Ultrafast MR imaging of the pelvis

Imaging of Soft-Tissue Musculoskeletal Masses: Fundamental Concepts

Radiologic evaluation of musculoskeletal soft-tissue masses has changed dramatically with the continued improvements in imaging technology. The integration of advanced imaging has provided the radiologist with a wide range of assessment tools, but as with all powerful arsenals, selection and application of the appropriate imaging method can be problematic. Although the choices available for imaging evaluation of musculoskeletal masses have changed dramatically, the basic objectives of this assessment have remained constant: diagnosis and staging. The basic principles for evaluating musculoskeletal soft-tissue masses and achieving these objectives have not changed. This article addresses application of the current imaging methods to assessment of soft-tissue musculoskeletal masses, emphasizing fundamental concepts. We do not intend to provide a comprehensive review of imaging techniques, but rather to provide a useful review of the concepts needed to select the appropriate initial imaging method, magnetic resonance (MR) imaging field of view, MR imaging sequences, contrast material requirements, and rapid image acquisition techniques. We also address use of the new quantitative techniques of chemical shift and diffusion-weighted imaging. Finally, we review the current uses of computed tomography and ultrasonography. Although the choices available for imaging evaluation of musculoskeletal masses have changed dramatically within the past decade, appropriate application of the fundamental concepts of imaging will maximize the diagnostic utility of imaging examinations. ^©RSNA, 2016.

Uterine anatomy and function on cine magnetic resonance imaging

The female reproductive organ undergoes dynamic morphological changes under the influence of hormonal stimuli, and particularly those mediated by estrogen and progesterone. The uterus changes both its morphological appearance and its functional movements in function of these influences. Functionally, the uterus is known to exert two kinds of inherent contractility: sustained uterine contractions and uterine peristalsis. The former is focal and consists of the sporadic bulging of the myometrium, while the latter is rhythmic and manifests itself as the subtle stripping movement in the subendometrial myometrium. The mechanisms underlying these uterine movements, their relationship and their correlation to age, pharmaceutical administration, and a variety of gynecologic and obstetrical problems remain under discussion. Cine MR imaging may offer the potential to directly observe the changes undergone by the uterus in relation to important functions such as fertility and menstrual problems.

Usefulness of thin-section single-shot turbo spin echo with half-Fourier acquisition in evaluation of local invasion of lung cancer

PURPOSE

To evaluate the usefulness of thin-section single-shot turbo spin echo with half-Fourier acquisition (SS-TSE-HF) alone for evaluation of local invasion of lung cancer.

MATERIALS AND METHODS

Our Institutional Review Board approved this retrospective study. Thirty-six patients with lung cancer who underwent magnetic resonance imaging (MRI) for evaluation of local invasion followed by curative surgery from July 2008 to June 2012 were enrolled in this study. Two reviewers independently and blindly reviewed computed tomography (CT) and MRI (thin-section SS-TSE-HF and conventional MRI, which consisted of conventional axial SS-TSE-HF, dynamic MRI with respiratory and/or cardiac cine, and T1 -weighted high-resolution isotropic volume examination [THRIVE]) for the presence of local invasion. Diagnostic performances were evaluated using gross surgical findings and pathological results as a standard reference.

RESULTS

The overall diagnostic performance for detecting local invasion of lung cancer between the two reviewers were as follows: specificity and accuracy of thin-section SS-TSE-HF (89.0% and 87.5%) were significantly higher than those of CT (25.6% and 46.9%, P < 0.001 for both) or conventional MRI (61.0% and 69.5%, P < 0.001 and P = 0.008, respectively). Sensitivity was 84.8% for thin-section SS-TSE-HF with the same value for CT (P = 0.246) and conventional MRI (P = 0.209).

CONCLUSION

Thin-section SS-TSE-HF sequence alone without any contrast agent demonstrated a relatively high diagnostic performance in evaluation of local invasion of lung cancer.

Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: comparison with Alvarado scoring system and histopathological results

PURPOSE

The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results.

MATERIALS AND METHODS

The study included 85 consecutive patients (mean age, 26.5±11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings.

RESULTS

Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively.

CONCLUSIONS

MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

Artifacts and pitfalls in MR imaging of the pelvis

Artifacts are intimately intertwined with MRI. For the practicing radiologist, effective supervision, troubleshooting, and interpretation of diagnostic MR studies require a solid knowledge of the pertinent artifacts. This article seeks to familiarize the reader with commonly encountered artifacts and pitfalls in pelvic imaging, the mechanism behind their generation, and methods of minimizing their negative impact or maximizing their diagnostic yield. It also serves as an exciting tool to learn many aspects of basic and advanced MR physics. Artifacts are categorized into patient- and sequence-related artifacts. Various manifestations of motion and vascular artifacts, susceptibility, altered tissue contrast, blurring, chemical shift artifact, volume averaging, and gadolinium (Gd) pseudolayering are explained, along with their proposed remedies.

