MR Imaging ofthe Knee using Fat Suppression Technique: A Preliminary Report 1

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1 Journ l of the Koren Rdiologic l Society : 30(3) : MR Imging ofthe Knee using Ft Suppression Technique: A Preliminry Report 1 Jin SuckSuh, M.D., Mi Hye Kim, M.D., Yong Soo Kim, M.D.2, Je Hyun Cho, M.D., Chng Yun Prk, M.D. Yeon Hee lee, M.D. Purpose: The purpose of this study is to evlute the usefulness of ft suppressiontechnique for MR imging ofthe knee. Mterils nd Methods: Twenty-eight knees of 26 ptientswere imged t 1.5 T MR system. Sgittl nd coronl T2-Weighted spin echo imges (SET2) nd sgittl ft suppression SET2{FSSE) were otined in ll cses. We used chemicl shift imging method for ft suppression. We compred FSSE with SET2 in terms of the conspicuity of lesions of menisci, crucite ligments, crtilge, one nd softtissue ofthe knee. Results: Meniscl lesions were detected on FSSE nd SET2 s well. FSSE depicted the lesion more conspicuously in 6 cses. For the depiction of ACl ter, SET2 ws superior to FSSE in 5 cses. FSSE ws etter for the visuliztion of the norml structure of crtilge nd it lso depicted the crtilginous lesions more conspicuously in 3 cses. Though one ruise could e detected on oth techniques, FSSEws etter. Conclusion: FSSE could provide the improved delinetion of menisci, crtilge, one ruise nd other soft tissues except the injuries of nterior crucite ligment. Although FSSE is relile method, it cn not replce SET2. It my e used s complementl method in the imging ofthe knee. Index Words : Knee. injuries Knee. MR studies Mgnetic resonnce (MR). comprtive studies Mgnetic Resonnce(MR). p 비 se sequences Mgnetic Resonnce(MR). technology INTRODUCTION Mgnetic resonnce (MR) imging hs ecome useful tool for imging the musculoskeletl s well s crnil system. Conventionl spin - echo(se) imging hs een most commonly pplied for injuries of the evlution of the knee (1-6) with 3- dimensionl grdient- echo imging (7-9). Chemicl shift imging technique hs lso een proposed to e helpful for tht purpose with the development of the techniques (10 20). We prospectively designed this study to compre the 1 Deprtment ofdignostic Rdiology, Yonsei University Coll ege 01 Medicine 2Deprtment ofdignostic Rdiology.lnJe University College 01 Medicine Received August 6, 1993 ; Accepted Septemer 15, 1993 Address reprint requestto: Jin-Suck Suh, M. D., D ep ηm ent oldignostic Rdi l ogy, Yonsei University College 01 Medicine, 134, Shinchon-Dong, Seodemun-Ku, Seoul, Kore. Tel.(82-2) clinicl efficcy of chemicl shift selective (CHESS) presturtion technique with conventionl SE technique in the evlution ofthe knee. MATERIAlS nd METHODS Mterils nd imging methods A totl of 26 ptients 28 knees with suspected internl derngement of the knee underwent MR exmintions. Arthroscopy ws pertormed in 5 ptients within one month fter the MR exmintion. AII ptients underwent plin rdiogrphy wheres only one did rthrogrphy AII ptients were exmined prospectively ccording to designed protoc 이 with 1.5 T MR imger (Sign ; GE Medicl System, Milwukee USA). AII exmintions were performed often positioning the knee nturlly in the mgnet with using dedicted trnsm it receive extremity coil. For loclizer we cquired n %

