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Objective Correct identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader’s experience on sensitivity and specificity of MRI in diagnosing ACS. Materials and methods A total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar’s test, t test, and U test (p Results Using non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p p p = .045) while the improvement in mean specificity was not significant. Reader’s experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant. Conclusion The addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader’s experience has shown to be another important factor for the diagnostic outcome.

This history page in the series “Leaders in Musculoskeletal Radiology” is dedicated to the memory and achievements of the German physician Heinrich Albers-Schönberg, a pioneer of radiology whose name is connected to the medical eponym Albers-Schönberg's disease, also referred to as osteopetrosis or marble bone disease.

Supraspinatus muscle atrophy is widely determined from oblique-sagittal MRI by calculating the occupation ratio. This ex vivo and clinical study aimed to validate the accuracy of 3D software- and MR-imaging-based muscle volumetry, as well as to assess the influence of the tear pattern on the occupation ratio. Ten porcine muscle specimens were volumetrized using the physical water displacement volumetry as a standard of reference. A total of 149 individuals with intact supraspinatus tendons, partial tears, and full-thickness tears had 3T MRI. Two radiologists independently determined occupation ratio values. An excellent correlation with a Pearson’s r of 0.95 for the variables physical volumetry using the water displacement method and MR-imaging-based muscle volumetry using the software was found and formed the standard of reference for the patient study. The inter-reader reliability was 0.92 for occupation ratios. The correlation between occupation ratios and software-based muscle volumes was good in patients with intact tendons (0.84) and partial tears (0.93) but considerably lower in patients with full-thickness tears (0.68). Three-dimensional-software- and MR-imaging-based muscle volumetry is reliable and accurate. Compared to 3D muscle volumetry, the occupation ratio method overestimates supraspinatus muscle atrophy in full-thickness tears, which is most likely due to the medial retraction of the myotendinous unit.

Cruciate ligament reconstruction and meniscal surgery are frequently performed for restoration of knee joint stability and function after cruciate ligament and meniscus injuries, and they contribute to the prevention of secondary osteoarthritis. In cruciate ligaments, the most common procedure is anterior cruciate ligament (ACL) reconstruction. Meniscal surgery most frequently consists of partial meniscectomy and suture repair, rarely of a meniscus transplant. In patients with symptoms following surgery, imaging reevaluation for a suspected intra-articular source of symptoms is indicated and mainly consists of radiography and magnetic resonance imaging. For proper imaging assessment of cruciate ligament grafts and the postoperative meniscus, it is crucial to understand the surgical techniques applied, to be familiar with normal posttreatment imaging findings, and to be aware of patterns and specific findings of recurrent lesions and typical complications. This article presents an updated review of the techniques and the imaging of cruciate ligament reconstruction and meniscus surgery, recurrent lesions, treatment failure, and potential complications.

It has been brought to our attention that there were two author names that weremisspelled in the above article in Seminars in Musculoskeletal Radiology, Volume 24, Number 3, 2020 (DOI: https://doi.org/10.1055/s-0040-1713119). The author names Andreas Heuck and Enzo Silvestri have been corrected in the byline above.

Seit Beschreibung des femoroazetabularen Impingements (FAI) hat sich dessen radiologische Diagnostik standig weiterentwickelt. Das biomechanische Konzept des FAI wird erlautert und es werden aktuelle Moglichkeiten radiologischer Verfahren bei der Diagnostik dargestellt. Basierend auf einer Literaturrecherche wird der aktuelle Wissensstand, insbesondere zur radiologischen Diagnostik des FAI, in einem Review zusammengefasst. Daruber hinaus wird ein Ausblick auf neue Methoden gegeben. Das FAI beschreibt ein dynamisches Phanomen mit einem mechanischen Konflikt zwischen dem Femurkopf und/oder -hals und dem Azetabulum. Wahrend die Verdachtsdiagnose des FAI klinisch gestellt wird, ist die bildgebende Diagnostik fur die Diagnosesicherung und zur Abklarung der zugrundeliegenden Deformitaten des proximalen Femurs (Cam-Deformitat) bzw. des Azetabulums (Pincer-Deformitat) sowie assoziierter Schaden des Gelenkknorpels und des Labrum unverzichtbar. Basis bildgebender Diagnostik sind a.-p.- und laterale Rontgenaufnahmen. MRT und MR-Arthrographie sind die bevorzugten Verfahren zur detaillierten Analyse von Deformitaten sowie der Detektion und Graduierung von Schaden an Gelenkknorpel (Sensitivitat: 58–91 %) und Labrum (Sensitivitat: 50–92 %). Gleichzeitig lassen sich mit ihnen andere Hufterkrankungen ausschliesen. Aktueller Stand und neue Entwicklungen der Bildgebung werden aufgezeigt. Fur die Diagnose des FAI bedarf es typischer klinischer und bildgebender Befunde. Die radiologische Diagnostik ist unverzichtbarer Bestandteil der Diagnosesicherung, der Differenzierung zugrundeliegender Deformitaten und der Beurteilung therapierelevanter Gelenkschaden.

Edema of the quadriceps fat pad (QFP) in MR imaging has been described as a distinct finding associated with anterior knee pain, its etiology, however, remains under debate. The aim of this study was to investigate a potential relationship between QFP edema, alterations of the quadriceps tendon (QT) and other anterior knee structures.800 consecutive, clinically indicated MRI exams of the knee at 3T were retrospectively analyzed for the absence or presence of QFP edema. If present, QFP edema was determined visually by three independent readers and classified into 3 grades (A to C); concomitant alterations of the QT were classified into 5 grades (1 to 5). Furthermore, QT thickness, femoropatellar cartilage degeneration and parameters of patellar instability were determined. 20 MRI studies of healthy individuals served as control group. For statistical analysis Kruskal-Wallis test, one-way ANOVA and Fleiss kappa were used.153 of 800 patients (19%) presented with various degrees of QFP edema. Analysis showed significantly higher grades of QT alterations in patients with intermediate (grade B) and intensive (grade C) QFP edema (p .001) compared to controls and also significantly different grades of QT alterations in patients with mild and intermediate compared to those with intensive QFP edema (p .001). Increased mean QT thickness was found in patients with intermediate and intensive QFP edema compared to controls (p .05).Our study suggests that QFP edema shows an association with QT alterations and QT thickness.

