Andrew W. Litt

Comparison of magnetic resonance angiography, conventional angiography, and duplex scanning.

Background and Purpose To determine the accuracy of magnetic resonance angiography in assessing patients with cerebrovascular disease, we performed a study comparing the results of conventional cerebral angiography, duplex scanning, and magnetic resonance angiography. Methods From 42 patients, a total of 25 carotid arteries were evaluated by all three techniques. The studies were independently read and sorted into five categories according to the degree of stenosis: 0–15%, normal; 16–49%, mild; 50–79%, moderate; 80–99%, severe; and totally occluded. Results Magnetic resonance angiography correlated exactly with conventional angiography in 39 arteries (52%); duplex scanning correlated with conventional angiography in 49 cases (65%). Compared with conventional angiography, both magnetic resonance angiography and duplex scanning tended to overread the degree of stenosis. The most critical errors associated with magnetic resonance angiography were three readings of total occlusion in vessels found to be patent on conventional angiograms. Conclusions Although magnetic resonance angiography offers great hope of providing high-quality imaging of the carotid artery with no risk and at less cost, data from this study suggest that misreading the degree of stenosis, or misinterpreting a stenosis for an occlusion, could lead to errors in clinical decisions. Guidelines for use of magnetic resonance angiography in a clinical setting are offered.

Gadolinium-enhanced 3D MRA of the aortic arch vessels in the detection of atherosclerotic cerebrovascular occlusive disease

PURPOSE Our goal was to evaluate non-breath-hold Gd-enhanced 3D MR angiography (MRA) for the detection of atherosclerotic occlusive disease of the aortic arch vessels and to compare image quality with two breath-hold techniques. METHOD One hundred sixty consecutive patients with known or clinically suspected atherosclerotic cerebrovascular occlusive disease underwent Gd-enhanced 3D MRA of the aortic arch and great vessels. One hundred twenty-six examinations were performed with the body coil after infusion of 40 ml of Gd-DTPA; 89 of these were performed without breath-holding and 37 were acquired during suspended respiration. Thirty-four examinations were performed in a body phased-array coil with breath-holding, a timing examination, and 20 ml of contrast agent by manual (n = 17) or power (n = 17) injection. Images were evaluated for the presence of blurring and ghosting artifacts and venous enhancement. Of the 27 patients who underwent non-breath-hold MRI and digital subtraction angiography (DSA), two readers blinded to the DSA results retrospectively evaluated the MRA examinations for the presence of occlusive disease of the innominate, carotid, subclavian, and vertebral arteries. DSA correlation was not evaluated for the 71 breath-hold studies. RESULTS Sensitivity and specificity for arch vessel occlusive disease with non-breath-hold MRA were 38 and 94% for Reader A and 38 and 95% for Reader B. Breath-holding significantly reduced blurring and ghosting artifacts (p < 0.001) when compared with non-breath-hold imaging, and use of 20 ml of contrast medium, with a timing examination, resulted in significantly less venous enhancement than seen with 40 ml (p < 0.001). CONCLUSION Non-breath-hold Gd-enhanced 3D MRA is insensitive for detecting arch vessel occlusive disease. Breath-hold imaging, in conjunction with a timing examination and a lower dose of contrast agent, improves image quality, but further studies are needed to assess diagnostic accuracy.

High resolution GRASE MRI of the brain and spine: 512 and 1024 matrix imaging.

