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Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI)

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Magnetic Resonance Imaging (MRI

Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to visualize detailed internal structures. MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body. An MRI machine uses a powerful magnetic field to align the magnetization of some atoms in the body, and radio frequency fields to systematically alter the alignment of this magnetization. This causes the nuclei to produce a rotating magnetic field detectable by the scanner—and this information is recorded to construct an image of the scanned area of the body.[1]:36 Strong magnetic field gradients cause nuclei at different locations to rotate at different speeds. 3-D spatial information can be obtained by providing gradients in each direction.

Magnetic resonance imaging (MRI scan) of the brain

MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart, and cancers compared with other medical imaging techniques such as computed tomography (CT) or X-rays. Unlike CT scans or traditional X-rays, MRI uses no ionizing radiation. HOW MRI WORKS The body is largely composed of water molecules. Each water molecule has two hydrogen nuclei or protons. When a person is inside the powerful magnetic field of the scanner, themagnetic moments of some of these molecules become aligned with the direction of the field. A radio frequency transmitter is briefly turned on, producing a further varyingelectromagnetic field. The photons of this field have just the right energy, known as the resonance frequency, to be absorbed and flip the spin of the aligned protons in the body. The frequency at which the protons resonate depends on the strength of the applied magnetic field. After the field is turned off, those protons which absorbed energy revert to the original lower-energy spin-down state. Now a hydrogen dipole has two spins, 1 high spin and 1 low. In low spin both dipole and field are in parallel direction and in high spin case it is antiparallel. They release the difference in energy as a photon, and the released photons are detected by the scanner as an electromagnetic signal, similar to radio waves.

The patient lies inside a massive hollow cylindrical magnet

As a result of conservation of energy, the resonant frequency also dictates the frequency of the released photons. The photons released when the field is removed have an energy — and therefore a frequency — which depends on the energy absorbed while the field was active. It is this relationship between fieldstrength and frequency that allows the use of nuclear magnetic resonance for imaging. An image can be constructed because the protons in different tissues return to their equilibrium state at different rates, which is a difference that can be detected. Five different tissue variables — spin density, T1 and T2 relaxation times and flow and spectral shifts can be used to construct images.[2] By changing the settings on the scanner, this effect is used to create contrast between different types of body tissue or between other properties, as in fMRI and diffusion MRI. The 3D position from which photons were released is learned by applying additional fields during the scan. This is done by passing electric currents through specially-wound solenoids, known as gradient coils. These fields make the magnetic field strength vary depending on the position within the patient, which in turn makes the frequency of released photons dependent on their original position in a predictable manner, and the original locations can be mathematically recovered from the resulting signal by the use of inverse Fourier transform.

Contrast agents may be injected intravenously to enhance the appearance of blood vessels, tumors or inflammation. Contrast agents may also be directly injected into a joint in the case of arthrograms, MRI images of joints. Unlike CT, MRI uses no ionizing radiation and is generally a very safe procedure. Nonetheless the strong magnetic fields and radio pulses can affect metal implants, including cochlear implants and cardiac pacemakers. In the case of cochlear implants, the US FDA has

subsequently went on to perform the first MRI body scan of a human being on July 3. patent #3. In 1973. are too variable for diagnostic purposes. using gradients.[12] As the National Science Foundation notes. and is particularly useful for tissues with many hydrogen nuclei and little density contrast. Damadian's initial methods were flawed for practical use.[6][7] and the first cross-sectional image of a living mouse was published in January 1974.S. in 2D and 3D. producing most of the noise that is heard during operation. He suggested that these differences could be used to diagnose cancer."[13] However. MRI is used to image every part of the body. HISTORY In the 1950s. connective tissue and most tumors.approved some implants for MRI compatibility. though later research would find that these differences. it did not describe a method for generating pictures from such a scan or precisely how such a scan might be done." In a 1971 paper in the journal Science. reported that tumors and normal tissue can be distinguished in vivo by nuclear magnetic resonance ("NMR"). an Armenian-American physician. it can approach 130 decibels (dB) with strong fields [4] (see also the subsection on acoustic noise). 1974. such as the brain. Raymond Damadian's "Apparatus and method for detecting cancer in tissue. 1977. Damadian created the world's first magnetic resonance imaging machine in 1972. Lauterbur published the first nuclear magnetic resonance image. Without efforts to damp this noise. "The patent included the idea of using NMR to 'scan' the human body to locate cancerous tissue.[17][18] .[14]Damadian along with Larry Minkoff and Michael Goldsmith.789.[11] While researching the analytical properties of magnetic resonance. a physicist and professor at the university.[3] so patients with such implants are generally not eligible for MRI.832 on March 17. which was later issued to him on February 5.[10] relying on a point-by-point scan of the entire body and using relaxation rates. while real.[5] Paul Lauterbur expanded on Carr's technique and developed a way to generate the first MRI images.[15][16] These studies performed on humans were published in 1977. Since the gradient coils are within the bore of the scanner. In the case of cardiac pacemakers.[9] Dr. Peter Mansfield. and professor at the Downstate Medical Center State University of New York (SUNY). then developed a mathematical technique that would allow scans to take seconds rather than hours and produce clearer images than Lauterbur had. scientist. Herman Carr reported on the creation of a one-dimensional MR image. 1972. muscle. Raymond Damadian. there are large forces between them and the main field coils. which turned out to not be an effective indicator of cancerous tissue.[8] Nuclear magnetic resonance imaging is a relatively new technology first developed at the University of Nottingham. the results can sometimes be lethal. U. England. He filed the first patent for an MRI machine.