2 Journl of the Koren Rdiologicl Society, 1994 ; 30(3) : xil SE T1 - weighted Imge (wl) with repetition time (TR) of 500 msec nd echo time (TE) of 30 msec. SE T2 - WI (SET2) consisting of TRs of msec nd TEs of msec (TR/TE= /20-80) ws used to otin sgittl imges, followed y SE T2WI with ft suppression(fsse). Coronl imges were otined y SET2 sequence AII imges were otined with mtrix size of 256 y 192 or 256 y 256, field of view of cm, nd one excittion. The slice thickness ws 3 mm, with inter slice gp of 1 mm. For the sgittl plne, we switched the phse nd frequency encoding directions to void chem icl shift rtifcts. For the FSSE we used chemicl shifting selective (CHESS) imging technique which hs the component of the frequency selective preprtion pulse, followed y conventionl SE sequence. We otined imges of the exctly sme plne for compring FSSE with SET2 sequences. The imging time with FSSE is equl to tht with SET2 when we use n equ ivl ent TR. Imge Interprettion We compred two techniques using the SET2 s stndrd reference ecuse it hs the known sensitivity nd specificity of the menisci nd ligments injuries (1, 2). For the comprison of SET2 nd FSSE on the sgittl plne, oth imges were reviewed y two of the uthors ( one rdiology specilist nd resident) t seprte session nd they mde consensus if the initil interprettion were different. First of ll, we undertook n interprettion for the first nd the second echo imges together, otined y SET2 sequence on the sme plne. And then we did it gin for the Imges y FSSE sequence. We tried to evlute the qulity of Fig. 1.. The lirst echo SET2 shows the low signl intensity 01 cortex nd meniscus nd tendon. Crtilge hs n intermedite signl in contrst to lt (Rectngulr cursors re mrked lor the mesurement 01 the signl intensity). In the second echo FSSE, Crtilge ecomes right nd muscle is 01 intermedite signl. Fig. 2. The signl difference olthe ACL nd PCL nd. In the second echo SET2, the PCL is seen hving drk signl unilormly, ut the ACL is seen s rod nd hving vrile signl intensities c. In the lirst echo FSSE the ACL hs ecome righter c

3 signl nd the clen visuliztion of structures of the knee. They re medil meniscus (MM), lterl meniscus (LM), nterior crucite ligment (ACU, posterior crucite ligment (PCU, crtilge, one mrrow, nd soft tissues. When they were pthologic in ppernce or signl, we ctegorized them into two groups, n ovious normlity nd n undetermined lesion. Therefter we tried to determine which pulse sequence is etter for the delinetion of lesions nd norml structures y compring oth pulse sequences. Meniscus ter ws dignosed when the incresed signl in the meniscus extended to the rticulr surfces or there ws deformity of meniscus itself. Crucite ligments were evluted for ters. We consider it ter when the signl of ligments ws not identified (non -visul iztion) or disrupted, or when the signl in the ACL ws highly incresed, nd when ACL showed nterior concvity with irregulr surfce (1). The criteri of norml crtilge ws irregulrities on the surfce. The one nd one mrrow were considered norml when T2WI reveled high signl intensities Jin Suck Suh, et l : MR Imging of the Kn ee usin g Ft Suppression Tec hnique 40 CNR SNR PWI T2WI.. PWI+FS 總꺼 A nd ltertion of shpe t the corticl mrgin. 80ft tissue structures of the knee joint re tendons, urse, muscles. They were considered norml when they hd n ltertion of norml signl chrcteristics. Imge nlysis No sttisticl nlysis ws underwent ecuse the numer ofthe ptients ws sml l. Clcultion of rtio of signl to noise (SNR) nd of contrst to noise (CNR). We lso mesured the signl intensity (81) of ech structure which ws considered norml so s to ojectively compre the contrst of the signls from meniscus, ligment, crtilge, joint fluid, nd one etween the two pulse sequences. For the mesurement we plced of squre shped region of interest (ROI) nd otined signl intensities using uilt-in routine of the MR scnner. And then, 8NR of ech structure ws CA:MS 디 FAT : MS ð FLUID MS A 1\/ν \μ 샤삐 / 게 BM CART FAT MN MS FLUID ACL1 ACL2 PCL FAT2 BG Fig. 3. The SNRs 01 ech region 01 interest 5 o PWI T2WI PWI+FS T2WμFS Fig. 5. The CNRs re different etween meniscus nd crtilge nd Iluid ccording to the pulse sequences, nd the CNR is excellent etween meniscus nd fluid in the li rst echo FSSE 50 SNR 45 CN 려 O 서 30 T BM : CA 口 FAT : CA ðms :CA MC : CA FLUID :CA 25 I I ::l U n LJ 는늠 l 10 o PWI T2WI PWI+FS T2WI+FS Fig. 4. The verge 01 the SNRs in the ech structure indicted re dependent on the sequences PWI T2WI PWI+FS T2WI+FS Fig. 6. The CNRs etween crtilge nd meniscus nd one mrrow re high in the lirst echo FSSE. %

