Routine MR Imaging Protocol Research Articles

Diagnostic Value of an Additional Sequence (Large-Field Coronal Stir) in a Routine Lumbar Spine MR Imaging Protocol to Investigate Lumbar Radiculopathy.

Lumbar radiculopathy mainly originates in the spine (lumbar disc herniation or spine osteoarthritis) but can sometimes be explained by extra-spinal nerve compression or confused with referred pain mimicking radiculopathy. Our main objective was to demonstrate the clinical benefit of the large-field coronal STIR (coroSTIR) sequence in the etiological assessment of lumbar radiculopathy with a duration of more than six weeks. Six hundred consecutive lumbar MRI scans performed using the same protocol were retrospectively reviewed. Two musculoskeletal radiologists independently assessed the coroSTIR sequence for the presence of extra-spinal anomalies (ESA) that could explain or contribute to the lumbar radiculopathy. The presence of an ESA was then correlated with sex, age, topography and lateralization of radiculopathy, history of vertebral surgery, as well as the presence of a spinal cause explaining the symptoms. Extra-spinal incidentalomas (ESI) with potential clinical impact visible only on the coroSTIR sequence were also systematically reported. An extra-spinal cause was detected on the coroSTIR sequence in 68 cases (11.3%), mainly gluteal tendinobursitis (30.9%), congestive hip osteoarthritis (25%), degenerative sacroiliac arthropathy (14.7%), or inflammatory sacroilitis (7.3%). Their prevalence was significantly correlated in multivariate regression with age (58 years vs. 53 years, p = 0.01), but not with the type of radiating pain (sciatica or cruralgia). The presence of ESI was also frequent (70 cases, 11.7%), including some potentially severe diagnoses (38% of tumor or pseudo-tumor mass requiring further assessment or monitoring). Considering its acceptable acquisition time, the detection of a significant number of potentially symptom-related extra-spinal anomalies, and the discovery of a non-negligible number of extra-spinal incidentalomas with potential clinical impact, the coronal STIR should be performed systematically in routine MRI for lumbar radiculopathy.

Vessel wall MR imaging in neuroradiology.

Vessel wall MR imaging (VW-MRI) has been introduced into clinical practice and applied to a variety of diseases, and its usefulness has been reported. High-resolution VW-MRI is essential in the diagnostic workup and provides more information than other routine MR imaging protocols. VW-MRI is useful in assessing lesion location, morphology, and severity. Additional information, such as vessel wall enhancement, which is useful in the differential diagnosis of atherosclerotic disease and vasculitis could be assessed by this special imaging technique. This review describes the VW-MRI technique and its clinical applications in arterial disease, venous disease, vasculitis, and leptomeningeal disease.

Role of adding T2 mapping sequence to the routine MR imaging protocol in the assessment of articular knee cartilage in osteoarthritis

BackgroundThis work aims at elucidating the role of adding complementary T2 mapping to the routine 1.5 Tesla MRI protocol in the articular knee cartilage assessment for early detection of osteoarthritis, and also, comparing the articular cartilage thickness and T2 relaxation times between the case and control groups regarding knee compartments affection.ResultsBoth sensitivities and specificities were 73.3% and 100%, respectively, for the standard MR protocol alone and 96.7% and 90% after adding the T2 mapping to the standard MR protocol that leads to significant sensitivity improvement. A comparison between patients and controls as regards T2 values showed a highly statistically significant difference (independent T test, p <0.001).ConclusionA combination of both morphological and T2 mapping MRI, together with clinical evaluation represents a desirable multimodal approach to the diagnosis of osteoarthritis. In the early detection of osteoarthritis, adding T2 mapping sequence to the standard MR protocol at 1.5 Tesla improved sensitivity from 73.3 to 96.7%.

