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Magnetic Resonance Imaging01:24

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Magnetic resonance imaging (MRI) is a noninvasive medical imaging technique based on a phenomenon of nuclear physics discovered in the 1930s, in which matter exposed to magnetic fields and radio waves was found to emit radio signals. In 1970, a physician and researcher named Raymond Damadian noticed that malignant (cancerous) tissue gave off different signals than normal body tissue. He applied for a patent for the first MRI scanning device in clinical use by the early 1980s. The early MRI...
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NMR Spectrometers: Radiofrequency Pulses and Pulse Sequences01:17

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A pulse is a short burst of radio waves distributed over a range of frequencies that simultaneously excites all the nuclei in the sample. Upon passing a radio frequency pulse along the x-axis, the nuclei absorb energy corresponding to their Larmor frequencies and achieve resonance. This shifts the net magnetization vector from the z-axis toward the transverse plane. This angle of rotation of the magnetization vector, or the flip angle, is proportional to the duration and intensity of the pulse.
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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
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Can a 15-sec FLAIR replace conventional FLAIR sequence in stroke MR protocols?

J Benzakoun1, B Maïer2, D Calvet3

  • 1Service d'Imagerie Morphologique et Fonctionnelle, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Université Paris Descartes, 12, rue de l'École de Médecine, 75006 Paris, France; Inserm U894, Centre de Psychiatrie et Neurosciences, 75014 Paris, France.

Journal of Neuroradiology = Journal De Neuroradiologie
|February 27, 2017
PubMed
Summary
This summary is machine-generated.

Ultrafast Echo-Planar FLAIR (EPI-FLAIR) significantly reduces MRI scan times and motion artifacts for acute stroke imaging. However, it shows a higher risk of missed diagnoses and lower positive predictive value for early infarction detection compared to conventional FLAIR.

Keywords:
FLAIRImagingMagnetic resonance imagingScan timeStroke

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Area of Science:

  • Neuroradiology
  • Medical Imaging
  • Stroke Diagnosis

Background:

  • Acute stroke recognition requires rapid imaging for timely treatment.
  • Magnetic Resonance (MR) imaging acquisition speed needs improvement for time-sensitive stroke protocols.
  • Conventional FLAIR sequences are time-consuming, posing challenges in acute stroke settings.

Purpose of the Study:

  • To compare the diagnostic performance of an ultrafast Echo-Planar FLAIR (EPI-FLAIR) sequence against a conventional FLAIR (cFLAIR) sequence.
  • To evaluate the ability of both FLAIR sequences in estimating the age of ischemic infarction.
  • To assess the impact of reduced acquisition time on diagnostic accuracy in acute stroke patients.

Main Methods:

  • 125 patients with suspected acute stroke underwent both EPI-FLAIR (15 seconds) and cFLAIR (2 minutes 15 seconds) at 1.5-Tesla.
  • Two blinded readers evaluated the sequences for diagnostic performance and artifact reduction.
  • Comparison included detection of hemorrhages, infarctions, and assessment of FLAIR-DWI mismatch for early infarction identification.

Main Results:

  • EPI-FLAIR demonstrated significantly fewer kinetic artifacts than cFLAIR (2-3% vs. 23-49%, P<0.001).
  • Diagnostic concordance between sequences was excellent (κ>0.9).
  • While sensitivity for identifying <4.5-hour infarctions was similar (65%), cFLAIR had a higher positive predictive value (73% vs. 50%, P=0.008).
  • One subarachnoid hemorrhage was missed on EPI-FLAIR.

Conclusions:

  • EPI-FLAIR drastically reduces FLAIR sequence acquisition time and minimizes motion artifacts.
  • EPI-FLAIR is associated with an increased risk of undiagnosed stroke mimics compared to cFLAIR.
  • The reduced acquisition time of EPI-FLAIR comes at the cost of a lower positive predictive value for detecting early (<4.5 hours) infarctions.