Magnetic Resonance Imaging - Wikipedia, The Free Encyclopedia

27/09/13
Magnetic resonance imaging - Wikipedia, the free encyclopedia
Magneticresonanceimaging
FromWikipedia,thefreeencyclopedia
Magneticresonanceimaging(MRI),nuclearmagneticresonance imaging(NMRI),ormagneticresonancetomography(MRT)isa medicalimagingtechniqueusedinradiologytovisualizeinternal structuresofthebodyindetail.MRImakesuseofthepropertyofnuclear magneticresonance(NMR)toimagenucleiofatomsinsidethebody. MRIcancreatemoredetailedimagesofthehumanbodythanarepossible withXrays. AnMRIscannerisadeviceinwhichthepatientlieswithinalarge, powerfulmagnetwherethemagneticfieldisusedtoalignthe magnetizationofsomeatomicnucleiinthebody,andradiofrequency magneticfieldsareappliedtosystematicallyalterthealignmentofthis magnetization.[1]Thiscausesthenucleitoproducearotatingmagnetic fielddetectablebythescannerandthisinformationisrecordedto constructanimageofthescannedareaofthebody.[2]Magneticfield gradientscausenucleiatdifferentlocationstoprecessatdifferentspeeds, whichallowsspatialinformationtoberecoveredusingFourieranalysisof themeasuredsignal.Byusinggradientsindifferentdirections,2Dimages or3Dvolumescanbeobtainedinanyarbitraryorientation. MRIprovidesgoodcontrastbetweenthedifferentsofttissuesofthebody, whichmakesitespeciallyusefulinimagingthebrain,muscles,theheart, andcancerscomparedwithothermedicalimagingtechniquessuchas computedtomography(CT)orXrays.UnlikeCTscansortraditionalX rays,MRIdoesnotuseionizingradiation.[3]
SequentialsectionsfromanMRIof thebrain,concurrentlyshowing slicesthroughtransverse,sagittal, andcoronalplanes(lefttoright).
ParasagittalMRIofthehead,with aliasingartifacts(noseandforehead appearatthebackofthehead)
Contents
1HowMRIworks 1.1Magneticfield 1.2Contrastagentsandimplants 1.3PrepolarizedMRI 2History 32003NobelPrize 4Applications 4.1BasicMRIscans 4.1.1T1weightedMRI 4.1.2T2weightedMRI 4.1.3T*2weightedMRI 4.1.4SpindensityweightedMRI
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4.2SpecializedMRIscans 4.2.1DiffusionMRI 4.2.2MagnetizationtransferMRI 4.2.3T1rhoMRI 4.2.4Fluidattenuatedinversionrecovery(FLAIR) 4.2.5Magneticresonanceangiography 4.2.6MagneticresonancegatedintracranialCSFdynamics(MRGILD) 4.2.7Magneticresonancespectroscopy 4.2.8FunctionalMRI 4.2.9RealtimeMRI 4.2.10InterventionalMRI 4.2.11Radiationtherapysimulation 4.2.12Currentdensityimaging 4.2.13Magneticresonanceguidedfocusedultrasound 4.2.14Multinuclearimaging 4.2.15Susceptibilityweightedimaging(SWI) 4.2.16OtherspecializedMRItechniques 4.3MolecularimagingofdiseasebiomarkersbyMRI 4.4Portableinstruments 4.5MRIversusCT 4.6EconomicsofMRI 5Safety 5.1Overuse 5.2Magneticfield 5.3Peripheralnervestimulation(PNS) 5.4Heatingcausedbyabsorptionofradiowaves 5.5Acousticnoise 5.6Cryogens 5.7Contrastagents 5.8Pregnancy 5.9Claustrophobiaanddiscomfort 5.10Guidance 5.11TheEuropeanPhysicalAgentsDirective 6Seealso 7References 8Furtherreading 9Externallinks
HowMRIworks
Mainarticle:Physicsofmagneticresonanceimaging
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MRImachinesmakeuseofthefactthatbodytissuecontainslotsofwater(H2O),andhenceprotons(1Hnuclei), whichwillbealignedinalargemagneticfield.[4]Eachwatermoleculehastwohydrogennucleiorprotons.When apersonisinsidethepowerfulmagneticfieldofthescanner,theaverage magneticmomentofmanyprotonsbecomesalignedwiththedirectionof thefield.Aradiofrequencycurrentisbrieflyturnedon,producinga varyingelectromagneticfield.Thiselectromagneticfieldhasjusttheright frequency,knownastheresonancefrequency,tobeabsorbedandflipthe spinoftheprotonsinthemagneticfield.Aftertheelectromagneticfieldis turnedoff,thespinsoftheprotonsreturntothermodynamicequilibrium andthebulkmagnetizationbecomesrealignedwiththestaticmagnetic field.Duringthisrelaxation,aradiofrequencysignal(electromagnetic radiationintheRFrange)isgenerated,whichcanbemeasuredwith receivercoils.
MedicalMRIscanner Informationabouttheoriginofthesignalin3Dspacecanbelearnedby applyingadditionalmagneticfieldsduringthescan.Theseadditional magneticfieldscanbeusedtogeneratedetectablesignalsonlyfromspecificlocationsinthebody(spatial excitation)and/ortomakemagnetizationatdifferentspatiallocationsprecessatdifferentfrequencies,which enableskspaceencodingofspatialinformation.The3DimagesobtainedinMRIcanberotatedalongarbitrary orientationsandmanipulatedbythedoctortobebetterabletodetecttinychangesofstructureswithinthebody.[5] Thesefields,generatedbypassingelectriccurrentsthroughgradientcoils,makethemagneticfieldstrengthvary dependingonthepositionwithinthemagnet.Becausethismakesthefrequencyofthereleasedradiosignalalso dependentonitsorigininapredictablemanner,thedistributionofprotonsinthebodycanbemathematically recoveredfromthesignal,typicallybytheuseofinverseFouriertransform.
