Intraoperative MRI with the Magnetom Open provides considerable additional information to optimize resection during surgical treatment of supratentorial tumors, pituitary adenomas, and epilepsy. The twin operating theater is a true alternative to a dedicated MRI system. Additional efforts are necessary to improve patient transportation time and instrument guidance within the scanner.
The authors assessed the clinical utility of a magnetic resonance angiography technique in the evaluation of intracranial circulation. Eighteen patients with a low likelihood of cerebrovascular disease (control group) and 40 patients with suspected cerebrovascular disease were imaged with a FISP (fast imaging with steady precession) sequence (repetition time of 50 msec, echo time of 15 msec, velocity compensation in the read and section-select directions with acceleration compensation in the read direction, 15 degrees anisotropic volume, and a 1.25-mm partition thickness). Ninety-four percent of images in the control group and 72% of images in the group with cerebrovascular disease were considered useful for diagnosis. This technique can provide accurate images of intracranial circulation and can be performed in conjunction with two-dimensional spin-echo or gradient-echo imaging. It was most useful in the evaluation of patent intracranial aneurysms, vessel displacement, and large-vessel occlusive disease. Disadvantages included limited field of view, persistent signal voids, limited spatial resolution, and inadequate depiction of lesions with slow flow.
A new electrocardiograph (ECG)-independent, "wireless" gating technique for cine magnetic resonance (MR) imaging was evaluated in 23 cases of cardiovascular disease; in each case, standard ECG-dependent image loops were available for comparison. The ECG-independent strategy references cine MR imaging data retrospectively to inherent periodic changes in MR signal related to the cardiac cycle. With a "double-section" method, both timing data reflecting such changes and imaging data can be acquired simultaneously. "Artificial R waves" are extracted from the timing data acquired with a projection approach. The ECG-independent image loops were diagnostic in 91% of cases. Their overall image quality was at least equal to that of available ECG-dependent versions in only 39% of cases, but this proportion increased to 53% if cases with suboptimal imaging orientations for monitoring of the motion-dependent signal changes were excluded. Orientation appeared to be the primary technical limitation associated with this ECG-independent technique; however, poor ventricular function also significantly impaired performance. Improvement in the performance of the ECG-independent strategy is anticipated with technical advances.
Magnetic resonance (MR) angiography is a noninvasive method of obtaining images without contrast agents. Recent developments in sequence design have allowed images of moving spins to be obtained without a loss of signal by rephasing the spins with three or four gradient pulses to compensate for constant velocity or acceleration, respectively. At longer echo times (TE), this approach allowed for low readout gradients and high signal-to-noise ratios. Angiograms with a resolution of 300 micron were obtained. With additional sequences that allow some dephasing but minimal signal loss, separate images of arteries and veins were obtained. Phase information was used to estimate flow velocity. Application of the rephasing scheme to gradient-echo sequences allowed for ungated, fast MR angiograms. Acceleration correction was important for long TE sequences, but velocity-corrected, gradient-echo sequences with a very short TE were comparable to velocity- and acceleration-corrected, gradient-echo sequences with slightly longer TEs. With ungated three-dimensional, gradient-echo sequences, susceptibility artifacts were minimized and excellent contrast-to-noise ratios were obtained.
This work describes a newly developed magnetic resonance imaging (MRI) data-acquisition strategy which replaces the standard Fourier phase-encoding with the spatially localized coefficients of wavelet-encoding and offers a new technique for image guidance when combined with a dynamic tracking algorithm. By using this new technique, only a specific fraction of the entire raw data set needs to be updated and reconstructed to visualize the movement of an interventional device during an MR guided procedure. The combination of wavelet-encoding and a dynamic tracking algorithm was implemented in two-dimensional and three-dimensional gradient-echo sequences on a 0.2-T open C-arm-shaped MR system (Siemens, Erlangen Germany) and tested in phantom and in vitro experiments. When applying the wavelet-encoding direction parallel to the movement of a straight interventional device, only those spatially localized wavelet-coefficients mainly affected by the interventional device are updated. This led to potential increases of the image frame rate by a factor of up to seven.
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