Magnetization transfer effects are demonstrated to be significant in determining the signal intensity from brain tissues on images acquired with multislice rapid acquisition relaxation enhanced (RARE) sequences. We report studies designed to determine how the signal intensities vary with slice number or, equivalently, off-resonance power deposition. The results obtained in fat, gray matter, and white matter are similar in form to those reported in kidney tissues during classic magnetization transfer experiments (J. Eng, T. L. Ceckler, and R. S. Balaban, Magn. Reson. Med. 17, 304 (1991)). Of clinical significance to RARE practitioners is the increase of contrast-to-noise ratios between gray and white matter on proton density-weighted images with increasing slice number.

The FAISE (fast-acquisition interleaved spin-echo) technique consists of a hybrid rapid-acquisition relaxation-enhanced (RARE) sequence combined with a specific phase-encode reordering method. Implemented on a 1.5-T unit, this multisection, high-resolution technique permits convenient contrast manipulation similar to that of spin-echo imaging, with selection of a pseudo-echo-time parameter and a TR interval. With a TR of 2 seconds, eight 256 x 256 images are obtained in 34 seconds with either T2 or proton-density weighting. A direct comparison between FAISE and spin echo for obtaining T2-weighted head images in healthy subjects indicates that FAISE and spin-echo images are qualitatively and quantitatively similar. Image artifacts are more pronounced on "proton-density" FAISE images than on the T2-weighted FAISE images. T1 contrast can be obtained with inversion recovery and short TR FAISE images. Preliminary temperature measurements in saline phantoms do not indicate excessive temperature increases with extended FAISE acquisitions. However, extensive studies of radio-frequency power deposition effects should be performed if the FAISE technique is to be fully exploited.

Renal involvement in von Hippel-Lindau (VHL) disease has emerged as the most prevalent cause of death in this hereditary disorder. In a group of 43 VHL patients (23 unrelated families) with renal lesions we examined whether severity of renal disease is affected by parental inheritance and VHL subtype (1, without pheochromocytoma; 2, with pheochromocytoma). We also tested whether and how nephron-sparing surgery could be applied. Renal involvement comprised multiple cysts and bilateral and multifocal carcinomas (RCC) which were detected by screening in 38 patients, at 30.5 (14 to 62) years of age. The severity of the renal disease was similar in VHL type 1 (79% of the pedigrees) and 2 (21%). It was not influenced by the sex of the carrier. Twenty-nine patients were operated on at a mean age of 33.6 years: 21 patients (28 kidneys or 61% of all operated kidneys) underwent nephron-sparing surgery, 4 had complete ablation of involved kidneys and thus required dialysis, 3 had uninephrectomy and 1 had cyst fenestration. Vascular thrombosis was the most severe early complication. It occurred in 4 of 9 kidneys treated by ex vivo surgery. During a median follow-up of 29 months, local recurrence occurred in 5 of 21 (24%) patients treated by nephron-sparing surgery, whereas 2 developed metastasis. Chronic renal failure (creatinine > 120 mumol/liter) affected 11 patients; in 9 of them, it was due to sequelae of surgery. In conclusion, screening of RCC and nephron-sparing surgery are of value in VHL patients. However, indications of ex vivo surgery should be drastically restricted and renal sequelae are not uncommon. Renal followup is required because of the risk of recurrence.

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