INTRODUCTION TO SPECIAL

IMAGING MODALITIES

DR.KHAMIS HASSAN BAKARI, MD, MMED, PhD

SCHOOL OF MEDICINE AND DENTISTRY,
THE UNIVERSITY OF DODOMA
Objectives
 What is MRI?
 MRI Sequences-T1,T2,DWI,FLAIR
 Neurological indications for cranial MRI
 Nuclear Medicine-Radionuclides, PET, SPECT
 Ultrasound
MAGNETIC RESONANCE
IMAGING
 A non-invasive medical imaging
technique that uses a magnetic field and
computer-generated radio waves to
create detailed images of the organs and
tissues

 Provides exquisite detail of brain, spinal

cord and vascular anatomy

 One is able to visualize anatomy in all

three planes: Axial, sagittal and coronal
MRI SLICES/PLANES
MRI Sequences
 T1&T2 weighted scans are most common

 T1&T2 rely on TR and TE

 Repetition Time (TR) is the amount of

time between successive pulse sequences
applied to the same slice

 Time to Echo (TE) is the time between

the delivery of the RF pulse and the
receipt of the echo signal
MRI Sequences
 T1-weighted images are produced by using
short TE and TR times

 The contrast and brightness of the image are

predominately determined by T1 properties of
tissue

 T2-weighted images are produced by using

longer TE and TR times

 The contrast and brightness are predominately

determined by the T2 properties of tissue
MRI Sequences
 T1-weighted imaging can also be
performed while infusing Gadolinium
(Gad)

 Gad is a non-toxic paramagnetic

contrast enhancement agent

 When injected during the scan, Gad

changes signal intensities by
shortening T1
MRI Sequences
 Thus, Gad is very bright on T1-
weighted images

 Gad enhanced images are esp useful

in looking at vascular structures and
breakdown in the blood-brain barrier
[e.g., tumors, abscesses,
inflammation (herpes simplex
encephalitis, multiple sclerosis, etc.)]
MRI Sequences
 Fluid Attenuated Inversion Recovery (Flair)

 Similar to a T2-weighted image except

that the TE and TR times are very long

 Abnormalities remain bright but normal

CSF fluid is attenuated and made dark

 This sequence is very sensitive to

pathology and makes the differentiation
btn CSF and an abnormality much easier
MRI Sequences
 Diffusion weighted imaging (DWI) is designed to
detect the random movements of water protons from
extracellular to intracellular spaces in ischemic conditions

 During ischemia, the Na-K pump shuts down and sodium

accumulates intracellularly

 Water then shifts from the extracellular to the

intracellular space due to the osmotic gradient

 As water movement becomes restricted intracellularly,

this results in an extremely bright signal on DWI

 Thus, DWI is an extremely sensitive method for

detecting acute stroke
Tissue T1-Weighted T2-Weighted Flair

CSF Dark Bright Dark

White Matter Light Dark Gray Dark Gray

Cortex Gray Light Gray Light Gray

Fat (within bone Bright Light Light

marrow)

Inflammation Bright Bright Bright

(infection,
demyelination)
MRI Sequences
Comparison of T1 vs. T1 with Gadolinium

Enhanced blood vessels

 Comparison of T1 vs. T1 with Gadolinium
Tissue T1-Weighted T2-Weighted
CSF Dark Bright
Muscle Gray Dark Gray
Spinal Cord Gray Light Gray
Fat (Subcutaneous Bright Light
tissue)

Disk (If intact & Gray Bright

hydrated)
Air (Pharynx) Very Dark Very Dark
Inflammation Dark Bright
(Edema, Infarction,
Demyelination)
Comparison of Flair vs. Diffusion-weighted

Acute Infarction only seen on DWI

Comparison of T1 vs. T2 - Spine
NEUROLOGICAL INDICATIONS FOR CRANIAL MRI

 Vascular (ischemic and hemorrhagic stroke, aneurysm,

venous thrombosis)

 Tumor (primary CNS and metastatic)

 Infection (abscess, cerebritis, encephalitis, meningitis)

 Inflammatory/Demyelinating Lesions (multiple

sclerosis, sarcoidosis, etc.)

