Clinical Cases
The "Clinical Cases" section provides selected images, along with a short relevant discussion, from patient exams, contributed by the MR expert network community. This section will with time cover the breadth of clinical MR. Important aspects of imaging technique and clinical findings will be discussed. Each case will also include a downloadable file (corresponding to each presented image), enabling the user to replicate on his/her MR system the specific imaging technique employed.
| Title | View Text |
Os-acromiale NEW author, Nirav A. Patel, MD, MBA |
| Active Multiple Sclerosis NEW authors, John Heymann, MD & Gregory Chaljub, MD |
| Subcapsular/extracapsular hematoma NEW authors, J. Ryan Mikus, MD, MS & Kim Kirschner, MD |
| Buford Complex authors, Raghuram K. Rao, MD, MPH & Andreas Von Ritschl, MD |
| Low Grade Glioma authors, Dr Snehal More MD & Dr Roy Riascos MD |
| Cholangiocarcinoma authors, Nirav Patel, MD, MBA, Gregory Wolfe, MD |
| Right-sided vestibular schwannoma authors, Harisha Kommana, MD, Andreas Von Ritschl, MD |
| Biceps tendon rupture authors, Lee Nakamura, MD, Siddharth P. Jadhav, MD |
| Hepatocellular carcinoma authors, Dr Sandra Parada Orrego MD, Dr Snehal More MD, Dr Kimberly Kirschner MD |
| Haglund’s syndrome authors, Dr Murli Surnedi MD, Dr Snehal More MD, Dr Siddharth Jadhav MD |
| Plasmacytoma (biopsy proven) authors, Dr Miguel Trelles MD, Dr Roy Riascos MD |
| Title | View Text |
Metastatic breast cancer authors,Harisha Komanna, MD |
| Posterior ankle impingement syndrome (Os trigonum syndrome) authors, Dr Harnoor Singh MD, Dr Siddharth P. Jadhav |
| Thoracic dural AV fistula authors, Dr Nirav Patel MD, Dr Claudia Cotes MD Faculty: Dr Andreas Von Ritschl MD |
| Bilateral renal artery stenosis authors, Dr Nirav Patel MD, Dr Joao Fernando Kazan Tannus MD, PhD |
| Synovial Osteochondromatosis authors, Dr Harisha Kommana MD, Dr Siddharth Jadhav MD |
| Arachnoid Cyst authors, Dr Nirav Patel MD, Dr Claudia Cotes MD Faculty: Dr Andreas Von Ritschl MD |
| Left Ovarian Dermoid authors, Dr Benny Tran MD, Dr Kimberly Kirshner MD |
| Talocalcaneal Fibrous Coalition authors, Raghuram K. Rao MD, MPH, Ashish Kandelwal, MD Siddharth P. Jadhav, MD |
| Vestibular Schwannoma authors, Dr Murli Surnedi MD |
| Cervical Fibroid authors, Harisha Kommana, MD , Joao Fernando Kazan Tannus M.D, Ph.D. |
| Cortical Desmoid authors, Dr. Lee Nakamura MD, & Dr Siddharth Jadhav MD. |
| Chiari I Malformation authors, Sandra Parada-Orrego, MD & Gregory Chaljub, MD |
| Endometrioma authors, Lee Nakamura MD, Joao Fernando Kazan Tannus M.D, Ph.D. |
| Transient Patellar Dislocation authors, Claudia C. Cotes, MD & Raghuram K. Rao, MD, MPH & Siddharth P. Jadhav, MD |
| Oligodendroglioma authors, Jennifer Mayne MD |
| Chiari II Malformation. authors, Harnoor Singh, MD and Siddharth P. Jadhav, MD |
| Osteochondral defect (unstable). authors, Sandra Parada-Orrego, MD; Raghuram K. Rao, MD, MPH; and Siddharth P. Jadhav, MD |
| Invasive Ductal Carcinoma (Moderately Differentiated). authors, Murali Surnedi, MD and Hanae Bahr, MD |
| Moderate-sized ASD and a tiny septal VSD. authors, Harnoor Singh, MD , Douglas Hughes, MD |
| Bucket handle tear in the left medial meniscus. authors, Snehal R More MD, Siddharth P Jadhav MD |
| Rathke cleft cyst authors, Shashank Prasad, MD |
| Urethral diverticulum authors, Ashish Khandelwal MD, Joao F Kazan-Tannus MD, PhD |
