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ABSTRACT: Magnetic resonance imaging examination of the upper spinal cord was done in sixteen adult patients with clinically definite multiple sclerosis (MS) by T2 weighted fluid attenuated inversion recovery (FLAIR) scanning in which the signal from cerebrospinal fluid was suppressed. These scans were compared with matched images obtained with conventional T1 and T2 weighted pulse sequences (including contrast enhancement). 6 lesions (five patients) were seen with the conventional scans and 37 lesions (fourteen patients) were seen with the FLAIR scans. The FLAIR sequence considerably improves the ability of MRI to demonstrate spinal involvement in MS.
The Lancet 04/1993; 341(8845):593-4. · 38.28 Impact Factor
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ABSTRACT: The results of magnetic resonance imaging (MRI) examinations in 50 patients with histological or clinical diagnoses of retroperitoneal disorders and 20 normal volunteers are presented. An increase in relaxation time (T1) was recognised in most pathological conditions except for four liposarcomas and one adrenal cortical neoplasm and one metastatic lesion of the same gland. Inversion recovery (IR) provided the best tissue contrast, enabling the detection of small lesions. Flow-dependent sequences and sagittal imaging planes were particularly helpful in the evaluation of aortic aneurysms. Ferric ammonium citrate used as an oral paramagnetic contrast agent and a short T1 inversion recovery sequence gave encouraging initial results in recognising bowel loops. Gadolinium-DTPA injected intravenously provided tumour enhancement, indicating vascular perfusion and demarcating tumour margins. An attempt to eliminate motion artefacts was carried out in 15 volunteers and six patients either by a new software system (respiratory ordered phase encoding) or by using short T1 inversion-recovery to suppress the high signal from fat. The same pulse sequence results were useful in demonstrating subcutaneous fistulous tracts by eliminating the adjacent fat. The actual role of MRI in the investigation of the retroperitoneum in view of current technical developments is discussed.
Clinical Radiology 10/1986; 37(5):441-9. · 1.95 Impact Factor
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ABSTRACT: The clinical application of the intravascular paramagnetic contrast agent gadolinium-DTPA for magnetic resonance imaging (MRI) imaging of tumours of the central nervous system (CNS) has been assessed over the past 3 years. Various patterns of contrast enhancement were observed, and situations in MRI where the administration of contrast medium may be useful have been defined. These include lesions which are isointense with normal brain matter, the separation of tumour from surrounding oedema, evaluation of the degree of blood-brain barrier breakdown, delineation of tumours obscured by overlying calcification on computed tomography (CT) and in the investigation of lesions in anatomical areas where CT has known limitations (brain stem, cervical spine). Changes in relaxation times in normal and abnormal tissues following contrast medium, toxicity and dosage of gadolinium-DTPA, and MRI pulse sequence techniques are reviewed.
British Journal of Radiology 10/1986; 59(705):865-73. · 1.31 Impact Factor
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ABSTRACT: The effect of gadolinium-DTPA (Gd-DTPA, Schering AG) as a magnetic resonance imaging (MRI) contrast agent was studied in 15 patients with liver tumours. A dose of 0.1 mmol/kg was used. An analysis of the time-course of enhancement, a comparison of four different pulse sequences, and a dose-comparison study were carried out with monitoring of haematological and biochemical parameters before and after injection of Gd-DTPA. Maximum enhancement, that is, increase in signal intensity, was noted on IR1400/400/13 between 10 and 20 min after injection while on SE580/40 and SE580/80 maximum enhancement was noted 30 min after injection. In some cases enhancement was noted up to 120 minutes after injection. SR1000/13f sequences showed very little enhancement. On comparison with contrast-enhanced X-ray computed tomography (CT), enhancement was greater on MRI in seven cases, equal in six and less in two, as assessed subjectively. Additional lesions were shown in one case using Gd-DTPA compared to precontrast enhanced MRI scans. However, no additional lesions were seen on contrast-enhanced MRI scans compared to contrast-enhanced CT scans. Gd-DTPA is capable of enhancing liver tumours on MRI and may have a place in the assessment of the operability of such lesions.
