Three-dimensional MRI of the glenoid labrum.

The objective of this study was to assess the accuracy of three-dimensional (3D) magnetic resonance imaging (MRI) reformation in the evaluation of tears of the glenoid labrum complex (GLC). Fifty-five shoulders were evaluated by MRI using standard spin-echo sequences. Gradient-refocused-echo axial projections were used to assess the GLC on the two-dimensional (2D) studies. Three-dimensional Fourier transform multiplanar gradient-recalled imaging with a resolution of 0.7 mm was also performed in all patients. Independent analyses of the anterior and posterior labra were performed in a blinded manner for both the 2D and 3D studies by three experienced musculoskeletal radiologists. Observations of the imaging studies were compared with the videoarthroscopic findings. The appearance of the GLC was rated on a scale of 0 to 4 (0-2 = normal, 3, 4 = abnormal or torn). The diagnostic confidence was averaged from the three reader's scores. Anterior labral tears were effectively detected with sensitivities of 89% and 96% and specificities of 96% and 100% (P < 0.0001) for the 2D and 3D studies, respectively. For posterior labral tears, the sensitivity and specificity of the 2D method were 47% and 98%, respectively. The sensitivity and specificity of the 3D volume sequence were 53% and 98%, respectively. The lower sensitivity of both imaging methods for detecting posterior labral tears may be influenced by the smaller number (n = 5) of arthroscopically confirmed cases in our study and reflects the difficulty of visualizing the posteroinferior borders of the GLC with present MRI techniques.

Magnetic resonance imaging of the thoracic aorta.

Magnetic resonance imaging (MRI) is steadily becoming recognized as a premier imaging modality for evaluating the thoracic aorta. Its noninvasive, nonimaging approach and refined resolution capabilities effectively combine the advantages of echocardiography, angiography, and computed tomography (CT) under the auspices of a single imaging device. On static spin-echo MRI, blood flow appears dark, allowing superb depiction of both intra- and extra vascular anatomy. With dynamic MR studies, gradient echo (cine) and phase velocity mapping techniques have proven effective in assessing the physiological consequences of anatomic vascular abnormalities in a qualitative and quantitative manner, respectively. Magnetic resonance angiography (MRA) is fast becoming a prominent vascular imaging method. Although still evolving, MRA bolsters the vascular imaging capabilities of MRI by enhancing the imaging resolution of the major branch vessels and collateral vessels. With continued advances in this area, MRI may adopt the role as the primary imaging method for assessing the thoracic aorta.

Detection of mycotic pseudoaneurysm of the ascending aorta using MRI.

Mycotic pseudoaneurysms of the ascending aorta are rare cardiovascular lesions that carry the risk of potentially disastrous complications such as aortic rupture or widespread sepsis. Regardless of its location in the arterial system, this lesion carries a high mortality rate. Early diagnosis of mycotic pseudoaneurysm is paramount for optimizing the chances of surgical therapy. While imaging strategies of this lesion have included aortography, echocardiography, and computed tomography, the information gained from each of these individual studies may be acquired in a single MR imaging session. MRI offers the fundamental advantages of noninvasiveness, nonionization, and multiplanar imaging capabilities. Additionally, MRI provides excellent soft tissue contrast, a wide field of view, qualitative and quantitative flow analysis, and an independence of operator expertise or patient body habitus.

Magnetic resonance imaging of the mediastinum.

Magnetic resonance (MR) imaging is becoming a primary modality for evaluating the mediastinum. MR affords multiplanar imaging capabilities without exposing patients to ionizing radiation. The inherent contrast effect of different mediastinal tissues sharply delineates anatomic structures on MR images without contrast enhancement. Gradient-echo and phase-mapping techniques permit noninvasive qualitative and quantitative assessment of mediastinal blood flow. High soft tissue contrast and flow analysis capabilities make MR imaging a valuable modality for evaluating mediastinal vascular disorders. Various mediastinal tumors and their extent are best identified by the use of T1-weighted, T2-weighted, and gadolinium-enhanced images. Both primary and secondary chest wall lesions may be assessed with standard spin-echo MR images. Complex pleuroparenchymal lesions may be evaluated by means of a multiplanar approach and modified pulse sequences. This article addresses the technical parameters governing MR imaging of the mediastinum and describes MR characteristics of various pathologic conditions.

Cardiopulmonary vascular imaging.

Magnetic resonance angiography (MRA) effectively maximizes the flow sensitivity of MR imaging (MRI) to display the body's vasculature. Although MRA has proven quite effective in imaging the intracranial and extracranial vessels, cardiopulmonary MRA faces several additional inherent challenges. Cardiorespiratory motion, vessel pulsatility, and irregular flow patterns all degrade image quality and necessitate appropriate compensation schemes. Although preliminary cardiopulmonary MRA methods appear promising, near instantaneous scan times may be necessary to fully maximize the potential of this technique. Multislice spin-echo and gradient-echo techniques have also proven effective. These methods may compensate for cardiac motion through either ECG-gating or referencing, and may maximize the signal characteristics from the intrinsic slow blood flow of the pulmonary vasculature. Phase velocity mapping techniques, which have proven capable of quantifying blood flow in the body, appear equally promising in preliminary studies in evaluating the cardiopulmonary vascular system. Because of the nature of blood flow dynamics in the cardiopulmonary vascular system, spin-echo (SE), gradient refocussed echo (GRE), and possibly phase mapping technique appear well suited for evaluating these regions.