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Changing MRI methods in head and neck imaging

Best Practice
Verbist, Berit, M.D., Ph.D. Leiden University Medical Centre • Netherlands

Robust head and neck imaging is becoming routine at Leiden University Medical Center (Leiden, The Netherlands) thanks to new techniques that provide better fat suppression and shorter scan times. Large-coverage, fat-free imaging is now a reality in imaging skull-base lesions, in otology, and in imaging of the orbit and nerves.
 Berit Verbist, MD, PhD Leiden University Medical Center
Berit Verbist, MD, PhD
Leiden University Medical Center

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Berit Verbist points out the challenges of obtaining good image quality in head and neck images. “We need very detailed images from a complex anatomical area, and the area is prone to movement artifacts so we need short acquisition times. We also need to minimize the number of sequences because it gets tiring for the patient if it takes too long. Another big problem is susceptibility artifacts, because of the boundaries between air, bone and tissue, and because many patients have undergone complex surgical procedures that include osteosynthetic materials, which leads to more artifacts and inhomogeneous fat suppression. There is also an interest in scanning with a large field of view, mainly for the lower neck and thoracic inlet.”

To overcome these challenges, Dr. Verbist is using mDIXON TSE (turbo spin echo) on the Ingenia 3.0T with the dS HeadNeckSpine coil. The mDIXON technique provides four images in one acquisition: water images (fat suppressed), in-phase images (without fatsuppression), out-of-phase images and fat images. “mDIXON TSE delivers very homogeneous fat suppression, even when we use a large field of view. It addresses the problems with distortion due to susceptibility and it allows us to use large fields of view. I’ve applied it in oncology patients and in brachial plexopathy patients. Soon I will use it for eye and orbit pathology and skull base lesions as well.”

mDIXON TSE addresses fat suppression, speed and image quality

“We often had to choose between scanning with or without fat suppression to keep the examination short. Sometimes it turned out we made the wrong choice because of imperfect fat suppression,” says Dr. Verbist. “The great thing about mDIXON TSE is that we don’t have to choose; we get both in one acquisition – and excellent image quality within an acceptable time. ExamCard times are reduced as fewer sequences need to be used.


Philips’ patented mDIXON TSE uses 2-echo technology instead of the slower 3-echo method, and this enables fast scan time and high resolution simultaneously.


“With better image quality, we get better diagnostic accuracy,” Dr. Verbist explains. “mDIXON TSE can trigger a change in imaging strategies in head and neck imaging, as it provides excellent image quality and we need fewer scans in an exam, because we get the images with and without fat suppression in only one scan. We can also enlarge the field of view, so it will be easier to image the entire neck. And, reading these high quality images is faster; it’s just easier to look at them.”


“For fat suppressed spine imaging of post-operative patients, patients with suspicious lesions or spondylodiscitis, we currently use the STIR sequence, but that has an inherently lower SNR and T2 weighting isn’t very good with this technique. The homogeneous fat suppression of mDIXON TSE can also be an attractive alternative here. For MSK scanning, mDIXON TSE can allow us to enlarge the field of view and, for instance, easily scan both hips at the same time.”

Diffusion TSE helps reduce susceptibility distortion

Dr. Verbist has also begun to use Diffusion TSE in head/neck imaging. “Again, the motion and the susceptibility in this area can distort standard EPI diffusion images enormously. In the brain we can use EPI diffusion, but in head and neck we need a method that is less prone to susceptibility artifacts. In addition, we need very thin slices, and yet it shouldn’t take too long. Diffusion TSE solves this by providing high quality images in a short acquisition time.”

“There are several indications for Diffusion TSE in head and neck, such as otology and oncology. It’s a very interesting and growing field at the moment. I’ve been using it a lot to help in assessment for cholesteatoma, which can result after chronic infection in the middle ear. Usually when patients have surgery for this condition, they will have another surgery about a year later to look for residual disease, but when we are able to visualize recurrent or residual disease with Diffusion TSE, we can make a better selection of the patients who will undergo a second operation. It’s also becoming more common to use Diffusion TSE for imaging primary cholesteatoma, in patients who have not yet had surgery. Those patients are first scanned with CT, but often CT shows total obscuration of the middle ear making it difficult to determine whether it’s inflammatory changes or cholesteatoma. Diffusion TSE helps to differentiate that.”
As Dr. Verbist brings mDIXON TSE and Diffusion TSE into routine practice, she is pleased with the process. “It’s an easy transition, because these are time-efficient techniques; they simply provide better images with fewer artifacts.”
Berit Verbist, MD, PhD, became certified radiologist at the Catholic University of Leuven, Belgium. She is senior staff member in head/neck radiology and neuroradiology at Leiden University Medical Centre and Radboud University Nijmegen Medical Centre. In 2003 she spent visiting fellowships in Head and Neck radiology at the University of Florida, Gainesville, USA and Oregon Health and Science University, Portland, USA. She is board member of the ESHNR.

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Jun 24, 2014

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