Merits of adding coronal-STIR sequence in a routine lumbo-sacral spine MR imaging protocol to investigate sciatica and sciatica-like symptoms

Merits of adding coronal-STIR sequence in a routine lumbo-sacral spine MR imaging protocol to investigate sciatica and sciatica-like symptoms

Merits of Adding Coronal-STIR Sequence in a Routine Lumbo-Sacral Spine MR Imaging Protocol to Investigate Sciatica and Sciatica-Like Symptoms

Background: Sciatica is defined by low back pain that radiates to the legs, with or without neurologic deficiency. sciatica or sciatica-like symptoms may result from spinal root compression in an extra-spinal location or from injury to the pelvic girdle. Aim: determine the value of coronal STIR sequence in the detection and diagnosis of extra-spinal causes of sciatica by adding it to routine MRI protocol of the lumbo-sacral spine in patients referred for sciatica-like symptoms. Methods: The current study involved an observational analysis for lumbo-sacral MRI examinations done for 50 patients, 22 males and 28 females, presenting with sciatica and sciatica-like symptoms. Results and conclusion: By adding a coronal STIR sequence to the routine MRI protocol, we were able to identify extra-spinal abnormalities that were not visible on routine sequences, in 10 patients (20%). 6 (8%) patients had abnormalities which were considered to be as a definite cause of sciatica and sciatica-like symptoms. In 4 (8%) patients, the coronal STIR also identified soft tissue abnormalities in the pelvis which were considered as equivocal causes of sciatica and sciatica-like symptoms. A higher prevalence of definite causes of extra-spinal sciatica was seen in patients between 24-40 years old. Also, prevalence of definite causes of sciatic pain was affected by history of neoplasia. Prevalence of definite causes of sciatic pain was not significantly affected by sex. However, most of the equivocal causes of sciatica were gynecological pathologies.

ROLE OF MRI T2 MAPPING IN ASSESSMENT OF ARTICULAR KNEE CARTILAGE IN OSTEOARTHRITIS

Background: T2 mapping of hyaline cartilage is an imaging technique for the qualitative and quantitative detection of thecartilage providing convincing color mapping and quantitative detection of the cartilage mainly regarding architecture and changes in water content, proteoglycan, and collagen matrix ultra-structure associated with early cartilage degeneration.Aim Of Work: This work aims at elucidating the role of MRI complementary T2 mapping in assessment of articular knee cartilage for improving sensitivity of early detection of Osteoarthritis. Also, compare the articular cartilage T2 relaxation values in normal subjects and patients with osteoarthritis. Patients And Methods: This prospective case-control study wasapproved by the Ethical Committee of Scientific Research in Ain Shams University, and the informed consent was obtained. The material of this study included sixty (60) subjects, divided into two groups, 50 patients (symptomatic group: 33 men and 17 women) with clinical evidence of osteoarthritis, and 10 normal control group (asymptomatic group 8 men and 2 women) were included in this study, with their ages ranged between 19-75 years. All patients and controls underwent MR imaging of the knee joint. MR imaging was performed at 1.5 Tesla by using a routine protocol with the addition of a sagittal, coronal, or axial T2 mapping sequence or all. The standard imaging planes of the knee were evaluated with articular cartilage assessment as intact or not. Thereafter, these standard planes were evaluated together with T2 maps and articular cartilage was again assessed as of normal (<48ms) or elevated (≥48ms) T2 value in terms of milliseconds. Generalized estimating equation models were used to compare the sensitivity and specificity of the routine MR imaging protocol and T2 maps. Results: Both sensitivities and specificities were 82% and 100%, respectively, for the routine MR protocol alone and 100% and 90% after the addition of the T2 mapping to the routine MR protocol. The addition of T2 maps to the routine MR imaging protocol significantly improved the sensitivity (Binary Diagnostic test, p = 0.01). AComparison between patients and controls as regards T2 values showed a highly statistically significant difference (Independent TTest, P<0 .001). Conclusion: A combination of both morphological and T2 mapping MRI, together with clinical evaluation represents a desirable multi-modal approach to the diagnosis of osteoarthritis. T2 mapping, as a biochemically sensitive MRI sequence of the knee improves sensitivity from 82% to 100% to detect early structural degeneration with better diagnostic information in the knee articular cartilage.

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment.

The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.

