtained.

Conclusion:

We have demonstrated the feasibility of using simultaneous transmission with human head‐sized volume coils and CRC phased arrays to improve homogeneity of the transmit RF B₁ field for high‐field MRI systems. J. Magn. Reson. Imaging 2010;32:476–481. © 2010 Wiley‐Liss, Inc.     

Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow

The purpose of this study was to investigate the treatment response in lateral epicondylitis (tennis elbow) by MRI. Magnetic resonance imaging was obtained in 30 patients with clinical symptoms of lateral epicondylitis of the elbow using T1-, T2- and T2-weighted fat-saturated (FS) sequences. The patients were randomised to either i.m. corticosteroid injection (n=16) or immobilisation in a wrist splint (n=14). Magnetic resonance imaging of the elbow was performed on a 1.5-T MR system at baseline and after 6 weeks. The extensor carpi radialis (ECRB) tendon, the radial collateral ligament, lateral humerus epicondyle at tendon insertion site, joint fluid and signal intensity changes within brachio-radialis and anconeus muscles were evaluated on the MR units workstation before and after 6 weeks of treatment. The MRI was performed once in 22 healthy controls for comparison and all images evaluated by an investigator blinded to the clinical status of the subjects. The MR images showed thickening with separation of the ECRB tendon from the radial collateral ligament and abnormal signal change in 25 of the 30 patients on the T1-weighted sequences at inclusion. The signal intensity of the ECRB tendon was increased in 24 of the 30 patients with lateral epicondylitis of the elbow on the T2-weighted FS sequences. In the patients there were no associations between pathologically signal intensity within the ECRB tendon on T1- and T2-weighted sequences and the degree of self-reported pain (Dumbells test) at inclusion. In general, the MRI changes persisted in the patients at follow-up after 6 weeks despite clinical remission. The increased signal intensity within the extensor tendon is indicative of lateral epicondylitis humeri. The changes in signal intensity and morphology of ECRB tendon seem to be chronic and may persist despite clinical improvement.