Objective Our goal was to implement 512 and 1024 matrix MRI of the brain in clinically acceptable imaging times. Materials and Methods With use of the GRASE (gradient-SE) imaging technique, 3 signals are refocused from each of 16 SEs, giving a total of 48 echoes per echo train, for a speed advantage of 1/48 over conventional SE imaging, Images in 1024 matrices are acquired in 2D Fourier transform (FT) multisectional MRI. In related experiments, multislab 3D FT GRASE imaging is performed using 16 partitions/slab, providing thinner 1 to 2 mm sections. In all imaging experiments, higher spatial resolution is obtained with stronger and faster gradients, 24 mT/m in 625 μs rise time, on a standard commercial MRI system. Results The 2D FT 1024 matrix images of the head were acquired in 4:20 min, with 20 sections and TR/TE 7040/115 ms in a rectangular FOV to obtain .28 x .27 mm2 spatial resolution. Small anatomic structures, including cochlea of inner ear, cranial nerves, and vascular detail, are readily demonstrated. The 512 matrix images were obtained in 4:40 min, with 16 sections and TR/TE 3,500/104 ms in a 24 cm FOV. The 3D FT Technique substantially increased slice coverage as well as image signal-to-noise ratio. Conclusion The results show that 1024 matrix MRI is technically feasible in clinically acceptable imaging time and offers advantage for high resolution imaging. Optimization of 1024 matrix and 3D FT GRASE imaging should improve the delineation of anatomic regions of interest.

Role of slice thickness in MR imaging of the internal auditory canal.

The relative efficacy of post-Gd-DTPA 5 and 3 mm axial T1-weighted images was compared in the detection of lesions in the internal auditory canal and cerebellopontine angle. One hundred twenty consecutive patients were prospectively evaluated with 5 mm axial T1-weighted slices. If these were negative or questionable, 3 mm axial slices were immediately obtained as the next sequence. Eighteen percent of cases were positive and in none of these was the 5 mm study normal. However, in 22 negative cases and two positive cases, a 3 mm study was necessary for confirmation. Five millimeter axial scanning post Gd-DTPA is recommended as the initial study for detection of masses in the internal auditory canal and cerebellopontine angle. Because this study requires fewer acquisitions than 3 mm sections and can be done satisfactorily on low and midfield systems, there are potential time- and cost-saving benefits to this approach.

Water excitation MPRAGE MRI of VII and VIII cranial nerves.

OBJECTIVE Our goal was to compare magnetization prepared rapid gradient echo--water excitation (MRPRAGE-WE) with conventional spin echo (CSE) in the evaluation of the VII and VIII cranial nerves. METHODS One hundred three consecutive patients with symptoms referable to the VII/VIII nerves were studied with CSE T1 and MPRAGE-WE following intravenous gadolinium contrast agent. Each right and left nerve pair was independently evaluated for the presence of an enhancing mass and for visualization of the nerves. RESULTS On the CSE images, 26 definite and 2 possible lesions were identified, whereas 28 definite and 2 possible abnormalities were seen on the MPRAGE-WE. Four cases were better identified on the MPRAGE-WE and one better seen on the CSE. This difference was not statistically significant (p = 0.19). CSE demonstrated the nerves partially in 23 instances and completely in 6; MPRAGE-WE showed the nerves partially in 35 and completely in 73. This was highly significant (p<0.001). CONCLUSION With equivalent or slightly improved lesion detection and better visualization of the nerves, MPRAGE-WE may replace CSE in studying the VII/VIII nerves.

Fluid Within Preexisting Pulmonary Air-Spaces: A Potential Pitfall in the CT Differentiation of Pleural from Parenchymal Disease

There have been many reports of the ability of CT to distinguish between parenchymal and pleural disease. The purpose of this report is to describe the appearance of seven cases of intraparenchymal fluid-filled air-spaces (bullae or lung cysts) in which the CT findings may resemble those of pleural disease and, thus, cast doubt on the specificity of the established criteria.

Utility of Endothelial Permeability Measurements in Differentiation between Atypical and Typical Meningiomas Using Perfusion-Weighted MRI

1061 scribe the presence of brain invasion as an important factor in recurrence risk . The distinction between atypical and typical meningiomas is clinically relevant because benign meningiomas have been shown to recur about 7-20% of the time, while atypical variants recur in 2940% of cases . Thus, prospectively grading meningiomas may have important clinical implications. The use of adjuvant therapy and its dose may vary depending on the grade. Addition of adjuvant therapy has been shown to be of proven benefit in improving disease-free survival .