Value of adding a T2 mapping sequence to a routine MR imaging protocol in evaluation of articular cartilage of the knee joint

Background: Magnetic resonance imaging (MRI) allows direct visualization of all tissues of the knee joint, including the articular cartilage with direct evaluation of chondral lesions. Beyond the morphological evaluation, MRI allows to characterize the structural organization (collagen network) and the matrix content of the cartilage. Such a quantitative approach may be performed in clinical practice by T2 mapping technique which can be used as early biomarker for knee osteoarthritis. T2 relaxation time measurements reflect these pathophysiological changes. T2 mapping technique had recently shown its potentiality to evaluate the quality of the cartilage composition since the transversal relaxation time (T2) reflects the ability of proton molecule to move and to exchange energy inside the cartilaginous matrix. Each variation of matrix content (water, proteoglycan and collagen) or each modification of the organization of the collagen network can induce T2 variations. Objective: The primary purpose of this study was determine whether the addition of a T2 mapping sequence to a routine MR imaging protocol could or could not improve diagnostic performance in the detection of the articular cartilage lesions and early identification of the cartilage degeneration within the knee joint. Methods: The current study is a cross sectional study that was conducted at private radiology centres in cairo.in the period between September 2019 and December 2020. The study included 20 patients. 13 Males and7 Females with age range from 25 to 65 years (mean age 41.53 years). Complaining from knee pain after direct trauma or twisting. Routine knee MR images from all patients were assessed for gross articular lesion. Then mean T2 values are obtained and the T2 maps are generated and reviewed. Comparative data of the overall Diagnostic indices of conventional MRI and T2 mapping are taken. Results: The age of the study group ranged from 25 to 65 years (mean age 41.53 years). The male patients represented the majority of our cases. We noted that there was more affection of the left knee compared to the right one with regional differences in the T2 values were observed as higher T2 values in the medial compartments cartilage (weight-bearing) compared to lateral ones’ cartilage (non-weight-bearing). Cases can be categorized according to the site of pain which was correlated later to the T2 values as: 15% anterior 35% medial, 15% lateral and 35% global. Out of the 20 cases, 12/20 (60 %) cases presented by knee pain following direct trauma, and 8/20 (40 %) cases presented by knee pain following knee twisting. All cases underwent conventional MRI with complementary T2 mapping sequence. In this study, the sensitivity, specificity, and accuracy of the conventional MRI results are 82.3%, 100 %, and 85 %, respectively. While the sensitivity, specificity, and accuracy of the T2 mapping finding results are 100 %, 100 %, and 100 %, respectively. Conclusion: In this study The addition of a T2 mapping of the knee cartilage sequence to a routine MR knee protocol at 1.5 T improved sensitivity in the detection of cartilage lesions within the knee joint from 82.3 % to 100 %, with improvement of accuracy from 85 % to 100%. The improvement in sensitivity with use of the T2 maps was in the identification of early cartilage degeneration.

Role of Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy and Transrectal Ultrasound in Evaluation of Prostatic Pathologies with Focus on Prostate Cancer.

SummaryBackgroundProstate cancer (PC) is an important medical and socio-economical problem due to its increasing incidence. The development of the prostate specific antigen (PSA) test, and a continuing decrease in the rates of other common neoplasms, such as lung and stomach since mid-1980s, prostate cancer has become one of the most common cancers among men. Prostate cancer (PC) is the second most common cancer in men, preceded only by lung cancer, and its early diagnosis is crucial for a successful treatment, that will prolong survival and improve quality of life.The main objective of our study was to evaluate the role of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and transrectal ultrasound (TRUS) in detecting prostatic pathologies and staging of prostate cancer by correlating these methods with histopathological results.Material/MethodsThe study is a cross-sectional diagnostic study performed in 66 patients with a high degree of clinical suspicion of prostatic pathology. All patients underwent TRUS, T1W, T2W, DWI, and 3D PRESSMRS sequences, and we also calculated ADC values and Cho Cr/Cit MRS ratios for all patients.ResultsCombination of MRI and MRS showed the highest diagnostic accuracy among the imaging modalities in detecting of prostatic neoplasm, followed by MRI, and then by TRUS. MRS plays a complementary role to MRI, by increasing its diagnostic accuracy. Due to a high cost, limited availability and increased scanning time, combination of MRI and MRS is currently not recommended as a first line investigation for detecting prostate neoplasms, hence USG (TRUS) remains the first line investigation due to its low cost, easy availability, time effectiveness and comparable efficacy.ConclusionsMRI MRS has more diagnostic accuracy than MRI alone for detection of prostate pathologies. MRS, plays significant complementary role and should be included in the routine MR imaging protocols. MRI helps in diagnosis, localization, better tissue characterization and staging of prostate cancer. TRUS is easily available, cost effective and has comparable efficacy.

