Journal of Advanced Clinical & Research Insights (2017), 4, 139–142

REVIEW ARTICLE

Magnetic resonance imaging: Refined to re-find

A. Cecile Priyanthi, B. N. Sumalatha, Vasthsala Naik, Amandeep Sodhi, Shriyanka Rajshekhar
Department of Oral Medicine and Radiology, Bangalore Institute of Dental Science and Research Center, Bengaluru, Karnataka, India

Keywords
Electron spin resonance, magnetic resonance
imaging, paramagnetism, spin echo, sweep
imaging in Fourier transform
Correspondence
Dr. A. Cecile Priyanthi, Department of Oral
Medicine and Radiology, Bangalore Institute
of Dental Science and Research Center, Hosur
Road, Bengaluru - 560 029, Karnataka, India.
E-mail: acecile.1992@gmail.com
Received 12th January 2017;
Accepted 20th March 2017
Abstract
The hunt for an alternative and naive imaging modality by the clinicians for maxillofacial
ailments has laid the foundations for various advancements in dental magnetic resonance
imaging (MRI). MRI is progressing for the past few decades from being a technique with
great potential to one that has become the primary diagnostic investigation for many
clinical problems. It has evolved from a confined diagnostic technique to more feasible
and advanced technique for accurate diagnosis. This article reviews the basic principle
of MRI, the recent and advanced changes such as the use of sweep imaging in Fourier
transform fusion imaging, dynamic imaging, three-dimensional spin echo imaging, area
specific magnetic coils, highly sensitive chemical probes, and electron spin resonance
imaging to visualize the hard tissues which would be a paradigm shift in maxillofacial
diagnosis.

doi: 10.15713/ins.jcri.178

Introduction MR signals align themselves with this magnetic field resulting

Magnetic resonance imaging (MRI) is a noninvasive imaging
modality which uses nonionizing electromagnetic radiation
to image mainly the soft tissue pathologies in the body. The
images are formed by the application of radiofrequency pulse
in the presence of controlled magnetic field.[1] MRI produces
high-quality images with excellent tissue characterization and
multiplanar imaging capacity for appropriate diagnosis.[2]
Conventional MRI usually maps soft tissue pathologies, bone
marrow involvement and perineural spread.[3] Teeth and other
hard tissues which contain high inorganic content cannot be
viewed in conventional MRI because of the fast decaying of
signals before digitization.[2] In recent years, MRI has evolved
with rapid development and wide applications by the invent
of newer pulse sequences and altered exposure time,[4] to
visualize these fast decaying signals making it suitable for clinical
maxillofacial and dental application.[2] Various advances are
being introduced to improve the image diagnostic excellence.
Basic Principle of MRI
Initially, patient is placed in a large magnet which produces
external magnetic field. The nuclei with unpaired protons like
that of hydrogen atom in the body which are more sensitive to
in two energy states - Spin-up: In the direction of the field and
spin-down: In the opposite direction of the field.[1] Then, when
the RF pulse is applied, protons which are aligned in the Z axis
by an external static magnetic field (by the imaging magnet),
that have a Larmor frequency matching that of electromagnetic
wave absorb energy and shift or rotate away from the direction
induced by the imaging magnet that is from Z axis to XY axis
resulting in resonance.
The gradient field modulates RF of the tissue according to
Larmor frequency, Longer RF pulse greater rotation (Z axis
to XY axis). A  maximal RF signal is induced in a receiver coil.
A mathematical process called Fourier transformation converts
the frequency formation contained in the signal from each
location in the imaged plane to respective intensity levels, that
are then interrupted as shades of gray in a matrix arrangement of,
for example, 256 X 256 pixels. There is a transfer of energy from
individual hydrogen nuclei (spin) to the surrounding molecules
(lattice) and also to adjacent hydrogen nuclei (spin). This result
in T1 and T2 weighted images, respectively.
A T1-weighted image is produced by a short repetition
time between RF pulses and a short signal recovery time.
A T2-weighted image is acquired using a long repetition time
between RF pulses and a long signal recovery time.[1] Repetition
time or TR is determined by the length of the relaxation

