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Comparison between 2D TSE and 3D SPACE in the evaluation of craniocervical ligaments. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:361-367. [PMID: 36477892 DOI: 10.1007/s00586-022-07459-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the MRI findings of the craniocervical junction ligaments and compare the 2D TSE sequence and 3D SPACE sequence on cervical spine MRI. METHODS Eighty cervical spine MRIs were retrospectively analyzed, including 2D TSE and 3D SPACE sequences. The visibility and morphology of the transverse ligament (TL) and alar ligament (AL) were evaluated by two readers using a five-point grading scale for visibility (1 = not visible, 2 = barely visible, 3 = adequately visible, 4 = good visibility, 5 = excellent visibility) and a four-point grading scale for morphology (0 = homogeneous low SI with normal thickness, 1 = high SI with normal thickness, 2 = reduced thickness, 3 = full-thickness rupture or indistinguishable from surrounding structures). The grades of the two sequences were compared. Reader agreements were measured using the percentage of exact agreement. RESULT The visibility grade of TL was significantly higher in 3D, indicating better visualization. The morphology grade of TL was significantly lower in the 3D, indicating more normal-appearing ligament. The exact agreements of visibility and morphology grade of TL tended to be higher in 3D. On the other hand, there was no significant difference in visibility grade of AL between the two sequences. The morphological grade of AL was significantly higher in 3D. The agreement of the morphological grade of AL tended to be lower in 3D. CONCLUSION The utilization of 3D sequences significantly improves the visibility of TL and could potentially reduce false-positive diagnoses of ligament injury.
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Eghtesadi M, Leroux E, Fournier-Gosselin MP, Lespérance P, Marchand L, Pim H, Artenie AA, Beaudet L, Boudreau GP. Neurostimulation for Refractory Cervicogenic Headache: A Three-Year Retrospective Study. Neuromodulation 2017; 21:302-309. [PMID: 29178511 DOI: 10.1111/ner.12730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Occipital nerve stimulation (ONS) has been used for the treatment of neuropathic pain conditions and could be a therapeutic approach for refractory cervicogenic headache (CeH). AIM The aim of this study is to assess the efficacy and safety of unilateral ONS in patients suffering from refractory CeH. METHODS We conducted a retrospective chart review on patients implanted from 2011 to 2013 at CHUM. The primary outcome was a 50% reduction in headache days per month. Secondary outcomes included change in EuroQol Group Visual Analog Scale rating of health-related quality of life (EQ VAS), six item headache impact test (HIT-6) score, hospital anxiety and depression scale (HADS) score, work status, and medication overuse. RESULTS Sixteen patients fulfilled the inclusion criteria; they had suffered from daily moderate to severe CeH for a median of 15 years. At one year follow-up, 11 patients were responders (69%). There was a statistically significant improvement in the EQ VAS score (median change: 40 point increase, p = 0.0013) and HIT-6 score (median change: 17.5 point decrease, p = 0.0005). Clinically significant anxiety and depression scores both resolved amongst 60% of patients. At three years, six patients were responders (37.5%). Out of the 11 responders at one-year post implantation, five had remained headache responders (R-R) and one additional patient became a responder (NR-R). There was a statistically significant improvement in the EQ VAS score (median change: 15 point increase, p = 0.019) and HIT-6 score (median change: 7.5 point decrease, p = 0.0017) compared with baseline. Clinically significant anxiety and depression scores both, respectively, resolved among 22.5% and 33.9% of patients. Five out of seven disabled patients were back to work. CONCLUSION ONS may be a safe and effective treatment modality for patients suffering from a refractory CeH. Further study may be warranted.
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Affiliation(s)
- Marzieh Eghtesadi
- Department of Chronic Pain and Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Elizabeth Leroux
- Department of General Neurology and Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Marie-Pierre Fournier-Gosselin
- Department of Surgery, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Paul Lespérance
- Department of Psychiatry, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Luc Marchand
- Department of General Neurology and Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Heather Pim
- Department of General Neurology, Centre de Recherche du CHUM, Chronic Pain and Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Andreea Adelina Artenie
- Department of Social and Preventative Medicine, School of Public Health, Centre de Recherche du CHUM, Montreal, Canada
| | - Line Beaudet
- Centre de Recherche du CHUM, Faculty of Nursing, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Guy Pierre Boudreau
- Department of Headache Management, Centre de Recherche du CHUM, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
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Kim W, Ahn KS, Kang CH, Kang WY, Yang KS. Comparison of MRI grading for cervical neural foraminal stenosis based on axial and oblique sagittal images: Concordance and reliability study. Clin Imaging 2017; 43:165-169. [DOI: 10.1016/j.clinimag.2017.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/27/2017] [Accepted: 03/10/2017] [Indexed: 10/20/2022]
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Pediatric Body Magnetic Resonance Imaging. Indian J Pediatr 2016; 83:941-51. [PMID: 26916887 DOI: 10.1007/s12098-015-1978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
Magnetic resonance imaging (MRI) is a radiation-free imaging modality with excellent contrast resolution and multiplanar capabilities. Since ionizing radiation is an important concern in the pediatric population, MRI serves as a useful alternative to computed tomography (CT) and also provides additional clues to diagnosis, not discernible on other investigations. Magnetic resonance cholangiopancreatography (MRCP), urography, angiography, enterography, dynamic multiphasic imaging and diffusion-weighted imaging provide wealth of information. The main limitations include, long scan time, need for sedation/anesthesia, cost and lack of widespread availability. With the emergence of newer sequences and variety of contrast agents, MRI has become a robust modality and may serve as a one-stop shop for both anatomical and functional information.
