MAGNETIC RESONANCE IMAGING

MAGNETIC RESONANCE IMAGING (MRI) Disadvantages of MRI

o Imaging modality utilizing the magnetic property of the nuclei 1. High operation cost
o Study of the response of magnetized tissue to a pulse of 2. Longer examination time – main disadvantage
radiofrequency whereby pathological tissue returns different 3. Poor images for lungs
signals as compared to normal tissues 4. Inability to show calcification with accuracy
5. Acute hemorrhages or bleeding not as well-visualized as in CT
Uses of MRI 6. Contraindications in patients with devices that are affected by
1. Imaging modality of choice for study of the brain & spinal cord magnets
2. Musculoskeletal (MSK)
o Accurate imaging for joints, ligaments and muscles Scientists
3. Cardiac imaging related to the cardiac cycle 1. FELIX BLOCH with EDWARD PURCELL
4. Assessment of mediastinal vascular structures o Both discovered Nuclear Magnetic Resonance (NMR)
(-) CM Spectroscopy
5. Abdominal imaging with better visualization of each organ 2. RAYMOND DAMADIAN
aided by presence of FAT o Reported the differences in NMR images/parameters
6. Pelvic imaging between normal tissues & abnormal tissues/tumors
o neoplasm (tumors) in males & females 3. PAUL LAUTERBUR
o Male – prostate gland and urinary bladder o Publicized the 1st NMR image
o Female – uterus, ovaries, fallopian tube, and urinary
bladder TERMS IN MRI IMAGE PRODUCTION
1) MAGNETIC MOMENT
Advantages of MRI o measurement of the magnetic properties of an object
1. Multiplanar imaging or particle (proton) that causes it to align w/ the static
– All the planes (axial, coronal, parasagittal, sagittal) magnetic field
2. No ionizing radiation o a force created when a magnetic dipole is in a
3. Excellent anatomical detail (presentation of an organ) magnetic field
4. (-) bone artifacts
5. Visualization of blood vessels without introduction of contrast 2) NET MAGNETIZATION
material o Integrated effect of all the individual nuclear magnetic
6. Contrast material is less frequently used than in CT moment & spin

3) 0 NET MAGNETIZATION
4) PRECESSION (WOBBLE)

1
 o Slow gyration of the axis of the spinning nucleus,
change in direction of the axis of rotation
o Caused by magnets
5) MAGENTIC RESONANCE
o Interaction between a spinning nucleus and an external
magnetic field
6) LARMOR FREQUENCY
o Frequency at which a nucleus precesses in a magnetic
field
o Frequency at which magnetic resonance can be
excited given by the Larmor equation
7) LARMOR EQUATION
o fundamental equation for MRI
o states that frequency of precession is proportional to
the magnetic field
o Formula 𝑾 = 𝒚𝑩𝐨
Where 𝑾 = Precessional Frequency
𝒚 = Gyromagnetic Ratio
Bo = Strength of Magnetic Field
8) GYROMAGNETIC RATION (GMR)
o Constant specific ratio for each nucleus relating that
precessional frequency in a magnetic field
o Every nucleus of the cell has its own GMR
9) RADIOFREQUENCY (RF)
o Electromagnetic radiation used in MRI having
frequencies of 0.3 kHz to 300 GHz for nuclear
excitation; unit: MHz (1-100)
10) SPECIFIC ABSORPTION RATE (SAR)
o Power absorbed by the tissue during radiofrequency
irradiation
11) FREE INDUCTION DECAY (FID)
o Signal emitted by a tissue after an RF pulse has
excited the nuclear spins of that tissue at resonance
decaying signal w/ a characteristic time constant
12) GRADIENT MAGNETIC FIELD
o Change in intensity of a magnetic field in space
13) FOURIER TRANSFORMATION
o Mathematical procedure used to generate the
spectrum from the FID, both in CT & MRI, Ultrasound
o Machine used in Algorithm
14) SPIN DENSTY (SD) /PROTON DENSITY (PD)
o Measurement of the concentration of mobile hydrogen
nuclei in tissue precessing at the larmor frequency to
produce MRI signal
15) TIME 1 RELAXATION TIME (T1RT)
o a.k.a. Spin Lattice/Longitudinal RT
o time constant for interaction between nuclear spins &
tissue lattice to return to normal following
Radiofrequency excitation
16) TIME 2 RELAXATION TIME (T2RT)
o a.k.a. Spin Spin/Transverse RT
o time constant for interaction between nuclear spins &
adjacent nuclear spins to return to normal following
Radiofrequency excitation
17) TESLA (T)
o SI unit of magnetic field strength
o Father of AC
18) GAUSS
o German mathematician
o older unit in MRI
2
Z-AXIS
o Where external magnetic field is directed 4 BASIC STEPS IN MR IMAGING
o Long axis of the patient 1) Place the patient in the magnet
2) Sending radiofrequency pulse (RF) by the coil
LONGITUDINAL MAGNETIZATION 3) Receiving signals from the patient again by the coil
o T1RT 4) Signals are sent to the computer for complex processing to get
o Magnetic vector along the z-axis where forces of proton the image
accumulate
PRODUCTION OF MR IMAGE
TRANSVERSE MAGNETIZATION  Normal set-up
o New magnetic vector caused by an RF pulse - each nucleus in magnetic dipole
 0 Net Magnetization
MAGNETIC FIELDS WITH DIFFERENT STRENGTHS - Randomly distributed dipoles in the body causes all spins
IN VARYING LOCATIONS and magnetic moments to cancel
1) SLICE SELECTION GRADIENT  Introduction of magnet causes polarization with appearance of
o Determines slice position net magnetization; causes nuclei to be in a state of
Precession
2) PHASE ENCODING GRADIENT  Each nucleus in precession will exhibit its own unique Larmor
o Turned ON after #1 Frequency and Gyromagnetic Ratio
 Pulse of radiofrequency causes excitation or flipping of the
3) FREQUENCY ENCODING GRADIENT nuclei
o Sent in end time of signal reception  Immediate absence of the RF pulse causes realignment
resulting to relaxation of the nuclei producing a signal
 Information from all three axes is sent to the computer to get  Free Induction Decay (FID)
the particular point in that slice from which the signal is coming - Signal emitted by the body tissue
from  Signal sent to computer for image processing