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Priyanthi, et al.
period between two excitation pulses and is, therefore, crucial
for T1 contrast. Echo time or TE is defined as the interval
between application of the excitation pulse and collection of
the MR signal and determines T2 contrast. The difference in
signal strength from region to region constitutes the basis of
tissue contrast and forms the substrate for interpretation of
the image.[1]
Applications in Oral and Maxillofacial Region
Conventional MRI is commonly used in diagnosis and evaluation
of soft-tissue pathology involving salivary glands, pharynx,
sinuses, orbit (benign and malignant lesions), for assessment of
intracranial lesions, neurological lesions, articular disk status in
temporomandibular joint (TMJ), to evaluate structural integrity
of nerve and implants.[1]
The arena of indications of MRI today has widened from
being restricted only to soft-tissue imaging, as this modality is
well equipped and revolutionized for hard tissue imaging as well
as altering MRI sequence and other properties. Some of the
recent advancements in the field of MRI include: Sweep imaging
in Fourier transform (SWIFT),[2] fusion imaging,[5] three-
dimensional (3D) spin echo (SE) imaging,[6] dynamic imaging,[7]
area specific magnetic coils,[8] highly sensitive chemical probes,[9]
and electron spin resonance (ESR) imaging.[10] Currently, in
clinical practice fusion imaging, functional MRI are in use by the
clinicians.
SWIFT
The initial diagnosis of dental caries plays an important role in
treatment and prognosis of that tooth. However, dental MRI
with SWIFT comes up as an innovative imaging modality which
not only overcomes the drawbacks of the former but also aids in
early diagnosis of dental caries.[11]
A change in gradient pulse sequence was done to view
both calcified and noncalcified dental tissues which capture
fast decaying signals called SWIFT. SWIFT uses a swept RF
excitation and real-time signal acquisition in a time-shared mode
in the presence of field gradients.[2] In conventional MRI, the
signal is acquired in the frequency domain, here, the signal is
considered as a time function. This gives a “zero echo time,” and
so has significant benefits for studying objects having very fast
spin-spin relaxation (or very short T2).[12]
The main advantage is the use of frequency modulated pulses
having more uniform excitation profiles than the chirp excitation
required in rapid-scan Fourier transformation. During SWIFT
acquisition the applied imaging gradients usually exceed all
intrinsic gradients due to susceptibility or inhomogeneity. For
this condition, the images obtained are fully independent of
transverse relaxation. The signal intensity depends only on T1
and spin density.[13]
In a recent study done by Djaudat Idiyatullin et al., to assess
the efficacy of this method which was compared with traditional
140
Advancements in dental MRI
X-ray methods and histological sections. The results showed
dental tissues with high resolution in short scanning times to
be useful for clinical applications.[2] The SWIFT technique in
MRI has many beneficial and novel properties which overcomes
disadvantages of the conventional techniques.[12]
3D SE MRI
Visual/tactile examinations in combination with conventional
X-rays have been the main stay for the significant diagnosis of
dental caries till date. The 3D SE is an alternative diagnostic
method wherein it aims to image water-filled tissues thereby
aiding in visualization of decayed teeth[6] and temporomandibular
disorders.
SE sequences replace conventional gradient sequences for
imaging.[14] SE sequence shows less magnetic field inhomogeneity
and images liquid-filled tissues thereby called as liquid imaging
technique.[6] It uses 180° RF pulse and shows high signal noise
ratio with short TE.[15]
In a journal published byTanasiewicz et al. 3D SE MRI was
used to visualize water filled pores within highly decayed tooth in
which decayed tissue is mapped as bright area whereas it limits to
map the calcified dental tissue thereby early diagnosis of carious
teeth is concealed.[16]
3D SE MRI images the bone and cartilage parts in TMJ more
superiorly thereby evaluating the internal derangement of TMJ.
Functional MRI (FMRI)
The advances in MRI have metamorphosed from the
conventional morphological imaging modality to functional
physiological version.[7] With the basic principles of MRI as
the foundation, certain advancements have today expanded
the horizon of MRI toward evaluating, analyzing and studying
fluid dynamics within organs and tissues of the body. The
advantage of FMRI is its high spatiotemporal resolution and
also its capability of networking the brain areas.[17] It has three
types  -  diffusion weighted imaging (DWI), dynamic contrast
enhanced MRI (DCE-MRI) and blood oxygen level dependent
MRI (BOLD MRI).
DWI generates diffusion weighted images and apparent
diffusion coefficient maps, using movement of water molecules
as the basic criteria.[11,17]
DCE-MRI uses low molecular weight paramagnetic contrast
agents such as gadolinium to assess this microvasculature as well
as the extravascular extracellular space of cancers.[17]
BOLD uses a T2-sensitive sequence during oxygen inhalation
to detect an increase in signal resulting from the reduced
paramagnetic effect of a reduction in the blood deoxyhemoglobin
