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26, rue des Cannes, 75005 Paris, France

MRI of the Body Edited by Daniel Vanel and Michael T. McNamara

o. Arcangioli, L. Arrive, B. Aubert, R. Benacerraf, J.-M. Bigot, J. Bittoun, S. Blangy, A. Bonnin, J. Broussin, D. Buthiau, J.-N. Buy, A.-E. Cabee, J.-M. Caille, S. Chagnon, J. -F. Chateil, A. Chevrot, C. Coffre, D. Couanet, E. Despres, J. De Treuf, J. Ecoiffier, L. Engelholm, G. Frija, F. Gires, N. Grenier, P. Grenier, C. Guinet, F. Heran, I. Idy-Peretti, J. Jean-Mart, P. Kien, H. Kressel, R. Lavayssiere, J. Leclere, A. Leroy-Willig, L. Malbec, M. Marichez, J. Masselot, E. Meary, Y. Menu, G. Pallardy, R.-A. Parienty, J.-D. Piekarski, J.-c. Roucayrol, E. Schouman-Claeys, C. Segebarth, A. Sibert, E. Somveille, A. Taieb, V. Taviere, D. Vadrot, C. Vallee, D. Vanel, M. Zalcman, M. Wybier

Foreword by Herbert Y. Kressel

With 1046 Figures

Springer-Verlag Paris Berlin Heidelberg New York Londres Tokyo Hong Kong

Daniel Vanel, M.D. Service de Radiodiagnostic Institut Gustave Roussy rue Camille Desmoulins 94805 Villejuif Cedex France

Michael T. Mc Namara, M.D. Chief, Service of Magnetic Resonance Imaging Centre Hospitalier Princesse Grace Principality of Monaco 98000

Translated by Suzanne Assenat

All translation, reproduction and adaptation rights reserved for all countries.

The law of March 11, 1957 forbids copies or reproductions intended for collective use. Any representation, partial or integral reproduction made by any process whatsoever without the consent of the author or his executors os illicit and constitutes a fraud dealt with by Articles 425 and following of the Penal Code.

© Springer-Verlag France 1989

Originally published by Springer-Verlag France 1989 Softcover reprint of the hardcover Ist edition 1989

The use of registred names, trademarks, etc. in this publication does not imply, even in the absence 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 publisher can give no guarantee for information about drug dosage and application there of contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceuticalliterature.

ISBN 978-3-642-87558-8 ISBN 978-3-642-87556-4 (eBook) DOI 10.1007/978-3-642-87556-4

2918/3917/543210 - Printed on Acid-free paper.

to Christine David Stephane Lila

and Mara (D.V.)

to Nathalie and Mitzi

(M.T.M.)

Foreword

As with the introduction of x -ray computed tomography, much of the initial development of magnetic resonance applications tended to focus on the central nervous system. The development of magnetic resonance imaging applications to other organ systems such as the chest, abdomen, pelvis and extremities has lagged somewhat behind, awaiting technical improvements, and a broader user base. The past two years have seen a marked increase in imaging applications throughout the body, most notably the musculoskeletal system. It is in this regard, that MRI of the Body is a welcome arrival as a text which describes both basic principles of magnetic resonance ima­ging and surveys the current status of magnetic resonance imaging applications throughout the body.

The volume is concise, focused, clinically oriented, and abun­dantly illustrated. In each organ system, the appropriate technical approach is discussed, the normal anatomic features are reviewed, and the range of pathologic appearances which may be encountered are described. The authors of the chapters provide a balanced overview of MR applications and describe both present limitations and future potential of magnetic resonance imaging applications in the organ system described.

The multi authored text has contributions by a number of French and Belgian radiologists who have long-standing experience in magnetic resonance imaging. The English edition has been coedi­ted by Dr. Daniel Vanel ofthe Institut Gustave Roussy in Paris, one of the pioneers in high field magnetic resonance imaging on the European continent, and Dr. Michael T. McNamara who has trained in MRI at the University of California at San Francisco and is currently in practice in Monaco. This able team of editors and contributors has combined to provide a sound overview of this rapidly developng area in the field of magnetic resonance imaging.

