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Pailler JI, Villalonga JF, Ries-Centeno T, Saenz A, Baldoncini M, Pipolo DO, Cárdenas Ruiz-Valdepeñas E, Kaen A, Hirtler L, Roytowski D, Solari D, Cervio A, Campero A. Clinical Applicability of the Sellar Barrier Concept in Patients with Pituitary Apoplexy: Is It Possible? LIFE (BASEL, SWITZERLAND) 2023; 13:life13010158. [PMID: 36676107 PMCID: PMC9861876 DOI: 10.3390/life13010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
There is evidence of association between sellar barrier thickness and intraoperative cerebrospinal fluid (CSF) leakage, impacting the postoperative prognosis of the patients. The aim of this study is to analyze the clinical applicability of the sellar barrier concept in a series of operated patients with pituitary apoplexy (PA). A retrospective study was conducted including 47 patients diagnosed with PA who underwent surgical treatment through a transsphenoidal approach. Brain magnetic resonance imaging (MRI) of the patients were evaluated and classified utilizing the following criteria: strong barrier (greater than 1 mm), weak barrier (less than 1 mm), and mixed barrier (less than 1 mm in one area and greater than 1 mm in another). The association between sellar barrier types and CSF leakage was analyzed, both pre- and intraoperatively. The preoperative MRI classification identified 10 (21.28%) patients presenting a weak sellar barrier, 20 patients (42.55%) with a mixed sellar barrier, and 17 patients (36.17%) exhibiting a strong sellar barrier. Preoperative weak and strong sellar barrier subtypes were associated with weak (p ≤ 0.001) and strong (p = 0.009) intraoperative sellar barriers, respectively. Strong intraoperative sellar barrier subtypes reduced the odds of CSF leakage by 86% (p = 0.01). A correlation between preoperative imaging and intraoperative findings in the setting of pituitary apoplexy has been observed.
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Affiliation(s)
- José Ignacio Pailler
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | - Juan Francisco Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
- Correspondence:
| | | | - Amparo Saenz
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | - Matías Baldoncini
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | - Derek Orlando Pipolo
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | | | - Ariel Kaen
- Hospital Virgen del Rocío, 41013 Sevilla, Spain
| | - Lena Hirtler
- Endoscopic Laboratory of Anatomy Center, Medical University of Vienna, 1090 Vienna, Austria
| | - David Roytowski
- Department of Neurosurgery, University of Cape Town, Cape Town 7701, South Africa
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita’ degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Andrés Cervio
- Departamento de Neurocirugía, FLENI, Buenos Aires 1625, Argentina
| | - Alvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
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Chen CC, Carter BS, Wang R, Patel KS, Hess C, Bodach ME, Tumialan LM, Oyesiku NM, Patil CG, Litvack Z, Zada G, Aghi MK. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Preoperative Imaging Assessment of Patients With Suspected Nonfunctioning Pituitary Adenomas. Neurosurgery 2017; 79:E524-6. [PMID: 27635958 DOI: 10.1227/neu.0000000000001391] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The authors reviewed published articles pertaining to the preoperative imaging evaluation of nonfunctioning pituitary adenomas (NFPAs) and formulated recommendations. OBJECTIVE To provide an exhaustive review of published articles pertaining to the preoperative imaging evaluation of nonfunctioning pituitary adenomas. METHODS The MEDLINE database was queried for studies investigating imaging for the preoperative evaluation of pituitary adenomas. RESULTS From an initial search of 5598 articles, 122 articles were evaluated in detail and included in this article. Based on analysis of these articles, the recommendations are as follows: (1) High-resolution magnetic resonance imaging (level II) is recommended as the standard for preoperative assessment of nonfunctioning pituitary adenomas, but may be supplemented with CT (level III) and fluoroscopy (level III). (2) Although there are promising results suggesting the utility of magnetic resonance spectroscopy, magnetic resonance perfusion, positron emission tomography, and single-photon emission computed tomography, there is insufficient evidence to make formal recommendations pertaining to their clinical applications. CONCLUSION The authors identified 122 articles that form the basis of recommendations for preoperative imaging evaluation of nonfunctioning pituitary adenomas. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_2. ABBREVIATIONS CT, computed tomographyDWI, diffusion-weighted imagingMRI, magnetic resonance imagingNFPA, nonfunctioning pituitary adenoma.