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Abstract
STUDY DESIGN Retrospective diagnostic trial. OBJECTIVE To determine the diagnostic performance of 3-dimensional turbo spin-echo (3D-TSE) isotropic magnetic resonance imaging (MRI) in the assessment of cervical spine pathology. SUMMARY OF BACKGROUND DATA MRI is the imaging modality of choice for many cervical spine pathologies. However, axial imaging may be suboptimal if the image plane is oriented differently than the plane of interest, due to lordosis, kyphosis, or deformity. 3D-TSE isotropic MRI is a promising novel technology that bypasses this limitation by enabling dynamic image reformation in any desired orientation. METHODS Forty-eight patients who underwent 3D-TSE and conventional 2-dimensional fast spin-echo (2D-FSE) T2-weighted cervical spine MRI at our institution were randomly selected. 3D-TSE and 2D-FSE sequences from each subject were independently evaluated by 2 orthopedic spine surgeons and 4 musculoskeletal radiologists. Images were assessed using specific pilot-tested criteria for stenosis, herniation, and degenerative changes. Intermethod, interrater, and intrarater agreements for 3D-TSE and 2D-FSE, and Fleiss κ coefficients were determined. RESULTS The overall intermethod agreement was 80.7%. The interrater agreement was 75.9% for 3D-TSE and 75.7% for 2D-FSE (P=0.47). The intrarater agreement was 82.2% for 3D-TSE and 81.5% for 2D-FSE (P=0.71). Fleiss κ coefficients were 0.42 for 3D-TSE and 0.43 for 2D-FSE (P=0.62), indicating moderate interrater reliability. The intermethod agreement and the 2D-FSE intrarater agreement were statistically similar (P=0.49). CONCLUSIONS There is a high degree of agreement between 3D-TSE and 2D-FSE MRI in assessing the cervical spine. The intermethod variability was statistically similar to the intrinsic intrarater variability of 2D-FSE MRI. This study demonstrates that 3D-TSE yields at least equivalent diagnostic information as conventional 2D-FSE in the cervical spine. In addition, reviewers noted subjective advantages of 3D-TSE image reprocessing, especially when evaluating greater pathology or deformity, with a simplified image acquisition process.
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Radhakrishnan R, Betts AM, Care MM, Serai S, Zhang B, Jones BV. Reduced Field of View Diffusion-Weighted Imaging in the Evaluation of Congenital Spine Malformations. J Neuroimaging 2015; 26:273-7. [PMID: 26597581 DOI: 10.1111/jon.12317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Aaron M Betts
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Marguerite M Care
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Suraj Serai
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Xiao L, Siu C, Yeung K, Leung A, Yuen M, Wong Y. MRI of the cervical spine with 3D gradient echo sequence at 3 T: initial experience. Clin Radiol 2015; 70:926-31. [DOI: 10.1016/j.crad.2015.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/05/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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Fast inner-volume imaging of the lumbar spine with a spatially focused excitation using a 3D-TSE sequence. Acad Radiol 2015; 22:423-9. [PMID: 25435184 DOI: 10.1016/j.acra.2014.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to evaluate the feasibility and technical quality of a zoomed three-dimensional (3D) turbo spin-echo (TSE) sampling perfection with application optimized contrasts using different flip-angle evolutions (SPACE) sequence of the lumbar spine. MATERIALS AND METHODS In this prospective feasibility study, nine volunteers underwent a 3-T magnetic resonance examination of the lumbar spine including 1) a conventional 3D T2-weighted (T2w) SPACE sequence with generalized autocalibrating partially parallel acquisition technique acceleration factor 2 and 2) a zoomed 3D T2w SPACE sequence with a reduced field of view (reduction factor 2). Images were evaluated with regard to image sharpness, signal homogeneity, and the presence of artifacts by two experienced radiologists. For quantitative analysis, signal-to-noise ratio (SNR) values were calculated. RESULTS Image sharpness of anatomic structures was statistically significantly greater with zoomed SPACE (P < .0001), whereas the signal homogeneity was statistically significantly greater with conventional SPACE (cSPACE; P = .0003). There were no statistically significant differences in extent of artifacts. Acquisition times were 8:20 minutes for cSPACE and 6:30 minutes for zoomed SPACE. Readers 1 and 2 selected zSPACE as the preferred sequence in five of nine cases. In two of nine cases, both sequences were rated as equally preferred by both the readers. SNR values were statistically significantly greater with cSPACE. CONCLUSIONS In comparison to a cSPACE sequences, zoomed SPACE imaging of the lumbar spine provides sharper images in conjunction with a 25% reduction in acquisition time.
