A COMPARISON STUDY OF MRI AND FMRI

Submitted by

Shanza Yasin BS-PHY\FA19\013

Syeda Khadija Ali BS-PHY\FA19\023

Sadia Sagheer BS-PHY\FA19\026

Ayesha Bibi BS-PHY\FA19\037

Arooj Maryam BS-PHY\FA19\044

Table of Contents
Chapter 1...............................................................................................................................................3
Introduction...........................................................................................................................................3
1.1 Imaging..................................................................................................................................3
1.2 Medical imaging.....................................................................................................................3
1.3 Modalities in medical imaging...............................................................................................3
1.3.1 X-Rays imaging...............................................................................................................3
1.3.2 Ultrasound imaging........................................................................................................4
1.3.3 Perfusion imaging..........................................................................................................6
1.3.4 CT scans imaging............................................................................................................8
1.3.5 PET scan imaging............................................................................................................9
1.4 Magnetic resonance imaging...............................................................................................10
1.5 Functional magnetic imaging resonance..............................................................................10
Chapter 2.............................................................................................................................................12
Physics of MRI and FMRI.....................................................................................................................12
Magnetic resonance imaging...............................................................................................................12
2.1.1 Process of MRI.............................................................................................................12
2.1.2 Discovery of MRI..........................................................................................................14
2.1.3 Use of MRI in medical field..........................................................................................14
2.2 Functional magnetic resonance imaging (fMRI)...................................................................22
2.2.1 Functional MR imaging of the abdomen......................................................................22
2.2.2 FMRI in biological response.........................................................................................23
2.2.3 Process of Functional Magnetic Imaging......................................................................24
2.2.4 Role of FMRI in drug development..............................................................................25
2.2.5 FMRI in Alzheimer's disease.........................................................................................26
2.2.6 FMRI in brain mapping and localization.......................................................................26
Chapter 3.............................................................................................................................................29
Comparison between MRI and FMRI...................................................................................................29
3.1 Table 1 : difference between MRI and fMRI........................................................................29
3.2 Difference between diagnosed diseases..............................................................................33
3.3 Magnetic resonance Imaging...............................................................................................33
3.3.1 Multiple Sclerosis.........................................................................................................33
 Chapter 1

Introduction
1.1 Imaging
Imaging is a representation of an objects form, especially (the formation of an
image).Imaging technology is the application of materials and methods to create, preserve, or
duplicate images.

1.2 Medical imaging

Medical imaging is the technique of imaging of the entire body for clinical analysis and
medical intervention as well as visual representation of the function of some organs and
tissues

1.3 Modalities in medical imaging

1.3.1 X-Rays imaging

X-Ray imaging is a medical imaging techniques that uses X-ray, a form of ionizing radiation,
to produce images of the body x-ray are type of electromagnetic radiation with wavelengths
that are shorter then visible light and are able to pass through different materials including the
human body.

The images show the parts of your body in different shades of black and white. This is
because different tissues absorb different amounts of radiation. Calcium in bones absorbs x-
rays the most, so bones look white. Fat and other soft tissues absorb less and look gray. Air
absorbs the least, so lungs look black. Since the discovery of X rays by Roentgen in 1895[1].

In X-ray diagnostics, radiation that is partly transmitted through and partly absorbed in the
irradiated object is utilized. An X-ray image shows the variations in transmission caused by
structures in the object of varying thickness, density or atomic composition.

After an introductory description of the nature of X-rays, the most important processes in the
X-ray source, the object (patient) and radiation detector for the generation of an X-ray image
will be described
 The x-ray intensity is sufficient to image a human extremity at 14 kVp and 180 mAs.
Pulsed x-ray with a repetition rate greater than 100 kHz was readily achieved by
programming the gate voltage. The CNT-based cold-cathode x-ray technology can potentially
lead to portable and miniature x-ray sources for industrial and medical applications [3].

1.3.2 Ultrasound imaging

Ultrasound waves are sound waves whose frequency are at upper limit of human hearing,
which is typically around 20,000 Hz ultrasound are waves having frequencies from several
kilohertz to several gigahertz .Ultrasound waves are commonly used in medical imaging to
produce imaging of internal organs and tissues, also used in a variety of applications , in
cleaning ,measuring distance, and non-destructive testing of materials.it used to stimulate
healing process in some medical conditions, such as soft tissue injuries and bone fracture.

Ultrasound imaging is a medical technique that uses sound waves to produce images of inside
body organs. These images are formed by sending the sound waves into the body which
bounce off the different tissues and organs and then return to ultrasound machine. The
machine then converts these sound waves into images that can be seen on screen. The way
ultrasound images look depend on how sound waves interact with the tissues in the body .For
example, At some parts of body waves are more reflected by tissues so they appear brighter
on screen, other tissues absorb more waves so they appear darker on screen[2]

The physics of ultrasound imaging is particularly involves the propagation of sound waves
more than 20,000 Hz frequency and their interaction with the different tissues. These waves
are generated by transducer which converts electrical energy to sound waves. The sound
waves are then directed into the body of different tissues; whether they are either absorbed,
reflected or transmitted [3].

When an ultrasound encounters a boundary between two media, some energy is transmitted
and some energy is reflected back that reflected energy depends on acoustic impedance (Z)
between the two medium. If the difference in Z is large, then a significant amount of energy
will be reflected back, whereas if the difference is small, then most of the energy will be
transmitted through the boundary.

The formula for acoustic impedance (Z) is Z = ρc, where ρ is the density of the medium and c
is the velocity of sound in the medium. Therefore, if the density or velocity of sound changes
significantly across a boundary, then the acoustic impedance will also change, leading to a
greater reflection of ultrasound energy. This is why reflections and echoes are commonly
used in medical imaging like we can say strong reflection of ultrasound occurring at the air-
tissues, tissue-bones and chest wall- lung.

