MRI BASICS

Dr.R.M.John Wesley
Dept of Orthopaedics
RMMCH

Guess who?

This is Dr.Raymond Vahan Damadian

Inventor of MRI and also initially
developed MRI compatible pacemaker

WHY MRI?
-MRI uses molecular composition of soft
tissues eg.water
-highly sensitive in detecting soft tissue
abnormalities than CT
-It can predict the acuity of the disease well
since it evaluates the changes in tissue
composition over time

WHAT MAKES UP AN
MRI SCANNER?
Main magnet
A superconducting magnet with a coil that is
cooled down to superconducting
temperature (4k or -269 degree C)
Most scanners have magnetic field strength
of 0.5 and 3 tesla

Coils
There are two different types of coils
A)Transmitter coils-Coils responsible for
transmitting the RF pulses.
B)Receiver coils
These coils are subjected to strong electrical
currents and exist within a strong magnetic
field that produces the repetitive knocking
sound during an MRI scan.

WHAT HAPPENS INSIDE MRI SCANNER

1)When the patient is placed in the scanner
magnet, the transmitter coils send a short
electromagnetic pulse (measured in
milliseconds) called a radiofrequency pulse.
Remember that at this point the spinning
protons in the patient have already aligned
with the external magnetic field of the
magnet.
2)This RF pulse is sent at a particular
frequency that changes the orientation of the

WHAT IS T1 AND T2?

On an MRI scan some tissues appear to be brighter or
darker than other tissues. Darkness depends on the
density of protons in that area - an increased density
being associated with a darker area. Relaxation times for
protons can vary and two times are commonly measured known as T1 and T2.
T1 and T2 are both time constants. T1 is called the
longitudinal relaxation time, and T2 is called the
transverse relaxation time.
TR is the repetition time between two RF pulses. A short
TR creates a T1-weighted image.

TE is the echo time between a pulse and its resultant

APPEARANCES IN T1 and
T2
On T1-weighted images, fat,
hemorrhage, proteinaceous fluid,
melanin, and gadolinium are typically
bright (white).
On T2-weighted images, fat, water,
edema, inflammation, infection, cysts,
and hemorrhage are typically bright.
Fat is T1-bright and T2-bright. Water is
T1-dark and T2-bright.

OTHER PULSE SEQUENCE TYPES

-DIFFUSION WEIGHTED MRI
-STIR(SHORT TAU INVERSION RECOVERY)
-FLAIR(FLUID ATTENUATED INVERSION RECOVERY)
-MRA/TOF-TIME OF FLIGHT MAGNETIC RESONANCE
ANGIOGRAPHY
-

FUNCTIONAL MRI
Functional MRI, or fMRI, correlates the brains
changing blood flow requirements with changes in
neural activity and translates them into differences in
the MRI signal, particularly on T2-weighted images.
fMRI is increasingly being used to map neural activity
in the brain or spinal cord.

MRI CONTRAST AGENTS: GENERAL

CONSIDERATIONS
-Gadolinium is the most common intravenous contrast
agent used in clinical MRI.
-Gadolinium is a rare earth, heavy metal ion that is
chelated to different compounds to form MRI contrast
agents
-When chelated to an acid known as gadolinium
diethylenetriaminepentaacetic acid (Gd-DTPA) it forms
gadopentetate dimeglumine, a commonly used
contrast agent.
-Gadolinium-based contrast agents are used in the
same way that iodinated contrast media are used in CT.

MRI SAFETY ISSUES

1)Claustrophobia
- Patients can occasionally experience such
extreme claustrophobia in the small
confines of the MRI scanner that they will
be unable to begin or complete the study.
Pretreatment with sedatives may help in
appropriate clinical situations.
Alternatively, the patient can be scanned in

. 2)FerromagneticObjects
Any ferromagnetic object inside the patient can be
moved by the magnetic field of the MRI scanner and
potentially damage adjacent tissues. Such internal
ferromagnetic objects also hold the potential to become
heated and cause burns to surrounding tissues.
Some foreign bodies, such as bullets, shrapnel, and
metal in the eyes (as can sometimes be found in metalworkers) can also be ferromagnetic.

Ferromagnetic objects outside the patient, such as

oxygen tanks, scissors, scalpels, and metallic tools, also
pose a risk to the patient as they could become
airborne once they enter the magnetic field and for this

PATIENT WITH IMPLANTED MEDICAL DEVICE

In 2005, ASTM International, formerly known as the American
Society for Testing and Materials, defined terminology, now
recognized by the FDA, for medical devices in patients undergoing
MRI examinations.
1)MR Safe refers to an item that has no known hazards in all MRI
environments. These products, such as plastic tubing, are
nonmetallic, nonconductive, and nonmagnetic.
2)MR Conditional refers to an item that has been demonstrated to
pose no known hazards in a particular MRI environment under
specific conditions of use. MRI environments differ as to the
strength of the main magnet, the gradient magnetic fields, and the
RF fields, to name a few parameters.