Protonsindifferenttissuesreturntotheirequilibriumstateatdifferentrelaxationrates.Differenttissuevariables, includingspindensity,T1andT2relaxationtimes,andflowandspectralshifts,canbeusedtoconstruct images.[6][7]Bychangingthesettingsonthescanner,thiseffectisusedtocreatecontrastbetweendifferenttypes ofbodytissueorbetweenotherproperties,asinfMRIanddiffusionMRI. MRIisusedtoimageeverypartofthebody,andisparticularlyusefulfortissueswithmanyhydrogennucleiand littledensitycontrast,suchasthebrain,muscle,connectivetissueandmosttumors.
Magneticfield
MRIscansrequireamagneticfieldwithtwoproperties,uniformfielddensityandstrength.Themagneticfield cannotvarymorethan1/10,000of1%andfieldstrengthranges(dependingonthescanner)from0.2to3teslasin strengthinscannerscurrentlyusedclinically,withresearchscannersinvestigatinghigherfieldstrengthssuchas7 teslas.Thelowerfieldstrengthscanbeachievedwithpermanentmagnets,whichareoftenusedin"open"MRI scannersforclaustrophobicpatients.[8]Higherfieldstrengthscanbeachievedonlywithsuperconductingmagnets. AnMRIwitha3.0teslastrengthmagnetmaybereferredtoasa"3TMRI"or"3teslaMRI" Sincethegradientcoilsarewithintheboreofthescanner,therearelargeforcesbetweenthemandthemainfield coils,producingmostofthehammeringnoisethatisheardduringoperation.Withouteffortstodampthisnoise,it canapproach130decibels(dB)withstrongfields[9](seealsothesubsectiononacousticnoise).
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Contrastagentsandimplants
MRIcontrastagentsmaybeinjectedintravenouslytoenhancetheappearanceofbloodvessels,tumorsor inflammation.Contrastagentsmayalsobedirectlyinjectedintoajointinthecaseofarthrograms:MRIimagesof joints.UnlikeCT,MRIusesnoionizingradiationandisgenerallyaverysafeprocedure.Nonethelessthestrong magneticfieldsandradiopulsescanaffectmetalimplants,includingcochlearimplantsandcardiacpacemakers. TherearemanyelectronicallyactivateddevicesthathaveapprovalfromtheU.S.FoodandDrugAdministration (FDA)topermitMRIproceduresinpatientsunderhighlyspecificMRIconditions(seewww.MRIsafety.com).In thecaseofcochlearimplants,theU.S.FDAhasapprovedsomeimplantsforMRIcompatibility.Inthecaseof cardiacpacemakers,theresultscansometimesbelethal,[10]sopatientswithsuchimplantsaregenerallynot eligibleforMRI.
PrepolarizedMRI
In2001,aresearchteamatStanfordinventedanewtechniquewhichcametobecalled"PrepolarizedMRI"or PMRI.[11]Theteamdemonstratedthatthemagnetsdonothavetobebothuniformandstrong.Rather,two magnetscanbeusedtogether,whereoneisstrongandtheotheroneisuniform.[12] ThefirstmagnetinaPMRIscannerisstrong,butnotuniform.Thismagnetcreatesaverystrongmagneticfield whichvariesinuniformitybyasmuchas40%.Thisisthe"prepolarize"component.Asecondmuchweaker (requiringonlytheelectricpowernecessarytoruntwohairdryers)butfarmoreprecisemagnetthencreatesa homogeneousmagneticfield.Thesetwomagnetscanbeordinarycopperwoundmagnets,greatlyloweringthe costofanMRIscanner.[12]Becausethemagneticfieldis"tuned"bythesecondmagnet,aPMRIscancanbe obtainedimmediatelyadjacenttoametalprosthetic,unlikeanMRIscan.[13]
History
In1952,HermanCarrproducedaonedimensionalMRIimageasreportedinhisHarvardPhDthesis.[14][15][16]In theSovietUnion,VladislavIvanovfiled(in1960)adocumentwiththeUSSRStateCommitteeforInventions andDiscoveryatLeningradforaMagneticResonanceImagingdevice,[17]althoughthiswasnotapproveduntil the1970s.[18] Ina1971paperinthejournalScience,[19]RaymondDamadian,an ArmenianAmericanphysician,scientist,andprofessorattheDownstate MedicalCenterStateUniversityofNewYork(SUNY),reportedthat tumorsandnormaltissuecanbedistinguishedinvivobynuclear magneticresonance("NMR").Hesuggestedthatthesedifferencescould beusedtodiagnosecancer,thoughlaterresearchwouldfindthatthese differences,whilereal,aretoovariablefordiagnosticpurposes. Damadian'sinitialmethodswereflawedforpracticaluse,[20]relyingona pointbypointscanoftheentirebodyandusingrelaxationrates,which turnedoutnottobeaneffectiveindicatorofcanceroustissue.[21]While researchingtheanalyticalpropertiesofmagneticresonance,Damadian createdtheworld'sfirstmagneticresonanceimagingmachinein1972.He
RaymondDamadian's"Apparatusand methodfordetectingcancerin tissue."
