MRI

Dr. Deedar Farhad Mustafa

FACHARZT RADIOLOGY
 Introduction
. Magnetic resonance imaging (MRI) is a
spectroscopic imaging technique used in
medical settings to produce images of the inside
of the human body.
. MRI is based on the principles of nuclear
magnetic resonance (NMR), which is a
spectroscopic technique used to obtain
microscopic chemical and physical data about
molecules
• Dr Isidor Rabi (Nobel in 1944), discovered NMR
(Nuclear Magnetic Resonance) in the late 1930s,
but considered it to be an artefact of his
apparatus!
• Bloch and Purcell were awarded the Nobel Prize
for Physics in 1952 for the discovery of NMR, and is
widely used in assessing complex chemical
compunds
• In 1977 the first MRI exam was performed on a
human being. It took 5 hours to produce one
image.
• Prof Peter Mansfield was awarded Nobel in 2003
for his discoveries in MRI (with Prof Paul C
Lauterbur of USA)
How Does it Work?
The magnetic resonance imaging is accomplished
through the absorption and emission of energy of
the radio frequency (RF) range of the
electromagnetic spectrum.
The Components of an MRI machine:
• A magnet which produces a very powerful uniform
magnetic field.
• Gradient Magnets which are much lower in
strength.
• Equipment to transmit radio frequency (RF).
• A very powerful computer system, which
translates the signals transmitted by the coils.
The magnet:
• The most important component of the MRI
scanner is the magnet:
• The magnets currently used in scanners today
are in the o.5-tesla to 3.0-tesla range
• Higher values are used for research.
There are three types of magnets used in MRI
systems:
• Resistive magnets
• Permanent magnets
• Super conducting magnets (the most
commonly used type in MRI scanners).