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Affiliation(s)
- Clark C Chen
- *Center for Theoretical and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego, San Diego, California; ‡Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; §Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California; ¶Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ‖Barrow Neurological Institute, Phoenix, Arizona; #Department of Neurosurgery, Emory University, Atlanta, Georgia; **Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; ‡‡Department of Neurosurgery, George Washington University, Washington, DC; §§Department of Neurological Surgery, University of Southern California, Los Angeles, California; ¶¶Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Morales H, Lemen L, Samaratunga R, Nguyen P, Tomsick T. Effects of iodinated contrast on various magnetic resonance imaging sequences and field strength: Implications for characterization of hemorrhagic transformation in acute stroke therapy. World J Radiol 2016; 8:588-593. [PMID: 27358686 PMCID: PMC4919758 DOI: 10.4329/wjr.v8.i6.588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/03/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize the effects of iodinated contrast material (ICM) on magnetic resonance imaging (MRI) comparing different sequences and magnetic fields, with emphasis to similarities/differences with well-known signal characteristics of hemorrhage in the brain.
METHODS: Aliquots of iopamidol and iodixanol mixed with normal saline were scanned at 1.5T and 3T. Signal intensity (SI) was measured using similar spin-echo (SE)-T1, SE-T2, gradient-echo (GRE) and fluid-attenuation-inversion-recovery (FLAIR) sequences at both magnets. Contrast to noise ratio (CNR) (SI contrast-SI saline/SD noise) for each aliquot were calculated and Kruskall-wallis test and graphic analysis was used to compare different pulse sequences and ICMs.
RESULTS: Both ICM showed increased SI on SE-T1 and decreased SI on SE-T2, GRE and FLAIR at both 1.5T and 3T, as the concentration was increased. By CNR measurements, SE-T2 had the greatest conspicuity at 3T with undiluted iopamidol (92.6 ± 0.3, P < 0.00) followed by iodixanol (77.5 ± 0.9, P < 0.00) as compared with other sequences (CNR range: 15-40). While SE-T2 had greatest conspicuity at 1.5T with iopamidol (49.3 ± 1, P < 0.01), SE-T1 showed similar or slightly better conspicuity (20.8 ± 4) than SE-T2 with iodixanol (23 ± 1.7). In all cases, hypo-intensity on GRE was less conspicuous than on SE-T2.
CONCLUSION: Iodixanol and iopamidol shorten T1 and T2 relaxation times at both 1.5T and 3T. Hypo-intensity due to shortened T2 relaxation time is significantly more conspicuous than signal changes on T1-WI, FLAIR or GRE. Variations in signal conspicuity according to pulse sequence and to type of ICM are exaggerated at 3T. We postulate T2 hypointensity with less GRE conspicuity differentiates ICM from hemorrhage; given the well-known GRE hypointensity of hemorrhage. Described signal changes may be relevant in the setting of recent intra-arterial or intravenous ICM administration in translational research and/or human stroke therapy.
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Kurosaki M, Tabuchi S, Akatsuka K, Kamitani H, Watanabe T. Application of phase sensitive imaging (PSI) for hemorrhage diagnosis in pituitary adenomas. Neurol Res 2013; 32:614-9. [DOI: 10.1179/174313209x455709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Quantitative assessment of changes in carotid plaques during cilostazol administration using three-dimensional ultrasonography and non-gated magnetic resonance plaque imaging. Neuroradiology 2012; 54:939-45. [DOI: 10.1007/s00234-012-1011-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 01/11/2012] [Indexed: 11/26/2022]
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Magnetic resonance imaging (MRI) and computed tomography (CT) findings in intrathecal catheter granuloma: Report of two cases. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2010.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Affiliation(s)
- Handan Cakmakci
- Department of Radiology, Medical School, Dokuz Eylül University, Balcova, Izmir, Turkey.