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filedthefirstpatentforanMRImachine,U.S.patent#3,789,832onMarch17,1972,whichwaslaterissuedto himonFebruary5,1974.[22] TheNationalScienceFoundationnotes,"ThepatentincludedtheideaofusingNMRto'scan'thehumanbodyto locatecanceroustissue."[23]However,itdidnotdescribeamethodforgeneratingpicturesfromsuchascanor preciselyhowsuchascanmightbedone.[24][25]Meanwhile,PaulLauterburexpandedonCarr'stechniqueand developedawaytogeneratethefirstMRIimages,in2Dand3D,usinggradients.In1973,Lauterburpublished thefirstnuclearmagneticresonanceimage[26][27]andthefirstcrosssectionalimageofalivingmouseinJanuary 1974.[28]Inthelate1970s,PeterMansfield,aphysicistandprofessorattheUniversityofNottingham,England, developedamathematicaltechniquethatwouldallowscanstotakesecondsratherthanhoursandproduceclearer imagesthanLauterburhad.Damadian,alongwithLarryMinkoffandMichaelGoldsmith,performedthefirst MRIbodyscanofahumanbeingonJuly3,1977,[29][30]studieswhichtheypublishedin1977.[31][32]andin1979 RichardS.Likesfiledpatent*4,307,343(http://patft.uspto.gov/netacgi/nphParser? Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s 1=4,307,343.PN.&OS=PN/4,307,343&RS=PN/4,307,343). In1980PaulBottomleyjoinedtheGEResearchCenterinSchenectady,NY,andhisteamorderedthehighest fieldstrengthmagnetthenavailablea1.5Tsystemandbuiltthefirsthighfieldandovercameproblemsof coildesign,RFpenetrationandsignaltonoiseratiotobuildthefirstwholebodyMRI/MRSscanner.[33]The resultstranslatedintothehighlysuccessful1.5TMRIproductline,withover20,000systemsinusetoday. BottomleyperformedthefirstlocalizedMRSinthehumanheartandbrain.Afterstartingacollaborationonheart applicationswithRobertWeissatJohnsHopkins,Bottomleyreturnedtotheuniversityin1994asRussellMorgan ProfessoranddirectoroftheMRResearchDivision.[34]AlthoughMRIismostcommonlyperformedat1.5T, higherfieldssuchas3Taregainingmorepopularitybecauseoftheirincreasedsensitivityandresolution.In researchlaboratories,humanstudieshavebeenperformedatupto9.4T[35]andanimalstudieshavebeen performedatupto21.1T.[36]
2003NobelPrize
ReflectingthefundamentalimportanceandapplicabilityofMRIinmedicine,PaulLauterburoftheUniversityof IllinoisatUrbanaChampaignandSirPeterMansfieldoftheUniversityofNottinghamwereawardedthe2003 NobelPrizeinPhysiologyorMedicinefortheir"discoveriesconcerningmagneticresonanceimaging".The NobelcitationacknowledgedLauterbur'sinsightofusingmagneticfieldgradientstodeterminespatial localization,adiscoverythatallowedrapidacquisitionof2Dimages.Mansfieldwascreditedwithintroducingthe mathematicalformalismanddevelopingtechniquesforefficientgradientutilizationandfastimaging.Theactual researchthatwontheprizewasdonealmost30yearsbefore,whilePaulLauterburwasatStonyBrookUniversity inNewYork.[citationneeded] TheawardwasvigorouslyprotestedbyRaymondVahanDamadian,founderofFONARCorporation,who claimedthatheinventedtheMRI,andthatLauterburandMansfieldhadmerelyrefinedthetechnology.Agroup called"TheFriendsofRaymondDamadian"(formedbyDamadian'scompany,FONAR[37]),tookoutfullpage advertisementsintheNewYorkTimesandTheWashingtonPostentitled"TheShamefulWrongThatMustBe Righted",demandingthathebeawardedatleastashareoftheNobelPrize.[38]
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Applications
Inclinicalpractice,MRIisusedtodistinguishpathologictissue(suchasabraintumor)fromnormaltissue.One advantageofanMRIscanisthatitisharmlesstothepatient.Itusesstrongmagneticfieldsandnonionizing electromagneticfieldsintheradiofrequencyrange,unlikeCTscansandtraditionalXrays,whichbothuse ionizingradiation.[citationneeded] WhileCTprovidesgoodspatialresolution(theabilitytodistinguishtwoseparatestructuresatasmalldistance fromeachother),MRIprovidescomparableresolutionwithfarbettercontrastresolution(theabilitytodistinguish thedifferencesbetweentwosimilarbutnotidenticaltissues).[39]Thebasisofthisabilityisthecomplexlibraryof pulsesequencesthatthemodernmedicalMRIscannerincludes,eachofwhichisoptimizedtoprovideimage contrastbasedonthechemicalsensitivityofMRI.[3] Forexample,withparticularvaluesoftheechotime(TE)andthe repetitiontime(TR),whicharebasicparametersofimageacquisition,a sequencetakesonthepropertyofT2weighting.OnaT2weightedscan, waterandfluidcontainingtissuesarebright(mostmodernT2sequences areactuallyfastT2sequences)andfatcontainingtissuesaredark.The reverseistrueforT1weightedimages.Damagedtissuetendstodevelop edema,whichmakesaT2weightedsequencesensitiveforpathology,and EffectsofTRandTEonMRsignal. generallyabletodistinguishpathologictissuefromnormaltissue.With theadditionofanadditionalradiofrequencypulseandadditional manipulationofthemagneticgradients,aT2weightedsequencecanbeconvertedtoaFLAIRsequence,in whichfreewaterisnowdark,butedematoustissuesremainbright.Thissequenceinparticulariscurrentlythe mostsensitivewaytoevaluatethebrainfordemyelinatingdiseases,suchasmultiplesclerosis.[3] ThetypicalMRIexaminationconsistsof520sequences,eachofwhichischosentoprovideaparticulartypeof informationaboutthesubjecttissues.Thisinformationisthensynthesizedbytheinterpretingphysician.[3]
BasicMRIscans
T1weightedMRI Mainarticle:Spinlatticerelaxationtime T1weightedscansrefertoasetofstandardscansthatdepictdifferencesinthespinlattice(orT1)relaxationtime ofvarioustissueswithinthebody.T1weightedimagescanbeacquiredusingeitherspinechoorgradientecho sequences.T1weightedcontrastcanbeincreasedwiththeapplicationofaninversionrecoveryRFpulse. GradientechobasedT1weightedsequencescanbeacquiredveryrapidlybecauseoftheirabilitytouseshort interpulserepetitiontimes(TR).T1weightedsequencesareoftencollectedbeforeandafterinfusionofT1 shorteningMRIcontrastagents.InthebrainT1weightedscansprovideappreciablecontrastbetweengrayand whitematter.Water(suchasCSFandblood)isdarkandwhitematterislighterthangrey.Inthebody,T1 weightedscansworkwellfordifferentiatingfatfromwaterwithwaterappearingdarkerandfatbrighter.[40]