The Attenuation of the ultrasound by the medium also plays an important role in ultrasound
imaging. In real when energy is removed from the beam by absorption, scattering and
reflection then the remaining beam decreases exponentially and leads the depth penetration in
the medium, allowing attenuation in different media. As the attenuation co-efficient of
ultrasound is high for bone as compared to soft- tissue .so with the large reflection from bone
tissue ,it is difficult to get the image of structure laying under the bone. On the other hand
water, fat, blood and muscles are good transmitter of ultrasound.

Ultrasonic waves are generated as well as detected by ultrasonic probe and transducer. A
transducer is actually a device that changes one form of energy into another form. A
transducer converts electrical energy to ultrasonic energy this is done by piezoelectric
effect .The piezoelectric effect is the ability of certain material to generate electric field in
response to applied mechanical stress. This effect is applied by certain a crystal from which
electric field causes them to oscillate; as a result acoustic waves are generated. The
piezoelectric effect is exhibited by a number 0f naturally occurred crystals like zirconium.

As ultrasound wave reflected from different tissues received by transducer, voltage pulses are
produced and processed by CRT, usually in three modes A (amplitude) mode, B (brightness)
mode and the last one is M (motion) mode. A mode consist of displaying of signal
amplitude .B mode a single point is displayed by echo and viewer have an apparent cross
section through the patient .Such cross sectional images are called ultrasonic tomograms.in
the last mode that is M mode known to be as presentation, the ultrasound images shows the
motion of internal structure of patient’s anatomy .The most frequent application of m mode is
Echocardiograph[3]
1.3.3 Perfusion imaging
Perfusion imaging is a medical imaging techniques used to visualize the flow of blood
through the vessels and tissues of the body it is typically used to evaluate the function of
organs such as the brain, heart and kidneys to diagnose conditions such as stroke, heart attack
and tumors.

Numerous techniques have been proposed in the last 15 years to measure various perfusion-
related parameters in the brain. In particular, two approaches have proven extremely
successful: injection of paramagnetic contrast agents for measuring cerebral blood volumes
(CBV) and arterial spin labeling (ASL) for measuring cerebral blood flows (CBF).

Perfusion imaging provides the ability to detect regional and global alterations in organ blood
flow. The utility of hepatic perfusion characterization relies on the resolution of each
component of its dual blood supply—the portal vein and the hepatic artery— because
contributions from each are altered predictably in many diseases. As early as 1954, Breedis
and Young (1) first described relative increases in arterial supply in the setting of primary and
metastatic liver tumors, thus heralding the possibility of arterial phase imaging to detect
malignant tumors. Changes in relative arterial and portal venous blood flow also are known
to be associated with the evolution of cirrhosis (2, 3).

Because most pathologic entities of the liver affect blood flow regionally, globally, or both
(4), perfusion imaging of the liver has been invoked as a means of improving the sensitivity
and specificity of diagnostic liver imaging. Herein, we provide a context for liver perfusion
imaging and review its physiologic basis. After highlighting goals for its use and
development, we review existing methods and

discuss their role in the evaluation of cirrhosis, hepatocellular carcinoma (HCC), and
metastatic disease. We conclude with a consideration of future direction in emerging field.

Myocardial perfusion is an imaging test. It's also called a nuclear stress test. It is done to
show how well blood flows through the heart muscle. It also shows how well the heart
muscle is pumping. For example, after a heart attack, it may be done to find areas of damaged
heart muscle. This test may be done during rest and while you exercise.
A myocardial perfusion scan uses a tiny amount of a radioactive substance, called a
radioactive tracer. The tracer travels through the bloodstream and is absorbed by the healthy
heart muscle. On the scan, the areas where tracer has been absorbed look different from the
areas that do not absorb it. Areas that are damaged or don't have good blood flow do not
absorb the tracer. The damaged areas may be called “cold spots” or “defects.”

A stress myocardial perfusion scan assesses blood flow to the heart muscle when it is
stressed. The heart is usually “stressed” from exercise. But, if you are unable to exercise, the
heart can be stressed taking a certain medicine that increases your heart rate or dilate blood
vessels as would occur during exercise.

After the radioactive tracer is injected, a special type of camera is used that can detect the
radioactive energy from outside the body. The camera takes images of the heart during stress
and again later at rest. The two sets of images are compared.

Myocardial perfusion is an imaging test. It's also called a nuclear stress test. It is done to
show how well blood flows through the heart muscle. It also shows how well the heart
muscle is pumping. For example, after a heart attack, it may be done to find areas of damaged
heart muscle. This test may be done during rest and while you exercise.

A myocardial perfusion scan uses a tiny amount of a radioactive substance, called a

radioactive tracer. The tracer travels through the bloodstream and is absorbed by the healthy
heart muscle. On the scan, the areas where tracer has been absorbed look different from the
areas that do not absorb it. Areas that are damaged or don't have good blood flow do not
absorb the tracer. The damaged areas may be called “cold spots” or “defects.”

A stress myocardial perfusion scan assesses blood flow to the heart muscle when it is
stressed. The heart is usually “stressed” from exercise. But, if you are unable to exercise, the
heart can be stressed by taking a certain medicine that increases your heart rate or dilate
blood vessels as would occur during exercise.

After the radioactive tracer is injected, a special type of camera is used that can detect the
radioactive energy from outside the body. The camera takes images of the heart during stress
and again later at rest[4].
1.3.4 CT scans imaging
A CT scans (computed tomography) also known as CAT (computerized axial tomography)
scan is a medical imaging procedure that uses X rays to create detailed cross sectional images
of the body. These images can be reconstructed in multiple plans including axial
(perpendicular to the body) coronal (parallel to the body but with the head at the top) and
sagittal (parallel to the body with the head at the side) plans Ct scans are useful for
diagnosing a wide range of conditions including injuries, infections, tumors and diseases of
the body diseases of blood vessels, liver, kidney and lungs. They are also used to guide
procedures such as biopsies and to monitor the progression of conditions over time.