TIME TO REPEAT (TR)  EXCITATION

o Time interval between start of one RF pulse of the next RF o nuclei energized and aligned against the external magnetic
pulse field
TIME TO ECHO (TE)
o Time interval between start of an RF pulse and reception 3 PARAMETERS WHERE MRI IS BASED:
of the echo 1) SPIN
2) T1RT
3) T2RT

3
SPIN DENSITY
o also known as Proton Density  The higher the concentration of mobile
o detects hydrogen concentration hydrogen nuclei, the stronger the Net
Magnetization at equilibrium, the more
HYDROGEN intense is the MRI signal
o Makes up 80% of all atoms in the human body  A strong MRI signal results in a better
o Exhibits strong magnetism image
o High GMR as compared to other nuclei in the body (42.6 ↑ [H+] concentration
MHz/T) o Bright MRI appearance
o Highest sensitivity for producing MRI signal o E.g. Fat and skin

Nucleus GMR (MHz/T) ↓ [H+] concentration

Hydrogen (H) 42.6 o Dark MRI appearance
Fluorine (F) 40.1 o E.g. Air, cortical bone
Phosphorus (P) 17.2
Tissues T1RT AT 1 TESLA
Sodium (Na) 11.3
Carbon (C) 10.7 Fat (bright) 180
Liver 270
Oxygen (O) 5.8
Potassium (K) 2.0 Spleen 480
Muscle 600
Blood 800
Tissue Spin Density CSF 2000
Muscle (bright) 100 Water 2500
White mater 100
Fat 98 TISSUES T2RT AT 1 TESLA
Kidney 95
Muscle (dark) 40
Spleen 92
Liver 91 Liver 50
Blood 90 Spleen 80
Cortical bone 1-10 Fat 90
Air (black) <1 Gray mater/White mater 100
Blood 180
Higher mobile [H+] CSF 300
o stronger net magnetization at Water (bright) 2500
equilibrium
o highly intense MRI signal