founder of FONAR Corporation. which both use ionizing radiation. Paul Lauterbur of the University of Illinois at Urbana-Champaign and Sir Peter Mansfield of the University of Nottingham were awarded the 2003 Nobel Prize in Physiology or Medicine for their "discoveries concerning magnetic resonance imaging". MRI provides comparable resolution with far better contrast .[22] In a letter to Physics Today. with aliasing artifacts APPLICATIONS In clinical practice. It uses strong magnetic fields and non-ionizing radiation in the radio frequency range.[19] An ad hoc group. One advantage of an MRI scan is that it is harmless to the patient. demanding that he be awarded at least a share of the Nobel Prize.In recording the history of MRI. unlike CT scans and traditional X-rays.[21] although this was not approved until the 1970s. who claimed that he invented the MRI.[23] Sagittal MR image of the knee Para-sagittal MRI of the head. a discovery that allowed rapid acquisition of 2D images. MRI is used to distinguish pathologic tissue (such as a brain tumor) from normal tissue. Mansfield was credited with introducing the mathematical formalism and developing techniques for efficient gradient utilization and fast imaging. in the Soviet Union. While CT provides good spatial resolution (the ability to distinguish two separate structures an arbitrarily small distance from each other).[20] Also. while Paul Lauterbur was at Stony Brook University in New York. The actual research that won the prize was done almost 30 years before. as well as discovering the NMR tissue relaxation differences that made this feasible. The Nobel citation acknowledged Lauterbur's insight of using magnetic field gradients to determine spatial localization.[7] and that Lauterbur and Mansfield had merely refined the technology. 2003 Nobel Prize Reflecting the fundamental importance and applicability of MRI in medicine. Mattson and Simon (1996) credit Damadian with describing the concept of whole-body NMR scanning. Herman Carr pointed out his own even earlier use of field gradients for one-dimensional MR imaging. The award was vigorously protested by Raymond Vahan Damadian. even earlier. Vladislav Ivanov filed (in 1960) a document with the USSR State Committee for Inventions and Discovery at Leningrad for a Magnetic Resonance Imaging device. called "The Friends of Raymond Damadian". took out full-page advertisements in the New York Times and The Washington Post entitled "The Shameful Wrong That Must Be Righted".

The T1 weighting can be increased (improving contrast) with the use of an inversion pulse as in an MP-RAGE sequence. This sequence in particular is currently the most sensitive way to evaluate the brain for demyelinating diseases. each of which is optimized to provide image contrast based on the chemical sensitivity of MRI. fat is differentiated from water . The typical MRI examination consists of 5–20 sequences. with short TE and short TR. Damaged tissue tends to develop edema. the CSF (cerebrospinal fluid) will be lighter in T2-weighted images. T2-weighted MRI T2-weighted scans are another basic type. Effects of TR. each of which are chosen to provide a particular type of information about the subject tissues. Like the T1-weighted scan. in other words. This information is then synthesized by the interpreting physician. and generally able to distinguish pathologic tissue from normal tissue. T1 and T2 on MR signal. The basis of this ability is the complex library of pulse sequences that the modern medical MRI scanner includes. such as multiple sclerosis. which are basic parameters of image acquisition. Due to the short repetition time (TR) this scan can be run very fast allowing the collection of high resolution 3D datasets. For example.and fluid-containing tissues are bright (most modern T2sequences are actually fast T2 sequences) and fat-containing tissues are dark. water.resolution (the ability to distinguish the differences between two arbitrarily similar but not identical tissues). and water lighter. a T2-weighted sequence can be converted to a FLAIR sequence. in particular differentiating fat from water . For example. T1-weighted images highlight fat deposition. With the addition of an additional radio frequency pulse and additional manipulation of the magnetic gradients. The reverse is true for T1-weighted images. Basic MRI scans T1-weighted MRI T1-weighted scans are a standard basic scan. In the brain T1-weighted scans provide good gray matter/white matter contrast. These scans are therefore particularly . with a T1 scan being collected before and after administration of contrast agent to compare the difference. but edematous tissues remain bright. TE. a sequence takes on the property of T2-weighting. This is one of the basic types of MR contrast and is a commonly run clinical scan. in which free water is now dark.with water darker and fat brighter[24] use a gradient echo (GRE) sequence. which makes a T2-weighted sequence sensitive for pathology. A T1 reducing gadolinium contrast agent is also commonly used.but in this case fat shows darker. On a T2-weighted scan. with particular values of the echo time (TE) and the repetition time (TR). in the case of cerebral and spinal study.