Since the introduction of CT scanning about 40 years ago, there has been significant
advancement in both the hardware and software of CT scanners. One area of hardware
development has been in the improvement of scanner motion, which has allowed for faster
and more accurate scans.

Modern CT scanner that use a rotating X-ray tube and a large circular array of detectors,
known as multi-detector CT (MDCT) scanner. These scanners are capable of producing high-
resolution images in a very short amount of time, with scan times as fast as one second or
less[5]

Figure 2: an early design in which the x-ray source and the

detector performed a combination of translational and
rotational motion. B: a modern scanner in which the x-ray
tube rotates within a stationary circular array of detectors.[2]
1.3.5 PET scan imaging
PET (positron emission tomography) is a type of medical imaging that uses specialized
cameras and small amount of radioactive tracer to produce detailed images of organs and
tissues with in the body. The tracer is injected into the body and then accumulates in the
organs and tissues being imaged.

In 1998, the first sample of PET system was used at the University of Pittsburgh. A similar an
atomic data merged with the PET scan have proved very convenient explanation of PET
images. The consequence of PET image fusion was so magnificent that hybrid PET scanner
was rapidly adapted by the industry[6].

The physics of PET involves positron-electron extermination into photons. For example, a
radiolabeled compound such as fluorodeoxyglucose (FDG) comprises 18F as the positron
emitting isotope. FDG is an analog of glucose that accumulates in metabolically active cells.
Because tumor cells are generally more active metabolically than the normal cells, an
increased absorption of FDG is positively correspond with the existence of tumor cells and
their metabolic activity.

When the positron is emitted by 18F, it annihilates a nearby electron, with the emission of
two 0.511-MeV photons in opposite directions. These photons are detected by ring detectors
placed in a circular gantry surrounding the patient. From the detection of these photons,
computer software (e.g., filtered back-projection algorithm) reconstructs the site of the
annihilation events the intervening anatomy. The site of increased FDG accumulates [8].

Figure 3 : PET scan of aortic vascular

1.4 Magnetic resonance imaging
MRI is a non-invasive technique for visualizing the internal organization and some bodily
functions. It employs nonionizing electromagnetic radiation and doesn't seem to pose any risk
from exposure. It uses radio frequency (RF) radiation to provide high-quality cross-sectional
photographs of the body in any plane, all while being subjected to precisely regulated
magnetic fields. The patient is placed within a big magnet, creating a reasonably strong
external magnetic field, and this creates the MR image. As a result, many atoms in the body,
including hydrogen, have their nuclei aligned with the magnetic field so that an RF signal
may be applied later. Body energy is emitted, identified, and utilized by a computer to create
the MR picture[7].

Figure 4Magnetic resonance imaging

1.5 Functional magnetic imaging resonance

The fMRI technique tracks minute variations in blood flow that are brought on by brain
activity. It may be used to determine which brain regions are in charge of crucial functions,
assess the consequences of a stroke or another illness, or direct brain treatment.

Figure 5 Functional magnetic resonance

 Chapter 2

Physics of MRI and FMRI

Magnetic resonance imaging

Magnetic resonance imaging is a powerful medical imaging technique that uses a strong
magnetic field of radio waves and a computer to create detailed images of internal organs and
tissues. MRI is particularly useful for imaging the brain, as it can provide comprehensive,
multi-parametric information on brain anatomy, function, and metabolism without the need
for invasive procedures[8].

Magnetic resonance imaging is a versatile imaging modality that can be used to diagnose a
wide range of conditions and injuries including neurological disorders, musculoskeletal
injuries, cardiovascular diseases, and cancer. MRI’s ability to provide highly detailed images
of soft tissues, such as the brain, spinal cord, and internal organs has made it an essential tool
in medical diagnosis and treatment planning.

In recent years, new MRI techniques such as diffusion and perfusion MRI have improved the
diagnostic capabilities of the modality, especially in cancer imaging. These techniques allow
for the assessment of tissue microstructure and blood flow which can help identify cancerous
tumors and determine the most appropriate treatment approach.

Overall, MRI is a valuable tool in modern medicine, and its uses are likely to continue to
grow as new techniques and applications are developed[9]

2.1.1 Process of MRI

The process of MRI typically involves following steps

1. Preparation: before the examination, the patient will be asked to remove all metal
objects from their body, including jewelry, watches, and clothing with metal zippers
and buttons. They will then be asked to change into hospital gowns and lie down on
the MRI table
 2. Positioning: MRI technology will help the patient into the correct position for the
examination. Depending on which part of the body is being imaged, the patient may
be asked to lie on their back, stomach, or side
3. Radiofrequency pulse: A radiofrequency pulse is sent through the body which
causes the hydrogen atoms in the body’s tissues to align in a particular way
4. Magnetic field: the MRI machine generates a strong magnetic field which causes the
aligned hydrogen atoms to emit signals that can be detected by the machine
5. Image acquisition: the machine takes a series of images of the body from different
angles, which are then processed by a computer to create detailed 2D or 3D images.
6. Contrast injection: in some cases, a contrast agent may be inserted into the patient’s
bloodstream to enhance the images. The contrast agent is typically a solution
containing a metal, such as gadolinium.
7. Completion: once the exam is complete, the patient will be helped off the table and
can resume normal activities immediately.
8. The entire process usually takes between 30 and 60 minutes depending on the part of
the body being imaged and the complexity of the examination.