Clinical Radiology 08/1986; 37(4):347-53. · 1.95 Impact Factor
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ABSTRACT: Initial clinical experience with magnetic resonance imaging (MRI) of the abdomen using short TI inversion-recovery (STIR) pulse sequences is described and compared with X-ray CT in a variety of abdominal disease. The extent of abnormality shown with MRI was greater than that with CT in 21 of 30 cases and equal in 9 cases. Lesion contrast was greater with MRI in 15 cases, equal in 14 and less in 1. The level of artefact was equal in 27 cases and greater with MRI in 3 cases. The STIR pulse sequence has significant advantages in producing high soft-tissue contrast, controlling respiratory artefact, avoiding confusion with intra-abdominal fat and identifying bowel loops.
Magnetic Resonance Imaging 02/1985; 3(3):251-4. · 1.99 Impact Factor
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ABSTRACT: The NMR scans of twenty-six patients who were referred with the clinically suspected or histologically verified diagnoses of brain stem tumour were reviewed. Twenty-one patients (eleven children and ten adults) had scans that were positive for tumour. Nine of these had histological confirmation. Eleven were irradiated without histology on the basis of the clinical diagnosis. The remaining patient was treated expectantly. The other five patients (two children and three adults) had CT and NMR scans that were negative for tumours. Clinical follow-up of these five cases for 9 to 29 months disclosed no further evidence of tumour. All but one tumour had evidence of an increased T1 and T2. Mass effects were seen in all but one case (not the same as the first exception). Multiplanar imaging was useful in determining intra- or extra-axial location as well as tumour extent. Intravenous Gadolinium-DTPA (a paramagnetic contrast agent) showed tumour enhancement in the two patients in whom it was used. NMR showed more extensive abnormality than CT in nineteen patients and similar abnormality to CT in two patients. CT demonstrated calcification better than NMR in the three cases in which it was observed.
Neuroradiology 02/1985; 27(3):202-7. · 2.82 Impact Factor
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ABSTRACT: A study of the magnetic resonance imaging (MRI) appearances of the kidneys in six normal volunteers and 52 patients is reported. Corticomedullary differentiation was seen with the inversion-recovery (IR 1400/400) sequence in the normal volunteers and in patients with functioning transplanted kidneys and acute tubular necrosis. Partial or total loss of corticomedullary differentiation was seen in glomerulonephritis, acute and chronic renal failure, renal artery stenosis, and transplant rejection. The T1 of the kidneys was increased in glomerulonephritis with nephrotic syndrome, but the T1 was within the normal range for renal medulla in glomerulonephritis without nephrotic syndrome, renal artery stenosis, and chronic renal failure. A large staghorn calculus was demonstrated with MRI, but small calculi were not seen. Fluid within the hydronephrosis, simple renal cysts, and polycystic kidneys displayed very low signal intensity and long T1 values. Evidence of recent hemorrhage into cysts was seen in polycystic kidneys. Tumors displayed varied appearances. Hypernephromas were shown to be hypo- or hyperintense with the renal medulla on the IR 1400/400 sequence. After intravenous injection of gadolinium-DTPA, there was marked decrease in the tumor T1.
American Journal of Roentgenology 01/1985; 143(6):1215-27. · 2.78 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) was performed in 20 patients before and after intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) in a dose of 0.1 mmol/kg. Twelve of the patients had clinical and histologic diagnoses of cerebral tumor, six had hepatic tumors, one had hepatic cysts, and one had transitional cell carcinoma of the bladder. Contrast enhancement was seen with all tumors, but not with the hepatic cysts. The degree of enhancement was greater than that seen with computed tomography (CT) in 13 cases, equal to it in six, and less in one. Contrast enhancement was detectable as long as 18 hr after injection of Gd-DTPA in one case of cerebral tumor. The margin between cerebral tumor and peritumoral edema could be delineated with contrast-enhanced MRI to the degree possible with contrast-enhanced CT. In the liver isointense enhancement was seen with saturation-recovery (SR), inversion-recovery (IR), and spin-echo (SE) sequences although not with all three sequences simultaneously. In general IR sequences were most sensitive for display of the contrast agent, but the enhancement often decreased the difference between abnormal and normal tissue. No short-term side effects were encountered and no significant change was seen in urea, creatinine, electrolytes, liver function tests, blood coagulation, or urine testing after injection of Gd-DTPA. Although much more work will be required to evaluate this contrast agent, these initial experiences are very promising.
