Magnetic resonance imaging of the cervical spine: Technical and clinical observations

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Magnetic Resonance Imaging 0 Volume 2, Number 2, 1984

In the analysis of the prostate, MRI displays the gland in three dimensions and therefore allows accurate volumetric measurements. The greatest potential of MRI seems to be its ability to detect pathology confined to the gland. However, it is not yet known if a neoplastic nodule can be differentiated from chronic prostatitis. Unlike x-ray CT, metallic clips produce no streaking artifacts, giving MRI a definite advantage in the evaluation of patients after radical surgery. These observations were made on a small number of patients. If the results are confirmed with a larger number of patients, MRI will assume a prominent role in the clinical evaluation of bladder and prostate cancer. Am. J. Roentg. 14l:llOl; 1983 NMR Scanning of the Pelvis: Initial Experience with a 0.3 T System Patrick J. Bryan,’ Harold E. Butler,’ Joseph P. LiPuma,’ John R. Haaga,’ Saba J. El Yousef,’ Martin I. Resnick,’ Alan M. Cohen,’ Vinay K. Malviya,3 A. Dennis Nelson,’ Mark Clampitt,’ Ralph J. Alfidi,’ Jeff Cohen,’ Stuart C. Morrison’ ‘Department of Radiology, University Hospitals. Case Western Reserve University, Cleveland, OH 44106; ‘Department of Urology, University Hospitals, Case Western Reserve University, Cleveland. OH 44106; 3Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University, Cleveland, OH 44106 Pelvic NMR scans were obtained on 29 patients using a 0.3 T superconducting magnet system. Pathologies studied included four bladder carcinomas, four prostatic carcinomas, four ovarian dermoid cysts, three ovarian cysts, three endometrial carcinomas, two endometriomas, and one each of serous cystadenoma of the ovary, benign prostatic hypertrophy, pelvic hematoma, and undifferentiated sarcoma. NMR is a very promising method for characterizing pelvic masses and in staging pelvic malignancies. It can show primary tumors of the prostate, bladder, and uterus and reveals tumor extension into pelvic fat. The pelvis is particularly well suited to NMR scanning because of the abundant natural contrast provided by pelvic fat and by urine in the bladder and gas in the bowel. There is also less motion blurring than in the upper abdomen and chest because there is relatively little respiratory motion of pelvic organs. Various pulse sequences were used in scanning the pelvis; their relative merits are discussed. Am. J. Roentg. 14l:llll; 1983 Magnetic Resonance Initial Experience

Imaging of the Female Pelvis:

Hedvig Hricak,’ Charles Alpers,’ Crooks,’ and Phillip E. Sheldon’

Lawrence

E.

‘Department of Radiology, University of California School of Medicine, San Francisco, CA 94143; ‘Department of Pathology, University of California School of Medicine, San Francisco, CA 94143 The potential of magnetic resonance imaging (MRI) was evaluated in 21 female subjects: seven volunteers, 12 patients scanned for reasons unrelated to the lower genitourinary tract, and two patients referred with gynecologic disease. The uterus at several stages was examined: the premenarcheal uterus (one patient), the uterus of reproductive age (12 patients), the postmenopausal uterus (two patients), and in an 8 week pregnancy (one patient). The myometrium and cyclic endometrium in the reproductive age are separated by a low-intensity line (probably stratum basale), which allows recognition of changes in thickness of the cyclic endometrium during the menstrual cycle. The corpus uteri can be distinguished from the cervix by the transitional zone of the isthmus. The anatomic relation of the uterus to bladder and rectum is easily outlined. The vagina can be distinguished from the cervix, and the anatomic display of the closely apposed bladder, vagina, and rectum is clear on axial and coronal images. The ovary is identified; the signal intensity from the ovary depends on the acquisition parameter used. Uterine leiomyoma, endometriosis. and dermoid cyst were depicted, but further experience is needed to ascertain the specificity of the findings. Am. J. Roentg. 141:1119; 1983 Magnetic Resonance Imaging of the Cervical Spine: Technical and CIinicaI Observations Michael T. Medic,’ Meredith A. Weinstein,’ William Pavlicek,’ Francis Boumphrey,’ Daniel Starnes,’ Paul M. Duchesneau’ ‘Department of Radiology, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44106; ‘Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44106 Seventy-two patients were examined to determine the clinical potential for magnetic resonance imaging (MRI) of the spine. MRI using different pulse sequences was compared with plain radiography, highresolution computed tomography, and myelography. There were 35 normal patients; pathologic conditions studied included canal stenosis, herniated disk, metastatic tumor, neurofibroma, trauma, Chiari malformation, syringomyelia, arteriovenous malformation, and rheumatoid arthritis. MRI provided sharply defined anatomic delineation and tissue characterization. It was diagnostic in syringomyelia and Chiari malformation and was useful in the evaluation of trauma and spinal canal block from any cause. MRI was sensitive to degenerative disk disease and infection. The spin-

