1. Clinical Application of Balanced Steady-State Free Precession Technique in Neuroradiology
Yueh-hsun Lu
Hsiu-mei Wu
Jiing-feng Limg
Wan-yuo Guo
Cheng-yen Chang
Taipei Veterans General Hospital, Taiwan
National Yang-Ming University, Taiwan

2. Properties of b-SSFP Total coherent steady-state magnetization
Image contrast is given by T2/T1 ratio high signal of fluid and fat, and low signal of soft tissues
Within a certain range, field inhomogeneity induced dephasing will be nearly completely refocused at TE=TR/2 (~SE)

3. Balanced Steady-State Free Precession
Scheffler Eur Radiol :2409–2418

4. Clinical Application in Neuroradiology
Ventriculocisternography
MR myelography with brachial plexus injury
CSF leakage
Delineation of intracranial cystic lesion

5. Ventriculocisternography

6. Ventriculocisternography↖
Obstructive hydrocephalus

7. Presurgical Evaluation for Hydrocephalus

9. MR myelogram and brachial plexus image

10. Brachial Plexus Imaging
T2WI
Axi FIESTA

11. Brachial Plexus Injury
31y/o M, Post Motorcycle Accident

12. CSF Leakage
Traumatic cause
Iatrogenic cause

13. Post Traumatic CSF Leakage
CT with bone window
T2WI

14. Post Traumatic CSF Leakage
Axi 3D FIESTA
COR 3D FIESTA

15. Post TSA CSF Rhinorrhea
3D FIESTA 1mm
TR/TR/FA: 4.88/1.38/65
2D FSE T2WI 2mm

16. ↖
3D FIESTA 1mm
TR/TR/FA: 4.88/1.38/65

17. Delineation of cystic lesion
Demonstration of normal structure

18. Diagnosis and Delineation of Arachnoid Cyst
3-month-boy, Arachnoid cyst with hydronephrosis

19. 61/M, right trigeminal neuralgia for 3 years
Delineation of Epidermoid Cyst
/M right trigeminal neuralgia for 3 years
FLAIR
DWI
3D b-SSFP
61/M, right trigeminal neuralgia for 3 years

20. 77/M vertigo attacks in recent weeks
Delineation of Cranial Nerves: CN 7th and 8th
77/M vertigo attacks in recent weeks

21. Detection and Delineation of Small Intracannalicular Acoustic Neuroma

22. Discussion
The quality of image is somehow machine and parameter dependent. Magnetic inhomogeneity will cause artifacts, such as banding artifact.
Flip angle effect and section aliasing effect.
Proper selection of TR/TE/Flip angle would improve the quality of image.

23. Section Aliasing Artifacts
flip angle effect alone is an important factor that presents an obvious tradeoff between image contrast and aliasing artifacts in 3D SSFP MR ventriculocisternography.
α=70 °
α=50 °
α=30 °
AJNR 26:1170–1173, May 2005

24. Conclusion
b-SSFP offers the highest SNR per unit time of all other imaging sequences.
The dynamic equilibrium of b-SSFP is insensitive to flow or motion.
It can provide the high resolution of ventriculocystography for delineation of CSF space lesion, cranial nerve, intradural cervical nerve roots and detection of CSF leakage.

25. Thank You For Your Attention
The 101 Building, Taipei, Taiwan

26. Imaging of Membranous Labyrinth
The use of T2-weighted imaging offers the opportunity for diagnosis and preoperative assessment of patients with congenital or acquired vestibulocochlear disease. This is of particular relevance in the planning of cochlear implantation, goals: (1). measuring the transverse diameter of the cochlear nerve, which is known to correspond closely to the remaining number of spiral ganglion cells in the cochlea itself (9). While this approach may reduce the instance of unsuccessful implantations in ears with severe denervation, (2) patentcy of cochlear fluid channel for electrode insertion. The anatomy of the cochlea has recently been elegantly reviewed in this Journal (10). It is a coiled structure of 2 turns containing three parallel fluid canals, an outer scala vestibuli (ascending spiral), an inner scala tympani (descending spiral), and the central, smaller, cochlear duct (scala media). Electrode implantation is usually performed by insertion of an electrode array into the scala tympani or scala vestibuli (2). This process may be complicated or prevented by malformation of the cochlea or by fibrotic or osseous obstruction of one or both fluid channels. Obstruction is particularly common as a sequela to meningitis or labyrinthitis, in which the occlusion may be due to fibrosis or to the formation of ectopic bone that may obliterate the fluid-filled channels necessary for implant insertions.
Current problem
Inconsistent imaging quality
Detail resoluton? 26

27. Imaging of 3D Membranous Labyrinth
75y/o m, TR/TE 6.9x1.7, 0.4mm, 14x14cm 488x256

28. Artifacts of b-SSFP Banding artifact Section aliasing artifact
Acquisition artifact
Susceptibility artifact

29. Banding Artifact

30. FIESTA C

31. FOV 24x24 cm 232 slices TR/TE/a: 5. 63/1
FOV 24x24 cm 232 slices TR/TE/a: 5.63/1.37/65 NEX:2 Matrix 448x256 Slice thickness: 1.4 0.7 mm
FOV 20x20 cm 182 slices TR/TE/a: 5.49/1.47/65 NEX:2 Matrix 448x256 Slice thickness: 1.4 0.7 cm