American Journal of Roentgenology 09/1984; 143(2):215-24. · 2.78 Impact Factor
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ABSTRACT: Two cases of iron overload in the liver are presented--one of hemochromatosis with associated hepatoma and one of hemosiderosis with probable androgen dependent multicentric hepatic adenomas. Nuclear magnetic resonance scans displayed the tumours as well as low liver parenchymal signal intensity on the saturation-recovery, inversion-recovery, and spin-echo pulse sequences probably as a result of decreased tissue T1 and T2.
Journal of Computer Assisted Tomography 07/1984; 8(3):446-9. · 1.22 Impact Factor
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ABSTRACT: The results of NMR examinations in 52 patients with histological or clinical diagnoses of cerebral tumor are reviewed. An increase in relaxation time was recognized in all tumors but problems were experienced in distinguishing the margin of tumors from surrounding edema. Mass effects were well demonstrated as a result of the high level of gray-white matter contrast available with inversion-recovery sequences and the use of coronal and sagittal imaging planes. In general repeated FID sequences were less sensitive in detecting tumors than inversion-recovery or spin-echo sequences. Periventricular edema was well demonstrated with spin-echo sequences and was of importance in recognizing acute or subacute hydrocephalus. Radiation therapy was associated with increased relaxation times particularly within white matter. Problems in the recognition of tumor recurrence following treatment are outlined. The opportunities and challenges that NMR imaging is now providing for physicists and radiologists are discussed.
Magnetic Resonance in Medicine 04/1984; 1(1):5-29. · 2.96 Impact Factor
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ABSTRACT: The results of initial clinical nuclear magnetic resonance imaging of the brain in eight normal and 52 children with a wide variety of neurologic diseases were reviewed. The high level of gray-white matter contrast available with inversion-recovery sequences provided a basis for visualizing normal myelination as well as delays or deficits in this process. The appearances seen in cases of parenchymal hemorrhage, cerebral infarction, and porencephalic cysts are described. Ventricular enlargement was readily identified and marginal edema was demonstrated with spin-echo sequences. Abnormalities were seen in cerebral palsy, congenital malformations, Hallervorden-Spatz disease, aminoaciduria, and meningitis. Space-occupying lesions were identified by virtue of their increased relaxation times and mass effects. Nuclear magnetic resonance imaging has considerable potential in pediatric neuroradiologic practice, in some conditions supplying information not available by computed tomography or sonography.
American Journal of Roentgenology 12/1983; 141(5):1005-18. · 2.78 Impact Factor
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ABSTRACT: The results of nuclear magnetic resonance (NMR) examinations in 26 patients with histologic (15 cases) or clinical (11 cases) diagnoses of tumors within the posterior fossa were reviewed and compared with x-ray computed tomography (CT). Most tumors displayed an increase in T1 and T2 relative to brain. All seven benign tumors were seen with both CT and NMR, although one of these cases initially was misdiagnosed on the basis of the CT findings. The extent of these tumors was equally well shown with CT and NMR in three cases but was demonstrated better by NMR in four. Calcification was seen with CT but not with NMR in two of these patients. All 19 malignant tumors were demonstrated with NMR. Two of these were not seen with CT. In 12 patients minimal changes consisting of a poorly defined low-attenuation are or minor displacement of the fourth ventricle were noted with CT, although much more extensive changes were seen with NMR. In three patients the changes were equally well shown with both techniques. In the remaining two cases, the extent of the tumor was defined more accurately with contrast-enhanced CT, where the margin between tumor and surrounding edema was better seen than with NMR. Mass effects were better demonstrated with NMR in 13 patients and equally well shown in six. Bony erosion was better demonstrated with CT in two cases. Hydrocephalus with periventricular edema was seen in five patients; in each it was more clearly demonstrated with NMR. The NMR diagnosis of tumors is discussed and relevant new developments are summarized.
American Journal of Roentgenology 10/1983; 141(3):489-96. · 2.78 Impact Factor
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ABSTRACT: Nuclear magnetic resonance (NMR) and X-ray computed tomographic (CT) imaging of the brain were performed on nine patients with clinical evidence of cerebral involvement by systemic lupus erythematosus (SLE). Focal lesions were demonstrated in eight patients by NMR and in six by CT. The examinations with both techniques were negative in one patient and showed essentially identical pathological conditions in three patients. In three patients NMR demonstrated more numerous lesions than CT. All lesions seen on CT were also seen on NMR, mostly with greater clarity and extent. In view of the limited number of patients, this study is preliminary, but it appears that NMR demonstrates more accurately the degree of brain involvement in SLE than CT.