Protons in the body are forced to align with the magnetic field created by the strong magnets
used in MRI machines. The protons are activated and spin out of equilibrium when a
radiofrequency current is pulsed through the patient, which causes them to struggle against
the magnetic field. The energy produced as the protons realign with the magnetic field can be
detected by the MRI sensors when the radiofrequency field is switched off. The surroundings
and the chemical make-up of the molecules affect how long it takes for the protons to realign
with the magnetic field and how much energy is released[10]. Based on these magnetic
resonance images, doctors may differentiate between different types of tissues[11]
 Figure 6: Proton like earth spin along its axis .In this respect it behaves like a small bar magnet. Under normal
circumstances, [10] these hydrogen proton “bar magnets” spin in the body with their axes randomly aligned [10]

2.1.2 Discovery of MRI

In Nuclear Magnetic Resonance (NMR) spectroscopy, the identity of an unknown substance
(such as a possible new medication) may be determined by the resonant qualities (the jiggling
of protons) of the atoms that comprise it, MRI employs a similar physical process. In
actuality, the only reason the method is known as MRI rather than NMR is because it first
appeared during the Cold War, when patients were reluctant to receive any kind of "nuclear"
treatment!

To aid chemists who had produced weird chemicals they couldn't identify, NMR
spectroscopy was first devised. An unknown sample is placed in a static magnetic field,
momentarily activated with radio-frequency photons (light), and then permitted to re-emit
those photons according to the approach (much like in MRI).

2.1.3 Use of MRI in medical field

MRI is used to diagnose various diseases such as

2.1.3.1 Parkinsonian syndrome

The differential diagnosis of parkinsonian syndromes is regarded as one of the most difficult
in neurology, and even at specialized facilities, clinical diagnosis error rates can be
substantial. Magnetic resonance imaging (MRI), despite a few drawbacks, has
unquestionably improved diagnostic precision in the differential diagnosis of
neurodegenerative Parkinsonism over the past three decades.
 This seeks to provide an overview of research findings addressing the usefulness of various
MRI techniques, including advanced sequences at high- and ultra-high-field MRI and
contemporary image analysis algorithms, in the assessment of Parkinson's disease. This
covers the diagnosis of early, new onset, and even prodromal Parkinson's disease, as well as
the exclusion of other possible diagnoses for Parkinson's disease, such as symptomatic
Parkinsonism and atypical Parkinsonism[12].

Figure 7: leukoencephalopathy with multiple white matter lesions on an axial T2 image in a patient with vascular
Parkinsonism [11]

2.1.3.2 Micro structural integrity of CNS

The microstructural integrity of the CNS can be measured biophysically by quantitative MRI
and compared across CNS areas, patients, and centers. Quantitative MRI methods that shed
light on the disease mechanisms in individuals with multiple sclerosis include relaxometry,
myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping,
and perfusion MRI.

These methods supplement traditional MRI methods. Included in this are (i) the existence and
degree of diffuse damage in CNS tissue outside of lesions (tissue that seems normal); (ii) the
heterogeneity of damage and repair in focal lesions; and (iii) the particular damage to CNS
tissue components. This review summarizes current pathological validation of quantitative
MRI techniques, recent technical developments in the field, and emerging applications of
quantitative MRI to patients with multiple sclerosis in both research and clinical settings[13].

An established tool in clinical use and study of human neurological problems is magnetic
resonance imaging (MRI). With the proliferation of specialized small animal MRI equipment,
translational MRI research using rodent models of CNS illnesses is gaining popularity.
Projects using this technology typically fall into one of two categories: 1) true "pre-clinical"
studies using MRI as a noninvasive disease monitoring tool and as a biomarker for specific
 aspects of the disease, or 2) studies examining the path mechanism of known human MRI
findings in CNS disease models. Most small animal MRI machines run at field strengths
between 4.7 and 11.7 Tesla[14]

2.1.3.3 Fatty liver diseases

It’s a common condition caused by the accumulation of fats in liver. Mostly people do not
show any symptoms but it may cause liver damage. It can be prevent by changing lifestyle
and diet.

More than 25% of adults worldwide are affected with nonalcoholic fatty liver disease
(NAFLD), a frequent cause of chronic liver disease. The term nonalcoholic steatohepatitis
(NASH) refers to a range of NAFLD conditions, including simple steatosis, in which fat
buildup in hepatocytes is the primary histological hallmark, and nonalcoholic steatohepatitis.
The current gold standard for distinguishing between steatohepatitis and hepatic steatosis is
liver biopsy. Noninvasive diagnostic techniques with high sensitivity and specificity are used
for the study of NAFLD because liver biopsy has a number of drawbacks.

Magnetic resonance imaging (MRI) technology advancements, particularly multipara metric

MRI techniques like proton density fat-fraction (PDFF), T2, and T1 mapping, together with
MR Electrography, are constantly being utilized in clinical practice[15].
Figure 8: Multiperamutic MRI and MRE obtained from healthy control [14]
 Figure 9: Multiperamutic MRI and MRE obtained from patient with steatosis hepatitis [14].

2.1.3.4 Cardiac magnetic resonance imaging (MRI):

The current state of cardiac magnetic resonance imaging (MRI) technology permits its
routine use in coronary heart disease patients (with the appropriate justifications) for
investigations of heart morphology and functions, as well as for the execution of stress tests
 for evaluating myocardial perfusion and contractile function. Coronary MRA and a few other
innovative MR methods are almost ready for widespread clinical use.

The detection of post-infarction scars, aneurysms, pseudo aneurysms, septal defects, mural
thrombi, and valve regurgitations can all be done with the help of cardiac MRI, which has
been proven to be a useful tool. Due to the method's inherent benefits, it is particularly
valuable when these pathological conditions cannot be fully confirmed or ruled out with
echocardiography. The best imaging technique for measuring myocardial mass, systolic
myocardial thickening, chamber volumes, and thickness in MRI[16].