It uses a spin echo or sometimes a gradient echo sequence. the assumption can be made that the majority of the fibers in this area are going parallel to that direction. with long TE and longTR. these taken together are called T*2. Therefore the molecule moves principally along the axis of the neural fiber. the diffusion may be anisotropic. In biological tissues however. Spin density weighted MRI Spin density. This also makes it more prone to susceptibility losses at air/tissue boundaries. a molecule inside the axon of a neuron has a low probability of crossing the myelinmembrane. For example. where the Reynolds number is low enough for flows to be laminar. SPECIALIZED MRI SCANS Diffusion MRI DTI image Diffusion MRI measures the diffusion of water molecules in biological tissues. these images have long been a clinical workhorse. If it is known that molecules in a particular voxel diffuse principally in one direction. Following an ischemic stroke. T*2-weighted MRI T*2 (pronounced "T 2 star") weighted scans use a gradient echo (GRE) sequence. with long TE and long TR. also called proton density. the only signal change coming from differences in the amount of available spins (hydrogen nuclei in water).[26] It is speculated that .well suited to imaging edema. The gradient echo sequence used does not have the extra refocusing pulse used in spin echo so it is subject to additional losses above the normal T2 decay (referred to as T2′). but can increase contrast for certain types of tissue. water molecules naturally move randomly according to turbulence and Brownian motion. DWI is highly sensitive to the changes occurring in the lesion. This enables researchers to make brain maps of fiber directions to examine the connectivity of different regions in the brain (using tractography) or to examine areas of neural degeneration and demyelination in diseases like Multiple Sclerosis. The recent development of diffusion tensor imaging (DTI)[7] enables diffusion to be measured in multiple directions and the fractional anisotropy in each direction to be calculated for each voxel. Because the spin echo sequence is less susceptible to inhomogeneities in the magnetic field. Another application of diffusion MRI is diffusion-weighted imaging (DWI). weighted scans try to have no contrast from either T2 or T1 decay. such as venous blood.[25] In an isotropic medium (inside a glass of water for example). with short TE and long TR.

The DWI enhancement appears within 5–10 minutes of the onset of stroke symptoms (as compared with computed tomography. This causes saturation of the bound spins which exchange into the bulk water. The magnetization transfer sequence applies RF saturation at a frequency that is far off resonance for the narrow line of bulk water but still on resonance for the bound protons with a spectral linewidth of kHz. then the effect can be measured in the spins of the bulk media due to the exchange processes. within the safety limits of specific absorption rate for RF irradiation. Due to exchange mechanisms. the (incoherent) spins bound to the macromolecules continually switch places with (coherent) spins in the bulk media and establish a dynamic equilibrium. researchers can highlight regions of "perfusion/diffusion mismatch" that may indicate regions capable of salvage by reperfusion therapy. Implementation of magnetization transfer involves choosing suitable frequency offsets and pulse shapes to saturate the bound spins sufficiently strongly. as a result of cytotoxic edema (cellular swelling). is responsible for the increase in signal on a DWI scan. two types of water molecules. On the other hand. i. These moving dipoles disturb the surrounding magnetic field however on long enough time-scales (which may be nanoseconds) the average field caused by the motion of protons is zero. This provides an indirect measure of macromolecular content in tissue. Like many other specialized applications.e. such as spin transfer or proton chemical exchange. free (bulk) and hydration (bound). such as echo planar imaging sequence. resulting in a loss of longitudinal magnetization and hence signal decrease in the bulk water. Free water protons have faster average rotational frequency and hence less fixed water molecules that may cause local field inhomogeneity. such as proteins. If the longitudinal magnetization of just the bound spins can be altered. hydration water molecules are slowed down by interaction with solute molecules and hence create field inhomogeneities that lead to wider resonance frequency spectrum. Conversely. Coupled with imaging of cerebral perfusion. most free water protons have resonance frequency lying narrowly around the normal proton resonance frequency of 63 MHz (at 1. . tend to have a fixed orientation and so the average magnetic field in close proximity to such structures does not average to zero. T2 relaxation. The net signal from these protons disappears very quickly.5 teslas). which often does not detect changes of acute infarct for up to 4–6 hours) and remains for up to two weeks. In magnetic resonance imaging of molecular solutions. protons. The wide frequency distribution appears as a broad spectrum that may be several kHz wide. which may be viewed classically as small magnetic dipoles.increases in restriction (barriers) to water diffusion. Magnetization transfer: Although there is no measurable signal from the bound spins. This is known as ―motional averaging‖ or narrowing and is characteristic of protons moving freely in liquid. In free liquids. this technique is usually coupled with a fast image acquisition sequence. The result is a spatial pattern in the magnetic field that gives rise to a residual dipolar coupling (range of precession frequencies) for the protons experiencing the magnetic field. or the bound spins that exchange into the bulk media. exhibit translational and rotational motions. protons bound to macromolecules. Magnetization Transfer MRI Magnetization transfer (MT) refers to the transfer of longitudinal magnetization from free water protons to hydration water protons in NMR and MRI. due to the loss of coherence of the spins. are found. in inverse proportion to the width. such as protein solutions. their longitudinal magnetization is preserved and may recover only via the relatively slow process of T1 relaxation. Because of this uniformity. This also results in slower transverse magnetization dephasing and hence longer T2.