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Tosaka M, Sato N, Hirato J, Fujimaki H, Yamaguchi R, Kohga H, Hashimoto K, Yamada M, Mori M, Saito N, Yoshimoto Y. Assessment of hemorrhage in pituitary macroadenoma by T2*-weighted gradient-echo MR imaging. AJNR Am J Neuroradiol 2007; 28:2023-9. [PMID: 17898201 PMCID: PMC8134270 DOI: 10.3174/ajnr.a0692] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intratumoral hemorrhage occurs frequently in pituitary macroadenoma and manifests as pituitary apoplexy and recent or old silent hemorrhage. T2*-weighted gradient-echo (GE) MR imaging is the most sensitive sequence for the detection of acute and old intracranial hemorrhage. T2*-weighted GE MR imaging was used to investigate intratumoral hemorrhage in pituitary macroadenomas. MATERIALS AND METHODS Twenty-five consecutive patients who underwent total or subtotal resection of pituitary macroadenoma with heights from 17 to 53 mm, including 1 patient with classic pituitary apoplexy, underwent MR imaging before surgery, including T2*-weighted GE MR imaging. For histologic assessment of the hemorrhage in whole surgical specimens, we used hematoxylin-eosin staining. RESULTS T2*-weighted GE MR imaging detected various types of dark lesions, such as "rim," "mass," "spot," and "diffuse" and combinations, indicating clinical and subclinical intratumoral hemorrhage in 12 of the 25 patients. The presence of intratumoral dark lesions on T2*-weighted GE MR imaging correlated significantly with the hemorrhagic findings on T1- and T2-weighted MR imaging (P < .02 and <.01, respectively), and the surgical and histologic hemorrhagic findings (P < .001 and <.001, respectively). CONCLUSION T2*-weighted GE MR imaging could detect intratumoral hemorrhage in pituitary adenomas as various dark appearances. Therefore, this technique might be useful for the assessment of recent and old intratumoral hemorrhagic events in patients with pituitary macroadenomas.
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Affiliation(s)
- M Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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Messori A, Polonara G, Mabiglia C, Salvolini U. Is haemosiderin visible indefinitely on gradient-echo MRI following traumatic intracerebral haemorrhage? Neuroradiology 2003; 45:881-6. [PMID: 14579110 DOI: 10.1007/s00234-003-1048-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2002] [Accepted: 05/19/2003] [Indexed: 11/30/2022]
Abstract
Gradient-echo (GE) MRI has been demonstrated to be the most sensitive current technique for detection of intracerebral haemosiderin, especially in the chronic stage of haemorrhage. Our purpose was to see whether GE MRI shows old haemorrhage indefinitely. We reviewed serial GE images of 105 adults with imaging features consistent with post-traumatic intracerebral haemorrhage, who had serial MRI at 1, 4-6, 12, and 24 months after trauma. Of 1235 scattered low-signal foci consistent with isolated intracerebral haemosiderin deposits on images at 4-6 months, 248 (20.1%) were not seen at 24-month assessment. Reviewing individual patients, we saw that in 71.8% of those with scattered haemosiderin deposits and 46.4% of those with haemosiderin surrounded by gliosis, the low-signal foci appeared less conspicuous with time. Even given certain limitations to the interpretation of these findings, it would appear that, even with the use of GE MRI, time affects the visibility of haemorrhagic intracerebral lesions. We therefore conclude that a time of 4-6 months to 1 year or slightly more should be recommended for most precise detection of haemosiderin deposits on MRI of head-injured patients, should this be thought desirable. Normal GE images may not exclude old haemorrhage.