2.1.3.5 Cerebral small vessel disease

(cSVD) cerebral small vessel disease is a main cause of stroke and dementia. Advance
structural imaging techniques, like diffusion magnetic resonance imaging, enable improved
detection of tissue damage, and also include characterization of tissue appearing normal on
conventional MRI. Insights into tissue composition at the molecular level are provided by
quantitative MRI, which includes iron and myelin imaging.

In the second section, we discuss how cutting-edge MRI methods can reveal dynamic or
functional blood artery anomalies that could be the subject of mechanistic study and early-
stage intervention studies. These methods include the measurement of blood-brain barrier
permeability using dynamic contrast enhanced MRI and the evaluation of cerebrovascular
reactivity using MRI techniques.

In the third section, we go through how imaging perforating arteries as well as flow velocity
and pulsatility within them is made possible by the enhanced spatial resolution offered by
ultrahigh field MRI at 7 T. The cutting-edge MRI methods we present enable enhanced
assessment of disease burden and progression while offering fresh pathophysiological
insights in cSVD. They are practical[17].
 Figure 10: weighted scans [16]

2.1.3.6 MRI in Bone Marrow edema

The term "bone marrow edema" (BME) refers to a specific magnetic resonance imaging
(MRI) pattern that can be seen in a variety of clinical entities. These clinical entities are
frequently characterized by pain as their primary symptom, but they differ significantly in
terms of histopathological findings, underlying causal mechanisms, and prognosis. Subjects
with knee osteoarthritis (OA) appear to have a pain-related development of cartilage
destruction and bone marrow lesions in the subchondral bone. Advanced OA histopathology
examinations have revealed widespread fibrosis and bone marrow necrosis.

In rheumatoid arthritis, BME of the subchondral bone is connected to an infiltration of

inflammatory cells and osteoclasts and is a good indicator of the progression of erosions.
Sacroiliac BME in spondyloarthritis[18].

Figure 11 : Locations frequently affected by bone marrow edema

2.1.3.7 MRI in Crohn's disease
Crohn's disease is an inflammatory bowel disease that is long-lasting and tends to occur in
cycles of flare-ups and remission. It involves inflammation that extends through multiple
layers of the bowel wall and appears as scattered patches with granulomas. While it can affect
any section of the digestive tract, the most frequent occurrence is in the ileocolic region,
specifically the lower right quadrant

MRI allows for the evaluation of both inflammatory changes within the bowel wall and
complications occurring outside the bowel in cases of Crohn's disease. The non-invasive
nature of MRI and its absence of ionizing radiation have motivated numerous research groups
to conduct comprehensive studies using this imaging technique to assess Crohn's disease[19].

Figure 12: Thicken bowl wall at terminal ileum mesenteric fat increases[18]

2.1.3.8 MRI to asses lung diseases

MRI is not as commonly used as other imaging methods for lung evaluation, but it can be
helpful in specific cases, such as assessing lung nodules or complications of lung diseases[20]

2.1.3.9 Advancement of MRI:

The most often utilized imaging methods in abdominal pathology are ultrasound (US),
computed tomography (CT), and magnetic resonance imaging (MRI). The evaluation of
abdominal disease by US is essential; it can occasionally be adequate for a full diagnosis and
has almost no contraindications. Both hepatic and non-hepatic pathology will benefit from
the addition of important diagnostic data provided by the use of US contrast agents.
Compared to MRI, CT has the benefit of being more accessible. The fundamental drawback
of CT is its reliance on ionizing radiation.
 The two main dangers associated with administering contrast media in CT are allergic
reactions and contrast-induced nephropathy in patients with poor renal function. The main
contraindications to using MRI in abdominal pathology are the existence of MRI "unsafe"
implants and equipment and its excellent tissue resolution[21].

2.2 Functional magnetic resonance imaging (fMRI)

Functional MR imaging has quickly transitioned from the research setting into clinical
practice over the past ten years. Preoperative functional MR imaging is currently accepted
clinical practice in community neurosurgery and neuroradiology practices as well as at large
academic institutes. In the upcoming years, functional MR imaging's clinical application will
only grow. Functional MR imaging (including resting-state functional MR imaging) will
probably continue to be used in the setting of neuropsychiatric illnesses [20].

fMRI generates unique and useful information for applications in both basic and clinical
neuroscience by detecting minute changes in the signals used to create magnetic resonance
pictures that are connected to neuronal activity in the brain. fMRI has numerous potential
applications because it is secure, non-invasive, and repeatable in both adults and children.
This succinct summary will make an effort to explain the physical foundation of fMRI, how it
is carried out in practice, some of the limits of the method, and some of the applications that
have been used thus far[21].

2.2.1 Functional MR imaging of the abdomen

The use of functional magnetic resonance (MR) imaging methods for the abdomen. The
confidence in identifying and characterizing localized hepatic lesions rises thanks to
diffusion-weighted imaging (DWI). The potential effects of DWI on the kidneys, pancreas,
intestines, and adrenal glands are described. Studies have suggested that quantitative dynamic
contrast-enhanced MR imaging characteristics like K (trans) may be used to forecast cancer
therapy results. The staging of liver fibrosis is thought to be a valuable application of MR
Elastography. The absence of protocol standardization with all functional MR imaging
techniques is a significant problem[22].
 Figure 13: Brain parts whose activity detected by fMRI

2.2.2 FMRI in biological response

Functional magnetic resonance imaging (fMRI) is performed. The traditional method makes
use of linear convolution models to connect experimentally generated inputs to observed
blood oxygen level dependent (BOLD) signals via a hemodynamic response function.
However, these models are oblivious to the underlying causal processes that explain reported
BOLD responses.

Recent research has concentrated on how BOLD responses are produced, and includes
models of functional integration that explain local dynamics through interactions with distant
regions, as well as biophysical input-state-output models incorporating neuronal and
hemodynamic state equations. Both strategies are combined in forward models with brain
level parameters, such as dynamic causal modeling, which models the entire causal chain
from external stimuli via induced neuronal dynamics to observable BOLD responses.

