M.F. Reiser · W. Semmler · H. Hricak (Eds.) Magnetic Resonance Tomography M.F. Reiser · W. Semmler · H. Hricak (Eds.) Magnetic Resonance Tomography With 1260 Figures and 175 Tables 123 Maximilian F. Reiser, Univ.-Prof. Dr. med. Dr. h.c. Institute for Clinical Radiology University Hospitals Grosshadern Ludwig-Maximilian University of Munich Marchioninistr. 15 81377 Munich Germany Wolfhard Semmler, Univ.-Prof. Dr. rer. nat. Dr. med. Division of Medical Physics in Radiology German Cancer Research Center Im Neuenheimer Feld 280 69120 Heidelberg Germany Hedvig Hricak, MD, PhD, Dr. h. c. Professor of Diagnostic Radiology and Chairman Department of Radiology Memorial Sloan-Kettering Cancer Center 1275 York Ave. New York, NY 10065 USA Parts of this book have been translated from the German original: M. Reiser, W. Semmler (eds) Magnetresonanztomographie 3rd ed. Springer 2002 ISBN 978-3-540-29354-5 e-ISBN 978-3-540- 29355-2 DOI 10.1007/b135693 Library of Congress Control Number: 2007933311 © 2008 Springer-Verlag Berlin Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi- cally the rights of translation, reprinting, reuse of illustrations, recitation, broad-casting, reproduction on microfilm or any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provi- sions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registed names, trademarks etc. in this publication does not imply, even in the ab- sence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: the publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Frido Steinen-Broo, eStudio Calamar, Spain Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com Preface This textbook—which describes the entirety of MRI in a agreed to come on board as an editor from an English- single volume—is now a more than fifteen-year-old tra- speaking country. Dr. Hricak introduced new ideas and dition. First published in German in 1992, it was updated topics, recruited additional authors who are experts in every five years to keep up with the rapid advancement their fields of study, and with her enthusiasm and persis- of the technology and clinical applications of MR tomog- tence substantially enriched and advanced this project. raphy. Because it covered its subject in great breadth and We are now extremely pleased to be able to present detail, it became one of the most popular textbooks on this English-language volume covering all aspects of MR MR tomography in German-speaking parts of the world. imaging. We hope that this book, like the German edi- Each subsequent edition not only summarized well-es- tions preceding it, will become a daily companion and tablished facts about MR tomography for practical ap- adviser to medical students, practicing radiologists and plication, but also discussed new procedures and insights other physicians, and that it will give them an even stron- acquired during the years since the previous edition. The ger sense of the vast potential of MR imaging as it is be- present, 4th edition maintains this tradition—only it does ing developed around the world. so in the English language. We want to take this opportunity to thank the authors, Today, experts in science and medicine are distributed who generously contributed their knowledge and insights throughout the world, and English is gaining acceptance to this book. Special thanks go to Ms. Ada Muellner for as the “lingua franca” of these fields. The idea of publish- her language editing. Finally, we are grateful to Springer ing the book in English was discussed multiple times Publishing—and particularly Dr. Ute Heilmann and Ms. over the years and was actively supported by Springer as Wilma McHugh—for supporting this project. represented by Dr. Ute Heilmann. Our goal was not sim- ply to produce an English translation of a German book, Maximilian F. Reiser but to produce a volume geared to the interests of an in- Wolfhard Semmler ternational community. We could not have reached this Hedvig Hricak goal without the collaboration of Dr. Hedvig Hricak, who Contents 1 Introduction ........................................................... 1 2 Basics of Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy ................................ 3 2.1 Overview ............................................................... 5 2.2 Physical Basics ......................................................... 8 G. Brix 2.2.1 Nuclear Spin and Magnetic Moment ...................................... 8 2.2.2 Nucleus in a Magnetic Field .............................................. 9 2.2.3 Macroscopic Magnetization .............................................. 11 2.2.4 Dynamic of Magnetization I: Resonance Excitation ........................ 12 2.2.5 Dynamic of Magnetization II: Relaxation .................................. 13 2.2.6 The MR Experiment ..................................................... 18 2.2.7 Standard Pulse Sequences ................................................ 19 2.2.8 Influence of the Electron Shell on the Local Magnetic Field ................. 22 References .............................................................. 25 Suggested Reading ...................................................... 25 2.3 Image Reconstruction ................................................... 26 G. Brix 2.3.1 Magnetic Gradient Fields ................................................ 