Özkan ÜNAL, Kemal KIRMACI, Serhat AVCU, Aydın BORA

Spinal MR görüntülemede restoreTSE sekansının tanıya olan katkısı

Bu çalışmada T2-ağırlıklı spinal MR görüntülemede restore Turbo Spin-Eko (TSE) sekansının tanıya olan katkısının belirlenmesi amaçlandı. Farklı ön tanılarla spinal MRG incelemesi yapılan 150 hastaya sagital planda T2-ağırlıklı TSE ve restore TSE sekansları uygulandı. 1.5 Tesla cihazda inceleme parametreleri TSE ve restore TSE sekans için eşit tutuldu. Her iki sekans BOS’un parlaklığı, vertebral kemik yapılar, intervertebral diskler, cilt altı yağlı doku ve spinal kord görüntüleri açısından karşılaştırıldı. Tüm incelemelerde T2-ağırlıklı restore TSE sekansı BOS’un daha parlak gösterilmesini ve çevre yapılardan daha iyi ayırt edilmesini sağlamıştır. Anterior subaraknoid mesafedeki daralmalar, spinal korda disk basısı, tümörlerin kistik komponentleri ve kistik lezyonlar restore TSE sekansı ile daha iyi vizüalize edilmiştir. Vertebral kemik yapılar, intervertebral diskler, ciltaltı yağlı doku ve spinal kord için her iki sekans arasında sinyal farklılığı saptanmamıştır. Hastaların değerlendirilmesinde tanısal açıdan restore TSE sekansının dezavantajı görülmemiştir.T2-A restore TSE sekansı BOS’u daha parlak göstermektedir. Özellikle servikal disk patolojilerinde tanıya daha fazla katkı sağlamaktadır. Ayrıca, servikal bölgede BOS akım artefaktları daha az izlenmiş, kistik lezyonlarda ve kistik komponentleri olan tümör olgularında üstün bulunmuştur. Spinal incelemelerde görüntü kalitesine sağlayacağı katkı nedeniyle restore TSE sekansının kullanılmasını önermekteyiz.

Diagnostic contribution of restore TSE sequence in spinal MR imaging

In this study, the diagnostic contribution of restore TSE sequence in T2-weighted spinal MR imaging is investigated.T2-weighted TSE and restore TSE sequences were performed in sagittal spinal MRI examination in 150 patients with different prediagnosis. 1,5 Tesla MRI system was used in this study. All examination parameters for both sequences were the same. Both sequences were compared for brilliance of cerebrospinal fuid, vertebral bony structures, intervertebral discs, and spinal cord images. In all examinations, restore TSE sequence showed cerebrospinal fuid brighter and distinguished surroundings better than TSE sequence. Demonstration of the narrowed anterior subaracnoid space, disc compression to spinal cord, cystic components of tumors and cystic lesions in restore TSE sequence was also better than TSE sequence. The tissues as vertebral bony structures, intervertebral discs, subcutaneous fatty tissue and spinal cord showed no defnite signal difference between the two sequences. No diagnostic disadvantage of the restore TSE sequence was observed in the evaluation of patients. Restore TSE sequence is especially helpful in the diagnosis of cervical disc pathologies and also it shows CSF brighter than TSE sequence. Besides, CSF fow artefacts are observed few in restore TSE sequence, and it is more useful than TSE sequence in cysts and tumoral lesions having cystic components. We recommend using restore TSE sequence in routine T2-weighted spinal examinations for its contribution in image quality.