By FMRI we can know specific relationships between BOLD signals and the underlying
metabolic and electrophysiological activity still need to be defined, their physical origins are
largely understood. In order to fulfill the greater demand for oxygen and other substrates, it is
well known that an increase in neuronal activity in a particular cortex region drives an
increase in the local blood flow. The blood flow shift is actually greater than what is required,
resulting in a net improvement in the ratio of oxygenated arterial blood to deoxygenated
 venous blood at the capillary level. In essence, the higher metabolic demand is exceeded by
the change in tissue perfusion, resulting in a decrease in the concentration of
deoxyhemoglobin in tissues.

Figure 14: Schematic illustration of the origins of the BOLD effect in fMRI [22]

2.2.3 Process of Functional Magnetic Imaging

During an fMRI scan, a subject lies down inside a powerful magnet of an MRI machine, and
the changes in blood flow and oxygenation in different areas of the brain are measured by the
machine. The stimulus or task presented to the subject is designed to activate specific brain
regions associated with a particular cognitive process, such as attention, memory or emotion.

The main imaging method used in fMRI is echo-planar imaging (EPI), which is an ultrafast
imaging method that can capture complete cross-sectional images of the brain in less than a
second. While EPI images have poorer resolution and overall quality than the images used for
radiological diagnosis, they have the advantage of being able to record the entire brain in a
 few seconds and can capture the hemodynamic response to transient events, making it
suitable for studying brain function.

Since the images in an fMRI sequence can differ due to signal variance and extraneous noise,
statistical analysis is used to compare sets of images acquired during different conditions.
Multiple recordings of the MRI signal increase the reliability of the results by allowing a
degree of signal averaging[23].

Overall, fMRI is a valuable tool for investigating brain function and connectivity in both
healthy and diseased populations, and it has the potential to contribute to the development of
novel diagnostic and treatment strategies for neurological and psychiatric disorders. The
resting state functional magnetic resonance imaging (rs-fMRI) technique has gained
advantages over other fMRI techniques due to its ease in signal acquisition and proficiency in
identifying functional areas in different patient populations.

Task-based fMRI has evolved as an advanced magnetic resonance technique to analyse and
evaluate the functional domains in the brain. Recent studies have observed that paediatric
patients, patients with disorders of consciousness, and patients with low intelligence quotient
are able to undergo RS-fMRI[24].

2.2.4 Role of FMRI in drug development

Researchers can discover brain regions that may make suitable targets for drug development
by utilizing fMRI to evaluate changes in brain activity connected to particular behaviors or
illnesses. Researchers might look into whether medications that target a specific brain region
might be useful in treating a given condition, for instance, if people with that disorder have
that region of the brain continuously overactive.

In the initial stages of drug research, FMRI may also be used to design new medications.
Researchers can swiftly screen a huge number of prospective therapeutic compounds to find
those that are most likely to be beneficial by utilizing fMRI to evaluate changes in brain
activity brought on by those molecules.

For guiding dose regimens in early-phase drug discovery, fMRI has a lot of untapped
promise. In theory, predictions about the anticipated brain reaction at greater or lower doses
might be made if there was a consistent link between dose and the BOLD response. There
are, however, not many examples of this form of pharmacometric fMRI modeling being used
in the literature.
2.2.5 FMRI in Alzheimer's disease
Both normal ageing and Alzheimer's disease (AD) result in significant modifications to the
structure and operation of the brain. Death of connections between brain systems and
extensive cortical neuronal death are two symptoms of AD in particular. The functional
coherence of brain activation is disturbed by the degradation of neuronal networks.
Functional network disturbances with recognizable characteristics have been found by recent
advances in brain imaging.

Here, we evaluate research looking at fMRI (Functional magnetic resonance imaging)

measurements of changes in functional connectivity, starting with healthy ageing and moving
on to Alzheimer's disease. We discuss research that use the three main techniques—seed-
based, ICA (independent components analysis), and graph theory to examine functional
connectivity. We conclude with a brief overview of additional methods, including
electroencephalography (EEG), magneto encephalography (MEG), and positron emission
tomography (PET).

In healthy ageing, connection and network integrity appear to decline, but in AD, this decline
is accelerated and some systems, such the default mode network (DMN), are particularly
affected. Although functional connectivity is a relatively recent area of study, it has
considerable potential to shed light on how the dynamics of brain networks alter with age and
in disease[25]

The main clinical phenotypes of multiple sclerosis (MS) have been reliably shown to involve
functional cortical alterations in studies using functional MRI (fMRI) of the motor, visual,
and cognitive networks. These fMRI changes are distinguished from healthy participants by
altered recruitment of regions usually dedicated to performing a particular task, recruitment
of new regions, different resting state activity, and disturbed connectivity. Such anomalies
change over the course of the disease, not only after an acute relapse but even in patients who
are clinically stable, according to studies that used fMRI longitudinally. The abnormalities of
the MS brain's structural and functional MRIs are connected. The degree of damage to the
brain's normal-appearing white and grey matter and to the movement- and cognitive-
associated fMRI alterations was found to be correlated with movement[26].

2.2.6 FMRI in brain mapping and localization

Accurate interpretation of activation-induced signal changes in blood oxygenation level
dependent (BOLD) contrast-based functional MRI poses a challenge. Factors other than
 activation-induced blood oxygenation changes contribute to the magnitude and dynamics of
the signal change, necessitating their consideration or removal.

The study of FMRI introduces a comprehensive approach for eliminating effects unrelated to
activation-induced blood oxygenation changes in fMRI brain activation maps. The method
employs hypercapnia stress normalization.

