The spine is the most common location for skeletal metastases, and the incidence of spinal metastasis shows an increasing tendency. Because metastatic spinal tumors progress from an anterior element to a posterior element resulting in continuing destruction of the pedicles, epidural extension and involvement of neural structures of the metastatic tumor are eventually visible. Therefore, it is clinically significant for radiologists to understand the pathophysiology of spinal metastasis and to assess the involvement of neural structures and the disintegration of spinal instability related to the pathophysiology. As MRI is also the best imaging modality for diagnosing spinal metastasis, radiologists should accurately assess spinal metastasis and provide practical information to physicians. Therefore, we will describe some analysis points focusing on the understanding of pathophysiology of spinal metastasis and the next step toward a more extensive clinical approach using MR imaging.

The purpose of this paper is to show the radiologic features of various lesions appearing as skin thickening or enhancement under the breast MRI. And histopathologic results of the skin lesions were correlated. Radiologist must be familiar with normal appearance of the breast skin under the MRI and a wide variety of conditions may affect the skin of the breast.

Purpose: Among RF pulses, a sinc pulse is typically used for slice selection due to its frequency-selective feature. When a sinc pulse is implemented in practice, it needs to be apodized to avoid truncation artifacts at the expense of broadening the transition region of the excited-band profile. Here a sinc pulse tailored by a new apodization function is proposed that produces a sharper transition region with well suppression of truncation artifacts in comparison with conventional tailored sinc pulses. A multiband pulse designed using this newly apodized sinc pulse is also suggested inheriting the better performance of the newly apodized sinc pulse. Materials and Methods: A new apodization function is introduced to taper a sinc pulse, playing a role to slightly shift the first zero-crossing of a tailored sinc pulse from the peak of the main lobe and thereby producing a narrower bandwidth as well as a sharper pass-band in the excitation profile. The newly apodized sinc pulse was also utilized to design a multiband pulse which inherits the performance of its constituent. Performances of the proposed sinc pulse and the multiband pulse generated with it were demonstrated by Bloch simulation and phantom imaging. Results: In both simulations and experiments, the newly apodized sinc pulse yielded a narrower bandwidth and a sharper transition of the pass-band profile with a desirable degree of side-lobe suppression than the commonly used Hanning-windowed sinc pulse. The multiband pulse designed using the newly apodized sinc pulse also showed the better performance in multi-slice excitation than the one designed with the Hanning-windowed sinc pulse. Conclusion: The new tailored sinc pulse proposed here provides a better performance in slice (or slab) selection than conventional tailored sinc pulses. Thanks to the availability of analytical expression, it can also be utilized for multiband pulse design with great flexibility and readiness in implementation, transferring its better performance.

Visualization of the tissue loss tangent property can provide distinct contrast and offer new information related to tissue electrical properties. A method for non-invasive imaging of the electrical loss tangent of tissue using magnetic resonance imaging (MRI) was demonstrated, and the effect of loss tangent was observed through simulations assuming a hyperthermia procedure. For measurement of tissue loss tangent, radiofrequency field maps ($B_1{^+}$ complex map) were acquired using a double-angle actual flip angle imaging MRI sequence. The conductivity and permittivity were estimated from the complex valued $B_1{^+}$ map using Helmholtz equations. Phantom and ex-vivo experiments were then performed. Electromagnetic simulations of hyperthermia were carried out for observation of temperature elevation with respect to loss tangent. Non-invasive imaging of tissue loss tangent via complex valued $B_1{^+}$ mapping using MRI was successfully conducted. Simulation results indicated that loss tangent is a dominant factor in temperature elevation in the high frequency range during hyperthermia. Knowledge of the tissue loss tangent value can be a useful marker for thermotherapy applications.

Purpose: To quantitatively and qualitatively compare fat-suppressed MRI quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using frequency selective fat-suppression (FSFS) T2- and postcontrast T1-weighted fast spin-echo images of the head and neck at 3T. Materials and Methods: The study was approved by our Institutional Review Board. Prospective MR image analysis was performed in 36 individuals at a single-center. Axial fat suppressed T2- and postcontrast T1-weighted images with IDEAL and FSFS were compared. Visual assessment was performed by two independent readers with respect to; 1) metallic artifacts around oral cavity, 2) susceptibility artifacts around upper airway, paranasal sinus, and head-neck junction, 3) homogeneity of fat suppression, 4) image sharpness, 5) tissue contrast of pathologies and lymph nodes. The signal-to-noise ratios (SNR) for each image sequence were assessed. Results: Both IDEAL fat suppressed T2- and T1-weighted images significantly reduced artifacts around airway, paranasal sinus, and head-neck junction, and significantly improved homogeneous fat suppression in compared to those using FSFS (P < 0.05 for all). IDEAL significantly decreased artifacts around oral cavity on T2-weighted images (P < 0.05, respectively) and improved sharpness, lesion-to-tissue, and lymph node-to-tissue contrast on T1-weighted images (P < 0.05 for all). The mean SNRs were significantly improved on both T1- and T2-weighted IDEAL images (P < 0.05 for all). Conclusion: IDEAL technique improves image quality in the head and neck by reducing artifacts with homogeneous fat suppression, while maintaining a high SNR.