4 Journl of the Koren Rdiologicl Society, 1994: 30(3 ) : clculted y the formul SNR= SI(ROI)/the stndrd devition of SI (ckground). CNR ws otined nd trnsformed it to n solute vlue y the formul, NR= SI (ROI1) -SI (ROI 2)/the stndrd devition of SI (ckground) CNR FL: ACL1 '" FL: ACL 2 o PWI T2WI PWI+FS T2WI+FS Fig. 7. The CNRs etween fluid nd the ACL nd PCL re represented. The second echo SET2 is the highest. RESULTS For the detection of signl normlities, it is necessry to hve high SNR of ech structure nd high CNR of one to djcent structures. The contrst of one to other structures is different etween SET2 nd FSSE. The signl nd contrst of the FSSE wwer optiml for the demonstrtion of the knee. The first echo FSSE showed the high signl intensity of rticulr crtilge nd j 이 nt effusion, nd the low signl intensity of menisci, tendons, ligments (except nterior crucite ligment of intermedite signl intensity), ft nd med 비 lry one (Fig. 1, 2). The muscles showed the intermedite signl intensity. The second echo FSSE ws not s good s the fi rst echo FSSE ecuse the former reveled reduced SNR with poor visuliztion of the norml structure except distinguishing rticulr crtilges from joint fluid which hd right signl The results of SNR nd CNR were shown in norml structures (Fig. 3-7). The SNR ws high in crtilge, fluid, nd ACL on the first echo FSSE (Fig. 3). The contrst etween menisci nd djcent crtilge nd fluid ws etter in the first echo FSSE thn the other imges Fig. 8. Lterl meniscus ter with incomplete discoid ppernce in the ptient hving the intermittent knee pin which hs egn during the volleyl l.. In the first echo SET2, meniscl ter is well disclosed. Excellent contrst etween ter contining fluid nd meniscus is oserved in the FSSE Fig. 9. Anorml signl in the medil men- ISCUS.. In the first echo SET2, the meniscus looks like hving type 2 signl. In the first echo FSSE, this liner signl is utting the inferior rticulr surfce of the meniscus. This normlity hs not yet confirmed y rthroscopy -566

5 Jin Suck Suh, et 81: MR Imging 01 the Knee using Ft Suppression Technique (Fig. 5). The contrst etween crtilge nd either medullry one or meniscus ws superior in the first echo FSSE to tht of SET2 (Fig. 6). The CNR of fluid to crucite ligments is high in the SET2 (Fig. 7) A totl of 28 knees ws included for compring FSSE with SET2 sequences. Twenty-one ptients hd one or more history of trum efore the MR exmintion, with durtion of rnging from 24 dys to severl yers. A summry of the results is provided in Tle 1. There were 18 meniscl ters, 10 involving medil Fig. 10. ACL prtil ter in the ptient, who is sketll plyer, with knee i 미 ury two months elore the MR exmintion. In the second echo SET2, ACL ter cn e well identilied, surrounded y right signl ofthe jointfluid.. In the lirst echo FSSE the signl 01 the ACL is not distinguished Irom the Iluid s well sset2 meniscus nd 8 involving lterl meniscus. Three lterl menisci which hd ter were discoid ppernce. For the meniscl ter, FSSE reveled ter p Fig. 11. A Prtil ter with hemtom in the PC L. () In the second echo SET2 nd () in the second echo FSSE, high signl is seen well i n contrst to the drk si gnl i ntensity 01 the PCL Fig. 12. Well visuliztion 01 hyline crtilge in the ptient with complint 01 intermittent knee pin. In the lirst SET2, intermedite signl is seen in hylinecrtilge.. In the lirst echo FSSE, the signl 01 rticulr crtilge is very high, resulting in excellent contrst etween the rticulr crtilge nd one nd meniscus. % /