Value of diffusion-weighted magnetic resonance imaging in the characterization of small solid renal lesions

Aim of the study Our aim was to assess the value of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurement for the characterization of small solid renal lesions. Patients and methods We prospectively evaluated 30 patients (18 men and 12 women). Their age ranging from 18 to 65 years (mean age of 49.6±12.9). They were examined by conventional MRI and DWI with b factors of 0, 600 and 1000 s/mm2. Mean ADC values of the normal renal parenchyma, benign, malignant small solid renal lesions were calculated Results The mean ADC value of normal renal parenchyma was significantly higher that of benign and malignant lesions. No statistical significance noted between the mean ADC values of benign and malignant renal lesions (P value=0.5). Among malignant lesions, the mean ADC value was highest in the RCC lesions (1.4±0.22) and lowest in the lymphoma lesions (0.679±0.08) showing statistical significance (P value=0.0001). The mean ADC values of RCC and TCC showed no statistical significance, whereas there was statistical significance was noted between RCC and pyelonephritis (P value=0.0004) , RCC and Angiomyolipomas (P value=0.0001), lesions. Conclusion DWI is a fast sequence that can be easily added to a routine MR imaging protocol. DWI is notably valuable in lesion detection and evaluation when gadolinium contrast medium cannot be administered. However, due to the overlap of ADC values between benign and malignant lesions, it cannot be used as a single diagnostic tool and should be concurrently interpreted in conjunction with conventional MRI for optimal characterization of renal lesions.

MR grading system of osteochondritis dissecans lesions: Comparison with arthroscopy

ObjectiveTo assess the diagnostic performance of combined three-dimensional (3D) gradient-echo (GRE) T1-weighted and routine MR imaging protocol for the evaluation of osteochondritis dissecans (OCD). Materials and methodsThis prospective study was approved by our institutional review board and all patients gave informed consent. Three-dimensional GRE MR sequence was added to the routine protocol performed on 40 consecutive patients (35 men, 5 women; age range, 12–57 years; mean age, 20 years) with 17 juvenile and 24 adult OCD lesions (27 in knees; 14 in elbows) which were confirmed by arthroscopy. Two independent musculoskeletal radiologists reviewed all MR images. The OCD lesions were classified into five stages by assessing the signal intensity of fragment–bone interface and the integrity of articular cartilage on MR images. Stage-IV and -V lesions were considered as unstable. The sensitivity, specificity, accuracy, and interobserver agreement (κ statistics) were calculated. ResultsThe sensitivity, specificity, and accuracy for detection of OCD instability were 100% (11 of 11), 100% (6 of 6), and 100% (17 of 17) in juvenile lesions; and 93% (14 of 15), 100% (9 of 9), and 96% (23 of 24) in adult lesions. The overall accuracy of MR findings in determining the staging was 90% (37 of 41) for reader 1 and 83% (34 of 41) for reader 2. Agreement between readers was substantial with a κ value of 0.75 for MR staging of OCD lesions. ConclusionsThree-dimensional GRE T1-weighted MR imaging combined with the routine sequences demonstrates excellent diagnostic capabilities in detecting unstable OCD lesions.

Detection and characterization of focal hepatic lesions with diffusion-weighted MR imaging: a pictorial review

The purpose of this pictorial review is to discuss the usefulness and limitations of diffusion-weighted (DW) MR imaging of the liver, demonstrating DW images of a variety of focal hepatic diseases. We include hepatocellular carcinoma, borderline-lesions in cirrhosis, metastasis, cavernous hemangioma, cyst, focal nodular hyperplasia, hepatic adenoma, abscess, and hematoma. DW imaging is an important supplementary sequence of routine MR imaging protocols of the liver. Radiologists need to understand its usefulness and limitations in the detection and characterization of benign and malignant focal hepatic diseases.

