NORMAL MRI BRAIN

DR. PIYUSH OJHA

DM RESIDENT
DEPARTMENT OF NEUROLOGY
GOVT MEDICAL COLLEGE, KOTA
 History: MRI
• 1940s – Bloch & Purcell: Nuclear Magnetic
Resonance (Nobel Prize in 1952)
• 1973 - Lauterbur: gradients for spatial localization of
images (ZEUGMATOGRAPHY)
• 1977 – Mansfield: first image of human anatomy, first
echo planar image
• 1990s - Discovery that MRI can be used to
distinguish oxygenated blood from deoxygenated
blood. Leads to Functional Magnetic Resonance
imaging (fMRI)
• Paul Lauterbur and Peter Mansfield won the Nobel
Prize in Physiology/Medicine (2003) for their
pioneering work in MRI
The first Human MRI scan was performed on 3rd july 1977 by Raymond
Damadian, Minkoff and Goldsmith.
MAGNETIC FIELD STRENGTH
• S.I. unit of Magnetic Field is Tesla.
• Old unit was Gauss.
• 1 Tesla = 10,000 Gauss
• Earth’s Magnetic Field ~ 0.7 x 10(-4) Tesla
• Refrigerator Magnet ~ 5 x 10(-3) Tesla
 MRI

• MRI is based on the principle of nuclear magnetic

resonance (NMR)
• Two basic principles of NMR
1. Atoms with an odd number of protons have spin
2. A moving electric charge, be it positive or
negative, produces a magnetic field
• Body has many such atoms that can act as good
MR nuclei (1H, 13C, 19F, 23Na)
• MRI utilizes this magnetic spin property of
protons of hydrogen to produce images.
• Hydrogen nucleus has an unpaired proton which is
positively charged
• Hydrogen atom is the only major element in the body
that is MR sensitive.
• Hydrogen is abundant in the body in the form of
water and fat

• Essentially all MRI is hydrogen (proton 1H) imaging

 TR & TE
• TE (echo time) : time interval in which signals are
measured after RF excitation
• TR (repetition time) : the time between two
excitations is called repetition time.
• By varying the TR and TE one can obtain T1WI and
T2WI.
• In general a short TR (<1000ms) and short TE (<45
ms) scan is T1WI.
• Long TR (>2000ms) and long TE (>45ms) scan is
T2WI.
 BASIC MR BRAIN SEQUENCES
• T1
• T2
• FLAIR
• DWI
• ADP
• MRA
• MRV
• MRS
 T1 W IMAGES
• SHORT TE
• SHORT TR

• BETTER ANATOMICAL DETAILS

• FLUID DARK
• GRAY MATTER GRAY
• WHITE MATTER WHITE
• MOST PATHOLOGIES DARK ON T1
• BRIGHT ON T1
– Fat
– Haemorrhage
– Melanin
– Early Calcification
– Protein Contents (Colloid cyst/ Rathke cyst)
– Posterior Pituitary appears BRIGHT ON T1
– Gadolinium
T1 W IMAGES
 T2 W IMAGES
• LONG TE
• LONG TR

• BETTER PATHOLOGICAL DETAILS

• FLUID BRIGHT
• GRAY MATTER RELATIVELY BRIGHT
• WHITE MATTER DARK
T1W AND T2 W IMAGES
 FLAIR – Fluid Attenuated Inversion
Recovery Sequences
• LONG TE
• LONG TR

• SIMILAR TO T2 EXCEPT FREE WATER SUPRESSION

(INVERSION RECOVERY)
• Most pathology is BRIGHT
• Especially good for lesions near ventricles or sulci
(eg Multilpe Sclerosis)
CT T1

T2 FLAIR
 T1W T2W FLAIR(T2)
TR SHORT LONG LONG
TE SHORT LONG LONG
CSF LOW HIGH LOW
FAT HIGH LOW MEDIUM
BRAIN LOW HIGH HIGH
EDEMA LOW HIGH HIGH
MRI BRAIN :AXIAL SECTIONS
 . Maxillary
Sinus