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Affiliation(s)
- A Messori
- Department of Neuroradiology, Umberto I Hospital and University of Ancona, via Conca, Torrette, 60020 Ancona, Italy
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Abstract
This article discusses all types of traumatic head injury in infants, children and adolescents. Neuroimaging patterns of injury help to make the precise diagnosis and assists in monitoring responses to therapy.
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Chakos MH, Shirakawa O, Lieberman J, Lee H, Bilder R, Tamminga CA. Striatal enlargement in rats chronically treated with neuroleptic. Biol Psychiatry 1998; 44:675-84. [PMID: 9798070 DOI: 10.1016/s0006-3223(98)00029-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Striatal enlargement with chronic neuroleptic treatment in schizophrenic patients has been reported by several investigators. Longitudinal magnetic resonance imaging studies of patients suggest that changes in striatal volume may be caused by treatment with antipsychotic medication. METHODS We have examined the effects of chronic neuroleptic treatment on postmortem striatal volume in the laboratory rat and have examined the relationship between striatal volume and vacuous chewing movements (VCMs). Autoradiographs of 50 rats treated with haloperidol (1.5 mg/kg/day) or drug free for varying durations of time (1-12 months) were utilized in this analysis. RESULTS Chronic treatment with neuroleptics (1 month or greater) was associated with larger striatal volumes. The increase in striatal volume was present at 1 month of treatment and was sustained to 12 months of treatment. Rats that developed the high-VCM syndrome had larger striatal volumes than both drug-free and low-VCM rats, while low-VCM rats had larger striatal volumes than drug-free rats. CONCLUSIONS These data suggest that chronic neuroleptic treatment is the cause of striatal enlargement in the laboratory rat, and that this enlargement is most prominent in rats that have the high-VCM syndrome.
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Affiliation(s)
- M H Chakos
- University of North Carolina at Chapel Hill, Neurosciences Hospital 27599-7160, USA
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Weingarten K, Filippi C, Zimmerman RD, Deck MD. Detection of hemorrhage in acute cerebral infarction. Evaluation with spin-echo and gradient-echo MRI. Clin Imaging 1994; 18:43-55. [PMID: 8180861 DOI: 10.1016/0899-7071(94)90146-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We investigated the efficacy of magnetic resonance imaging (MRI) in the detection and delineation of acute hemorrhagic cerebral infarction and evaluated the role of gradient-echo imaging in these patients. This study was performed prospectively. Entry criteria were: (1) Clinical evidence of acute supratentorial infarction later confirmed by at least one imaging study, and (2) unenhanced computed tomography (CT) and MRI scans performed within 72 hours of ictus. The first 50 patients who met these criteria were included. Comparison of CT and spin-echo (SE) and gradient-echo (GE) MRI at 0.6 T for the visualization of infarction and for the detection or exclusion of hemorrhage were done. There were no cases in which CT was superior to MRI for the diagnosis of either bland or hemorrhagic infarction. All 50 infarcts were detected on long TR SE MRI and 30/50 on GE scans. Eighteen infarcts were judged to be hemorrhagic on the basis of well-established CT and MRI criteria. In all these cases, hemorrhage was most obvious on GE scans as focal areas of marked hypointensity, including 10 cases in which SE MRI and CT demonstrated subtle, equivocal, or no evidence of hemorrhage. In addition, GE MRI allowed for the exclusion of hemorrhage in five cases with equivocal findings of hemorrhage on long TR SE MRI. GE MRI is a valuable adjunct to SE sequences for the detection or exclusion of hemorrhage in acute infarcts with equivocal or mild intensity changes on SE MRI. With further improvements in fast-scanning techniques and a greater understanding of the pathophysiology and clinical implications of hemorrhagic infarction, it may be possible to replace CT with a combination of SE and GE MRI as the primary imaging modality in the evaluation of acute infarction.
