1313

Perspective

. . ; . ‘ .f: ‘“ . . . :‘ :

Fast Spin-Echo MR Imaging of the Brain and Spine:

Current Concepts
American Journal of Roentgenology 1992.158:1313-1320.

Kendall M. Jones,1 Robert V. Mulkem,2 Richard B. Schwartz,1 KoiChi Oshio,1 Patrick D. Barnes,2 and
FerenC A. Jolesz1

Fast spin-echo (FSE) sequences are recently developed selectedFSE sequences. Improvements in image quality and
modifications of the rapid acquisition relaxation enhanced FSE sequence innovations have been so rapid, however, that
(RARE) sequences initially described by Henning et al. [1-4]. many of the techniques implemented and images obtained
The basic pulse sequence underlying all RARE/FSE methods for comparative purposes have become almost outdated
is the Carr-Purcell-Meiboom-Gill (CPMG) echo train. This se- before the completion of controlled clinical trials.
quence was originally introduced over 30 years ago in order This article describes current concepts concerning the op-
to make transverse relaxation time (T2) measurements that timization of FSE pulse sequences in the brain and spine and
would be largely free from errors introduced by imperfect comments on the strengths and weaknesses of FSE. State-
refocusing pulses [5], the latter being accomplished by mak- of-the-art and potential future applications of this pulse se-
ing a 90#{176}
phase shift between the excitation pulse and quence are discussed from a practical perspective.
ensuing refocusing pulses. In RARE/FSE sequences, each
echo of the CPMG train is phase encoded with a distinct
phase-encode gradient, read out in the presence of a fre- Fast Spin-Echo MR Imaging of the Brain
quency-encoding gradient, and phase “unwound” after read-
out [1]. It has now been shown that with a judicious selection During the past 10 months, CSE images were supple-
of the number of echoes per train and tailored phase-encode mented when feasible with FSE images by using 1 .5-T Signa
reordering algorithms, FSE sequences can be fashioned to scanners equipped with a 4.6 hardware/software configura-
yield high-quality Ti -weighted, proton density-weighted, and tion (General Electric Medical Systems, Milwaukee, WI). For
T2-weighted images far more rapidly than is possible with the past several months, all proton density-weighted and T2-
conventional spin-echo (CSE) sequences0]. Further- [6-i weighted images have been obtained by using only selected
more, FSE images retain true spin-echo T2 contrast features FSE sequences. The primary FSE sequence used for brain
rather than the T2* contrast features associated with gra- studies during this time consisted of an eight-echo CPMG
dient-echo methods. train in which the first four echoes were used for proton
A number of dinical studies are currently under way, and density-weighted images and the second four for T2-weighted
several have been completed comparing FSE and CSE se- images. Various combinations of scanning parameters TR/
quences. The results have shown a promising correlation pTE1 ,pTE2 were used. Here, pTE is the pseudo-echo time
between the two sequences [9, 10], with the implication that as determined by the specific phase-encode reordering algo-
the slower CSE sequences will ultimately be replaced by rithm introduced by Melki et al. [7]. An extremely useful

Aecelved December 12, 1991 ; accepted after revision January 17, 1992.
I Department of RadiOlOgy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 021 15. Address reprint requests to K. M.
Jones.
2 Department of Radiology, The Children’s Hospital, Harvard Medical School, Boston, MA 02115.

AJR 158:1313-1320, June 1992 0361-803X/92/1586-13130 American Roentgen Aay Society