Item does not contain fulltext No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. KEY POINTS: . Standardized training and/or accreditation methods in the field of MSK radiology is lacking at a national level.. . With certification methods, such as the European diploma in musculoskeletal radiology, a more homogeneous European landscape could be created in the future with a view to subspecialist training.. . Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology..

Degenerative disease may lead to spinal canal stenosis and long-lasting pain. It is among the leading cause of disability that may affect the ability to work. It has become more common in an increasingly aging population. MRI is the most comprehensive imaging modality and provides detailed morphologic information. A standardized terminology facilitates communication with referring physicians. Yet imaging findings need careful interpretation in conjunction with the results of clinical tests and symptoms to truly help guide therapeutic decision making. This review summarizes aspects of normal anatomy of the intervertebral disk, pathologic mechanisms, terminology, and examples of the imaging spectrum of disk degeneration and herniation.

INTRODUCTION: The occurrence of the impingement syndrome of the shoulder is dependent on muscle activity and arm position. However, the current radiological workup is based on conventional radiographs, CT or MRI obtained at 0 degree of abduction and at muscular relaxation. The objective of this study was the development of a technique for simultaneous visualization of the humerus, scapula, clavicle and their relationship to the M. supraspinatus--in different arm abduction positions with and without muscle activity--as well as the determination of the minimal acromio-humeral distance. METHOD: The shoulder joints of 8 volunteers were examined in an open MRI system at 60 degrees, 90 degrees and 120 degrees of abduction, using a T1 weighted 3D gradient echosequence. Forces of 10 N were applied at the distal humerus. After 3D reconstruction, the acromio-humeral distance was computed with Euclidian distance transformation. RESULTS: With increasing abduction, the acromio-humeral distance decreased significantly (p < 0.05), but the distance vector was localised laterally to the M. supraspinatus at 120 degrees. With muscle activity a reduction of the subacromial space of 29% (p < 0.05) occurred at 60 degrees whereas at 120 degrees a 51% (p < 0.05) increase was noted. At 90 degrees, no significant difference was observed. CONCLUSION: With the technique presented it is possible to determine the subacromial space width in different arm positions independent of the specific section orientation, with and without muscle activity. The method can be used as a basis for biomechanical investigations and for the clinical diagnosis of impingement syndrome.

Purpose The purpose of this study was to determine the type and frequency of characteristic bone and soft tissue changes on MRI of patients with a clinical diagnosis of plantar fasciitis. Materials and methods 28 patients with a clinical diagnosis of plantar fasciitis underwent MR imaging. Besides T1- and T2-weighted sequences, short-tau-inversion-recovery sequences were used routinely. In 27 patients T1-weighted images after intravenous contrast injection were acquired additionally. As a control group the images of 15 patients without clinical signs for plantar fasciitis were evaluated. Results In 25 of 28 cases (89%) the clinical diagnosis of plantar fasciitis was established by MR imaging. The most common finding was a peritendinous edema at the calcaneal insertion site which was found in all 25 patients. In 19 of 25 cases (76%) a bone marrow edema of the calcaneus was present. In 14 of 25 cases (56%) an intratendinous signal intensity increase of the plantar fascia could be observed which showed contrast enhancement in 12 cases. Compared to the control group (mean thickness 3.3 mm) the plantar fascia showed significant thickening in the 25 MR positive patients (mean thickness 6.72 mm). Discussion Besides thickening of the plantar fascia and intratendinous signal intensity increase with contrast enhancement to some extent, bone marrow edema of the calcaneus and peritendinous edema close to the plantar fascia are characteristic signs of plantar fasciitis on MRI. Both signs can reliably be seen on STIR sequences only.

Objectives: The tumor Gleason score is an important prognostic factor in prostate cancer (PCA). This retrospective study analyzes whether serum prostate-specific antigen (PSA), or magnetic resonance imaging (MRI)-based PSA density of the entire prostate (PSAD) or the prostatic transitional zone (PSAT) distinguishes between PCA of Gleason scores 6 or lower (G6-) and 7 or higher (G7+). Materials and Methods: Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo (FSE) MRI images of the prostate in 61 patients with previously untreated PCA. Automated standardized microparticle enzyme immuno-assay (EIAs) measured PSA. Results: Thirty patients had G6- and 31 patients had G7+. PSA values ranged from 1.0 to 57.2 ng/mL. Assignment to G6 - or G7+, respectively, was correct in 49 of 61 (80%) cases (odds ratio [OR], 17.1; 95% confidence interval [CI], 4.8-61.5) for PSA above the optimal cutoff level of 10.35 ng/mL, 48 cases (79%; OR, 13.7; 95% CI, 4.0-46.8) for PSAD above the optimal cutoff level of 0.23 ng/ mL/cm 3 , and 45 cases (74%; OR, 6.9; 95% CI, 2.2-21.3) for PSAT above the optimal cutoff level of 0.38 ng/mL/cm 3 (no significant differences, McNemar test). Conclusions: In patients with biopsy-proven PCA, serum PSA level alone and MRI-based PSAD and PSAT help distinguish between G6- and G7+. PSAD and PSAT do not improve the level of confidence at which this discrimination is made.

Das Knie ist vergleichsweise exponiert gegenuber Traumata. Sein Kapsel-Band-Apparat ist ein wesentlicher Faktor fur die Gelenkstabilitat. Umgekehrt erhoht persistierende Instabilitat das Risiko fur die Arthroseentstehung, und entsprechende Schadigungen mussen zeitnah und umfassend diagnostiziert werden. Die MRT-Abklarung mit (T)SE-Sequenzen in allen 3 Hauptebenen als Basisprotokoll ist empfehlenswert. Vor allem fettsupprimierte Sequenzen (STIR/T2w, PD-FS-TSE) sind nutzlich, da sie sehr sensitiv knochenmarkodemahnliche Veranderungen (BMEP) erfassen. Dieser Befund lenkt oft erst die Aufmerksamkeit des Radiologen auf die — manchmal nur diskreten, weit weniger ins Auge fallenden — zugrunde liegenden Pathologien. In typischer topographischer Verteilung und gibt Aufschluss uber den Unfallmechanismus und damit Hinweise auf andere assoziierte Verletzungen des Kapsel-Band-Apparats oder der Menisken. BMEP ist sehr ausgedehnt bei Kontusionsverletzungen, bei avulsiven Lasionen jedoch meist sehr diskret. Zu den Zeichen, moglichen Fallstricken und die Treffsicherheit der Magnetresonanztomographie (MRT) fur die Diagnose spezifischer Verletzungen wie Meniskus-, Kreuz- oder Kollateralbandrissen existiert eine Fulle von Literatur. Allerdings ist die kombinierte Verletzung mehrerer der genannten Strukturen haufig und beeinflusst die Therapieentscheidung. Dementsprechend ist es Aufgabe des Radiologen, uber die Erfassung einer einzelnen Lasion hinauszugehen und eine umfassende Beschreibung aller verletzten Strukturen zu geben. Voraussetzung dafur ist die Kenntnis der — manchmal komplexen — Anatomie und typischer Verletzungskonstellationen.