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Abdulhadi MA, Perno JR, Melhem ER, Nucifora PGP. Characteristics of spondylotic myelopathy on 3D driven-equilibrium fast spin echo and 2D fast spin echo magnetic resonance imaging: a retrospective cross-sectional study. PLoS One 2014; 9:e100964. [PMID: 25025170 PMCID: PMC4099062 DOI: 10.1371/journal.pone.0100964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/01/2014] [Indexed: 12/13/2022] Open
Abstract
In patients with spinal stenosis, magnetic resonance imaging of the cervical spine can be improved by using 3D driven-equilibrium fast spin echo sequences to provide a high-resolution assessment of osseous and ligamentous structures. However, it is not yet clear whether 3D driven-equilibrium fast spin echo sequences adequately evaluate the spinal cord itself. As a result, they are generally supplemented by additional 2D fast spin echo sequences, adding time to the examination and potential discomfort to the patient. Here we investigate the hypothesis that in patients with spinal stenosis and spondylotic myelopathy, 3D driven-equilibrium fast spin echo sequences can characterize cord lesions equally well as 2D fast spin echo sequences. We performed a retrospective analysis of 30 adult patients with spondylotic myelopathy who had been examined with both 3D driven-equilibrium fast spin echo sequences and 2D fast spin echo sequences at the same scanning session. The two sequences were inspected separately for each patient, and visible cord lesions were manually traced. We found no significant differences between 3D driven-equilibrium fast spin echo and 2D fast spin echo sequences in the mean number, mean area, or mean transverse dimensions of spondylotic cord lesions. Nevertheless, the mean contrast-to-noise ratio of cord lesions was decreased on 3D driven-equilibrium fast spin echo sequences compared to 2D fast spin echo sequences. These findings suggest that 3D driven-equilibrium fast spin echo sequences do not need supplemental 2D fast spin echo sequences for the diagnosis of spondylotic myelopathy, but they may be less well suited for quantitative signal measurements in the spinal cord.
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Affiliation(s)
- Mike A. Abdulhadi
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, United States of America
| | - Joseph R. Perno
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Elias R. Melhem
- University of Maryland, Baltimore, Maryland, United States of America
| | - Paolo G. P. Nucifora
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania, United States of America
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Eberhardt K, Ganslandt O, Stadlbauer A. Improved magnetic resonance myelography of the lumbar spine using image fusion and volumetry. J Neurosurg Spine 2014; 20:220-6. [DOI: 10.3171/2013.10.spine13119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study was to investigate the usefulness and diagnostic potential of an improved MR myelography approach using a dedicated, heavily T2-weighted, 3D MRI sequence in combination with image fusion. A further aim was to compare dural areas and volumes of normal and pathological altered lumbar spine levels, and accuracy in the assessment of the stenoses, with those obtained by postmyelographic CT.
Methods
Fifty patients underwent myelography, postmyelographic CT, and the improved MR myelography approach using a dedicated, heavily T2-weighted, 3D MRI sequence and image fusion. Dural cross-sectional areas and volumes for normal lumbar levels and levels with stenosis were calculated for postmyelographic CT and MR myelography data. The significant differences and Pearson correlations between dural cross-sectional areas and volumes from L1–2 to L5–S1 of postmyelographic CT and MR myelography were analyzed. The 99% CIs for normal and stenotic levels in patients with claudication distances less than 100 meters were calculated.
Results
For both dural areas and volumes in normal lumbar levels, the authors found no significant differences and strong correlations between postmyelographic CT and MR myelography. For the lower lumbar levels (L4–5 and L5–S1) they found significantly larger dural areas on MR myelography compared with postmyelographic CT, but not for the upper levels (L2–3 and L3–4). Dural volume analysis revealed significantly larger volumes for MR myelography at all 4 lumbar levels with stenoses in the cohort (L2–3 to L5–S1). Complete separation with no overlap was found between the 99% CIs for normal levels and stenotic levels.
Conclusions
Differences in dural areas and volumes in this study may have been caused by the fact that in the case of a severely compressed thecal sac, the viscosity of the intrathecally applied contrast agent is too high in the framework of myelography. The gravitationally dependent component is thus too low to achieve sufficient fluid contrast. An optimized MR myelography approach—a dedicated 3D MR myelography sequence with high spatial resolution in combination with image fusion—is required to achieve a more reliable diagnosis of lumbar spine stenoses, especially with severe compression, compared with postmyelographic CT. This MR myelography approach may be helpful in preventing overestimation of lumbar spine stenoses. The upper limits of 99% CIs for stenotic levels can be interpreted as an indication for surgical treatment. However, further studies that include postoperative outcomes are required.