Herbert Y. Kressel Professor of Radiology

Director of David W. Devon Medical Imaging Center

List of authors

O. Arcangioli, M.D. Service de Medecine Nuc1eaire, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cedex, France

L. Arrive, M.D Service de Radiologie, Hotel Dieu, 2, place du Parvis de Notre Dame, 75004 Paris, France

B. Aubert, M.D. Service de Radiophysique, Institut Gustave Roussy, Rue Camille Desmoulins, 94805 Villejuif Cedex, France

R. Benacerraf, Prof. Service de Radiologie, Hopital Bichat, 46, rue Henri Huchard, 75018 Paris, France

J-M. Bigot, Prof. Service de Radiologie A, Hopital Tenon, 20, rue de la Chine, 75020 Paris, France

J. Bittoun, M.D. Service de Biophysique et Medecine Nuc1eaire, CHU de Bicetre, 94275 Le Kremlin Bicetre Cedex, France

S. Blangy, M.D. Service de Radiologie, Hopital de Montmorency, 95160 Montmorency, France

A. Bonnin, M.D. Service de Radiologie, Hopital de Montmorency, 95160 Montmorency, France

A. Bonnin, Prof. Radiologie A, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cedex 14, France

J. Broussin, Prof. Service d'Electroradiologie, Hopital Pellegrin, place Amelie Raba Leon, 33076 Bordeaux, France

D. Buthiau, M.D. IRM Felix Faure, 75-80, avenue Felix Faure, 75015 Paris, France

X List of authors

J-N. Buy, M.D. Service de Radiologie, Hotel Dieu, 2, place du Parvis de Notre Dame, 75004 Paris, France

A-E. Cabee, M.D. IRM Paris Nord, 6, avenue Charles Peguy, 95200 Sarcelles, France

J-M. Caille, Prof. Neuroradiologie, Hopital Pellegrin, place Amelie Raba Leon, 33076 Bordeaux, France

S. Chagnon, M.D. Service de Radiologie, Hopital Lariboisiere, 2, rue Ambroise Pare, 75475 Paris Cedex 10, France

J-F. Chateil, M.D. Service de Radiologie, Hopital des Enfants, 168, Cours de l'Argonne, 33000 Bordeaux, France

A. Chevrot, Prof. Service de Radiologie B, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cedex 14, France

C. Coffre, M.D. Cabinet de Radiologie, 34-36, rue des Meches, 94000 Creteil, France

D. Couanet, M.D. Radiodiagnostic, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cedex, France

E. Despres, M.D. Service de Radiologie et Imagerie Medicale, Hopital Saint­Joseph, 7, rue Pierre Larousse, 75674 Paris Cedex 14, France

J. De Treuf, M.D. Service de Radiologie, Hopital Erasme, 808, route de Lennik, 1070 Bruxelles, Belgium

J. Ecoiffier, Prof. Service de Radiologie, Hotel Dieu, 2, place du Parvis de Notre Dame, 75004 Paris, France

L. Engelholm, M.D. Service de Radiologie, Hopital Erasme, 808, route de Lennik, 1070 Bruxelles, Belgium

G. Frija, Prof. Service de Radiologie, Hopital Raymond Poincare, 104, boulevard Poincare, 92380 Garches, France

F. Gires, M.D. Service de Radiologie B, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cedex 14, France

List of authors XI

N. Grenier, M.D. Service de Radiologie, Hopital Pellegrin, place Amelie Raba Leon, 33076 Bordeaux, France

P. Grenier, Prof. Service de Radiologie Hotel Dieu, 2, place du Parvis de Notre Dame, 75004 Paris, France

C. Guinet, M.D. Service de Radiologie, 2, place du Parvis de Notre Dame, 75004 Paris, France

F. Heran, M.D. Service de Neuroradiologie, Hopital Henri Mondor, 51, avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France

1. Idy-Peretti, M.D. Service de Biophysique et Medecine Nucleaire, CHU de Bicetre, 94275 Le Kremlin Bicetre Cedex, France

J. Jean-Mart, Prof. Service de Radiologie, Hopital Erasme, 808, route de Lennik, 1070 Bruxelles, Belgium

P. Kien, M.D. Service d'IRM, Hopital Pellegrin, place Amelie Raba leon, 33076 Bordeaux, France

H. Kressel, Prof. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, U.S.A.

R. Lavayssiere, M.D. IRM Paris Nord, 6, avenue Charles Peguy, 95200 Sarcelles, France

J. Leclere, M.D. M€decine Nucl€aire, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cedex, France

A. Leroy-Willig, M.D. Medecine Nucleaire, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cedex 14, France

L. Malbec, M.D. Service de Radiologie, Hotel Dieu, 2, place du Parvis de Notre­Dame, 75004 Paris, France

M. Marichez, M.D. Service de Radiologie et Imagerie Medicale, Hopital Saint­Joseph, 7, rue Pierre Larousse, 75674 Paris Cedex 14, France

