Radio-frequency coil selection for MR imaging of the brain and skull base.

Radio-frequency coils play a crucial role in the quest for optimal magnetic resonance (MR) image resolution. Given the growing variety of specialized coils available for neuroradiologic imaging applications, it is critical that radiologists use a coherent strategy for successfully matching these coils to specific imaging situations. First, fundamental concepts of coil design are reviewed. Subsequently, a coil-selection algorithm for neuroimaging applications is described. The algorithm uses the patient's clinical history to derive a region of interest, a desired spatial resolution, and a desired contrast resolution. These factors are then used to impose anatomic coverage and imaging protocol constraints on the set of available coils. Finally, coil selection is further refined according to patient tolerance factors. The following coils are considered for use with a 1.5-T superconducting MR imager; namely, quadrature birdcage head, neurovascular phased-array, and dual single-circular-element coils, as well as investigational coils that have not yet been approved by the U.S. Food and Drug Administration: reduced-volume birdcage end-cap, temporal lobe phased-array, carotid artery phased-array, coils. Rationales are discussed regarding appropriate coil selection for screening whole brain and imaging brainstem, cranial nerves, orbits, cerebral cortex, mesial temporal lobes, and internal auditory canal, and for MR angiography.

Intraneural perineurioma of the common peroneal nerve. Case report and review of the literature.

Intraneural perineurioma, or localized hypertrophic mononeuropathy (LHM), is a focal lesion that produces a slowly progressive mononeuropathy in a peripheral nerve. The authors describe the clinical presentation, magnetic resonance (MR) neurography characteristics, and pathological characteristics of a perineurioma involving the peroneal nerve. Although there has been much debate surrounding the cause of this lesion, a literature review supports the argument that this is a neoplastic lesion, best referred to as intraneural perineurioma. Surgical management includes excision to prevent progression of palsy and placement of a nerve graft if clinically indicated. A 28-year-old woman presented with a 2-year history of progressive painless right peroneal nerve palsy. Magnetic resonance neurography revealed a right common peroneal nerve mass. At surgery, the mass was easily excised, leaving significant nerve fascicles intact. Intraoperative biopsy was not performed nor was a nerve graft placed. Pathological investigation demonstrated onion bulb-shaped whorls consistent with the appearance of intraneural perineurioma; immunochemical analysis confirmed the diagnosis. A review of the literature supports the argument that perineurioma, or LHM, is a neoplastic process, making "intraneural perineurioma" the most appropriate name. The authors also demonstrate the utility of MR neurography in the identification isolated nerve tumors and review the surgical management of this lesion.

The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial essay.

SUMMARY: Fifteen patients with neuropathic leg pain referable to the lumbosacral plexus or sciatic nerve underwent high-resolution MR neurography. Thirteen of the patients also underwent routine MR imaging of the lumbar segments of the spinal cord before undergoing MR neurography. Using phased-array surface coils, we performed MR neurography with T1-weighted spin-echo and fat-saturated T2-weighted fast spin-echo or fast spin-echo inversion recovery sequences, which included coronal, oblique sagittal, and/or axial views. The lumbosacral plexus and/or sciatic nerve were identified using anatomic location, fascicular morphology, and signal intensity as discriminatory criteria. None of the routine MR imaging studies of the lumbar segments of the spinal cord established the cause of the reported symptoms. Conversely, MR neurography showed a causal abnormality accounting for the clinical findings in all 15 cases. Detected anatomic abnormalities included fibrous entrapment, muscular entrapment, vascular compression, posttraumatic injury, ischemic neuropathy, neoplastic infiltration, granulomatous infiltration, neural sheath tumor, postradiation scar tissue, and hypertrophic neuropathy.

Analysis of partial volume effects in diffusion-tensor MRI.

The diffusion tensor is currently the accepted model of diffusion in biological tissues. The measured diffusion behavior may be more complex when two or more distinct tissues with different diffusion tensors occupy the same voxel. In this study, a partial volume model of MRI signal behavior for two diffusion-tensor compartments is presented. Simulations using this model demonstrate that the conventional single diffusion tensor model could lead to highly variable and inaccurate measurements of diffusion behavior. The differences between the single and two-tensor models depend on the orientations, fractions, and exchange between the two diffusion tensor compartments, as well as the diffusion-tensor encoding technique and diffusion-weighting that is used in the measurements. The current single compartment model's inaccuracies could cause diffusion-based characterization of cerebral ischemia and white matter connectivity to be incorrect. A diffusion-tensor MRI imaging experiment on a normal human brain revealed significant partial volume effects between oblique white matter regions when using very large voxels and large diffusion-weighting (b approximately 2.69 x 10(3) sec/mm(2)). However, the apparent partial volume effects in white matter decreased significantly when smaller voxel dimensions were used. For diffusion tensor studies obtained using typical diffusion-weighting values (b approximately 1 x 10(3) sec/mm(2)) partial volume effects are much more difficult to detect and resolve. More accurate measurements of multiple diffusion compartments may lead to improved confidence in diffusion measurements for clinical applications.