. Nasopharynx

Post Contrast sagittal T1 Weighted

M.R.I.
Section at the level of Foramen
. Cervical Cord Magnum

Cisterna Magna

. Mandible

Post Contrast Axial MR Image of the brain

 Orbits

Post Contrast sagittal T1 Wtd

Internal Jugular Vein M.R.I.
Section at the level of medulla

Sigmoid Sinus
Medulla

Cerebellar Tonsil

Post Contrast Axial MR Image of the brain

 Cavernous Sinus

ICA

Basilar Artery
Post Contrast sagittal T1 Wtd
Pons M.R.I.
Temporal Section at the level of Pons
IV Ventricle
lobe
IAC
Vermis
MCP
Cerebellar
Hemisphere

Mastoid
Sinus
 Orbits

Frontal
Lobe

Midbrain
Temporal Lobe
Aqueduct of Sylvius
Post Contrast sagittal T1 Wtd
M.R.I.
Section at the level of Mid Brain
Occipital Lobe

Middle Cerebral Artery Posterior Cerebral Artery

Post Contrast Axial MR Image of the brain

 Sylvian Fissure

Frontal lobe

III Ventricle
Post Contrast sagittal T1 Wtd
M.R.I.
SectionIIIatVentricle
the level of the

Occipital Lobe

Temporal Lobe

Fig. 1.5 Post Contrast Axial MR Image of the brain

 Frontal
Lobe

Frontal Horn
Caudate Nucleus
. Putamen
. Internal Cerebral Vein
Internal Capsule

Choroid Plexus Post Contrast sagittal T1 Wtd

M.R.I.
Section at the level of Thalamus

Occipital Lobe

Temp Lobe

Thalamus Superior Sagittal Sinus

Fig. 1.6 Post Contrast Axial MR Image of the brain
Genu of corpus callosum

Choroid plexus within the

body of lateral ventricle
Post Contrast sagittal T1 Wtd
M.R.I.
Section at the level of Corpus
Callosum

Splenium of corpus callosum

 Frontal Lobe

Body of the
Corpus Callosum Post Contrast sagittal T1 Wtd
M.R.I.
Section at the level of Body of
Corpus Callosum
Parietal Lobe

Post Contrast Axial MR Image of the brain

 Frontal Lobe

Post Contrast sagittal T1 Wtd

M.R.I.
Section above the Corpus Callosum

Parietal Lobe

Post Contrast Axial MR Image of the brain

MRI BRAIN :SAGITTAL SECTIONS
 White Matter

Grey Matter
 Parietal Lobe

Frontal Lobe White Matter

Lateral Sulcus Occipital Lobe

Temporal Lobe
Grey Matter

Cerebellum
 Gyri of cerebral Sulci of cerebral
cortex Cortex

Frontal Lobe
Temporal
Lobe

Cerebellum
 Parietal Lobe

Frontal Lobe

Occipital
Lobe

Temporal
Lobe

Cerebellum
 Parietal Lobe

Frontal Lobe

Occipital Lobe

Transverse sinus
Orbit

Cerebellar
Hemisphere
 Precentral Sulcus

Lateral Ventricle

Occipital Lobe

Optic Nerve

Maxillary sinus
 Corpus callosum
Thalamus

Caudate
Nucleus

Tentorium
Cerebell

Pons

Tongue
 Thalamus

Genu of Corpus
Callosum
Splenium of
Corpus callosum

Hypophysis
Midbrain

Ethmoid air
Fourth Ventricle
Cells

Inferior nasal
Concha
Pons
 Body of corpus Thalamus
callosum
Splenium of
Corpus
Genu of corpus callosum
callosum