26 2.3.2 Slice-Selective Excitation ................................................. 27 2.3.3 Principle of Spatial Encoding within a Partial Volume: Projections .......... 28 2.3.4 Methods of Image Reconstruction in MRI ................................. 30 2.3.5 Multiple-Slice Technique ................................................ 34 Suggested Reading ...................................................... 35 2.4 Image Contrasts and Imaging Sequences ................................. 36 G. Brix, H. Kolem, and W.R. Nitz 2.4.1 Image Contrasts ......................................................... 36 2.4.2 Classical Imaging Sequences ............................................. 37 2.4.3 Gradient-Echo Techniques ............................................... 44 2.4.4 Modification of k-Space Sampling ........................................ 53 2.4.5 Preparation Techniques .................................................. 56 2.4.6 Sequence Families ....................................................... 57 References .............................................................. 74 Suggested Reading ...................................................... 75 2.5 Technical Components .................................................. 76 M. Bock 2.5.1 Magnet ................................................................. 76 2.5.2 Gradients ............................................................... 83 VIII Contents 2.5.3 Shim ................................................................. 84 2.5.4 Radiofrequency System ................................................. 85 2.5.5 Computer System ...................................................... 87 2.5.6 Patient Monitoring ..................................................... 88 2.5.7 Summary .............................................................. 90 References ............................................................. 91 2.6 Contrast Agents ....................................................... 92 A. Huppertz and C.J. Zech 2.6.1 Physicochemical Properties of MR Contrast Agents ....................... 92 2.6.2 Dependency of Contrast Agents from the Magnetic Field Strength ......... 94 2.6.3 Safety of MR Contrast Agents ........................................... 95 2.6.4 Value of Contrast Agents in Clinical Practice ............................. 97 References ............................................................. 108 2.7 Flow Phenomena and MR Angiographic Techniques ..................... 114 M. Bock 2.7.1 Introduction ........................................................... 114 2.7.2 MR Properties of Blood ................................................. 114 2.7.3 Time-of-Flight MRA ................................................... 114 2.7.4 Arterial Spin Labeling .................................................. 117 2.7.5 Native-Blood Contrast .................................................. 118 2.7.6 Black-Blood MRA ...................................................... 118 2.7.7 Velocity-Dependent Phase .............................................. 120 2.7.8 Contrast-Enhanced MRA ............................................... 121 2.7.9 Summary .............................................................. 127 References ............................................................. 128 2.8 Diffusion-Weighted Imaging and Diffusion Tensor Imaging .............. 130 O. Dietrich 2.8.1 Introduction ........................................................... 130 2.8.2 Physics of Diffusion .................................................... 130 2.8.3 MR Measurement of Diffusion-Weighted Images ......................... 136 2.8.4 MR Measurement of Diffusion Tensor Data .............................. 141 2.8.5 Visualization of Diffusion Tensor Data ................................... 145 References ............................................................. 149 2.9 Risks and Safety Issues Related to MR Examinations ..................... 153 G. Brix 2.9.1 Safety Regulations and Operating Modes ................................ 153 2.9.2 Static Magnetic Fields .................................................. 153 2.9.3 Time-Varying Magnetic Gradient Fields ................................. 156 2.9.4 Radiofrequency Electromagnetic Fields .................................. 161 2.9.5 Special Safety Issues, Contraindications .................................. 164 References ............................................................. 165 3 Brain, Head, and Neck ................................................. 169 3.1 Brain: Modern Techniques and Anatomy ................................ 172 M. Wintermark, M.D. Wirt, P. Mukherjee, G. Zaharchuk, E. Barbier, and W.P. Dillon 3.1.1 Introduction ........................................................... 172 3.1.2 Diffusion-Weighted Imaging ............................................ 173 3.1.3 Diffusion Tensor Imaging ............................................... 175 Contents IX 3.1.4 Dynamic Susceptibility Contrast Imaging ................................ 178 3.1.5 Arterial Spin Labeling .................................................. 179 3.1.6 Spectroscopy .......................................................... 183 References ............................................................. 