Intensity correction by subtraction for phased-array MRA images.

A method of intensity correction is described that is particularly useful for magnetic resonance angiography images acquired with phased-array coils. In this method a low-pass filtered version of the image is subtracted from the original image to remove signal variations due to the phased-array coil. This avoids the noise amplification caused by division correction and enhances the signal-to-noise ratio of small arteries in maximum intensity projections. J. Magn. Reson. Imaging 2000;12:501-504.

A geometric analysis of diffusion tensor measurements of the human brain.

The degree of diffusion tensor anisotropy is often associated with the organization of structural tissues such as white matter. Numerous measures of diffusion anisotropy have been proposed, which could lead to confusion in interpreting and comparing results from different studies. In this study, a new method for representing the diffusion tensor shape, called the three-phase (3P) plot, is described. This is a graphical technique based upon a barycentric coordinate system, which weights the tensor shape by a combination of linear, cylindrical, and spherical shape factors. This coordinate system can be used to map and potentially segment different tissues based upon the tensor shape. In addition, the 3P plot can be used to examine the shape properties of existing measures of diffusion anisotropy. In this paper, the 3P plot is used to compare four well-known anisotropy measures: the anisotropy index, the fractional anisotropy, the relative anisotropy, and the volume fraction. Computer simulations and diffusion tensor images of normal brains were obtained to study the properties of this new mapping technique. Magn Reson Med 44:283-291, 2000.

Enhanced image detail using continuity in the MIP Z-buffer: applications to magnetic resonance angiography.

In this paper a new algorithm is presented for the segmentation and display of blood vessels from images obtained with magnetic resonance angiography (MRA) and other three-dimensional (3D) angiographic imaging techniques. The algorithm developed is based on the observation that vessels are strongly evident in the maximum intensity projection (MIP) Z-buffer as regions of high continuity and low local roughness. Roughness is measured here by the minimum chi2 value of a low-order local least-squares fit in the principal directions through each point in the MIP Z-buffer. Although some background pixels in the Z-buffer exhibit low local roughness, the size of the connected region is nearly always much smaller than even the very smallest vessels that appear in the MIP image. It is shown that by applying connectivity to the regions of low roughness, there is nearly complete separation between vascular detail and background. When connectivity is further applied in the original 3D image, vascular bed segmentation becomes nearly complete. The algorithm consists of three basic steps: a) determination of the minimum local roughness at each point in the MIP Z-buffer; b) connection of all neighboring points of low local roughness; and c) connection of all points in the original 3D image matrix that are connected to the points determined in the MIP Z-buffer and that are above an intensity threshold. The algorithm as presented is not optimized but demonstrates a very strong potential for improved portrayal of vascular detail.

A three-coil comparison for MR angiography.

The purpose of this work was to compare intracranial magnetic resonance angiography (MRA) image quality using three different radiofrequency coils. The three coil types included a reduced volume quadrature birdcage coil with endcap, a commercially available quadrature birdcage head coil, and a four-element phased-array coil. Signal-to-noise ratio (SNR) measurements were obtained from comparison studies performed on a uniform cylindrical phantom. MRA comparisons were performed using data acquired from 15 volunteers and applying a thick-slab three-dimensional time-of-flight sequence. Analysis was performed using the signal difference-to-noise ratio, a quantitative measure of the relative vascular signal. The reduced-volume endcap and phased-array coils, which were designed specifically for imaging the intracranial volume of the head, improved the image SNR and vascular detail considerably over that obtained using the commercially available head coil. The endcap coil configuration provided the best vascular signal overall, while the phased-array coil provided the best results for arteries close to the coil elements.

A median filter for 3D FAST spin echo black blood images of cerebral vessels.

High-resolution black-blood MRA images of intracranial vascular anatomy can be obtained using 3D fast spin-echo techniques. Although these images demonstrate excellent contrast between vessels and surrounding soft tissues, the dark signal from air and bone can obscure the desired vascular information when a minimum intensity projection image is created. In this paper, we describe an image processing technique based upon a median filter that is effective for detecting narrow vessel-like structures. Minimum intensity projection images of the filtered MRA volume can be obtained in any orientation without prior segmentation of the skull or surrounding air spaces. The filter is very effective for detecting and visualizing small vessels, but is much less effective for detecting vessels and vascular pathology larger than the filter detection width. The filtering technique is demonstrated on black-blood MRA images from a volunteer study.

Incidental detection of hippocampal sclerosis on MR images: is it significant?