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T2weightedMRI Mainarticle:Spinspinrelaxationtime T2weightedscansrefertoasetofstandardscansthatdepictdifferencesinthespinspin(orT2)relaxationtimeof varioustissueswithinthebody.LiketheT1weightedscan,fatisdifferentiatedfromwater,butinthiscasefat showsdarker,andwaterlighter.Forexample,inthecaseofcerebralandspinalstudy,theCSF(cerebrospinal fluid)willbelighterinT2weightedimages.Thesescansarethereforeparticularlywellsuitedtoimagingedema, withlongTEandlongTR.Becausethespinechosequenceislesssusceptibletoinhomogeneitiesinthemagnetic field,theseimageshavelongbeenaclinicalworkhorse.[citationneeded] T2weightedMRI T2(pronounced"T2star")weightedscansuseagradientecho(GRE)sequence,withlongTEandlongTR.The gradientechosequenceuseddoesnothavetheextrarefocusingpulseusedinspinechosoitissubjectto additionallossesabovethenormalT2decay(referredtoasT2),thesetakentogetherarecalledT2.Thisalso makesitmorepronetosusceptibilitylossesatair/tissueboundaries,butcanincreasecontrastforcertaintypesof tissue,suchasvenousblood.[citationneeded] SpindensityweightedMRI Spindensity,alsocalledprotondensity,weightedscanstrytohavenocontrastfromeitherT2orT1decay,the onlysignalchangecomingfromdifferencesintheamountofavailablespins(hydrogennucleiinwater).Itusesa spinechoorsometimesagradientechosequence,withshortTEandlongTR.[citationneeded]
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SpecializedMRIscans
DiffusionMRI Mainarticle:DiffusionMRI DiffusionMRImeasuresthediffusionofwatermoleculesinbiologicaltissues.[41]Clinically,diffusionMRIis usefulforthediagnosesofconditions(e.g.,stroke)orneurologicaldisorders(e.g.,multiplesclerosis),andhelps betterunderstandtheconnectivityofwhitematteraxonsinthecentralnervoussystem.[42]Inanisotropicmedium (insideaglassofwaterforexample),watermoleculesnaturallymoverandomlyaccordingtoturbulenceand Brownianmotion.Inbiologicaltissueshowever,wheretheReynoldsnumberislowenoughforflowstobe laminar,thediffusionmaybeanisotropic.Forexample,amoleculeinsidetheaxonofaneuronhasalow probabilityofcrossingthemyelinmembrane.Thereforethemoleculemovesprincipallyalongtheaxisofthe neuralfiber.Ifitisknownthatmoleculesinaparticularvoxeldiffuseprincipallyinonedirection,theassumption canbemadethatthemajorityofthefibersinthisareaareparalleltothatdirection.[citationneeded]
Therecentdevelopmentofdiffusiontensorimaging(DTI)[27]enablesdiffusiontobe
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Therecentdevelopmentofdiffusiontensorimaging(DTI)[27]enablesdiffusiontobe measuredinmultipledirectionsandthefractionalanisotropyineachdirectiontobe calculatedforeachvoxel.Thisenablesresearcherstomakebrainmapsoffiber directionstoexaminetheconnectivityofdifferentregionsinthebrain(using tractography)ortoexamineareasofneuraldegenerationanddemyelinationin diseaseslikemultiplesclerosis. AnotherapplicationofdiffusionMRIisdiffusionweightedimaging(DWI). Followinganischemicstroke,DWIishighlysensitivetothechangesoccurringinthe lesion.[43]Itisspeculatedthatincreasesinrestriction(barriers)towaterdiffusion,asa resultofcytotoxicedema(cellularswelling),isresponsiblefortheincreaseinsignalon aDWIscan.TheDWIenhancementappearswithin510minutesoftheonsetof DTIimage strokesymptoms(ascomparedwithcomputedtomography,whichoftendoesnot detectchangesofacuteinfarctforupto46hours)andremainsforuptotwoweeks. Coupledwithimagingofcerebralperfusion(http://www.trauma.org/archive/neuro/cpp.html),researcherscan highlightregionsof"perfusion/diffusionmismatch"thatmayindicateregionscapableofsalvagebyreperfusion therapy. Likemanyotherspecializedapplications,thistechniqueisusuallycoupledwithafastimageacquisitionsequence, suchasechoplanarimagingsequence. MagnetizationtransferMRI Mainarticle:Magnetizationtransfer Magnetizationtransfer(MT)referstothetransferoflongitudinalmagnetizationfromfreewaterprotonsto hydrationwaterprotonsinNMRandMRI. Inmagneticresonanceimagingofmolecularsolutions,suchasproteinsolutions,twotypesofwatermolecules, free(bulk)andhydration(bound),arefound.Freewaterprotonshavefasteraveragerotationalfrequencyand hencefewerfixedwatermoleculesthatmaycauselocalfieldinhomogeneity.Becauseofthisuniformity,mostfree waterprotonshaveresonancefrequencylyingnarrowlyaroundthenormalprotonresonancefrequencyof 63MHz(at1.5teslas).ThisalsoresultsinslowertransversemagnetizationdephasingandhencelongerT2. Conversely,hydrationwatermoleculesaresloweddownbyinteractionwithsolutemoleculesandhencecreate fieldinhomogeneitiesthatleadtoawiderresonancefrequencyspectrum. Infreeliquids,protons,whichmaybeviewedclassicallyassmallmagneticdipoles,exhibittranslationaland rotationalmotions.Thesemovingdipolesdisturbthesurroundingmagneticfield.However,onlongenoughtime scales(whichmaybenanoseconds)theaveragefieldcausedbythemotionofprotonsiszero.Thisisknownas "motionalaveraging"ornarrowingandischaracteristicofprotonsmovingfreelyinliquid.Ontheotherhand, protonsboundtomacromolecules,suchasproteins,tendtohaveafixedorientationandsotheaveragemagnetic fieldincloseproximitytosuchstructuresdoesnotaveragetozero.Theresultisaspatialpatterninthemagnetic fieldthatgivesrisetoaresidualdipolarcoupling(rangeofprecessionfrequencies)fortheprotonsexperiencing themagneticfield.ThewidefrequencydistributionappearsasabroadspectrumthatmaybeseveralkHzwide. Thenetsignalfromtheseprotonsdisappearsveryquickly,ininverseproportiontothewidth,duetothelossof