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Affiliation(s)
- Knut Eberhardt
- 1MRI Center of Excellence, District Hospital Castle of Werneck, Germany
| | - Oliver Ganslandt
- 2Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany; and
| | - Andreas Stadlbauer
- 2Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany; and
- 3MR Physics Group, Department of Radiology, Landesklinikum St. Poelten, Austria
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Imaging of the entire cerebrospinal fluid volume with a multistation 3D SPACE MR sequence: feasibility study in patients with hydrocephalus. Eur Radiol 2012; 23:1450-8. [PMID: 23239062 DOI: 10.1007/s00330-012-2732-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/27/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the feasibility of imaging the entire cerebrospinal fluid (CSF) volume using the SPACE MR sequence. METHODS The SPACE sequence encompassing the brain and spine was performed at 1.5 T in 12 healthy volunteers and 26 consecutive patients with hydrocephalus. Image contrast was estimated using difference ratios in signal intensity between CSF and its background. Segmentation of CSF was performed using geometrical features and a topological assumption of CSF shapes. Subarachnoid and ventricular CSF space volumes were assessed in volunteers and patients and linear discriminant analysis was performed. RESULTS Image contrast was 0.94 between the CSF and the brain and 0.90 between the CSF and the spinal cord. According to the phantom study, the accuracy of CSF volume measurement was 98.5 %. A clear distinction between patients and healthy volunteers was obtained using the linear discriminant analysis. Significant linear regression was found in healthy volunteers between ventricular (Vv) and the whole subarachnoid CSF volume (Vs) with Vv = 0.083 Vs. CONCLUSIONS Imaging of the entire CSF volume is feasible in healthy volunteers and patients with hydrocephalus. CSF volume can be obtained on a whole-body scale. This approach may be of use for the diagnosis and follow-up of patients with hydrocephalus. KEY POINTS • MRI assessment of CSF volume is feasible in healthy volunteers/hydrocephalus patients. • CSF volume can be obtained on a whole-body scale. • The ratio of subarachnoid and ventricular CSF is constant in healthy volunteers. • CSF linear discriminant analysis can distinguish between patients and healthy volunteers. • Entire CSF volume imaging is useful for diagnosing and following hydrocephalus.
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Finkenzeller T, Zorger N, Kühnel T, Paetzel C, Schuierer G, Stroszczynski C, Fellner C. Novel application of T1-weighted BLADE sequences with fat suppression compared to TSE in contrast-enhanced T1-weighted imaging of the neck: cutting-edge images? J Magn Reson Imaging 2012; 37:660-8. [PMID: 23034901 DOI: 10.1002/jmri.23843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 08/29/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate if the use of BLADE sequences might overcome some limitations of magnetic resonance imaging (MRI) in the extracranial head and neck, which is a diagnostically challenging area with a variety of artifacts and a broad spectrum of potential lesions. MATERIALS AND METHODS After informed consent and Institutional Review Board approval, two different BLADE sequences with (BLADE IR) and without inversion pulse (BLADE) were compared to turbo-spin echo (TSE) with fat saturation for coronal T1-weighted postcontrast imaging of the extracranial head and neck region in 40 individuals of a routine patient collective. Visual evaluation of image sharpness, motion artifacts, vessel pulsation, contrast of anatomic structures, contrast of pathologies to surrounding tissue as well as BLADE-specific artifacts was performed by two experienced, independent readers. Statistical evaluation was done by using the Wilcoxon test. RESULTS Both BLADE and BLADE IR were significantly superior to TSE regarding pulsation artifacts and delineation of thoracic structures. TSE provided better results concerning contrast muscle/fat tissue and contrast lymph nodes/fat. More important, it showed significantly better contrast of several lesions, facilitating the detection of patient pathology. CONCLUSION T1-weighted coronal imaging of the extracranial head and neck region is demanding. T1-weighted BLADE sequences still have drawbacks in anatomical contrast and lesion detection but offer possibilities to achieve reasonable image quality in difficult cases with a variety of artifacts.
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Affiliation(s)
- Thomas Finkenzeller
- Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany.