189 3.2 Normal Development, Congenital, Hereditary, and Acquired Diseases of the Central Nervous System in Pediatrics ....... 193 B.B. Ertl-Wagner and C. Rummeny 3.2.1 Introduction ........................................................... 193 3.2.2 Examination Technique ................................................. 193 3.2.3 Normal Development of the Brain ....................................... 194 3.2.4 Congenital Disorders of the Brain ....................................... 197 3.2.5 Phakomatoses ......................................................... 216 3.2.6 Hypoxic–Ischemic Injuries to the Pediatric Brain ......................... 226 3.2.7 Metabolic Diseases of the Pediatric Brain ................................. 231 References ............................................................. 241 3.3 Intracranial Tumors ................................................... 243 M. Essig 3.3.1 Introduction ........................................................... 243 3.3.2 The WHO Classification of Brain Tumors ................................ 243 3.3.3 Practical Aspects of MR Imaging in Brain Tumors ........................ 244 3.3.4 Blood–Brain Barrier and Tumor Enhancement: Mechanisms and Applications ........................................... 245 3.3.5 Intra-Axial Cerebral Tumors ............................................ 248 3.3.6 Extra-Axial Cerebral Tumors ............................................ 273 3.3.7 Non-Tumorous Changes ................................................ 288 3.3.8 Functional Imaging in Intracranial Tumors ............................... 290 References ............................................................. 302 3.4 Cerebrovascular Disease ............................................... 310 D.C. Bergen, J.M. Fagnou, and R.J. Sevick 3.4.1 Introduction ........................................................... 310 3.4.2 MR Technique ......................................................... 310 3.4.3 Acute Ischemic Stroke .................................................. 311 3.4.4 Intracerebral Hemorrhage .............................................. 327 3.4.5 Intracerebral Hemorrhage Etiology ...................................... 334 References ............................................................. 344 3.5 Intracranial Infections ................................................. 348 E. Turgut Tali and Serap Gültekin 3.5.1 Meningitis ............................................................. 348 3.5.2 Empyema ............................................................. 355 3.5.3 Cerebritis and Abscess .................................................. 357 3.5.4 Encephalitis ........................................................... 373 References ............................................................. 378 3.6 Neurodegenerative Disorders ........................................... 381 S. Karimi and A.I. Holodny 3.6.1 Introduction ........................................................... 381 3.6.2 Dementia .............................................................. 381 3.6.3 Disorders with Prominent Motor Disability .............................. 387 3.6.4 Hydrocephalus ......................................................... 389 3.6.5 Mesial Temporal Sclerosis ............................................... 395 References ............................................................. 396 X Contents 3.7 Pituitary Gland and Parasellar Region .................................. 399 M. Kanagaki, N. Sato, and Y. Miki 3.7.1 Introduction ........................................................... 399 3.7.2 Examination Techniques ................................................ 399 3.7.3 Normal Anatomy ...................................................... 400 3.7.4 Pathological Conditions ................................................ 404 References ............................................................. 429 3.8 The Orbits ............................................................. 433 N. Hosten, C. Zwicker, and M. Langer 3.8.1 Introduction ........................................................... 433 3.8.2 Examination Techniques ................................................ 433 3.8.3 Normal Anatomy ...................................................... 434 3.8.4 Pathological Lesions .................................................... 434 3.8.5 Differential Diagnosis .................................................. 442 3.8.6 Diagnostic Procedures .................................................. 442 References ............................................................. 444 3.9 Magnetic Resonance of the Skull Base and Petrous Bone ................. 445 R. Maroldi, D. Farina, A. Borghesi, E. Botturi, and C. Ambrosi 3.9.1 Introduction ........................................................... 445 3.9.2 Normal Anatomy ...................................................... 450 3.9.3 Lesions of the Skull Base ................................................ 454 3.9.4 Lesions of the Temporal Bone ........................................... 474 References ............................................................. 481 3.10 Head and Neck ........................................................ 483 H.E. Stambuk and N.J. Fischbein 3.10.1 Introduction ........................................................... 