the renal arteries.g. In this case the loss of coherence is described as a "static dephasing". and the legs (called a "run-off"). Techniques involving phase accumulation (known as phase contrast angiography) can also be used to generate flow velocity maps easily and accurately. T2 is a measure of the loss of coherence that excludes static dephasing. where most of the signal on an image is due to blood that recently moved into that plane. At the slowest extreme the interaction time is effectively infinite and occurs where there are large. This type of decay. the signal from any particular tissue can be suppressed. see also FLASH MRI. Fluid attenuated inversion recovery (FLAIR) Fluid Attenuated Inversion Recovery (FLAIR)[27] is an inversion-recovery pulse sequence used to null signal from fluids. T2* is a measure of the loss of coherence in an ensemble of spins that include all interactions (including static dephasing). the thoracic and abdominal aorta.g. such as multiple sclerosis (MS) plaques. and by collisions between molecules.T1ρ (T1rho): Molecules have a kinetic energy that is a function of the temperature and is expressed as translational and rotational motions. In general. A variety of techniques can be used to generate the pictures. The moving dipoles disturb the magnetic field but are often extremely rapid so that the average effect over a long time-scale may be zero. a metallic implant). the interactions between the dipoles do not always average away. Magnetic resonance venography (MRV) is a similar procedure that is used to image . depending on the time-scale. is known as T1ρ. occurring under the influence of RF. at risk of rupture). the rate of decay of an ensemble of spins is a function of the interaction times and also the power of the RF pulse. it can be used in brain imaging to suppress cerebrospinal fluid (CSF) so as to bring out the periventricular hyperintense lesions. stationary field disturbances (e. It is similar to T2 decay but with some slower dipolar interactions refocused as well as the static interactions. However. For example. such as administration of aparamagnetic contrast agent (gadolinium) or using a technique known as "flow-related enhancement" (e. using an RF pulse to reverse the slowest types of dipolar interaction. 2D and 3D time-of-flight sequences). Magnetic resonance angiography Magnetic Resonance Angiography Magnetic resonance angiography (MRA) generates pictures of the arteries to evaluate them for stenosis (abnormal narrowing) or aneurysms(vessel wall dilatations. By carefully choosing the inversion time TI (the time between the inversion and excitation pulses). MRA is often used to evaluate the arteries of the neck and brain. There is in fact a continuum of interaction time-scales in a given biological sample and the properties of the refocusing RF pulse can be tuned to refocus more than just static dephasing.

Functional MRI .veins.[29][30] Diastolic time data acquisition (DTDA). especially those affecting the brain. In this method.[31] and to provide information on tumor metabolism.[28] Magnetic resonance gated intracranial CSF dynamics (MR-GILD) Magnetic resonance gated intracranial cerebrospinal fluid (CSF) or liquor dynamics (MR-GILD) technique is an MR sequence based on bipolar gradient pulse used to demonstrate CSF pulsatile flow in ventricles. the tissue is now excited inferiorly. while signal is gathered in the plane immediately superior to the excitation plane—thus imaging the venous blood that recently moved from the excited plane. MRSI requires high SNR achievable only at higher field strengths (3 T and above). Because the available signal is used to encode spatial and spectral information. aqueduct of Sylvius and entire intracranial CSF pathway. The spatial resolution is much lower (limited by the available SNR). It is a method for analyzing CSF circulatory system dynamics in patients with CSF obstructive lesions such as normal pressure hydrocephalus.[32] Magnetic resonance spectroscopic imaging (MRSI) combines both spectroscopic and imaging methods to produce spatially localized spectra from within the sample or patient. It also allows visualization of both arterial and venous pulsatile blood flow in vessels without use of contrast agents. Systolic time data acquisition (STDA). cisterns. This signature is used to diagnose certain metabolic disorders. but the spectra in each voxel contains information about many metabolites. Magnetic resonance spectroscopy Magnetic resonance spectroscopy (MRS) is used to measure the levels of different metabolites in body tissues. The MR signal produces a spectrum of resonances that correspond to different molecular arrangements of the isotope being "excited".

Real-time MRI Real-time MRI refers to the continuous monitoring (―filming‖) of moving objects in real time. body position and scanned. however. BA17). including the primary visual cortex (V1. Interventional MRI The lack of harmful effects on the patient and the operator make MRI well-suited for "interventional radiology". where the images produced by a MRI scanner are used to guide minimally invasive procedures. The CBV method requires injection of a class of MRI contrast agents that are now in human clinical trials. Of course. Increased neural activity causes an increased demand for oxygen. Because deoxygenated hemoglobin attenuates the MR signal. reproducible. Radiation therapy simulation Because of MRI's superior imaging of soft tissues. The brain is scanned at low resolution but at a rapid rate (typically once every 2–3 seconds). Functional MRI (fMRI) measures signal changes in the brain that are due to changing neural activity. For therapy simulation. While many different strategies have been developed over the past two decades. correcting for any spatial distortion inherent in the system. The BOLD effect also allows for the generation of high resolution 3D maps of the venous vasculature within neural tissue. it may potentially expand the role of fMRI in clinical applications. In many cases MRI examinations may become easier and more comfortable for patients.[33] this mechanism is referred to as the BOLD (blood-oxygen-level dependent) effect. and the vascular system actually overcompensates for this. the flexible nature of MR imaging provides means to sensitize the signal to other aspects of the blood supply.0 mm. is that the surgical procedure is temporarily interrupted so that MR images can be acquired to verify the success of the procedure or guide subsequent surgical work. The CBF method provides more quantitative information than the BOLD signal. While BOLD signal is the most common method employed for neuroscience studies in human subjects. A specialized growing subset of interventional MRI is that of intraoperative MRI in which the MRI is used in the surgical process. Some specialized MRI systems have been developed that allow imaging concurrent with the surgical procedure. The new method promises to add important information about diseases of the joints and the heart. Because this method has been shown to be far more sensitive than the BOLD technique in preclinical studies. Alternative techniques employ arterial spin labeling (ASL) or weight the MRI signal by cerebral blood flow (CBF) and cerebral blood volume (CBV). The . a patient is placed in specific. Increases in neural activity cause changes in the MR signal via T* 2 changes. it is now being utilized to specifically locate tumors within the body in preparation for radiation therapy treatments.5 to 2. such procedures must be done without any ferromagnetic instruments. shape and orientation of the tumor mass. increasing the amount of oxygenated hemoglobin relative to deoxygenated hemoglobin. the vascular response leads to a signal increase that is related to the neural activity.A fMRI scan showing regions of activation in orange. albeit at a significant loss of detection sensitivity. More typical. a recent development reported a real-time MRI technique based on radial FLASH that yields a temporal resolution of 20 to 30 milliseconds for images with an in-plane resolution of 1. The precise nature of the relationship between neural activity and the BOLD signal is a subject of current research. The MRI system then computes the precise location.