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Hodel J, Besson P, Outteryck O, Zéphir H, Ducreux D, Monnet A, Chéchin D, Zins M, Rodallec M, Pruvo JP, Vermersch P, Leclerc X. Pulse-triggered DTI sequence with reduced FOV and coronal acquisition at 3T for the assessment of the cervical spinal cord in patients with myelitis. AJNR Am J Neuroradiol 2012; 34:676-82. [PMID: 22918433 DOI: 10.3174/ajnr.a3254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI is a promising technique for imaging of the spinal cord, but the technique has susceptibility-induced artifacts. We evaluated a pulse-triggered DTI sequence with an rFOV technique and coronal acquisition for the assessment of the cervical spinal cord in patients with myelitis at 3T. MATERIALS AND METHODS A rFOV acquisition was established by a noncoplanar application of the excitation and the refocusing pulse in conjunction with outer volume suppression. The DTI sequence was performed in the coronal plane in 12 healthy volunteers and 40 consecutive patients with myelitis. Probabilistic tractography of the posterior and lateral funiculi was performed from the C1 to C7 levels. FA, MD, aD, rD, and ratios of aD and rD were measured. RESULTS In healthy volunteers, mean DTI indices within the whole-fiber pathways were the following: FA = 0.61, MD = 1.17 × 10(-3) mm(2)/s, aD = 1.96 × 10(-3) mm(2)/s, rD = 0.77 × 10(-3) mm(2)/s, and ratios of aD and rD = 2.5. Comparison of healthy controls and patients with myelitis identified statistically significant differences for all DTI parameters. Different patterns of myelitis, including spinal cord atrophy and active inflammatory lesions, were recognized. There was a significant correlation between clinical severity and DTI parameters. CONCLUSIONS The present work introduces a new approach for DTI of the cervical spinal cord at 3T, enabling a quantitative follow-up of patients with myelitis.
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Affiliation(s)
- J Hodel
- Department of Neuroradiology, CHU Salengro, Lille, France.
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Andre JB, Zaharchuk G, Saritas E, Komakula S, Shankaranarayan A, Banerjee S, Rosenberg J, Nishimura DG, Fischbein NJ. Clinical evaluation of reduced field-of-view diffusion-weighted imaging of the cervical and thoracic spine and spinal cord. AJNR Am J Neuroradiol 2012; 33:1860-6. [PMID: 22555576 DOI: 10.3174/ajnr.a3134] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE DWI has the potential to improve the detection and evaluation of spine and spinal cord pathologies. This study assessed whether a recently described method (rFOV DWI) adds diagnostic value in clinical patients. MATERIALS AND METHODS Consecutive patients undergoing clinically indicated cervical and/or thoracic spine imaging received standard anatomic sequences supplemented with sagittal rFOV DWI by using a b-value of 500 s/mm(2). Two neuroradiologists blinded to clinical history evaluated the standard anatomic sequences only for pathology and provided their level of confidence in their diagnosis. These readers then rescored the examinations after reviewing the rFOV DWI study and indicated whether this sequence altered findings or confidence levels. RESULTS Two hundred twenty-three patients were included in this study. One hundred eighty patient scans (80.7%) demonstrated at least 1 pathologic finding. Interobserver agreement for identifying pathology (κ = 0.77) and in assessing the added value of the rFOV DWI sequence (κ = 0.77) was high. In pathologic cases, the rFOV DWI sequence added clinical utility in 33% of cases (P < .00001, Fisher exact test). The rFOV DWI sequence was found to be helpful in the evaluation of acute infarction, demyelination, infection, neoplasm, and intradural and epidural collections (P < .001, χ(2) test) and provided a significant increase in clinical confidence in the evaluation of 11 of the 15 pathologic subtypes assessed (P < .05, 1-sided paired Wilcoxon test). CONCLUSIONS rFOV diffusion-weighted imaging of the cervical and thoracic spine is feasible in a clinical population and increases clinical confidence in the diagnosis of numerous common spinal pathologies.
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Affiliation(s)
- J B Andre
- Departments of Radiology, Stanford University, Stanford, California, USA.
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Andre JB, Bammer R. Advanced diffusion-weighted magnetic resonance imaging techniques of the human spinal cord. Top Magn Reson Imaging 2012; 21:367-78. [PMID: 22158130 DOI: 10.1097/rmr.0b013e31823e65a1] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unlike those of the brain, advances in diffusion-weighted imaging (DWI) of the human spinal cord have been challenged by the more complicated and inhomogeneous anatomy of the spine, the differences in magnetic susceptibility between adjacent air and fluid-filled structures and the surrounding soft tissues, and the inherent limitations of the initially used echo-planar imaging techniques used to image the spine. Interval advances in DWI techniques for imaging the human spinal cord, with the specific aims of improving the diagnostic quality of the images, and the simultaneous reduction in unwanted artifacts have resulted in higher-quality images that are now able to more accurately portray the complicated underlying anatomy and depict pathologic abnormality with improved sensitivity and specificity. Diffusion tensor imaging (DTI) has benefited from the advances in DWI techniques, as DWI images form the foundation for all tractography and DTI. This review provides a synopsis of the many recent advances in DWI of the human spinal cord, as well as some of the more common clinical uses for these techniques, including DTI and tractography.
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Affiliation(s)
- Jalal B Andre
- Department of Radiology, Stanford University, Stanford, CA 94305-5105, USA.