Der Diagnostik des Prostatakarzinoms kommt wegen seiner hohen Inzidenz und den verbesserten stadienadaptierten Therapiemoglichkeiten eine grose Bedeutung zu. Dabei spielen bildgebende Verfahren bei den klinisch oft unzureichend diagnostizierbaren Fallen eine wesentliche Rolle fur die pratherapeutische Abklarung. Die MRT ist dabei dem TRUS sowohl in der Tumordetektion und Lokalisation als auch beim Staging uberlegen. Die Untersuchungstechnik fur hochauflosende MR-Untersuchungen der Prostata beinhaltet die Verwendung einer Kombination von Endorektal- und Phased-array-Spulen sowie den Einsatz multiplanarer T2w-FSE- und T1w-SE-Sequenzen. Die in der Literatur mitgeteilten neueren Ergebnisse fur die Treffsicherheit im Staging des PC liegen bei 82–88% mit Sensitivitaten von 80–95% und Spezifitaten von 82–93%. Eigene Ergebnisse fur das Tumorstaging ergaben bei 106 radikal operierten Patienten fur die Beurteilung eines kapseluberschreitenden Wachstums eine Sensitivitat von 91 und eine Spezifitat von 83%; die entsprechenden Ergebnisse fur die Erkennung einer Samenblaseninfiltration waren 86 und 93%. Es werden die typischen, stadienbezogenen Befunde des Prostatakarzinoms in der MRT als auch die wichtigsten differenzialdiagnostischen Probleme wie chronische Prostatitis,biopsiebedingte Einblutungen und therapiebedingte Strukturveranderungen der Prostata besprochen. Auch die aktuellen diagnostischen Moglichkeiten und Grenzen der MR-Spektroskopie der Prostata werden diskutiert.

Cancer of the endometrium is the most common invasive gynecologic malignancy in North America. Although transvaginal sonography is often the initial imaging examination in women with dysfunctional uterine bleeding, MRI offers multifactorial assessment once the diagnosis of endometrial cancer has been established. Specifically, preoperative contrast-enhanced MRI alters the likelihood ratios for myometrial invasion, which in turn affects type and extent of surgery performed. This information also helps identify patients who would most benefit from referral to a tertiary care center for treatment by a gynecologic oncologist.

Zu den gutartigen knochenbildenden Tumoren zahlen das Osteom, Enostom, Osteoidosteom und das Osteoblastom. Sie sind oft durch einen typischen Befund im Rontgenbild oder auch in anderen radiologischen Verfahren charakterisiert. Aus der Zusammenschau von radiologischem Befund und klinischen Informationen kann haufig bereits eine spezifische Diagnose gestellt werden. Dieser Ubersichtsartikel stellt neben dem radiologischen Erscheinungsbild der Tumoren auch die fur die Diagnostik wichtigsten Aspekte von Epidemiologie, klinischer Symptomatik und pathologischen Befunden dar. Auch auf die radiologisch-interventionellen Therapiemoglichkeiten beim Osteoidosteom wird eingegangen.

The aim of this study was to visualize the arteries from the distal aorta to the ankle joint and to determine the accuracy of MR angiography for detecting stenoses and occlusions.Twenty-four patients with peripheral arterial occlusive disease underwent digital subtraction angiography and were examined on a 1.5-T MR scanner. The transit time for contrast material was determined with a test bolus injection. A T1-weighted three-dimensional gradient-echo sequence with short TR and TE was used for a dynamic measurement at the level of the iliac arteries, the upper leg, and the lower leg arteries. For each level a single dose of gadolinium was injected into an antecubital vein with an MR power injector. Maximal-intensity-projection reconstructions were calculated after subtraction of the first measurement at each level. Two experienced MR radiologists who were unaware of the digital subtraction angiography results interactively evaluated both the MIP reconstructions and the single slices on a workstation, first independently and then in a consensus interpretation.With digital subtraction angiography, 80 hemodynamically significant stenoses and 39 occlusions were detected. For the stenoses and occlusions, a sensitivity of 100% was found for MR angiography. The specificity for the assessment of stenoses and occlusions was 98% and 94%, respectively, for the iliac arteries; 98% and 94%, respectively, for the upper leg arteries; and 94% and 95%, respectively, for the lower leg arteries. Most false-positive findings of occlusion were due to metal stents present in the iliac (n = 3) and upper leg (n = 4) arteries.The MR imaging technique that we used revealed the arteries from the distal aorta to the ankle and proved to be reliable at showing arterial stenoses and occlusions.

Die MRT spielt eine bedeutende Rolle bei der diagnostischen Abklarung von Skelettmetastasen. Prinzipiell kann man dabei 2 Anwendungsbereiche der MRT unterscheiden: Neben dem gelaufigen Einsatz zur Abklarung unklarer Befunde oder der gezielten hochauflosenden Darstellung ossarer Lasionen kann die MRT auch als primares Screeningverfahren zur Metastasensuche eingesetzt werden. Verglichen mit der Szintigraphie liegt hierbei der Hauptvorteil der MRT neben der hoheren Gesamtzahl an entdeckten Lasionen vor allem in der morphologischen Darstellung, die sowohl das Ausmas maligner Veranderungen aufzeigt als auch eine exakte Abgrenzung zwischen benignen und malignen Veranderungen ermoglicht. Da unklare szintigraphische Anreicherungen, vor allem bei Patienten mit dem klinischen Verdacht auf ossare Metastasierung, haufig zu einer aufwendigen Zusatzdiagnostik fuhren, denken wir, dass die Ganzkorper-Skelett-MRT nicht nur ein genaues, sondern auch kostengunstiges diagnostisches Verfahren in der Abklarung einer Skelettmetastasierung darstellen kann, wenn sich die Indikation zu dieser Untersuchung streng nach der Klinik und der therapeutischen Relevanz der Untersuchungsergebnisse richtet.