• In addition to the main magnet, the MRI

machine also contains three gradient
magnets. These magnets have a much lower
magnetic field and are used to create a
variable field.
 Technology:
• How Does It All Work?
• Spin: The atoms that compose the human body
have a property known as spin (a fundamental
property of all atoms in nature like mass or
charge).
• Spin can be thought of as a small magnetic field
and can be given a + or – sign and a mathematical
value of multiples of 1⁄2.
• Components of an atom such as protons,
electrons and neutrons all have spin.
• Protons and neutron spins are known as
nuclear spins.
• An unpaired component has a spin of 1⁄2 and
two particles with opposite spins cancel one
another .
• In NMR it is the unpaired nuclear spins that
produce a signal in a magnetic field.
• Human body is mainly composed of fat and
water, which makes the human body composed
of about 63% hydrogen.
• Why Are Protons Important to MRI?
– positively charged
– spin about a central axis
– a moving (spinning) charge creates a magnetic
field.
– the straight arrow (vector) indicates the direction
of the magnetic field
We all are made up of elements
• 92 elements occur naturally on earth.
• Human body is built of only 26 elements.
• Oxygen, hydrogen, carbon, nitrogen elements
constitute 96 % of human body mass.
• Oxygen is 65 % of body mass; carbon is 18.5
%, hydrogen 9.5 %, nitrogen 3.2 %.
• Let us ignore all elements but Hydrogen.
Why hydrogen?
• Simplest element with atomic number of 1 and
atomic weight of 1
• When in ionic state (H+), it is nothing but a
proton.
• Proton is not only positively charged, but also
has magnetic spin (wobble)!
• MRI utilizes this magnetic spin property of
• protons of hydrogen to elicit images!!
• We are magnets!
But why we can’t act like magnets?
• The protons (i.e. Hydrogen ions) in body are
spinning in a hap hazard fashion, and cancel all
magnetism. That is our natural state!
. When placed in a large
magnetic field, hydrogen atoms
have a strong tendency to align
in the direction of the magnetic
filed
. in an external magnetic
field they align parallel or anti-
parallel.
. the lower energy state
(parallel) is preferred, so a few
more protons align this way
• the protons perform a motion that resembles
the wobbling of a spinning top, that was hit
• this motion is called precession
• the precession frequency is dependent on the
strength of the external magnetic field
(a relationship which is described by the Larmor
equation). The stronger the magnetic field, the
higher the precession frequency.
What happens after we put the patient into the
magnet?
We send in radiowave
Energy Absorption:
• The MRI machine applies radio frequency (RF)
pulse that is specific to hydrogen.
• The RF pulses are applied through a coil that is
specific to the part of the body being scanned.
Resonance:
• The gradient magnets are rapidly turned on
and off which alters the main magnetic field.
• The pulse directed to a specific area of the
body causes the protons to absorb energy and
spin in different direction, which is known as
resonance
• Frequency (Hz) of energy absorption depends
on strength of external magnetic field.
Imaging:
• When the RF pulse is turned off the hydrogen
protons slowly return to their natural alignment
within the magnetic field and release their
excess stored energy. This is known as
relaxation.
What happens to the released energy?
• Released as heat OR
• Exchanged and absorbed by other protons OR
• Released as Radio Waves
What happens with the protons, when they are
exposed to this RF-pulse
• Some of them pick up energy, and go from a
lower to a higher energy level.
• Let us assume that from the net sum of 6
protons pointing up, after the RF pulse is sent
in 2 point down. The result is that these 2
protons cancel out the magnetic forces of the
same number of protons that point up. In
effect, then, the magnetization in longitudinal
direction decreases from 6 to 2.
• The RF pulse also has a whip-like action: it gets
the precessing protons in synch and this has
another important effect.
• Due to the RF pulse, the protons do not point in
random directions any more, but move in step, in
synch - they are "in phase". They now point in
the same direction at the same time, and thus
their magnetic vectors add up in this direction
• This results in a magnetic vector pointing to the
side to which the precessing protons point, and
this is in a transverse direction, This is why it is
called trans- versal magnetization.
So rembember
• When we put the patient in the MR machine, the
protons line up parallel or anti-parallel to the
machines magnetic field. A magnetic field in the
patient, longitudinal to the external field results.
• Sending in an RF pulse that has the same frequency
as the precession frequency of the protons causes
two effects:
- Some protons pick up energy, start to walk on their
hands, and thus decrease the amount of longitudinal
magnetization.
- The protons get in synch, start to precess in phase.
Their vectors now also add up in a direction
transverse to the ex- ternal magnetic field, and thus
a transversal magnetization is established.
In summary: the RF pulse causes longitudinal
magnetization to decrease, and establishes
a new transversal magnetization
Measuring the MR Signal:
• the moving proton vector induces a signal in
the RF antenna
• The signal is picked up by a coil and sent to the
computer system.
• the received signal is sinusoidal in nature
• The computer receives mathematical data,
which is converted through the use of a Fourier
transform into an image.
Two times scale T1 and T2
• T1 is the spin-lattice relaxation time-scale for
the longitudinal magnetization to come back to
its initial value
• T2 is the spin-spin relaxation time
for the transverse magnetization to decrease to
zero
• T1-weighted imaging: higher spatial resolution
• T2-weighted imaging: higher tissue contrast
• typically both time-scales are used
Recap. ( what does the image represent?)
• For every unit volume of tissue, there is a
number of cells, these cells contain water
molecules, each water molecule contain one
oxygen and two hydrogen atoms.
• Each hydrogen atom contains one proton in its
nucleus. Different tissues thus produce
different images based on the amount of their
hydrogen atoms producing a signal
• What kind of images?