Firstly, the study demonstrates the significant impact of resting blood volume distribution
across voxels on activation-induced BOLD signal changes. Secondly, it presents evidence on
the effects of hypercapnia (increased carbon dioxide levels) and hypoxia (oxygen deficiency)
on both resting and activation-induced signal changes. These findings suggest that global
hemodynamic stresses may serve as a valuable tool for non-invasively mapping blood
volume[27].

2.2.6.1.1 Neurosurgical surgery

Pre-operative fMRI mapping performed before receiving neurosurgical surgery is one
example of how noninvasive localization of brain function is utilized to investigate and treat
neurological disorders. Despite recognized drawbacks, the primary method for creating these
maps depends on brain activity induced by a task and has dominated the field of medicine for
more than 20 years.

Pre-operative fMRI mapping based on correlations in spontaneous brain activity has recently
been established, although it has its own drawbacks and is not currently used in many clinical
settings. Here, we demonstrate how task-based mapping and spontaneous mapping can both
be carried out simultaneously using the same pre-operative fMRI data. These two methods
offer complementary information pertinent to functional localization and may be used in
conjunction to more accurately identify eloquent motor cortex.

Our technique's accuracy, sensitivity, and specificity are evaluated by comparison with
mapping of electrical cortical stimulation in eight people with uncontrollable epilepsy.
Through prospective replication in a separate dataset of six patients from a different center,
we are able to show the broad applicability and repeatability of our method. We see a
considerable increase in signal to noise and mapping accuracy irrespective of threshold in
both cohorts as well as in each individual patient, as measured by receiver operating
characteristic curves.
 Collectively, it show that altering fMRI data processing to include both task-based and
spontaneous activity greatly enhances functional localization in patients undergoing
preoperative procedures. This technique could be useful in many situations because it doesn't
need changing the standard pre-operative data collecting techniques or adding extra scan
time[28]

Figure 15: FMRI of brain activity

2.2.6.2 Advancement of FMRI

Functional Magnetic Resonance Imaging (fMRI) has witnessed significant advancements
over the years, leading to improved capabilities and expanding its applications. Some notable
advancement in fMRI include

 Include spatial and temporal resolution

 Development of advance analysis technique
 Resting-state FMRI
 Multi model imaging integration
 Real-time FMRI
 Chapter 3

Comparison between MRI and FMRI

3.1 Table 1 : difference between MRI and fMRI

properties MRI(Magnetic Resonance fMRI (Functional magnetic
imaging) Resonance imaging)
Purpose Visualize anatomical structure Study brain function and
activity
Imaging purpose Organs ,tissues ,bones and Brain activity and specific
structures throughout the regions of the brain
body[9].
Information Detailed anatomical diseases Images showing active brain
provided images during specific task
and activities.

Applications Diagnostic imaging[11]. Neuroscience research,

cognitive studies and brain
mapping
Principle Alignment and realignment of Changes in Blood flow and
hydrogen atom. oxygen levels in the brain
In simple words we can say In simple words we can say
the principle of MRI involves fMRI relies on the
using a strong magnetic field measurement of changes in
and radio waves to align and blood flow and oxygenation
perturb the protons within the levels in the brain to detect
body's tissues, detecting the active regions during specific
emitted energy signals, and tasks or at rest. The recorded
processing them to generate BOLD signals are analyzed to
 detailed images[11]. create activation maps that
provide information about
brain function and
organization[23].
Magnetic field Strong magnetic field is used, Strong magnetic field is used,
strength and radio radio waves are used to detect radio waves are used to detect
waves utilization signals emitted by hydrogen changes in blood flow and
atoms oxygen level in brain
Clinical relevance Assists to diagnosis disease and Helps to understand brain
abnormalities functioning, connectivity and
neurology

Image time MRI takes longer time as it fMRI takes less time to
involve detailed anatomical acquire image as FMRI scans
imaging[29]. focus only on brain activity,
so it allow on shorter
acquisition of time[30].
Temporal resolution MRI has nearly 20-25ms In case of fMRI temporal
temporal resolution which can resolution have some limits
be adjusted according to because of the hemodynamic
demand[29]. response as it imposes
fundamental limit on the time
precision measurement during
fMRI[27].
Sensitivity to motion As we know in MRI we get fMRI is more sensitive to
anatomical image of body by motion as record blood flow
passing magnetic fields so in brain and functioning,
patient remain in resting during movement the blood
position[31]. flow changes and results are
effected[32].

Spatial resolution MRI has comparatively low fMRI has spatial resolution of
spatial resolution then nearly 3-4mm with higher
fMRI[29]. magnetic field of 7T and
 pixel size of 500 micron[33].
Functional In case of MRI the patient is While during fMRI
paradigms not required to perform any imaging ,participant had to
specific task during do some specific task
imaging[31]. according to the given
instructions[34].
Hemodynamics Magnetic resonance imaging Functional magnetic
response as used magnetic field to resonance imaging (fMRI),
visualize body organs and which monitors changes in
strange activity in body ,so we blood flow, volume, and
say that ,magnetic resonance oxygenation that take place
imaging does not measure concurrently with the activity
Hemodynamics response of neurons, is the most
directly. popular method for
noninvasively detecting
whole-brain activity in
people. The blood
oxygenation-level-dependent
(BOLD) signal, which is now
the most reliable and widely
utilized fMRI signal, is
created when these changes
are combined[35].
Sensitivity to small Magnetic Resonance Imaging FunctionalMagnetic
lesions technique (MRI) is more Resonance Imaging (FMRI)
sensitive to small lesions, such is not able to show these
as tumors or vascular small abnormalities as its just
abnormalities specific to brain functioning
 3.2 Difference between diagnosed diseases
We can distinguish between MRI and FMRI based on the diseases that these two diagnostic

methods are used to treat, since we are aware that MRI uses a visual representation of the
body's organs like body interior structure[36].But in case of FMRI we discuss about the
functional images of any activity involve in our brain for example we can say metabolic
activity over time[23]So below going to discuss some of these disease to differentiate
between the main working of MRI and FMRI

3.3 Magnetic resonance Imaging

3.3.1 Multiple Sclerosis

The central nervous system (CNS) is afflicted by the potentially crippling condition known as
multiple sclerosis (MS).A persistent demyelinating illness of the central nervous system,
multiple sclerosis. Cognitive impairment has a significant impact on essential everyday tasks
while being an often ignored indicator and symptom. Throughout the lifespan, multiple
sclerosis has a variable prevalence of cognitive impairment, which can make it challenging to
identify MS from other causes as people get older. Grey matter shrinkage is an early indicator
of probable future dementia, according to MRI studies, which also reveal that extensive
alterations to brain networks contribute to cognitive failure. Episodic memory and processing
speed are thought to be the cognitive domains that are most often impacted by
neuropsychological conditions[37].