| Adhesive capsulitis Snehal R More MD, Siddharth P Jadhav MD |
| Arteriovenous malformation authors, Snehal R. More, MD and Tomas Uribe, MD |
| Cervical Cancer authors, Murali Surnedi, MD |
| Labral Tear Jennifer Mayne, MD and Siddharth P. Jadhav, MD |
| Cavernous malformation or a "Cavernoma authors, Kristin Casey, MD and Andreas Von Ritschl, MD |
| Prostate carcinoma authors, Murali Surnedi, MD and Joao F. Kazan-Tannus, MD, PhD |
| Fracture of the Scapula authors, Shashank Prasad, MD and Siddharth P. Jadhav, MD |
| Capillary telangiectasia authors, authors,Sankaman N. Praisoody, MD and Sandra Parada-Orrego, MD |
| Articular Cartilage Defect authors, Siddharth P. Jadhav, MD and Ashish Khandelwal, MD |
| Congenital Cystic Adenomatoid Malformation authors, Joao F. Kazan-Tannus, MD, PhD and Shashank Prasad, MD |
| Renal Cell Carcinoma authors, Raghuram K. Rao MD, MPH, Joao F. Kazan-Tannus, MD, PhD |
| Vestibular Schwannoma authors, Sankaman N. Praisoody, MD Val M. Runge, MD |
| Ganglion Cyst: authors, Snehal R. More, MD Siddharth P. Jadhav, MD |
| Tako-Tsubo Cardiomyopathy author, Radko Krissak, MD, Christina Doesch, MD |
| Nephroblastoma author, Johanna Nissen, MD |
| Dilatative Arteriopathy author, Stefan Haneder, MD |
| Metastatic Melanoma author, lexandra Gutfleisch, MD |
| Severe Degenerative Changes of the Hip Joint authors, Miriam Reichert, MD, Henrik Michaely, MD |
| Partial Rupture of the Posterior Cruciate Ligament authors, Miriam Reichert, MD, Henrik Michaely, MD |
| Contrast Enhanced MRA of Dissection of the Carotid Artery authors, Alexandra Gutfleisch, MD, Henrik Michaely, MD |
| Contrast Enhanced MRA of the Carotid Arteries authors, Alexandra Gutfleisch, MD, Henrik Michaely, MD |
| An Overview of Imaging Techniques for the Carotid Bifurcation author, Randal Aschenbeck, MD |
| Contrast Enhanced MRA of the Pulmonary Arteries, Demonstrating Pulmonary Embolism authors, Henrik Michaely, MD, Ulrike Attenberger, MD |
| Contrast Enhanced MRA of the Renal Arteries, with Renal Artery Stenosis authors, Johanna Nissen, MD, Henrik Michaely, MD |
| MRA – False Aneurysm of the Renal Artery authors, Johanna Nissen, MD, Henrik Michaely, MD |
| Contrast Enhanced MRA of a Pelvic Arteriovenous Malformation author, Alexandra Gutfleisch, MD |
| Arteriovenous Malformation author, Fei Ai, MD and John N. Morelli, MD |
| Cervical Carcinoma authors, Wei Zhang MD , John N. Morelli, MD |
| Contrast Enhanced MRA of the Abdomen and Lower Extremities, Demonstrating Multifocal Atherosclerotic Vessel Stenoses author, Ulrike I Attenberger, MD |
| Continuous table movement MRA for diagnosis of generalized atherosclerotic disease author, Harald Kramer, MD |
| Meningioma author, Fei Ai, MD and John N. Morelli, MD |
| Optic Sheath Meningioma author, Tobias Saam, MD |
| Suprasellar Germinoma author, Fei Ai, MD and John N. Morelli, MD |
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Metastatic Pituitary Disease author, Fei Ai, MD and John N. Morelli, MD |
| Pituitary Macroadenoma author, Val M. Runge, MD |
| Oligoastrocytoma author, Fei Ai, MD and John N. Morelli, MD |
| Astrocytoma authors, Wei Zhang MD , John N. Morelli, MD |
| Cavernoma authors, Wei Zhang MD , John N. Morelli, MD |
| Brain Abscess authors, Fei Ai, MD , John N. Morelli, MD |
| Cerebellar glioma author, Fei Ai, MD and John N. Morelli, MD |
| Thalamic glioma author, Wei Zhang, MD |