• T1WI
• BOLD images
• T2WI
• MRA MRV
• T2WI PDWI
• Post-Gd images
• ► PDWI DWI
• ► Post-Gd images Volumetric images
• ► DWI ADC
• ► Volumetric images MR arthrograms
• MRA
• ► MR arthrograms
• GE
• FLAIR
• Perfusion images
• STIR
• fMRI
• Etc
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How MR is done?
• Before entering tunnel, there is a checklist!
• No mobiles, no credit cards, please!
• Known potential safety concerns due to large
static magnetic field:
• Internal cardiac pacemakers
• Steel cerebral aneurysm clips (ferromagnetic)
• Small steel slivers embedded in eye
• Life-support equipment with magnetic steel
• Cochlear implants
• Malfunction: ICDs, neurostimulators, bone
growth stimulators (prosthetic heart valves)
• Superficial burns (uninsulated wire leads)
• NEED sedation: infants, younger peds, agitated
• adults (claustrophobia)
• Precautions: magnetic plastic cards, watches,
• hearing aids, ferromagnetic steel objects (LEAVE
• OUTSIDE)
• Loud noise (long-term hearing loss)
• Pregnancy!
Is entering the tunnel safe?
• No definite long-term harmful effects
• Pregnancy is a relative contraindication, as we
will never be able to tell with 100% certainty
that MRI is 100% safe during pregnancy!
• Babies and children need sedation or GA
• Some people fear tunnels (claustrophobia)
When to MRI?
• When everything else fails, there is MRI
• When you want to borrow time from the
patient, request MRI and hope that the waiting
time will take care of the patient
Advantages of MRI
• No ionizing radiation & no short/long-term
effects demonstrated
• Variable thickness, any plane
• Better contrast resolution & tissue
discrimination
• Various sequences to play with to characterise
the abnormal tissue
• Many details without I.V contrast.
Disadvantages of MRI
• Time consuming
• Not easily available
• No on-call service
• Need to tweak sequences as per the clinical
questions; hence cannot be generalised
Neuroimaging = MRI
No neurology or neurosurgery without MRI
• MR brain has largely replaced CT brain in n in
USA (but for head injury, suspected acute
intracranial haemorrhage)
• Superior to CT in most occasions
• CT is poor man’s MRI in all other indications!
• Show me a person with migraine who has
not undergone MRI in USA!
Indications (almost everything)
• Anatomy
• Trauma
• Hydrocephalus
• Congenital anomalies
• Hereditary and metabolic diseases
• Cranial nerves
• Infections
• Arteriograms and Venograms
• Demyelination
• Vascular event
• Skull base
• Tumours
• Pituitary gland
Dementia
Spine imaging:
• MR is the investigation of choice
• Conventional CT, CT myelogram and
conventional myelogram are no longer are no
longer performed, unless MR is
contraindicated.
• Indications and contraindications – same
• First line of investigation in suspected spinal
infection, cord compression, cauda equina,
sciatica
Head and Neck imaging
• MR is complementary or second line of
investigation in many of head and neck
pathologies
• Superior to CT in staging head and neck
malignancies
• Characterise the head and neck lesions better
than CT
• Complementary to CT in petrous temporal and
• paranasal sinus evaluation
• First line of investigation in orbital lesions
Tongue base carcinoma
Musculoskeletal imaging
• Initial evaluation of bones – Plain films; then
MRI
• MRI sensitive than CT in diagnosing occult
fractures
• Initial evaluation of soft tissues – USG; then
MRI
• Joint imaging = MRI
Indications
• Occult fractures
• Marrow abnormality
• Ligament pathologies
• Tendon pathologies
• Muscular injuries
• Infection
• Bone and soft tissue tumour
• Labral pathologies
 Fracture,
salter and Harris type?
Abdominal MRI
• Problem solving tool in liver, pancreatic, renal
and adrenal lesions
• Primary modality in local staging of rectal ca,
endometrial ca, cervical ca, prostate ca, vaginal
ca
• Non-invasive modality in evaluating
pancreaticobiliary tract – MRCP
• Scrotal and penile imaging
• Uterus and ovary imaging
Rectal cancer
Vascular MRI
Peripheral vascular arteriogram with or without
I.V contrast
Aortogram  Dissection
Pulmonary arteriogram When CT is
contraindicated
Cardiac MRI
• Coming in a big way
• Very useful in congenital heart diseases,
cardiomyopathies
• Evidence is emerging in the evaluation of
myocardial infarction
Breast MRI:
• Problem solving
• Breast implants
• Recurrence
• Multifocal disease
Fetal MRI
• Assessment of congenital anomalies
• Placental abnormalities
• Twin assessment