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MRI  Basics

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Magnetic Resonance Imaging (MRI) of the Brain and Spine: Basics

Magnetic resonance imaging (MRI) is one of the most commonly used


tests in neurology and neurosurgery. MRI provides exquisite detail of
brain, spinal cord and vascular anatomy, and has the advantage of being
able to visualize anatomy in all three planes: axial, sagittal and coronal
(see the example image below).

MRI has an advantage over CT in being able to detect flowing blood and
cryptic vascular malformations. It can also detect demyelinating disease, and
has no beam-hardening artifacts such as can be seen with CT. Thus, the
posterior fossa is more easily visualized on MRI than CT. Imaging is also
performed without any ionizing radiation.

PHYSICS OF MRI
MRI is based on the magnetization properties of atomic nuclei. A powerful,
uniform, external magnetic field is employed to align the protons that are
normally randomly oriented within the water nuclei of the tissue being
examined. This alignment (or magnetization) is next perturbed or disrupted by
introduction of an external Radio Frequency (RF) energy. The nuclei return to
their resting alignment through various relaxation processes and in so doing
emit RF energy. After a certain period following the initial RF, the emitted
signals are measured. Fourier transformation is used to convert the frequency
information contained in the signal from each location in the imaged plane to
corresponding intensity levels, which are then displayed as shades of gray in a
matrix arrangement of pixels. By varying the sequence of RF pulses applied &
collected, different types of images are created. 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.
Tissue can be characterized by two different relaxation times – T1 and T2. T1
(longitudinal relaxation time) is the time constant which determines the rate at
which excited protons return to equilibrium. It is a measure of the time taken
for spinning protons to realign with the external magnetic field. T2 (transverse
relaxation time) is the time constant which determines the rate at which excited
protons reach equilibrium or go out of phase with each other. It is a measure of
the time taken for spinning protons to lose phase coherence among the nuclei
spinning perpendicular to the main field.

MRI IMAGING SEQUENCES


The most common MRI sequences are T1-weighted and T2-weighted scans.
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. Conversely, T2-weighted images are produced by using
longer TE and TR times. In these images, the contrast and brightness are
predominately determined by the T2 properties of tissue.
In general, T1- and T2-weighted images can be easily differentiated by looking
the CSF. CSF is dark on T1-weighted imaging and bright on T2-weighted
imaging.
A third commonly used sequence is the Fluid Attenuated Inversion
Recovery (Flair). The Flair sequence is similar to a T2-weighted image except
that the TE and TR times are very long. By doing so, abnormalities remain
bright but normal CSF fluid is attenuated and made dark. This sequence is very
sensitive to pathology and makes the differentiation between CSF and an
abnormality much easier.
TR TE
(msec) (msec)
T1-Weighted
500 14
(short TR and TE)
T2-Weighted
4000 90
(long TR and TE)
Flair
9000 114
(very long TR and TE

Above: Most common MRI Sequences and their Approximate TR and TE


times.
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. Thus, Gad is very bright on T1-weighted images. Gad
enhanced images are especially useful in looking at vascular structures
and breakdown in the blood-brain barrier [e.g., tumors, abscesses,
inflammation (herpes simplex encephalitis, multiple sclerosis, etc.)].
Diffusion weighted imaging (DWI) is designed to detect the random
movements of water protons. Water molecules diffuse relatively freely in
the extracellular space; their movement is significantly restricted in the
intracellular space. Spontaneous movements, referred to as diffusion,
rapidly become restricted in ischemic brain tissue. During ischemia, the
sodium - potassium 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.

Comparison of T1 vs. T2 vs. Flair (Brain)

Tissue T1-Weighted T2-Weighted Flair


Dark Bright Dark
Light Dark Gray Dark Gray
Gray Light Gray Light Gray
Bright Light Light
Inflammation
(infection, Dark Bright Bright
demyelination)

Comparison of T1 vs. T1 with Gadolinium

Comparison of Flair vs. Diffusion-weighted

Comparison of T1 vs. T2 - Spine

Tissue T1-Weighted T2-Weighted


Dark Bright
Gray Dark Gray
Gray Light Gray
Bright Light
Gray Bright
Very Dark Very Dark
Inflammation
(edema, infarction, Dark Bright
demyelination)

NEUROLOGICAL INDICATIONS FOR CRANIAL MRI


● Vascular (ischemic and hemorrhagic stroke, AVM, 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 for many images

CONTRAINDICATIONS TO MRI
There are few contraindications to MRI. Most contraindications to MRI can be
divided into the following groups:
● 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 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)

Revised 07/04/16
Copyrighted 2006, David C Preston, MD

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