Magnetic resonance guided focused ultrasound In MRgFUS therapy. and also detects traumatic brain injuries that may not be diagnosed using other methods[35] . 17O and 19F can be administered in sufficient quantities in liquid form (e. This allows the physician to ensure that the temperature generated during each cycle of ultrasound energy is sufficient to cause thermal ablation within the desired tissue and if not. 3D gradient echo scan. temperature within the tissue rises to more than 65 °C (150 °F). Current density imaging works because electrical currents generate magnetic fields. 17O-water) that hyperpolarization is not a necessity. or T2 imaging. It is used to enhance the detection and diagnosis of tumors. Such nuclei include helium-3. to adapt the parameters to ensure effective treatment. permits precise triangulation for radiation therapy. sodium-23. high-resolution. Susceptibility weighted imaging (SWI) Susceptibility weighted imaging (SWI). Alzheimer's). as well as functional imaging of the brain. This special data acquisition and image processing produces an enhanced contrast magnitude image very sensitive to venous blood. potential applications include functional imaging and imaging of organs poorly seen on 1H MRI (e.g. three dimensional. is a new type of contrast in MRI different from spin density. allowing for precise focusing of ultrasound energy. lungs and bones) or as alternative contrast agents. RF spoiled. ultrasound beams are focused on a tissue—guided and controlled using MR thermal imaging—and due to the significant energy deposition at the focus. Current density imaging Current density imaging (CDI) endeavors to use the phase information from images to reconstruct current densities within a subject. Multinuclear imaging is primarily a research technique at present.g. phosphorus-31 andxenon-129. real-time. T1. when combined with the specific body position. so can be imaged directly. Injectable solutions containing 13C or stabilized bubbles of hyperpolarized 129Xe have been studied as contrast agents for angiography and perfusion imaging. Inhaled hyperpolarized 3He can be used to image the distribution of air spaces within the lungs.[34] Multinuclear imaging Hydrogen is the most frequently imaged nucleus in MRI because it is present in biological tissues in great abundance. However. The MR imaging provides quantitative. However. oxygen-17. 23Na and 31P are naturally abundant in the body. fluorine-19. 31P can potentially provide information on bone density and structure. and because its high gyromagnetic ratio gives a strong signal. carbon13. multiple sclerosis. hemorrhage and iron storage. Gaseous isotopes such as 3He or 129Xe must be hyperpolarized and then inhaled as their nuclear density is too low to yield a useful signal under normal conditions. which in turn affect the phase of the magnetic dipoles during an imaging sequence. completely destroying it. vascular and neurovascular diseases (stroke and hemorrhage. any nucleus with a net nuclear spin could potentially be imaged with MRI. MR imaging provides a three-dimensional view of the target tissue. thermal images of the treated area. This technology can achieve precise ablation of diseased tissue.patient is then marked or tattooed with points that. This method exploits the susceptibility differences between tissues and uses a fully velocity compensated.

tissue contrast can be altered to enhance different features in an image (see Applications for more details). while contrast agents for MRI have paramagnetic properties. Both CT and MR images may be enhanced by the use of contrast agents. such as gadolinium andmanganese. such as iodine or barium. requiring long scan times to capture spectroscopic data or build up MRI images. double inversion recovery MRI (DIR-MRI) or phase-sensitive inversion recovery MRI (PSIR-MRI). to acquire images. while a variety of properties may be used to generate contrast in MR images. such as bone and calcifications (calcium based) within the body (carbon based flesh).[41][42] MRI versus CT A computed tomography (CT) scanner uses X-rays. in the case of solid tumors of the abdomen and chest. Furthermore. and may be less likely to require the person to be sedated or anesthetized. relative to tissue.Other specialized MRI techniques New methods and variants of existing methods are often published when they are able to produce better results in specific fields. or of structures (vessels. CT is often preferred as it suffers less from motion artifacts. it does not expose the patient to the hazards of ionizing radiation.[36][37] Another example is MP-RAGE (magnetization-prepared rapid acquisition with gradient echo). because. Research with atomic magnetometers have discussed the possibility for cheap and portable MRI instruments without the large magnet. all of them able to improve imaging of the brain lesions.[45][46] However. MRI is generally superior. By variation of scanning parameters. CT and MRI scanners are able to generate multiple two-dimensional cross-sections (slices) of tissue and three-dimensional reconstructions. used to alter tissue relaxation times. In the past. less expensive. MRI can generate cross-sectional images in any plane (including oblique planes). Some can be used for both EFNMR spectroscopy and MRI imaging. .[39] Portable instruments Portable magnetic resonance instruments are available for use in education and field research. Using the principles of Earth's field NMR. MRI. the development of multi-detector CT scanners with near-isotropic resolution. CT usually is more widely available. a type of ionizing radiation. Contrast in CT images is generated purely by X-ray attenuation. MRI is also best suited for cases when a patient is to undergo the exam several times successively in the short term. they have no powerful polarizing magnet.[40] The low strength of the Earth's field results in poor signal to noise ratios. CT was limited to acquiring images in the axial (or near axial) plane. on the other hand. allows the CT scanner to produce data that can be retrospectively reconstructed in any plane with minimal loss of image quality. teeth[43] and even fossils[44]). making it a good tool for examining tissue composed of elements of a higher atomic number than the tissue surrounding them. The scans used to be called Computed Axial Tomography scans (CAT scans).[38] which improves images of multiple sclerosis cortical lesions. However. faster. so that such instruments can be small and inexpensive. Examples of these recent improvements are T* 2-weightedturbo spin-echo (T2 TSE MRI). uses non-ionizing radio frequency (RF) signals to acquire its images and is best suited for soft tissue (although MRI can also be used to acquire images of bones. Contrast agents for CT contain elements of a high atomic number. For purposes of tumor detection and identification in the brain. bowel). unlike CT.