 1314 JONES ET AL. AJA:i58, June 1992

combination for obtaining 28 slices through the adult brain is and the updated FSE sequence, but we have found no
a 2500/i 8,90 combination with an 1 8-msec echo spacing and significant differences in lesion conspicuity to date with the
one signal average per phase encode. This allows 14 slice possible exception of some cases of intracranial hemorrhage
locations to be acquired with 256 x 1 92 image matrices in (discussed later).
only 2 mm 6 sec. We have used a 5-mm slice thickness with Many users do not require zero-gap studies of the entire
a 5-mm interslice gap in an interleaved manner to acquire 5- brain. We have found that the eight-echo FSE sequence that
mm contiguous proton density-weighted and T2-weighted uses a 5-mm/2.5-mm slice/gap (i 4 slices) and a 2000-msec
images at 28 slice locations in only 4 mm 12 sec. Early studies TR can be used quite efficiently for brain imaging in children
with this sequence that used 256 x 128 matrices reduced [9]. The 2000-msec TR renders CSF hypointense relative to
the total acquisition time to 2 mm 40 sec. However, a number brain parenchyma on the proton density-weighted image,
of problems with Gibbs (ringing) artifacts and blurring on helping to separate subependymal and subpial lesions from
proton density-weighted images were encountered that have CSF and to distinguish CSF-containing structures from other
been reduced or eliminated by using a 192 or 256 image water-Containing lesions when both appear hyperintense on
matrix. Several early studies also used a pTEi of 30 msec T2-weighted images (e.g., arachnoid cyst vs low-grade astro-
[9]. However, the resulting proton density-weighted images cytoma). A more recent modification has been the implemen-
showed high CSF signal that could obscure periventricular tation of a six-echo FSE sequence in which the first three
lesions, leading to the adoption of pTEi s between 1 5 and 20 echoes are used for the proton density-weighted image and
msec. the last three are used for the T2-weighted image. The shorter
Although modifications with respect to TR and matrix size echo train allows i 8 slices to be acquired in a 2000-msec TR,
were made that lengthened acquisition times, our current yielding full-volume coverage with a five-skip 2.5-mm slice
sequence produces a threefold time savings as compared setting. The sequence is now acquired with two signal aver-
American Journal of Roentgenology 1992.158:1313-1320.

with CSE methods that use identical imaging parameters. ages per phase-encode step and is restricted to 256 x 192
Summarizing our current optimized protocol for adult brain image matrices. Excellent proton density-weighted and T2-
imaging, proton density-weighted and T2-weighted images weighted images that use 1 8 slice locations with 5-mm slice
of the entire brain (2500/i 8,90, one acquisition, 256 x 192 thickness are now acquired in 4 mm i 8 sec, permitting
matrix, 5-mm/0-mm slice/gap, 28 slice locations) are obtained acquisitions in both the axial and coronal planes in less time
in 4 mm i 2 sec. Overall image quality has been excellent, than is required for a single CSE acquisition with a 256 x i 28
with reduced motion artifact and nearly identical lesion con- image matrix, two signal averages, and a 2000-msec TR (8
spicuity compared with CSE images. We have observed no mm 56 sec).
significant differences in the imaging characteristics of ex- Despite the overall similarity between CSE and FSE images,
traaxial (Fig. 1) or intraaxial masses, infarcts, inflammatory some important differences between them deserve comment.
lesions, or white matter disease, such as multiple sclerosis The most favorable difference results from faster scanning
(Fig. 2). Clinical trials are under way to determine if subtle times, with concomitant reduction in motion artifact and, in
differences are seen in imaging characteristics between CSE some cases, reduced phase artifact from flowing blood. In

Fig. 1.-FSE (2500/90) MR Image of brain shows a Fig. 2.-A and B, CSE (3000/30, A) and FSE (3000/30, B) MR images of brain both show
msnlnglema. Signal Intensity of tumor Is same as that periventricular white matter leslons of multiple sclerosis.
of gray matter. Prominent area of edema Is present
anteriorto lesion.
 AJA:158, June 1992 FAST SPIN-ECHO MR OF BRAIN AND SPINE 1315

Fig. 3.-A, CSE MR image of brain (2000/30)

shows severe motion artifact. T2-weighted images
were uninterpretable and were never filmed.
B, FSE MR Image (2000/80) at same level ob-
tamed immediately after CSE MR image cleariy
shows right superior temporal infarct (arrows).
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some instances, excellent images were obtained by using objects as dental braces, orthopedic hardware, aneurysm
American Journal of Roentgenology 1992.158:1313-1320.

