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Summer 2007

The Major Impact of MR Imagery

I vividly recall the first MR image of the brain I laid eyes on. It was an amazing picture, even for 1979, and at that moment, I knew the world of neuroradiology had changed forever. I did not, however, appreciate then the tremendous impact this technology would have on us all.

The advances over the ensuing three decades have been nothing short of stupendous, and have changed the practice of medicine and improved the health and well-being of patients around the world. With computer advances have come faster and more precise imaging techniques, and—combined with advances in stereotactic techniques—image-guided therapy has developed into a standard in many medical centers.

New MR techniques, summarized in this issue of Neuroscience at UCSF Medical Center, are making even more dramatic advances in our understanding of the mechanisms of disease processes and are resulting in better therapy for patients. Cynthia Chin, M.D., associate professor of radiology at UCSF, describes the application of MR and CT imaging to the diagnosis and therapy of lesions in the peripheral nervous system.

We have all had the experience of evaluating a patient with arm or leg symptoms in which the MR image of the spine is unrevealing. Dr. Chin details how we can now look at the peripheral nerves leaving the spine, in many cases showing us the pathology remote from the spine responsible for the patient's symptoms.

Armed with that information, she uses CT guidance to precisely place small quantities of anesthetic and steroid mixtures at the point of nerve inflammation or compression. CT guidance, while taking a bit longer than conventional fluoroscopy procedures, verifies the compression of the nerve prior to the procedure, and directs the precise deposition of smaller quantities of contrast-enhanced steroid, permitting better patient outcomes.

Pratik Mukherjee, M.D., Ph.D., details the exciting developments in the field of diffusion tractography, an MR technique that uses the restriction of water motion within axons to image white matter tracts. This has tremendous potential for not only subcortical anatomic pathway mapping, but also quantifying damage to white matter structures as well as monitoring myelination in the developing brain.

I hope you enjoy these and the other exciting articles detailing the tremendous advances in neuroscience occurring at UCSF.

William Dillon, M.D.
Section Chief, Neuroradiology

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