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<meta name="DC.Title" content="Magic Angle Effect: A Relevant Artifact in MR Neurography at 3T?" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2402" />
<meta name="DC.Date" content="2011-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive findings.

MATERIALS AND METHODS: Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2app was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180 ms).

RESULTS: In healthy subjects, the prolongation of T2app from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms ( P &lt; .001). The increase in T2app relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° ( P &lt; .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, P &lt; .0001).

CONCLUSIONS: Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is unlikely.

CNR
:   contrast-to-noise ratio
DE-TSE
:   dual-echo turbo-spin-echo
lROI
:   larger intraneural region of interest with a pixel-size of 21
MA
:   magic angle effect
MRN
:   MR neurography
NCS/EMG
:   nerve conduction studies/electromyography
sROI
:   small intraneural region of interest with a pixel size of 5
T2app
:   apparent intraneural T2 relaxation time
TIRM
:   turbo inversion-recovery magnitude
TSE
:   turbo spin-echo" />
<meta name="DC.Contributor" content="T. Kästel" />
<meta name="DC.Contributor" content="S. Heiland" />
<meta name="DC.Contributor" content="P. Bäumer" />
<meta name="DC.Contributor" content="A.J. Bartsch" />
<meta name="DC.Contributor" content="M. Bendszus" />
<meta name="DC.Contributor" content="M. Pham" />
<meta name="article:published_time" content="2011-05-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="Magic Angle Effect: A Relevant Artifact in MR Neurography at 3T?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive  findings.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2&lt;sub&gt;app&lt;/sub&gt; was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180  ms).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;In healthy subjects, the prolongation of T2&lt;sub&gt;app&lt;/sub&gt; from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). The increase in T2&lt;sub&gt;app&lt;/sub&gt; relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, &lt;i&gt;P&lt;/i&gt; &amp;lt;  .0001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is  unlikely.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_firstpage" content="821" />
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<meta name="citation_author" content="T. Kästel" />
<meta name="citation_author" content="S. Heiland" />
<meta name="citation_author" content="P. Bäumer" />
<meta name="citation_author" content="A.J. Bartsch" />
<meta name="citation_author" content="M. Bendszus" />
<meta name="citation_author" content="M. Pham" />
<meta name="citation_fulltext_world_readable" content="" />
<meta name="twitter:title" content="Magic Angle Effect: A Relevant Artifact in MR Neurography at 3T?" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive findings.

MATERIALS AND METHODS: Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2app was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180 ms).

RESULTS: In healthy subjects, the prolongation of T2app from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms ( P &lt; .001). The increase in T2app relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° ( P &lt; .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, P &lt; .0001).

CONCLUSIONS: Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is unlikely.

CNR
:   contrast-to-noise ratio
DE-TSE
:   dual-echo turbo-spin-echo
lROI
:   larger intraneural region of interest with a pixel-size of 21
MA
:   magic angle effect
MRN
:   MR neurography
NCS/EMG
:   nerve conduction studies/electromyography
sROI
:   small intraneural region of interest with a pixel size of 5
T2app
:   apparent intraneural T2 relaxation time
TIRM
:   turbo inversion-recovery magnitude
TSE
:   turbo spin-echo" />
<meta name="og-title" property="og:title" content="Magic Angle Effect: A Relevant Artifact in MR Neurography at 3T?" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/5/821" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive findings.

MATERIALS AND METHODS: Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2app was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180 ms).

RESULTS: In healthy subjects, the prolongation of T2app from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms ( P &lt; .001). The increase in T2app relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° ( P &lt; .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, P &lt; .0001).

CONCLUSIONS: Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is unlikely.

CNR
:   contrast-to-noise ratio
DE-TSE
:   dual-echo turbo-spin-echo
lROI
:   larger intraneural region of interest with a pixel-size of 21
MA
:   magic angle effect
MRN
:   MR neurography
NCS/EMG
:   nerve conduction studies/electromyography
sROI
:   small intraneural region of interest with a pixel size of 5
T2app
:   apparent intraneural T2 relaxation time
TIRM
:   turbo inversion-recovery magnitude
TSE
:   turbo spin-echo" />
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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive  findings.</p></div>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2<sub>app</sub> was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180  ms).</p></div>
<div id="sec-3" class="subsection">
<p id="p-4"><strong>RESULTS:</strong> In healthy subjects, the prolongation of T2<sub>app</sub> from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms (<em>P</em> &lt; .001). The increase in T2<sub>app</sub> relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° (<em>P</em> &lt; .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, <em>P</em> &lt;  .0001).</p></div>
<div id="sec-4" class="subsection">
<p id="p-5"><strong>CONCLUSIONS:</strong> Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is  unlikely.</p></div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">CNR<span class="def-item-dt-sep"></span></dt><dd>contrast-to-noise ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">DE-TSE<span class="def-item-dt-sep"></span></dt><dd>dual-echo turbo-spin-echo<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">lROI<span class="def-item-dt-sep"></span></dt><dd>larger intraneural region of interest with a pixel-size of 21<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">MA<span class="def-item-dt-sep"></span></dt><dd>magic angle effect<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">MRN<span class="def-item-dt-sep"></span></dt><dd>MR neurography<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">NCS/EMG<span class="def-item-dt-sep"></span></dt><dd>nerve conduction studies/electromyography<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">sROI<span class="def-item-dt-sep"></span></dt><dd>small intraneural region of interest with a pixel size of 5<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">T2<sub>app</sub><span class="def-item-dt-sep"></span></dt><dd>apparent intraneural T2 relaxation time<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">TIRM<span class="def-item-dt-sep"></span></dt><dd>turbo inversion-recovery magnitude<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">TSE<span class="def-item-dt-sep"></span></dt><dd>turbo  spin-echo</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/32/5/821.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 32</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2011 </div></div>
      
      
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      <div class="highwire-cite-title">Magic Angle Effect: A Relevant Artifact in MR Neurography at 3T?</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">821-827; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2402 </span></div>
  
  
  
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      <div class="highwire-cite-title">Magic Angle Effect: A Relevant Artifact in MR Neurography at 3T?</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Kästel</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Heiland</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Bäumer</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">Bartsch</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Bendszus</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Pham</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">821-827; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2402 </span></div>
  
  
  
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