FSE when CSE images were uninterpretable (Fig. 3). The clips, or metallic ventricular shunt components.
greatest disparity between FSE and CSE images is the mark- Since FSE uses echoes with different T2 weightings to
edly increased signal from fatty tissues in FSE. Although the form the raw k-space data matrix [1 5], a leakage of signal
cause for this increased signal has not been established along the phase-encode direction is unavoidable [1 6, 17]. The
definitively, we believe that the mechanism responsible is a end result is a structured noise component along the phase-
decreased contribution from spin-spin splittings among lipid encode direction with concomitant decreased signal to noise
protons to the T2 decay process because of the multiple, when compared with CSE images produced with comparable
closely spaced i 80#{176}
refocusing pulses used in FSE. Theoret- scanning parameters. Measurements indicate reductions of
ical and experimental support for this hypothesis may be signal-to-noise ratios (SNR5) for brain tissue that are on the
found in the literature [i i i 2]. We have not found the bright
, order of 25% [9, 1 0]. In brain imaging, this reduction is not
fat signal to be a problem in brain imaging, although a lipoma readily apparent owing to the routine use of quadrature coils
or other fat-containing structure might conceivably be mis- with a resultant high SNR. In spine imaging, however, where
taken for a subacute hemorrhage. One possibility for making volume coils are used in conjunction with surface receiver
the distinction would be to look for the presence or absence coils, noisier images are often observed, particularly when a
of the standard chemical-shift artifact along the read-gradient small number of acquisitions or shorter TR5 are used. This
direction. Such artifacts are bandwidth dependent but are the issue is addressed more fully in the next section.
same in FSE as in CSE, since both encode spatial information Of the advantages of FSE in brain imaging, perhaps the
along the read axis in precisely the same manner. An alter- greatest is the versatility resulting from the reduced acquisi-
native and more straightforward approach is to apply fat- tion times. The time savings may be used purely to obtain
suppression techniques, as discussed later. faster images with similar image quality compared CSE,
with
Another important observation is the slight reduction in or to provide greatly improved image quality (e.g., increased
magnetic susceptibility loss with FSE compared with CSE signal to noise, increased spatial resolution, or improved
Images, an effect again attributed to the use of closely spaced image contrast) in a comparable time period. If speed is of
i 80#{176}
pulses In FSE [7, 10, 13, i 4J. This has both advantages utmost importance, scanning times may be reduced even
and disadvantages for FSE imaging. Perhaps the most im- further through the use of longer echo trains or by eliminating
portant disadvantage is the reduction in signal loss associated either proton density-weighted or T2-weighted images. For
with hemorrhagic blood products (Fig. 4). In a recent study, example, by lengthening the echo train to 16 and using all 16
slightly higher signal intensity measurements were obtained echoes for a T2-weighted image, 14 slice locations (2000/75,
In hemorrhagic foci and iron-containing nuclei on FSE images 1 5-msec echo spacing, 256 x 256 matrix) in can be imaged
when compared with CSE counterparts [10]. Although all only 66 sec with excellent image quality (Fig. 5). Such an
hemorrhages were detected in this series, it is quite possible adjunct sequence might be quite useful for rapidly obtaining
that a small hemorrhagic lesion might not be seen on FSE additional coronal images in cases of temporal lobe epilepsy,
images or might be mistaken for edema or some other abnor- orfor obtaining images in additional planes to assist in surgical
mality. Additional sequences (e.g., gradient echo) may be planning.
useful if subtle brain hemorrhage is of significant concern. On There are, of course, limitations to how far an echo train
the positive side, decreased magnetic susceptibility effects can be usefully extended, and to how much the interecho
have proved advantageous when imaging such structures as interval can be reduced. As the echo train is extended, more
the sinuses or skull base, or such artifact-producing metallic heavily T2-weighted echoes are used to fill k-space data lines,
 i 3i 6 JONES ET AL. AJR:158, June 1992