J. Masselot, Prof. Radiodiagnostic, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cedex, France

XII List of authors

E. Meary, M.D. Service de Radiologie, Hotel Dieu, 2, place du Parvis de Notre Dame, 75004 Paris, France

Y. Menu, M.D. Radiodiagnostic, Hopital Beaujon, 100, boulevard du General Leclerc, 92110 Clichy, France

G. Pallardy, M.D. Service de Radiologie B, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cedex 14, France

R-A. Parienty, M.D. IRM Felix Faure, 78-80, avenue Felix Faure, 75015 Paris, France

J-D. Piekarski, M.D. Service de Radiologie, Fondation Rothschild, 26, rue Manin, 75019 Paris, France

J -CO Roucayrol, Prof. Medecine Nucleaire, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cedex 14, France

E. Schouman-Claeys, M.D. Service de Radiologie, Hopital Raymond Poincare, 104, boulevard Raymond Poncare, 92380 Garches, France

C. Segebarth, M.D. Unite d'IRM, Hopital Erasme, 808, route de Lennik, 1070 Bruxelles, Belgium

A. Sibert, M.D. Service de Radiologie, Hopital Bichat, 46, rue Henri Huchard, 75018 Paris, France

E. Somveille, M.D. Service de Radiologie, Hopital Bichat, 46, rue Henri Huchard, 75018 Paris, France

A. Taieb, Prof. Service de Radiologie et Imagerie Medicale, Hopital Saint­Joseph, 7, rue Pierre Larousse, 75674 Paris Cedex 14, France

V. Taviere, M.D. Radiopediatrie, Hopital des Enfants Malades, 149, rue de Sevres, 75015 Paris, France

D. Vadrot, Prof. Service de Radiologie, Hotel Dieu, 2, place du Parvis de Notre Dame, 75004 Paris, France

C. Vallee, M.D. Radiologie, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris Cede x 14, France

List of authors XIII

D. Vanel, M.D. Radiodiagnostic, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cedex, France

M. Zalcman, M.D. Radiologie, Hopital Erasme, 808, route de Lennik, 1070 Bruxelles, Belgium

M. Wybier, M.D. Radiologie, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75674 Paris, France

Table of contents

Foreword, Herbert Y. Kressel ............................................................. VII List of authors ..................................................................................... IX

Physical basis, I. Idy-Peretti and J. Bittoun ..................................... . Physical basis of nuclear magnetic resonance .............................. .

The magnetization of matter ................................................... . Elementary magnetic momentum and local magnetization ..... 2 Effect of a homogeneous, stable external magnetic field .... .... 3 Components of nuclear magnetization ............. ..... ..... ............. 4 Nuclear magnetic resonance .................................................... 5 Return of nuclear magnetization to equilibrium ... ....... ............ 6

Signal parameters ... ......................... .............................................. 8 The nuclear magnetic resonance signal... ..... ........................... 8 Pulse sequences ....................................................................... 10

Formation of an image .................................................................. 15 Magnetic field gradients ......................... ......... ....... .......... ....... 16 Signal location ....................... .......................................... ........ 17 Imaging method with two-dimensional Fourier Transform (2D-Ff) .................................................................................... 18 Fast imaging methods .................................. ............... ....... ...... 19 Contrast media ....................... ........... ................ ....... ..... ........... 20 Chemical shift.......................................................................... 21 Flow in imaging .................................. ..................................... 22 Practical progress of an MRI examination ....... ..... ........... ....... 23

Glossary... ....... ......... .................. ......... ........................................... 24

Artifacts, B. Aubert ............................................................................ 31 System-specific artifacts ................................................................ 31

Influence of the basic characteristics ................. ...................... 31 Influence of system quality ...................................................... 32

Patient-specific artifacts ................................................................ 33 Artifacts common to all patients .............................................. 33 Artifacts peculiar to given patients .......................................... 36

Quality control, B. Aubert ................................................................. 37 Definition of QC parameters ......................................................... 37

Basic parameters ...................................................................... 37 Complementary parameters ..................................................... 38

Test substances and test objects ..... .................. ................ ............. 39 Test substances ...... ......... ......................................................... 39

XVI Table of contents

Test objects ..... ..... ....... ........... ..... .... ......... ......... ....... .... ......... ... 40

NMR spectroscopy from experimental to clinical spectroscopy, J. Bittoun and A. Leroy-Willig ........................................................... 45

Principle of NMR spectroscopy... ...... ......... ..... ............. ..... .... ....... 45 Chemical shift .... ..... ......... ............................. ....... .... ....... ..... .... 45 Spectrum quantification .. .... ....... ...... ................ ........... ..... .... .... 46