Abstracts

0 L. A. MINKOFF,EDITOR

echo technique, with three pulse sequence variations, seems very promising. A short echo time (TE) produces the best signal-to-noise ratio and spatial resolution. Lengthening the TE enhances differentiation of various tissues by their signal intensity, while the combined increase of TE and recovery time (TR) produces selective enhancement of the cerebrospinal fluid signal intensity. Am. J. Roentg. 141:1129;

1983

NMR Imaging of the Spine Jong S. Han,’ Benjamin Kaufman,’ Saba J. El Yousef,’ Jane E. Benson,’ Charles T. Bonstelle,’ Ralph J. Alfidi,’ John R. Haaga,’ Hong Yeung,* Richard G. Huss’ ‘Department of Radiology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, 2074 Abington Rd., Cleveland, OH 44106. Address reprint requests to J. S. Han; ‘Technicare Corporation, Solon, OH 44139

The usefulness of nuclear magnetic resonance (NMR) images in the evaluation of spinal disorders below the craniocervical junction was studied. Six normal subjects and 41 patients with various spinal abnormalities were examined. NMR proved capable of demonstrating important normal and pathologic anatomic structures; it was useful in the evaluation of syringohydromyelia and cystic spinal cord tumors, and the bright signal intensity of lipoma was quite impressive. In the evaluation of herniated disk, NMR images offered a new perspective by visualizing abnormal degradation of the signal intensity of the nucleus pulposus itself. NMR images were least valuable in the evaluation of spondylosis and spinal stenosis. Although NMR imaging of the spine is still in a very early developmental stage, the absence of both ionizing radiation and risks associated with contrast material makes it especially attractive as a new diagnostic method. This limited experience with currently available equipment suggests that, with technical refinement, the efficacy of NMR of the spine will increase. Am. J. Roentg. 141:1137;

1983

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lesions. The ability to image the cord directly rather than indirectly as in myelography, the absence of bone artifact as in computed tomography, and the multiplanar capabilities indicate that MRI will be the procedure of choice in the examination of the spinal cord. Current limitations include partial-volume effects due to slice thickness and the inability to perform contiguous sections when using multiplanar techniques. The relative increase in signal from cerebrospinal fluid with long TR and TE sequences in spin-echo imaging may result in less sensitivity than in the brain for detection of cord edema and/or infarction. Am. J. Roentg. 141:1147;

1983

Recognition of Lumbar Disk Herniation with NMR

N. I. Chafetz,’ H. K. Genant,‘.2 K. L. Moon,’ C. A. Helms,’ J. M. Morris* 1Department of Radiology, University of California School of Medicine, San Francisco, CA 94143; ‘Department of Orthopaedic Surgery, University of California School of Medicine, San Francisco, CA 94143

Fifteen nuclear magnetic resonance (NMR) studies of 14 patients with herniated lumbar intervertebral disks were performed on the UCSF NMR imager. Computed tomographic (CT) scans done on a GE CT/T 8800 or comparable scanner were available at the time of NMR scan interpretation. Of the 16 posterior disk ruptures seen at CT, 12 were recognized on NMR. Diminished nucleus pulposus signal intensity was present in all ruptured disks. In one patient, NMR scans before and after chymopapain injection showed retraction of the protruding part of the disk and loss of signal intensity after chemonucleolysis. Postoperative fibrosis demonstrated by CT in one patient and at surgery in another showed intermediate to high signal intensity on NMR, easily distinguishing it from nearby thecal sac and disk. While CT remains the method of choice for evaluation of the patient with suspected lumbar disk rupture, the results of this study suggest that NMR may play a role in evaluating this common clinical problem. Am. J. Roentg. 141:1153;

1983

Magnetic Resonance Imaging of the Spinal Cord and Canal: Potentials and Limitations

NMR Imaging of the Chest at 0.12 T: Initial Clinical Experience with a Resistive Magnet

David Norman, Catherine M. Mills, Michael BrantZawadzki, Andrew Yeates, Lawrence E. Crooks, Leon Kaufman

Leon Axe],’ Herbert Y. Kressel,’ David Thickman,’ David M. Epstein,’ William Edelstein,* Paul Bottomley,= Rowland Redington,’ Stanley Baum’

Department of Radiology, University of California School of Medicine, San Francisco, CA 94143

‘Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104; ‘General Electric Research and Development Center, Schenectady, NY 12301

Preliminary experience with magnetic resonance imaging (MRI) of the spinal cord and canal in 17 patients indicates considerable promise in the diagnosis of neoplastic, degenerative, and congenital

The chests of 40 subjects were imaged with an experimental nuclear magnetic resonance (NMR) imager