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coherenceofthespins,i.e.,T2relaxation.Duetoexchangemechanismssuchasspintransferorprotonchemical exchange,the(incoherent)spinsboundtothemacromoleculescontinuallyswitchplaceswith(coherent)spinsin thebulkmediaandestablishadynamicequilibrium. Magnetizationtransfer:Althoughthereisnomeasurablesignalfromtheboundspins,ortheboundspinsthat exchangeintothebulkmedia,theirlongitudinalmagnetizationispreservedandmayrecoveronlyviatherelatively slowprocessofT1relaxation.Ifthelongitudinalmagnetizationofjusttheboundspinscanbealtered,thenthe effectcanbemeasuredinthespinsofthebulkmediaduetotheexchangeprocesses.Themagnetizationtransfer sequenceappliesRFsaturationatafrequencythatisfaroffresonanceforthenarrowlineofbulkwaterbutstillon resonancefortheboundprotonswithaspectrallinewidthofkHz.Thiscausessaturationoftheboundspinswhich exchangeintothebulkwater,resultinginalossoflongitudinalmagnetizationandhencesignaldecreaseinthe bulkwater.Thisprovidesanindirectmeasureofmacromolecularcontentintissue.Implementationof magnetizationtransferinvolveschoosingsuitablefrequencyoffsetsandpulseshapestosaturatetheboundspins sufficientlystrongly,withinthesafetylimitsofspecificabsorptionrateforRFirradiation. T1rhoMRI T1(T1rho):Moleculeshaveakineticenergythatisafunctionofthetemperatureandisexpressedastranslational androtationalmotions,andbycollisionsbetweenmolecules.Themovingdipolesdisturbthemagneticfieldbut areoftenextremelyrapidsothattheaverageeffectoveralongtimescalemaybezero.However,dependingon thetimescale,theinteractionsbetweenthedipolesdonotalwaysaverageaway.Attheslowestextremethe interactiontimeiseffectivelyinfiniteandoccurswheretherearelarge,stationaryfielddisturbances(e.g.,ametallic implant).Inthiscasethelossofcoherenceisdescribedasa"staticdephasing".T2*isameasureofthelossof coherenceinanensembleofspinsthatincludesallinteractions(includingstaticdephasing).T2isameasureofthe lossofcoherencethatexcludesstaticdephasing,usinganRFpulsetoreversetheslowesttypesofdipolar interaction.Thereisinfactacontinuumofinteractiontimescalesinagivenbiologicalsample,andtheproperties oftherefocusingRFpulsecanbetunedtorefocusmorethanjuststaticdephasing.Ingeneral,therateofdecayof anensembleofspinsisafunctionoftheinteractiontimesandalsothepoweroftheRFpulse.Thistypeofdecay, occurringundertheinfluenceofRF,isknownasT1.ItissimilartoT2decaybutwithsomeslowerdipolar interactionsrefocused,aswellasstaticinteractions,henceT1T2.[44] Fluidattenuatedinversionrecovery(FLAIR) Mainarticle:Fluidattenuatedinversionrecovery FluidAttenuatedInversionRecovery(FLAIR)[45]isaninversionrecoverypulsesequenceusedtonullifythe signalfromfluids.Forexample,itcanbeusedinbrainimagingtosuppresscerebrospinalfluid(CSF)soasto bringoutperiventricularhyperintenselesions,suchasmultiplesclerosis(MS)plaques.Bycarefullychoosingthe inversiontimeTI(thetimebetweentheinversionandexcitationpulses),thesignalfromanyparticulartissuecan besuppressed. Magneticresonanceangiography Mainarticle:Magneticresonanceangiography
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Magneticresonanceangiography(MRA)generatespicturesofthearteriestoevaluatethemforstenosis(abnormal narrowing)oraneurysms(vesselwalldilatations,atriskofrupture).MRAisoftenusedtoevaluatethearteriesof theneckandbrain,thethoracicandabdominalaorta,therenalarteries, andthelegs(calleda"runoff").Avarietyoftechniquescanbeusedto generatethepictures,suchasadministrationofaparamagneticcontrast agent(gadolinium)orusingatechniqueknownas"flowrelated enhancement"(e.g.,2Dand3Dtimeofflightsequences),wheremostof thesignalonanimageisduetobloodthatrecentlymovedintothatplane, seealsoFLASHMRI.Techniquesinvolvingphaseaccumulation(known asphasecontrastangiography)canalsobeusedtogenerateflowvelocity mapseasilyandaccurately.Magneticresonancevenography(MRV)isa similarprocedurethatisusedtoimageveins.Inthismethod,thetissueis nowexcitedinferiorly,whilethesignalisgatheredintheplane immediatelysuperiortotheexcitationplanethusimagingthevenous bloodthatrecentlymovedfromtheexcitedplane.[46]
Magneticresonanceangiography
MagneticresonancegatedintracranialCSFdynamics(MRGILD) Magneticresonancegatedintracranialcerebrospinalfluid(CSF)orliquordynamics(MRGILD)techniqueisan MRsequencebasedonbipolargradientpulseusedtodemonstrateCSFpulsatileflowinventricles,cisterns,the aqueductofSylvius,andtheentireintracranialCSFpathway.ItisamethodforanalyzingCSFcirculatorysystem dynamicsinpatientswithCSFobstructivelesionssuchasnormalpressurehydrocephalus.Italsoallows visualizationofbotharterialandvenouspulsatilebloodflowinvesselswithouttheuseofcontrastagents.[47][48] Diastolictimedataacquisition(DTDA). Systolictimedataacquisition(STDA).
Magneticresonancespectroscopy Mainarticles:InvivomagneticresonancespectroscopyandNuclearmagneticresonancespectroscopy Magneticresonancespectroscopy(MRS)isusedtomeasurethelevelsofdifferentmetabolitesinbodytissues. TheMRsignalproducesaspectrumofresonancesthatcorrespondstodifferentmoleculararrangementsofthe isotopebeing"excited".Thissignatureisusedtodiagnosecertainmetabolicdisorders,especiallythoseaffecting thebrain,[49]andtoprovideinformationontumormetabolism.[50]
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Magneticresonancespectroscopicimaging(MRSI)combinesbothspectroscopicandimagingmethodstoproduce spatiallylocalizedspectrafromwithinthesampleorpatient.Thespatialresolutionismuchlower(limitedbythe availableSNR),butthespectraineachvoxelcontainsinformationaboutmanymetabolites.Becausetheavailable signalisusedtoencodespatialandspectralinformation,MRSIrequireshighSNRachievableonlyathigherfield strengths(3Tandabove).[citationneeded] FunctionalMRI Mainarticle:Functionalmagneticresonanceimaging FunctionalMRI(fMRI)measuressignalchangesinthebrainthataredue tochangingneuralactivity.Thebrainisscannedatlowresolutionbutata rapidrate(typicallyonceevery23seconds).Increasesinneuralactivity causechangesintheMRsignalviaT2changes[51]thismechanismis referredtoastheBOLD(bloodoxygenleveldependent)effect.Increased neuralactivitycausesanincreaseddemandforoxygen,andthevascular systemactuallyovercompensatesforthis,increasingtheamountof oxygenatedhemoglobinrelativetodeoxygenatedhemoglobin.Because deoxygenatedhemoglobinattenuatestheMRsignal,thevascular responseleadstoasignalincreasethatisrelatedtotheneuralactivity.The precisenatureoftherelationshipbetweenneuralactivityandtheBOLD signalisasubjectofcurrentresearch.TheBOLDeffectalsoallowsfor thegenerationofhighresolution3Dmapsofthevenousvasculature withinneuraltissue.
