Brain MRI

MRI PROTOCOLS
Brain MRI
 Indications :
1- Multiple sclerosis MS
2- Primary tumor assessment and
metastasis.
3- evaluation of infarction.
4- Unexplained neurological symptoms
and defect
 Brain MRI
 Equipment :
 1- Head coil (circularly polarized
(CP) head coils. These volume coils
are closely shaped around the head
of the patient. At best, CP coils
provide a signal to- noise ratio (SNR)
gain of √2 compared with non-CP
coils
2- Immobilization pads
3- Ear plugs
Brain MRI
 Patient position :
 Pt supine , head first within head coil ,
interpupillary line is parallel to table and
head straight , the longitudinal alignment
light with midsagittal line ,the horizontal
one passes through the nasion .
Brain MRI protocol
 Technical Data :
 Excellent SNR and brain contrast is achieved.
Particularly using FSE with fine matrix , especially on T2
weighted images.
 CSF has a long T1 recovery time and long T2 decay
time therefore appear black low signal on T1 and white
high signal on T2.
 Protein within water (CSF) decreases T1 relaxation
therefore produces a higher signal than pure CSF.
 White matter on T1 weighted images produces a
relatively high signal compared to grey matter.
 On T2 weighted images white matter produces a lower
signal , while grey matter produces a much brighter
signal .
Brain MRI protocol ( Adults)
1. Localizer ( 3 planes or sagittal and axial)
2. Axial T2
3. Axial T1
4. Axial FLAIR
5. Sagittal T2
6. Coronal T1
7. diffusion
Brain MRI protocol
 Axial sequence :
plot on sagittal plane, parallel to line
through anterior and posterior
commissure ,from the foramen magnum
to vertex .
 Brain MRI protocol
 Slice thickness : 5-6
mm
 Slice gap : 20% of the
slice thickness ( 1-1.2
mm)
 Saturation slab :
parallel to slices ,
inferior to most caudal
slice 10 mm and
thickness 50-80 mm
Brain MRI protocol
T2 weighted :
FSE
TR : 3500-4500
TE : 100-120
Brain MRI protocol
 T1 weighted :
FSE or SE
TR : 450-600
TE :12-25
Brain MRI protocol
 Axial FLAIR :
TR :9000
TE :120
TI :2300

FLAIR sequence
Suppression of CSF signal .it useful for
preiventicular or cord lesions such as
MS.
Brain MRI protocol
 Sagittal :
Brain MRI protocol
 Sagittal plot on coronal and axial
localizer .
 Same slice thickness , gap and
saturation slab .
 T2 weighted:
 FSE
 TR : 3500-4500
 TE:100
Brain MRI protocol
 Coronal sequence :
 Plot on sagittal localizer
 Same parameters of T1 sequence .
Brain MRI protocol
 Coronal T1 image
Brain MRI protocol
Brain MRI protocol

 Diffusion sequence
 •Excellent non-invasive method of measuring the
diffusion characteristics of biological tissue.
 •Based on Spin Echo.
 •Includes two additional large gradients around a 180 o
pulse:
 -Static spins: dephasing of the spins due to the first lobe
is followed by an exact rephasing by the second lobe.
 -Diffusing spins: rephasing will not be complete which
results in a signal loss within a given voxel, in addition to
T1- and T2-effects.
Brain MRI protocol
 Diffusion sequence :
 Important in the investigation of early
stroke , utilize in pediatric pt to
investigate the effect of hypoxia and
myelination pattern .
Brain MRI protocol ( Additional )

 Diffusion sequence
 Very sensitive to motion of fluid molecules

 Postprocessing ’Diffusion’ package to calculate

parametric maps (e.g. ADC-, eADC-, FA-map).
 •FiberTrak package to track fibers for diffusion
tensor data with at least 6 diffusion directions.
Fiber track ( Additional )
Hemorrhage in brain MRI
  Age
 Hyperacute ( < 24 hrs old )
T1 :Hypointense T2 :Hyperintense
 Acute ( 1-3 days ),
T1 :Hypointense T2 : Hypointense, surrounded
by hyperintense margin
 Subacute ( 4-14 days ),
T1: Hyperintense,T2 : hypointense
 Chronic (> 14 days )
T1 :Hypointense T2 :hypointense margin
surrounding hyperintense fluid cavity
Hyperacute hemorrhage
Acute Hemorrgahe
Subacute Hemorrhage
Chronic Hemorrhage
Brain Infarction (stroke)

Magnetic resonance imaging in acute stroke. Left: Diffusion-

weighted MRI in acute ischemic stroke performed 35 minutes after
symptom onset. Right: Apparent diffusion coefficient (ADC) map
obtained from the same patient at the same time.
SPECIAL BRAIN MRI
PROTOCOLS
Brain MRI protocol ( Tumors)
 Axial T1 ( HR)
 Axial T2 ( HR)
 Sagittal T2
 Adminstration of 10 ml of Gd-DTPA
( 0.2 ml per kg )
 Axial T1
 Coronal T1
 Sagittal T1
Brain MRI protocol ( Tumors)
Perfusion