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1. Scarabino T, Giannatempo GM, Perfetto F, Popolizio T, Salvolini U. Magnetic resonance myelography with a fast-spin-echo sequence. Radiol Med. 1996; 91:202-6.
2. 2. Larsen DW, Teitelbaum GP, Norman D. A possible pitfall on fast-spin-echo MR imaging of the spine simulating intradural pathology. Clinical Imaging 1996; 20:140-2.
3. Gillams AR, Soto JA, Carter AP. Fast spin echo vs. convantional spin echo in cervikal spine imaging. Eur Radiol. 1997; 7:1211-4.
4. Thorpe JW, Kidd D, Kendall BE, Tofts PS, Barker GJ, Thompson AJ, et al. Spinal cord MRI using multiarray coils and fast spin echo. I. Technical aspects and fndings an healthy adults. Neurology 1993; 43:2625-31.
5. Finelli DA, Hurst GC, Karaman BA, Simon JE, Duerk JL, Bellon EM. Use of magnetization transfer for improved contrast on gradient-echo MR images of cervical spine. Radiology 1994; 193:165-71.
6. Huang IH, Emery KH, Laor T, Valentine M, Tiefermann J. Fast-recovery fast spin-echo T2-weighted MR imaging: a free-breathing alternative to fast spinecho in the pediatric abdomen. Pediatr Radiol. 2008; 38:675-9.
7. Finelli DA. Magnetization transfer in neuroimaging. Magn Reson Imaging Clin N Am. 1998; 6:31-52.
8. Melhem ER, Caruthers SD, Jara H. Cervical spine: three-dimensional MR imaging with magnetization transfer prepulsed turbo feld echo techniques. Radiology 1998; 207:815-21.
9. Melhem ER, Benson ML, Beauchamp NJ, Lee RR. Cervical spondylosis: three-dimentional gradientecho MR with magnetization transfer. AJNR Am J Neuroradiol. 1996; 17:705-11.
10. Yousem DM, Atlas SW, Goldberg HI, Grossman RI. Degenerative narrowing of the cervical spina neural foramina: evaluation with high-resolution 3DFT gradient-echo MR imaging. AJNR Am J Neuroradiol. 1991; 12:229-36.
11. Yousem DM, Atlas SW, Hackney DB. Cervical spine disk herniation: comparison of CT and 3DFT gradient echo MR scans. J Comput Assist Tomogr. 1992; 16:345-51.
12. Ross JS, Ruggieri PM, Gliklih M, Obuchowski N, Dillinger J, Masaryk TJ,et al. 3D MRI of the cervical spine: low fip angle FISP vs. Gd-DTPA turbo FLASH in degenerative disc disease. J Comput Assist Tomogr. 1993; 17:26-33.
13. Feinberg DA, Kiefer B, Litt AW. High resolution GRASE MRI of the brain and spine. 512 and 1024 matrix imaging. J Comput Assist Tomogr. 1995; 19:1-7.
14. Held P, Seitz J, Fründ R, Nitz W, Lenhart M, Geissler A. Comparison of two-dimensional gradient echo, turbo spin echo and two-dimensional turbo gradient spin echo sequences in MRI of the cervical spinal cord anatomy. Eur J Radiol. 2001; 38:64-71.
15. Enzmann DR, Rubin JB. Cervical spine: MR imaging with a partial fip angle, gradient-refocused pulse sequence. Part I.General considerations and disk disease. Radiology. 1988; 166:467-72.
16. Sze G, Merriam M, Oshio K, Jolesz FA. Fast spinecho imaging in the evaluation of intradual disease of the spine. AJNR Am J Neuroradiol. 1992; 13:1383-92.
17. Chappell PM, Glover GH, Enzmann DR. Contrast on T2-weighted images of the lumbar spine using fast spin echo and gated conventional spin echo sequences. Neuroradiology. 1995; 37:183-6.
18. Ross JS, Ruggieri P, Tkach J, Obuchowski N, Dillinger J, Masaryk TJ, et al. Lumbar degenerative disk disease: prospective comparison of conventional T2-weighted spin echo imaging and T2-weighted rapid acquisition relaxation-enhanced imaging. AJNR Am J Neuroradiol. 1993;14:1215-23.
19. Robertson WD, Jarvik JG, Tsuruda JS, Koepsell TD, Maravilla KR. The comparison of a rapid screening MR protocol with a conventional MR protocol for lumbar spondylosis. AJR Am J Roentgenol. 1996; 166:909-16.
20. Lycklama à Nijeholt GJ, Barkhof F, Castelijns JA, Waesberghe JH, Valk J, Jongen PJ, et al. Comparison of two MR sequences for the detection of multiple sclerosis lesions in the spinal cord. AJNR Am J Neuroradiol. 1996;17:1533-8.
21. Hittmair K, Mallek R, Prayer D, Schindler EG, Kollegger H. Spinal cord lesions in patients with multiple sclerosis: comparison of MR pulse sequences. AJNR Am J Neuroradiol. 1996; 17:1555-65.
22. Ross JS. Newer sequences for spinal MR imaging: smorgasbord or succotash of acronyms. AJNR Am J Neuroradiol. 1999; 20:361-73.
23. Filippi M, Yousry TA, Alkadhi H, Stehling M, Horsfeld MA, Voltz R. Spinal cord MRI in multiple sclerosis with multicoil array: a comparison between fast spin echo and fast FLAIR. J Neurol Neurosurg Psychiatry 1996; 61:632-5.
24. Keiper MD, Grossman RI, Brunson JC, Schnall MD. The low sensitivity of fuid-attenuated inversionrecovery MR in the detection of multiple sclerosis of the spinal cord. AJNR Am J Neuroradiol. 1997; 18:1035-9.
25. 25. Scarabino T, Perfetto F, Giannatempo GM, Cammisa M, Salvolini U. The reduction of ferromagnetic artifacts by using a fast-spin-echo sequence in the postoperative assessment of degenerative diseases of the cervical spine. Radiol Med. 1996; 91:174-6.
26. Yıldız A, Özboyacı S. [New advances in functio- nal imaging methods]. Turkiye Klinikleri J Med Sci 2000;20:96-101.