Clinical application of high and ultra high-field MRI

The 21st century ushered in the century of human beings. The previous era characterized by the chase after super technology has been replaced by a new era which focuses on the meaning of human existence and quality of life. Clinical practice has accordingly also undergone rapid change. Amongst the many competing technologies, clearly magnetic resonance technology, especially ultra high-field magnetic resonance imaging, plays a major role in defining current clinical practice. Elimination of all invasive aspects from diagnostic imaging, including intravenous infusion or use of ionizing radiation, is one of the final goals of the new generation of clinical imaging. This goal is especially worthwhile when one consider the welfare of children. Technological MRI advancements are steadily bridging the gap towards this goal. With T2 reversed and three-dimensional anisotropy (3DAC) contrast imaging on a 3.0T system, the anatomical resolution of routine clinical images has reached a level of resolution equivalent to general pathology. Realistic imaging microscopy application is also on the horizon with the establishment of clinical 7.0T systems. Individual brain activation maps can now be readily obtained under clinical settings thanks to high-field functional MRI (fMRI). Nevertheless, because active self-organizing processes of cortical functionalities are under active development in the pediatric population, fMRI has only limited, if any, clinical usage in children. Similarly, whereas connectivity analysis in the individual patient using diffusion tensor imaging (DTI) has little clinical usage in the pediatric population, DTI can be successfully applied to multiple subject analysis for exploring unknown connectivity abnormalities in this age group. Magnetic resonance spectroscopy (MRS) and its pictorial display (spectroscopic imaging) is now finding more and more clinical applications across the age spectrum of patients.