Comparison of velocity-encoded MR imaging and fluid dynamic modeling of steady and disturbed flow.

The contrast of flow-encoded magnetic resonance (MR) images obtained in vivo and the accuracy of velocity measurements are complicated by the presence of complex flow states. The effects of complex flow states on MR flow-encoded images were studied and quantitative flow information was obtained with an MR phase-subtraction technique. Regions of complex flow, including flow stagnation and separation and laminar flow, could be clearly identified on the phase images. The MR imaging velocity measurements were validated by comparison with numerical simulation results for three-dimensional velocity distributions. The velocity MR images and the profiles obtained from the simulation generally agreed well for flow rates of 660 and 1,680 mL/min. This agreement lends support to both the fluid dynamic model and the physical basis of the phase imaging technique and establishes the validity of flow-encoded phase imaging as an in vivo flow quantitation method, especially under low Reynolds number flow conditions.

Hepatic focal nodular hyperplasia: MR imaging at 1.0 and 1.5 T.

Ten cases of hepatic focal nodular hyperplasia (FNH) were studied with magnetic resonance (MR) imaging. Proof of diagnosis was by needle biopsy or follow-up of as long as 5 years. Both short TR/TE and long TR/TE images were obtained. The most common finding was isointensity of the lesion relative to liver parenchyma with all pulse sequences. A central scar was seen in only one patient and was hyperintense on long TR/TE images. Slight hyperintensity of the lesion on short TR/TE and long TR/TE images was seen in two cases. Textural heterogeneity was present in only one of these. The most common presentation in our series was a visually isointense lesion relative to liver on short TR/TE images and an isointense or slightly hyperintense lesion on long TR/TE images. A review of the literature and the present findings suggest that FNH has a variable appearance on MR images.

Juxta-articular large cell lymphoma.

Three patients with juxta-articular large cell lymphoma presented as suffering from monarthropathies. A spectrum of radiographic changes was observed that included subchondral sclerosis, regional osteopenia, effusion, and mottled lytic changes in the juxta-articular region of the affected joint. MRI was performed in two patients. In one, it revealed a high signal mass on T2-weighted sequences. In the second, a mass bridging the joint was demonstrated which was difficult to appreciate on CT and was not visible radiographically. In all cases, biopsies revealed large cell non-Hodgkin's lymphoma of bone. We present these studies to emphasize this unusual pattern of non-Hodgkin's lymphoma as well as to demonstrate the contribution of MRI to the diagnosis.

Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study.

The rate at which profound hyponatremia should be corrected is the focus of a recent clinical debate. We prospectively studied neurological outcomes with serial magnetic resonance imaging in 13 hyponatremic subjects with serum sodium concentrations of less than 115 mmol/L (mean initial serum sodium concentration, 103.7; range, 93-113 mmol/L). All subjects were corrected to mildly hyponatremic levels at 24 hours and ultimately underwent an increase in serum sodium concentration of 25 mmol/L without development of hypernatremia. Magnetic resonance imaging revealed the development of pontine lesions in 3 patients. The correction rate of hyponatremia over the first 24 hours was significantly faster in patients with pontine lesions (mean +/- SD, 1.25 +/- 0.4 mmol/(L . hr) versus 0.74 +/- 0.3 mmol/(L . hr); p less than 0.05). Initial sodium concentration was also significantly lower in the pontine lesion group (97.3 +/- 6.7 vs 105.6 +/- 5.2 mmol/L, p less than 0.05). We conclude that the correction rate of hyponatremia plays a significant role in the pathogenesis of pontine lesions in individuals with profound hyponatremia who undergo large increases in sodium concentration as a result of severe initial hyponatremia.

Primary malignant giant cell tumor of bone: "dedifferentiated" giant cell tumor.

Well documented examples of primary malignant giant cell tumor of bone (giant cell tumor and concurrent sarcoma arising de novo) are exceedingly rare in the literature. We report a case arising in the left ischium of a 44-yr-old man. He had no previous history of radiation therapy or multiple resections. Histologically, the tumor was a typical giant cell tumor of bone juxtaposed to a malignant fibrous histiocytoma (MFH). The juxtaposition of a high grade sarcoma (MFH) and a locally aggressive nonmalignant neoplasm such as giant cell tumor is analogous to several other tumors of bone and soft tissue in which a low grade malignant or locally aggressive tumor can be associated with MFH or fibrosarcoma de novo, namely chondrosarcoma, chordoma, liposarcoma, and well differentiated intraosseous and parosteal osteosarcoma. The presence of a high grade malignant component in each of the aforementioned neoplasms generally portends a more ominous prognosis, although this is not invariably true. Recognition of the phenomenon of "dedifferentiation" (or tumor progression) in some bone tumors and sarcomas is important to ensure appropriate treatment. Distinction from secondary malignant giant cell tumors which are usually radiation induced is also important, since the latter have a much worse prognosis than those with dedifferentiation occurring de novo.

Eigenimage filtering in MR imaging: an application in the abnormal chest wall.

A postprocessing linear filter was applied to spin-echo images on 10 patients with known or suspected chest wall invasion due to bronchogenic carcinoma. This technique known as eigenimage filtering allows selective feature extraction of suspected abnormalities from conventional MR images. The final result is an image with marked increased contrast range through enhancement of a desired process (tumor) with suppression of an interfering process (e.g., normal surrounding tissue). This preliminary work demonstrates the ease with which the technique may be implemented, the contrast enhancement obtained between the desired and the interfering feature in the final eigenimage, and its ability to correct for partial volume averaging effects. Also demonstrated are artifacts that can interfere with the interpretation of the eigenimage and a method for minimizing these artifacts in the final eigenimage.

