HASTE Sequence Research Articles

Use of non-echo-planar diffusion-weighted MR imaging for the detection of cholesteatomas in high-risk tympanic retraction pockets.

Non-echo-planar DWI MR imaging (including the HASTE sequence) has been shown to be highly sensitive and specific for large cholesteatomas. The purpose of this study was to determine the diagnostic accuracy of HASTE DWI for the detection of incipient cholesteatoma in high-risk retraction pockets. This was a prospective study of 16 patients who underwent MR imaging with HASTE DWI before surgery. Surgeons were not informed of the results, and intraoperative findings were compared against the radiologic diagnosis. Sensitivity, specificity, and positive and negative predictive values were calculated. Among the 16 retraction pockets, 10 cholesteatomas were diagnosed intraoperatively (62.5%). HASTE showed 90% sensitivity, 100% specificity, 100% positive predictive value, and 85.7% negative predictive value in this group of patients. We found only 1 false-negative finding in an infected cholesteatoma. We demonstrate a high correlation between HASTE and surgical findings, suggesting that this technique could be useful for the early detection of primary acquired cholesteatomas arising from retraction pockets and could help to avoid unnecessary surgery.

Comparison of 3D Maximum intensity projection (MIP) reconstruction and 2D T2 Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (HASTE) sequence in magnetic resonance cholangiopancreatography

Introduction: Magnetic resonance cholangiopancreatography (MRCP) is a method that allows noninvasive visualization of pancreatobiliary tree and does not require contrast application. It is a modern method based on heavily T2-weighted imaging (hydrography), which uses bile and pancreatic secretions as a natural contrast medium. Certain weaknesses in quality of demonstration of pancreatobiliary tract can be observed in addition to its good characteristics. Our aim was to compare the 3D Maximum intensity projection (MIP) reconstruction and 2D T2 Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (HASTE) sequence in magnetic resonance cholangiopancreatography.Methods: During the period of one year 51 patients underwent MRCP on 3T „Trio“ system. Patients of different sex and age structure were included, both outpatient and hospitalized. 3D MIP reconstruction and 2D T2 haste sequence were used according to standard scanning protocols.Results: There were 45.1% (n= 23) male and 54.9% (n=28) female patients, age range from 17 to 81 years. 2D T2 haste sequence was more susceptible to respiratory artifacts presence in 64% patients, compared to 3D MIP reconstruction with standard error (0.09), result significance indication (p=0.129) and confidence interval (0.46 to 0.81). 2D T2 haste sequences is more sensitive and superior for pancreatic duct demonstration compared to 3D MIP reconstruction with standard error (0.07), result significance indication (p=0.01) and confidence interval (0.59 to 0.87)Conclusion: In order to make qualitative demonstration and analysis of hepatobiliary and pancreatic system on MR, both 2D T2 haste sequence in transversal plane and 3D MIP reconstruction are required.

Diagnostic Value of Cardiac MRI in Comparison to Trans-Thoracic Echocardiography in Detection and Characterization of Cardiac Masses

Background: Cardiac masses are uncommon and encompass a spectrum of lesions with different histological features. Despite rarity, serious complications associated with these lesions render the need for a sensitive, specific, and accurate diagnostic tool which may lead to treatment options such as cardiac surgery as a major invasive intervention. Objectives: The purpose of this study was to compare accuracy and specificity of trans-thoracic echocardiography (TTE) and cardiac MRI (CMRI) as the two non-invasive diagnostic methods available. Patients and Methods: Thirty-eight patients who were suspected to have cardiac or pericardiac space occupying lesions on TTE were included in this study. CMRI protocols include steady cine imaging, HASTE and 3D-IR FLASH sequences after contrast (Gd-chelate) administration in first pass and delayed images added to common CMRI sequences (T1 and T2 TSE) Results: Of the 38 subjects, 27 (PPV, 68.4%) had findings in CMRI in favor of SOL (other studies were either normal or suggestive of other disorders such as cardiomyopathies). Of these, 18 were solid masses and 9 were either cystic mass lesions or clots. In view of CMRI findings and clinical indications, 20 patients underwent operation and for all of them the diagnosis of SOL lesions was confirmed (no false positive). On CMRI, 11 cardiac tumors had findings suggestive of malignancy, which was consistent with the histopathology results in 10 operated patients (specificity, 90.9% of tissue diagnosis). CMRI features in 7 patients were in favor of indeterminate or benign lesions with a PPV of 83.3% after histological comparison (6 masses were resected). Five lesions which were suspected of being neoplastic masses on TTE, turned out to be endocardial vegetations or thrombi on CMRI (PPV, 78%). In five patients who underwent CMRI for characterization of cystic lesion detected by TTE, findings of both modalities were almost consistent with each other with a superior precision in CMRI characterization. Invasion to adjacent organs or remote organs involvement was detected in 7 patients, completely compatible with intra-operational observations and/or further investigations (specificity, 100%). Conclusions: CMRI with specific sequences and multiplanar image is by far the most accurate non invasive modality in detection and evaluation of mass lesions in and around heart.

