Brain MRI

Brain MRI
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Indications : 1- Multiple sclerosis MS 2- Primary tumor assessment and metastasis. 3- evaluation of infarction. 4- Unexplained neurological symptoms and defect

Brain MRI
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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 .
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Brain MRI protocol
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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 .

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Brain MRI protocol ( Adults)
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Localizer ( 3 planes or sagittal and axial) Axial T2 Axial T1 Axial FLAIR Sagittal T2 Coronal T1 diffusion

Brain MRI protocol
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Axial sequence : plot on sagittal plane, parallel to line through anterior and posterior commissure ,from the foramen magnum to vertex .

Brain MRI protocol
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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
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T2 weighted : FSE TR : 3500-4500 TE : 100-120

Brain MRI protocol
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T1 weighted : FSE or SE TR : 450-600 TE :12-25

Brain MRI protocol
Axial FLAIR : TR :9000 TE :120 TI :2300
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FLAIR sequence Suppression of CSF signal .it useful for preiventicular or cord lesions such as MS.

Brain MRI protocol
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Sagittal :

Brain MRI protocol
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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
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Coronal sequence : Plot on sagittal localizer Same parameters of T1 sequence .

Brain MRI protocol
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Coronal T1 image

Brain MRI protocol

Brain MRI protocol
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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
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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 )
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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.

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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
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Hyperacute hemorrhage

Acute Hemorrgahe

Subacute Hemorrhage

Chronic Hemorrhage

Brain Infarction (stroke)

Magnetic resonance imaging in acute stroke. Left: Diffusionweighted 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.

MRA for Brain
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Time-of-flight (TOF) or Inflow angiography, uses a short echo time and flow compensation to make flowing blood much brighter than stationary tissue. As flowing blood enters the area being imaged it has seen a limited number of excitation pulses so it is not saturated, this gives it a much higher signal than the saturated stationary tissue

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
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Brain MRI protocol ( Tumors)

Perfusion
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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 postprocessing packages.
Perfusion image with pathology in left parietal area

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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
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Brain MRI protocol ( CPA)
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Axial sequence plot on coronal localizer. Slice thickness :2-3 mm Slice gap : 20% of slice thickness ( 11.2mm) Sat. slab : inferior and superior .

Brain MRI protocol ( CPA)
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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.

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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)
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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
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Brain MRI protocol (MS)

FLAIR Images

:Hyperintense lesion is noted in the pontine tectum at the floor of the fourth ventricle

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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)
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Axial T2 Plot on sagittal parallel to temporal lobe . Slice thickness 3mm Gap 1- 1.2 mm Sat slab .

Brain MRI protocol (epilepsy)
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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)
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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 hippocampus
Coronal FLAIR

Brain MRI protocol (Pituitary)
Localizer € Sagittal T1 ,T2 HR € Coronal T1 HR € Post contrast € Coronal T1 € Sagittal T1 € Best with dynamic sequence
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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
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Brain MRI protocol (Pituitary)
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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
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Orbit MRI protocol
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Coronal Plot on axial localizer 3mm slice thickness Gap 20%

Orbit MRI protocol
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Axial plot on coronal localizer 3mm slice thickness Gap 20%

Orbit MRI protocol
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Parasagittal : Plot on axial along with optic nerve 3mm slice thickness Gap 20%

Spectroscopy MRI ( Additional )

Functional MRI ( Additional ) BOLD imaging