MRI

Magnetic Resonance Imaging

History
Year Event

1946

MR phenomenon - Bloch and Purcell. Back projection MRI Lauterbur

1973

1992

Functional MRI

2003

Nobel Prize - Lauterbur and Mansfield

Overview

Nonionising radiation imaging modality MRI is recently developed imaging modality that can totally replace conventional X-ray generating equipment and film. Essentially it involves the behavior of protons (positively charged nuclear particles) in a magnetic field.

Overview
Steps of an MR examination involve 1. 2. 3. 4.

The patient is placed in a magnetic field, A radio wave is sent in, The radio wave is turned off, The patient emits a signal, which is received and used for Reconstruction of the picture
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5.

Components of MRI system

1. 1. 2. 2. 3. 4. 5. 6.

Magnet - also includes

Gradient Coil RF Coil

Power supplies Computer system A documentation system Cooling system Monitoring camera

Screening before MRI

Patient is asked to remove Glasses RPD Hearing aid Jewellery Watch Wallet or money clip Pens or pencils Keys Coins Pocket knife

Belt buckle Shoes Magnetic strip cards Credit and bank cards Hair pins Metal hooks Sanitary belt Safety pins

Contraindications

Due to high magnetic field used in MRI examination, for certain patients MRI is contraindicated and is unsuitable for imaging Patient having
Aneurysm clips (ferromagnetic types) Cardiac pacemakers Otologic and ocular implants Cochlear implants Metallic foreign body
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Physical Fundamentals
AXIS

When an external magnetic field is applied, the N and S poles of H atoms (protons) do not align exactly with the direction of the magnetic field. The axes of spinning protons oscillate or wobble with a slight tilt from a position which was parallel with the flux of external magnet.

This tilting or wobbling is called precession.

The rate or frequency of precession is called the Resonant or Larmor frequency, which is proportional to the strength of the applied
AXIS

Magnetism

The Larmor frequency of hydrogen is 42.58 MHZ in a magnetic field of 1 Tesla. 1 Tesla is 10,000 times the earths magnetic field. The magnetic field strengths used for MR imaging range from 0.1 to 4.0T.

T1 and T2 Weighted Images

The time constant that describes the rate at which

the net magnetization returns to equilibrium by this

transfer of energy is called T1.

The time constant that describes the rate of loss of transverse magnetization is called T2 relaxation

time / transverse (Spin) relaxation time.

T1 and T2 Weighted Images

T1 weighted images are called fat images.

1. because the fat has the shortest T1 relaxation
time. 2. emits the lightest signal relative to other tissues and thus appear bright in the image. 3. High anatomic detail is possible in this type of

image because of good image contrast.

4. Useful for depicting small anatomic regions (eg: TMJ)

T1 and T2 Weighted Images

T2 Weighted images are called water

images.
1. water has the longest T2 relaxation tine and

thus appear bright in the image.

2. the T2 time of abnormal tissues is longer than that of normal tissues. 3. Images with T2 weighting are most commonly used when looking for inflammatory changes

and tumors.

Tissue characteristics

Liquids have long T1 and a long T2

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Tissue characteristics

Fat has a short T1 and a short T2

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Fluids have a long T1

i.e. they take a long time to reestablish their longitudinal magnetic moment, produce a weak signal & appear dark on T1-weighted images

Fat behaves in the opposite manner and has a short T1,

produces a strong signal and appears white on T1 weighted images.

T1 weighted image
Fluid dark Fat- white
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Fluids such as CSF have a long T2

give a strong transverse signal for a long time and appear white on T2- weighted images.

Fat on the other hand has a short T2,

produces a weak signal and appears dark.

T2 weighted image
Fluid- white Fat - dark

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Indications for MRI in the Head & Neck

Assessment of intracranial lesions involving particularly the posterior cranial fossa, pituitary & spinal cord Tumor staging evaluation of the site, size and extent of all soft tissue tumors including nodal involvement, involving all areas in particular:
Salivary glands Tongue and floor of mouth Pharynx / larynx Sinuses Orbits
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Indications for MRI in the Head & Neck

Investigation of the TMJ to show both the bony and

soft tissue components of the joint including the

disc position.

MRI may be indicated:

When diagnosis of internal derangement is in doubt

As a preoperative assessment before disc

surgery

Implant assessment
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Advantages
1. 2. 3. 4.

Ionizing radiation is not used No adverse effects have yet been demonstrated Image manipulation available. High-resolution images can be reconstructed in all

planes (using 3D volume techniques ).

5.

Excellent differentiation between different soft tissues is possible & between normal and abnormal tissues enabling useful differentiation between benign and malignant diseases.

6.

Useful in determining intra-medullary spread.

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Disadvantages
1.

Bone does not give an MR signal, a signal is only obtainable from bone marrow.

2.

Scanning time can be long and is thus demanding

on the patient.

3. 4.

Equipment tends to be claustrophobic and noisy. Metallic objects, e.g. endotracheal tubes need to be replaced by non-ferromagnetic alternatives.

5. 6.

Equipment is very expensive.

Bone, teeth, air and metallic objects all appear black, making differentiation difficult.
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Conclusion

MRI is a complex but effective imaging system that

has a variety of clinical indications directly related

to the diagnosis and treatment of oral and maxillofacial abnormalities .

While not routinely applicable in dentistry,

appropriate use of MRI can enhance the quality of

patient care in selected cases.