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AfMRIscanshowingregionsof activationinorange,includingthe primaryvisualcortex(V1,BA17).
WhileBOLDsignalanalysisisthemostcommonmethodemployedforneurosciencestudiesinhumansubjects, theflexiblenatureofMRimagingprovidesmeanstosensitizethesignaltootheraspectsofthebloodsupply. Alternativetechniquesemployarterialspinlabeling(ASL)orweightingtheMRIsignalbycerebralbloodflow (CBF)andcerebralbloodvolume(CBV).TheCBVmethodrequiresinjectionofaclassofMRIcontrastagents thatarenowinhumanclinicaltrials.BecausethismethodhasbeenshowntobefarmoresensitivethantheBOLD techniqueinpreclinicalstudies,itmaypotentiallyexpandtheroleoffMRIinclinicalapplications.TheCBF methodprovidesmorequantitativeinformationthantheBOLDsignal,albeitatasignificantlossofdetection sensitivity.[citationneeded] RealtimeMRI Mainarticle:RealtimeMRI RealtimeMRIreferstothecontinuousmonitoring("filming")ofmovingobjectsinrealtime.Whilemany differentstrategieshavebeendevelopedoverthepasttwodecades,arecentdevelopmentreportedarealtimeMRI techniquebasedonradialFLASHanditerativereconstructionthatyieldsatemporalresolutionof20to30 millisecondsforimageswithaninplaneresolutionof1.5to2.0mm.Thenewmethodpromisestoaddimportant informationaboutdiseasesofthejointsandtheheart.InmanycasesMRIexaminationsmaybecomeeasierand morecomfortableforpatients.[52]
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InterventionalMRI Mainarticle:InterventionalMRI ThelackofharmfuleffectsonthepatientandtheoperatormakeMRIwellsuitedfor"interventionalradiology", wheretheimagesproducedbyaMRIscannerareusedtoguideminimallyinvasiveprocedures.Ofcourse,such proceduresmustbedonewithoutanyferromagneticinstruments.[citationneeded] AspecializedgrowingsubsetofinterventionalMRIisthatofintraoperativeMRIinwhichtheMRIisusedinthe surgicalprocess.SomespecializedMRIsystemshavebeendeveloped thatallowimagingconcurrentwiththesurgicalprocedure.Moretypical, however,isthatthesurgicalprocedureistemporarilyinterruptedsothat MRimagescanbeacquiredtoverifythesuccessoftheprocedureor guidesubsequentsurgicalwork.[citationneeded]
Radiationtherapysimulation BecauseofMRI'ssuperiorimagingofsofttissues,itisnowbeingutilized tospecificallylocatetumorswithinthebodyinpreparationforradiation therapytreatments.Fortherapysimulation,apatientisplacedina specific,reproducible,bodypositionandscanned.TheMRIsystemthen computesthepreciselocation,shapeandorientationofthetumormass, correctingforanyspatialdistortioninherentinthesystem.Thepatientis thenmarkedortattooedwithpointsthat,whencombinedwiththespecific bodyposition,permitsprecisetriangulationforradiation therapy.[citationneeded] Currentdensityimaging Currentdensityimaging(CDI)endeavorstousethephaseinformationfromimagestoreconstructcurrentdensities withinasubject.Currentdensityimagingworksbecauseelectricalcurrentsgeneratemagneticfields,whichinturn affectthephaseofthemagneticdipolesduringanimagingsequence.[citationneeded]Theseexperienceshave highlightedtheimportanceofwholebodymagneticresonanceimaginginearlydiagnosisofpathologies,because whenpatientsshowmanifestationsthroughXrayandCT,theirprognosisalreadymaybeunfavorableor grim.[citationneeded] Magneticresonanceguidedfocusedultrasound InMRgFUStherapy,ultrasoundbeamsarefocusedonatissueguidedandcontrolledusingMRthermal imagingandduetothesignificantenergydepositionatthefocus,temperaturewithinthetissuerisestomorethan 65C(150F),completelydestroyingit.Thistechnologycanachievepreciseablationofdiseasedtissue.MR imagingprovidesathreedimensionalviewofthetargettissue,allowingforprecisefocusingofultrasoundenergy. TheMRimagingprovidesquantitative,realtime,thermalimagesofthetreatedarea.Thisallowsthephysicianto ensurethatthetemperaturegeneratedduringeachcycleofultrasoundenergyissufficienttocausethermalablation withinthedesiredtissueandifnot,toadapttheparameterstoensureeffectivetreatment.[53]
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Multinuclearimaging HydrogenisthemostfrequentlyimagednucleusinMRIbecauseitispresentinbiologicaltissuesingreat abundance,andbecauseitshighgyromagneticratiogivesastrongsignal.However,anynucleuswithanet nuclearspincouldpotentiallybeimagedwithMRI.Suchnucleiincludehelium3,lithium7,carbon13, fluorine19,oxygen17,sodium23,phosphorus31andxenon129.23Naand31Parenaturallyabundantinthe body,socanbeimageddirectly.Gaseousisotopessuchas3Heor129Xemustbehyperpolarizedandtheninhaled astheirnucleardensityistoolowtoyieldausefulsignalundernormalconditions.17Oand19Fcanbe administeredinsufficientquantitiesinliquidform(e.g.17Owater)thathyperpolarizationisnota necessity.[citationneeded] Multinuclearimagingisprimarilyaresearchtechniqueatpresent.However,potentialapplicationsinclude functionalimagingandimagingoforganspoorlyseenon1HMRI(e.g.,lungsandbones)orasalternativecontrast agents.Inhaledhyperpolarized3Hecanbeusedtoimagethedistributionofairspaceswithinthelungs.Injectable solutionscontaining13Corstabilizedbubblesofhyperpolarized129Xehavebeenstudiedascontrastagentsfor angiographyandperfusionimaging.31Pcanpotentiallyprovideinformationonbonedensityandstructure,aswell asfunctionalimagingofthebrain.Multinuclearimagingholdsthepotentialtochartthedistributionoflithiumin thehumanbrain,thiselementfindinguseasanimportantdrugforthosewithconditionssuchasbipolar disorder.