4
MAGNETISM
o Fundamental property of matter possessed by all substances B. MRI CONSOLE WITH COMPUTER
o Degree depends on magnetic susceptibility of an atom
C. POWER SUPPLY
MAGNETIC SUSCEPTIBILITY I. Type 1 – high current power supply for magnets
o Ability of a substance to get affected by an external magnetic II. Type 2 – precision power supply for secondary coils
field
o Is related to electron configuration of an atom MAGNETS USED IN MRI
A. PERMANENT MAGNET
TYPES OF SUBSTANCES BASED ON MAGNETIC o Made up of ferromagnetic substances
SUSCEPTIBILITY o ALNICO
1. PARAMAGNETISM - alloy of aluminum, nickel, cobalt
o Unpaired electrons within the atom o Low cost
o Affects external magnetic field towards its direction o Low magnetic field strength (0.2-0.5 T)
o E.g. Gadolinium, Oxygen, Melanin o Disadvantage
- Low SNR
2. DIAMAGNETISM - Low resolution
o Repelled by the magnetic field
B. ELECTROMAGNET/RESISTIVE MAGNET
3. FERROMAGNETISM o Applies principle that moving electrical charge induces
o Strongly attracted to a magnetic field w/ retention of a magnetic field around it
magnetism even if the external magnetic field is removed o Uses spring/coil wire
o E.g. Iron, Cobalt, Nickel o SOLENOID – material in coil wire
o Huge heat generation
1 TESLA o Needs water cooling system
= 10 kg o Low magnetic field strength (0.2 – 0.37)
= 10, 000 Gauss o High operational cost
o Easy installation
PARTS OF MRI MACHINE o Needs rigid framework (gantry) because of resistive
A. GANTRY magnet
a. Patient Couch C. SUPERCONDUCTING MAGNET (SC)
b. Magnet o Magnet containing coils are made from a
c. Secondary Coils superconducting metal alloy
1) Shim Coils o Completely eliminates resistance
2) Gradient Coils o Metals that lose their electrical resistance at very low
3) RF Coils/Probe temperature producing higher magnetic field
strength
o Housed in a DEWAR
5
 STRUCTURE OF A SUPERCONDUCTING MAGNET
1) SUPERCONDUCTING WIRE
o Made up of Namibium (Nb) and Titanium
(Ti) alloy embedded in a copper matrix
placed tightly inside an aluminum bore tube
and fixed by high thermal conductivity epoxy
binder
o Placed in an insulated Aluminun bore tube
2) CHAMBERS OF SUPERCONDUCTING MAGNET
a. LIQUID NITROGEN – outer
o With radiation shield
o Surrounds container of liquid helium
o Prevents any heat exchange between
helium and its surroundings
o Lessens evaporation of liquid Helium
b. LIQUID HELIUM – inner
o Surrounds the SC coil
o Cools superconducting material
o Needs replenishment every 6 months
o Maintained in cold temperature
3) DEWAR
o Houses the SC magnet
RAMPING
o process where the SC (superconducting) magnet is energized
by delivering current from an external power source to the SC
wire after it has been cooled by the liquid helium and nitrogen
QUENCH
o discharge or loss of magnetic field of SC magnet (cold
temperature) due to increased resistance in the SC coil
resulting to formation of heat
SECONDARY COILS IN MRI
1) SHIM COILS
o Provides the homogenous or uniform magnetic field;
located; located in the aperture of the main magnet
o Shimming
- process of making the magnetic field
homogenous
2 TYPES OF SHIMMING
a. Active
o done by passing current through the gradient coils which
generates small magnetic field gradients superimposed on the
main magnetic field
o located within the Helium vessel
b. Passive
o Done by keeping metal pieces (shim plates) in the magnetic
field to oppose inhomogeneity (homogenous)
Homogeneity
o parts per million (ppm)
- expresses homogeneity of magnetic field (pulse
in magnetic field)
o 10 ppm is sufficient for every routine spin echo imaging
- MRI average
FACTORS THAT LEAD TO NON-HOMOGENOUS MAGNETIC
FIELD
1) Imperfect coil
2) Current densities w/in the wire
3) Presence of metal w/in the environment
2) GRADIENT COILS
o Provide spatial information about the tissue from which the
signal is emitted; plane of scan determined electronically
o Used for localization or gradient echo sequence
o Consists of 3 sets of coils in XYZ direction
o Gradient strength (stiffeness)
6
 o Measured in Gauss/cm or mT/m 1) HEAD & BODY COILS
o 15-20 mT/m – for High-resolution imaging o Volume coils; transceivers
GRADIENT COILS
o Used to vary the magnetic field strength over the extent of the 2) SURFACE COILS
magnetic field o improve snr significantly when used to image structures near
o Located coaxially in the room temperature compartment of the the surface of the patient
magnet bore o act as receiver only
o designed as per requirement for particular parts
EDDY CURRENT o E.g. Flex coils
o Generated by the gradient system - Used for joints
o Degrades homogeneity of magnetic field - Wrapped around the knee, shoulder, and ankle
o Does not produce uniform magnetic field
o Causes heat production leading to evaporation of cyrogens 3) PHASE ARRAY COILS
o Combine the advantages of the surface coils (increased SNR
Cryogen bath (ice) – restricts Bo lines to acceptable location; and resolution) and volume coils (increased coverage)
more expensive o Consist of multiple small coils
o Used in body imaging, spine, pelvis, cardiac
3) RADIOFREQUENCY PROBE
o Antenna coil that transmits and also detects the MRI MRI COMPUTER
signal; located inside the gradient coils; closest to patient Functions
o Transceiver 1) Data Collection
o Loop of wire used to transmit RF pulse into patient 2) Data manipulation
o Loop of wire that receives signal from the patient 3) Image viewing
4) Image storage
RF PULSE 5) Image retrieval
o Energy transmission in a form of short, intense bursts of 6) Image documentation
RF
o Cause phase coherence & flip protons from low energy Picture Archiving and Communication System (PACS) – encrypt
state to high energy state
FACILITY DESIGN OF MRI EQUIPMENT
5 TYPES OF RF COILS 1) Room should be shielded against radio interference and fringe
o Head magnetic fields
o Body Coil 2) Non-magnetic materials should be used
o Surface/Local Coils 3) Plumbing should use PVC or copper
o Phased Array Coils 4) Lighting should be direct current
o Solenoid Coil
o Helmholtz Coil