6 Journl of the Koren Rdiologicl Society, 1994; 30(3) : Fig. 13. Pes nserinus ursitis in the ptient without n cute injury. () In the first echo nd () the second echo FSSE, right fluid signl is seen t the ttchment region f the pes nserius in ddition to ter of the posterior horn ofthe medil meniscus Tle 1. Summry ofthe SET2 nd FSSE in 28 Knees Findings SET2 F88E Menisci Norml Undetermined 2 2 Ter ACL Norml Undetermined 3 3 Ter 5 6 PCL Norml Undetermined 0 Ter Crtilge Norml Poor 11 Anorml ft tissue Norml Undetermined 2 Anorml 3 4 Bone Norml Undetermined 3 Anorml 0 6 prently in 6 cses etter thn SET2 did ecuse ter hd etter contrst in the former thn in the ltter( Fig. 8). One showed ter with FSSE ut it ppered in the undetermined ctegory with SET2(Fig. 9). In the re mining 5, we lredy red s to meniscl ters with greement. As we use the rthroscopic findings s gold stndrd in 5 cses, 2 ters nd 3 norml of the medil meniscus, they were well correlted with the MR interprettion. For the lterl meniscus we did not find rdil ter(tlse negtive). Of the remining 4 there were one norml nd 3 ters confirmed r throscopiclly(tle 2) Of the 28 ACLs, 20 were norml, 5 hd ters, nd 3 were undetermined. SET2 gve more confidenue thn FSSE in the ccignosis of norml ACLs in 5 of 20 norml ACLs. Among 5 ters, only one showed etter delinetion of ter with SET2 thn FSSE (Fig. 1 이. There ws only one PCL lesion which hd hemtom or fluid collection within the PC L( Fig. 11). Both ACL nd PCL were correctly disclosed on MR imges in the 5 cses confirmed rthroscopiclly. There ws only one prtil ter of ACL, wheres others were norml. We mde n greement tht femorl crtilges were norml in 23 knees nd norml in 4 nd One ws poor in gnol ity. The crtilge ws norml in 12 cses (Fig. 12) nd there were 3 crtilginous normlities. The imges with ft suppression ws etter thn those without ft suppression. Five cses of nthroscopiclly confirmed normlity were norml on MR imges. We did not try to evlute MR imges for ptell nd tiil crtilges. We found soft tissue normlities such s pes nserinus ursitis(fig. 13), ptellr tendon injury, preptellr soft tissue thickening, gnglion, nd poplitel cyst. Two of these were distinct in nture of the lesion on FSSE. Six of the 28 knees showed normlly in cresed signl within the one on FSSE(Fig. 14), wheres only3 showed equivocl chnge in signl intensities on SET2. Although these signl chnges of medullry one in contrst to the djcent norml looking signl hve een not proven histologiclly or y the f 이 low - up studies, these were considered to e either hemorrhge or edem which were proly relted to previous trum or chronic stress. MR imging hs n dvntge for detecting the norml soft tissue nd one normlities over the rthroscopy DISCUSSION Chemicl shift imging my llow n improved contrst etween lesions nd norml structures y wy of

7 Jin Suck Suh, et l: MR Imging of the Knee using Ft Suppression Technique Fig. 14. Bone mrrow edem or hemorrhge with n vulsion frcture olthe ACL t the tiil ttchm en t.. In the first echo SET2, one mrrow norml signl is not well seen s well in the second echo SET2 (not shown here). In the first echo FSSE, multiple regions 01 high signl intensity re seen in the tii nd femur Tle 2. Comprison of SET2 nd FSSE with Arthroscopic Findings in Five Ptients Arthroscopy Findings T- F- T+ F+ Medi l meniscus ter SET FSSE Lterl meniscus ter SET2 3 0 FSSE 3 0 ACL SET FSSE 4 0 o PCL SET2 5 0 o o FSSE 5 0 o o T - = True Negtive, F - = Flse Negtive T + = True Positive, F + = Flse Positive ABBREVIATIONS: BM : one mrrow CART : crtilge