Primary tumors of the foot: MR imaging.

The findings at magnetic resonance (MR) imaging of eight patients with primary tumors of the foot were compared with those at gross pathologic examination. In all cases, there was excellent correlation between the two studies. When compared with computed tomography (CT), MR imaging was superior in defining the presence and extent of local disease. While the appearances of various foot neoplasms are nonspecific, the ease of multiplanar imaging, the superior contrast resolution, and the sensitivity to marrow abnormalities are major advantages of MR imaging over CT in staging foot neoplasms. These advantages are crucial when foot-sparing curative resection of a malignancy is contemplated. The combination of plain radiography and MR imaging may be all that is necessary for optimal preoperative detection and local staging of tumors of the foot.

Meniscal abnormalities of the knee: 3DFT fast-scan GRASS MR imaging.

The ability to use fast-scan techniques to obtain MR images without sacrificing diagnostic accuracy is a desirable goal in MR imaging. We describe a series of patients in whom fast-scan MR imaging was found to be equal to conventional spin-echo imaging in the detection and characterization of meniscal abnormalities. Thirty-five patients with suspected meniscal tears were studied with fast-scan imaging (3DFT-GRASS), and the results were compared with those of conventional spin-echo imaging. Three-millimeter contiguous sections through the entire knee were obtained in 5 min by using the 3DFT-GRASS technique. 3DFT-GRASS and spin-echo images agreed in all cases regarding the presence or absence of an abnormality and its degree of severity. We conclude that fast-scan 3DFT-GRASS MR imaging is useful when screening the knee for the presence of meniscal abnormalities.

MR imaging strategies in primary and metastatic malignancy.

This article gives the rationale of the indications for the use of MRI in the evaluation of primary and metastatic malignancies of the neck, chest, abdomen, male and female pelvis, and musculoskeletal system. The imaging protocols for each of these areas is also included.

Central pontine myelinolysis after rapid correction of hyponatremia: a magnetic resonance imaging study.

We describe a patient with severe hyponatremia (serum sodium 94 mmol/L) who developed encephalopathy and decorticate posturing after a 29 mmol/L rise in serum sodium concentration during the first 24 hours of correction. High-resolution computed tomography of the pons was normal during the first, second, and twelfth weeks of the illness. Subsequent magnetic resonance imaging revealed a pontine lesion consistent with central pontine myelinolysis.

Eigenimage filtering in MR imaging.

This article presents the technical aspects of a linear filter, referred to as eigenimage filtering, and its applications in magnetic resonance (MR) imaging. The technique is used to obtain a single composite image depicting a particular feature of interest while suppressing one or more interfering features. The appropriate weighting components to be used in the linear filter are determined on the criterion that the desired feature is enhanced while the interfering features are suppressed. The criterion is expressed mathematically as a ratio. By applying Rayleigh's principle, the ratio is maximized by finding the eigenvector associated with the maximum eigenvalue of the corresponding generalized eigenvalue problem. The appropriate weighting factors for the linear filter are the elements of the eigenvector which maximize the ratio. The utilization of the technique is demonstrated in its application to a simulated MR image sequence as well as to acquired MR image sequences of a normal and an abnormal brain.

Magnetic Resonance Imaging for Meniscal Tears of the Knee.

In brief: Magnetic resonance imaging (MRI). has become a standard diagnostic technique in many medical facilities for evaluating the menisci of the knee. MRI provides superior soft-tissue contrast with high resolution and takes little time (typically less than 30 minutes). It does not require intra-articular contrast media and is not limited to surface abnormalities, as are arthrography and arthroscopy. Unlike MRI, both arthrography and arthroscopy cause disturbances to the external capsule of the knee, with associated patient discomfort and limited physical activity for some time following the procedure. The author discusses the advantages of MRI and presents a case report in which it was used to make the diagnosis and determine the appropriate treatment modality.

Chest-wall invasion by carcinoma of the lung: detection by MR imaging.

Nineteen patients with bronchogenic carcinoma were studied by MR imaging to determine the presence of chest-wall invasion. All studies were carried out at 1.5 T, and the results were correlated with chest radiographs or CT scans. All MR studies were interpreted before surgery (13 cases) and without knowledge of the results of other radiologic studies. MR findings indicative of chest-wall invasion included a high-signal focus within the chest wall and/or chest-wall thickening with increased signal on spin-echo (SE) images having a repetition time of 2500 msec and an echo time of 50-100 msec (SE 2500/50-100). In one case, noncontour-deforming high-signal intensity within chest-wall musculature (but no other abnormality) was demonstrated on SE 2500/50-100 images. Coronal or sagittal imaging facilitated identification of tumor contiguity with extrathoracic structures in apical lesions. Contrast differences between normal and invaded chest wall on T2-weighted images were the most helpful in assessing chest-wall involvement. These preliminary observations indicate that MR imaging is useful in the evaluation of chest-wall invasion by carcinoma of the lung.

Vascular and soft tissue calcification in systemic oxalosis: CT diagnosis.

Hyperoxaluria may result in diffuse deposition of calcium oxalate crystals in multiple organs. A patient with primary hyperoxaluria presented with peripheral ischemia on this basis. Computed tomography clarified the diagnosis and helped to direct the appropriate management.