 Trauma (epidural hematoma, subdural hematoma,

contusion)

 Hydrocephalus & Congenital Malformations

LIMITATIONS OF MRI
 Subject to motion artifact

 Inferior to CT in detecting acute

hemorrhage

 Inferior to CT in detection of bony

injury

 Requires prolonged acquisition time

CONTRAINDICATIONS TO MRI

 Implanted devices and other metallic devices

 Pacemakers and other implanted electronic

devices
 Aneurysm clips and other magnetizable materials
 Cochlear implants
 Some artificial heart valves

 Intraocular metallic foreign bodies

 Screening CT of the orbits if history suggests

possible metallic foreign body in the eye
  Unstable patients (most resuscitation
CONTRAINDICATIONS TO MRI

equipment cannot be brought into the

scanning room)

 Pregnancy (relative contraindication due to

unknown effects on the fetus)

 Other – severe agitation, or

claustrophobia (may require anesthesia
assistance)
NUCLEAR MEDICINE
INTRODUCTION TO NUCLEAR MEDICINE

 A medical specialty that uses radioactive tracers

(radiopharmaceuticals) to assess bodily functions to
diagnose and treat diseaseS

 A radioactive tracer-Chemical compound in which

one or more atoms have been replaced by a
radioisotope

 Monitoring its radioactive decay, a radiotracer can be

used to explore the mechanism of chemical
reactions
RADIO-ISOTOPES/RADIOPHARMACEUTICALS

 The most common radiotracer is F-18

fluorodeoxyglucose (FDG), a molecule
similar to glucose
 18F-FDG-18-Flourine-2-deoxy-2-Glucose

 Cancer cells are more metabolically active

and may absorb glucose at a higher rate

 Other radionuclides includes 11

c, 13
N,15O, 18
F,
32
P, 35S, 99mTc, 123I
Single Photon Emission Computed Tomography (SPECT)

 Provides three-dimensional (tomographic)

images of the distribution of radioactive
tracer molecules that have been introduced
into the patient’s body

 Uses gamma camera detectors that can

detect the gamma ray emissions from the
tracers that have been injected into the
patient
Positron Emission Tomography PET/CT/MRI

 PET scans also use radiopharmaceuticals to create

three-dimensional images

 While SPECT scans measure gamma rays, the decay

of the radiotracers used with PET scans produce
small particles called positrons

 A positron is a particle with roughly the same mass

as an electron but oppositely charged
ULTRASOUND
ULTRASOUND

 An imaging method that uses high

frequency sound waves to characterize
tissue

 Unlike x-rays, ultrasounds don't use

any radiation

 Two main categories of ultrasounds:

 Obstetric ultrasound
 Diagnostic ultrasound
ULTRASOUND

 Advantages
 Uses non-ionizing sound waves not associated with
carcinogenesis - this is particularly important for the
evaluation of fetal and gonadal tissue

 More readily available in most centers compared to

CT or MRI

 Less expensive to perform than CT or MRI

 Straightforward to perform portably, unlike CT/MRI

 Few (if any) contraindications to the use of

ultrasound, compared with MRI/CT
ULTRASOUND

 The real-time nature of ultrasound imaging is

useful for the evaluation of physiology as well
as anatomy (e.g. fetal heart rate)

 Doppler evaluation of organs and vessels adds

a dimension of physiologic data, not available
on other modalities (with the exception of
some MRI sequences)

 Ultrasound images may not be as adversely

affected by metallic objects, as opposed to CT
or MRI
ULTRASOUND

 Disadvantages

 Adequate training is required to accurately and

efficiently conduct an ultrasound exam and there is
non-uniformity in the quality of examinations
("operator dependence")

 Ultrasound is not capable of evaluating the internal

structure of tissue types with high acoustical
impedance (e.g. bone, air)

 It is also limited in evaluating structures encased in

bone (e.g. cerebral parenchyma inside the calvaria)
ULTRASOUND

 Disadvantages

 The high frequencies of ultrasound result in a

potential risk of thermal heating or mechanical
injury to tissue at a microscopic level, this is of
most concern in fetal imaging

 Presence of unique artifacts which degrade

image quality or may lead to misinterpretation

 some ultrasound exams may be limited by

abnormally large body habitus