MRI Diffusion measurements on phantoms: comparison between EPI and HASTE sequences utilizing two fitting methods in Apparent Diffusion Coefficient (ADC) measurements

MRI Diffusion measurements on phantoms: comparison between EPI and HASTE sequences utilizing two fitting methods in Apparent Diffusion Coefficient (ADC) measurements

Automatic iceball segmentation with adapted shape priors for MRI‐guided cryoablation

To develop and evaluate an automatic segmentation method that extracts the 3D configuration of the ablation zone, the iceball, from images acquired during the freezing phase of MRI-guided cryoablation. Intraprocedural images at 63 timepoints from 13 kidney tumor cryoablation procedures were examined retrospectively. The images were obtained using a 3 Tesla wide-bore MRI scanner and axial HASTE sequence. Initialized with semiautomatically localized cryoprobes, the iceball was segmented automatically at each timepoint using the graph cut (GC) technique with adapted shape priors. The average Dice Similarity Coefficients (DSC), compared with manual segmentations, were 0.88, 0.92, 0.92, 0.93, and 0.93 at 3, 6, 9, 12, and 15 min timepoints, respectively, and the average DSC of the total 63 segmentations was 0.92 ± 0.03. The proposed method improved the accuracy significantly compared with the approach without shape prior adaptation (P = 0.026). The number of probes involved in the procedure had no apparent influence on the segmentation results using our technique. The average computation time was 20 s, which was compatible with an intraprocedural setting. Our automatic iceball segmentation method demonstrated high accuracy and robustness for practical use in monitoring the progress of MRI-guided cryoablation.

Detection of acute pulmonary embolism: feasibility of diagnostic accuracy of MRI using a stepwise protocol

Multidetector computed tomography (MDCT) has become the imaging method of choice in patients suspected of having pulmonary embolism (PE) but has the inherent limitation of radiation dose and the side effects of contrast agents. The purpose of the study was to assess the feasibility of a stepwise MRI protocol in the clinical setting of acute PE. The stepwise approach should make it possible to diagnose acute PE in critically ill patients using fast MR sequences and included the option to add comprehensive sequences when patients were stable. Forty-five patients with acute PE (26 men, 19 women; 41 ± 16 years) were included in this prospective study. The diagnosis was initially confirmed by MDCT as gold standard. MRI at 1.5 T was subsequently performed without any delay in medical treatment. The MRI protocol proceeded stepwise from robust to detailed imaging techniques (i.e., from TrueFISP and single shot HASTE sequence to MR perfusion and 3D-MR angiography) if the patient was able to tolerate additional imaging time. Diagnostic accuracy was evaluated on the central (lobar) and peripheral (segmental) levels. The complete MR protocol was applied in 40 of the 45 patients (88 %). In the remaining five patients with severe dyspnea the diagnosis of acute PE was established by using fast TrueFISP sequences that were insensitive to respiratory movement. All five patients suffered from a major central PE. Highest sensitivity was achieved by MR perfusion (lobar, 98 %; segmental, 95 %). Real-time TrueFISP and MR angiography showed the highest specificity (lobar, 90-100 %; segmental, 95-97 %). The combination of all MR sequences matched closely the results of MDCT (lobar: sensitivity 98 %, specificity 100 %; segmental: sensitivity 95 %, specificity 97 %). MRI using a stepwise protocol is a promising approach for diagnosing acute PE. The protocol can be tailored for dyspneic patients with central PE using real-time MRI sequences. The diagnostic accuracy for peripheral PE can be improved by using combined MR techniques, achieving comparable results to MDCT.