within cancer.[17] This method intends to bring about the
treatment modalities which have the potential to acknowledge
the latest treatment outcome.[17]
Functional MRI includes its applications indirectly in
measuring the functional movements of lip, teeth, tongue, and
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Advancements in dental MRI
also functional movements of TMJ in closed and open methods
thereby creating the association of brain activation with various
oral functions (chewing, swallowing, digestion, and speech).[18]
Fusion Imaging
The other advanced MRI modality to image the functional aspects
of the organs and the disease process called fusion imaging has been
introduced. It uses the combination of nuclear medicine studies
such as positron emission tomography (PET) and conventional
MRI to assess both the functional and morphological aspects of
the pathological site thus called as PET-MRI (fusion imaging).[5]
Both PET and MRI are taken separately and fused with the help
with various software for better quality assessment.
The applications are mainly in oncology studies like tumors
of odontogenic origin  -  such as ameloblastoma, odontogenic
keratocyst, and adenomatoid odontogenic tumor  -  and also
in neurological disorders, infections, etc., due to changes in
imaging parameters of both the techniques, the image quality
is compromised.[5] Thus many studies are still in progress to
overcome these limitations.
Future Advances in MRI
Many technical advances in the field of MRI are still being done
to further help the clinicians in appropriate diagnosis. The few
studies under progress are the area specific magnetic coils,[8]
highly sensitive chemical probes,[9] and ESR imaging.[10]
Area Specific Magnetic Coils
The conventional MRI uses large magnetic coil wherein the
resultant image shows low sensitivity for certain areas, masking
the image’s resolution.[8] To overcome this disadvantage area
specific wireless magnetic coils are proposed.[16] It also aids
in less image acquisition time.[8] The various studies are being
done to assess the feasibility of usage of these area specific coils
in dental MRI to visualize a high-quality image. In a study done
by Ute Ludwig et al., these wireless inductively-coupled intraoral
coils were used and the resultant image had improved resolution
thus raising the performance of dental MRI.[8]
This recent technique is said to overcome the current trend
of using cone-beam computed tomography technique for better
imaging in future prospects. Its indications include planning
of dental implant therapy, inflammatory diseases of teeth, its
supportive structures, alveolar bone, and neoplastic process.
MRI displays cancellous bone, oral mucosa, periodontium and
dental pulp directly and cortical bone, teeth roots are said to be
displayed indirectly in contrast to the surrounding soft tissues.
Highly Sensitive Chemical Probes
Various studies are being carried out to create highly sensitive
chemical probes with the detection of MRI to tag cells and to
Journal of Advanced Clinical & Research Insights  ●  Vol. 4:4  ●  Jul-Aug 2017141
Priyanthi, et al.
identify the movement of cell population. An inert fluorine-19
agents “nanoemulsions” is taken up by altered cells of interest.
These are detected by MRI, enabling to appreciate cellular
movements. These radioisotopes produce positive signal hot-
spot images with no background signal because of the absence of
fluorine concentration in tissues. Iron present in blood actually
augments the 19F MRI signals.[9]
The applications are in various treatment modalities such as
immunotherapy, study of stem cells and treating inflammation.
ESR
Electron paramagnetic resonance also known as ESR is a
spectroscopic technique which detect tissues with electrons that
are not paired. ESR is similar to nuclear magnetic resonance
(NMR), the basic difference being that ESR is concerned with
the magnetically induced splitting of electron spin states while
NMR describes the splitting of nuclear spin states.
When a magnetic field from an external source is applied,
the paramagnetic electrons orients in a direction parallel or
antiparallel to that of the applied magnetic field. This creates two
different energy states for the unpaired electrons and by Zeeman
effect causes splitting of spectral lines into various components.
The results are taken as they are moved between the two energy
states. It uses microwave radiofrequency.
Its application is in the study of free radicals, organic and
inorganic components, etc. Many researches are being carried
out to improve the various forms and applications of ESR.[10]
Conclusion
MRI being a vast imaging technique, various advancements are
emerging to improve and refine the quality of the image to assess
both the morphological and functional changes occurring in the
maxillofacial region so to enhance in naïve diagnosis. Thus, the
applications of MRI have traveled a long way in establishing its
principles from “REFINED” to “RE-FIND.”
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How to cite this article: Priyanthi AC, Sumalatha BN, Naik V,
Sodhi A, Shriyanka R. Magnetic resonance imaging: Refined to
re-find. J Adv Clin Res Insights 2017;4:139-142.

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142 Journal of Advanced Clinical & Research Insights  ●  Vol. 4:4  ●  Jul-Aug 2017