Most significant results of spectrocopy in man .... ........... ..... ........ 46 Spectroscopy of Phosphorus 31 ..... ......... ..... .... ..... ........... ........ 46 Spectroscopy of other nuclei ... ...... .... ..... ......... ......... ......... ...... 48

Clinical application... ..... ......... ........... ..... .... ......... ......... ....... ....... ... 50 Localization of the spectrum ..... ........... ....... ....... ......... ......... ... 50 Magnetic field homogeneity...... ....... .... ..... ......... .... ..... ....... ..... 50

Conclusion..... ....... ........... ....... ......... ........... ................ ......... ..... ..... 51

Contrast media, E. Schouman-Claeys and G. Frija .......................... 53 Theoretic basis ............................................................................... 53

Paramagnetic substances ......................................................... 53 Superparamagnetic substances ................................................ 53 Effects on contrast... ....... .... ........... ........... ..... ............. ....... ...... 54

Paramagnetic ions... ....... ......... .... ....... .... ....... ....... ........... ..... .... ...... 54 General points.......................................................................... 54 Physicochemical, pharmacokinetic and toxicological properties of simple gadolinium complexes ............................ 55 Imaging considerations .. ...... ........... .... ..... ..... ...... ......... ..... .... ... 56

Other contrast media ..................................................................... 58 Other intravascular products .................................................... 58 Oral contrast agents ............. ....... .... ....... ....... ............. ......... ..... 59 Inhaled contrast agents ... ...... .... ........... ....... ......... .... ....... ......... 59

Experimental models ..... ....... ...... ..... ...... ..... .... ..... ...... ..... .... ........... 59 Clinical applications... ....... ...... ........... ......... ........... ......... ......... .... 60

Neurological applications-brain ............................................... 60 Other applications ....... ..... ........ .... ....... .... ........... ..... .... ....... ...... 61

Conclusion ...... ........... ........... ..... ...... ..... ...... .... ..... ..... ...... ......... ...... 62

Head and neck, J-D. Piekarski, F. Heran, o. Arcangioli and J. Leclere ...................................................................................... 65

Facial structures - nasopharynx and parapharyngeal spaces.... .... 65 Technique ............. ............. ....... ...... ..... .... ........... ..... ...... .......... 65 Normal anatomy ...................................................................... 65 Pathology... ....... ......... ...... ............. ..... ...... ........... ........... .... ...... 66 Limitations ........ ......... ...... ............. ........... ........... ........... .......... 71

Superficial soft tissue (excluding the orbits) : parotid gand and temporomandibular joint ...... ............ ............. ......... ............. .......... 71 The parotid gland ...... ........... ............. ...... ......... ........... ............. ...... 72

Temporomandibular joint ........................................................ 72 Buccal cavity and the oropharynx ................................................. 72

Technique ................................................................................ 72 Anatomy .................................................................................. 73 Pathology ................................................................................. 73 Limitations ............................................................................... 73

Cervical region ..... .............................................. ...... ............. ........ 73

Table of contents XVII

Pharynx and larynx ................................................................. . 73 Thyroid and parathyroid glands .............................................. . 74 The vascular grooves .............................................................. . 80 Cervical soft tissue - the thoracic inlet ................................... . 81

Conclusion .................................................................................... . 81

Thorax, P. Grenier ............................................................................. . 85 Exploration techniques ................................................................. . 85

Choices of TR ......................................................................... . 85 Choice of TE ........................................................................... . 85 Other parameters ..................................................................... . 86 Section orientation .................................................................. . 86 Cardiorespiratory gating ......................................................... . 86 Other techniques ..................................................................... . 88

Nonnal anatomy ........................................................................... . 90 Mediastinum ........................................................................... . 90 Hili of the lungs ...................................................................... . 97 Pulmonary parenchyma .......................................................... . 97 Pleura ...................................................................................... . 97 Thoracic wall .......................................................................... . 97 Diaphragm .............................................................................. . 98

Pathological findings .................................................................... . 98 Mediastinal masses ................................................................. . 98 Aortic pathology ..................................................................... . 105 Hilar masses ............................................................................ . 110 Pulmonary vascular pathology ............................................... . 110 Lung pathology ....................................................................... . 111 Pleura and thoracic wall pathology ......................................... . 112

Conclusion .................................................................................... . 114

Heart, G. Frija and E. Schouman-Claeys .......................................... . 119 General points ............................................................................... . 119

Examination techniques .......................................................... . 119 Adverse effects - contraindications ........................................ . 120