Fig. 4.-A, CSE MR image of brain (2000/80) shows right frontal hemorrhage with central Fig. 5.-FSE T2-weighted coronal MR Image
deoxyhemoglobin (arrow). (2000/75) of brain in a healthy volunteer. Total
B, Central deoxyhemoglobin appears and measures slightiy higher in signal intensity on corre- Imaging time was 66 sec.
spending FSE MR Image with identical scan parameters. Scalp fat appears very bright (arrows).
(Reprinted with permission from Joneset al. [10].)
American Journal of Roentgenology 1992.158:1313-1320.

leading to increased blurring, or edge enhancement and ring- a TR as long as 6000 msec to increase conspicuity of multiple
ing artifacts [6, 7, i 6, i 7]. These effects have not been sclerosis lesions. Such a long TR would not be practical with
observed on T2-weighted images for echo-train lengths of up CSE owing to the excessive motion artifact.
to i 6, although for proton density-weighted images such In summary, FSE provides images similar in contrast
effects become noticeable for echo-train lengths greater than characteristics to CSE images, but allows much greater flex-
four [7, 17]. ibility in setting image parameters. This flexibility may be used
to obtain very rapid dual-echo images in any plane, or to
improve spatial resolution or overall image quality.
High-Resolution Brain Imaging

If speed is of less concern than image quality, increased

Fast Spin-Echo MR Imaging of the Spine
signal averaging with FSE may be used to provide superior
images compared with CSE in comparable acquisition times. For the past 4 months, we have replaced CSE with FSE
Such an approach is especially useful for obtaining high- sequences specifically designed for routine spine imaging in
spatial-resolution images (e.g., Si 2 x 51 2 image matrices, 1- adults. Our routine screening examination consists of sagittal
to 3-mm slice thicknesses) with their inherently small voxels Ti -weighted and T2-weighted FSE images with supplemental
and reduced SNR. CSE axial proton density-weighted or gradient-echo images.
The use of multiple acquisitions (four, eight, or even 12 Ti -weighted FSE images can be obtained simply by decreas-
repetitions) affords excellent signal even with very thin slices ing the TR, and we have obtained excellent images in 1 mm
or small voxel size, formerly not practical with CSE owing to 59 sec (600/i 2, 256 x 192 matrix, four-echo train length,
long acquisition times. For instance, a 51 2 x 51 2 image four acquisitions, 4-mm/0.5-mm slice/gap, 10 slice locations).
matrix acquired with a 16-echo train, four signal averages, Since Ti -weighted images can already be rapidly obtained
and a 2000/90 TR/pTE may be acquired in only 4 mm i 6 sec. with conventional techniques, the time savings is not as
In addition to increasing the number of acquisitions and impressive with Ti -weighted FSE images as with T2-
reducing the voxel size or slice thickness, a small field of view weighted FSE images. In addition, the whole-body transmit
(FOV) may be used to obtain fine structural detail in a specific coil-surface receive coil combination used for the spine
anatomic region of interest. We have used FOVs as small as makes reduced SNR more apparent than on FSE brain images
8-1 6 cm in combination with a 1 - to 3-mm slice thickness obtained with a quadrature coil. For this reason, we routinely
and four to 1 2 acquisitions to obtain detailed anatomic infor- obtain four acquisitions for both Ti - and T2-weighted FSE
mation in small regions of interest such as the pituitary fossa, images. In addition, the Ti - and T2-weighted FSE spine
cavernous sinuses, internal auditory canal, and brainstem. sequences do not use zero phase-encode reordering [6, 7],
Such a protocol may be very useful for delineation of specific and the effective TE is the central echo of the CPMG train [8].
cranial nerves or to confirm the presence of a very small or With the T2-weighted FSE sequence, i 4 images are ob-
equivocal lesion (Fig. 6). In addition to increasing spatial tamed in 3 mm 16 sec (4000/i 02, 256 x 192 matrix, 16-echo
resolution or SNR, FSE allows the manipulation of contrast train length, four acquisitions, 4-mm/0.05-mm slice/gap). We
options normally not considered. For example, we have used have found that the long TR provides improved contrast and
 AJA:158, June 1992 FAST SPIN-ECHO MR OF BRAIN AND SPINE 1317