Economics of MRI MRI equipment is expensive. depending on project scope.500 and a professional charge might be $350 [47] although the actual fees received by the equipment owner and interpreting physician are often significantly less and depend on the rates negotiated with insurance companies or determined by governmental action as in the Medicare Fee Schedule. This is because of favorable reimbursement rates from insurers and federal government programs.3 million USD. Many private insurers have followed suit. For example. In the US Northeast. in cases where MRI contrast agents are used. Construction of MRI suites can cost up to $500. cochlear implants. These include pacemakers.[48] Many insurance companies require preapproval of an MRI procedure as a condition for coverage. MRI scanners have been significant sources of revenue for healthcare providers in the US. insulin pumps. Patients are therefore always asked for complete information about all implants . an orthopedic surgery group in Illinois billed a charge of $1.116 for a knee MRI in 2007 but the Medicare reimbursement in 2007 was only $470. shifting the economic landscape. Magnetic field Most forms of medical or biostimulation implants are generally considered contraindications for MRI scanning.0 tesla scanners often cost between $2 million and $2. These include:  Powerful magnetic fields  Cryogenic liquids  Noise  Claustrophobia In addition. an equipment charge for the actual performance of the MRI scan and professional charge for the radiologist's review of the images and/or data. or more. the Deficit Reduction Act of 2005 significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans. SAFETY A number of features of MRI scanning can give rise to risks. 3. an equipment charge might be $3. implantable cardioverter-defibrillators. Insurance reimbursement is provided in two components.5 tesla scanners often cost between $1 million and $1.5 million USD. loop recorders.91. In the US. deep brain stimulators and capsules retained from capsule endoscopy. 1. vagus nerve stimulators. Looking through an MRI scanner.000 USD. these also typically have associated risks.

non-electrically conductive. . Several deaths have been reported in patients with pacemakers who have undergone MRI scanning without appropriate precautions.before entering the room for an MRI scan. eliminating all of the primary potential threats during an MRI procedure.  MR Conditional sign MR-Conditional — A device or implant that may contain magnetic. In the United States a classification system for implants and ancillary clinical devices has been developed by ASTM International and is now the standard supported by the US Food and Drug Administration:  MR Safe sign MR-Safe — The device or implant is completely non-magnetic. Interaction of the magnetic and radio frequency fields with such objects can lead to trauma due to movement of the object in the magnetic field or thermal injury from radio-frequency induction heating of the object. electrically conductive or RFreactive components that is safe for operations in proximity to the MRI.[50] Ferromagnetic foreign bodies such as shell fragments.[citation needed] To reduce such risks. Cardiovascular stents are considered safe. however. and nonRF reactive.[49] and specialized protocols have been developed to permit the safe scanning of selected implants and pacing devices. provided the conditions for safe operation are defined and observed (such as 'tested safe to 1. implants are increasingly being developed to make them able to be safely scanned. Titanium and its alloys are safe from movement from the magnetic field.5 teslas' or 'safe in magnetic fields below 500 gauss in strength'). or metallic implants such as surgical prostheses and aneurysm clips are also potential risks.

[51][52] To reduce the risks of projectile accidents. producing minute expansions and contractions of the coil itself. This can heat the body to the point of risk of hyperthermia in patients. particularly in obese patients or those with thermoregulation disorders. often by changing into a gown or scrubs and ferromagnetic detection devices are used by some sites[53][54] There is no evidence for biological harm from even very powerful static magnetic fields[55] Radio frequency energy A powerful radio transmitter is needed for excitation of proton spins. etc. Several countries have issued restrictions on the maximum specific absorpsion rate that a scanner may produce. rapidly switched gradients used in techniques such as EPI. Acoustic noise Switching of field gradients causes a change in the Lorentz force experienced by the gradient coils. Peripheral nerve stimulation (PNS) The rapid switching on and off of the magnetic field gradients is capable of causing nerve stimulation. where ferromagnetic objects are attracted to the center of the magnet. As a result of dB/dt limitation. The reason the peripheral nerves are stimulated is that the changing field increases with distance from the center of the gradient coils (which more or less coincides with the center of the magnet). American and European regulatory agencies insist that manufacturers stay below specified dB/dt limits (dB/dt is the change in field per unit time) or else prove that no PNS is induced for any imaging sequence. this category is reserved for objects that are significantly ferromagnetic and pose a clear and direct threat to persons and equipment within the magnet room. diffusion MRI. Volunteers report a twitching sensation when exposed to rapidly switched fields. MR Unsafe sign MR-Unsafe — Nearly self-explanatory. commercial MRI systems cannot use the full rated power of their gradient amplifiers. and there have been incidences of injury and death. Note however that when imaging the head. weak gradients used in the early days of MRI. fMRI. Although PNS was not a problem for the slow. are indeed capable of inducing PNS. particularly in their extremities. the heart is far off-center and induction of even a tiny current into the heart must be avoided at all costs. ferromagnetic objects and devices are typically prohibited in proximity to the MRI scanner and patients undergoing MRI examinations are required to remove all metallic objects. As the switching is typically in the . the strong. The very high strength of the magnetic field can also cause "missile-effect" accidents.