Journal of Computer Assisted Tomography 07/1983; 7(3):461-7. · 1.22 Impact Factor
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ABSTRACT: Attention is drawn to the use of nuclear magnetic resonance (NMR) spin-echo sequences in the recognition of white matter disease of the brain. In 5 patients with multiple sclerosis, 8 lesions were seen with postcontrast x-ray computed tomography (CT) (37.5 g of iodine), 33 with inversion-recovery (IR) scans, and 47 with spin-echo (SE) scans. Partial volume effects were less of a diagnostic difficulty with SE scans than with IR scans. Extensive areas of abnormal white matter were seen with CT, IR, and SE scans in a patient with leucodystrophy associated with congenital muscular dystrophy. In a patient with adrenoleucodystrophy focal lesions were seen with CT, IR, and SE scans. In addition, loss of gray-white matter contrast was seen in both occipital lobes with IR scans. Extensive areas of white matter involvement were also seen in a case of Binswangers disease.
Journal of Computer Assisted Tomography 05/1983; 7(2):290-4. · 1.22 Impact Factor
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ABSTRACT: Fifty patients with clinical diagnoses of disease within the posterior fossa were examined with a nuclear magnetic resonance (NMR) scanner and the results were compared with X-ray computed tomography (CT). A variety of NMR pulse sequences reflecting proton density, T1, T2 and blood flow were used and imaging was performed in transverse coronal and sagittal planes. In many cases NMR provided diagnostic information unavailable from CT scans. This included recognition of lesions not seen with CT in infarction and multiple sclerosis, as well as more precise definition of mass effects, oedema and anatomical relationships in other diseases. Extrinsic and intrinsic tumours were readily distinguished, as were brain-stem and cerebellar tumours. Arnold-Chiari malformations were demonstrated with sagittal scans and cerebellar atrophy was identified. A patient treated with radiotherapy displayed more extensive changes in the surrounding brain with NMR than with CT. Evidence of occlusion or reduced flow was found in two cases with vertebro-basilar disease. Occlusion of the internal carotid artery was also demonstrated. Computed tomography was superior to NMR in demonstrating calcification and bone erosion. In four of 14 tumours studied, contrast-enhanced CT demonstrated the margin between tumour and surrounding oedema or brain better than NMR. Nuclear magnetic resonance imaging is a versatile, non-invasive technique capable of demonstrating a wide spectrum of disease within the posterior fossa.
Clinical Radiology 04/1983; 34(2):173-88. · 1.95 Impact Factor
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ABSTRACT: Nuclear magnetic resonance (NMR) scans of the head and liver were obtained in 13 patients with Wilson disease, and the results were compared with computed tomography (CT). Twelve age and sex matched normal controls were also scanned with NMR. The subjects were scanned using repeated free induction decay (RFID), inversion-recovery (IR), and spin-echo (SE) sequences. The IR scans of the brain provided excellent anatomical localisation while SE scans highlighted pathological areas. Within the brain, NMR demonstrated abnormalities in two patients with normal CT scans. More extensive involvement was shown with NMR in three additional cases. In the liver, NMR and CT showed similar abnormalities of morphology. T1 values were within the normal range in all cases, including three patients with high liver copper levels at the time of NMR examination.
Journal of Computer Assisted Tomography 03/1983; 7(1):1-8. · 1.22 Impact Factor
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ABSTRACT: The use of NMR inversion-recovery (IR) sequences to demonstrate brain anatomy is illustrated. The high level of grey-white matter contrast is of value in localising anatomical structures and demonstrating myelination during childhood. While the resemblance of IR scans to gross anatomical sections in different planes is close, it is limited by the spatial resolution of the NMR scanner, artefacts and partial volume effects.