7
FRINGE MAGNETIC FIELD
o Stray magnetic field outside patient’s aperture or outside IMAGE ACQUISITION IS RELATED TO:
the bore of the magnet 1) TR TIME
2 PROCESSES THAT SHIELD THE MRI SYSTEM 2) MATRIX SIZE
1) PASSIVE SHIELDING 3) NUMBER OF AVERAGES
o Done by lining the wall of the MR room by steel or MRI NOISE IS DECREASED BY THE FOLLOWING
copper (Faraday Cage) 1) Large voxel size
2) Large number of averages
4) ACTIVE SHIELDING 3) Long TR
o Uses additional solenoid magnet outside the cryogen 4) Short TE
bath that restricts the external magnetic field lines to an 5) Surface coils
acceptable location
o Expensive  FDA suggested limit for magnetic field
o 2 TESLA
FARADAY CAGE (RF SHIELD)
o Carefully-constructed wire mesh shield enclosing the MRI  SAR limit
machine to attenuate extraneous sources of o 0.4 watt/k
radiofrequency
BIOLOGIC EFFECTS OF MRI
RESONANCE 1) Augmentation of T-wave amplitude in electrocardiogram
o When an RF pulse & protons have the same frequency 2) Electric currents induced
protons, energy is produced up from the left pulse o Mild cutaneous sensations
o Involuntary muscular contractions
MAGENTIC FIELDS W/ DIFFERENT STRENGTH IN VARYING o Cardiac arrhythmias
LOCATION o Light flashes from retinal stimulation (Phosphenes)
1) Slice selection g 3) Increase body temperature
2) Phase encoding o Radiofrequency exposure
3) Frequency
PATIENTS EXCLUDE FROM MAGNETS
CHARACTERISTICS OF MR IMAGING Any device that is attracted or affected by magnetism
1) Spatial Resolution - Cardiac pacemaker
o improved with increasing MRI signal strength - Surgical clips
- Shrapnel/metallic foreign bodies
2) Contrast Resolution - Implanted electrodes
o Null region - Internal drug infusion pumps
- total loss of contrast due to improper RF pulse
selection
3) Noise
8
MRI IN PREGNANT PATIENTS Categories of Pulse Sequence:
o Its safety is not fully established 1) Spin Echo Sequence (SE )
o Can be performed if the other imaging modalities (CT, a. conventional
ultrasound) cannot provide the needed information b. turbo / fast
2) Inversion Recovery (IR)
3) Gradient Echo Sequence (GRE)
GRADING OF MRI SYSTEMS ACCORDING TO MAGNETIC FIELD 4) Ultra-fast Sequences
STRENGTH a. Echo Planar Imaging (EPI)
1) High field systems 1) Spin Echo Pulse Sequence
= 1 - 2 TESLA a. consist of 90˚ and 180˚ pulses
b. signal received by receiver coil
2) Mid-field systems c. increased magnitude of TM
= 0.35 - 0.5 TESLA
TR – time between two 90˚ pulses
3) Low-field systems TE – time between 90˚ pulse & reception of echoes
= < 0.2 TESLA T1WI – useful for demonstrating anatomy - baseline
T2WI – demonstrates pathology
 High and Mid field
o superconducting and resisting magnets Turbo SE Sequence
 Low field – permanent a) increase in scanning speed when multiple 180˚
o Permanent magnets rephrasing pulses are sent after 90˚ pulse
K-SPACE b) K – space is filled much faster with multiple echoed filled
o Imaginary space which represents raw data matrix in a single TR

Two (2) Axes of K – Space: Turbo Factor (Echo Train Length)

1) Horizontal o number of 180˚ pulses after each 90˚ pulse
o represents phase axis & is centered in the middle of
several horizontal Advantages of Multiple – Spin – Echo Sequence
2) Frequency 1) use for clinical application
o vertical & perpendicular to the phase axis 2) greatly reduced scan time

PULSE SEQUENCE 2) Inversion Recovery ( IR ) Sequence

o interplay of various parameters leading to a complex cascade
of events with RF pulse & gradients to form MR image
o makes scanning shorter
o consist of an inverting 180˚ pulse followed by 90˚ excitation
pulse followed by a rephrasing 180˚ pulse
o useful in saturation of water and fat
o suppression of particular tissue by changing T1
o used in post – contrast imaging as it enhances signal from
tissues taking up contrast
9
Types of IR Sequences Basis for Rapid Sequence Techniques
a) short 1) Low flip angle with gradient reversal
ex. STIR 2) RF refocusing
b) medium
ex. MPRAGE, Turbo FLASH
c) long MAJOR ULTRAFAST SCANNING TECHNIQUES:
ex. FLAIR 1) RARE (Rapid Acquisition with Relaxation Enhancement)
STIR (Short T1 Inversion Recovery) o Fast spin – echo sequence
- most of pathologies appear bright o A.ka. Turbo SE / Fast SE
- mainly used in body imaging o provides sufficient signal intensities on components that
exhibit very long T2RT
FLAIR (Fluid Attenuated Inversion Recovery) ex. Fluids
- most of pathologies appear bright o shows body liquids with character of angiography
- used in neuroimaging
USES of RARE
GRE (Gradient Echo) Sequence 1) MR Cholangiogram (Biliary Tree)
o no 180˚ pulse 2) MR Myelogram (Spinal Cord)
o rephrasing of TM done by gradients 3) MR Urogram (Urinary System)
o smaller flip angle ( < 90˚ ) - background soft tissues are not visualized