Study of the heart ......................................................................... . 120 Cardiac cycle .......................................................................... . 120 Imaging sequences and nonnal findings ................................. . 121 Choice of section planes ......................................................... . 125

Clinical applications ..................................................................... . 125

Breast, J. Masselot ............................................................................. . 137 Imaging technique ........................................................................ . 137 MR image of the nonnal breast .................................................... . 137 Results .......................................................................................... . 137

Technical aspects .................................................................... . 137 Benign pathology .................................................................... . 137 Malignant pathology ............................................................... . 140

Conclusion .................................................................................... . 141

Liver, biliary tract, portal system, spleen, Y. Menu and S. Chagnon .................................................................................. . 143

Technique ..................................................................................... . 143 Sequences ............................................................................... . 143

XVIII Table of contents

Contraindications ..................................................................... 148 Preparation ............................................................................... 148

Nonnal anatomy ............................................................................ 149 Clinical findings .... ..... ... ...... ........... ............... ..... ......... ......... ..... .... 149

MRI of the liver ....................................................................... 149 MRI of the biliary tract ............................................................ 157 MRI of the portal system ......................................................... 159 MRI of the spleen .................................................................... 162

Conclusion....... ....... ........... ........... ........... ......... ......... ....... .... ..... .... 164

PancreaG, L. Engelholm, C. Segebarth, J. De Treuf, M. Za1cman and J. Jean-Mart .................................................................................. 169

Application of MR imaging techniques to the pancreas ............... 169 Nonnal pancreas ............................................................................ 169 Acute and chronic pancreatitis ..... ........... ....... ....... ......... ..... .... ...... 171 Liquid collections and pseudocysts ..... ..... .... ..... .... ..... ..... .... ....... ... 172 Pancreatic hemorrhage .......... ............... ..... .... ..... ......... ......... ......... 173 Tumors of the pancreas ....... ..... ...... ..... ...... ....... ....... .... ......... ..... .... 173 Metabolic diseases ......................................................................... 176 Vascular abnonnalities associated with hepatic diseases .............. 176 Present situation, prospects, comparison with CT ........................ 176 Tissue characterizarion .................................................................. 176

Gastrointestinal tract, L. Engelholm, C. Segebarth, J. De Treuf, M. Za1cman and J. Jean-Mart .............................................................. 179

MR examination technique for the GI tract ................................... 179 General preparation of the patient ... ....... ......... .... ....... ......... .... 179 Contrast media..... ..... ...... ........... ....... .... ......... ........... ......... ...... 179 Patient position ........................................................................ 180 Body coils and surface coils ...... ........... ......... ........... ......... ...... 180 Imaging parameters ................................................................. 180

Nonnal anatomy of the rectum ... ............ ..... .... ....... .... ......... ..... ..... 180 Abnonnalities of the GI tract ......................................................... 181

Crohn'sdisease ........................................................................ 181 Rectal and colonic tumors ........ ..... ...... .... ..... ..... ...... ......... ....... 181 Extramural signs ...................................................................... 183 Invasion of neighboring organs ............................................... 184 Adenopathy .............................................................................. 184 Tumor recurrence..................................................................... 185 MR signs of reccurence ........................................................... 185 Tissue characterization .. ........ ...... ......... ......... ....... .... ......... ...... 186

Advantages and dIsadvantages of MR - Future prospects .... ........ 186

The kidneys and perirenal space, E. Despres, M. Marichez and A. Taieb ........................................................................................ 189

Technique..... ........... ........... ....... ............ ......... ....... ... ...... ......... ...... 189 Anatomy ........................................................................................ 189 Mass lesions ......... ...... ............. ............. ......... ... ........ ... ...... ..... .... ... 190

Cystic lesions..... ........... ....... ............ ......... ....... .... ..... ...... ..... .... 190 Solid lesions... ............. ............... .... ......... ........... ....... .... ........... 192

Loss of corticomedullary differentiation ...................................... 195 Transplanted kidneys .............................................................. 195

Table of contents XIX

Perirenal lesions ..... ..... .... ......... ....... ....... ......... ..... ......... ........... ..... 197 Collections ... ..... ......... ....... ....... ......... ....... ......... ......... ....... .... ... 197 Retroperitoneal fat ....... ......... ......... ..... ....... ......... ..... .... ............ 197

Paramagnetic substances ... ...... ....... ......... ..... .... ..... ......... ........... .... 198

Adrenal glands, M. Marichez, E. Despres and A. Taieb ...... ............. 199 MRI procedure ... ....... ... ...... ... .... ......... ..... ... ...... ......... ......... ........... 199 Normal anatomy ............................................................................ 200 Secretory tumors of the adrenals ................................................... 202