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Three-dimensional isotropic T2-weighted cervical MRI at 3T: comparison with two-dimensional T2-weighted sequences. Clin Radiol 2011; 67:106-13. [PMID: 22142499 DOI: 10.1016/j.crad.2011.06.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/20/2011] [Accepted: 06/29/2011] [Indexed: 11/24/2022]
Abstract
AIM To compare three-dimensional (3D) isotropic T2-weighted magnetic resonance imaging (MRI) sequences and reformation with two-dimensional (2D) T2-weighted sequences regarding image quality of the cervical spine at 3T. MATERIALS AND METHODS A phantom study was performed using a water-filled cylinder. The signal-to-noise and image homogeneity were evaluated. Fourteen (n=14) volunteers were examined at 3T using 3D isotropic T2-weighted sagittal and conventional 2D T2-weighted sagittal, axial, and oblique sagittal MRI. Multiplanar reformation (MPR) of the 3D T2-weighted sagittal dataset was performed simultaneously with image evaluation. In addition to artefact assessment, the visibility of anatomical structures in the 3D and 2D sequences was qualitatively assessed by two radiologists independently. Cohen's kappa and Wilcoxon signed rank test were used for the statistical analysis. RESULT The 3D isotropic T2-weighted sequence resulted in the highest signal-to-noise ratio (SNR) and lowest non-uniformity (NU) among the sequences in the phantom study. Quantitative evaluation revealed lower NU values of the cerebrospinal fluid (CSF) and muscles in 2D T2-weighted sagittal sequences compared to the 3D volume isotropic turbo spin-echo acquisition (VISTA) sequence. The other NU values revealed no statistically significant difference between the 2D turbo spin-echo (TSE) and 3D VISTA sequences (0.059<p<0.959). 3D VISTA images showed significantly fewer CSF flow artefacts (p<0.001) and better delineated intradural nerve rootlets (p=0.001) and neural foramina (p=0.016) compared to 2D sequences. CONCLUSION A 3D T2 weighted sequence is superior to conventional 2D sequences for the delineation of intradural nerve rootlets and neural foramina and is less affected by CSF flow artefacts.
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Mortazavi MM, Mariwalla NR, Horn EM, Tubbs RS, Theodore N. Absence of MRI soft tissue abnormalities in severe spinal cord injury in children: case-based update. Childs Nerv Syst 2011; 27:1369-73. [PMID: 21538127 DOI: 10.1007/s00381-011-1472-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Occult spinal cord injury should be suspected based not only on the mechanism of trauma but also on the age of the patient. The pediatric spine has unique biomechanical and anatomical properties that must be considered carefully when evaluating spinal cord trauma. For instance, the hypermobility and elasticity of the spinal column in children often lead to self-reducing injuries that can mask spinal cord injury. CASE ILLUSTRATION We present the case of a 22-month-old male patient who was found to have ligamentous injury detected by magnetic resonance imaging (MRI) in the upper cervical spine but missed by MRI in the lower thoracic spine. Furthermore, there was no spinal cord injury in the upper cervical spine, but indeed a serious insult in the thoracic region. Since the advent of MRI, spinal cord injury without radiographic abnormality (SCIWORA) has become increasingly rare but not altogether extinct. CONCLUSIONS We present a noteworthy example of the inadequacy of MRI in revealing SCIWORA, a term that is antiquated as we combine the latest imaging techniques with a better understanding of the biomechanics of trauma and spine injury. Based on the literature and our case illustration, we believe that the biomechanics of the pediatric spine must be considered when children who may have sustained a SCIWORA are examined.
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Affiliation(s)
- Martin M Mortazavi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Zaharchuk G, Saritas EU, Andre JB, Chin CT, Rosenberg J, Brosnan TJ, Shankaranarayan A, Nishimura DG, Fischbein NJ. Reduced field-of-view diffusion imaging of the human spinal cord: comparison with conventional single-shot echo-planar imaging. AJNR Am J Neuroradiol 2011; 32:813-20. [PMID: 21454408 DOI: 10.3174/ajnr.a2418] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DWI of the spinal cord is challenging because of its small size and artifacts associated with the most commonly used clinical imaging method, SS-EPI. We evaluated the performance of rFOV spinal cord DWI and compared it with the routine fFOV SS-EPI in a clinical population. MATERIALS AND METHODS Thirty-six clinical patients underwent 1.5T MR imaging examination that included rFOV SS-EPI DWI of the cervical spinal cord as well as 2 comparison diffusion sequences: fFOV SS-EPI DWI normalized for either image readout time (low-resolution fFOV) or spatial resolution (high-resolution fFOV). ADC maps were created and compared between the methods by using single-factor analysis of variance. Two neuroradiologists blinded to sequence type rated the 3 DWI methods, based on susceptibility artifacts, perceived spatial resolution, signal intensity-to-noise ratio, anatomic detail, and clinical utility. RESULTS ADC values for the rFOV and both fFOV sequences were not statistically different (rFOV: 1.01 ± 0.18 × 10(-3) mm(2)/s; low-resolution fFOV: 1.12 ± 0.22 × 10(-3) mm(2)/s; high-resolution fFOV: 1.10 ± 0.21 × 10(-3) mm(2)/s; F = 2.747, P > .05). The neuroradiologist reviewers rated the rFOV diffusion images superior in terms of all assessed measures (P < 0.0001). Particular improvements were noted in patients with metal hardware, degenerative disease, or both. CONCLUSIONS rFOV DWI of the spinal cord overcomes many of the problems associated with conventional fFOV SS-EPI and is feasible in a clinical population. From a clinical standpoint, images were deemed superior to those created by using standard fFOV methods.
