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Diffusion-Weighted Imaging of the Appendicular Skeleton with a Non–Carr-Purcell-Meiboom-Gill Single-Shot Fast Spin-Echo Sequence

¹ Department of Radiology, Gazi University School of Medicine, Besevler, Ankara 06510, Turkey.
² GE Medical Systems, Istanbul, Turkey.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —32-year-old healthy male volunteer with normal MRI findings. Coronal images obtained at same level with two different diffusion-weighted imaging (DWI) techniques: echo-planar imaging (EPI) DWI (A) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (B), both at b = 600 mm2/s, and corresponding, respectively, to apparent diffusion coefficient (ADC) maps (C and D). Increased signal with better background suppression is noted with non-CPMG SSFSE technique. Mean ADC (± SD) for right femoral head is 0.54 ± 0.17 and 0.31 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Please note that images obtained with non-CPMG SSFSE technique have decreased susceptibility-induced artifacts and increased signal-to-noise ratio compared with EP images.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —32-year-old healthy male volunteer with normal MRI findings. Coronal images obtained at same level with two different diffusion-weighted imaging (DWI) techniques: echo-planar imaging (EPI) DWI (A) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (B), both at b = 600 mm2/s, and corresponding, respectively, to apparent diffusion coefficient (ADC) maps (C and D). Increased signal with better background suppression is noted with non-CPMG SSFSE technique. Mean ADC (± SD) for right femoral head is 0.54 ± 0.17 and 0.31 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Please note that images obtained with non-CPMG SSFSE technique have decreased susceptibility-induced artifacts and increased signal-to-noise ratio compared with EP images.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —32-year-old healthy male volunteer with normal MRI findings. Coronal images obtained at same level with two different diffusion-weighted imaging (DWI) techniques: echo-planar imaging (EPI) DWI (A) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (B), both at b = 600 mm2/s, and corresponding, respectively, to apparent diffusion coefficient (ADC) maps (C and D). Increased signal with better background suppression is noted with non-CPMG SSFSE technique. Mean ADC (± SD) for right femoral head is 0.54 ± 0.17 and 0.31 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Please note that images obtained with non-CPMG SSFSE technique have decreased susceptibility-induced artifacts and increased signal-to-noise ratio compared with EP images.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —32-year-old healthy male volunteer with normal MRI findings. Coronal images obtained at same level with two different diffusion-weighted imaging (DWI) techniques: echo-planar imaging (EPI) DWI (A) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (B), both at b = 600 mm2/s, and corresponding, respectively, to apparent diffusion coefficient (ADC) maps (C and D). Increased signal with better background suppression is noted with non-CPMG SSFSE technique. Mean ADC (± SD) for right femoral head is 0.54 ± 0.17 and 0.31 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Please note that images obtained with non-CPMG SSFSE technique have decreased susceptibility-induced artifacts and increased signal-to-noise ratio compared with EP images.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —46-year-old woman with right femoral head avascular necrosis (AVN). Coronal fast spin-echo inversion recovery image shows subchondral ischemic focus representing AVN.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —46-year-old woman with right femoral head avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from left femoral head is 0.51 ± 0.12 and 0.32 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from right femoral head is 1.49 ± 0.61 and 1.40 ± 0.51 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. This reflects increased diffusion due to accompanying bone marrow edema. Please note increased contrast-to-noise ratio and higher image quality obtained with non-CPMG technique.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —46-year-old woman with right femoral head avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from left femoral head is 0.51 ± 0.12 and 0.32 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from right femoral head is 1.49 ± 0.61 and 1.40 ± 0.51 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. This reflects increased diffusion due to accompanying bone marrow edema. Please note increased contrast-to-noise ratio and higher image quality obtained with non-CPMG technique.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —46-year-old woman with right femoral head avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from left femoral head is 0.51 ± 0.12 and 0.32 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from right femoral head is 1.49 ± 0.61 and 1.40 ± 0.51 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. This reflects increased diffusion due to accompanying bone marrow edema. Please note increased contrast-to-noise ratio and higher image quality obtained with non-CPMG technique.