FAT :ft MS : meniscus MC : muscle FL : fluid ACL : nterior crucite I igment ACL 1 : nterior crucite I igment upper hlf ACL 2 : nterior crucite ligment lower hlf PCL : posterior crucite ligment FAT 2 : ft signl ner the crucite ligmnets SNR : signl-to-noise rtio CNR : contrst-to-noise rtio BG : ckground PWI : proton density weighted imge T2WI : T2-weighted imge PWI + FS : proton density weighted imge with ft suppression T2WI + FS : T2-weighted imge with ft suppression ET2 : T2-weighted spin echo imge SSE : ft suppresssion T2-weighted imge eliminting high signl of ft in the ntomic regions where undnt ft ppers. Vrious techniques of ft suppression hve een pplied in clinicl use. It is possile to eliminte the signl from ft ecuse ft nd wter hve slightly different resonnt frequencies Methods using phse sensitive implementtion re Dixon method, chopper ft suppression, nd threepoint Di xon technique(11-15). By the Di xon method oth in -phse nd out- of phse imges cn e otined. But the disdvntge is long post-proce ssing time. With chopper ft suppression, the limittion of p이 onged post- processing time cn e solved A technique sturting one chemicl component efore p 비 se sequence is chemicl shifted selective (CHESS) presturtion method(16). This technique is simple nd widely used in clinicl imging even though it hs disdvntge of inhomogeneous suppression of ft signl inspite of either the creful shimming of mgnet or modifiction of presturtion pulse,or oth (17). Somtimes, hyrid techniques hve een proposed for complete suppression of ft(18, 19). Another technique is short tu inversion recovery(stir) pulse sequence in which the pproprite inversion time is pplied to null out ft signi(20). The drwck is smll numer of slices we cn get in given TR time. Since MR imging hs een used for the evlution of knee pthology, its roles hve een descried(3, 4). The overll greement etween MR nd rthroscopic findings hs een reported to e over 90%(5). Vrious grding systems of meniscl injury hve een reported(6, 7). Pseudoters in lterl menisci on sgittl imges were demonstrted with emphsis on the orienttion of the meniscofemorl ligments.(21) In ymptomtic volunteeers, the grde 2 signl of the menisci were well correlted with the ge of ptients, nd erly ppernce of the signl normlities egun during the second decde(22). The signl chnge of the menisci cn occur with uncertin significnce fter repetitive impulsive loding cused y jogging (23). The efficcy of MR imging of ACL injuries including MR criteri of ACL ter ws descried in detils(1). % -

8 Journl of the Koren Rdiologic l Society, 1994 ; 30(3 ) : MR imging fter ACL reconstruction ws well correlted with rthroscopic results(2). MR imging is useful in the ssessment of the sttus of the osteochon- drl lesions, occult sucorticl osteochondrl frc- tures, nd lterl tiil rim(segond) frctures(24-2?) Some investigtors compred different imging techniques to determine which one ws etter or worse(7-9, 28). There were no difference etween T1 nd T2 - weighted SE imging for the meniscl evlution(28). Some prefer 3D MR imging to 20 SE imging for the detection of meniscl or ligmentous injuries or oth ecuse the former hs n dvntge f the thin, contiguous section s well s high ptient through put(7-9). Others thought tht 20 SE nd 3D grdient echo imging hd complementry role for the evlution of the internl derngement of the knee (29) Li ttle hve een reported out the knee MR imging using ft suppression techniques(10, 30, 31). The ft suppression techniques cn provide good contrst resolution in the region where high signl of the undnt ft oscures lesions, nd cn eliminte the chemicl shift misregistrtion prolems t tissue interfces. The chemicl shift selective(chess) imging technique, s