Superior
Colliculus

Inferior
Colliculus

Nasal Septuml
Pons

Medulla
 Cingulate Gyrus

Splenium of
Genu of corpus Corpus
callosum callosum

Ethmoid
air cells
Fourth Ventricle

Oral cavity
 Thalamus
Corpus Callosum

Parietal Lobe
Frontal
Lobe

Occipital Lobe

Cerebellum

Maxillary
Sinus
 Parietal Lobe

Frontal Lobe Lateral Ventricle

Occipital Lobe

Temporal
Lobe

Cerebellum
 Parietal Lobe

Frontal Lobe

Lateral Sulcus Middle Temporal Gyrus

Superior Temporal
Gyrus

Inferior Temporal External Auditory

Gyrus Meatus
 Internal cerebral vein
Superior sagittal sinus
. Bone

Parietal lobe
Inferior sagittal sinus

Vein of Galen
Corpus callosum
Occipital lobe

Mass intermedia
of thalamus
Straight sinus

. Vermis
Sphenoid Sinus
. IV ventricle

Cerebellar tonsil
MRI BRAIN :CORONAL SECTIONS
 Superior Sagittal Sinus

Longitudinal
Fissure

Straight Sinus

Sigmoid Sinus

Vermis
Straight Sinus Lateral Ventricle,
Occipital Horn

Cerebellum
Arachnoid Villi
Falx Cerebri

Lateral Ventricle

Great Cerebral
Vein
Vermis of
Tentorium Cerebellum
Cerebelli
Cerebellum
 Splenium of
Lateral Ventricle
Corpus callosum

Posterior
Internal Cerebral
Cerebral
Vein
Artery
Superior
Tentorium
Cerebellar
Cerebelli
Artery
Fourth Ventricle

Foramen
Magnum
Cingulate Gyrus Corpus Callosum

Choroid Plexus

Superior Colliculus Thalamus

Cerebral Aqueduct Pineal Gland

Vertebral Artery
 Insula
Crus of Fornix

Lateral Sulcus

Cerebral Peduncle
Middle Cerebellar
Peduncle

Olive
 Corpus Callosum
Caudate Nucleus
Thalamus
Third Ventricle
Cerebral
Peduncle
Hippocampus
Parahippocampal
Pons
gyrus
 Lateral Ventricle
Body of Fornix

Third Ventricle

Uncus of Temporal
Lobe
Hippocampus
Temporal Horn of
Lateral Ventricle
Internal Capsule
Caudate Nucleus
Insula
Lentiform
Optic Tract Nucleus
Hypothalamus

Amygdala

Parotid Gland
 Cingulate Gyrus

Internal Capsule
Caudate
Nucleusa

Optic Nerve Lentiform

Nucleus
Internal
Carottid Artery

Nasopharynx
 Superior Sagittal
Sinus
Longitudinal
Fissure

Genu Of
Lateral Sulcus Corpus
Callosum

Temporal Lobe

Parotid Gland
 Frontal Lobe

Ethmoid Sinus

Nasal Septum
Nasal
Nasal Cavity Turbinate
Massetor
Tongue
 Frontal Lobe

Medial Rectus
Superior Rectus

Lateral Rectus Inferior Rectus

Maxillary Sinus
Inferior Turbinate
Tooth
 Superior Sagittal Sinus

Grey Matter

White Matter

Eye Ball

Maxillary Sinus

Tongue
 Frontal lobe

Corpus callosum

Frontal horn
III

Pituitary gland Caudate nucleus

Optic nerve
sp Pituitary stalk

Internal carotid artery

np
Cavernous sinus

Coronal Section of the Brain at the level of Pituitary gland

Post Contrast Coronal T1 Weighted MRI
FLAIR & STIR SEQUENCES
 Short TI inversion-recovery (STIR) sequence

• In STIR sequences, an inversion-recovery pulse is used to

null the signal from fat (180° RF Pulse).