Fig. 6.-A, Axial FSE MR image of brainstem

shows questionable lesion in right pens (arrow).
B, Corresponding high-resolution FSE MR Im-
age clearly shows right pontine lesion (arrow).
Increased noise is due to use of only four acqul-
sitlens. Right pontine infarctwas suspected dm1-
daIly.

increased SNR. With a shorter TR (e.g., 3000 msec), images sequence places a 1 80#{176}
inversion pulse 1 00 msec before the
tended to have a “noisy” appearance owing to lower SNR. T2-weighted FSE sequence, nulling the fat signal. Conven-
American Journal of Roentgenology 1992.158:1313-1320.

The use of a 256 x 256 matrix has also provided significant tional STIR has proved useful in many clinical settings [18-
improvement in image quality with only a small time penalty. 21 ], although long scanning times and motion artifact have
We have found the uniformly bright appearance of fat on hindered widespread use. With STIR FSE, we have obtained
all FSE sequences (Ti proton density-,
-, and T2-weighted excellent images in 2 mm 30 sec (1 6-echo train length, 3104/
images) to be the most dramatic difference between conven- 1 1 0/90 [TR/Tl/TE], 256 x 192 matrix, four acquisitions, 4-
tional and FSE images of the spine. Although marrow may mm/0.5-mm slice/gap, seven slice locations).
appear relatively dark in young patients with hematopoietic Because Ti and T2 contrast are additive with STIR imag-
(red) marrow, the marrow often appears remarkably bright in ing, lesion conspicuity is often enhanced. Fat suppression is
older patients with fatty (yellow) marrow, even on heavily T2- more complete when using STIR FSE than when using T2-
weighted images. As might be expected, this appearance on weighted FSE with CHESS. However, our early experience
TI -weighted images can be quite useful in the case of marrow has demonstrated nearly identical contrast-to-noise ratios for
metastases, since most lesions appear dark on this sequence. the two techniques when measuring the signal intensities of
These dark lesions are, therefore, highly conspicuous against metastatic lesions, normal adjacent marrow, and noise pos-
a background of bright marrow (Fig. 7A). Given the generally terior to the spine (Fig. 7C). In general, we have not found a
brighter appearance of fat on Ti -weighted FSE sequences, significant difference in lesion conspicuity when using STIR
metastatic lesions often appear more conspicuous than on FSE and T2-weighted FSE with CHESS pulse fat saturation.
Ti-weighted CSE sequences owing to the higher contrast Lesions often appear slightly brighter on the T2-weighted
between the low-intensity lesions and the very bright marrow images, probably owing to greater overall signal, but marrow
background. often appears darker on STIR FSE, and background noise is
On T2-weighted images, however, bright fat may pose a slightly reduced. STIR FSE is more prone to artifact, especially
disadvantage in the evaluation of both marrow disease and motion and flow-related artifact, and overall image quality
degenerative disease. Metastatic lesions (usually bright on appears slightly inferior to that on T2-weighted FSE images.
T2-weighted images) are often poorly seen against the back- The use of aliasing-suppression software with STIR FSE is
ground of bright fatty marrow. In the case of degenerative essential. Gradient-moment nulling, although not yet available,
spine disease in an older patient with bright (fatty) marrow, should improve image quality significantly. For T2-weighted
the posterior vertebral margins (including osteophytes) are images, however, we have not encountered significant flow-
poorly seen adjacent to the bright CSF. Fat suppression related artifact, even though gradient-moment nulling has not
imaging performed with a frequency-selective pulse (250-Hz yet been implemented. Intrinsic cord lesions are very well
bandwidth) and gradient dephasing (chemical-shift selective seen on T2-weighted FSE, perhaps in part owing to the use
saturation, CHESS) has proved most helpful in rendering of a relatively long TR (4000 msec). Intrinsic cord tumors,
marrow dark on T2-weighted FSE images, and can be per- syringomyelia, demyelination, cord infarction, and cord
formed without time or slice penalty. Although the more compression (Fig. 8) have all been well shown with this
superficial fat adjacent to the coil remains bright, the deeper sequence. Degenerative disk disease, including disk hernia-
structures including fatty vertebral marrow spaces appear tion, also is well seen on FSE (Fig. 9). For reasons that are
dark. Posterior osteophytes are now clearly seen, and high- not entirely clear, FSE appears to be quite sensitive to
signal marrow metastases are easily identified (Fig. 7B). changes associated with degenerative disk disease. Although
The short TI inversion-recovery (STIR) FSE sequence has normal disks appear appropriately bright, even mild degen-
also been a useful adjunct for spine imaging. The STIR FSE erative changes may render disk material quite dark on FSE.
 1318 JONES ET AL. AJA:158, June 1992