| Arachnoid cyst author, Fei Ai, MD and John N. Morelli, MD |
| Tethered spinal cord author, Fei Ai, MD and John N. Morelli, MD |
| Chiari I malformation author, Fei Ai, MD and John N. Morelli, MD |
| Juvenile Nasopharyngeal Angiofibroma author, Harald Kramer, MD |
| Hypertrophic cardiomyopathy (HCM) authors, Daniel Theisen, MD | Harald Kramer, MD | Bernd Wintersperger, MD |
| Anterior Cruciate Ligament Disruption author, Matthias P. Lichy, MD, MSc |
| Perthes Lesion - Anterior Labral Separation author, Annie Horng, MD |
Enchondromaauthor, Fei Ai, MD and John N. Morelli, MD |
Liposarcomaauthor, Fei Ai, MD and John N. Morelli, MD |
Myxochondrosarcomaauthor, Fei Ai, MD and John N. Morelli, MD |
Nonossifying Fibromaauthor, Fei Ai, MD and John N. Morelli, MD |
| Tenosynovial Giant-cell Tumor author, Fei Ai, MD and John N. Morelli, MD |
| Synovial Sarcoma authors, Fei Ai, MD , John N. Morelli, MD |
| Ewing Sarcoma Author, Fei Ai, MD |
| Enchondroma authors, Fei Ai, MD , John N. Morelli, MD |
| Gout authors, Fei Ai, MD , John N. Morelli, MD |
| Liposarcoma authors, Fei Ai, MD , John N. Morelli, MD |
| Neurofibroma authors, Fei Ai, MD , John N. Morelli, MD |
| Ollier Disease authors, Fei Ai, MD , John N. Morelli, MD |
| Osseous Lymphoma authors, Fei Ai, MD , John N. Morelli, MD |
| Low-grade malignant fibrous histiocytoma author, Fei Ai, MD |
| Osteosarcoma author, Wei Zhang, MD |
| Fibroepithelial papilloma author, Fei Ai, MD |
| Metastatic Vertebral Disease author, Fei Ai, MD |
Clinical Methods
Magnets, Spins, and Resonances: An introduction to the Basics of Magnetic Resonance
This 193 page essay describes in easily understandable language the basic principles of MR. It starts with a short excursion through MR physics. The essay then proceeds to a discussion of spin relaxation and echoes, which leads to the section dedicated to the resultant observed signal and generation of the final image. The wide range of tissue contrasts that can be achieved, how fast images are generated, and the actual components that make up an MR system, are all then discussed in turn.
| Title | View |
| Magnets, Spins, and Resonances: An introduction to the Basics of Magnetic Resonance |
Magnets, Flows and Artifacts: Basics, Techniques, and Applications of Magnetic Resonance
This 133 page essay describes in easily understandable language several important topics encompassing overall image quality and then specifically the impact of flow. It starts with a short discussion of image quality and important factors therein. Flow and motion are then discussed in depth. The essay continues with the topics of saturation and chemical shift, which are important in a discussion of image quality and flow effects. Functional imaging, fast imaging techniques, and the detection and avoidance of image artifacts, are all then discussed in turn.
| Title | View |
| Magnets, Flows and Artifacts: Basics, Techniques, and Applications of Magnetic Resonance |
Definition and Clarification of TR in Modern Imaging, with Emphasis on Cardiac ApplicationsAs MR has evolved, the definition of TR has become quite complex, particularly with gated sequences. This article begins with an introduction to TR, covering its definition in spin echo and multislice fast spin echo sequences, and subsequently discusses in depth its definition in the plethora of cardiac gated sequences employed in modern imaging.