• STIR sequences provide excellent depiction of bone marrow

edema which may be the only indication of an occult
fracture.
 FSE STIR

Comparison of fast SE and STIR sequences

for depiction of bone marrow edema
 Fluid-attenuated inversion recovery
(FLAIR)
• First described in 1992 and has become one of the corner stones of
brain MR imaging protocols

• An IR sequence with a long TR and TE and an inversion time (TI) that

is tailored to null the signal from CSF

• Nulled tissue remains dark and all other tissues have higher signal
intensities.
• Most pathologic processes show increased SI on T2-WI,
and the conspicuity of lesions that are located close to
interfaces b/w brain parenchyma and CSF may be poor in
conventional T2-WI sequences.

• FLAIR images are heavily T2-weighted with CSF signal

suppression, highlights hyper-intense lesions and improves
their conspicuity and detection, especially when located
adjacent to CSF containing spaces
Clinical Applications of FLAIR sequences:

• Used to evaluate diseases affecting the brain parenchyma neighboring

the CSF-containing spaces for eg: MS & other demyelinating
disorders.

• Unfortunately, less sensitive for lesions involving the brainstem &

cerebellum, owing to CSF pulsation artifacts

• Mesial temporal sclerosis (MTS) (thin section coronal FLAIR)

• Tuberous Sclerosis – for detection of Hamartomatous lesions.

• Helpful in evaluation of neonates with perinatal HIE.

• Embolic infarcts- Improved visualization

• Chronic infarctions- typically dark with a rim of high

signal. Bright peripheral zone corresponds to gliosis, which
is well seen on FLAIR and may be used to distinguish old
lacunar infarcts from dilated perivascular spaces.
 FLAIR
T2 W
WHICH SCAN BEST DEFINES THE ABNORMALITY

T1 W Images:
Subacute Hemorrhage
Fat-containing structures
Anatomical Details
T2 W Images:
Edema
Tumor
Infarction
Hemorrhage
FLAIR Images:
Edema,
Tumor
Periventricular lesion
 DIFFUSION WEIGHTED IMAGES (DWI)

• Free water diffusion in the images is Dark

(Normal)
• Acute stroke, cytotoxic edema causes
decreased rate of water diffusion within the
tissue i.e. Restricted Diffusion (due to
inactivation of Na K Pump )
• Increased intracellular water causes cell
swelling
• Areas of restricted diffusion are
BRIGHT.
• Restricted diffusion occurs in
– Cytotoxic edema
– Ischemia (within minutes)
– Abscess
 Other Causes of Positive DWI
• Bacterial abscess, Epidermoid Tumor
• Acute demyelination
• Acute Encephalitis
• CJD
• T2 shine through ( High ADC)
 T2 SHINE THROUGH
• Refers to high signal on DWI images that is not
due to restricted diffusion, but rather to high T2
signal which 'shines through' to the DWI image.

• T2 shine through occurs because of long T2 decay

time in some normal tissue.

• Most often seen with sub-acute infarctions, due

to Vasogenic edema but can be seen in other
pathologic abnormalities i.e epidermoid cyst.
• To confirm true restricted diffusion - compare
the DWI image to the ADC.
• In cases of true restricted diffusion, the
region of increased DWI signal will
demonstrate low signal on ADC.
• In contrast, in cases of T2 shine-through, the
ADC will be normal or high signal.
APPARENT DIFFUSION COEFFICIENT Sequences
(ADC MAP)

• Calculated by the software.

• Areas of restricted diffusion are dark
• Negative of DWI
– i.e. Restricted diffusion is bright on DWI,
dark on ADC
• The ADC may be useful for estimating the lesion age
and distinguishing acute from subacute DWI lesions.

• Acute ischemic lesions can be divided into

Hyperacute lesions (low ADC and DWI-positive) and
Subacute lesions (normalized ADC).

