Anisocoria como manifestación inicial de esclerosis múltiple. Utilidad de la resonancia magnética nuclear de 3 teslas / Anisocoria as initial manifestation of multiple sclerosis. Use of 3 tesla magnetic resonance imaging

Mujer de 21 años que presenta midriasis arreactiva en ojo derecho que contrae con el test de pilocarpina al 1%. La angio-TC craneal y la resonancia magnética nuclear (RMN) de 1,5 T no detectaron anomalías. Ante una posterior limitación de la aducción, supraducción e infraducción de dicho ojo, se solicitó una RMN de 3 T, que evidenció una lesión del mesencéfalo en la salida del tercer par craneal. Tras mejoría, no tuvo nuevos episodios hasta 18 meses después, cuando acudió con una probable neuritis óptica y síntomas sistémicos. En este momento la RMN de 1,5 T detectó placas desmielinizantes infratentoriales y supratentoriales. La punción lumbar posterior y la evolución clínica confirmaron el diagnóstico de esclerosis múltiple recurrente-remitente

A 21-year-old woman seen in this clinic with non-reactive mydriasis in the right eye that contracted with 1% pilocarpine. Cranial angio-CT and 1.5 T magnetic resonance imaging (MRI) did not detect any disease. Given a subsequent limitation of adduction, supraduction, and infarction of the right eye, a 3 T MRI was requested. This showed a lesion of the midbrain at the exit of the 3rd cranial nerve. After improvement, no new episodes were observed until 18 months later, when the patient presented with probable optic neuritis and systemic symptoms. At this time the 1.5 T MRI detected infratentorial and supratentorial demyelinating plaques. A subsequent lumbar puncture and clinic outcome confirmed the diagnosis of relapsing-remitting multiple sclerosis

Anisocoria as initial manifestation of multiple sclerosis. Use of 3 tesla magnetic resonance imaging. / Anisocoria como manifestación inicial de esclerosis múltiple. Utilidad de la resonancia magnética nuclear de 3 teslas.

A 21-year-old woman seen in this clinic with non-reactive mydriasis in the right eye that contracted with 1% pilocarpine. Cranial angio-CT and 1.5 T magnetic resonance imaging (MRI) did not detect any disease. Given a subsequent limitation of adduction, supraduction, and infarction of the right eye, a 3 T MRI was requested. This showed a lesion of the midbrain at the exit of the 3rd cranial nerve. After improvement, no new episodes were observed until 18 months later, when the patient presented with probable optic neuritis and systemic symptoms. At this time the 1.5 T MRI detected infratentorial and supratentorial demyelinating plaques. A subsequent lumbar puncture and clinic outcome confirmed the diagnosis of relapsing-remitting multiple sclerosis.

Formación editorial en radiología / Editorial training in radiology

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Feasibility of a Synthetic MR Imaging Sequence for Spine Imaging.

BACKGROUND AND PURPOSE: Synthetic MR imaging is a method that can produce multiple contrasts from a single sequence, as well as quantitative maps. Our aim was to determine the feasibility of a synthetic MR image for spine imaging. MATERIALS AND METHODS: Thirty-eight patients with clinical indications of infectious, degenerative, and neoplastic disease underwent an MR imaging of the spine (11 cervical, 8 dorsal, and 19 lumbosacral MR imaging studies). The SyntAc sequence, with an acquisition time of 5 minutes 40 seconds, was added to the usual imaging protocol consisting of conventional sagittal T1 TSE, T2 TSE, and STIR TSE. RESULTS: Synthetic T1-weighted, T2-weighted, and STIR images were of adequate quality, and the acquisition time was 53% less than with conventional MR imaging. The image quality was rated as "good" for both synthetic and conventional images. Interreader agreement concerning lesion conspicuity was good with a Cohen κ of 0.737. Artifacts consisting of white pixels/spike noise across contrast views, as well as flow artifacts, were more common in the synthetic sequences, particularly in synthetic STIR. There were no statistically significant differences between readers concerning the scores assigned for image quality or lesion conspicuity. CONCLUSIONS: Our study shows that synthetic MR imaging is feasible in spine imaging and produces, in general, good image quality and diagnostic confidence. Furthermore, the non-negligible time savings and the ability to obtain quantitative measurements as well as to generate several contrasts with a single acquisition should promise a bright future for synthetic MR imaging in clinical routine.

Normal Values of Magnetic Relaxation Parameters of Spine Components with the Synthetic MRI Sequence.

BACKGROUND AND PURPOSE: SyMRI is a technique developed to perform quantitative MR imaging. Our aim was to analyze its potential use for measuring relaxation times of normal components of the spine and to compare them with values found in the literature using relaxometry and other techniques. MATERIALS AND METHODS: Thirty-two spine MR imaging studies (10 cervical, 5 dorsal, 17 lumbosacral) were included. A modified multiple-dynamic multiple-echo sequence was added and processed to obtain quantitative T1 (millisecond), T2 (millisecond), and proton density (percentage units [pu]) maps for each patient. An ROI was placed on representative areas for CSF, spinal cord, intervertebral discs, and vertebral bodies, to measure their relaxation. RESULTS: Relaxation time means are reported for CSF (T1 = 4273.4 ms; T2 = 1577.6 ms; proton density = 107.5 pu), spinal cord (T1 = 780.2 ms; T2 = 101.6 ms; proton density = 58.7 pu), normal disc (T1 = 1164.9 ms; T2 = 101.9 ms; proton density = 78.9 pu), intermediately hydrated disc (T1 = 723 ms; T2 = 66.8 ms; proton density = 60.8 pu), desiccated disc (T1 = 554.4 ms; T2 = 55.6 ms; proton density = 47.6 ms), and vertebral body (T1 = 515.3 ms; T2 = 100.8 ms; proton density = 91.1 pu). Comparisons among the mean T1, T2, and proton density values showed significant differences between different spinal levels (cervical, dorsal, lumbar, and sacral) for CSF (proton density), spinal cord (T2 and proton density), normal disc (T1, T2, and proton density), and vertebral bodies (T1 and proton density). Significant differences were found among mean T1, T2, and proton density values of normal, intermediately hydrated, and desiccated discs. CONCLUSIONS: Measurements can be easily obtained on SyMRI and correlated with previously published values obtained using conventional relaxometry techniques.