SS (Steady State ) 2) STEAM (Stimulated Echo Acquisition Method)

o shortest IR - used in cardiac imaging
o shorter scan time - importantly applied in MR spectroscopy
o affects image – contrast tissues in long T2 which appears
bright 3) Subsecond FLASH (Fast Low Angle Shot)
o used in body imaging where physiological motion needs to
Three (3) Types of Steady State: be overcome
1) Coherent (in – phase ) residual TM ex. Peristaltic motions
ex. FISP , GRASS o used in cardiac perfusion
2) Incoherent (spoiled ) residual TM
ex. FLASH 4) EPI (Echo Plannar Imaging)
3) SSFP (Steady State Free Precession) o decrease scan time by filling multiple of K – space in a
- shorter TR single TR
- shorter scan time o multishot EPI improves SNR & spatial resolution
ex. PSIF o gives better PD and T1WI but increases scan time

10
 Application of EPI: - reduces visible MR signal from specific semi – solid
1) EPI Diffusion imaging tissue resulting to increased contrast to noise ratio with
2) EPI Perfusion imaging fluid components
3) Functional imaging with BOLD USES:
4) Echo plannar cardiac imaging a. MRA
5) Abdominal imaging b. muscle studies

IPAT (Integrated Parallel Acquisition Technique) Basic Types of Sequences & Its Uses:
o image data is done simultaneously by 2 or more receiver coils 1) FLASH (Fast Low Angle Shot)
with different spatial sensitivities o brain imaging
o reduces time by half o T1WI
o pre & post contrast studies
Key Hole Imaging o T2WI FLASH show acute bleed as a DARK signal; useful
- mainly used in contrast enhanced MRA to detect cerebral hemorrhage
(Magnetic Resonance Angiography) o for flow & angiographic studies
o cardiac imaging visualization
Artifacts Reducing Techniques: a. heart movement (cardiac motion)
1) PACE (Perspective Acquisition Correction) b. wall thickness
2) IPAT c. valves with ECG synchronization
- reduces motion artifacts - for functional brain mapping
3) Flow compensation
- gradient motion rephrasing corrects phase shift caused by 2) FLAIR (Fluid Attenuated Inversion Recovery)
motion o used in neuroimaging
4) LOTA (Low Term Averaging) - extent of perilesional edema
- reduces breathing & motion artifacts - brain infarcts
5) ROPE (Respiratory Ordered Phase Encoding) - multiple sclerosis – bright lesions
- reduces breathing artifacts - Subarachnoid Hemorrhage
6) ECG Triggering - syrinx – cyst in the spinal cord
- synchronizes acquisition with particular phase of cardiac
cycle 3) Medium T1 IR Sequence
7) Saturation Band o GM vs. WM differentiation
- reduces artifacts from adjacent tissues by saturation o forms part of temporal lobe epilepsy protocol

SNR Improving Techniques: 4) CISS (Constructive Interference at Steady State)

1) TONE (Tilt Optimized Non – Saturation Excitation) o study of cranial nerves
- utilizes varying flip angle in MRA sequence with no loss o I to XII
of signal-to-noise distal
2) MTC (Magnetization Transfer Contrast)
11
 5) MPRAGE (Magnetization Prepared Rapid Acquisition o produce by anatomy moving along a gradient during pulse
Gradient Echo) sequence resulting to phase mismapping
o show good GM – WM contrast o corrected by:
o used in routine T2WI sequences a. change in phase encoding direction
b. use of GMR (Gradient Motion Rephasing)

2) Aliasing / Wrap around

6) STIR (Short T1 Inversion Recovery) o anatomy that exists outside the FOV (Field of View) appear in
o Identify lesions an image
o bone marrow imaging
a. marrow edema 3) Chemical Shift Related
b. bone metastasis screening o difference in precessional frequency of protons in water & fat
o orbital imaging o expressed in PPM
o joint imaging
Types of Chemical Shift Related artifacts
7) TRUFI (True Free Induction Steady State) a. Chemical Shift Misregistration Artifact
o abdominal imaging - Appears as DARK EDGE at interface between fat
o cardiac imaging and water
o fetal imaging b. Inteference from Chemical Shift
o MR enteroclysis - Appears as DARK EDGE around certain organs
where fat and water interfaces occur within the
8) HASTE (Half Fourier Acquisition with Turbo Spin Echo) same voxel
o abdominal imaging
o cardiac imaging 4) Truncation / Edge / Gibbs / Ringing
o MR myelogram o produce low intensity band running through high intensity area
o MR enteroclysis causing misleading in long narrow structure
ex. spinal cord & vertebra
9. MEDIC (Multi Echo Data Image Combination)
o used in cervical spine imaging with flow compensation to
avoid artifacts from neck vessels