Role of diffusion-weighted magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma

To determine the clinical value of diffusion-weighted imaging (DWI) for the diagnosis of extrahepatic cholangiocarcinoma (EHCC) by comparing the diagnostic sensitivity of DWI and magnetic resonance cholangiopancreatography (MRCP). Magnetic resonance imaging examination was performed in 56 patients with suspected EHCC. T1-weighted imaging, T2-weighted imaging, MRCP and DWI sequence, DWI using single-shot spin-echo echo-planar imaging sequence with different b values (100, 300, 500, 800 and 1000 s/mm(2)), were performed. All cases were further confirmed by surgery or histopathological diagnosis. Two radiologists jointly performed the analysis of the DWI and MRCP images. Apparent diffusion coefficient (ADC) value and signal-noise ratio were calculated for EHCC. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were tested using DWI with a b value of 500 s/mm(2) and MRCP images, respectively. Histopathological diagnosis confirmed that among the 56 cases, 35 were EHCC (20 hilar and 15 distal extrahepatic), 16 were cholangitis, and 5 were calculus of bile duct. Thirty-three out of the 35 EHCC cases were detected by DWI. EHCC exhibited differential levels of high signal intensity in DWI and low signal intensity in the ADC map. The mean value for ADC was (1.31 +/- 0.29) x 10(-3) mm(2)/s. The detection rate of EHCC was significantly higher by DWI (94.3%) than by MRCP (74.3%) (P < 0.05). There was a significant difference in sensitivity (94.3% vs 74.3%), specificity (100% vs 71.4%), accuracy (96.4% vs 73.2%), positive predictive value (100% vs 81.3%), and negative predictive value (91.3% vs 62.5%) between DWI and MRCP in diagnosing EHCC. DWI has a high sensitivity for the detection of EHCC as it shows the EHCC lesion more unambiguously than MRCP does. DWI can also provide additional clinically important information in EHCC patients when added to routine bile duct MR imaging protocols.

Assessment of peritrochanteric high T2 signal depending on the age and gender of the patients

Introduction The aim of this study is to evaluate the incidence of peritrochanteric high T2 signal (peritrochanteric edema, peritendinitis) on routine MR imaging studies and to determine whether reporting peritrochanteric edema is always clinically relevant depending on the age and gender of the patients. Materials and methods We evaluated 79 consecutive bilateral hip MR images performed in our department between January 2006 and December 2006 (57 female, 22 male patients, mean age 49 years). Each study was evaluated for areas of T2 hyperintensity representing edema around the greater trochanter. Patients with a known fracture, tumor, history of radiation therapy, history of hip surgery and prothesis were excluded from the study. Patients with signal intensity alterations within the thickened gluteus medius/minimus tendons (tendinitis) or peritrochanteric bursal fluid accumulation (bursitis) were also excluded. All patients were scanned with our routine MR imaging protocol for hip imaging. Results In 55 of the 79 patients (70%) peritrochanteric edema was detected on MR images and 52 of these 55 patients (95%) had these changes on both hips. The median age was 56 years for the patients with peritrochanteric edema and 35.5 years for the patients without peritrochanteric edema. There was statistical significance between the median ages of the patients and a significant increased risk of peritrochanteric edema was found over 40 years of age. There was no significant difference between male and female patients. Conclusion Bilateral peritrochanteric high T2 signal may be a part of the degeneration process and we suggest that it may not be necessarily reported if the clinical findings do not support greater trochanteric pain syndrome.

Diffusion weighted MR imaging of pancreatic islet cell tumors

Purpose The aim of our study is to demonstrate the feasibility of body diffusion weighted (DW) MR imaging in the evaluation of pancreatic islet cell tumors (ICTs) and to define apparent diffusion coefficient (ADC) values for these tumors. Materials and methods 12 normal volunteers and 12 patients with histopathologically proven pancreatic ICT by surgery were included in the study. DW MR images were obtained by a body-phased array coil using a multisection single-shot echo planar sequence on the axial plane without breath holding. In addition, the routine abdominal imaging protocol for pancreas was applied in the patient group. We measured the ADC value within the normal pancreas in control group, pancreatic ICT, and surrounding pancreas parenchyma. Mann–Whitney U-test has been used to compare ADC values between tumoral tissues and normal pancreatic tissues of the volunteers. Wilcoxon Signed Ranks Test was preferred to compare ADC values between tumoral tissues and surrounding pancreatic parenchyma of the patients. Results In 11 patients out of 12, conventional MR sequences were able to demonstrate ICTs succesfully. In 1 patient an indistinct suspicious lesion was noted at the pancreatic tail. DW sequence was able to demonstrate the lesions in all of the 12 patients. On the DW images, all ICTs demonstrated high signal intensity relative to the surrounding pancreatic parenchyma. The mean and standard deviations of the ADC values (×10 −3 mm 2/s) were as follows: ICT ( n = 12), 1.51 ± 0.35 (0.91–2.11), surrounding parenchyma ( n = 11) 0.76 ± 0.15 (0.51–1.01) and normal pancreas in normal volunteers ( n = 12), 0.80 ± 0.06 (0.72–0.90). ADC values of the ICT were significantly higher compared with those of surrounding parenchyma ( p < 0.01) and normal pancreas ( p < 0.001). Conclusion DW MR imaging does not appear to provide significant contribution to routine MR imaging protocol in the evaluation of pancreatic islet cell tumors. But it can be added to MR imaging protocol to detect the lesion in a limited number of patients with clinical suspicion for pancreatic ICT with negative or suspicious imaging findings.