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Affiliation(s)
- G Zaharchuk
- Department of Radiology, Stanford University, California, USA.
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Mueller-Mang C, Law M, Mang T, Fruehwald-Pallamar J, Weber M, Thurnher MM. Diffusion tensor MR imaging (DTI) metrics in the cervical spinal cord in asymptomatic HIV-positive patients. Neuroradiology 2010; 53:585-92. [PMID: 21046094 PMCID: PMC3139090 DOI: 10.1007/s00234-010-0782-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 10/13/2010] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study was conducted to compare diffusion tensor MR imaging (DTI) metrics of the cervical spinal cord in asymptomatic human immunodeficiency virus (HIV)-positive patients with those measured in healthy volunteers, and to assess whether DTI is a valuable diagnostic tool in the early detection of HIV-associated myelopathy (HIVM). METHODS MR imaging of the cervical spinal cord was performed in 20 asymptomatic HIV-positive patients and in 20 healthy volunteers on a 3-T MR scanner. Average fractional anisotropy (FA), mean diffusivity (MD), and major (E1) and minor (E2, E3) eigenvalues were calculated within regions of interest (ROIs) at the C2/3 level (central and bilateral anterior, lateral and posterior white matter). RESULTS Statistical analysis showed significant differences with regard to mean E3 values between patients and controls (p = 0.045; mixed-model analysis of variance (ANOVA) test). Mean FA was lower, and mean MD, mean E1, and mean E2 were higher in each measured ROI in patients compared to controls, but these differences were not statistically significant. CONCLUSION Asymptomatic HIV-positive patients demonstrate only subtle changes in DTI metrics measured in the cervical spinal cord compared to healthy volunteers that currently do not support using DTI as a diagnostic tool for the early detection of HIVM.
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Affiliation(s)
- Christina Mueller-Mang
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Hodel J, Silvera J, Bekaert O, Rahmouni A, Bastuji-Garin S, Vignaud A, Petit E, Durning B, Decq P. Intracranial cerebrospinal fluid spaces imaging using a pulse-triggered three-dimensional turbo spin echo MR sequence with variable flip-angle distribution. Eur Radiol 2010; 21:402-10. [DOI: 10.1007/s00330-010-1925-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 07/12/2010] [Accepted: 07/26/2010] [Indexed: 11/28/2022]
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Fellner C, Menzel C, Fellner FA, Ginthoer C, Zorger N, Schreyer A, Jung EM, Feuerbach S, Finkenzeller T. BLADE in sagittal T2-weighted MR imaging of the cervical spine. AJNR Am J Neuroradiol 2009; 31:674-81. [PMID: 19942708 DOI: 10.3174/ajnr.a1894] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Image quality and diagnostic reliability of T2-weighted MR images of the cervical spine are often impaired by several kinds of artifacts, even in cooperative patients. The aim of this study was to evaluate if BLADE sequences might solve these problems in a routine patient collective. MATERIALS AND METHODS TSE and BLADE sequences were compared in 60 patients for T2-weighted sagittal imaging of the cervical spine. Image sharpness, motion artifacts, truncation artifacts, metal artifacts, CSF flow phenomena, contrast of anatomic structures (vertebral body/disk, spinal cord/CSF), and diagnostic reliability of spinal cord depiction were evaluated by 2 independent readers. Another 2 readers selected the sequence they would prefer for diagnostic purposes. Statistical evaluations were performed by using the Wilcoxon and the chi(2) test; differences with P < .05 were regarded as statistically significant. RESULTS BLADE was significantly superior to TSE regarding image sharpness, image contrast, diagnostic reliability of spinal cord depiction, motion artifacts, CSF flow phenomena, and truncation artifacts; for metal artifacts no significant improvements were found. In 50 of 60 patients, BLADE was preferred for diagnostic purposes, and TSE was favored in 3 patients. The number of examinations that were nondiagnostic due to impaired spinal cord depiction was reduced from 12 in TSE to 3 in BLADE, and nondiagnostic examinations due to overall motion artifacts were reduced from 2 to 1. CONCLUSIONS Using the BLADE sequence for sagittal T2-weighted imaging of the cervical spine proved to be advantageous to reduce various kinds of artifacts.