Purpose: To develop a technique for quantifying the $^{13}C$-metabolites by performing frequency-selective hyperpolarized $^{13}C$ magnetic resonance spectroscopy (MRS) in vitro which combines simple spectrally-selective excitation with spectrally interleaved acquisition. Methods: Numerical simulations were performed with varying noise level and $K_p$ values to compare the quantification accuracies of the proposed and the conventional methods. For in vitro experiments, a spectrally-selective excitation scheme was enabled by narrow-band radiofrequency (RF) excitation pulse implemented into a free-induction decay chemical shift imaging (FIDCSI) sequence. Experiments with LDH / NADH enzyme mixture were performed to validate the effectiveness of the proposed acquisition method. Also, a modified two-site exchange model was formulated for metabolism kinetics quantification with the proposed method. Results: From the simulation results, significant increase of the lactate peak signal to noise ratio (PSNR) was observed. Also, the quantified $K_p$ value from the dynamic curves were more accurate in the case of the proposed acquisition method compared to the conventional non-selective excitation scheme. In vitro experiment results were in good agreement with the simulation results, also displaying increased PSNR for lactate. Fitting results using the modified two-site exchange model also showed expected results in agreement with the simulations. Conclusion: A method for accurate quantification of hyperpolarized pyruvate and the downstream product focused on in vitro experiment was described. By using a narrow-band RF excitation pulse with alternating acquisition, different resonances were selectively excited with a different flip angle for increased PSNR while the hyperpolarized magnetization of the substrate can be minimally perturbed with a low flip angle. Baseline signals from neighboring resonances can be effectively suppressed to accurately quantify the metabolism kinetics.

Osteoid osteoma, a frequent lesions of bone, is usually intraosseous but occasionally subperiosteal. We describe the case of a 19-year-old male with knee pain caused by subperiosteal osteoid osteoma. Radiologic evaluation was performed with radiographic, computed tomography (CT), ultrasonographic (US) and magnetic resonance imaging (MRI). But the preoperative diagnosis of osteoid osteoma was delayed because of unusual imaging findings and atypical symptom. After excisional biopsy, histological examination confirmed the diagnosis of osteoid osteoma. The lesion was treated successfully with CT-guided radiofrequency ablation.

Introduction: Distant metastases of mucoepidermoid carcinoma (MEC) are reported with the most common sites being the soft tissue of skin, lung, liver, and bone. We report here a very rare case of MEC with multiple metastases to the kidney, adrenal gland, skull and gluteus maximus muscle. Case report: A 63-year-old male patient presented with left-sided headache. Radiologic evaluations including CT and MRI showed ill-defined soft tissue lesion involving the left infratemporal fossa and left sphenoid sinus, and multiple enlarged lymph nodes in neck and mediastinum. PET-CT demonstrated multiple hypermetabolic lesions in and around the left kidney, left adrenal gland, right ischium, right gluteus maximus and skull base. These lesions were confirmed as MEC with multiple metastases through biopsy. Discussion: Only one case of metastasis to the skull has been previously reported, and moreover, there has not been a case of metastatic MEC to the kidney, adrenal gland and gluteus maximus muscle so far in the medical literature. It is important to acknowledge the possibility of every unusual MEC metastases, since the presence of metastasis has statistically significant influence on the survival of MEC.

Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. Early diagnosis and treatment of WE is important to avoid persistent brain damage. Although histopathologic examination usually demonstrates pin-point hemorrhages in affected brain parenchyma, secondary hemorrhage is a rare but serious complication of WE. We experienced a rare case of intracranial hemorrhage related to WE in a 56-year-old male patient with malnourishment.

We report a case of perivalvular abscess in a 66-year-old man with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. No clinical features suspicious of infective endocarditis were noted, however, transthoracic echocardiography revealed non-specific echogenic focal wall thickening at mitral-aortic intervalvular fibrosa. Perivalvular abscess in the aortic valve was demonstrated as focal wall thickening between the anterior mitral leaflet and the non-coronary cusp of the aortic valve with peripheral enhancement and central low signal intensity on LGE CMR imaging. Other features suggestive of infective endocarditis, such as neither vegetation nor valvular perforation were present. The perivalvular abscess did not grow after intensive intravenous antibiotics therapy, and the patient was discharged without surgical treatment. CMR with LGE provided an early accurate diagnosis of perivalvular abscess. The diagnosis of perivalvular abscess using LGE CMR imaging was not previously reported in Korea.