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Affiliation(s)
- K Weingarten
- Department of Radiology, New York Hospital-Cornell Medical Center, New York 10021
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Abstract
The appearance of intracranial hematoma on magnetic resonance (MR) images has been described. However, the appearance of hematoma on ECG-gated spin-echo images, which are used for cardiac imaging, has not been described previously. Accordingly a retrospective analysis of nine consecutive patients with acute and subacute mediastinal bleeding imaged with ECG-gated spin-echo MR images was done. The time interval between the incipient event and the date of the MR study was determined, and the signal appearance of the hemorrhage was evaluated relative to striated muscle and fat. MR findings were corroborated by other imaging modalities and surgical findings. Acute hematomas showed medium to high signal intensity, whereas subacute hematomas had areas of high signal intensity on images acquired with ECG gating to every heart beat (repetition time = R-R interval) and a short echo time (30 msec). The characteristic signal intensities of blood on ECG-gated MR images are usually distinct in comparison to other pericardial and mediastinal fluid collections. The ability of MR to specifically identify blood within the first few hours after hemorrhage was not tested in this study.
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Affiliation(s)
- K C Seelos
- Department of Radiology, University of California, San Francisco 94143
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Abstract
Magnetic resonance phase images can enable identification of any type of motion, including the velocity and direction of flow, and thus provide valuable supplements to magnitude images, which depict stationary tissue most effectively. A method is described for the simultaneous display of phase and magnitude by color encoding the phase data and superimposing it on the magnitude image to facilitate clinical interpretation. Color-encoded data not only depict the location and direction of flow along specific axes but can also provide relative velocity information through shades of color. Implementation of the technique is described, and the factors to be considered during interpretation of color flow-encoded images are discussed.
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Affiliation(s)
- T A Tasciyan
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107
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Matwiyoff NA, Gasparovic C, Mazurchuk R, Matwiyoff G. On the origin of paramagnetic inhomogeneity effects in whole blood. Magn Reson Med 1991; 20:144-50. [PMID: 1658536 DOI: 10.1002/mrm.1910200115] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Asymmetric 7 T proton NMR signals of water in RBC suspensions containing intracellular deoxyhemoglobin are composites of chemically shifted extracellular and intracellular resonances broadened by gradient diffusion and modulated by transmembrane water exchange. This allows assessment of field dependences of acute hematoma intensities in proton MRIs at lower field strengths (less than or equal to 1.5 T).
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Affiliation(s)
- N A Matwiyoff
- University of New Mexico School of Medicine, Center for Non-Invasive Diagnosis, Albuquerque 87131
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Abstract
The relatively long scan times with currently available technology restrict the range of MRI applications, increase the cost of scanning by limiting throughput, and lead to image artifacts from patient motion during scans. Ultrafast imaging, in several guises, is now poised for introduction into clinical practice. With the Instascan method, a descendant of the echo-planar technique, complete MR images may be obtained hundreds to thousands of times faster than in conventional approaches and now yield spatial resolution and contrast directly comparable to standard MRI. "Single-shot" imaging methods, such as Instascan, are utilized in the study of dynamic processes, in the direct evaluation of motion (as in diffusion sensitive imaging), and in dramatic new applications, including the interactive control of intraparenchymal laser surgery. Improvements to the small flip-angle method, FLASH, have also pushed scan times into the subsecond domain; this method may be implemented on presently available imaging equipment but yields contrast behavior different from the traditional spin-echo techniques and displays signal-to-noise ratios significantly lower than single-shot imaging. Ultimately, incorporating ultra-fast MR imaging techniques into the armamentarium of the radiologist will likely require changes to many aspects of the MRI practice, from expanded involvement with the scan process to management of the increased data load, and may lead to dramatic changes in the scope of the MRI practice.
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Affiliation(s)
- M S Cohen
- Advanced NMR Systems, Inc., Woburn, Massachusetts 02129
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