• Chronic lesions can be differentiated from acute lesions

by normalization of ADC and DWI.
 Nonischemic causes for decreased ADC
• Abscess

• Lymphoma and other tumors

• Multiple sclerosis

• Seizures

• Metabolic (Canavans Disease)

DWI Sequence ADC Sequence
65 year male-Acute Rt ACA Infarct
 Clinical Uses of DWI & ADC in Ischemic Stroke

• Hyperacute Stage:- within one hour minimal hyperintensity seen in

DWI and ADC value decrease 30% or more below normal (Usually
<50X10-4 mm2/sec)

• Acute Stage:- Hyperintensity in DWI and ADC value low but after 5-
7days of episode ADC values increase and return to normal value
(Pseudonormalization)

• Subacute to Chronic Stage:- ADC value are increased but hyperintensity

still seen on DWI (T2 shine effect)
 POST CONTRAST (GADOLINIUM ENHANCED)

• Post contrast images are always T1 W images

• Sensitive to presence of vascular or extravascular Gd
• Useful for visualization of:
– Normal vessels
– Vascular changes
– Disruption of blood-brain barrier
MR ANGIOGRAPHY / VENOGRAPHY
 MR ANGIOGRAPHY
• TWO TYPES OF MR ANGIOGRAPHY

– CE (contrast-enhanced) MRA

– Non-Contrast Enhanced MRA

• TOF (time-of-flight) MRA
• PC (phase contrast) MRA
 CE (CONTRAST ENHANCED) MRA
 T1-shortening agent, Gadolinium, injected iv as contrast
 Gadolinium reduces T1 relaxation time
 When TR<<T1, minimal signal from background tissues
 Result is increased signal from Gd containing structures
 Faster gradients allow imaging in a single breathhold
 CAN BE USED FOR MRA, MRV
 FASTER (WITHIN SECONDS)
 TOF (TIME OF FLIGHT) MRA

 Signal from movement of unsaturated blood converted into

image
 No contrast agent injected
 Motion artifact
 Non-uniform blood signal
 2D TOF- SENSITIVE TO SLOW FLOW – VENOGRAPHY
 3D TOF- SENSITIVE TO HIGH FLOW – MR ANGIOGRAPHY
 PHASE CONTRAST (PC) MRA
 Phase shifts in moving spins (i.e. blood) are measured
 Phase is proportional to velocity
 Allows quantification of blood flow and velocity
 velocity mapping possible
 USEFUL FOR
– CSF FLOW STUDIES (NPH)
– MR VENOGRAPHY
 Anterior Cerebral
Artery

Middle Cerebral
Artery
Internal Carotid
Artery
Posterior Cerebral Basilar Artery
Artery

Superior Vertebral Artery

Cerebellar Artery

Anterior Inferior Posterior Inferior

Cerebellar Artery Cerebellar Artery
 Anterior Cerebral
Artery
Middle Cerebral
Artery
Internal Carotid
Artery
Basilar Artery

Posterior Cerebral
Artery Vertebral Artery
MR VENOGRAPHY
Superior
Sagittal Sinus

Straight Sinus

Internal
Confluence
Cerebral Vein
of Sinuses
Vein of Galen

Transverse Sinus

Internal Sigmoid Sinus

Jugular Vein

NORMAL MR VENOGRAPHY (Lateral View)

NORMAL MR VENOGRAPHY (Lateral View)
 GRE Sequences (GRADIENT RECALLED ECHO)

• Form of T2-weighted image which is susceptible

to iron, calcium or blood.
• Blood, bone, calcium appear dark
• Areas of blood often appears much larger than
reality (BLOOMING)
• Useful for:
– Identification of haemorrhage / calcification
Look for: DARK only
 MR SPECTROSCOPY

• Non-invasive physiologic imaging of brain that

measures relative levels of various tissue
metabolites.

• Used to complement MRI in characterization

of various tissues.
 Observable metabolites
Metabolite Resonating Normal function Increased
Location
ppm
Lipids 0.9 & 1.3 Cell membrane Hypoxia, trauma, high grade
component neoplasia.