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| Definition and Clarification of TR in Modern Imaging, with Emphasis on Cardiac Applications Author, Gary McNeal, MS BME |
MR Protocols
The goals of this series of MR imaging protocols are to:
- Offer protocols that are state of the art for newer equipment and contrast agents to enable clinicians to use MR imaging technologies to their fullest capabilities
- Provide an important educational service to radiologists and radiology technologists by presenting optimized approaches for the acquisition of highly diagnostic images of the central nervous system (CNS), body, and vasculature using newer-generation MR scanners, sequences, and acquisition parameters
- Demonstrate how protocols should be modified to take into account the different physicochemical properties of the currently available MR contrast agents Suggested protocols specific to General Electric (GE), Siemens, and Philips MR systems are included, with these protocols developed based on the consensus of 3 panels of experts with experience on each platform.
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| MR Protocols |
Clinical Lectures
Nodular Lesions in Diffuse Liver Disease
| Title | View slides and audio |
| Nodular Lesions in Diffuse Liver Disease |
Continuous Table Movement in MR Angiography - syngo Tim CT
| Title | View |
| Continuous Table Movement in MR Angiography - syngo Tim CT by Harald Kramer, MD |
Clinical Articles
Case Report: syngo TimCT – MR Angiography in Clinical Routine
K. Lederle; S. Haneder; U. Attenberger; G. Weisser; S. O. Schoenberg; H. J. Michaely
Studies at the University Medical Center in Mannheim, Germany show that the continuous moving table MRA approach is a major improvement in imaging the lower extremities in a clinical setting as it combines an easy, fast and robust workflow with good clinical results and is applicable to a broad range of patients.
| Title | View PDF |
| syngo TimCT – MR Angiography in Clinical Routine |
Case Report: Fast Joint Imaging at 1.5 Tesla with a Combination of the Quadrature Knee and Body Matrix Coil in Case of Severe Knee Pain of an Obese Patient
Marietta Garmer M.D., Serban Mateiescu
Knee MRI is challenging in both obese patients and patients in pain, requiring in some cases special coil setups as imaging is impossible with a conventional closed knee coil. In the presented case, a flexible coil setup is demonstrated in combination with open-bore MR technology. This illustrates the benefit of such setups in the diagnosis of knee pain in obese patients.
| Title | View PDF |
| Fast Joint Imaging at 1.5 Tesla with a Combination of the Quadrature Knee and Body Matrix Coil in Case of Severe Knee Pain of an Obese Patienty |
Case Report: Knee MR Imaging of Haemarthrosis in a
Case of Haemophilia AM. A. Weber, J. K. Kloth
University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
Imaging pediatric joints is often still a domain of x-ray and ultrasound. However, the application of MRI is of growing importance, not only because of its excellent soft tissue contrast but also because of its capability to early and precisely detect bone destruction. In this case, Prof. Marc-André Weber (University of Heidelberg, Germany) reports on the imaging findings of a 14-year-old male with known hemophilia A.
| Title | View PDF |
| Knee MR Imaging of Haemarthrosis in a Case of Haemophilia |
Wei Jun Zhang1; Hans-Peter Hollenbach
Robust fat saturation can be achieved by different approaches including the application of inversion recovery sequences or advanced fat suppression pulses such as SPAIR. However, in some cases, such as the musculoskeletal imaging of the shoulder, the combination of a T2- weighted turbo spin echo (TSE) sequence with a conventional spectral fat saturation pulse is needed. When imaging obese or very tall patients, the shoulder has to be positioned off-center in many MR exams and therefore several factors will affect image quality with spectral fat saturation. This article provides tips on patient positioning and sequence set-up that will help you to achieve high quality spectral fat saturation.
| Title | View PDF |
| Tips for T2-weighted TSE Shoulder Imaging with Spectral Fat Saturation |
Markus Lentschig, M.D.
To diagnose peripheral neurologic deficits, imaging of the vertebral disks alone may not be sufficient. Depending on the clinical symptoms, the nerve roots themselves need to be evaluated in detail. In the presented case of a traumatic lesion of the brachial plexus, Markus Lentschig, MD (MR and PET/CT Center, Bremen, Germany) presents his 1.5 T imaging protocol for the evaluation of the cervical nerve roots and brachial plexus.
| Title | View PDF |
| Traumatic Lesion of the Left Brachial Plexus |
Assessment of Tumor Extension and
Improved Localization for Planning and
Nerve Sparing Radical Prostatectomy Matthias Philipp Lichy, M.D.
