To better understand the morphologic appearance of avascular necrosis (AVN) of the femoral head on magnetic resonance (MR) images (1.5 T) and computed tomographic (CT) scans, the records of 21 lesions were reviewed retrospectively. All MR imaging studies included T1-weighted images (T1WI) (repetition times [TR] of 400-1,000 msec, and echo times [TE] of 20-25 msec), and 15 included T2-weighted images (T2WI) (TR = 2,000-2,500 msec; TE = 60-80 msec). MR signal features of the lesions were compared with features on the corresponding CT scans. Abnormalities in the superoanterior aspect of the femoral head were noted on both image types in all 21 lesions but were more obvious on MR images in two. A characteristic margin of peripheral sclerosis seen on CT scans in 95% (20 of 21) of lesions corresponded to a line of low intensity on MR images. Fractures complicating AVN were seen in eight lesions at CT scanning. On T1WI, fractures were not clearly delineated. On T2WI, fractures were of high intensity but were depicted less clearly than on CT scans. Central signal intensity of the lesions on T1WI correlated with the presence or absence of fracture: 88% (seven of eight) of the lesions with fractures appeared less intense than fat, compared with only 8% (one of 13) of lesions without fractures (P less than .005). While MR imaging is a sensitive method for early diagnosis of AVN, CT scanning can more accurately identify fractures and is thus important for staging.
MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease.M L Schiebler, B C Yankaskas, C Tempany, C E Spritzer, M D Rifkin, H M Pollack, P Holtz and E A ZerhouniAudio Available | Share
Pelvic magnetic resonance images obtained at 1.5 T of 29 male patients with no known genitourinary tract disease were retrospectively reviewed. Normal anatomic features of the prostate and its adjacent structures were studied with spin echo techniques with short and long repetition times/echo times (TR/TE). Long TR/TE (T2-weighted) images routinely showed differentiation of peripheral and central prostatic zones, as well as a separate periprostatic venous plexus. Guidelines were developed to optimize imaging of the relationship of the prostate to adjacent structures.
The conversion of hematopoietic to fatty marrow is known to correlate with physiologic decreases in intramedullary blood flow. To determine whether the chronology of conversion is altered in patients with hip ischemia, T1-weighted magnetic resonance (MR) images of the hips in 50 healthy people and 27 with documented avascular necrosis (AVN) were reviewed. The distribution of fatty (high-signal) versus hematopoietic (low-signal) marrow was noted with respect to age. All patients had fatty marrow in the femoral capital epiphysis and greater trochanter. Hematopoietic intertrochanteric marrow was seen in 95% (80 of 84) of femurs in control subjects less than 50 years old, but in only 12.5% (two of 16) of those in control subjects older than 50 years (P less than .005). Only 33% (19 of 57) of patients less than 50 years with AVN had predominantly hematopoietic intertrochanteric marrow (P less than .005). The early conversion to fatty marrow in most patients with AVN as depicted by MR imaging may be an effect of decreased vascularity of the proximal femur and may allow the identification of patients at increased risk for AVN.
The use of magnetic resonance (MR) to preoperatively evaluate patients with primary hyperparathyroidism was assessed using a 1.5 T system and surface coil reception. Twenty-five patients with primary hyperparathyroidism were studied before surgical exploration. Axial images, 5 mm thick, were obtained from the thyroid cartilage to the sternal notch. Both T1-weighted [short repetition time (TR). short echo time (TE)] and T2-weighted (long TR, long TE) spin echo sequences were performed in most cases. Parathyroid adenomas typically demonstrated greater signal than surrounding tissues on T2-weighted sequences. yet demonstrated signal intensity that was less than or equal to normal thyroid tissue on T1-weighted sequences. Using these criteria, MR correctly identified 17 of 20 surgically proven parathyroid adenomas in the neck. Magnetic resonance appeared less sensitive in two patients with parathyroid hyperplasia, identifying only one of six hyperplastic glands. We conclude that MR with surface coils provides high contrast, anatomic delineation of the neck and is useful for preoperative localization of parathyroid tumors.
Thirty-nine patients (30 women and 9 men) underwent magnetic resonance imaging (MRI) and scintigraphic examinations to compare MRI evaluation qualitatively with the accepted standard of nuclear medicine diagnosis. Disorders evaluated included multinodular goiter (toxic and nontoxic), diffuse thyrotoxic states and solitary cold nodules (benign and malignant). Scintigraphy accurately detected palpable nodules and provided a gold standard against which to compare MRI findings. MRI frequently detected additional smaller nonpalpable lesions of uncertain clinical significance. High-resolution surface-coil MRI was more sensitive in detecting lesions not evident on scintigraphic images, although specificity could not be ascertained. T2-weighted images corresponded more closely to scintigraphic findings than T1. MRI provided superior anatomic detail in multiple imaging planes without any ionizing radiation exposure or need for IV contrast. MRI did not differentiate benign from malignant etiologies.
To assess blood flow rapidly, a limited-flip-angle, gradient recalled pulse sequence was modified to acquire two views at the same phase-encoding step in successive repetitions. One view is obtained with first-moment flow compensation, while the second view is obtained with selectable flow encoding (non-zero first moment) along one direction. Blood flowing along the encoded direction acquires a phase difference between the two views, resulting in signal dependent on both direction and speed of flow. Stationary tissues undergo no phase change. Therefore, the phase shift between the two views produces an image that spatially renders flow direction and velocity. With a 24-msec repetition time, a 256 X 128 matrix, and two excitations, data acquisition is completed in 13 seconds per location (both a magnitude image and a flow image are produced at each location). Images generated with flow phantoms confirmed the accuracy of this method. Preliminary clinical evidence in 23 human subjects suggests that this method is useful in evaluating portal hypertension, distinguishing arterial from venous flow, distinguishing between slow flow and clot, and confirming the presence of clot. This method appears to be a fast, easy way to assess blood flow in large vessels.