we hd used, cn simply e pplied to lmost ll imging techniques commercilly ville. Hyline crtilge invrily ppers right on oth T1 - or T2 - weighted imges with ft suppression so tht rticulr crtilge is redy to e distinguished from corticl ones, ft, nd muscles. Although other uthors hd difficulties in distinguishing muscle nd hyline crtilge or fluid nd crtilge, we didn 't met ny prolems to distinguish crtilge disorders from fluid. Tht ws ecuse we used longer TR thn tht they used. There is no difference etween two techniques for the meniscl lesions(30), ut in our experience, the contrst etween menisci nd rticulr crtilge is superior on ft suppression imges. We could hve confidence in the detection of one ruises nd sucorticl lesions which could not e disclosed on conventionl SE imges. We hve to e cutious to tell the ACL ter, ecuse even norml ACL my pper right Our study hs some limittions: the numer ofcses included ws smll ; rthroscopic findings were ville in only 5 cses ; s we reviewed FSSE fter reviewing SET2, this could give rise to potentil interprettion is In summry, FSSE provides us the improve choice replcing SET2 sequence for the evlution of knee. REFERENCES 1. Lee JK, Yo L, Phelps CT, Wirth CR, CzjkJ, Lozmn J. Anterior Crucite ligment ters: MR imging compred with rthroscopy nd clinicl tests. Rdiology 1988 ; Rk KM, Gill 이 y SO, Scheler RA, Ykes WF, Li ljedhl RR. Anterior crucite ligment reconstruction: evlution with MR imging. Rdiology 1991 ; 178 : Bssett LW, Grover JS, Seeger LL. Mgnetic resonnce imging 01 knee trum. Ske/etl Rdio/1990 ; 19 : Hrtzmn S. Reicher MA, Bssett LW, Ouckwiler GR, Mndelum B, Gold RH. MR imging 01 the knee. prt 1. chronic disorders. Rdiology 1987 ; 162: Mink JH, Levy T, Crues JV Ters 01 the nterior crucite ligment nd menisci 01 the knee: MR imging evlution. Rdi ology 1988 ; 167 : Crues JV, Mink J, Levy TL, Lotysch M, Stoller ow. Meniscl ters 01 the nee : ccurcy 01 MR imging. Rdiology 1987 : 164 ; Tyrrell RL, Gluckert K, Pthri M, Modic MT. Fst threedimensionl MR Imging 01 the knee: comprison with rthroscopy. Rdiology 1988 ; 166 : Hrms SE, Flmig OP, FisherCF, Fulmer JM. New method lorlst MR imging olthe knee. Rdiology 1989 ; 173: Hggr AM, Froelich JW, Hershen 00, Sdsvn K. Meniscl normlities 01 the knee : 30FT Fst-scn GRASS MR imging AJR 1988 ; 150 : Tottermn S, Weiss SL, Szumowski J, Ktzerg RW, Hornk JP, Proskin HM, Eisen J. MR lt suppression technique in the evlution 01 norml structures 01 the knee. J Comput Assist Tomogr 1989 ; 13 : Oixon WT. Simple proton spectrocopic imging. Rdiology 1984 ; 153 : Lodes CC, Felmlee JP, Ehmn RL. Seghl CM, Greenlel JF, Glover GH, Gry JE. Proton MR chemicl shift imging using doule nd triple phse contrst cquis 비 n methods. J. Comput Assist Tomogr 1989; 13 : Glover GH, Schneider E. Three-point Oixon technique lor true wter/lt decomposition with BO inhomogeneity correction Mgn Reson Med 1991 ; 18 : Szumowski J, Plewes OB. Sepertion 01 lipid nd wter MR imging signls y chopper verging in the time domin. Rdiology 1987 ; 165 : Borrello JA, Chenevert TL, Meyer CR, Aisen AM, Glzer GM. Chemicl shift-sed true wter nd lt imges: regionl phse correction 01 modilied spin-echo MR imges. Rdiology 1987 ; 164 : Hsse A, Frhm J, Hnicke W, Mtthei O. H-NMR chemicl shift selective (CHESS) imging. PhysMed 8io/1985 ; 30 : Mo J, Yn H Bidgood O,Jr. Ft suppression with n improved selective prest