We describe the findings from various cross-sectional imaging modalities in patients with cardiac valve adherent masses. The techniques are discussed, and imaging findings are compared with the results of cardiac surgery. All three patients had neurological symptoms and/or cardiac murmurs. Transthoracic and/or transesophageal echocardiography revealed the cardiac mass in all three. For differentiation of thrombus and cardiac neoplasm magnetic resonance imaging (MRI) was also performed in all three patients and electron-beam computed tomography (EBCT) in two. Fast segmented cine gradient-echo MRI techniques provided mass depiction in all patients, while T1-weighted spin-echo imaging failed in mass detection in one patient. None of the patients showed evidence of valve regurgitation or stenosis in flow sensitive cine MRI. EBCT excluded mass calcifications in both patients and reliably demonstrated the valve attached lesions. Although echocardiography is the modality of choice in evaluating cardiac masses and especially valve attached masses, MRI and EBCT provide additional information about tissue characteristics and allows an excellent overview of the cardiac and paracardiac morphology. Fast segmented cine gradient-echo MRI is especially able to depict even small tumors attached to rapidly moving cardiac valves, and valve competence can be easily assessed within the same examination.

The imaging characteristics of two EPI-hybrid breath-hold sequences, T2-weighted fast spin-echo [FSE, effective echo time (TEeff) 138 ms] and half Fourier single shot turbo spin-echo (HASTE, TEeff 60 ms), were compared in hepatic imaging. A total of 111 patients with suspected hepatic disease were studied at 1.5 Tesla using a body phase-array coil. The signal-to-noise (S/N) and contrast-to-noise (C/N) ratios for organs and lesions were calculated and quantitatively compared. Organ delineation, visualization of anatomical structures and pathological lesions, artifacts, and total image quality were qualitatively assessed and statistically compared. The final diagnoses were metastases from colorectal, breast, and pancreatic cancer in 23/111, hepatocellular carcinoma in 15/111, cysts in 19/111, hemangiomas in 9/111, several other lesions in 7/111, and no lesions in 38/111 of the cases. A total of 139 lesion in 73% of the patients were seen while 85% of the lesions were at least 1.5 cm in size. Regarding S/Ns HASTE was significantly (P0.03) superior to FSE with only minor (P0.05) differences in C/Ns between the two sequences for anatomical and pathological structures. HASTE demonstrated in almost all (97.3%) of the cases no artifacts, while on fast SE imaging moderate to minor artifacts were present in 23.5-51.7% of the cases. The overall image quality and diagnostic confidence was rated significantly higher (good 43.2%, excellent 53.2%) for HASTE than for fast SE imaging (good 44.8%, excellent 17.6%). Providing comparable C/Ns for anatomical and pathological structures, breatheld HASTE imaging proved to be superior to fast SE in T2-weighted imaging of the upper abdomen regarding general image quality, and, with adequate technical prerequisites, may be a suitable substitute of fast T2-imaging techniques.

The purpose of this study was to evaluate MR imaging findings of the common extensor tendon in patients with lateral epicondylitis and asymptomatic volunteers studied on a 0.2-T dedicated system. In 23 patients (age range 29-58 years, mean age 47 years) with clinical symptoms of lateral epicondylitis MR imaging was performed using T1-, T2- and contrast-enhanced T1-weighted spin-echo sequences. In addition, the elbows of seven healthy volunteers (age range 22-29 years, mean age 25 years) and the symptom-free contralateral elbow of 11 of the 23 patients (age range 29-58 years, mean age 47 years) were studied as controls. Five patients were surgically treated after the MR examination and the results of histopathology were correlated with MR findings. Of the patients, 95.6 % showed intratendinous signal intensity changes on T1-weighted images on the symptomatic side. In 69.6 % signal alterations were observed on T2-weighted sequences and in 56.5 % an intratendinous contrast enhancement was present. Histopathology showed fibrovascular proliferation and fatty degeneration in patients with distinct signal intensity changes and contrast enhancement. Patients with only minor signal intensity changes on T1- and T2-weighted sequences and no contrast enhancement demonstrated fibrosclerotic degeneration and intratendinous cartilage formation in histopathology. The contralateral elbow showed signal intensity changes in 6 of 11 (54.5 %) cases on T1-weighted images and in 3 of 11 (27.3 %) on T2-weighted images. In the group of healthy volunteers minor signal intensity changes of the common extensor tendon could be seen in only 1 case. In patients with lateral epicondylitis of the elbow the type and extent of pathologic changes within the common extensor tendon can be evaluated using a dedicated low-field MR system. On the basis of MR imaging findings a more specified therapy planning among the variety of treatment modalities can be achieved.

Objective: The purpose of this study was to develop a method for three-dimensional (3D) visualization of the whole vascular system of the carotid and vertebral arteries using spiral computed tomographic angiography (SCTA), that allows accurate, qualitative and quantitative evaluation, of anatomical abnormalities, including detection of additional lesions, and estimation of degree of stenosis. Materials and methods: Fifteen patients with anatomical and pathological abnormalities of the arterial vascular system detected by color-coded duplex ultrasound were studied using intraarterial digital subtraction angiography (IA-DSA) with aortic arch injection, and SCTA. The carotid and vertebral arteries were segmented using an interactive threshold interval density volume-growing method and visualized with a color-coded shaded-surface display (SSD) rendering method. The adjacent bone structures were visualized using a transparent volume rendering method. Results: In all cases, the entire volume of the vascular system of the carotid and vertebral arteries could be visualized on SCTA, and the anatomical and pathological abnormalities on 3D SCTA correlated well with that seen on IA-DSA. Conclusion: Results of 3D SCTA had a high degree of correlation with results of IA-DSA in the evaluation of the vascular system of the carotid and vertebral arteries. The 3D SCTA with a subsecond spiral CT scanner is useful for the visualization of anatomical and pathological abnormalities in the circulation in the carotid and vertebral arteries and offer a promising minimally invasive alternative compared with other diagnostic procedures.