Liquid helium. compared with iodinated agents.[62] Although gadolinium agents have proved useful for patients with renal impairment. in addition to the required quench pipe. when given at usual doses—this has made contrast-enhanced MRI scanning an option for patients with renal impairment.1%. an event known as "quench". to which the fetus is particularly sensitive.[59] Oxygen deficiency monitors are usually used as a safety precaution. 0. Keeping the O2 levels safe for patient/physicians and. current guidelines in the United States are that dialysis patients should only receive gadolinium agents where essential. Since a quench results in rapid loss of all cryogens in the magnet. Contrast agents The most commonly used intravenous contrast agents are based on chelates of gadolinium. their physical properties present specific hazards. Anaphylactoid reactions are rare. MRI avoids the use of ionizing radiation. If the rapidly expanding helium cannot be dissipated through an external vent. Making sure the MRI Scanner is working properly. that may be linked to the use of certain gadolinium-containing agents. In general. Rooms built in support of superconducting MRI equipment should be equipped with pressure relief mechanisms[60] and an exhaust fan. many MRI scanners rely on cryogenic liquids to enable superconducting capabilities of the electromagnetic coils within. brand name Eovist (US) or Primovist (EU). An unintentional shut-down of a superconducting electromagnet.03–0. as a precaution. sometimes referred to as 'quench pipe'. it may be released into the scanner room where it may cause displacement of the oxygen and present a risk of asphyxiation. However. 2. Though the cryogenic liquids used are non-toxic. undergoes near explosive expansion as it changes from liquid to a gaseous state. a classification of agents according to potential risks has been released. involves the rapid boiling of liquid helium from the device. but other agents have been linked too. the most commonly used cryogen in MRI. contaminants inside the cryostat. these agents have proved safer than the iodinated contrast agents used in X-ray radiography or CT.[63] Although a causal link has not been definitively established.[58] Cryogens As described in Physics of Magnetic Resonance Imaging. in patients with severe renal failure requiring dialysis there is a risk of a rare but serious illness.nephrogenic systemic fibrosis.[66][67] Recently a new contrast agent named gadoxetate.[68] Pregnancy No effects of MRI on the fetus have been demonstrated. who would otherwise not be able to undergo contrast-enhanced CT.audible frequency range. improper cryogen fill technique. The use of an Oxygen monitor is important for two reasons: 1.[69] In particular. recommissioning the magnet is expensive and time-consuming. the resulting vibration produces loud noises (clicking or beeping). This is most marked with high-field machines[56] and rapid-imaging techniques in which sound intensity can reach 120 dB(A)(equivalent to a jet engine at take-off). or extreme magnetic or vibrational disturbances.[61] Of particular interest is the lower incidence of nephrotoxicity. where more gadolinium-containing agents are available.[64][65] In Europe.[57] and therefore appropriate ear protection is essential for anyone inside the MRI scanner room during the examination. and that dialysis should be performed as soon as possible after the scan to remove the agent from the body promptly. was approved for diagnostic use: this has the theoretical benefit of a dual excretion path. but may also be triggered by equipment malfunction. Spontaneous quenches are uncommon. occurring in approx. current guidelines . The most frequently linked is gadodiamide.

g. Nervous patients may still find the following strategies helpful:  Advance preparation  visiting the scanner to see the room and practice lying on the table  visualization techniques  chemical sedation  general anesthesia Coping while inside the scanner  holding a "panic button"  closing eyes as well as covering them (e. Because scan times on these older scanners may be long (occasionally up to 40 minutes for the entire procedure). Claustrophobia and discomfort Due to the construction of some MRI scanners. they produce inferior scan quality because they operate at lower magnetic fields than closed scanners. The concerns in pregnancy are the same as for MRI in general. one additional concern is the use of contrast agents. in-utero diagnosis and evaluation of fetal tumors. but the fetus may be more sensitive to the effects— particularly to heating and to noise.5 tesla open systems have recently become available. The part of the body being imaged must lie at the center of the magnet. Alternative scanner designs. as these subjects cannot be instructed to hold still during the scanning session. This means that claustrophobia is less of an issue. commercial 1. and planning for procedures (such as the EXIT procedure) to safely deliver and treat babies whose defects would otherwise be fatal. However. This is particularly the case during the first trimester of pregnancy. other fetal interventions. which is at the absolute center of the tunnel. gadolinium compounds are known to cross the placenta and enter the fetal bloodstream. Though open scanners have increased in popularity. eye mask)  listening to music on headphones or watching a movie. Obese patients and pregnant women may find the MRI machine to be a tight fit. they can be potentially unpleasant to lie in. facilitating open fetal surgery. such as open or upright systems. primarily teratomas. Pregnant women may also have difficulty lying on their backs for an hour or more without moving. as organogenesis takes place during this period. However. Despite these concerns. while in the machine. and many patients now find MRI an innocuous and easily tolerated procedure. MRI without contrast agents is the imaging mode of choice for pre-surgical. people with even mild claustrophobia are sometimes unable to tolerate an MRI scan without management. Modern scanners may have larger bores (up to 70 cm) and scan times are shorter.[70] For babies and young children chemical sedation or general anesthesia are the norm. MRI is rapidly growing in importance as a way of diagnosing and monitoring congenital defects of the fetus because it can provide more diagnostic information than ultrasound and it lacks the ionizing radiation of CT.recommend that pregnant women undergo MRI only when essential. washcloth.  . can also be helpful where these are available. and it is recommended that their use be avoided. Older models of closed bore MRI systems feature a fairly long tube or tunnel. using mirror-glasses and a projection screen or via a Head-mounted display. providing much better image quality than previous lower field strength open models.