Conn's disease .......................................................................... 202 Pheochromocytoma ....... ....... ......... ..... ......... ....... ..... ....... ......... 203 Adrenal hyperplasia - Cushing's disease .................................. 204

Non-secretory tumors .................................................................... 205 Metastases ... ..... ......... ....... ....... ... .... ......... ......... ..... ....... ....... ..... 205 Nonhyperfunctioning adenomas .............................................. 205

Other lesions.................................................................................. 206 Cysts ........................................................................................ 206 Myelolipoma ............................................................................ 206 Neuroblastoma ......................................................................... 206 Hematoma .... ... ....... ......... ..... ........... ....... ..... .... ..... ....... ... .......... 207 Adrenal carcinoma................................................................... 208

Contribution of spectroscopy imaging to adrenal investigation .... 208 Conclusion ...... ... .... ..... ......... ....... ....... ......... ....... ..... ....... ....... ..... .... 209

Large retroperitoneal blood vessels, A. Taieb, M. Marichez and E. Despres..................................................................................... 211

Exploration technique .................................................................... 211 Normal findings............................................................................. 212

Abdominal aorta and its visceral branches .... ......... ..... ....... ..... 212 Appearance of the inferior vena cava..... ..... .... ..... ....... ..... ....... 212 Spatial resolution of MRI ... ...... ... ...... ....... ........... ..... ....... ... ..... 213

Pathological findings ..................................................................... 213 Aneurysm of the abdominal aorta............................................ 213 Aortic dissections .... ..... .... ..... ........... ......... ......... ....... ..... .......... 213 Periaortic pathology and retroperitoneal fobrosis.............. ...... 216 Atheromatous disease .............................................................. 216 The vena cava ... ...... ... ...... ......... .................... ........... ......... ....... 216

Conclusion .... ......... ....... .... ..... .................... ......... ......... ............. ..... 217

Retroperitoneal adenopathy, R. Lavayssiere, A.E. CaMe and R.A. Parienty ................................................................................ 219

Technique ...................................................................................... 219 Sequences ................................................................................ 219 Section plane .... ......... ....... .... ....... ......... ......... ........... ........... ..... 219 In practice .... ..... .... ....... .... ....... ... ...... ... ...... ........... ......... ..... ...... 220

Findings ......................................................................................... 220 Conclusion..... ......... ........... ........... ......... ......... ........... ....... ............. 221

Gynecology, 1. Masselot and D. Buthiau ........................................... 223 Examination technique....... ........... ........... ......... ........... ....... .......... 223 Normal anatomy ............................................................................ 223

Uterus ....................................................................................... 223

XX Table of contents

Vagina ...................................................................................... 225 Ovaries and adnexa ..... ....... ......... .... ................... ................ ...... 226 The genital vessels ..... .................... ................... ........... ..... ....... 226 The lymph nodes .. ........... ......................................... ..... ........... 226

Benign pathology... .................... ........... ..... ......... ..... ......... ............ 227 Uterus ....................................................................................... 227 Ovaries ............... ..... ......... ........... .... .............. ....... ................ .... 228 Other pathology ...................................................................... 231

Malignant pathology ...................................................................... 232 Carcinoma of the uterine body ................................................ 232 Cancer of the cervix .................................. ................ .... ..... ...... 235 Pelvic recurrence of uterine cancer .......................................... 237 Malignant ovarian tumors ........ ....................... ............. ............ 238 Other gynecological tumors ..................................................... 238 Adenopathy .............................................................................. 238

Postoperative pathology and therapeutic follow-up ...................... 239 Conclusion .......................... ........... ....... .... .............. .... ....... ............ 239

Male pelvis, L. Arrive, L. Malbec, J.N. Buy, C. Guinet, D. Vadrot, E. Meary, J.M. Bigot and J. Ecoiffier ................................................. 241

Technique ................... .................... ........... ................ ......... ........... 241 Patient preparation ........ ........... .... ........... ..... ......... ......... ..... ..... 241 Imaging parameters ................................................................. 241

Normal anatomy ............................................................................ 242 Pelvic wall ............................................................................... 242 Pelvic contents ......................................................................... 242

Pathology... ................ ........... ........... .... ......... ....... ......... ......... ..... ... 245 Bladder pathology .................................................................... 245 Postoperative pathology (tumor recurrence, infectious diseases) ................................... 252 Lymph node pathology ............................................................ 252 Bone metastases ....................................................................... 253

Conclusion ... .... ..... ...... ......... ............. ........... ......... ..... .......... ..... ..... 254