3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: Initial results in comparison to HRCT

PurposeTo evaluate the diagnostic accuracy of 3Tesla proton MRI for the assessment of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia. Material and methodsIn a prospective study, 3Tesla MRI was performed in 19 febrile neutropenic patients (5 women, 14 men; mean age 61 years±14.2; range 23–77 years). All patients underwent high-resolution CT less than 24h prior to MRI. The MRI protocol (Magnetom Tim Trio, Siemens) included a T2-weighted HASTE sequence (TE/TR: 49ms/∞, slice thickness 6mm) and a high-resolution 3D VIBE sequence with an ultra-short TE<1ms (TE/TR 0.8/2.9ms, slice thickness 2mm). The VIBE sequence was examined before and after intravenous injection of 0.1mmol/kg gadoterate meglumine (Dotarem, Guerbet). The presence of pulmonary abnormalities, their location within the lung, and lesion type (nodules, consolidations, glass opacity areas) were analyzed by one reader and compared to the findings of HRCT, which was evaluated by a second independent radiologist who served as the reference standard. The findings were compared per lobe in each patient and rated as true positive (TP) findings if all three characteristics (presence, location, and lesion type) listed above were concordant to HRCT. ResultsPulmonary abnormalities were characterized by 3Tesla MRI with a sensitivity of 82.3% and a specificity of 78.6%, resulting in an overall accuracy of 88% (NPV/PPV 66.7%/89.5%). In 51 lobes (19 of 19 patients), pulmonary abnormalities visualized by MR were judged to be concordant in their location and in the lesion type identified by both readers. In 22 lobes (11 of 19 patients), no abnormalities were present on either MR or HRCT (true negative). In 6 lobes (5 of 19 patients), ground glass opacity areas were detected on MRI but were not visible on HRCT (false positives). In 11 lobes (7 of 19 patients), MRI failed to detect ground glass opacity areas identified by HRCT. However, since the abnormalities were disseminated in these patients, accurate treatment decisions were possible in every case based on MRI. In one case MRI showed a central area of cavitation, which was not visualized by HRCT. ConclusionInfectious nodules and consolidations can be detected in neutropenic patients with acute myeloid leukemia with a sufficient diagnostic accuracy by 3Tesla MRI. Detection of ground glass opacity areas is the main limitation of 3-Tesla MRI when compared to HRCT.

Proton MRI in the evaluation of pulmonary sarcoidosis: Comparison to chest CT

PurposeThe purpose of this study was to determine the feasibility of proton MRI of the lung in sarcoidosis patients and the agreement between the imaging appearance of pulmonary sarcoidosis on MRI and CT. Materials and methodsChest CT scans and dedicated pulmonary MRI scans (including HASTE, VIBE, and TrueFISP sequences) were performed within 90 days of each other in 29 patients. The scans were scored for gross parenchymal opacification, reticulation, nodules, and masses using a 3-point lobar scale. Total and subset scores for corresponding MRI and CT scans were compared using the Spearman correlation test, Bland–Altman plots, and Cohen's quadratic-weighted kappa analysis. MRI scores were compared to CT by lobe and disease category, using percentage agreement, Spearman rank correlation, and Cohen's quadratic-weighted kappa. ResultsThe mean (±s.d.) time between MRI and CT scans was 33±32 days. There was substantial correlation and agreement between total disease scoring on MRI and CT with a Spearman correlation coefficient of 0.774 (p<0.0001) and a Cohen's weighted kappa score of 0.646. Correlation and agreement were highest for gross parenchymal opacification (0.695, 0.528) and reticulation (0.609, 0.445), and lowest in the setting of nodules (0.501, 0.305). Agreement testing was not performed for mass scores due to low prevalence. Upper lobe scoring on MRI and CT demonstrated greater agreement compared to the lower lobes (average difference in Cohen's weighted kappa score of 0.112). ConclusionThere is substantial correlation and agreement between MRI and CT in the scoring of pulmonary sarcoidosis, though MRI evaluation in the upper lobes may be more accurate than in the lower lobes.

P.13.4 Diaphragm structural abnormalities revealed by NMR imaging in the dystrophic dog

In DMD patients, respiratory muscle weakness induces a severe respiratory failure in the course of the disease. Hence, treating also the dystrophic respiratory muscles is of paramount importance and one of the arguments in favor of systemic therapy. In parallel, there is a need for novel non-invasive outcome measures for the diaphragm muscle, complementary to the histologic evaluation and the radiographic studies previously reported. NMR imaging has proven very efficient to discriminate dystrophic muscles from healthy control ones and even more, successfully treated dystrophic muscles from untreated ones in a loco-regional therapeutic trial of GRMD dogs, the canine counterpart of DMD patients. We investigated the ability of NMR to evaluate the diaphragm, which was imaged with a 3D SPACE T1-weighted sequence in 5 healthy and 8 GRMD dogs (mean age: 13.6 and 14.6 months, respectively), using a 3-tesla NMR scanner. In addition, breath-hold T2-weighted HASTE sequences were performed in 3 healthy and 7 GRMD dogs. In all dogs, diaphragms were visualized, particularly the ventral segment, cranial to the liver. In healthy dogs, it appeared as a thin, homogeneous, T1- and T2-hypointense structure compared to the liver. In GRMD dogs, as early as at 3 months of age, the diaphragm was thickened (11.2 ± 6.0 mm vs 2.4 ± 0.7 mm in healthy dogs), when measured in the sagittal plan, cranially to the liver close to its insertion to the manubrium; p To conclude, this study demonstrated the feasibility of NMR imaging of the diaphragm muscle despite its thinness, its complex shape, and respiratory motion artefacts. We described for the first time the dystrophic diaphragm abnormalities, as they can be visualized by NMR imaging as early as at 3 months of age. NMRI is a promising outcome measure for the diaphragm evaluation in preclinical trials using GRMD dogs.