In almost all cases the existing regulations are aligned with the ICNIRP limits so that the Directive should. An employer may commit a criminal offense by allowing a worker to exceed an exposure limit. and incidental localized heating. and the ICNIRP guidelines it is based on. The introduction of the Directive has brought to light an existing potential issue with occupational exposures to MRI fields. movement of ferromagnetic bodies. There are at present very few data on the number or types of MRI practice that might lead to exposures in excess of the levels of the Directive. issued a substantial revision to theirMRI Design Guide. have little impact on any employer already meeting their legal responsibilities. the International Commission on Non-Ionizing Radiation Protection (ICNIRP). In February 2008. The aims of the Directive. and in particular the advice of the European Commissions's advisor. in theory. However. Originally scheduled to be required by the end of 2008. a UK healthcare regulatory body. which may not be exceeded. The European Physical Agents Directive The European Physical Agents (Electromagnetic Fields) Directive is legislation adopted in European legislature. the Joint Commission. changing magnetic fields and radio frequency energy. Field strength limits are given. which includes physical or facility safety considerations. The ACR White Paper on MR Safety has been rewritten and was released early in 2007 under the new title ACR Guidance Document for Safe MR Practices.Guidance Safety issues. issued their Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use. Some member nations passed complying legislation and are now attempting to repeal their state laws in expectation that the final version of the EU Physical Agents Directive will be substantially revised prior to the revised adoption date. the Medicines in Healthcare product Regulation Agency (MHRA). on MRI safety issues. the United States Veterans Administration. The actual limits in the Directive are very similar to the limits advised by the Institute of Electrical and Electronics Engineers. if that is how the Directive is implemented in a particular member state. a US healthcare accrediting organization. with the exception of the frequencies produced by the gradient coils. each individual state within the European Union must include this directive in its own law by the end of 2012. In July 2008. In December 2007.[71][72] There is a justifiable concern amongst MRI practitioners that if the Directive were to be enforced more vigorously than existing . where the IEEE limits are significantly higher. The directive applies to occupational exposure to electromagnetic fields (not medical exposure) and was intended to limit workers’ acute exposure to strong electromagnetic fields. issued a Sentinel Event Alert #38. the regulations impact significantly on MRI. including the potential for biostimulation device interference. Many Member States of the EU already have either specific EMF regulations or (as in the UK) a general requirement under workplace health and safety legislation to protect workers against electromagnetic fields. their highest patient safety advisory. as may be found near electricity substations. a federal governmental agency serving the healthcare needs of former military personnel. have been addressed in the American College of Radiology's White Paper on MR Safety. The Directive is based on the international consensus of established effects of exposure to electromagnetic fields. with separate sections of the regulations limiting exposure to static magnetic fields. radio or television transmitters or industrial equipment. are to prevent exposure to potentially harmful fields. which was originally published in 2002 and expanded in 2004.

This has since been removed from the regulations. the interior structure of each element is not visible in this mode of operation. The solution is calledsegmentation. . this would be a significant step back. a level that corresponds to fat). it is possible for a software program to build a volume by 'stacking' the individual slices one on top of the other. This is why it is unlikely to happen without strong justification. operation and maintenance of MRI scanners with magnets of 2 T and stronger. Individual government agencies and the European Commission have now formed a working group to examine the implications on MRI and to try to address the issue of occupational exposures to electromagnetic fields from MRI. Instead. resolution. A threshold level is set. so that even at an oblique angle.legislation. the use of MRI might be restricted. transparency and colors are used to allow a better representation of the volume to be shown in a single image . and whilst it is unlikely to be restored as it was without a strong justification. it can become impossible to separate them simply by adjusting volume rendering parameters. display of images does not need to be restricted to the conventional axial images.g. The effect of such a limit might be to restrict the installation. some restriction on static fields may be reintroduced after the matter has been considered more fully by ICNIRP. 3D rendering techniques Surface rendering A threshold value of greyscale density is chosen by the operator (e. Multiple models can be constructed from various different thresholds. the bones of the pelvis could be displayed as semi-transparent. and cartilage. In the initial draft a limit of static field strength to 2 T was given. Volume rendering Surface rendering is limited in that it only displays surfaces that meet a threshold density. allowing different colors to represent each anatomical component such as bone. Image segmentation Where different structures have similar threshold density.g. and only displays the surface closest to the imaginary viewer. a manual or automatic procedure that can remove the unwanted structures from the image. However. or near isotropic. The program may then display the volume in an alternative manner. or working practices of MRI personnel might have to change. one part of the image does not conceal another. using edge detection image processing algorithms. THREE-DIMENSIONAL (3D) IMAGE RECONSTRUCTION The principle Because contemporary MRI scanners offer isotropic. As the increase in field strength has been instrumental in developing higher resolution and higher performance scanners. From this. muscle. In volume rendering.e. a 3dimensional model can be constructed and displayed on screen.

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