Ziel: Als virtuelle Koloskopie bezeichnet man eine neue Methode, die aus Bilddaten der radiologischen Schnittbildverfahren, CT, Elektronenstrahl-CT (EBT) und MRT mittels computerunterstutzter Bildnachverarbeitung simulierte dreidimensionale (3D-), endoskopieahnliche Bilder des Kolons erzeugt. Ziel unserer Untersuchung war die Bestimmung der Wertigkeit der virtuellen EBT-Koloskopie zum Nachweis von kolorektalen Polypen und Tumoren in vitro am Tumormodell und in Patientenstudien. Anhand publizierter Studien der virtuellen Koloskopie mit Spiral-CT und MRT sollen die verschiedenen Untersuchungstechniken dargestellt und verglichen werden. Material und Methode: 6 Polypen mit einem Durchmesser von 3–12 mm wurden nach Abheben und Umstechen der Mukosa in Schweinekolon gebildet. Nach Distension mit Raumluft wurde dieses Tumormodell mit EBT im „continuous volume scanning (CVS)-Mode” mit 3-mm-Kollimation und 3 verschiedenen Pitchverhaltnissen (0,4; 0,8; 1,5) gescannt; 20 Patienten mit positivem Hamocculttest wurden nach rektaler CO2-Insufflation und i. v.-Gabe von 1 mg Glucagon in Atemanhaltetechnik mit einem den ganzen Kolonrahmen abdeckenden CVS-Scan (13 s Untersuchungsdauer) untersucht. Endoskopische 3D-Durchflugsrekonstruktionen wurden von 2 unabhangigen Radiologen hinsichtlich des Vorliegens von Polypen oder Tumoren beurteilt. Die zu erwartende effektive Dosis fur die EBT-Koloskopie wurde uber Messungen mit einem Alderson-Phantom, welches mit Thermolumineszenzdosimetern bestuckt war, berechnet. Ergebnisse: Schon bei einem Pitch von 1,5 wurden alle Polypen im Tumormodell erkannt. Die Reduzierung des Pitch auf 0,8 oder 0,4 verbesserte nicht die Erkennbarkeit der Polypen auf den endoskopischen 3D-Rekonstruktionen. Alle Tumoren (n = 4) und Polypen (n = 3) der Patientenuntersuchungen wurden korrekt identifiziert. 2 falsch-positive Befunde wurden erhoben. Die effektive Dosis pro Scan errechnete sich zu maximal 3,2 mSv. Schlusfolgerungen: Unsere vorlaufigen Ergebnisse deuten darauf hin, das die virtuelle EBT-Koloskopie eine vielversprechende Methode zum Nachweis von kolorektalen Tumoren ist. Der Stellenwert der verschiedenen Techniken der virtuellen Koloskopie (Spiral-CT, EBT, MRT) mus erst noch bestimmt werden.

Minimally invasive thermotherapies for focal tissue destruction on the basis of laser-, microwave-, focused ultrasound-, or cryogen-induced changes of tissue temperature represent an alternative to surgical tissue ablation, particularly in the treatment of tumors. The thermotherapy modalities listed necessitate indirect guidance and monitoring, since they often do not lend themselves to immediate visual control. In the brain, in head and neck tumors, in the liver, and in the prostate, MRI reliably and accurately delineates both the positions of interstitial thermotherapy applicators and--in contrast-enhanced, T1-weighted images--the perfusion defects in tissue necrosis induced by thermotherapy. The transfer of results of in-vitro and in-vivo model studies to assess interstitial temperature and lesion development during thermotherapy to the actual treatment of patients, however, is still in an initial phase. Further development of both rapid MRI sequences and MRI scanners suited for interventions will show how far treatment systems and guidance systems can be adapted to one another.

The purpose of this study was to predict diameters of lesions induced by laser-induced thermotherapy (LITT) of benign prostatic hyperplasia (BPH) from MRI signal/tissue temperature correlations during on-line monitoring with a temperature-sensitive fast low-angle shot (FLASH) sequence. Twenty LITT procedures with Nd:YAG (1,064 nm) and diode (830 nm) lasers were monitored on line with a T1-weighted FLASH sequence at 1.5 Tesla. Interstitial prostate temperature (T) was measured on line in 10 LITT procedures and laser energy deposition in 12. Slopes of linear regression curves for signal intensity (SI) over T were applied to determine SI at 60 degrees C to estimate diameters of intraprostatic LITT lesions. Diameters of unperfused LITT lesion cores in contrast-enhanced T1-weighted images served as gold standards. Linear regression curves with an average slope of -.54% SI/degrees C were obtained in 17 LITT procedures. Correlation coefficients were r = .92-.95 for SI/T and SI/energy deposition. Baseline variation of SI at body temperature was +/-3.9%, corresponding to +/-7 degrees C. Prediction of size (13 lesions) from on-line FLASH imaging was correct in 10 of 13, whereas 3 lesions were overestimated. Prediction of LITT lesion diameters from on-line MRI monitoring is possible with a temperature-sensitive FLASH sequence in the prostate. Accuracy may suffice to assign target regions of interest to tissue locations to be protected from coagulation.

To evaluate detection of parametrial invasion at magnetic resonance (MR) imaging with fat suppression.In 35 patients with cancer of the cervix, MR imaging was performed with the following sequences: T2-weighted turbo spin echo (SE), turbo short inversion time inversion recovery (STIR), and unenhanced or gadolinium-enhanced T1-weighted SE with and without excitation-spoiling fat suppression. Images obtained with each sequence were evaluated for parametrial invasion by two blinded radiologists separately, who scored their level of diagnostic confidence from 0 to 10 (no confidence to high confidence). Then, all images were evaluated together and findings were correlated with histopathologic findings.No statistically significant differences were found between staging with T2-weighted turbo SE, turbo STIR, and T1-weighted fat-suppressed gadolinium-enhanced SE images. Staging with T1-weighted SE, T1-weighted gadolinium-enhanced SE, and T1-weighted fat-suppressed SE images was significantly worse (P.05). Diagnostic confidence was lower (P.001) with T1-weighted gadolinium-enhanced SE and T1-weighted fat-suppressed gadolinium-enhanced SE images (5.5 and 6.2 points, respectively) compared to staging with T2-weighted turbo SE and turbo STIR images (8.2 and 7.6 points, respectively). No statistically significant improvement in staging accuracy was found when all images were evaluated together.In MR diagnosis of parametrial invasion, the addition of fat-suppressed or gadolinium-enhanced MR images did not improve the accuracy with T2-weighted turbo SE images alone.