 Perfusion imaging

 Perfusion imaging tracks the transient passage of

a Gd-based contrast agent bolus by means of a
fast dynamic scan:
 •Contrast agent will be injected as a bolus.
 •Simultaneously, a fast dynamic scan will be
started.
 •This dynamic scan will be evaluated with post-
processing packages.
Perfusion image with pathology in left parietal area
Perfusion ( Additional )
Brain MRI protocol ( CPA)
 (Cerebellopontine angle)
 Localizer 3 planes
 Axial T1
 Axial T2
 Coronal T1
 Coronal T2
 Post contrast T1 axial and coronal
Brain MRI protocol ( CPA)
 Axial sequence plot on coronal localizer.
 Slice thickness :2-3 mm
 Slice gap : 20% of slice thickness ( 1-
1.2mm)
 Sat. slab : inferior and superior .
Brain MRI protocol ( CPA)
 Definition :
 Acoustic schwannomas are
benign tumors of Schwann
cells. Schwannomas typically
involve the cranial nerves and
most commonly the sensory
nerves-VIII and V. Rarely there
can be involvement of cranial
nerve VII or the nerves within
the jugular sheath ( IX, X, X1).
Patients typically present with
tinnitus or sensorineural
hearing loss, although the
mass typically arises from the
vestibular portion of the nerve.
 Radiographic appearance :
 MR demonstrates a T1
isointense (without
gadolinium), intensely
enhancing mass (with
gadolinium ) extending into
the internal auditory canal.
The mass demonstrates
increased signal with T2
weighting .
Brain MRI protocol ( CPA)

T1 Axial T1 axial with Gad.

Brain MRI protocol ( CPA)

T2 axial T1 with Gad coronal

Brain MRI protocol (MS)
 an autoimmune condition in which the
immune system attacks the central nervous
system (affects principally the white matter
in the brain and spinal cord ), leading to
demyelination (which the myelin sheath of
neurons is damaged ) MS affects the ability
of nerve cells in the brain and spinal cord
to communicate with each other
 It is more common in females than males
(3:2)
Brain MRI protocol (MS)
 Routine brain
 Best with sagittal FLAIR ( HR)
 Adminstration of contrast
 Brain MRI protocol (MS)

FLAIR Images:   Hyperintense lesion is noted in the pontine tectum at the floor of the fourth ventricle.
 Brain MRI protocol (MS)

T2WI:   Large callosal-septal plaque. T2WI:   Callosal-septal

plaques are hyperintense.
Brain MRI protocol (MS)

Postcontrast T1WI :   Enhancing lesion floor of 4th ventricle.

Brain MRI protocol (epilepsy)
 Axial T2
 Plot on sagittal parallel to temporal
lobe .
 Slice thickness 3mm
 Gap 1- 1.2 mm
 Sat slab .
Brain MRI protocol (epilepsy)
 Coronal sequence
 Plot on sagittal perpendicular to line of
hippocamaple grey matter.
 Same slice thickness
 TR :7000
 TE: 40
 TI : 400
Brain MRI protocol (epilepsy)
 There is increased
signal seen on both
FLAIR image in the
right hippocampus
in comparison with
the left. There is
also evidence of
asymmetry of tissue
with loss of volume
in the right Coronal FLAIR
hippocampus
Brain MRI protocol (Pituitary)
 Localizer
 Sagittal T1 ,T2 HR
 Coronal T1 HR
 Post contrast
 Coronal T1
 Sagittal T1
 Best with dynamic sequence
Brain MRI protocol (Pituitary)
 Coronal sequence
 Plot on mediosagittal localizer superior
to sella.
 Slice thickness 2mm
 Gap : 0-20% of thickness
 2 sat. slab

Small FOV
Brain MRI protocol (Pituitary)
 Sagittal sequence
 Plot in coronal localizer superior to sella
 Same parameters
Brain MRI protocol (Pituitary)

T1 sagittal T1 sagittal post contrast

Brain MRI protocol (Pituitary)
Orbit MRI protocol
 Scout 3 planes
 Axial T1 , T2 HR
 Coronal T1 ,T2 HR
 Axial Fat sat.
 Parasagittal T2
Orbit MRI protocol
 Coronal
 Plot on axial localizer
 3mm slice thickness
 Gap 20%
Orbit MRI protocol
 Axial plot on coronal localizer
 3mm slice thickness
 Gap 20%
Orbit MRI protocol
 Parasagittal :
 Plot on axial along with optic nerve
 3mm slice thickness
 Gap 20%
Spectroscopy MRI ( Additional )
Functional MRI ( Additional )
BOLD imaging