0:01

Well, since this is an MRI online course,

0:05

I just want to emphasize the techniques that we

0:08

use for MR imaging at high resolution for

0:13

head-neck pathology. In this case,

0:14

I'm showing you a case from our skull base sequence,

0:19

but it's the same sequences as

0:21

the head-neck MRI as well.

0:24

So you notice that I'm showing you a CISS

0:26

image here. And in this case,

0:30

it's centered on the skull base

0:31

but we're also seeing the parotid pathology.

0:34

And it's a T2-weighted sequence.

0:39

I would just point out that, as I said,

0:42

this is a 0.6 millimeter.

0:44

So, sub-millimeter thick sections that allow us

0:48

to create coronal and sagittal reconstructions.

0:52

So if I pull down the coronal reconstruction

0:55

on this patient,

0:59

sorry,

1:00

you see that it's a high-quality

1:05

coronal CISS reconstruction.

1:07

And the CISS reconstruction is also at 0.6 mm.

1:11

So we are effectively competing with CT,

1:14

which has similar thin sections. On the vibe

1:19

image, which is a T1-weighted sequence,

1:21

dark CSF. You see, again,

1:23

that the parotid gland has the brighter signal

1:25

intensity tissue because of the fat.

1:28

In this case,

1:28

we've opened up the field of view a little bit wider,

1:34

but this VIBE image, as you can see, is 0.8 mm.

1:39

So again,

1:40

sub-millimeter thick section to compete

1:43

for resolution with the CT scanning.

1:46

And similar to the VIBE,

1:49

we can create 0.8 millimeter coronal

1:52

reconstructions from scanning only one time.

1:57

So the advantage here is that you don't

1:58

have to scan in multiple planes.

2:00

You can just take the VIBE and the CISS in a

2:03

single plane and avoid scanning

2:06

in coronal or sagittal.

2:08

And this can be done whether you're

2:09

using it pre-gad or post-gad.

2:12

So let me go to the post-gad VIBE.

2:14

This is the post-gad VIBE, which is 0.8 mm,

2:18

again allowing us to do very good quality

2:21

coronal and sagittal reconstructions.

2:23

You don't have to scan in multiple planes anymore.

2:26

We just take the VIBE and reconstruct it in the

2:30

sagittal and coronal plane. And as you can see,

2:34

nice fat suppression,

2:36

homogeneous fat suppression,

2:38

good demonstration of the parotid tissue.

2:42

And you notice that the T1 pre-gad was done

2:47

without fat suppression, so the fat is bright.

2:49

The fat is your friend because it will

2:51

outline such things as little lymph nodes in the

2:54

parotid tissue, as well as any mass that

2:57

is occurring in the parotid gland.

2:59

So these are our advanced techniques

3:03

for evaluating head and neck pathology.

3:07

We also will include the diffusion-weighted

3:09

imaging to characterize any masses,

3:11

if that is considered.

3:15

And this can be done either supplemental to your

3:20

routine of 3 mm thick sections

3:22

through the head and neck,

3:24

which have a larger field of view.

3:27

So I wanted to just give you a little sense of

3:30

the quality of the image that you can achieve

3:33

with both T2-weighted as well as

3:36

T1-weighted on advanced MR.