Comparison of multiecho postprocessing schemes for SWI with use of linear and nonlinear mask functions.

BACKGROUND AND PURPOSE: SWI is an MR technique conventionally implemented with single-echo gradient-echo data. The purpose of this study was to compare single-echo SWI processing and 2 multiecho SWI processing schemes: postaverage, where an SWI image is created for each echo and then averaged to create a single volume; and frequency-based, where a SWI image is generated from an average frequency image. Linear and nonlinear mask functions were investigated for all 3 processing schemes. MATERIALS AND METHODS: Comprehensive optimizations were performed. Single and multigradient-echo data were acquired at 3T in 10 volunteers. Contrast-to-noise ratio was measured in various structures. Visibilities of the same structures were ranked in different SWI images by trained raters. RESULTS: When image evaluation was based on measurements of contrast-to-noise ratio, the nonlinear mask and frequency-based scheme were superior. However, when image evaluation was based on ranks of qualitative visibility, the linear mask and postaverage scheme were superior. Although the nonlinear mask and frequency-based scheme allow increased contrast of paramagnetic perturbers such as the globus pallidus, periventricular veins, red nucleus, and subthalamic nucleus, they do not necessarily increase the information content of the image; rather, they result in a harsh contrast that is visually unpleasing to radiologists and wherein more subtle structure is relatively less apparent. CONCLUSIONS: Linearly masked postaverage SWI is the recommended implementation of multiecho SWI for radiologic use; however, nonlinearly masked frequency-based SWI may have use in computer-based segmentation or registration.

The borderline patient and military life.

The view that the borderline patient can cope surprisingly well in a highly structured environment despite long-standing severe personality disturbance is studied. Military life provides such a structured environment and its role in the lives of these patients is presented through two case reports. The concept that the Army becomes 'military parents', accepts massive projections and survives splitting whilst providing a 'universal ego and super-ego' is developed and felt to be fundamental to the stability that borderline patients can achieve within the Services.

Psychogenic urinary retention.

The literature on psychogenic urinary retention is reviewed. 2 cases treated by analytical psychotherapy are reported, in which significant demand for physical punishment was revealed and seen as linked to unacceptable, unconscious sadistic and aggressive feelings. Some psychodynamic aspects of what is considered to be "a disturbance of internal body space' are discussed. Psychogenic urinary retention has received little attention in the literature. It may represent the uneasy position this disorder of bodily function occupies in clinical practice, with clear physical symptoms and associated psychological factors. The condition is more frequent in females, usually young adults. Case histories regularly record the placid, passive presentation of these patients, childhood enuresis and disturbed backgrounds. The diagnosis, "hysteric', is frequent and most psychodynamic evaluations suggest the symptom represents a displacement of unacceptable sexual wishes and impulse. 2 patients treated by analytical psychotherapy are reported who, whilst fulfilling many of the criteria already noted, additionally revealed an intense desire for physical punishment. This punitive demand had less to do with unacceptable sexual wishes, than guilt at repressed aggressive drives of considerable magnitude. The role of aggression in the genesis of psychogenic urinary retention has so far been little studied.