Periodic MRI Lung Volume Assessment in Fetuses With Congenital Diaphragmatic Hernia: Prediction of Survival, Need for ECMO, and Development of Chronic Lung Disease

The purpose of the study was to investigate the ability to predict survival, need for extracorporeal membrane oxygenation (ECMO), and incidence of chronic lung disease in patients with congenital diaphragmatic hernia in the context of a classification into three different times of gestation (< 28, 28-32, and > 32 weeks) by assessing the ratio between observed and expected MRI fetal lung volume. The data analysis included 226 fetuses with congenital diaphragmatic hernia. MRI was performed at different times of gestation with a T2-weighted HASTE sequence. Receiver operating characteristic curve analysis was performed to investigate the prognostic value of assessment of the ratio between observed and expected MRI fetal lung volumes at different stages of fetal growth. For all reviewed times of gestation, the ratio between observed and expected MRI fetal lung volumes had almost equivalent statistically significant differences for neonatal survival (p ≤ 0.0029), need for ECMO therapy (p ≤ 0.0195), and development of chronic lung disease (p ≤ 0.0064). Results with high prognostic accuracy for early and for medium and late times in gestation also were obtained. Receiver operating characteristic analysis showed the highest area under the curve (≥ 0.819) for neonatal survival. In patients with congenital diaphragmatic hernia, the relation between observed and expected MRI fetal lung volume is a valuable prognostic parameter for predicting neonatal mortality, morbidity represented by the development of chronic lung disease, and the need for ECMO therapy in early gestation (< 28 weeks) as well as later gestation with no statistically significant differences.

TH‐C‐141‐08: A Feasibility Study of the Utility of Dynamic Contrast‐Enhanced MRI for Treatment Planning and Monitoring Treatment Response in Lung Stereotactic Body Radiation Therapy

Purpose: To investigate the feasibility of pulmonary DCE‐MRI in 1) identifying regions of functional lung for lung SBRT treatment planning; 2) assessing tumor response during and after SBRT; and 3) characterizing regions of radiation‐induced lung injury after SBRT. Methods: In this IRB‐approved feasibility study, participants being treated with 3–5 fractions of 12–18 Gy undergo pulmonary DCE‐MRI at baseline, during treatment (1–2 days after first fraction) and post‐treatment (1–2 weeks and then 3–4 months). DCE‐MRI is performed using a clinical 3D DCE‐MRI protocol, that includes T2‐weighted HASTE, T1‐weighted VIBE, and 3D turbo FLASH sequences. The parameters for the 3D turbo FLASH were: TR/TE=2.2/0.84msec, FOV=400mm, 256×208, slice thickness 3.6 mm, 1 excitation, BW=930kHz, FA=10, coronal orientation, temporal resolution=4sec, 42 frames, Gd‐DTPA iv. 0.1 mmol/kg. Time‐intensity curves are derived after motion‐correction, and fit to a two‐compartment plasma/extracellular extravascular space (EES) model to derive pharmacokinetic parameters for the tumor and surrounding treated lung, including kep, the characteristic rate of transfer of contrast tracer between plasma and the EES. The study aims to enroll 20 patients, with a preliminary assessment of feasibility after 7 patients. Results: The first patient was enrolled, and all the 4 MRI studies were successfully completed within the timeframe defined by the protocol, without complications. Images of the lung and tumor were obtained with satisfactory quality for pharmacokinetic analysis. Pharmacokinetic parameter maps based on DCE‐MRI were generated and registered to the corresponding planning 4DCT for each scan. In this first patient, kep in a tumor ROI was 1.09 before treatment, 0.20 after 2 fractions of 18 Gy, and 0.76 two weeks after the final fraction. Conclusion: The feasibility of acquiring and incorporating information from DCE‐MRI into lung stereotactic body radiation therapy has been demonstrated on an initial patient. Quantitative analysis will be performed after accrual of more participants. Kaye Scholar Grant and Siemens Research Partnership Grant