MRI Artifacts 5) Magnetic Susceptibility Artifact

o cause significant image degradation/distortion Magnetic Susceptibility
o Leads to misinterpretation o ability of the substance to become magnetized
o causes signal loss and distortion of boundaries
MRI Artifacts: o causes signal loss & distortion of boundaries
1) Ghosts
o replica / copy in the image caused by motion
12
6) Straight Lines 1. testes
o Caused by RF interference simulated echo and spike in K- 2. eyes
space
o Caused by radiowaves from sources outside the MRI machine EXPOSURE TO MRI:
o < 3 Tesla – amount of exposure
7) Zipper – like o 3T causes the following:
o A line with alternating bright & dark pixels propagating along 1. vertigo
the frequency encoding direction 2. headache
3. peripheral nerves stimulation
8) Shading Artifact
o uneven contrast with loss of signal intensity in one part of the FDA Limit for MRI Examination:
image SAR = < 0.4 watt/k

9) Cross Excitation Acoustic Noise

o phenomenon where adjacent nuclei are excited & received o caused by vibrations of gradient coil
energy causing saturation & affects contrast o Noise increases with:
a. Thin slices
10) Cross talk b. Small FOV
o When energy is dissipated to nuclei from neighboring slice as c. Less TR & TE
nuclei within the selected slice relaxes after the RF pulse is
switched off 4 ZONES IN MRI SITE:
o Zone I: Free access to general public
MRI BIOEFFECTS: o Zone II: Place where gathering a patient’s history &
A. SMF (Static Magnetic Field) preparation is performed; patient preparation
Effects: o Zone III: Physically restricted from general public access
a. raise skin temperature (MR personnel are allowed)
b. electrical induction – muscle o Zone IV: MR scanner room; Located within Zone III
c. cardiac effects
d. neuron effect *Non-MRI personnel are not allowed to enter III & IV without prior
B. GMF (Gradient Magnetic Field) screening
Effects: *Metallic object are not allowed in Zones III and IV
a. ventricular fibrillation
b. epileptogenic potential
c. visual flashes Adverse Effects of Ferromagnetic Objects
C. RF (Radiofrequency) 1. displacement
Effects: 2. induction of electric current in the object
a. heat 3. excessive heat – burns
(2) Two organs sensitive to RF: 4. misinterpretation due to presence of artifacts
13
 Classification of MR Contrast Media (Methods of CM
PREGNANT PATIENT IN MRI Introduction)
o case to case basis A. Parenteral (Intravenous)
o scanning permitted in any stage except during the 1st B. Oral
trimester of pregnancy
o use of other safer modalities
o No contrast material should be used Classes of CM used in MRI
o Lactating patients: no breastfeeding within 36-48hrs/ 2days 1) Paramagnetic Agents
o Develop magnetic moment when placed in a magnetic
CONTRAINDICATION: field
1) Aneurysm and hemostatic clip – staple wire o Ex. Gadolinium – most common CM
2) Dental devices – causes artifacts SIDE EFFECTS INCLUDE:
3) Ocular implants – causes minor injury and discomforts - Headache
4) Otologic implants – absolutely not - Nausea
5) If Bullets and shrapnels are near in vital organs - Infection dite symptoms
- Allergic reactions
6) Penile implants
- Seizures
7) Pacemaker
2) Supermagnetic agents
o Variety of perenteral iron oxides
*prostatic heart valves can undergo MRI examination.
o Ex. Ferridex (AMI-25)
Ferrumoxstran (AMI-227)
ABSOLUTE CONTRAINDICATION IN MRI
3) Diamanetic agents
1) Pacemakers
2) defibrillator
A. Parenteral Agents based on Relaxivity
3) cochlear implants
1) Positive Relaxation Agents (T1 Agents)
4) neuro stimulator
o paramagnetics
5) bone growth stimulator
- Increase in signal intensity in T1WI
6) infusion pumps
- Ex. Gadolinium
7) intraocular foreign body
2) Negative Relaxation Agent (T2 Agents)
8) aneurysm clips
- Reduction in signal intensity of the tissue in T2WI
- Superparamagnetic & ferroagnetic
- Ex. Iron Oxide paticles
Contrast Enhancement in MRI improves the ff:
1. Detection Mechanism of MR Contrast Enhancement
2. Delineation 1) Spin Density
3. Tumor characterization 2) Relaxivity (T1, T2)
4. Accurate Interpretation (reading) 3) Magnetic Susceptibility
4) Diffusion & perfusion of CM

14
 - Causes positive contrast enhancement on T1WI in the
Dipole-Dipole Interaction liver
o Phenomenon by which excited protons are affected by nearby 3. Dysprosium Chelates (Dy-HP-DO3A)
excited protons/electrons - More superior than Gd Chelates

