J. Cruz Maurício

Bio: J. Cruz Maurício is an academic researcher from Universidade Nova de Lisboa. The author has contributed to research in topics: Breast MRI & SPAIR. The author has an hindex of 2, co-authored 4 publications receiving 20 citations.

STIR, SPIR and SPAIR techniques in magnetic resonance of the breast: A comparative study

Abstract: The amount of fat is a component that complicates the clinical evaluation and the differential diagnostic between benign and malign lesions in the breast MRI examinations. To overcome this problem, an effective erasing of the fat signal over the images acquisition process, is essentials. This study aims to compare three fat suppression techniques (STIR, SPIR, SPAIR) in the MR images of the breast and to evaluate the best image quality regarding its clinical usefulness. To mimic breast women, a breast phantom was constructed. First the exterior contour and, in second time, its content which was selected based on 7 samples with different components. Finally it was undergone to a MRI breast protocol with the three different fat saturation techniques. The examinations were performed on a 1.5 T MRI system (Philips?). A group of 5 experts evaluated 9 sequences, 3 of each with fat suppression techniques, in which the frequency offset and TI (Inversion Time) were the variables changed. This qualitative image analysis was performed according 4 parameters (saturation uniformity, saturation efficacy, detail of the anatomical structures and differentiation between the fibroglandular and adipose tissue), using a five-point Likert scale. The statistics analysis showed that anyone of the fat suppression techniques demonstrated significant differences compared to the others with (p > 0.05) and regarding each parameter independently. By Fleiss’ kappa coefficient there was a good agreement among observers P(e) = 0.68. When comparing STIR, SPIR and SPAIR techniques it was confirmed that all of them have advantages in the study of the breast MRI. For the studied parameters, the results through the Friedman Test showed that there are similar advantages applying anyone of these techniques.

Medir o cérebro, para quê?

Abstract: Varias sao as “janelas” da Ressonância Magnetica (RM) que hoje tem aplicacao na clinica1-2. Servem para fundamentar o diagnostico (p.e., da encefalopatia microvascular do idoso), o prognostico (p.e., do declinio cognitivo), a terapeutica (p.e., da desmielinizacao primaria). Com elas tambem poderemos aceder ao estudo fiavel da substância branca aparentemente normal (T2 convencional), o que sera importante para prever a evolucao. Havendo, agora, uma outra contrastizacao quantificavel – sem T1 nem T2 –, a designacao generica dos metodos sera RMq3.

Espetroscopia (1H) por ressonância magnética do disco intervertebral lombar no adulto e sua aplicação na rotina imagiológica

Abstract: Aims – To assess the potential of magnetic resonance spectroscopy (1H‑MRS) in the diagnostic of degenerative disease of the lumbar disc and to advocate the adding of this technique in the classification of the invertebral disc involution vs degeneration (L4‑L5 and L5‑S1) in the clinical routine of lumbar pain status, not related with mechanic causes. Material and method – We studied 102 out of 123 lumbar intervertebral discs. The distribution among spaces was 61 discs at L4‑L5, 41 at L5‑S1 level and 34 at D12‑L1 level. The magnetic resonance studies were performed using a 1.5 T scan-ner. A single‑voxel Point Resolved Spectra Selection (PRESS) technique was used. The ratios [Lac/Nacetyl], [Nacetyl/(Lac+Lip)] and additionally the resonance of lipids were applied to evaluate the biochemistry of the discs, its involution, disc disruption and eventual susceptibility to initiate degeneration process. The ratios and the lipidic value of L4‑L5‑S1 discs were ascertained with the different behavior of D12‑L1. Furthermore, the comparison between L4‑L5, L5‑S1 and D12‑L1 discs was performed according with rating in T2 weighted (adjusted scale 1‑4 from Pfirrmann1 criteria). Results – Related to D12‑L1, the ratios and the lipids of L4‑L5‑S1 discs are statistically different. When used as a complementary of conventional T2 weighted, they have a good discrimination in the all degrees of disc involution vs degeneration. The ratio [Lac/Nacetyl] at L4‑L5‑S1 level was increased when compared to D12‑L1 (p=0.033 for disks with [1+2] score of involution and p=0.004 for disks with score [3+4]). These results suggest that disc degeneration vs involution in higher degrees defines a decrease in the lactate’s peak. The ratio [Nacetyl/(Lac+Lip)] provides a good discrimination of involution between scores [1+2] and [3+4] at L4‑L5 level, presenting the values of the ratios (mean 0.65 and 0.5 with p=0.04). The mean ratio of [Nacetyl/(Lac+Lip)] in the L4‑L5 disc was 1.8 times higher than that of L1‑D12. The lipid spectrum at L4‑L5‑S1 in the higher scores showed no constant prevalence in the resonance frequencies. Conclusion – The (1H) spectroscopy of intervertebral discs may contribute with a supplementary semiology to the conventional MRI. The resonances of L4‑L5 and L5‑S1 discs, involuted or degenerated, must be related with D12‑L1, which are more stable and have lower likelihood of disc degeneration.