[citationneeded] Susceptibilityweightedimaging(SWI) Mainarticle:Susceptibilityweightedimaging Susceptibilityweightedimaging(SWI),isanewtypeofcontrastinMRIdifferentfromspindensity,T1,orT2 imaging.Thismethodexploitsthesusceptibilitydifferencesbetweentissuesandusesafullyvelocity compensated,threedimensional,RFspoiled,highresolution,3Dgradientechoscan.Thisspecialdataacquisition andimageprocessingproducesanenhancedcontrastmagnitudeimageverysensitivetovenousblood, hemorrhageandironstorage.Itisusedtoenhancethedetectionanddiagnosisoftumors,vascularand neurovasculardiseases(strokeandhemorrhage,multiplesclerosis,Alzheimer's),andalsodetectstraumaticbrain injuriesthatmaynotbediagnosedusingothermethods.[54] OtherspecializedMRItechniques Newmethodsandvariantsofexistingmethodsareoftenpublishedwhentheyareabletoproducebetterresultsin specificfields.ExamplesoftheserecentimprovementsareT2weightedturbospinecho(T2TSEMRI),double inversionrecoveryMRI(DIRMRI)orphasesensitiveinversionrecoveryMRI(PSIRMRI),allofthemableto improveimagingofbrainlesions.[55][56]AnotherexampleisMPRAGE(magnetizationpreparedrapidacquisition withgradientecho),[57]whichimprovesimagesofmultiplesclerosiscorticallesions.[58]
*
MolecularimagingofdiseasebiomarkersbyMRI
Mainarticle:Molecularimaging
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MRIhastheadvantagesofhavingveryhighspatialresolutionandisveryadeptatmorphologicalimagingand functionalimaging.MRIdoeshaveseveraldisadvantagesthough.First,MRIhasasensitivityofaround103 mol/Lto105mol/Lwhich,comparedtoothertypesofimaging,canbeverylimiting.Thisproblemstemsfrom thefactthatthedifferencebetweenatomsinthehighenergystateandthelowenergystateisverysmall.For example,at1.5teslas,atypicalfieldstrengthforclinicalMRI,thedifferencebetweenhighandlowenergystates isapproximately9moleculesper2million.ImprovementstoincreaseMRsensitivityincludeincreasingmagnetic fieldstrength,andhyperpolarizationviaopticalpumpingordynamicnuclearpolarization.Therearealsoavariety ofsignalamplificationschemesbasedonchemicalexchangethatincreasesensitivity.[citationneeded] ToachievemolecularimagingofdiseasebiomarkersusingMRI,targetedMRIcontrastagentswithhigh specificityandhighrelaxivity(sensitivity)arerequired.Todate,manystudieshavebeendevotedtodeveloping targetedMRIcontrastagentstoachievemolecularimagingbyMRI.Commonly,peptides,antibodies,orsmall ligands,andsmallproteindomains,suchasHER2affibodies,havebeenappliedtoachievetargeting.Toenhance thesensitivityofthecontrastagents,thesetargetingmoietiesareusuallylinkedtohighpayloadMRIcontrast agentsorMRIcontrastagentswithhighrelaxivities.[59]
Portableinstruments
Portablemagneticresonanceinstrumentsareavailableforuseineducationandfieldresearch.Usingtheprinciples ofEarth'sfieldNMR,theyhavenopowerfulpolarizingmagnet,sothatsuchinstrumentscanbesmalland inexpensive.SomecanbeusedforbothEFNMRspectroscopyandMRIimaging.[60]Thelowstrengthofthe Earth'sfieldresultsinpoorsignaltonoiseratios(SNR),requiringlongscantimestocapturespectroscopicdataor buildupMRIimages.However,theextremelylownoisefloorofSQUIDbasedMRIdetectors[61]andthelow densityofthermalnoiseinthelowfrequencyoperatingrange(tensofkiloHertz)mayresultinusableSNR approachingthatofmidfieldconventionalinstruments.Further,theultralowfieldtechnologiesenableelectron spinresonancedetection,andpotentiallyimaging,atsafeoperatingfrequencies.[62] ResearchwithatomicmagnetometershasaddressedthepossibilityofcheapandportableMRIinstrumentswithout alargemagnet.[63][64]
MRIversusCT
TheuseofXrays,atypeofionizingradiation,incomputedtomography(CT)allowsforexaminationoftissues composedofelementsofahigheratomicnumberthanthesurroundingtissues.MRI,incontrast,usesnonionizing radiofrequency(RF)signalstoacquireimagesandisbestsuitedforsofttissue(althoughMRIcanalsobeusedto visualizebones,teeth[65]andevenfossils[66]). SinceCTscansuseionizingradiation(Xrays)toproduceimages,thereisariskofdamagetoDNAthatcan subsequentlycausecancer.In2007,itwasestimatedthat0.4%ofcurrentcancersintheUnitedStatesweredueto CTsperformedinthepast,andthatinthefuturethisfiguremayincreasetoashighas1.52%basedonpastrates ofCTusage.[67]UnlikeCT,MRIdoesnotuseionizingradiation,althoughitisassociatedwithotherrisks.[68] ContrastinCTimagesisgeneratedpurelybyXrayattenuation,whileavarietyofpropertiesmaybeusedto generatecontrastinMRimages.Byvaryingthescanningparameters,tissuecontrastcanbealteredtoenhance differentfeaturesinanimage(seeApplicationsformoredetails).BothCTandMRimagesmaybeenhancedby