Gadolinium (Gd) Adverse Reaction to Gadolinium

o Rare earth metal of lanthanide group w/ atomic # of 64 1. Nausea
o Accumulation of free Gd ions result to toxicity 2. Headache
3. Anaphylaxis
Chelates
o Combined w/ Gd to prevent its toxicity by rapid & total renal Patients prone to Gd Reaction
excretion 1. History of Allergy
o Substances that have the high affinity for metal ions that 2. Asthmatics
makes them less toxic & facilitate their excretion 3. Previous drug reactions
4. Iodinated Compound reactions
2 Groups of Chelates
I. LINEAR Oral Contrast Agents
a. Gd-DTPA – Gadopentetate Dimeglumine (Magnevist, 1. Positive
Magniscan) - Manganese Chloride
b. Gd-DTPA – BMA – Gadodiamide (Omniscan) - Gd-DTPA
c. Gd – Bismethoxyethylamide, Gadoversatamide - Oil Emulsion
(Optimask) 2. Negative
- Barium Sulfate
II. MACROCYCLIC (Ring)
a. Gd-HP-DO3A – Gadoteridol (Prohance) ROLES OF CM IN MRI (neuro)
b. Gd-DOTA – Gadoterate Meglumine (Dotarem) 1. CNS Neoplasms
c. Gd-D03A – Botrol – Gadobutrol (Gadovist) o Tumor identification
o Margin delineation of tumors
2 Combinations that Prevent Toxicity o Invasion (congenital/traumatic/tumor)
1. Gd Chelates o Enhancement
2. Dysprosium Chelates o Recurrence vs. Necrosis

2. CNS Infections
Other MRI Contrast Agents o Lesion characterization
1. Iron Oxide o Assessment of lesion activity
- bright metastatic lesions o Acute vs. Chronic infection
2. Mn-DPDF Magnafodipir trisodium o Monitor progression vs. Regression

15
 3. Ischemic CNS Diseases Standard MRI Appearance
o Temporal dating - w/o use of CM but can visualize BV
o Characterization
4. Spine *All fluid containing structures appear bright in T2WI
o Scar vs. Disc
o Tumor vs. Syrinx BASIC MRI IMAGES
 Water
5. Leptomeningeal metastasis - Long T1 & T2
- Dark in T1WI
2 types of Syrinx - Bright in T2WI
a. Congenital
b. Traumatic  Fat
- Short T1 & T2
6. Body - Bright in T1WI
o Viable vs. Necrotic lesion - Less bright/dark in T2WI
o ID active infection
o ID recurrent neoplasm  Air
o Benign vs. Malignant - Always black in all sequence
ROLES OF CM IN ABDOMINAL MRI IMAGING  Bone Cortex
o Viable versus necrotic tissue - Dark in T1 & T2WI in all sequence
o ID active infection
o ID recurrent neoplasm  Bone Medulla
o Benign versus malignant - Depends on fat content
MRI IMAGE DESCRIPTIONS
 Brain
 Hyperintense MRI Signal - brightest - White Matter bright in T1WI
- High proton concentration [H+] - Gray Matter brighter due to higher water content
- Short T1
- Long T2
 Isointense – same  Blood
- Dark in all Spin Echo sequences
 Hypointense – less bright/low signal - Bright in GRE sequences
- Low proton concentration [H+]
- Long T1  Calcification
- Short T2 - Dark
 Air Intensity – always black

16
STROKE IMAGING 3. Chronic (>1month) – iso to hypoI
1) GRADIENT- HEMO SEQUNCE
- Show acute bleeding Brain Edema
2) Fast FLAIR - Hyperintense in PD & T2
- Shows subarachnoid hemorrhage - Hypointense in T1WI
3) IV Gd injection
- Tumor evaluation Brain Hemorrhage
- CNS infection - MRI sensitive to detect subacute & chronic intracranial
MRA bleed
- Rapid data acquisition
- Unwanted tissue saturated Brain Tumors
- Axial, coronal, sagittal
Routine MRI Studies of the BRAIN 1. Astrocytoma – low in T1, high in T2
- Axial, coronal, sagittal 2. Oligodendrogliomas – mixed
- 5-10mm 1. Ependymoma – mixed
- T1 & T2 (axial) 2. Glioblastoma – mixed
- T2 (coronal) 3. Metastasis – best detected w/ Gd study
4. Meningioma – mixed
Slice thickness of PCE 5. Lymphomas – variable
- Sagittal & coronal images (2-4 mm) 6. Craniopharyngioma – solid, cyst, cal

CSF Brain Infections

- Hypointense (T1WI) 1. Meningioma
- Hyperintense (T2WI) - Initially normal findings (hyperintense)
CM - Enhancement (peripheral)
- Gd, IV, 0.1 mml/kg 2. Empyema
- Slow infusion, flowing blood does not enhance - Hyperintense
3. Abscess – mixed
MRI Scans obtained parallel to AML 4. TB Meningitis
AML - Radiographic baseline - Hyperintense
MRI in CNS TRAUMA (PD T2WI) CVD
1. Shear injury 1. Acute Infarct – hyperintese
2. Non-hemorrhagic contusion 2. Chronic infarct – hypointense
3. Subdural Hemorrhage (SDH)
MRI of SPINE
MRI HEMATOMAS - GRASS & FISP
1. Acute (<1 wk old) – iso to hypoI in T1WI - Axial & Sagittal
2. Subacute (>1-<4wks) – variable - ST of 4-5mm
17
 - Body Isointense in T1WI MUSCULOSKELETAL SYSTEM IN MRI
- SC isodense in T1 o Low signal intensity
1) Cortical bone
SPINAL CORD IN MRI 2) Ligament
- Higher signal than CSF in T1WI 3) Tendon
- Lower signal than CSF in T2WI 4) Fibrous lesion