9 Jin Suck Suh, et l: MR Imgin g of the Kn ee using Ft Suppression Technique 21. Vhey TN, Bennett HT, Arrington LE, Shelourne KD, Ng liction, nd short-term sequle evluted with MR imging. J. MR imging 01 the knee : pseudoter 01 the lterl men- Rdiology 1991 ; 178: iscus cused y the meniscolemorl ligment. AJR 1990 ; 27. Mink JH, Deutsch AL. Occult crtilge nd one i 미 uries : the knee: detection, clssiliction, nd ssessment with MR 22. Kornick J, Trelelner E, McCrthy S, Lnge R, Lynch K, Jokl P. imging. Rdiology 1989 ; 170: Meniscl normlities in the symptomtic pop 비 tion t 28. Evncho AM, Fjmn WA, 8tiles RG, Brunner MC, Peterson MR imging. Rdiology 1990 ; 177 : J, Fleming L. Mgnetic resonnce imging 01 knee menisci 23. Kursunoglu-Brhme S, 8chwigholer B, Gundry C, Ho C, Comprison 01 spin echo pulse sequences. Invest Rdiol Resnick D. Jogging cuses cute chnges in the knee joint: 1990 ; 25: n MR study in norml volunteers. AJR 1990 ; 154: 29. Reeder JD, Mtz 80, Becker L, Andelmn SM. MR imging the knee in the sgittl projection : comprison 01 three- 24. Desmet AA, Fisher DR, Grl BK, Lnge RH. Osteochondritis dimensionl grdient-echo nd spin-echo sequences AJR dissecns 01 the knee: vlue 01 MR imging in determining 1989 ; 153 : lesion stility nd the presence 01 rticulr crtilge 30. Koenig H, 8uter R, Deimling M, Vogt M. Crtilgedisorders delects. AJR 1990; 155 : : comprison 01 spin-echo CHESS, nd FLASH sequence MR 25. Weer WN, Neumnn CH, Brkos JA, Petersen SA, imges. Rdiology1987 ;164: Steinch L8, Gennt HK. Lterl tiil rim (Segond) 31. Chndnni VP, Ho C, Chu P, Trudell D, Resnick D. Knee hy- Irctures: MR imging chrcteristics. Rdiology 1991 ; 180 line crtilge evluted with MR imging : A cdveric study : involving multiple imging sequences nd intrrticulr in- 26. Veliet AD, Mrks PH, Fowler PJ, MunroTG Occult posttru- jection 01 Gdolinium nd sline solution. Rdiology 1991 mtic osteochondrllesions 01 the knee: prevlence, clssi- 178: 대한방사선의학회지 1994: 30(3) : 지방신호억제방법을이용한슬관절의자기공명영상 : 예비보고 서진석 김미혀 1. 김용수 1. 조재현 박창윤 이연희 연세대학교의과대학진단방사선과학교실 1 인제대학교의과대학방사선과학교실 목 적. 자기공염영상방법을사용하여슬관절의병변을진단하려고할때통상적인스핀에코방법과, 지방신호억제를병 행한스핀에코방법의차이점을알아보고자하였다. 대상및방법. 슬관절의병번이의심되는 26 명의환자 (28 슬관절 ) 에게 1. 5T 자기공명영상장치를사용하여시상면을따 라통상적인스핀에코방법과, 지방신호억제를병행한스핀에코방법을시행하여영상을얻었다. 지방억제방법은화학이동 선택공명 (CHESS ) 방법을사용하였다. 두방법의동일면영상을비교할때, 반월판연골, 십자인대, 관절연콜, 을및연부조직 의병변유무와확실성 ( Conspicuity) 에중점을두었다. 결과 : 지방신호억제방법을이용한영상에서반월판연굴, 관절연콜, 골및연부조직의병변을좀더잘관찰할수있었 다. 그러나전십자인대의병변관찰에는통상적인스핀에코방법이좋았다. 결 론 : 저자들은지방신호억제를병행한스핀에코방법과통상적인스핀에코밤법은슬관절의병변을진단하는데상호 보완적인역할을할것으로사료된다. m

10 따1994 년도국제학술대회일정표 [ill] 1994/06/05-09 Cirse 94 - Crdiovsculr nd Interventionl Rdiologicl SOC. venue: contct : of Europe Aghi Pelghi Crete, Greece. Mrs. B. Läuli, Ex. Oir. C.I. R.S.E., P.O. Bos 201, 8028 Zurich, Switzerlnd. (tei: ; fx: ) [004697] 1994/06/12-14 Europen Congress on Medicl Rdiology venue: Kongressent. Folkets Hus Oslo, Norwy. contct: Christine B. Askim, Help Arrngement - Service, P.O. Box 597, 1301 Sndvik, Norwy. (te 1: ; fx: ) 1994/06/ th Annul Conf. nd Postgrdute Course in Hed nd Neck Rdiology venue: Wshington O.c., USA. contct : Ms. Beth A. Filip, Am. Soc. Hed & Neck Rdiol, 2210 Midwest Rod, Ok Brook, IL 60521, USA (te1: ; fx: ) 1994/07/12-14 Esdir Seminr - N eurordiology nd N euroscience venue: Mrseille, Frnce. contct: Prof. L. Pssriello, U niversity L Spienz", Policlinico Umerto!, Rome, LI, Itly (tel: ; fx : ) [000865] 1994/07/ th Triennil congress World fed. For Ultrsound in Medicine nd Biology venue: Spporo Prk Hotel Spporo, Jpn. contct: Or. Morimichi Fukud, MO, Spporo Medicl Co llege, (tel:81-\\-61121\\ ; fx:81-\\ ) [004075] 1994/08/ th Annul Meeting of the Society of Mgnetic Resonnce in Medicine venue: Sn Frncisco Hilton & T. Sn Frncisco, CA, USA contct: SM RM Business office, Sutie 3C, \9\8 University Avenue, Berkeley, CA 94704, USA. (tel: 1-5\0-84\ \899 ; fx: \ \2340) 1994/08/ th Intern. Conf. on Mgnetic Resonnce Biologicl Syst. venue: Koningshof Ve1dhoven, The Netherlnds. contct: Mrs. A. Mnders, Koningshof, P.O. Box \40, 5500 AC Veldhoven, The Netherlnds (tel: ; fx:) 제공 : 대한방사선의학회국제협력위원회