Sequenz-Evaluation für die MR-Enterografie für Patienten mit Morbus Crohn

To evaluate a routine MR enterography (MRE) protocol for patients with Crohn's disease (CD) in order to assess and rank the subjectively most important sequences regarding diagnostic decisions. We prospectively examined 84 patients (42 male) with known CD using a coronal T2 / T1-weighted balanced SSFP (TrueFISP), axial T2-weighted single shot TSE (HASTE) as well as an axial T1-weighted gradient-echo sequence (2D-FLASH) before intravenous contrast application and a 2D-FLASH sequence with axial and coronal orientation after intravenous contrast application. 4 experienced radiologists subjectively evaluated the sequences independently using a scale between 1 and 5 (1 = excellent; 5 = non-diagnostic) regarding their diagnostic significance for a final radiologic decision. The ranking of the different sequences was statistically tested by the Friedman analysis. The following ranking was found: HASTE sequences were ranked prior to contrast-enhanced axial gradient-echo (2D-FLASH). The third to fifth ranking was TrueFISP, the axial contrast-enhanced 2D-FLASH and the 2D-FLASH without contrast, respectively. Differences between the first and second rank were significant (p < 0.05), and all other differences were highly significant (p < 0.01). The stable and fast T2-weighted MR sequences without intravenous contrast represented by axial HASTE and coronal TrueFISP were ranked as number 1 and 3. The examination protocol should be completed by a coronal T1-weighted gradient-echo-sequence after contrast injection, which can be supplemented by an axial acquisition. The T1-weighted gradient-echo sequence without contrast could be omitted.

Right atrial volume and body mass index in corrected tetralogy of Fallot correlate with the incidence of supraventricular arrhythmia - an MRI study

Background Patients with corrected Tetralogy of Fallot (cTOF) can develop supraventricular arrhythmias. So far, right atrial (RA) volume in TOF has not been evaluated in the context of arrhythmia. The aim of this study was to evaluate if right atrial (RA) volume in TOF correlates with the occurrence of supraventricular arrhythmias. To identify other risk factors for arrhythmias additional parameters were included in the analysis: anthropomorphic parameters (BMI, age, gender), previous shunt, high right ventricular (RV) volumes and pulmonary regurgitation (PR). Methods Cardiac MRI (CMR) and 24h Holter ECG-monitoring were performed in 69 consecutive patients with cTOF (Table 1). CMR protocol included triplanar HASTE sequences, standard SSFP cine images, flow measurements of the aorta, pulmonary trunk and pulmonary arteries. RA and LA volumes were retrieved from HASTE sequences and SSFP cine images. Results Mean values for RA volume were 49 +-19 ml/m 2 from HASTE sequences. In 23 patients endsystolic and enddiastolic RA-volumes were obtained from cineSSFP and compared to HASTE sequences. Bland-Altman analysis confirmed correlation of RA volumes from both sequences in atrial diastole with minimal overestimation by HASTE sequences. Mean RV volumes were 97 +-27 ml/m 2 ,p ulmonary valve regurgitation fraction 21 +-19 %. Mean heart rate on Holter was 75, ranging from from 52 to 124 bpm. 57 of 69 patients had supraventricular arrhythmias as singular extrasystolies, couplets or short runs. Mean BMI was 25 kg/m 2 with a range from 15.5 to 36 kg/m 2 . Based on multivariate regression analysis RA volume (p<0.01) as well as BMI (p<0.01) were identified as independent risk factors for supraventricular arrhythmias. No correlation was found for gender, age, previous shunt, RV volume or degree of residual pulmonary regurgitation. Conclusions TOF patients with high RA volumes or high BMI exhibited supraventricular arrhythmias more often, regardless of age, gender, previous shunt, RV volume or PR.

Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP

To obtain reference values for pancreatic flow output rate (PFR) and peak time (PT) in healthy volunteers and chronic pancreatitis (CP); to correlate quantification of secretin enhanced magnetic resonance cholangiopancreatography (SMRCP) of pancreatic fluid output following secretin with fecal elastase-1 (FE-1) tests. The present study includes 53 subjects comprised of 17 healthy individuals and 36 patients with CP from April 2011 to January 2013. The 36 patients with CP were divided into three groups of mild CP (n = 14), moderate CP (n = 19) and advanced CP (n = 3) by M-ANNHEIM classification for CP.. Fifty-three cases underwent FE-1 test and magnetic resonance imaging using 3.0 T-device (Signa EXCITE, GE Healthcare). Coronal T2-weighted single-shot turbo spin-echo, spiratory triggered, covering the papillae, duodenum and small bowel. MRCP was performed with a heavily T2-weighted fat-suppressed long TE HASTE sequence (thick slab 2D MRCP sequence), repeated every 2 min up to 11 min after 0.1 mL/kg secretin injection (Secrelux, Sanochemia(®), Germany). FE-1 test used sandwich enzyme-linked immunosorbent assay (ELISA) test (ScheBo. Tech(®), Germany). A good linear correlation showed between the calculated volume and the actual volume by Phantom experiments. Fifty-three paired Quantification of secretin enhanced magnetic resonance cholangiopancreatography (MRCPQ) and FE-1 data sets were analyzed. The mean FE-1 of 53 cases was 525.41 ± 94.44 μg/g for 17 healthy volunteers, 464.95 ± 136.13 μg/g for mild CP, 301.55 ± 181.55 μg/g for moderate CP, 229.30 ± 146.60 μg/g for advanced CP. Also, there was statistically significant difference in FE-1 (P = 0.0001) between health and CP. The mean values of PFR and PT were 8.18 ± 1.11 mL/min, 5.76 ± 1.71 min for normal; 7.27 ± 2.04 mL/min, 7.71 ± 2.55 min for mild CP; 4.98 ± 2.57 mL/min, 9.10 ± 3.00 min for moderate CP; 4.13 ± 1.83 mL/min, 12.33 ± 1.55 min for advanced CP. Further, statistically significant difference in PFR (P = 0.0001) and PT (P = 0.0001) was observed between health and CP. Besides, there was correlation (r = 0.79) and consistency (K = 0.6) between MRCPQ and ELISA Test. It was related between M-ANNHEIM classification and PFR (r = 0.55), FE-1 (r = 0.57). SMRCP can provide a safe, non-invasive and efficient method to evaluate the exocrine function of the pancreas.

Functional MRI of the thoracic spinal cord during vibration sensation

To demonstrate that it is possible to acquire accurate functional magnetic resonance images from thoracic spinal cord neurons. The lower thoracic spinal dermatomes (T7-T11) on the right side of the body were mechanically stimulated by vibration for 15 participants. Neuronal responses to vibration sensation were measured in the thoracic spinal cord using a HASTE sequence on a 3 Tesla MRI system. Signal increases were observed in the corresponding lower thoracic spinal cord segments ipsilateral to the side of stimulation in the dorsal aspect of the spinal cord. This is the first study to provide proof of principle that functional imaging of the entire thoracic spinal cord is possible, by detecting neuronal activity in the thoracic spinal cord during sensory stimulation using spinal fMRI.

Utilidad de la entero-resonancia magnética en el estudio de la enfermedad de Crohn pediátrica

ObjectiveTo determine the usefulness of MRI enterography for assessing the extension and activity of paediatric Crohn's disease. MRI findings were compared with clinical, biological, endoscopic and other imaging data. Patients and methodsStudies of MRI enterography use in patients younger than 18 years of age were reviewed. Patients received 500-1000mL of polyethylene glycol one hour before examination (1.5-TMR). T2 HASTE sequences with or without fat saturation, T2 true-FISP, T1 with fat saturation, pre- and post gadolinium-enhanced VIBE sequences, and dynamic and diffusion HASTE were acquired. Thickening of the bowel wall, mucosal enhancement, and extra-luminal complications were evaluated. Five MRI patterns (normal, fibrosis, mild, moderate, and severe transmural activity) were defined. Findings were compared with PCDAI scores, inflammatory parameters, and endoscopic and histological results. ResultsTwenty-two studies were reviewed. Optimal intestinal distension was present in 82% of the cases. Mild side effects were observed in 12% of patients. There was a significant relationship between MRI patterns and PCDAI scores (P=.002), sedimentation rate (P=.006) and serum PCR levels (P=.047) and a non-significant relationship with the histology (P=.571). MRI enterography correctly assessed the ileal (80%) and colonic (66%) extension. Extra-luminal complications unrelated to MRI classification (P=.274) were reported in 86.4% of studies. ConclusionsThere was a significant relationship between MRI patterns and PCR, sedimentation rate, and PCDAI scores. MRI enterography showed excellent agreement with ileoscopies, and allowed endoscopically non-accessible areas to be assessed, as well as the diagnosis of extra-luminal complications without irradiation.