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —46-year-old woman with right femoral head avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from left femoral head is 0.51 ± 0.12 and 0.32 ± 0.14 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from right femoral head is 1.49 ± 0.61 and 1.40 ± 0.51 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. This reflects increased diffusion due to accompanying bone marrow edema. Please note increased contrast-to-noise ratio and higher image quality obtained with non-CPMG technique.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —38-year-old man with lunate avascular necrosis (AVN). Coronal fast spin-echo inversion recovery image shows bone marrow edema confined to lunate.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —38-year-old man with lunate avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from capitate bone is 0.58 ± 0.19 and 0.31 ± 0.11 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from lunate is 1.53 ± 0.58 and 1.44 ± 0.49 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Higher mean ADC values seen in lunate reflect increased diffusion due to accompanying bone marrow edema.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —38-year-old man with lunate avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from capitate bone is 0.58 ± 0.19 and 0.31 ± 0.11 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from lunate is 1.53 ± 0.58 and 1.44 ± 0.49 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Higher mean ADC values seen in lunate reflect increased diffusion due to accompanying bone marrow edema.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —38-year-old man with lunate avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from capitate bone is 0.58 ± 0.19 and 0.31 ± 0.11 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from lunate is 1.53 ± 0.58 and 1.44 ± 0.49 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Higher mean ADC values seen in lunate reflect increased diffusion due to accompanying bone marrow edema.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —38-year-old man with lunate avascular necrosis (AVN). Diffusion-weighted imaging (DWI) performed at same level with two different techniques: echo-planar imaging (EPI)–based DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). AVN is more readily seen on non-CPMG SSFSE images than EP images. Mean ADC (± SD) measured from capitate bone is 0.58 ± 0.19 and 0.31 ± 0.11 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. ADC measured from lunate is 1.53 ± 0.58 and 1.44 ± 0.49 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. Higher mean ADC values seen in lunate reflect increased diffusion due to accompanying bone marrow edema.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —56-year-old woman with breast cancer involving right humerus. Axial contrast-enhanced T1-weighted image shows strong contrast enhancement at right humeral head consistent with metastasis.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —56-year-old woman with breast cancer involving right humerus. Diffusion-weighted imaging (DWI) performed in coronal plane with two different techniques: echo-planar imaging (EPI) DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). Mean ADC (± SD) measured from humeral head is 1.07 ± 0.12 and 0.82 ± 0.17 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. These values are lower than those measured in infectious process and avascular necrosis and reflect water diffusion restriction by tumor cells.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —56-year-old woman with breast cancer involving right humerus. Diffusion-weighted imaging (DWI) performed in coronal plane with two different techniques: echo-planar imaging (EPI) DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). Mean ADC (± SD) measured from humeral head is 1.07 ± 0.12 and 0.82 ± 0.17 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. These values are lower than those measured in infectious process and avascular necrosis and reflect water diffusion restriction by tumor cells.

View larger version (186K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —56-year-old woman with breast cancer involving right humerus. Diffusion-weighted imaging (DWI) performed in coronal plane with two different techniques: echo-planar imaging (EPI) DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). Mean ADC (± SD) measured from humeral head is 1.07 ± 0.12 and 0.82 ± 0.17 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. These values are lower than those measured in infectious process and avascular necrosis and reflect water diffusion restriction by tumor cells.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —56-year-old woman with breast cancer involving right humerus. Diffusion-weighted imaging (DWI) performed in coronal plane with two different techniques: echo-planar imaging (EPI) DWI (B) and non–Carr-Purcell-Meiboom-Gill (non-CPMG) single-shot fast spin-echo (SSFSE) DWI (C), both at b = 600 mm2/s, and corresponding, respectively, apparent diffusion coefficient (ADC) maps (D and E). Mean ADC (± SD) measured from humeral head is 1.07 ± 0.12 and 0.82 ± 0.17 x 10–3 mm2/s for EPI and non-CPMG SSFSE DWI, respectively. These values are lower than those measured in infectious process and avascular necrosis and reflect water diffusion restriction by tumor cells.

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