USES OF STRI: MuUSCLES IN MRI

1) Vertebral focal lesion o Moderate signal intensity in T1WI
2) Trauma o Low signal intensity in T2WI
3) Marrow lesions
IV CONTRAST STUDY:
MARROW IMAGING IN MRI 1) Improve lesion margin
o MRI most sensitive 2) Presence of necrosis
o Yellow marrow 3) Cyst formation
- Bright in T1WI 4) Tumor vascularity assessment
- Isointense in T2W1
o Red marrow MRI of SHOULDER
- Iso-to-hyponintense in T1WI and T2WI - Axial, coronal, sagittal
o T1WI – most useful in marrow evaluation - 3-4mm ST
- Tears appear Hyperintense
MRI of HEART
- Mass MRI of Knee
- Thrombus - Knee is full extension
- Post MI evaluation - 15 degrees external rotation
CINE Imaging – cardiac cycle imaging - 3mm ST

THE ABDOMINAL IMAGING in MRI

SEQUENCES USED IN MUSCULOSKELETAL IMAGING I. LIVER

o T1WI – intramedullary tumor extent - Intermediate intensity parenchyma
o T1WI – soft tissue extension & cortical involvement - Shorter T1RT and T2RT than the spleen
o STIR – tumors/patholies stand out - Brighter than the spleen in T2WI

Anulus Fibrosus – dark 1) Hemangioma

Nucleus Pulposus – dark in T1WI; bright in T2WI - Hypointense (T1WI)
Ligaments – dark - Hyperintense (T2WI)
- Use SE Sequence
18
 2) Hepatocellular Carcinoma - Zonal anatomy best visualized in T2WI
- Hyperintense in T2WI
3) Liver metastasis b. Female (T2WI used)
- MRI is most sensitive study w/ use of Gd - Sagittal Plane – ideal for uterine zonal anatomy &
vaginal anatomy
II. BILIARY TREE - MRCP
Bile Uterus
- Hyperintense (fasting state) - Endometrium – high signal; HyperI
- Hypointense TI; Hyperintense T2 (Non-fasting state) - Myometrium – low signal; HypoI
- Serosa/peripheral – intermediate signal; HyperI
III. PANCREAS - MRCP Ovaries
- Hyperintense; SE T1WI - Stroma – low signal; hypo
1. Pancreatitis - Follicles – high signal; hyper
- Hypointense T1WI
- Hyperintense T2WI UB (use T2WI)
2. Cyst - Muscular wall – low signal; hypointense
- Dark in T1WI - Urine – high signal; hyperintense
- Bright T2WI

IV. SPLEEN
- Hypointense
- STIR

V. KIDNEYS
- Intermediate intensity
- FLASH for renal masses
VI. STAGING OF PELVIC TUMORS
- UB, PG, uterus
- Use surface coils

a. Male
- Scrotal MRI uses circular loop coil
- Prostate gland uses endorectal coil

3 Regions of the Prostate Gland

1. Central/transitional Zone – low signal; hypo
2. Peripheral zone – high “”; hyper; bright
3. Stroma – low “”; hypo
19
 ABBREVIATIONS MEDIC – Multi Echo Data to Image Combination
MPRAGE – Magnetization Prepared Rapid Acquisition Gradient Echo
ADC – Analog to Digital Converter PC – Phase Contrast
a.k.a. Apparent Diffusion Coefficient RARE – Respiratory Ordered Phase Encoding
CEMRA – Contrast Enhanced Magnetic Resonance SSFP – Steady State Free Precession
FOV – Field Of View STE – Stimulated Echo
FT – Fourier Transformation STEAM – Stimulated Echo Acquisition Method
GMR – Gradient Motion Rephasing STIR – Short T1 Inversion Recovery
a.k.a. Nulling TOF – Time of Flight
GRE – Gradient Echo TONE – Tip Optimized Non-Saturated w/ Steady Precession
IR – Inversion Recovery TSE – Turbo Spin Echo
LM – Longitudinal Magnetization VIBE – Volume Interpolated Body Examination
MTC – Magnetization Transfer Contrast
NEX – Number of Excitation
a.k.a Averages of Acquisition
NMV – Net Magnetization Vector
PD – Proton Density (Spin Density
RF – Radiofrequency
SAR – Specific Absorption Rate
SE – Spin Echo
SNR – Signal to Noise Ratio
TE – Time to Echo
TR – Time to Repeat
TI – Time to Invert
TM – Middle Inteval
VENC – Velocity Encoding
BLOOD – Blood Oxygen Level Dependent Imaging
CISS – Constructive Interface at Steady State
DESS – Double Echo in Steady State
EPI – Echo Planar Imaging
FISP – Free Induction with Steady Precession
FLAIR – Fluid Attenuated Inversion Recovery
FLASH – Fast Low Angle Shot
GRASS – Gradient Recalled Acquisition in the Steady State
GRE – Gradient Echo Sequence
HASTE – Half fourier Acquisition w/ Turbo Spin Echo
IPAT – Integrated Parallel Acquisition Technique
LOTA – Long Term Averaging
20