3MRI Unsafe refers to any item known to pose hazards in all MRI

MRI IN PREGNANCY
In pregnancy, MRI is preferred in the
second and third trimesters, and
gadolinium is
contraindicated.
The use of gadolinium contrast
agents is not recommended in
pregnant patients, because
gadolinium crosses the placenta, is
subsequently excreted by the fetal
kidneys, and has unknown effects on

NEPHROGENIC SYSTEMIC FIBROSIS

In patients with renal insufficiency, gadoliniumbased contrast agents have been associated with
a rare, painful, debilitating, and sometimes fatal
disease called nephrogenic systemic fibrosis
(NSF).
NSF produces fibrosis resembling scleroderma
of the skin, eyes, joints, and internal organs.
Patients with preexisting renal dysfunction,
especially those on dialysis, are at the greatest
risk for developing NSF due to the use of
gadolinium-based contrast agents.

MRI DIAGNOSTIC APPLICATIONS

MCQS

1)LIGHT BULB APPEARANCE ON MRI

IS SEEN IN
A)PHEOCHROMOCYTOMA
B)ADRENAL ADENOMA
C)ADRENAL CORTICAL TUMOUR
D)ADRENAL CALCIFICATION

ANS:PHEOCHROMOCYTOMA
marked hyperintensity seenon T2 weighted sequences however this finding is
neither sensitive nor specific and pheochromocytomas are more often
heterogeneous with intermediate or high T2 signal intensity.

ALSO SEEN IN
A)SHOULDER LOCATION
The lightbulb sign refers to the abnormal AP radiograph appearance of
the humeral head in posterior shoulder dislocation.

B)LIGHT BULB SIGN -HEPATIC

HEMANGIOMA
Thelight bulb sign of a hepatic haemangiomais a feature than can be seen on MRI
imaging with a classic hepatic haemangioma. This refers to marked hyperintensity
seenon heavily T2 weighted sequences that has been likened to a glowing light bulb.

2)ICE CREAM CONE

APPEARANCE IN MRI IS
SEEN IN?
A)PILOCYSTOCASTOCYTOMA
B)ACOUSTIC NEUROMA
C)GLOMUS JUGULARE
D)MENINGIOMA

ANS:ACOUSTIC
NEUROMA
a medium sized (1.5 to 3 cm) acoustic schwannoma:
typical appearance, with the intracanalicular component
representing "the cone" and the cerebellopontine angle
(CPA) component representing the "ice cream"

3)RADIOIODINE IS USED IN
THE TREATMENT OF
A)PAPILLARY CA THYROID
B)MEDULLARY CA THYROID
C)FOLLICULAR CA THYROID
D)ANAPLASTIC CA THYROID

ANS:FOLLICULAR CA
THYROID

4)ALL OF THE FOLLOWING ARE

PURE BETA EMITTERS EXCEPT
A)YTTRIUM 90
B)PHOSPHOROUS 32
C)STRONTIUM 89
D)SAMARIUM 153

ANS:D SAMARIUM 153

5Which of the following

contrast agents can be used
in a patient with renal
dysfunction for the
prevention of contrast
nephropathy?
A. Low osmolar contrast
B. Ionic contrast
C. Fenoldopam
D. Acetylcysteine

ANS: A. Low osmolar

contrast

PREVENTION OF CONTRAST NEPHROPATHY

Non ionic low osmolar contrast agents are preferred
in patients with decreased renal function to prevent
contrast nephropathy
Ionic contrast media have a higher risk for contrast
nephropathy, and hence should be avoided
The amount of contrast media used should be limited
The patient should be well hydrated before the
procedure
Supplementary interventions include use of Nacetylcysteine, fenoldopam, theophylline, prostaglandins
and magnesium

6)The MR imaging in
multiple sclerosis will show
lesions in:
A. White matter
B. Grey matter
C. Thalamus
D. Basal ganglia

ANS: A. White matter

Multiple sclerosis is a demyelinating
disorder. Hence the lesions will be seen
in the white matter (due to loss of
myelin).

7)On MRI the differential

diagnosis of spinal cord
edema is?
a) Myelodysplasia
b) Myelomalacia
c) Myeloschisis
d) Cord tumors

ANS:B Myelomalacia

8)Most common hormone

deficiency seen after
intracranial radiation therapy?
a) Prolactin
b) Gonadotropins
c) ACTH
d) Growth hormone

ANS D)GROWTH HORMONE

9)DIAGNOSE

DIAGNOSIS:JOUBERT SYNDROME
The molar tooth sign refers to the appearance of the
midbrain in axial section which the elongated
superior cerebellar peduncles give the midbrain an
appearance reminiscent of a molar or wisdom tooth.

10)DIAGNOSE

DIAGNOSIS:MULTIPLE SYSTEM
ATROPHY
HOT CROSS BUN SIGN :T2 hyperintensity
forms a cross on axial images through the
pons, representing selective degeneration of
pontocerebellar tracts
ALSO SEEN IN
spinocerebellar atrophy types 2 and 3
parkinsonism secondary to vasculitis
variant Creutzfeldt-Jakob disease (vCJD)

DIAGNOSE THE CONDITION AND

NAME THE SIGN SHOWN HERE

Mother in law sign used to describe lesions that enhance

early during the arterial phase and remain opacified well
after the venous phase. The sign is jokingly named after
the uncanny ability of mothers in law to arrive early and
stay late. Such behaviour matches the classic
angiographic enhancement pattern of meningiomas.

The above lateral image is from a common

carotid artery injection during the venous
phase and demonstrates a large
olfactory groove meningioma.

THANK YOU AND BEST

WISHES