Pathology of the scrotum, A. Sibert, E. Someville, S. Blangy and R. Benacerraf .... ........... ....... ...... ........... ........... ......... ............. .... .... 257

Examination technique ... .... ........ ..... ...... ..... .... ......... ............. ..... .... 257 Normal appearance ........................................................................ 257 Pathology of the scrotum ............................................................... 258

Mass lesions of the testes ...................................................... '" 259 Inflammatory pathology: orchiepididymitis ....... ..... ...... ..... .... 259 Traumatic pathology..... ........ ....... .... ....... ......... ........... .... ..... .... 259 Other pathological conditions .. ...... ......... ........... ...... ....... ... ...... 259

Conclusion ............... ........... ....... ........ ............. ....... .... ........... ......... 261

Joints, F. Gires, A. Chevrot, A. Leroy-Willig, M. Wybier, C. Vallee, J.C. Roucayrol and G. Pallardy ........................................................... 263

General technical points ................................................................ 263 Pulse sequences ... ...... ...... ....... ........ ......... ........... .... ....... .... ...... 263 Coils ......................................................................................... 263 Parameters influencing image quality...... ............. .... ......... ..... 264 Section plane and thickness .. ...... ........... .... ........... ......... ...... .... 264 Position of the patient....... ...... ........... ....... .... ..... ........ ...... ........ 264

Table of contents XXI

Examination procedure ............. ..................... .......................... 264 Tissue characterization in the different sequences .................. 264 Windows ... ............................................ ....... .............. ....... ....... 266

Normal images .............................................................................. 266 Shoulder ... ............ ..................... .......................................... ..... 266 Elbow ....................................................................................... 268 Hand and wrist ................................................................. ........ 268 Hip and sacroiliac joint ............................................................ 269 Knee ......................................................................................... 270 Ankle and foot ............. ................... ......................................... 270

General findings ....................... .............. ....... ................................ 270 Liquid effusion ............ ................................... ...................... .... 270 Cartilages ............. .............. ....... ............................... .......... ...... 271 Subchondral bone .............. ..... ....... .......................................... 271 The synovial membrane ... ....................... ............................. .... 272 Ligaments and tendons ...... ....... ..................... .......... .......... ...... 272 Muscles ... .............. ....... ..... .................................................. ..... 272

Pathological conditions ..... ..... ................ ............ ...................... ..... 272 Trauma ..................................................................................... 272 Infection and arthritis ............................................................... 278 Osteonecrosis ...... ....... .............. ....... ......................................... 278 Sympathetic reflex dystrophy............. ..................... ........ ........ 278 Arthrosis and mechanical dystrophy.... ............ ..... .................. 279 Primary synovial osteochondromatosis ........ -...... ..... ................ 280 Periarthritis ...... ....... ..... ................ ..... .......................... ..... ..... ... 280 Metabolic arthropathy.. ........... ..... ..... ............................... ........ 280 Periarticular soft tissue disease and other pathogical conditions ............... ..... ....... ......... ..... ............................... ......... 281

Spine, N. Grenier, I.F. Chateil, P. Kien, H. Kressel, I.M. Caille and 1. Broussin .................................................................................... 285

Technical considerations ............................................................... 285 Surface coils ..... ......... ..... ......... ....... ..... .............. ................. ...... 285 Spatial resolution and signal-to noise ratio .............................. 285 Choice of the sequences ...................... .... ............ ............ ......... 286 Limitation of motion artifacts... ..... ....... ......... ............ ..... ......... 286 Choice of the section planes ....... ....... ..... ................ ..... ............ 287

Normal images .............................................................................. 287 Lumbar spine... ................ .............. ....................... ......... ....... ... 287 Dorsal spine ............................................................................. 291 Cervical spine .... ......... ....... ......... ..... ....... ................ ......... ........ 292

Degenerative pathology.... ........... ..... ......... ....... ..... ......... ......... ...... 294 Lumbar level......... ......... ..... .... ....... ....... ....... ......... ............... .... 294 Cervical level ... ....................... ......... ..... .............. .... ....... .......... 300

Infections of the disk and of the vertebra .... ......... ....... .................. 302 Spondylolysis and spondylolisthesis ............................................. 303 Trauma ........................................................................................... 303

Detection of epidural hematomas .. ................ ................ .......... 304 Bone lesions ....... ..... .... ......... ..... ......... ....................... ............... 304 Disk lesions ............ .... ......... ..... ......... ....... ....... ......... ......... ....... 304 Ligamentous lesions ....... ....... ..... .... ....... ................ .................. 304 Detection of spinal cord lesions............................................... 304