Intraobserver and Interobserver Variability of Renal Volume Measurements in Polycystic Kidney Disease Using a Semiautomated MR Segmentation Algorithm

Total renal volume and changes in kidney volume are markers of disease progression in autosomal-dominant polycystic kidney disease (ADPKD) but are not used in clinical practice in part because of the complexity of manual measurements. This study aims to assess the intra- and interobserver reproducibility of a semiautomated renal volumetric algorithm using fluid-sensitive MRI pulse sequences. Renal volumes of 17 patients with ADPKD were segmented from high-resolution coronal HASTE and true fast imaging with steady-state precession (FISP) MR acquisitions. Measurements performed independently by four readers were repeated, typically after 7 days. Intraobserver agreement indexes were calculated for total kidney volume for each patient. Interobserver agreement indexes were obtained for the six paired combinations of readers as well as for two readers after rigorous formalized training. Pearson and concordance correlation coefficients, coefficients of variation (CVs), and 95% limits of agreement were determined. The HASTE and true FISP sequences performed similarly with a median intraobserver agreement of greater than 98.1% and a CV of less than 2.4% across all readers. The median interobserver agreement was greater than 95.2% and the CV was less than 7.1%, across all reader pairs. Reader training further lowered interobserver CV. The mean total kidney volume was 1420 mL (range, 331-3782 mL) for HASTE imaging and 1445 mL (range, 301-3714 mL) for true FISP imaging, with mean image processing times per patient of 43 and 28 minutes, respectively. This semiautomated MR volumetric algorithm provided excellent intraobserver and very good interobserver reproducibility using fluid-sensitive pulse sequences that emphasize cyst conspicuity.

Primary lung cancers

PurposeThe purpose was to objectively evaluate image quality characteristics of half-Fourier single-shot turbo spin-echo (HASTE) and three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) for small (<1 cm) lung cancers found by magnetic resonance imaging (MRI) screening. MethodsFrom 2000 to 2009, 19,000 normal subjects were screened by MRI, and 15 cases were found to have lung cancers <1 cm. Those nodules were analyzed by image quality indices such as the signal to noise ratio, signal difference to noise ratio, percent contrast, percent contrast to noise ratio, and signal ratio of tumor to normal lung parenchyma. The area of the tumors measured by the two MR sequences and the computed tomography (CT) was compared. ResultsThe lung cancers showed significantly higher percent contrast, percent contrast to noise, and the signal ratio of tumor to normal lung parenchyma by 3D-VIBE as compared to HASTE. Tumor area estimated by HASTE was significantly larger than that estimated by VIBE. There was no significant difference in the signal to noise ratio and signal difference to noise ratio between the two MR sequences. ConclusionsThe 3D acquisition technique offers high contrast and contrast to noise ratios, while HASTE is associated with closer approximation of area estimation as compared to CT. Both sequences have similar signal to noise ratios and signal difference to noise ratios. The HASTE sequence is considered to be an essential part of imaging protocol in MR screening of lung especially for small nodules.

A duplication cyst masquerading as a meckel's diverticulum

Gastrointestinal tract duplication cysts are rare congenital malformations, usually presenting in infancy or early childhood with a variety of symptoms within the GI tract. Sources of GI bleeding can present a diagnostic dilemma despite conventional radiological & endoscopic investigations. We present an unusual case of a 13 year old boy, who presented with an acute abdomen and malaena with contrasting radiological and operative findings. A 13 year old boy was referred to our hospital with a 2 week history of severe central abdominal pain and 2 episodes of malaena. On assessment he appeared well and was haemodynamically stable. On physical examination his abdomen was tender centrally. Digital rectal examination was normal. Blood tests revealed a Haemoglobin of 7.2 with a MCV of 58.3. Abdominal X-ray showed faecal loading. An ultrasound scan of his abdomen found an abnormally dilated fluid-filled loop in the right iliac fossa extending into the pelvis. An MRI scan with Haste sequences was undertaken for additional clarity, and this favoured a Meckel9s appearance. A laparotomy revealed a large 30 cm long cystic lesion in the mesentery of the ileum. The ileum was extremely adherent to this cyst, thus en bloc ileal resection was performed with primary anastomosis. The boy was discharged uneventfully on post-operative day 3. Histology confirmed a congenital duplication cyst with heterotopic gastric glands. This demonstrated an area of haemorrhage subserosally. Alimentary tract duplications are rare childhood anomalies, but may cause intestinal obstruction, intussusception, haemorrhage or perforation. They are most commonly located in the ileum, but can occur anywhere from pharynx to rectum. They are lined by intestinal tract mucosa and share a common smooth muscle wall and blood supply with adjacent bowel wall, with which they can communicate. Malignant change has rarely been reported in adults, in particular within rectal duplication cysts. The duplication cyst attached to this boy9s ileum revealed gastric mucosa, which contains acid-secreting parietal cells resulting in peptic-ulcer type ulceration and bleeding. Intestinal duplication cysts should be considered in the differential diagnosis of GI bleeding in children. Complete excision is the treatment of choice.

