THE BEST IMAGING FOR THORACIC SPINE ARACHNOID WEBS and CYSTS

https://mriquestions.com/fiesta-v-fiesta-c.html

QUESTIONS

AND

ANSWERS

IN MRI

•   Modification of FIESTA/TrueFISP to reduce banding artifacts

•   Synonym: CISS

•   Two FIESTA sequences with and without RE-phase alternation

FIESTA (Fast Imaging Employing Steady-state Acquisition) is the GE name for a balanced steady-state gradient echo sequence that Siemens calls TrueFISP and Philips calls balanced-FFE. As described in a prior Q&A, these sequences may be affected by phase shift errors across the image that produce banding artifacts. Such artifacts are particularly prominent at the skull base and other locations where there are susceptibility distortions of the main magnetic field. They are also more problematic in 3D acquisitions where TR values may exceed 10-15 msec.

FIESTA-C is a modification of the basic FIESTATrueFISP sequence. The equivalent Siemens product is called CISS (Constructive Interference Steady State). FIESTA­C/CISS is composed of a pair of TrueFISP acquisitions run back-to-back preceded by an automatic shimming procedure. The first uses phase altemation of the RF­ pulses (-f-a, —0, +0, —a, ...) while the second does not (+a, -s-a, ta, etc). When the paired data sets are combined in maximum intensity projection, the phase errors cancel, resulting in an image largely free of dispersion banding. This combination of paired signals is performed automatically after data collection (which increases reconstruction time slightly).

FIESTA-C/CISS is currently the sequence of choice for CSF-cisternography for visualizing cranial nerves at the skull base. When used in the 3D mode, it provides high signal from CSF based on T2/TI contrast and high spatial resolution. Furthermore, like FIESTA/TrueFISP, it has inherent flow compensation because of its perfectly balanced gradients.

References

Borelli AJ. Non-contrast MR arthrograms generate exquisite images. GE Signa Pulse, Spring, 2008, pp 54-55. (Brief description and examples of GE’s COSMIC sequence).

Casselman J, Kuhweide R, Deimling M, et al. Constructive Interference in Steady State- 3DFT MR imaging of the inner ear and cerebellopontine angle. AJNR Am J Neuroradiol 1993; 14:47-57.

Above is the GE Cube MRI that Banner University Radiology Natalie A. McMillan a "director" tried to tell me that was equivalent to GE Fiesta-c. 

Background story on getting to have this Fiesta MRI(first picture above):

Dr. Ali A. Baaj made me find a radiology clinic that performed FIESTA-C MRI’s as he had never ordered a FIESTA-C MRI’s before for any of his spine patients at Weil Cornell, NY or Banner University Hospital in Phoenix Az. Ali said "he did not have the staff to find a place to get this Fiesta MRI!"

After calling around  I was told by radiology scheduling at  Banner Hospital in Tucson, Az that they did have the capability of performing the FIESTA-C mri scan at the Breast Clinic on Campbell ave. in Tucson Az. A skeptical Chief Neurosurgeon Ali A. Baaj wrote the order for me to get my specific FIESTA-C MRI for my Thoracic spinal cord as it can better identify growths in the spinal column/CSF fluid without artifacts, as I told him previously. I called Banner radiology scheduling (Diana) 5 times to be sure the machine they were sending me to had the right software on it. Diana finally called back and made the determination that the breast MRI machine on Campbell had the right MRI machine.

 I showed up at the University Banner radiology breast clinic and again confirm with the tech (Alexia) that she had the right FIESTA-C MRI software. Even as I was put in the tube Alexia said “Oh yes you are getting the FIESTA-C MRI scan."

After the MRI scan I went to the main Campbell hospital and got a copy of my MRI and put it in my computer to review. There was no FIESTA-C on the images and they instead substituted a Cube software imaging software which is inferior and shows artifacts from CSF around the spinal cord. Disappointed, I called the Radiology Head office at UofA and got Natalie A. McMillian a Director. McMillian tried to say Cube was just as good as FIESTA-C. I told her in no way were the two the same. I asked who made the decision to switch to Cube MRI? Was it the tech or the radiologist that made that decision to switch from what the surgeon orders said? I said it was very deceitful and disrespectful to me and the surgeon. She would not answer the question of who switched to the inferior Cube MRI.

Natalie A. McMillan made an appointment that same day to get the correct FIESTA-C MRI at Banner clinic at 3838 Campbell ave. The FIESTA-C MRI is noisier than a regular MRI. However, the images are far superior to regular MRI. The images pretty much eliminate the artifacts from CSF flow and show what is actually going on in the spinal canal. In my case it showed the arachnoid web had grown back within 10 months and was no different than before the spinal surgery. Not as Ali A. Baaj, chief neurosurgeon, at Banner Hospital had said after looking at the previous plain MRI and the Cube MRI. This proved his post operative diagnoses was wrong.

If I had not looked myself at the MRI disc they would have gotten away with it. Natalie A. McMillan thinks University Banner radiology did nothing wrong and I should be happy she corrected the problem. I told her I did not think so. How many other people are not getting the scan that is ordered by the physician and don't have the knowledge to check? This was inexcusable by UofA Banner Radiology! Is a student radiologist or a regular staff radiologist making these decisions?

Help us all as the system is broke.

UofA Banner did ask me to call them as they will want to look into this more. However, I called Radiology Director Natilie A. McMillian, and said she would take care of it. I doubt that, as Radiology Director Natilie A. McMillian's attitude was cavalier at best.

A very disappointed Alumni,

Now, for those who say get a CT Myelogram of the T-Spine to see what is going in the spinal column - look below at my CT Myelogram from before the surgery that answered no questions.  Dr. Sergio Rivero neurosurgeon that was called in at the ER at Tucson Medical Center TMC, after my collapse, ordered the famous CT Myelogram that was suppose to answer all the questions. He was met with resistance from the TMC radiology department and they finally gave into him the following day.  There is a good reason for pushback from radiology as it is an invasive procedure that injects a dye into your spinal cord CSF fluid! Note: years ago  they (radiology departments all over) used a oil based dye and it actually caused Arachnoiditis. Great!

CT Myelogram:

IMPRESSION

1.  Focal ventral cord displacement and dorsal cord deformity at T5-6, consistent with an arachnoid web or arachnoid

cyst. There has been no significant change since 12/11/2021, given differences in imaging modality.

2.  Mild mid thoracic dextroscoliosis, without disc protrusion or cord compression.

Patient provided MRI of T spine 2018

There is evidence of the arachnoid web at the T5 level.

Plan:

Discussed with patient surgery options at this hospitalization of have this scheduled as an outpatient.