Fig. 7.-A, Ti-weighted FSE MR image of spine (600/12, 256 x 256 matrix, four acquisitions, 2:37 mm) shows dark vertebral metastases with retropulsion
at U level (arrow). Normal vertebral marrow appears very bright.
American Journal of Roentgenology 1992.158:1313-1320.

B, T2-weighted FSE MR image with CHESS fat suppression (3000/102, 256 x 256, four acquisitions, 3:15 mm) shows increased signal in corresponding
metastases.
C, STIR FSE MR image (4105/90, 256 x 192, four acquisitions, 3:18 mm) shows similar findings. Overall image quality appears slightly inferior to T2-
weighted study, but fat suppression is more complete (arrows).

Fig. 8.-T2-weighted FSE MR image of thoracic

spine (3000/102) without fat suppression shows
cord compression from metastatic embryonal cell
carcinoma (short solid arrow). CSF is outlined by
dark spinal cord anterioriy (open arrow) and bright
fat posteriorly (long solid arrow). Marrow remains
dark despite lack of fat suppression owing to
young age of this patient (23 years).

Fig. 9.-T2-weighted FSE MR image of lumbar

spine (4000/102) with CHESS fat suppression
shows disk herniatiens at L4-L5 and L5-S1. Her-
nlated or otherwise degenerative disks often ap-
pear quite dark on FSE Images, as in this case.

We have not found this to be a problem, although conceivably echo 3D sequences overestimated neuroforaminal stenosis
some difficulty may be encountered in differentiating herniated in spine images owing to increased magnetic susceptibility
disk material from a posterior osteophyte. effects [22]. In addition, the degree of overestimation was
To obtain high-definition brain or axial spine images, we increased with motion, whereas motion artifact is generally
have used a novel three-dimensional (3D) multislab volume reduced with FSE techniques. It is unclear whether the re-
technique that allows for oblique slab prescription [8]. Excel- duction of magnetic susceptibility effects will have a significant
lent image quality with less than 2-mm slice thickness has effect on the conspicuity or appearance of vertebral osteo-
been obtained with this technique (Fig. 1 0). Although the phytes, although posterior osteophytes (dark on routine fat-
technique is still under investigation, early results are prom- suppressed images) appear quite conspicuous adjacent to
ising. Three-dimensional FSE poses a theoretical advantage the bright posterior CSF. The addition of a phased-array spine
over 3D gradient-echo techniques in that magnetic suscepti- coil has afforded high-resolution imaging of the entire cord in
bility effects are reduced. In a recent study, axial gradient- less than 4 mm (Fig. 1 1).
 AJR:158, June 1992 FAST SPIN-ECHO MR OF BRAIN AND SPINE 1319

Fig. 10.-3D FSE axial MR image of lumbar

spine (2500/110), 1.8 mm in thickness. Individual
nerverootsare seen adjacent to bright CSF. Alias-
Ing artifact is seen laterally.

