Contrast on T2-weighted images of the lumbar spine using fast spin-echo and gated conventional spin-echo sequences

Basic principles of magnetic resonance imaging

We have come full circle from spinning quarks to 3D medical images. The bulk of MRI is now performed using slice-selective gradients, during which RF energy is applied to excite the hydrogen nuclei. By stepping a phase-encoding gradient during each TR and using a frequency-encoding gradient as the data are sampled, the 3D human object can be reduced to many individual points or voxels. By acquiring multiple slices at once, the time efficiency of imaging can be vastly improved. Many newer strategies use variations of this technique to acquire multiple lines of data during a single echo, enshrining spin warp imaging as the most important method of signal acquisition for MRI.

Post-operative lumbar spine: comparative study of TSE T2 and turbo-FLAIR sequences vs contrast-enhanced SE T1

AIM

To compare turbo T2 weighted spin echo (TSE T2) and turbo-FLAIR (fluid attenuated inversion recovery) vs gadolinium enhanced T1 weighted spin echo (SE T1) sequence in the differential diagnosis between disc herniation and post-surgical fibrosis.

MATERIALS AND METHODS

Sixty-four patients who underwent surgical treatment for lumbar disc herniation with persistent or recurrent post-surgical symptoms were studied with a 0.5 Tesla MR system. The sequences used were TSE T2, turbo-FLAIR and T1 SE with and without intravenous gadolinium DTPA. The enhanced T1 SE sequence was considered the gold standard. Sensitivity and specificity were calculated.

RESULTS

The sensitivity was 100% for both TSE T2 and turbo-FLAIR sequences. The specificity was 94% for TSE T2 and 92% for turbo-FLAIR. Negative predictive value was 100% for both sequences and positive predictive value 84% and 80% for TSE T2 and turbo-FLAIR, respectively.

CONCLUSION

Although both sequences show high sensitivity, TSE-T2 presents greater specificity than turbo-FLAIR as compared to enhanced T1 SE. TSE T2 also offers the advantage of myelographic effect. We consider that the use of rapid sequences may avoid the need for intravenous contrast medium in most cases, reserving gadolinium DTPA only to those where all the criteria for hernia or fibrosis are not fulfilled.

A review of MRI pulse sequences and techniques in neuroimaging

BACKGROUND

The unmatched soft tissue contrast provided by magnetic resonance imaging (MRI) has made it the modality of choice for many neuroimaging examinations. The fact that signal intensity in MRI depends on many parameters, including spin-lattice and spin-spin relaxation times, proton density, and velocity, makes it possible to highlight various pathologies by appropriate choice of pulse sequences and pulse sequence parameters. It is somewhat overwhelming however, to filter through various pulse sequences and parameters in order to understand how their selection affects image contrast. This brief review is intended to highlight common pulse sequences and parameters as well as introduce new techniques currently being released for clinical use.

MATERIALS

Basic pulse sequences are described and the influence of the acquisition parameters on image contrast are illustrated. Such basic sequences include the ubiquitous spin echo, fast spin echo, and gradient echo sequences. Specialized techniques for fat suppression and magnetic resonance angiography are also presented. Currently approved contrast agents for use in MRI are briefly reviewed, and various advanced pulse sequences, such as those for diffusion and magnetization transfer contrast imaging, are briefly outlined.

RESULTS

The utility of basic and advanced pulse sequences are demonstrated by clinical examples and images of normal brain and spine. New sequences and techniques are briefly outlined with regard to their potential for improving neuroimaging examinations.

CONCLUSIONS

This brief review outlines how the choice of pulse sequence and acquisition parameters influences the resulting image contrast for a variety of basic and advanced imaging techniques.