BACKGROUND AND PURPOSE: The prevalence of hippocampal sclerosis in the general nonepileptic patient population is not well described. While reports of its association with partial complex seizures are abundant, its absence in nonafflicted patients is generally presumed but not well documented. To test the hypothesis that hippocampal sclerosis is specific for epilepsy, we reviewed the MR imaging studies of 207 patients referred for hearing loss to determine whether high-resolution MR imaging could detect unsuspected hippocampal sclerosis in nonepileptic patients. METHODS: Our institution screens patients with hearing loss by using high-resolution coronal and axial temporal bone MR imaging that includes the hippocampus within the imaging volume. We retrospectively reviewed 207 studies randomly selected from this database. RESULTS: The hippocampus was normal in 205 patients; in the remaining two patients we identified one or more primary determinants for hippocampal sclerosis. Subsequent retrospective chart review revealed that both patients had had previously diagnosed seizure disorders. CONCLUSION: The imaging determinants of hippocampal sclerosis are not prevalent in nonepileptic patients. Incidental identification of hippocampal sclerosis on MR images is uncommon and significant, and should prompt further clinical investigation to exclude a seizure disorder.

Optimized visualization of vessels in contrast enhanced intracranial MR angiography.

In this study, the problem of small vessel visualization in magnetic resonance angiography is addressed. The loss of vessel contrast due to slow flow-related signal saturation can be compensated by the T1 reduction obtained from the use of an MR contrast agent, such as Gd-DTPA. The vessel/background signal-difference-to-noise ratio (SDNR) is shown to strongly depend on the imaging parameters, as well as on the time course of the blood T1 values obtained from the contrast injection. Specifically, it was found that vessel SDNR increases almost linearly with TR, if the sampling bandwidth is reduced proportionately.

Contrast-enhanced magnetic resonance angiography of cerebral arteries. A review.

The loss of blood vessel visibility due to the signal saturation of slow flow can be partially overcome by the T1 reduction that occurs with the use of contrast agents such as Gd-DTPA during magnetic resonance angiography (MRA) studies. Dynamic-imaging techniques that have been applied successfully in abdominal imaging may also be useful for intracranial applications. However, the time between arterial and venous enhancement is very short during intracranial circulation. This limits the spatial resolution that can be obtained between arterial and venous enhancement. Fortunately, the blood-brain barrier and the relatively long duration of significant decrease in blood T1 has led to the development of very high resolution intracranial MRA techniques. Knowledge of the contrast-agent dilution factors and the ultimate resulting relaxation rates can be used to optimize the imaging parameters to maximize vessel signal relative to the background signal (the signal-difference-to-noise ratio). The additional venous vascular detail in the contrast-enhanced study can be spatially resolved in the 3D image data and determined by incorporating information from both high-resolution precontrast and postcontrast studies. In this article, the history, development and application of contrast agents in MRA are presented.

Intracranial black-blood MR angiography with high-resolution 3D fast spin echo.

Three-dimensional fast spin-echo (3DFSE) techniques are promising for black-blood imaging of cerebral vessels. In this study, flow-related signal dephasing was demonstrated as the primary mechanism for blood signal attenuation. Parameter optimization of TR (1500 to 3000 ms), receiver bandwidth (25 to 31.25 kHz), effective TE (25.7 to 30.1 ms), and ETL (7 to 8) was accomplished by making measurements of vessel-to-tissue contrast-to-noise ratios on vessels. A comparison of high-resolution 3DFSE and 3DTOF magnetic resonance angiography demonstrated that 3DFSE can generate images with equivalent or better small vessel detail than conventional techniques. 3DFSE black-blood techniques may provide improved sensitivity of small arteries and veins with slow or in-plane flow and immunity to flow-related distortions. Future studies with optimized parameters will determine the clinical efficacy of this technique.

Terson syndrome: CT evaluation in 12 patients.

PURPOSE: Terson syndrome may be overlooked in the acute setting and often requires ophthalmologic intervention to prevent long-term visual loss. In this syndrome, vitreous or retinal hemorrhage results from an abrupt rise in intracranial pressure, leading to retinal venous hypertension and intraocular hemorrhage. Our objective was to determine whether imaging findings could be discovered that might facilitate an earlier diagnosis. METHODS: Our inpatient medical record data base for 1991-1996 listed 11 patients with Terson syndrome. The medical records of these 11 patients were reviewed retrospectively and compared with their noncontrast head CT scans and with scans of 10 control subjects. One additional case was discovered prospectively, for a total of 12 patients. Three radiologists unaware of the patients' history evaluated CT scans of the orbits for evidence of intraocular hemorrhage. RESULTS: CT findings in eight patients were suggestive of retinal hemorrhage manifested by a retinal crescent or nodule that was slightly hyperdense relative to the vitreous humor. There was a high degree of concordance between the retrospective and independent reviews. CONCLUSION: Retinal nodularity and crescentic hyperdensities are evident on CT scans in the majority of patients with Terson syndrome. Although findings are subtle and not present in all cases, in the setting of subarachnoid hemorrhage they suggest retinal hemorrhage and warrant detailed fundoscopic evaluation.