2043 RELATIONSHIP BETWEEN PHYSICAL EXAMINATION, DYNAMIC MRI, AND INTRA-OPERATIVE FINDINGS IN THE TREATMENT OF PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20122043 RELATIONSHIP BETWEEN PHYSICAL EXAMINATION, DYNAMIC MRI, AND INTRA-OPERATIVE FINDINGS IN THE TREATMENT OF PELVIC ORGAN PROLAPSE Forrest Jellison, Ngoc-Bich Le, A. Lenore Ackerman, Lisa Rogo-Gupta, Denise Chow, Karim Chamie, Steven Raman, Larissa V. Rodriguez, and Shlomo Raz Forrest JellisonForrest Jellison Los Angeles, CA More articles by this author , Ngoc-Bich LeNgoc-Bich Le Los Angeles, CA More articles by this author , A. Lenore AckermanA. Lenore Ackerman Los Angeles, CA More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta Los Angeles, CA More articles by this author , Denise ChowDenise Chow Los Angeles, CA More articles by this author , Karim ChamieKarim Chamie Los Angeles, CA More articles by this author , Steven RamanSteven Raman Los Angeles, CA More articles by this author , Larissa V. RodriguezLarissa V. Rodriguez Los Angeles, CA More articles by this author , and Shlomo RazShlomo Raz Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study is to determine the relationship between physical examination (PE), dynamic MRI, and operative findings in the surgical repair of pelvic organ prolapse (POP). METHODS A cohort of 71 patients who underwent surgical repair for anterior compartment prolapse between 2009 and 2011 were selected for a retrospective analysis. Clinical symptoms were determined by validated questionnaires. Preoperative PE and dynamic MRI findings were compared with the intraoperative findings of the anterior, apical and posterior compartments. Dynamic MRI employed a previously described limited T2 weighted Haste sequence. RESULTS A total of 71 patients with a mean age of 64 (range of 33-99, and median 65) were included. The median parity was 2 (range 0–9). The mean score of the PFDI-20 and PFIQ-8 were 125 and 269, respectively. Anterior compartment repair was performed for the entire cohort with concomitant surgical repairs in 89%—49% had apical compartment repair and 74% had repair of the posterior compartment. When dynamic MRI was compared to intraoperative findings, detection of apical compartment prolapse (uterine or vault) had a sensitivity of (100%, 100%), specificity (70%, 95%), and ROC (0.85, 0.97). In contrast, when PE was compared to intraoperative findings of apical compartment prolapse (uterine or vault), detection rate had a sensitivity of (42%, 33%), specificity (86%, 93%), and ROC (0.64,0.63), respectively. In evaluation of the posterior compartment, dynamic MRI and PE had a sensitivity (76%, 85%), specificity (16%, 63%), and ROC (0.16, 0.74) when compared to intraoperative findings. Anterior compartment prolapse detection rates of (93%, 96%) were similar when dynamic MRI and PE were compared to intraoperative findings. Dynamic MRI had additional anatomical findings in 34% of the patients (simple and complex ovarian cysts, nabothian cyst, uterine fibroids, sacral cysts, umbilical and inguinal hernias, ureteral stone, bladder thickening, and hydronephrosis of the kidney). CONCLUSIONS Dynamic MRI was able to predict prolapse for all compartments, but is moderately less reliable for posterior compartment when compared with intraoperative findings. PE was able to predict anterior compartment prolapse but is less reliable for apical and posterior compartments when compared with intraoperative findings. MRI predicted apical prolapse better than PE. Further investigation in evaluation of posterior compartment is warranted. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e824 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Forrest Jellison Los Angeles, CA More articles by this author Ngoc-Bich Le Los Angeles, CA More articles by this author A. Lenore Ackerman Los Angeles, CA More articles by this author Lisa Rogo-Gupta Los Angeles, CA More articles by this author Denise Chow Los Angeles, CA More articles by this author Karim Chamie Los Angeles, CA More articles by this author Steven Raman Los Angeles, CA More articles by this author Larissa V. Rodriguez Los Angeles, CA More articles by this author Shlomo Raz Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...