MRI

A 14-year-old female patient presented for evaluation of a right foot mass. She stated that she was generally asymptomatic but would occasionally experience significant discomfort if she bumped her foot. Physical examination revealed fullness to the lateral aspect of the foot, which was concerning for bony expansion of the fifth metatarsal. No point tenderness, overlying skin lesions, or neurological deficits within the foot were noted. Multiple imaging modalities were carried out for further evaluation.

Breast MRI has been available for over a decade. It is only now, however, that the examination is becoming recognized as an indispensable adjunct to mammography and ultrasound. Several key factors contribute to this acceptance of clinical breast MRI.

The 0.6T Fonar Upright MRI is not in the same class as 3T scanners, but it features capabilities superconducting technologies can't match. High-field imaging is performed with the patient relaxed in a supine position. Upright imaging is conducted while the patient sits, stands, or flexes in a weight-bearing position to duplicate the conditions that cause his or her pain.

Radiologists who wonder why diagnostic imaging has been targeted for utilization constraints need only examine the Medicare B experience from 2000 to 2005. Medicare payments for outpatient medical imaging rose 93% during that period from $6 billion to more than $11 billion. The increase reflected a shift in preference to high-cost, high-tech modalities, especially CT and MR. Utilization among cardiologists exploded.

Vantage Titan, a wide-bore 1.5T scanner, highlights MR offerings from Toshiba America Medical Systems at the RSNA meeting this week. The work-in-progress features a bore 18% wider than any 1.5T scanner currently on the market, according to the company. A specially designed gradient system offers an amplitude of 30 and a slew rate of 130 to expand the field-of-view.

Inspired by vertebroplasty's success, Greek researchers have shown that percutaneous cement injections can also successfully stabilize arthritic and neoplastic lesions affecting the femoral head. The technique offers pain relief and an alternative to surgery in selected patients.

The latest evolution of GE Healthcare's Signa HD x (high definition x) platform offers MR pulse sequences that overcome barriers to diagnostic scans in some difficult-to-image patients. The xt version, shown at the RSNA meeting, features two major innovations: 3D Cube and Ideal.

In a surprising discovery, researchers from Germany have found that whole-body staging of patients with recently diagnosed malignant melanoma using either MRI or PET/CT could miss a substantial number of metastatic lesions.

Confirma is showing at the RSNA meeting its breast MR coil enhanced with interventional components. Launched at RSNA 2006 as a purely diagnostic device, the Access Breast Coil is now outfitted with a grid plate and stabilization plate, a configuration cleared in July by the FDA. The four-channel phased-array coil was also modified to improve patient comfort, reduce weight, and increase physician access to the patient. The version slated for the RSNA exhibit floor is certified for use on Siemens Avanto, Espree, and Symphony MR scanners.

Providers can eliminate the use of gadolinium-based contrast by using new pulse sequences from Toshiba America Medical Systems. The angiography techniques rely on differences in the MR signal that distinguish blood and surrounding soft tissue.

An analysis of imaging data suggests that PET/CT should be the modality of choice for directing cervical cancer patients to appropriate therapy.

Paramed Medical Systems showcased an upgrade to its U-shaped open system MR scanner. The 0.6T midfield system, MR-Open, now features a large field-of-view and a closed cooling system for the superconducting magnet.

Injections of corticosteroids and anesthetics guided by CT or MR imaging offer a reliable therapeutic option for the treatment of chronic lower back pain from sacroiliac joint lesions, according to researchers from Germany and the U.S.

Providers can eliminate the use of gadolinium-based contrast by using new pulse sequences from Toshiba America Medical Systems. The angiography techniques rely on differences in the MR signal that distinguish blood and surrounding soft tissue.

MRI has outrun other modalities in a screening trial involving high-risk women. Such research helps justify an estimated $1.4 billion a year in direct costs for the U.S. if new American Cancer Society guidelines are followed.

In a surprising discovery, researchers from Germany have found that whole-body staging of patients with recently diagnosed malignant melanoma using either MRI or PET/CT could miss a substantial number of metastatic lesions.

MR arthrography and ultrasound bring different strengths to imaging and management of joint injuries and stresses, according to research presented at the RSNA meeting. Contrast-enhanced ultrasound is a superior method of assessing neovascularity in patients with lateral epicondylitis, while MR can detect signs of recurrent carpal tunnel syndrome after surgery. A combination of MRI and ultrasound may be the most effective solution for imaging medial elbow pain.

Researchers are calling for both legislation and public awareness to curb the magnitude and severity of injuries to children from accidents on all-terrain vehicles after compiling the largest series of imaging findings in children suffering ATV injuries.

Hitachi Medical Systems formally launched its 1.2T vertical field open MR scanner at the RSNA meeting. Oasis, shown as a work-in-progress at last year’s meeting, cleared the FDA in September.

Magnetic resonance arthrography (MRA) and ultrasound bring different strengths to imaging and treating joint injuries and stresses, according to research presented at the RSNA meeting. Contrast-enhanced ultrasound is a superior method of assessing of neovascularity in patients with lateral epicondylitis, while MR can detect signs of recurrent carpal tunnel syndrome after surgery. A combination of MRI and ultrasound may be the most effective solution for imaging medial elbow pain.

Esaote introduced S-SCAN, a dedicated joint and spine MR scanner derived from the company’s earlier released G-SCAN system. It includes improved electronics, new coils for lumbar and cervical spine, new pulse sequences, and a modified magnet.

Fonar featured a new scoliosis application for its Upright MR scanner. New software and a receiver coil produce coronal, sagittal, and axial views of the entire spine.

A wide-bore 3T scanner small enough to fit in the same footprint as a 1.5T system debuted at Siemens RSNA booth. At 170 cm, Verio is the shortest 3T on the market, according to the company, but the 70-cm bore diameter may be of greater interest to prospective buyers.

HIV-positive patients could benefit from the ability of MR diffusion tensor imaging to reveal microscopic changes in their spinal cords before abnormalities show up on conventional MR imaging. The early warning could identify those who would benefit from antiretroviral therapy.

Diffusion-weighted MR imaging could one day become a routine exam for noninvasive characterization and staging of uterine tumors, replacing unnecessary catheter or surgical biopsies, according to several studies released Sunday at the RSNA meeting.

Public policymakers have long sought valid scientific evidence linking lung disease and secondhand smoke. Their wait ended Monday at the 2007 RSNA meeting, when Chengbo Wang, Ph.D., announced clinical trial results using hyperpolarized helium-3 diffusion MRI to make the connection.

The massive American College of Radiology Imaging Network 6666 trial shows that adding ultrasound to the initial screening protocol for high-risk women could help detect 30% more cancers. The cost, however, could be many more needless biopsies of benign lesions.

In a novel approach to cervical spine trauma, researchers have found that changes in diffusion tensor imaging parameters are most marked at the spinal cord injury site and also reflect the severity of cord injury.

New CT perfusion scanning techniques that are safer and faster than older CT protocols could offer a practical imaging alternative to MR perfusion for stroke patients, according to two studies presented at the 2007 RSNA meeting. Findings also emphasize a new trend for widening the window for thrombolysis.

Executives at Siemens Medical Solutions are out to give competitors, including those selling reburbished MRs, a run for their money. Listing below $1 million, the company’s new Essenza MR scanner is the most affordable 1.5T system in the industry.