Fig. 11.-T2-weighted FSE MR image of spine

(3000/90)was obtained In 3:19 mm with 512 x 512
matrix and phased-array coil. Posterior fat Is bright
owing to lack of fat suppression.
American Journal of Roentgenology 1992.158:1313-1320.

Conclusions be obtained by using a small FOV (8-i 6 cm), multiple acqui-

sitions (four to 12), smaller matrix size, or thin slice profiles
FSE is a promising technique for the rapid acquisition of
(1 -3 mm). Three-dimensional imaging is now feasible without
images with true spin-echo contrast features. Depending on
the disadvantages of gradient-echo imaging. Applications in
the desired protocol, FSE images may be obtained approxi-
both brain and spine include image reconstruction and manip-
mately three to 16 times faster than CSE images. Advantages
ulation for surgical planning, and detailed evaluation of focal
aside from the rapid imaging include decreased motion arti-
regions of disease or anatomic structures such as specific
fact; decreased magnetic susceptibility effects when imaging
cranial nerves.
metallic objects, skull base, or neuroforamina; and versatility.
Further refinements in both hardware and software should
Disadvantages include reduced magnetic susceptibility ef-
provide improvements in FSE techniques, and many applica-
fects in hemorrhagic lesions and the bright appearance of fat
tions, including rapid spectroscopic imaging [23], remain to
on T2-weighted images, although this latter problem may be
be explored. Reductions in interecho interval should be pos-
easily overcome by using fat suppression. This may be
sible, reducing artifact and permitting the collection of longer
accomplished by using CHESS pulse fat saturation, or by
useful echo trains, although at the expense of increased
using STIR FSE, with the additional benefit of additive Ti and
bandwidth and reduced SNR.
T2 contrast. STIR FSE spine images, however, appear more
At our institutions, replacement of CSE sequences with
prone to motion and flow-related artifact.
FSE has significantly reduced the patient’s waiting time for
For routine brain imaging in the adult patient, we obtain
elective MR examination. While further refinements are clearly
dual-echo FSE images with the following protocol: 2500/
to be expected, FSE is already a practical alternative to CSE
i 8,90, one acquisition, 256 x 192 matrix, 5-mm/0-mm slice/
imaging, providing nearly identical lesion conspicuity with far
gap, 28 slice locations, and eight-echo train length (4 mm i 2
greater versatility. Controlled clinical trials should provide
sec). For routine spine images, we obtain sagittal Ti -weighted
more information about the potential usefulness of this tech-
FSE images (600/i 2, four acquisitions, 256 x 1 92 matrix, 4-
nique and also should determine if more subtle differences
mm/0.5-mm slice/gap, four-echo train length, 10 slice loca-
are seen in lesion conspicuity that have not as yet been
tions in i mm 59 sac). These are supplemented with sagittal
appreciated.
T2-weighted FSE images (4000/i 02, four acquisitions, 256 x
192 matrix, 4-mm/0.5-mm slice/gap, 1 6-echo train length, 14
slice locations in 3 mm i 6 sec). Axial FSE Ti -weighted or ACKNOWLEDGMENTS
proton density-weighted images also may be obtained. We
We thank Gordon Sze, Todd Constable, and Robert Smith for
perform CHESS fat suppression on all T2-weighted spine
providing us with the inversion-recovery FSE sequence used for the
sequences, including suspected metastases (dark marrow vs FSE STIR studies described herein.
bright lesion) and degenerative disk disease (improved con-
spicuity of posterior osteophytes).
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Erratum
In the article “MR Imaging of the Stellate Ganglion: Normal Appearance,” by Hogan and Erickson (AJR 1992;158:655-659) an error was
made in captioning several of the figures. The legends to Figures 6, 7, and 8 are transposed with those to Figures 1 i , 12, and 13. AJR and
Waverly Press apologize for this error.
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