Inflammatory pathology........................ .............. ......................... 305

XXII Table of contents

Post-treatment appearance of the spine ......................................... 306 Post-surgery ............................................................................. 306 Post-chemonucleolysis ............................................................ 306 Post-radiation therapy .............................................................. 307

Spinal tumors................................................................................. 307 Benign tumors .... ..... .... ....... .... ....... .... ..... ......... ......... ......... ....... 307 Malignant spine tumors ........................................................... 309

Conclusion....... ......... ......... ........... ........... ......... ..... .... ....... ....... ...... 311

Primary musculoskeletal tumors, D. Vanel and C. Coffre .............. 315 Advantages and limitations of MRI .... ......... ..... ........... ..... .... ... ..... 315

Advantages .............................................................................. 315 Limitations ............................................................................... 315

Technique ...................................................................................... 315 Contribution of MRI to diagnosis .. ...... ......... ......... ......... ......... ..... 317 Assessment of tumor extension ... ......... .... ......... ..... .... ..... ......... ..... 318

Intramedullary extension of bone tumors .. .... ......... ......... ........ 318 Soft tissue extension ...... ....... ...... ......... ................ .... ......... ....... 319 Vessels ..................................................................................... 319 Intraarticular expansion " ........ .... ........... ......... ........... .............. 319

Treatment efficacy..... ........... ....... ...... ........... ......... ........... ......... .... 320 Post-treatment checkup ................................................................. 321 Practical examples ......................................................................... 322

Osteosarcoma ........................................................................... 322 Ewing's sarcoma ...................................................................... 324 Chondrosarcomas .......... .... ............. ....... .... ........... ................... 325 Chordoma and other sacral tumors .......................................... 325 Other primitive malignant bone tumors ................................... 325 Soft-tissue tumors .................................................................... 325

Conclusion ... ....... .... ......... ................. .... ........... ........... ........... ..... ... 325

Bone Marrow: MRI of diffuse and multifocal bone marrow malignancy, J. Leclere, D. Couanet, L. Ollivier and C. Parmentier .. 327

Technique ...................................................................................... 327 Normal bone marrow ..................................................................... 328 Pathological bone marrow ............................................................. 328

Low-signal marrow .................................................................. 330 High-signal marrow ................................................................. 330 Multifocal bone marrow disease .............................................. 333

Conclusion ............ , ........................................................................ 335

Role of MR in non-oncologic pediatric imaging, V. Taviere .......... 339 Technique .... ........... ........... ............. ........... .... ..... ............. .... ..... ..... 340 Indications ..................................................................................... 342 Discussion ..................................................................................... 347 Conclusion..... ........... ........... ....... .......... ....... ........... .... ......... ....... ... 349

MRI in pediatric oncology, D. Couanet ........................................... 351 Material and techniques ............. .... ............. ......... ........... .... ....... .... 351 Tumoral pathology ........................................................................ 353

Neuroblastoma ......................................................................... 353 Nephroblastoma ....................................................................... 356

Table of contents XXIII

Non-Hodgkin lymphoma (NHL) ............................................. 356 Rhabdomyosarcoma and soft-tissue sarcomas ........................ 357 Hepatoblastoma ... .... ..... .... ......... ......... ....... ............ .... ........... ... 359 Hodgkin's disease ..................................................................... 359

Conclusion .. .... ......... ..... ... ...... ......... ......... ....... ....... .... ..... ......... ...... 359

Obstetrical MRI, F. Heran ................................................................ 363 The mother ...... ......... ..... .... ..... ......... ....... ......... ....... .... ..... ....... ....... 363

MRI pelvimetry ........ ....... ..... .... ..... ....... ........... ....... ..... ....... ..... 363 Lumbar spine in pregnant women ... .... ..... .... ......... ... ....... ..... ... 364 Uterus ....................................................................................... 365 Trophoblastic tumors ... .... ......... ......... ..... .... ..... ....... ..... ....... ..... 365

The fetus ........................................................................................ 366 General points ... .... ......... ....... ....... ... ...... ......... ....... ..... ....... ....... 366 Appearance of the major organs .............................................. 366 Other intrauterine structures .... ......... ....... ......... ..... ..... ....... ...... 367

Application of MRI to radiation therapy, B. Aubert ...................... 369 Contribution of MRI to radiation therapy planning ...................... 369 Geometric distortion ...................................................................... 370

Gradient calibration ................................................................. 370 Distortion in multiple-slice mode ............................................ 371

Index ................................................................................................. 375