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Affiliation(s)
- C Fellner
- Institute of Radiology, University Medical Center Regensburg, Germany.
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Baumert B, Wörtler K, Steffinger D, Schmidt GP, Reiser MF, Baur-Melnyk A. Assessment of the internal craniocervical ligaments with a new magnetic resonance imaging sequence: three-dimensional turbo spin echo with variable flip-angle distribution (SPACE). Magn Reson Imaging 2009; 27:954-60. [DOI: 10.1016/j.mri.2009.01.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 12/12/2008] [Accepted: 01/18/2009] [Indexed: 11/27/2022]
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Magnetic resonance imaging of the cervical spine: comparison of 2D T2-weighted turbo spin echo, 2D T2*weighted gradient-recalled echo and 3D T2-weighted variable flip-angle turbo spin echo sequences. Eur Radiol 2008; 19:713-21. [PMID: 18813933 DOI: 10.1007/s00330-008-1175-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 06/28/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
To compare an isotropic three-dimensional (3D) high-resolution T2-weighted (w) MR sequence and its reformations with conventional sequences for imaging of the cervical spine. Fifteen volunteers were examined at 1.5 T using sagittal and axial 3D T2-w, sagittal and axial 2D T2w, and axial 2D T2*w MR sequences. Axial reformations of the sagittal 3D dataset were generated (3D MPR T2w). Signal-to-noise and image homogeneity were evaluated in a phantom and in vivo. Visibility of ten anatomical structures of the cervical spine was evaluated. Artifacts were assessed. For statistical analysis, Cohen's kappa, Wilcoxon matched pairs, and t-testing were utilized. There were no significant differences in homogeneity between the sequences. Sagittal 3D T2w enabled better delineation of nerve roots, neural foramina, and intraforaminal structures compared to sagittal 2D T2w. Axial 3D T2w and axial 3D MPR T2w resulted in superior visibility of most anatomical structures compared to axial 2D T2w and comparable results to 2D T2*w concerning the spinal cord, nerve roots, intraforaminal structures, and fat. Artifacts were most pronounced in axial 2D T2w and axial 3D T2w. Acquisition of a 3D T2w data set is feasible in the cervical spine with superior delineation of anatomical structures compared to 2D sequences.
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Dare AO, Dias MS, Li V. Magnetic resonance imaging correlation in pediatric spinal cord injury without radiographic abnormality. J Neurosurg 2002; 97:33-9. [PMID: 12120649 DOI: 10.3171/spi.2002.97.1.0033] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to determine correlations between clinical syndromes and early magnetic resonance (MR) imaging-documented findings in children with spinal cord injury without radiographic abnormality (SCIWORA). METHODS The authors retrospectively reviewed the records obtained in 20 patients who presented with SCIWORA to the Children's Hospital of Buffalo between 1992 and 1999. Initial neurological syndromes, subsequent hospital course and outcome, and early MR imaging findings obtained using conventional sequences on a 1.5-tesla unit were recorded. Neurological syndromes on presentation were complete (Frankel Grade A) in two patients (10%), severe partial (Frankel Grade C) in one patient (5%), and mild partial (Frankel Grade D) in 17 patients (85%). Partial neurological deficits resolved in 14 (78%) of 18 patients within 72 hours and lasted more than 72 hours in four patients (22%). Magnetic resonance imaging was performed in both patients presenting with complete injuries and in 17 of 18 patients presenting with partial neurological deficits. The studies were obtained within 24 hours in 17 patients (85%). Neuroimaging revealed spinal cord swelling at the cervical level in one of the children with complete injury and cord edema with associated hemorrhage at cervical and thoracic levels in the other. Neural and extraneural elements were shown to be normal in all 17 patients with partial injuries who underwent MR imaging, including in the four patients with partial motor deficits lasting more than 72 hours. CONCLUSIONS In this series, the predominant neurological presentation of SCIWORA was a mild, partial syndrome that resolved within 72 hours. Magnetic resonance imaging revealed abnormal features only in those patients with complete neurological deficits. These findings suggest that in the acute setting conventional MR imaging sequences may lack the sensitivity to demonstrate neural and extraneural abnormalities associated with partial or temporary neurological deficits of SCIWORA, even when those deficits persist beyond 72 hours.
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Affiliation(s)
- Amos O Dare
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA
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Abstract
Optimization of the MR image requires an understanding of technical parameters, pulse sequences, artifacts, and the use of contrast agents. More technical information and in-depth details about the practical concepts for performing MRI in children can be found in the references accompanying this article.
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Affiliation(s)
- Sudha Anupindi
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 32 Fruit Street, White 246, Boston, MA 02114, USA.
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