From Cavern-Dwellers to Cavernoma Science

See related article, pages 3222–3230. Since the introduction of noninvasive imaging tools roughly 30 years ago, vascular malformations of the brain have attracted increasing interest. Among them, cerebral cavernous malformations (CCM) appear to be the most frequently diagnosed entity with current prevalence estimates ranging from 100 to 500 cases per 100000 in the general population.1 They may come to clinical attention after epileptic seizures, progressive neurological syndromes, or symptomatic hemorrhage, but overall, asymptomatic lesions seem to be most frequently encountered since the introduction of highly sensitive gradient echo (T2*) weighted sequences in routine MR imaging protocols.2 Despite increasing detection rates and growing insight into underlying molecular and genetic mechanisms, many practical issues remain as yet unsolved, particularly when it comes to actual patient care and counseling: First, no standardized imaging protocols exist. Brain MRI with the aforementioned T2*-weighted images are now considered the diagnostic standard, but the absence of contrast-enhanced T1 sequences may miss an associated developmental venous anomaly and vice versa, which may for example impact on the strategy of any neurosurgical intervention (Figure 1). Figure 1. Brain MRI study of a 37-year-old woman presenting with left internuclear ophtalmoplegia, ataxia, and a dissociated sensory deficit attributable to a left posterior pontine hematoma on FLAIR-weighted images (left plane). Three-month follow-up …

Measurement of temporal lobe T2 relaxation times using a routine diagnostic MR imaging protocol in epilepsy

Objective: To determine the applicability of a fast spin-echo (FSE) pulse sequence for T2 relaxation time measurements in diagnostic imaging of temporal lobe epilepsy (TLE) and in epilepsy research. To compare FSE T2-relaxometry to the measurements with multi-echo sequence and visual assessment of MR scans. Methods: MR imaging and T2 relaxometry was performed with widely used 1.5 T scanner only. Fast dual-echo sequence (TE-14/85 ms) and multi-echo pulse sequence were used for T2 measurements. Normal ranges of T2 values in regions of interest in temporal lobe were estimated in 20 healthy controls. Sixty-five patients with intractable focal epilepsy were studied. Fifty-five patients had TLE, three multilobar focal epilepsy and seven extratemporal focal epilepsy. Results: T2 measurements with the FSE showed good reproducibility in the test objects and control subjects. In one TLE case unilateral focal T2 changes were not identified visually. T2-relaxometry was more sensitive than visual inspection of MR scans in assessing bilateral hippocampal changes: there were 15 cases with abnormal bilateral T2 values. Visually bilateral changes were detected in six out of these 15 cases (40%). In six cases (40%) only unilateral changes were diagnosed visually, and in three cases (20%) bilateral changes were classified as probable with qualitative evaluation. T2 relaxation time measurement supplied additional objective data in cases with ambiguous hippocampal changes on visual assessment: T2-relaxometry confirmed hippocampal abnormalities in seven cases judged visually as probable. In four cases with the suspicion of hippocampal changes T2 values appeared to be normal. Conclusion: In TLE patients, images constructed from FSE sequences can be used to estimate T2 relaxation times easily and reliably. T2 measurements are an objective method to diagnose structural changes in the temporal lobe. T2-relaxometry is most helpful to assess bilateral hippocampal abnormalities, and thus might have an impact on estimating postsurgical outcome.