To our knowledge no comparative studies investigating patients' acceptance of different MR systems have been published. We therefore studied a number of subjective criteria to evaluate both patients' acceptance of and subjective conditions during magnetic resonance imaging (MRI) studies. MRI studies were performed using four separate systems. Two were conventional body MR systems operating at 1.0 or 1.5 Tesla, another was a 0.2 Tesla open whole-body MR system, and the last was a 0.2 Tesla MR system dedicated to the study of extremities. Forty patients for each MR system (total of 160 patients) participated in a standardized, written interview focusing on aspects of their subjective condition, including their perception and acceptance of different factors relevant to the study on respective MR systems. The patients' subjective condition and acceptance was predominantly positive for all MR systems. Differences between MR systems were noted with respect to noise, width of patient gantry, comfort of patient positioning and degree of well-being. Such differences, however, do not lend preference to the use of one particular type of MR system. Therefore, the choice of MR system should be based on the technical features required for the intended studies.

Degenerative and overuse diseases as well as impingement syndromes of the hand are illustrated and discussed in this review article. Osteoarthritis of the interphalangeal joints as described by Heberden and Bouchard is a ubiquitous articular disease often associated with synovitis and erosive joint destruction. Osteoarthritis of the trapeziometacarpal joint is classified into four stages for proper indication of operation. Overuse can result in stenosing tenosynovitis around the wrist and in synovitis with or without impingement of the flexor or extensor tendons of the digitis or ruptures of the annular and cruciform pulleys. Although diagnosis of these entities is usually made by history and clinical investigation, ultrasound and MRI can be helpful tools in imaging of these diseases. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the characteristic degeneration pattern of the wrist and represent the degeneration mechanisms in scapholunate insufficiency and nonunion of the scaphoid. SLAC wrist is a gradual degeneration classified in three stages and found in posttraumatic scapholunate rupture, calcium pyrophosphate dehydrate deposition disease (CPPD), rheumatoid arthritis, neuropathic diseases, trauma, and beta 2-microglobulin associated amyloid deposition. Ulna impaction syndrome is increasingly recognized as a cause of ulnar sided pain and exhibits a characteristic MRI appearance.

PURPOSE The detectability with magnetic resonance mammography (MR-M) of non-invasive ductal carcinoma in situ (DCIS), its morphology, and patterns of contrast enhancement were studied. MATERIAL AND METHODS A total of 849 MR-M examinations were performed in 741 patients using a dynamic, contrast-enhanced FLASH 3D sequence at 1.0 T. Surgical breast biopsies were obtained in 332 cases. Histological work-up confirmed 164 carcinomas, including 20 DCIS. RESULTS Of 20 DCIS, 14 were correctly diagnosed by MR-M on the basis of focal increase of signal intensity. In two cases (10%), no increase of signal intensity was observed. In another three cases (15%), multifocal enhancement lead to a false-negative diagnosis. In one case (5%), DCIS was a random finding in a patient diagnosed and treated for adjacent phylloides tumour. The sensitivity of MR-M was 70%. 4 (20%) of the DCIS did not show microcalcifications at conventional mammography and were only detected at MR-M. The sensitivity of conventional mammography also amounted to 70%. However, the combination of both imaging methods increased sensitivity to 90%. CONCLUSION Ductal carcinoma in situ is not reliably detectable by MR-mammography alone due to lack of a uniform pattern of enhancement.

PURPOSE: To determine whether contrast-enhanced and fat-suppressed sequences contribute to the MR imaging diagnosis of parametrial invasion. METHODS: 21 patients with carcinoma of the cervix were prospectively examined with a phased-array coil and a 1.5T MR-scanner using the following sequences: transverse T2-weighted turbo spin echo (T2-TSE), T1-weighted spin echo (T1-SE) and fat suppressed T1-weighted SE sequences before and after Gd-DTPA. The sequences were evaluated separately for the presence of parametrial invasion. Image quality and diagnostic confidence were classified on a scale of 0-10 (nondiagnostic-excellent). Findings were compared to the results of the pathohistological examination. RESULTS: Sensitivity, specificity and diagnostic accuracy were highest for T2-TSE sequences (100%, 79% and 86%, respectively). Contrast-enhanced T1-SE sequences with fat-suppression (71%, 79%, and 76%) showed no improvement compared to T2-TSE. Unenhanced fat-suppressed T1-SE (100%, 30%, and 56%) and unenhanced T1-SE (100%, 7%, and 38%) as well as contrast-enhanced T1-SE (86%, 20%, and 47%) were significantly worse than T2-TSE. With similar image quality (p < 0.05) diagnostic confidence was higher on T2-TSE than on any of the other sequences (p < 0.001). CONCLUSION: Considering the cost-effectiveness of the examination, for the MR diagnosis of parametrial invasion the use of fat-suppressed contrast-enhanced sequences can be abandoned in favour of T2-weighted TSE sequences.