The potential of state-of-the-art MRI at 3 T, in prostate imaging without the use of an endorectal coil, is discussed in this article. Two clinical cases are presented, with MRI in each instance able to improve both therapy planning and surgical outcome.
| Title | View PDF |
| Assessment of Tumor Extension and Improved Localization for Planning and Nerve Sparing Radical Prostatectomy |
Marius Horger, M.D.
Multiple myeloma is a malignant hematologic disorder characterized by the infiltration of neoplastic plasma cells into bone marrow. Detection of medullary involvement is best accomplished with the aid of MRI. Visualization of myeloma burden at baseline and during therapy is beneficial for improved patient management and accurate prognostic evaluation. Therefore, whole-body imaging protocols are mandatory, especially for assessment of myeloma infiltration in all bone marrow cavities (medullary involvement) as well as for diagnosis of extramedullary involvement.
| Title | View PDF |
| Nonsecretory Multiple Myeloma MRI Monitoring of Therapy Response |
Philip Aschoff, MD; Christina Pfannenberg, MD; Claus Claussen, MD; Heinz-Peter Schlemmer, MD
With breast carcinoma, detection of metastases and estimation of tumor load is of high relevance for patient-individualized therapy regimes. This article presents two cases that show the advantages of MRI for imaging bone metastases originating from breast cancer. In both cases, there was the high clinical suspicion of tumor recurrence with metastastic spread. The patients underwent therefore combined whole- body 18F FDG PET/CT and whole-body MRI for tumor staging with special focus on the brain, liver and bone marrow.
| Title | View PDF |
| Whole-Body MRI for Accurate Assessment of Tumor Load of Bone Metastases Originate from Mamma Carcinoma |
Case Reports: Tumor Detection by Diffusion-Weighted MRI and
ADC-Mapping with Correlation to PET/CT Results Matthias Philipp Lichy, M.D.; Philip Aschoff, M.D.;
Christina Pfannenberg, M.D.; Schlemmer Heinz-Peter, M.D.
Early and accurate estimation of metastatic spread is essential for a patient-adapted, efficient therapy regime. In this context, whole-body and multi-step MRI have already helped to improve the diagnostic accuracy of staging examinations. As a further step, it is known that cancer is also often characterized by higher cellularity and therefore restriction of water diffusion. Diffusion-weighted imaging (DWI) with high b-values has therefore been applied to image metastases in order to help improve the diagnostic accuracy of MRI. The working-group of Schlemmer et al., Department of Radiology, University of Tuebingen, Germany, have compared the findings with results of 18F-FDG PET/CT exams.
| Title | View PDF |
| Case Reports: Tumor Detection by Diffusion-Weighted MRI and ADC-Mapping with Correlation to PET/CT Results |
Bernhard Klumpp, M.D.; Philip Aschoff, M.D.; Mehmet Oeksuez M.D.
Christiane Pfannenberg, M.D.; Heinz-Peter Schlemmer, M.D.
Neuroendocrine tumors may be challenging to diagnose. Diffusion-weighted MR imaging (DWI) plays an important role in the accurate detection of liver lesions, which may be occult onconventional MRI and especially CT. In the presented case, the suspicion of diffuse hepatic spread is also supported by the additionally performed 68Ga-DOTATOC PET. The article shows, that DWI of the liver is a valuable tool for the exact estimation of hepatic tumor load.
| Title | View PDF |
| Case Report: Metastases from Neuroendocrine Carcinoma: Value of Diffusion-Weighted MR Imaging Compared to 68Ga-DOTATOC PET-CT |
Static Magnetic Field
There are two types of forces exerted on a ferrous (iron) object when brought in close proximity to an MR magnet: rotational and translational. The rotational force (torque) is that which causes a ferrous object to turn and align with the direction of the magnetic field. Rotational forces are strongest at the isocenter of the magnet.
Translational forces are those that cause a ferrous object to be pulled toward the magnet isocenter. Bringing a ferrous object into the magnet room is extremely dangerous and should not be done. Many times, once one feels the pull of the magnetic field, it is too late.
The series of pictures, as well as video, demonstrate the strength of a 1.5 T magnet (which was being decommissioned) and its effect upon a non-MR compatible wheelchair that was brought into the scan room.
Imaging Techniques
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