Right-Lower-Quadrant Pain and Suspected Appendicitis in Pregnant Women: Evaluation with MR Imaging—Initial Experience

PURPOSE

To determine if there is a role for magnetic resonance (MR) imaging in evaluation of pregnant women with acute right-lower-quadrant pain in whom acute appendicitis is suspected.

MATERIALS AND METHODS

Informed consent and institutional review board approval were obtained. Images obtained with a 1.5-T MR imager and medical records of 23 pregnant women (age range, 19-34 years; mean age, 24.7 years) who presented with acute right-lower-quadrant pain were retrospectively reviewed. MR protocol included use of transverse, coronal, and sagittal noncontiguous T2-weighted single-shot fast spin-echo (SE) sequences; transverse fat-suppressed T2-weighted fast SE sequences; transverse T1-weighted gradient-recalled-echo sequences; and transverse and coronal short inversion time inversion-recovery sequences performed through the lower abdomen and pelvis. MR findings were evaluated by two radiologists and compared with surgical and pathologic findings and clinical follow-up data.

RESULTS

Appendix was detected in 20 (86.9%) of 23 patients. Seven patients underwent surgery; four had acute appendicitis, and three had ovarian torsion. Two patients with pelvic abscesses not related to appendicitis underwent percutaneous drainage. Fourteen patients were treated medically. Dilated thick-walled appendix and periappendiceal inflammation were detected in three (75%) of four patients with acute appendicitis. In one patient with appendicitis, the appendix could not be visualized, but inflammation was present in the right lower quadrant. In three patients with ovarian torsion, MR imaging demonstrated right adnexal mass or inflammation. MR imaging was used to correctly identify pelvic abscesses and healthy appendix in two patients. A healthy appendix was depicted in 17 (89.5%) of 19 patients without acute appendicitis.

CONCLUSION

MR imaging shows promise for evaluation of pregnant women in whom acute appendicitis is suspected by enabling diagnosis of other possible causes of right-lower-quadrant pain, including ovarian torsion or pelvic abscesses, and demonstrating a healthy or unhealthy appendix.

T2-weighted MRI of the female pelvis: comparison of breath-hold fast-recovery fast spin-echo and nonbreath-hold fast spin-echo sequences

In 49 patients who had pelvic abnormalities, breath-hold T2-weighted fast-recovery (FR)-fast spin-echo (FSE) (imaging time = 24 sec) and nonbreath-hold FSE MR images (2 min 8 sec) were compared qualitatively (on a four-point scale) and quantitatively (using signal-to-noise ratios (SNRs) and contrast ratios (/SIs of the lesions-SIs of the myometrium/SIs of the myometrium)). Motion artifacts were reduced on breath-hold FR-FSE (3.8:3.2 = breath-hold FSE:nonbreath-hold FSE, P < 0.01) and image quality was comparable (3.8:3.7, NS). In all patients, pathology (leiomyoma [N = 26], adenomyosis [N = 10], endometrial carcinoma [N = 8], and ovarian cystic lesions [N = 21]) was recognized with comparable lesion conspicuity (3.8:3.7, NS) and better delineation of the structures (3.9:3.6, P < 0.05) on the FR-FSE images. There was no significant difference in contrast ratios, although SNRs (e.g., myometrium 18.3:25.8, P < 0.01) were better and the uterine zonal anatomy was recognized better on the nonbreath-hold FSE (3.4:3.7, P < 0.05). These differences did not affect the diagnosis. Breath-hold FR-FSE provides the benefits of motionless imaging and a short examination time, although lower SNRs were noted. J. Magn. Reson. Imaging 2001;13:930-937.

Fetal shoulder measurements by fast and ultrafast MRI techniques

The purpose of this study was to evaluate magnetic resonance imaging (MRI) of fetal shoulder measurements of fetuses with suspected macrosomia. The actual fetal shoulder measurements made immediately after birth were compared with measurements obtained by fast and ultrafast MRI techniques antepartum. Eight singleton diabetic pregnant mothers underwent MRI examination with fast imaging in steady-state precession (TrueFISP) and spin-echo (SE) and gradient-echo (GE) echo-planar (EPI) sequences to show the fetal shoulder width. The actual shoulder width was measured immediately postpartum by a neonatologist. There was a statistically significant correlation between the MRI measurements and the actual shoulder width (P < 0.001 - P < 0.05) for all sequences. TrueFISP (r = 0.98, P < 0.001) was superior to EPI sequences (r = 0.88, P < 0.01 for SE EPI and r = 0.80, P < 0.05 for GE EPI). The images of all three sequences used were free of major motion artifacts. Fast and ultrafast sequences seem to be reliable for fetal shoulder measurements and the TrueFISP was the most accurate sequence compared to SE and GE echo-planar sequences. J. Magn. Reson. Imaging 2001;13:938-942.