Elimination of eddy current artifacts in diffusion-weighted echo-planar images: the use of bipolar gradients.

Small gradient fields resulting from incompletely canceled eddy currents can cause geometric distortion in echo-planar images. Although this distortion is negligible in most echoplanar applications, the large gradient pulses used in diffusion-weighted echo-planar imaging can result in significant image distortion. In this report, it is shown that this distortion can be significantly reduced by the application of bipolar gradient waveforms. Both bipolar diffusion-sensitizing gradients and an inverted gradient preparatory pulse were examined for minimizing the eddy currents responsible for these distortions.

Quantitative comparison of conventional spin echo and fast spin echo during brain myelination.

PURPOSE: Fast SE (FSE) sequences have largely replaced conventional SE (CSE) T2-weighted sequences in the brain and have been generally accepted as qualitatively comparable. The purpose of the present study was to subject these sequences to a quantitative comparative analysis in the brain. METHOD: A quantitative analysis of relative signal intensities of white and gray matter was performed comparing CSE and FSE T2-weighted sequences in brains of 20 children at varying stages of myelination. RESULTS AND CONCLUSION: At all ages in individual patients, white matter had less signal intensity (SI) relative to gray matter on FSE than CSE, though the relative difference in SI was small. This resulted in white matter appearing slightly more myelinated on FSE than CSE. This difference is attributed to differences in magnetization transfer. In myelinated brain (white matter hypointense to gray matter), contrast-to-noise was greater with FSE, while in unmyelinated brain, contrast-to-noise was greater with CSE.

Brachial plexus: MR imaging with a dedicated phased array of surface coils.

A phased array of surface coils was constructed for magnetic resonance imaging in three different regions in the brachial plexus. Four-coil subsets of the six-coil array were activated at any given time during imaging in three volunteers. An in vivo estimate of the signal-to-noise ratio (S/N) at three locations in the brachial plexus indicated that the phased-array coil provided a signal-to-noise ratio that was three to six times higher than that of the body coil.

Atherosclerosis of the carotid artery: evaluation by magnetic resonance angiography.

Carotid artery atherosclerotic plaques (APs) can lead to brain ischemia, an event shown to correlate with both the degree of stenosis and the composition of the AP. Currently, accurate estimates of stenosis can be obtained by either x-ray angiography or three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA). Our purpose was to determine whether three-dimensional TOF MRA images could also provide information on plaque location, morphology, and composition. Seven pre-endarterectomy patients underwent three-dimensional TOF MRA. After endarterectomy, plaque histology was evaluated. Three-dimensional TOF MRA images contained sufficient soft tissue contrast to differentiate the plaques from the surrounding tissues in all cases. Estimation of plaque morphology had 80% correlation with histology. Finally, intraplaque hemorrhage and calcification were deplicted as regions of moderately high and very low intensity, respectively. These preliminary results suggest that three-dimensional TOF MRA may be useful in studying the development and progression of carotid atherosclerosis.

Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology.

Currently, diagnosis and management of disorders involving nerves are generally undertaken without images of the nerves themselves. The authors evaluated whether direct nerve images obtained using the new technique of magnetic resonance (MR) neurography could be used to make clinically important diagnostic distinctions that cannot be readily accomplished using existing methods. The authors obtained T2-weighted fast spin-echo fat-suppressed (chemical shift selection or inversion recovery) and T1-weighted images with planes parallel or transverse to the long axis of nerves using standard or phased-array coils in healthy volunteers and referred patients in 242 sessions. Longitudinal and cross-sectional fascicular images readily distinguished perineural from intraneural masses, thus predicting both resectability and requirement for intraoperative electrophysiological monitoring. Fascicle pattern and longitudinal anatomy firmly identified nerves and thus improved the safety of image-guided procedures. In severe trauma, MR neurography identified nerve discontinuity at the fascicular level preoperatively, thus verifying the need for surgical repair. Direct images readily demonstrated increased diameter in injured nerves and showed the linear extent and time course of image hyperintensity associated with nerve injury. These findings confirm and precisely localize focal nerve compressions, thus avoiding some exploratory surgery and allowing for smaller targeted exposures when surgery is indicated. Direct nerve imaging can demonstrate nerve continuity, distinguish intraneural from perineural masses, and localize nerve compressions prior to surgical exploration. Magnetic resonance neurography can add clinically useful diagnostic information in many situations in which physical examinations, electrodiagnostic tests, and existing image techniques are inconclusive.