Lactate 1.3 Denotes anaerobic Hypoxia, stroke, necrosis,

glycolysis mitochondrial diseases,
neoplasia, seizure

Alanine 1.5 Amino acid Meningioma

Acetate 1.9 Anabolic precursor Abscess ,

Neoplasia,
Metabolite Location Normal function Increased Decreased
ppm
NAA 2 Nonspecific Canavan’s Neuronal loss,
neuronal marker disease stroke, dementia,
(Reference for AD, hypoxia,
chemical shift) neoplasia, abscess

Glutamate , 2.1- 2.4 Hypoxia, HE Hyponatremia

glutamine, Neurotransmitter
GABA
Succinate 2.4 Part of TCA cycle Brain abscess

Creatine 3.03 Cell energy Trauma, Stroke, hypoxia,

marker hyperosmolar neoplasia
(Reference for state
metabolite ratio)
Metabolite Location Normal Increased Decreased
ppm function

Choline 3.2 Marker of cell Neoplasia, Hypomyelination

memb turnover demyelination
(MS)

Myoinositol 3.5 & 4 Astrocyte AD

marker Demyelinating
diseases
 Metabolite ratios:

Normal abnormal

NAA/ Cr 2.0 <1.6

NAA/ Cho 1.6 <1.2

Cho/Cr 1.2 >1.5

Cho/NAA 0.8 >0.9

Myo/NAA 0.5 >0.8

 MRS

Inc Cho/Cr
Myo/NAA Slightly inc Cho/ Cr Dec NAA/Cr Dec NAA/Cr
Cho/NAA Cho/NAA Inc acetate, Dec NAA/
Dec NAA/Cr Normal Myo/NAA succinate, amino Cho
± lipid/lactate ± lipid/lactate acid, lactate Inc
Myo/NAA

Demyelinating
Malignancy Neuodegenerat
disease Pyogenic
abscess ive
Alzheimer
 MRS APPLICATION
• ICSOLs
• Differentiate Neoplasms from Nonneoplastic
Brain Masses
• Radiation Necrosis versus Recurrent Tumor
• Inborn Errors of Metabolism
• RESEARCH PURPOSE FOR
NEURODEGENERATIVE DISEASES
 PERFUSION STUDIES

 Perfusion is the process of nutritive delivery of arterial

blood to a capillary bed in the biological tissue

means that the tissue is not getting

enough blood with oxygen and nutritive elements
(ischemia)

means neoangiogenesis – increased

capillary formation (e.g. tumor activity)
 APPLICATIONS OF PERFUSION IMAGING
 Stroke  Tumors
Detection and Diagnosis, staging, assessment of
assessment of tumour grade and prognosis
ischemic stroke Treatment response
(Lower perfusion ) Post treatment evaluation
Prognosis of therapy effectiveness
(Higher perfusion)
 REFERENCES
• CT and MRI of the whole body – John R Haaga (5th
edition)
• Osborne Brain : Imaging, Pathology and Anatomy
• Neurologic Clinics (Neuroimaging) : February 2009,
volume 27
• Bradley ‘s Neurology in Clinical Practice (6th edition)
• Adams and Victor’s: Principles of Neurology (10th
edition)
• Understanding MRI : basic MR physics : Stuart Currie
et al : BMJ 2012
• Harrison’s textbook of Internal Medicine (18th
edition)
THANK YOU
 CRANIAL NERVES IMAGING
• CISS / 3D FIESTA SEQUENCE

• Heavily T2 Wtd Sequences

• Allows much higher resolution and clearer

imaging of tiny intracranial structures
MAGNETIZATION TRANSFER (MT) MRI

• MT is a recently developed MR technique that alters contrast

of tissue on the basis of macromolecular environments.

• MTC is most useful in two basic area, improving image

contrast and tissue characterization.

• MT is accepted as an additional way to generate unique

contrast in MRI that can be used to our advantage in a variety
of clinical applications.
 GRADATION OF INTENSITY
IMAGING

CT SCAN CSF Edema White Gray Blood Bone

Matter Matter

MRI T1 CSF Edema Gray White Cartilage Fat

Matter Matter

MRI T2 Cartilage Fat White Gray Edema CSF

Matter Matter

MRI T2 CSF Cartilage Fat White Gray Edema

Flair Matter Matter