Breast MRI. Fundamentals and technical aspects

Abstract: In this pocket-size, soft cover 241 page book (hard cover edition published in 2008) prof. Hendrick shares all his experience and knowledge he has gathered over the years as a researcher and teacher in the fi eld of breast magnetic resonance imaging (MRI). The topic is not so simple, yet the way it is addressed (one-on-one teacher-student approach) offers a continuous exchange of knowledge between the teacher and pupil driving to the expected mastering of the subject matter. Starting from the fundamentals of magnetic resonance breast imaging one is taken through all its different modalities and sequences, learning how to use these and how MRI works. Much discussion is devoted to contrast agents, protocols (acquisition and post-processing), artefacts and errors. Hints are also given on safety and patients considerations and to new developments in breast MRI. A very useful appendix on MRI patient and non-patient screening forms in english and spanish, closes the book. The author refers to the “mathematically inclined reader” in order to help him properly understand some of the presented – sometimes at large – formulas; I would also include the “physics inclined reader” since without this sort of inclination and knowledge one would sometimes get lost. The book will be greatly appreciated by all those who are dealing with breast MRI due to its more and more widespread use and its importance in the clinical and diagnostic setting. The less than 10 minute procedure time, due to the use of updated, and even dedicated, scanners and proposed protocols, makes breast MRI competitive and offers more information (just to quote the perfusion curves) than mammography. BOOK REVIEW RECENSIONE

ADEM: Distinct disease or part of the MS spectrum?

Abstract: In the editorial “ADEM: Distinct disease or part of the MS spectrum?” by Hartung and Grossman (Neurology 2001;56:1257–1260), three large studies were compared …

Fat suppression techniques (STIR vs. SPAIR) on diffusion-weighted imaging of breast lesions at 3.0 T: preliminary experience

Abstract: The aim of this work was to perform a qualitative and quantitative comparison of the performance of two fat suppression techniques on breast diffusion-weighted imaging (DWI). Fifty-one women underwent clinical breast magnetic resonance imaging, including DWI with short TI inversion recovery (STIR) and spectral attenuated inversion recovery (SPAIR). Four were excluded from the analysis due to image artefacts. Rating of fat suppression uniformity and lesion visibility were performed. Agreement between the two sequences was evaluated. Additionally, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values for normal gland, benign and malignant lesions were compared. Receiver operating characteristic analysis was also performed. From the 52 lesions found, 47 were detected by both sequences. DWI-STIR evidenced more homogeneous fat suppression (p = 0.03). Although these lesions were seen with both techniques, DWI-SPAIR evidenced higher score for lesion visibility in nine of them. SNR and CNR were comparable, except for SNR in benign lesions (p < 0.01), which was higher for DWI-SPAIR. Mean ADC values for lesions were similar. ADC for normal fibroglandular tissue was higher when using DWI-STIR (p = 0.006). Sensitivity, specificity, accuracy and area under the curve values were alike: 84.0 % for both; 77.3, 71.4 %; 80.9, 78.3 %; 82.5, 81.3 % for DWI-SPAIR and DWI-STIR, respectively. DWI-STIR showed superior fat suppression homogeneity. No differences were found for SNR and CNR, except for SNR in benign lesions. ADCs for lesions were comparable. Findings in this study are consistent with previous studies at 1.5 T, meaning that both fat suppression techniques are appropriate for breast DWI at 3.0 T.