Neuroradiology 02/1983; 25(3):113-8. · 2.82 Impact Factor
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ABSTRACT: A preliminary study of nuclear magnetic resonance imaging of the brains of four normal children (36 weeks' postmenstrual age to 5 years) showed long T(1) areas in the periventricular region of the neonate as well as evidence of progressive myelinisation with increasing age. Study of 18 patients of 40 weeks' postmenstrual age to 4 years showed an apparent deficit in myelinisation in an infant with probable rubella embryopathy and another with ventricular dilatation of unknown cause. Abnormal scans were obtained in an infant with congenital muscular dystrophy, and abnormalities were visualised at the lateral ventricular margins in a case of acute hydrocephalus after shunt blockage. Periventricular regions of increased T(2) were seen in a term infant aged 4 days after severe birth asphyxia and convulsions.Nuclear magnetic resonance imaging appears to provide a unique demonstration of myelinisation in vivo and shows changes in pathological processes of importance in paediatric practice.
British medical journal (Clinical research ed.) 10/1982; 285(6344):774-6.
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ABSTRACT: Cranial nuclear magnetic resonance (NMR) scans were performed on 13 healthy volunteers and 140 patients with a broad spectrum of neurologic disease and compared with x-ray computed tomography (CT) scans. The NMR scans included a variety of sequences reflecting proton density, blood flow, T1, and T2 as well as transverse, sagittal, and coronal images. White matter, gray matter, and cerebrospinal fluid were clearly distinguished in the normal brain with inversion-recovery (IR) sequences, and normal progressive myelination was demonstrated in infants and children. Acute hemorrhages displayed short T1 values, but other pathologic processes such as infarction, infection, demyelination, edema, and malignancy were associated with long T1 values. Cysts had very long T1 values (about that of cerebrospinal fluid). Spin-echo (SE) sequences showed increased values of T2 in a variety of conditions and highlighted lesions against the relatively featureless background of the remaining brain. With inversion-recovery scans, different stages of infarction were recognized in the hemispheres. NMR was more useful than CT in demonstrating brainstem infarction. The white matter lesions in demyelinating diseases were well demonstrated with NMR scans. Many more lesions were observed in multiple sclerosis with NMR than with CT. Benign tumors were well seen and usually had shorter T1 values than malignant tumors. Mass effects from tumors were generally better demonstrated with NMR than with CT, including more subtle mass effects such as displacement of the external capsule. Abnormalities were seen in diseases of the basal ganglia, including marked atrophy of the head of the caudate nucleus in Huntington chorea. Advantages of NMR imaging include the high level of gray-white matter contrast, lack of bone artifact, variety of possible sequences, transverse, sagittal, and coronal imaging, sensitivity to pathologic change, and lack of known hazard. Disadvantages include lack of bone detail, limited spatial resolution, lack of contrast agents, and cost. Promising directions for future clinical research include developmental neurology, tissue characterization with T1 and T2, assessment of blood flow, and the development of contrast agents. Much more detailed evaluation will be required, but NMR seems to be a potentially important addition to existing techniques of neurologic diagnosis.
American Journal of Roentgenology 09/1982; 139(2):215-36. · 2.78 Impact Factor
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ABSTRACT: Eight normal volunteers and 32 patients with a variety of neurological disease were studied with a nuclear magnetic resonance (NMR) scanner using repeated free induction decay (RFID), inversion-recovery (IR) and spin-echo (SE) sequences. The results were compared with X-ray computed tomography (CT). RFID sequences which produce images that reflect changes in proton density displayed very little grey-white matter contrast and relatively small changes in disease. IR sequences which produce images that are dependent on T1 showed a high level of grey-white matter contrast and demonstrated changes in a variety of pathological processes. Although SE scans, which have a strong T2 dependence, had shown no abnormality in previous studies of patients with neurological disease, sequences of this type with longer values of tau displayed abnormalities in cerebral infarction, haemorrhage, herpes encephalitis, multiple sclerosis, cerebral oedema, hydrocephalus, tumours and Wilson's disease. All of these conditions were associated with an increase in T2. Abnormalities were demonstrated in cases of multiple sclerosis and brainstem infarction with NMR scans where no abnormality was seen with CT. More extensive changes were seen with NMR in cases of hemisphere infarction, systemic lupus erythematosis, herpes encephalitis, hydrocephalus (periventricular oedema) and Sturge-Weber disease. The margin between malignant tumour and surrounding oedema was better defined with contrast enhanced CT in four of eight malignant tumours, equally well defined in one, and better defined with NMR in three cases. NMR spin-echo sequences provide a sensitive technique for detecting abnormalities in a variety of neurological disease.
Clinical Radiology 08/1982; 33(4):395-414. · 1.95 Impact Factor