Zielsetzung: Die Abklarung vaskularer Komplikationen durch die DSA bei Nieren- und Pankreastransplantationen erfordert einen invasiven Eingriff in meist diabetisch vorgeschadigte Gefase, und die Verwendung jodhaltiger Kontrastmittel kann nephrotoxische Wirkungen zeigen. Es wurde die Wertigkeit der kontrastverstarkten MR-Angiographie in dieser Patientengruppe uberpruft. Patienten und Methodik: Es wurden 11 Untersuchungen bei 8 Patienten nach Nieren- und Pankreastransplantation mit einer kontrastverstarkten T1-gewichteten 3D-Gradientenechosequenz mit ultrakurzen Echozeiten durchgefuhrt. Es wurde eine dynamische Untersuchung mit 3 aufeinanderfolgenden Messungen nach Gd-DTPA (Magnevist®)-Injektion durchgefuhrt. Die Ergebnisse wurden bei allen Patienten mit dem intraoperativen Befund und bei 3 Patienten mit der DSA verglichen. Ergebnisse: Die distale Aorta abdominalis, die Aa. iliacae sowie die Hauptstamme der transplantierten Gefase und ihre Aste nach der ersten Aufzweigung konnten kontrastreich dargestellt werden. Die Parenchymperfusion konnte bei allen transplantierten Organen gut beurteilt werden. Die Ergebnisse der MRA korrelierten gut mit dem intraoperativen Befund und mit der DSA. Eine Darstellung der grosen venosen transplantierten Gefase gelang bei 4 Patienten. Schlusfolgerungen: Die ersten Erfahrungen mit der verwendeten MRA-Sequenz zeigen, das diese Technik ein nichtinvasives Verfahren zur Beurteilung der grosen arteriellen Transplantatgefase und zur Beurteilung der Perfusion von Pankreas- und Nierenparenchym sein kann. Verbesserungen der MRA-Technik sind zur zuverlassigen Darstellung der venosen Gefase der transplantierten Organe notwendig. Zur Uberprufung der Wertigkeit der MRA bezuglich Stenosen der Transplantatgefase sind grosere Vergleichsstudien notwendig.

Purpose To determine the diagnostic value of high resolution MR imaging with a circularly polarised (c.p.) body phased-array coil for the staging of pelvic lymph nodes in cervical carcinoma. Material and methods 42 patients with histologically proven carcinoma of the cervix were studied on a 1.5 T scanner by using a c.p. body phased-array coil. The imaging protocol included T2-weighted turbo-spin-echo (TSE) and T1-weighted spin-echo sequences pre and post i.v. application of Gd-DTPA; slice thickness was 5-7 mm and pixel size 0.53 mm2. Lymph nodes with a diameter of > or = 8 mm were considered to have metastatic involvement. MR imaging results were compared with histopathologic findings. Results MR imaging showed enlarged lymph nodes (> or = 8 mm) in 16 of 18 patients with histologic proof of lymph node metastases (sensitivity 89%). In 22 of 24 cases MR findings were true negative (specificity 92%). Diagnostic accuracy was 91%. Conclusion High-resolution MR imaging with a c.p. body phased-array coil provides high sensitivity, specificity, and diagnostic accuracy for pelvic lymph node staging in cervical carcinoma.

RATIONALE AND OBJECTIVES The authors compare the value of a new circularly polarized body array coil (BAC) system with a standard body coil (BC) for high-resolution magnetic resonance imaging of the female pelvis. METHODS Twenty patients with cervical cancer were examined with a BC and BAC. Imaging parameters were kept constant (sagittal T2-weighted turbo spin-echo: repetition time = 4000 mseconds; effective echo time = 99 mseconds; 160 x 160 mm field of view; 256 x 256 matrix; 0.63 x 0.63 mm pixel size; 4-mm slice thickness). Images were scored for lesion-to-organ delineation and overall image quality/ artifacts using a scale from 5 to 1 (excellent to poor). Signal-to-noise (S/N) ratios for different tissues (tumor, uterus, vagina, rectum, muscle, and fat) as well as contrast-to-noise (C/N) ratios between tumor and (1) uterus, (2) vagina, and (3) rectum were calculated. Magnetic resonance tumor staging was performed according to the International Federation of Gynecology and Obstetrics (FIGO) classification. RESULTS Using the BAC, S/N and C/N ratios increased significantly compared with the BC (S/N: 2.7-3.4-fold increase for all organs evaluated, P < 0.001: C/N: tumor versus uterus 2.4-fold, P < 0.01; tumor versus vagina 6.1-fold, P < 0.001; tumor versus rectum 3.1-fold, P < 0.01). This resulted in an improved overall image quality (average ratings: BAC-4.3 points; BC-2.6 points; P < 0.001). Lesion-to-organ delineation (average ratings: BAC 4.3-4.1 points, BC 3.5-2.7 points for all organs evaluated; P < 0.001) was increased noticeably on BAC images. No significant difference was found for staging accuracy. CONCLUSIONS Circularly polarized BAC provide superior S/N and C/N ratios and improve lesion conspicuity compared with standard BC.

PURPOSE To assess whether the hepatic density on CT scans of patients receiving amiodarone therapy differs significantly from the hepatic density of a control group not receiving the drug. METHODS Hepatic density was assessed by CT in 31 patients receiving amiodarone, 7 receiving short-term (12-14 days), 8 receiving mid-term (20-89 days) and 16 receiving long-term therapy (3-26 months), as well as in a control group of 15 patients. RESULTS Mean liver density of all patients under amiodarone therapy (77.9 +/- 11.7 HU) was significantly higher (p < 0.005) than in the control group (56.6 +/- 2.8 HU). The smallest increase in density was found in patients with short-term therapy (64.8 +/- 3.4 HU; p < 0.05), the greatest increase in patients with long-term therapy (85.0 +/- 8.9 HU; p < 0.001). CONCLUSION In patients receiving amiodarone therapy, a significantly increased hepatic density on CT scans is observed. This finding has to be considered as a differential diagnosis to other hepatopathies with increased density of the liver.

PURPOSE To assess the clinical value of MRI in patients with benign prostatic hyperplasia (BPH) before, during, and after interstitial laser-induced thermotherapy (LITT) of the prostate. METHODS Ten patients with symptomatic BPH had MRI examinations of the prostate 48 h before and after LITT. Online monitoring with MRI at 1.5 T of interstitial Nd:YAG laser energy deposition in the prostate was performed in two patients, repeating a T1-weighted FLASH sequence (TR 100 ms, TE 5 ms, flip angle 90 degrees) every 20 s. Follow-up MRI examinations 2-3 weeks, 6-8 weeks, and 6-12 months after LITT were carried out in eight patients, using T2-weighted FSE images and contrast-enhanced T1-weighted SE images. RESULTS The prostate was well delineated in all patients on T2-weighted FSE images, with a rather homogeneous peripheral gland and an inhomogeneous central gland. Volume measurements yielded reproducibilities of 3.2%-4.7%. Signal intensity in the FLASH sequence decreased during LITT, both in the prostate in vivo and in specimens of bovine prostate and seminal vesicles in vitro, with signal developments running in parallel. Areas of energy deposition and signal alteration were not sharply delineated. The latter margin of the laser-induced lesions could not be predicted from the FLASH images, while the tip of the laser fibre was easily recognized. Contrast-enhanced T1-weighted MR images immediately after LITT clearly demarcated low signal intensity laser lesions from high signal intensity surrounding prostate tissue. Follow-up examinations showed a decrease of 20% of prostate volume over a period of 6-12 months after LITT. Correlation between prostate volume development and lesion volume alteration was 0.85-0.90 (P = 0.002-0.007) at all follow-up times. CONCLUSIONS MRI allows rather precise recognition of intraprostatic alterations after LITT, including volume changes over a period of up to 1 year after therapy that can be predicted immediately after LITT. While laser energy deposition in the prostate can be monitored by MRI with T1-weighted FLASH sequences as a function of temperature alteration, it is not possible to determine the lesion margins immediately from the FLASH images. Online temperature development map generation will be necessary to influence on-going LITT procedures with MRI.