3.3.2 Ligament and tendon injuries

MRI is effective in visualizing injuries in Ligaments and Tendons such as injury in hand
tendon the tenosis of the A1 annular ligaments, the fibrous outer layer of the retinacula, and
both. Proliferative tenosynovitis, in contrast, affects the tendon sheath's synovial inner layer
and causes tendon involvement and tendinitis. The flexor compartments are more prone to
 pyrogenic tenosynovitis. The hand's small gaps necessitate the employment of a high-
resolution MRI method[38].

Similarly MRI is also used in ligament injuries like in Peroneal tendon and ligament A
neglected cause of lateral hindfoot discomfort and dysfunction that can be challenging to
detect from lateral ankle ligament injuries is pathological abnormalities of the peroneal
tendons[39].

Figure 16 Anatomy of lateral ankle

3.3.3 Chiari malformation detection by MRI

The term "Chiari malformation" refers to a condition in which brain tissue extends into the
spinal canal. There are several variations of the illness, with Type 1 being the most prevalent.
When an MRI is conducted, it is frequently discovered as an accidental discovery and
frequently causes little, if any, symptoms. Headaches, vertigo, and nausea may be brought on
by a constriction of the foramen magnum brought on by a spinal fluid circulation blockage. In
symptomatic situations, surgical therapy must be taken into account[40].

3.3.4 Rheumatoid Arthritis detection by MRI

MRI can assess the extent of joint damage and inflammation in Rheumatoid Arthritis aiding
in diagnosis and treatment planning. Muscle variations between RA patients and healthy
controls may be discernible using quantitative MRI and assessments of muscle strength.
These variations may be observed in RA patients who have not yet begun therapy, in those
who still have active illness, and in those who have recently come out of clinical remission.
This shows that early-stage RA patients' muscles are damaged, and that symptoms of
muscular pathology and weakness can still be seen throughout clinical remission.
3.3.5 Stroke
We show stroke symptoms affecting the vertebral, basilar, cerebellar, and posterior cerebral
arteries. Highlighted characteristics of posterior circulation strokes include patterns of basilar
artery occlusions. Magnetic resonance imaging is the method of choice in cases where
posterior circulation strokes are suspected since the clinical severity and prognosis of these
strokes are very varied and they are more challenging to detect with CT-based neuroimaging.
So, magnetic resonance imaging is the technique of choice in suspected posterior circulation
strokes and we can say MRI can provide the detailed image of the brain to identify the
affected areas[41].

Figure 17 image of brain stroke [41]

Above disease related to interior body structure, now some diseases are discussed further
which are related to brain functional activityand observed by using functional magnetic
resonance imaging technique.

3.4 Functional Magnetic Resonance Imaging

3.4.1 Epilepsy
FMRI can help in identify the area that is affected by epilepsy and identify the potential
surgical treatment options. Epilepsy is disorder in brain which specified by repeated
seizures[42].

3.4.2 Obsessive Compulsive Disorder

Obsessive-compulsive disorder is a serious and incapacitating mental illness that poses many
difficulties for neuroscience. Recent developments in its neuropsychological foundation,
genetic and developmental causes, are discussed. Metacognitive ideas are compared to and
assessed alongside hypotheses relating to an imbalance between habitual and goal-directed
behaviour, as well as neurological correlates in the cortico-striatal circuitry. Obsessive-
compulsive disorder (OCD) treatments include psychological, pharmaceutical, and surgical
 methods, while their underlying processes are still up for discussion. OCD treatments often
have varying degrees of success. In general, dimensional psychiatry is used to discuss the
potential for novel animal models and a comprehensive knowledge of the pathophysiology of
OCD.FMRI scans can show distinctive brain pattern associated with OCD and aid in
diagnosis and treatment[43].

3.4.3 Depression
Although cortical connection networks may have a role in the choice of treatments for major
depressive illness, functional magnetic resonance imaging research has only limited
therapeutic usefulness. Electroencephalography (EEG), a technology more readily used in
clinical practice, has been used to uncover functional connectivity networks that resemble
those seen in functional magnetic resonance imaging[44].

3.4.4 Bipolar Disorder

However, little is known about the resting-state functional connectivity (rsFC) within the
reward circuit. Studies have found that neural functional abnormalities detected by functional
magnetic resonance imaging (fMRI) in brain regions implicated in reward processing during
reward tasks show promise to distinguish bipolar from unipolar depression (UD). In this
work, we retrospectively compared rsFC within the reward circuit between UD and depressed
BD to identify neurobiomarkers for early diagnosis of bipolar disease (BD)[45].

3.4.5 Autism Spectrum Disorder (ASD)

With regard to neurodevelopmental diseases, functional magnetic resonance imaging (fMRI)
has been extensively employed to investigate the connections between brain function and
phenotypic traits. The major networks of the brain have been identified thanks to methods
like resting-state functional connectivity (FC). One fMRI network in particular, the default
mode network (DMN), has been linked to both attentional and social-cognitive deficiencies
in attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD)[46].
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