483 3.10.2 Mucosal Diseases of the Head and Neck .................................. 484 3.10.3 Non-Mucosal Diseases of the Head and Neck ............................ 509 Suggested Reading ..................................................... 533 4 Spine and Spinal Canal ................................................ 535 4.1 Extradural Diseases of the Spine ........................................ 536 C.S. Poon, J. Doumanian, G. Sze, M. Johnson, and C.E. Johnson 4.1.1 Introduction ........................................................... 536 4.1.2 Degenerative Spine Disease ............................................. 536 4.1.4 Extradural Spine Tumors ............................................... 562 4.1.5 Vertebral Column Trauma .............................................. 574 References ............................................................. 587 4.2 Intradural Extramedullary Spine ....................................... 590 D. Lin 4.2.1 Introduction .......................................................... 590 4.2.2 Examination Techniques ................................................ 590 4.2.3 Normal Anatomy ...................................................... 591 4.2.4 Pathological Findings ................................................... 592 4.2.5 Indications and Value of MRI ........................................... 613 Acknowledgement ..................................................... 614 References ............................................................. 614 Contents XI 4.3 Intramedullary Diseases of the Spinal Cord ............................. 617 P. Pawha, C. Shen, J. Doumanian, F. Lin, M. Johnson, R. Ashton, and G. Sze 4.3.1 MRI Techniques for Spinal Cord Imaging ................................ 617 4.3.2 Intramedullary Neoplasms .............................................. 618 4.3.3 Vascular Diseases of the Spinal Cord ..................................... 625 4.3.4 Demyelinating Disease ................................................. 640 4.3.5 Radiation Myelopathy .................................................. 647 4.3.6 Intramedullary Infectious and Inflammatory Diseases ..................... 649 4.3.7 Intramedullary Traumatic Injury ........................................ 653 References ............................................................. 659 5 Thorax and Vasculature ............................................... 663 5.1 Lungs, Pleura, and Mediastinum ........................................ 666 G. Layer and H.U. Kauczor 5.1.1 General Requirements for Imaging of Thoracic Organs .................... 666 5.1.2 Basic MR Sequences for Imaging of the Chest ............................ 666 5.1.3 MRI of Ventilation ..................................................... 670 5.1.4 Use of Contrast Agents ................................................. 671 5.1.5 Signal Intensities and Contrast Behavior ................................. 672 5.1.6 Normal Anatomy ...................................................... 672 5.1.7 Lung Diseases .......................................................... 674 5.1.8 Diseases of the Pleura .................................................. 688 5.1.9 Mediastinal Disease .................................................... 690 5.1.10 Differential Diagnosis .................................................. 693 5.1.11 Value of MRI with Regard to Other Imaging Modalities ................... 694 5.1.12 Diagnostic Procedure ................................................... 696 References ............................................................. 696 5.2 High-Risk Screening Breast MRI ....................................... 700 E.A. Morris 5.2.1 Importance of Early Detection .......................................... 700 5.2.2 Pathology of Breast Cancer: What Are We Looking for? ................... 701 5.2.3 Why Consider MRI? ................................................... 701 5.2.4 Defining the High-Risk Population ...................................... 701 5.2.5 Overview of High-Risk MRI Screening Studies ........................... 704 5.2.6 Description of High-Risk Screening MRI Studies ......................... 704 5.2.7 National Guidelines .................................................... 706 5.2.8 Current Issues with Using MRI for Screening ............................. 706 5.2.9 Increased Call-Backs and Biopsies ....................................... 707 5.2.10 Inconsistency of DCIS Detection ........................................ 707 5.2.11 MRI Interpretation .................................................... 707 5.2.12 MRI Technique ........................................................ 708 5.2.13 Research Needed ....................................................... 708 5.2.14 Summary .............................................................. 709 References ............................................................. 709 5.3 Heart ................................................................. 711 5.3.1 Acquisition Techniques and Protocols ................................... 711 B.J. Wintersperger References ............................................................. 717 5.3.2 Congenital Heart Disease: Cardiac Anomalies and Malformations .......... 718 T.R.C. Johnson References ............................................................. 732