Purpose The capacity of dynamic contrast-enhanced MR mammography to distinguish between different forms and grades of mastopathy according to Prechtel's classification was evaluated in a retrospective study. Patients and methods MR mammograms of 51 patients with histologically proven mastopathy were retrospectively evaluated in areas subsequently biopsied. Results Mean values of regressive and hyperplastic types of mastopathy differed significantly no significant differences were found between proliferating and non-proliferating mastopathies or Prechtel grades I-III mastopathy when MRI data obtained with a FLASH 3 D sequence (TR = 8.4 ms, TE = 3 ms, flip angle = 30 degrees at 1.0 T) were compared one minute, three, 5 and 8 minutes after i.v. bolus administration of contrast media (Gd-DTPA, 0.1 mmol/kg body weight). Conclusion Our data indicate that dynamic contrast-enhanced MR mammography does not allow the differentiation of proliferating and non-proliferating mastopathy according to the Prechtel classification. Dynamic MR mammography assessment of breast cancer risk does not seem to be feasible.

Quantitative spirometrically controlled computed tomography (with 1-mm-thick sections) was performed twice (with a 5-minute break) in 24 adult patients with pulmonary disease to objectively evaluate parenchymal changes in the lung. Twelve measurements of attenuation were made on apical, carinal, and basal scans (right, left, total of each level, total right, total left, total of all three scans), obtained at 50% vital capacity. Since differences in measurements between the first and second examination were not significant, the method provides highly reproducible results.

PURPOSE We aimed both at improving image quality and diagnostic value of pancreatic MRI by using fast multislice imaging techniques and at demonstrating normal and pathologic signal enhancement in the pancreas after i.v. gadopentate-dimeglumine. METHODS MR imaging at was performed in 30 patients with suspicion of pancreatic neoplasm or chronic disease and in 15 patients without pancreatic abnormalities. RESULTS SNR, CNR, mean signal enhancement, and time/signal-intensity curves were calculated. Signal enhancement after i.v. Gd-DTPA averaged 34.4% in neoplasms (n = 14) vs 58.8% in pancreatic tissue not involved by tumour (p < 0.05) in T1-w SE and was also significant in the T1-w GE sequence (p < 0.005). CNR (pancreas vs lesion) and SNR improved significantly (p < 0.005; pancreas: p < 0.001; lesion: p < 0.05) after i.v. Gd-DTPA administration. In patients without pancreatic disease enhancement curves of pancreas demonstrate a rapid signal increase (79.0% after 34 s). Patients with adenocarcinoma or chronic pancreatitis demonstrated flattened signal intensity curves and higher peak signal intensity values (90.1, 111.3% after 68 s). The slope of signal increase of neoplastic tissue was significantly different (p < 0.01) from unaffected parenchyma (48.3% after 51 s, 90.1% after 68 s). CONCLUSION MR imaging with fast T2-w SE and T1-w SE sequences provides excellent visualisation of the pancreas and adequate conspicuity of pancreatic adenocarcinoma. Following i.v. Gd-DTPA significant enhancement of tumour/parenchyma contrast is found.

Markedly T2-weighted MR images of the pelvis can be obtained with TSE sequences using short acquisition times. In order to determine whether TSE sequences at 0.5 Tesla produce diagnostically valuable images, 9 normals and 53 patients with suspected gynaecological tumours were examined with TSE and SE sequences. Visual comparison showed a considerable superiority of the TSE sequences in most respects. The quality of the TSE images was regarded as very good in 82% and good in 18% (SE sequences: 27% very good, 55% good, 18% moderate), delineation of anatomical structures 81% very good and 19% good (SE sequence: 31% very good, 53% good, 16% moderate). TSE sequences were also superior in the detection of pathological changes (87% very good, 13% good) compared with SE sequences (56% very good, 37% good, 7% moderate). Venous plexuses in the parametrium were better demonstrated by SE sequences. There were significantly higher signal to noise ratios (SNR) with TSE sequences for fat, bone marrow (each p < 0.001), and urine (p < 0.05). Using muscle as reference tissue, there were significantly higher signal-difference to noise ratios (SDR) for fat (p < 0.001), and bone marrow (p < 0.0001), the other pelvic organs and tumours showed no significant differences between the SNR and SDR. TSE sequences are well suited to replace SE sequences in the MR diagnosis of gynaecological tumours.

Fat-suppressed STIR (short TI inversion recovery) sequences were compared to plain and contrast-enhanced T1-weighted SE sequences of head and neck tumors. 19 patients underwent MR imaging on a 0.5 Telsa system (T5-II, Philips). STIR imaging parameters: TR/TE = 1000/20 ms, inversion pulse 100 ms. All films were read by four radiologists. The image quality was graded: score from 0 to 5, by means that grade 5 = optimal quality. Sensitivity was 89% in STIR, 96% in SE sequences. Tumor delineation was graded good in the enhanced T1-weighted and enhanced fat suppression images. The unenhanced imaging was superior in STIR (STIR/T1 = 2.8/2.43). The tumor contrast was best in contrast enhanced and plain STIR sequences (STIR contrast = 3.41), and in the contrast enhanced T1-weighted SE (3.33). STIR almost equaled T1 post-contrast in respect of tumour conspicuity, but the sensitivity was lower. STIR can be a supplement to SE, but cannot substitute T1 postcontrast. The combined use is expected to have the highest assessment value.