Essentials of body MRI

414 Pages·2012·19.29 MB·English

by  William E. Brant

ESSENTIAL S OF B ODY MRI
This page intentionally left blank
ESSENTIALS OF BODY MRI
William E. Brant, MD, FACR Eduard E. de Lange, MD
PROFESSOR OF RADIOLOGY PROFESSOR OF RADIOLOGY
DIRECTOR, THORACOABDOMINAL IMAGING DIVISION DIRECTOR, BODY MRI
DEPARTMENT OF RADIOLOGY AND MEDICAL IMAGING DEPARTMENT OF RADIOLOGY AND MEDICAL IMAGING
UNIVERSITY OF VIRGINIA UNIVERSITY OF VIRGINIA
CHARLOTTESVILLE, VIRGINIA CHARLOTTESVILLE, VIRGINIA
1
1

Oxford University Press, Inc., publishes works that further
Oxford University’s objective of excellence
in research, scholarship, and education.
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offi ces in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland Th ailand Turkey Ukraine Vietnam
Copyright © 2012 by Oxford University Press, Inc.
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
www.oup.com
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Essentials of body MRI / [edited by] William E. Brant, Eduard E. de Lange.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-19-973849-6
I. Brant, William E. II. De Lange, Eduard E.
[DNLM: 1. Magnetic Resonance Imaging. WN 185]
616.07548—dc23
2011039714

Th is material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the
conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to off er
accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge
about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side
eff ects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures
with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of
conduct and safety regulation. Th e publisher and the authors make no representations or warranties to readers, express or implied, as to
the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or
warranties as to the accuracy or effi cacy of the drug dosages mentioned in the material. Th e authors and the publisher do not accept, and
expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or
application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed in China
on acid-free paper
We dedicate this book in memory of our fr iend, mentor and colleague,
Dr. Th eodore E. Keats, who served as Professor of Radiology for 47 years
at the University of Virginia Health Sciences Center, and was the department’s
chairman for 29 years. He was a visionary and pioneer in promoting new
imaging technologies, including MRI, and a great inspiration to all who
worked with him and observed his exemplary dedication to teaching. Th is text
can be viewed, in part, as a refl ection of Dr. Keats’s inspiration for the
mission of teaching radiology.
William E. Brant, MD
Eduard E. de Lange, MD
This page intentionally left blank
To my daughter, Rachel, who brings tremendous joy, graciousness, strength, and humor
to our lives, and to my wife, Barbara, whose patience and support grants me many
hours working at my desk.
W.E.B.
To Cesca, Mabet, and Sacha
E.E.d.L.
This page intentionally left blank
PREFACE
M agnetic resonance imaging (MRI) has fi nally found its place topics to a level that is easily understandable to the neophyte
as an invaluable diagnostic tool for the primary diagnosis and as well as to the practicing radiologist who has limited experi-
problem solving of diseases of the body, including the abdo- ence in this area. In the nine other chapters the clinical appli-
men, pelvis, heart, and great vessels. Reasons for the slow cations of body MRI are discussed with respect to the
implementation of the modality for routine use in body imag- appearance of normal anatomic structures; the diagnosis of
ing was that the acquisition of data was relatively slow making diseases of the abdomen, pelvis, heart, and great vessels; and
it diffi cult for the patients to undergo the examination, and the role of the modality in solving diagnostic problems. We
images were oft en nondiagnostic because of artifacts from tried to keep the discussions short and concise while allowing
breathing, the moving bowel, and the beating heart. Th e con- for a maximum number of fi gures to illustrate each subject.
tinuing improvement of the MR scanner hardware and the To facilitate the learning process, the key points of each
development of fast pulse sequences that allow acquisition of topic are emphasized as “Essentials to Remember,” highlighted
high-quality, motion-artifact-free images within a breath hold in separate, boxed sections throughout the text. We feel that
have made the modality as important a tool for imaging the these “Essentials” will greatly aid the reader in comprehending
body as it has been for imaging the brain and musculoskeletal the material and understanding the important points. Th is
system. Many radiology residency training programs now have text refl ects the practice of body MRI at the University of
dedicated rotations devoted entirely to body MRI. Th is cre- Virginia. All authors are, or have been, associated with our
ates the need for a text that introduces the resident, fellow, or institution. Th e format of the chapters and the discussed topics
medical student to the intricacies of the modality and allows are based on years of teaching our residents, fellows, and med-
for a quick understanding of the essential points in this diffi - ical students in body MRI.
cult fi eld. W e express our thanks to our associate authors for contrib-
To fully understand body MRI and comprehend the work- uting to this venture, to the residents and fellows for their sug-
ings of specifi c pulse sequences that allow for rapid acquisition gestions and criticisms, and to the MR technologists who
of high-quality, motion-artifact-free images within a breath performed the many clinical studies that provided the fi gures
hold, an understanding of MR physics is essential. Although for this book. We further want to thank James R. Brookeman,
there are many available texts and reviews describing MR Ph.D., for his critical review of the text on MR physics; Brian
physics, these are oft en written at a level of complexity that T. Burkholder, R.T.R. (MR), for obtaining the images on the
escapes the beginning student radiologist. Further, most texts normal volunteers; Sherry S. Deane and Shirley M. Naylor for
provide broad coverage of the fi eld but do not primarily focus their administrative work; and Andrea Seils, Senior Editor,
on the specifi c issues related to body MRI. We felt, therefore, and Staci Hou, Assistant Editor, of Oxford University Press
that a description of the physics, pulse sequences, and other USA for their encouragement, support, and, most impor-
practical considerations specifi cally related to body MRI is tantly, tolerance as we worked on this book.
necessary to help the reader fully understand the imaging
appearance of clinical disease. Th is text is provided in the fi rst William E. Brant, MD, FACR
two chapters. When writing these, we strove to simplify the Eduard E. de Lange, MD
ix