Common use of Temporal Clause in Contracts

Temporal. Time (msec) Time (msec) Angle (degrees) Voxel Size (mm3) b Values (sec/mm2) Resolution (sec) Diagnostic MR imaging session Note.—DCE = dynamic contrast enhanced, NA = not applicable, 3D = three dimensional. T2 weighted Axial turbo spin-echo 3620 116 180 0.4 3 0.4 3 3.0 NA NA DW Single-shot echo-planar with diffusion modules and fat 2500 91 1.5 3 1.5 3 3.0 0, 50, 500, and 800 NA suppression pulses DCE 3D T1-weighted spoiled gradient echo 34 1.6 14 1.5 3 1.5 3 4.0 NA 2.5 Proton density 3D T1-weighted spoiled gradient echo 800 1.6 8 1.5 3 1.5 3 4.0 NA NA session True FISP True FISP 4.48 2.24 70 1.1 3 1.1 3 3.0 NA NA DW Single-shot echo-planar with diffusion modules and fat 2000 67 1.8 3 1.8 3 4.0 0, 100, 500, and 800 suppression pulses T2 weighted Axial turbo spin-echo 3620 104 120 0.8 3 0.8 3 .0 NA NA included low-signal-intensity areas in the peripheral zone (PZ) and/or a homogeneous low T2 signal intensity area with ill-defined margins or a len- ticular shape within the CG (39). After identification of CSRs on T2-weighted images, the ADC maps and multipara- metric dynamic contrast-enhanced MR imaging color maps transfer constant (Ktrans), extravascular extracellular volume (ve), rate constant (Kep), and washout were analyzed in a color over- lay mode on the T2-weighted images. The generally known features of PCa on dynamic contrast-enhanced MR im- ages (13,40) (high ve, Ktrans, Kep, and negative washout) and areas of restric- tion on ADC maps (especially in the PZ and CG) were used to identify CSRs qualitatively (38). Additionally, after the functional data from DW and dy- namic contrast-enhanced MR imaging were evaluated in relation to the CSR findings on the T2-weigthed images, the DW and dynamic contrast-enhanced MR images were viewed separately and in combination to determine additional CSRs not evident on T2-weighted im- ages. Finally, the information from all the imaging modalities were combined and used to determine the CSRs within the PZ and CG of the prostate (38). diffusion in three directions was mea- sured by using four b values. Finally, the imager software calculated ADC maps automatically (Fig 2). After identification of the CSRs, adjustments were applied to the biopsy device to move the needle sleeve ex- actly toward a CSR (41,42). To control needle sleeve direction, T2-weighted true fast imaging with steady preces- sion (FISP) images were acquired in the axial and sagittal direction. Biopsy was performed in all determined CSRs on the diagnostic MR images, even if they were not visible on the T2-weight- ed anatomic MR images obtained at the time of biopsy. In these cases, the DW MR images were used to move the needle sleeve toward the CSR. After fixation of the needle sleeve in the correct position, one or more tissue samples were taken at the re- gion with lowest ADCs in each CSR with an 18-gauge, fully automatic, core needle, double-shot biopsy gun (Invi- vo) with a needle length of 150 or 175 mm and tissue sampling core length of 17 mm. After obtaining a biopsy spec- imen, fast T2-weighted axial and sag- ittal true-FISP images were obtained with the needle left in situ. During the biopsy session, at least one biopsy specimen was obtained from each CSR. The biopsy specimen that was lo- cated in the most diffusion-restricted area of each CSR was selected for image analysis. This was performed by using the true-FISP confirmation image and the corresponding ADC map obtained during the biopsy session. Some patients had multiple CSRs. The CSRs of all pa- tients were analyzed without knowledge of the histopathologic outcomes. MR images of the biopsy specimens were analyzed with an in-house developed an- alytical software workstation (37). The calculated ADC maps were projected on the postbiopsy T2-weighted true-FISP images (confirmation image with the needle left in situ) to determine the bi- opsy location. By using this location, a region of interest was drawn manually with the size and extent of the most diffu- sion-restricted region on the ADC map, representing the biopsied CSR (Fig 3). In case of the absence of restricted dif- fusion on the ADC maps, a low-signal- intensity area on T2-weighted images was used to draw the region of interest. All regions of interest were annotated in consensus by two radiologists (T.H., In a second session, prostate biopsies were performed in the same MR im- ager with a dedicated MR-compati- ble biopsy device (Invivo, Schwerin, Germany) (38,41–43). As previously described, the patient was placed in a prone position and the rectally in- serted needle sleeve was attached to the arm of the MR-compatible biopsy device. A pelvic phased-array coil was used for signal reception (36,38). Identification of the CSR, deter- mined during the initial MR exam- ination, was achieved by using the following MR sequences (Table 1): First, an axial T2-weighted turbo spin- echo sequence was performed. Sec- ond, an axial DW sequence was per- formed with a single-shot echo-planar imaging sequence with diffusion mod- ules and fat suppression pulses. Water