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It was only in 1980 that the first recognisable magnetic resonance images of the human brain were published, by Moore and Holland from Nottingham University in England. There then followed a number of clinical trials of brain imaging, the most notable from the Hammersmith Hospital in London using a system designed by EMI, the original manufacturers of the first CT machines. A true revolution in medicine has ensued; in only a few years there are thousands of scanning units, and magnetic resonance imaging (MRI) has assumed a central importance in medical investigation. It is an extraordinary fact that within a few years of development, the esoteric physics of nuclear spin, angular momentum, and magnetic vector precession were harnessed to provide exquisite images of living anatomy; modem science has no greater tribute. That indisputable king of neurology and the oldest of recorded conditions, epilepsy, has not been untouched by the new technology; indeed, it is our view that the introduction of MRI of electroencephalography (EEG) in the late has been as important to epilepsy as was that 1930s. Now, for the first time, the structural and aetiological basis of the condition is susceptible to thorough investigation, and MRI can provide structural detail to parallel the functional detail of EEG. MRI has the same potential as had EEG over 50 years ago, to provide a new level of understanding of the basic mechanisms, the clinical features and the treatment of epilepsy.
The second volume of Frontiers in European Radiology covers two very promising techniques in diagnostic radiology, namely digital radiography and nuclear mag netic resonance imaging. Leading experts in both fields from Europe and the Unit ed States were invited to give a critical overview; digital fluoroscopy is reported on mainly by American scientists since this technique has been developed primarily in the United States, while the results of nuclear magnetic resonance imaging are pre sented by British groups currently at the forefront of research in this field. The pa pers reflect the state of the art at mid-1981, when the contributors gathered for the yearly symposium on Current Topics in Diagnostic Radiology in Berne, Switzer land. Nuclear magnetic resonance imaging, also known as spin imaging or zeugmato graphy, has produced striking progress within the past few years - even within the past few months - as described in three papers of this volume. The images generally reflect the distribution of mobile protons contained within water and fats, and pro vide remarkable discrimination between different tissues. Malignant tissue might be identified with this technique, and a wide range of disorders associated with water concentration, diffusion, and flow would be amenable to study; the measurement of blood flow could be particularly interesting."
There has been increasing interest in neonatal neurology, especially since imaging techniques were introduced in the neonatal ward. Looking at the natural history of imaging techniques, we can identify three main axes of its development. Logically, it was first essential to image the brain morphologically. For this purpose, computed tomography was initially used, followed by ultra sound. However, to improve the quality of the images, magnetic resonance imaging was introduced. Major features of ultrasound and magnetic reso nance imaging are their safety and lack of ionization. Morphological imaging techniques have proved to be insufficient to ex plain the mechanisms underlying CNS injuries. Thus, it was essential to develop functional techniques to assess cerebral hemodynamics and oxy genation. The use of Doppler ultrasound, PET scanning, SPECT scanning and, more recently, NIRS have widened our knowledge of general neurolog ical problems. Finally, to achieve our goal of attaining a better understanding of CNS injuries, it is important to assess cerebral cellular metabolism. Magnetic resonance spectroscopy was introduced to achieve this goal. We hope that this book links these different techniques in order to widen our horizon. The future is promising and bound to provide further develop ments, which however can only be understood if we grasp the present level of development.
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