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usingcontrastagents.ContrastagentsforCTcontainelementsofahighatomicnumberrelativetothetissuebeing investigated,suchasiodineorbarium,whilecontrastagents(suchasgadoliniumandmanganese)forMRIhave paramagneticpropertiesthatareusedtoaltertissuerelaxationtimes.CommonlyusedMRIcontrastagentsmaybe contraindicatedinpeoplewithsignificantpermanentortransientkidneydysfunction.[69] CTandMRIscannersareabletogeneratemultipletwodimensionalcrosssections(tomographs,or"slices")of tissueandthreedimensionalreconstructions.MRIcangeneratecrosssectionalimagesinanyplane(including obliqueplanes).Inthepast,CTwaslimitedtoacquiringimagesintheaxialplane(ornearaxialplane),andso theseimageswerecalledComputedAxialTomographyscans(CATscans).However,thedevelopmentofmulti detectorCTscannerswithnearisotropicresolutionallowstheCTscannertoproducedatathatcanbe retrospectivelyreconstructedinanyplanewithminimallossofimagequality.Forpurposesoftumordetectionand identificationinthebrain,MRIisgenerallysuperior.[70][71]However,inthecaseofsolidtumorsoftheabdomen andchest,CTisoftenpreferredasitlessaffectedbymotionartifacts.Furthermore,CTusuallyismorewidely available,faster,andlessexpensive. MRIisalsobestsuitedforcaseswhenapatientistoundergoseveralexamsintheshortterm,sinceitdoesnot exposethepatienttothehazardsofionizingradiation.HoweverMRIisusuallycontraindicatedifthepatienthas anytypeofmedicalimplant,suchasvagusnervestimulators,implantablecardioverterdefibrillators,loop recorders,insulinpumps,cochlearimplants,deepbrainstimulators,metallicforeignbodies(e.g.,shrapnelorshell fragments),ormetallicimplantssuchassurgicalprostheses.Thesedevicescanmalfunctionorheatupduringan MRIscan,soCTscansareconsideredthesaferoptionforthesepatients.[citationneeded]
EconomicsofMRI
Standard1.5teslaMRIscannersusedtocostbetweenUS$1millionandUS$1.5million.Standard3.0teslaMRI scannerswouldoftencostbetweenUS$2millionandUS$2.3million.ConstructionofMRIsuitescouldcostupto US$500,000ormore,dependingonprojectscope.PMRIscannerstodaynowcostagreatdealless,around US$50,000.[72] MRIscannershavebecomesignificantsourcesofrevenueforhealthcare providersintheUS.Thisisbecauseoffavorablereimbursementrates frominsurersandfederalgovernmentprograms.Insurancereimbursement isprovidedintwocomponents,anequipmentchargefortheactual performanceandoperationoftheMRIscanandaprofessionalchargefor theradiologist'sreviewoftheimagesand/ordata.IntheUSNortheast,an equipmentchargemightbe$3,500andaprofessionalchargemightbe $350,[73]althoughtheactualfeesreceivedbytheequipmentownerand interpretingphysicianareoftensignificantlylessanddependontherates negotiatedwithinsurancecompaniesordeterminedbytheMedicarefee LookingthroughanMRIscanner. schedule.Forexample,anorthopedicsurgerygroupinIllinoisbilleda chargeof$1,116forakneeMRIin2007,buttheMedicare reimbursementin2007wasonly$470.91.[74]ManyinsurancecompaniesrequireadvanceapprovalofanMRI procedureasaconditionforcoverage.
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IntheUS,theDeficitReductionActof2005significantlyreducedreimbursementratespaidbyfederalinsurance programsfortheequipmentcomponentofmanyscans,shiftingtheeconomiclandscape.Manyprivateinsurers havefollowedsuit.[citationneeded] IntheUnitedStates,anMRIofthebrainwithandwithoutcontrastbilledtoMedicarePartBentails,onaverage,a technicalpaymentofUS$403andaseparatepaymenttotheradiologistofUS$93.[75]InFrance,thecostofan MRIexamisapproximately150euros.Thiscoversthreebasicscansincludingonewithanintravenouscontrast agentaswellasaconsultationwiththetechnicianandawrittenreporttothepatient'sphysician.[citationneeded]In Japan,thecostofanMRIexamination(excludingthecostofcontrastmaterialandfilms)rangesfromUS$155to US$180,withanadditionalradiologistprofessionalfeeofUS$17.[76]InIndia,thecostofanMRIexamination includingthefeefortheradiologist'sopinioncomestoaroundRs30004000(US$5060),excludingthecostof contrastmaterial.
Safety
AnumberoffeaturesofMRIscanningcangiverisetorisks. Theseinclude: Powerfulmagneticfields Radiowaves Cryogenicliquids Noise Claustrophobia. Inaddition,incaseswhereMRIcontrastagentsareused,thesealsotypicallyhaveassociatedrisks.
Overuse
MedicalsocietiesissueguidelinesforwhenphysiciansshoulduseMRIonpatientsandrecommendagainst overuse.MRIcandetecthealthproblemsorconfirmadiagnosis,butmedicalsocietiesoftenrecommendthatMRI notbethefirstprocedureforcreatingaplantodiagnoseormanageapatient'scomplaint.Acommoncaseistouse MRItoseekacauseoflowbackpaintheAmericanCollegeofPhysicians,forexample,recommendsagainstthis procedureasunlikelytoresultinapositiveoutcomeforthepatient.[77][78]Nevertheless,MRIhastheadvantageof notusingionizingradiationtocreatemedicalimages,unlikeotherimagingmodalitiessuchasCTand conventionalradiography.
Magneticfield
SometypesofmedicalimplantsaregenerallyconsideredcontraindicationsforMRIexaminations,whileothers maybeacceptableforpatientsunderhighspecificMRIconditions.Patientsarethereforealwaysaskedfor completeinformationaboutallimplantsbeforeenteringtheroomforanMRIscan.Severaldeathshavebeen reportedinpatientswithpacemakerswhohaveundergoneMRIscanningwithoutappropriateprecautions.[79]To reducesuchrisks,implantsareincreasinglybeingdevelopedtomakethemabletobesafelyscanned,[80]and specializedprotocolshavebeendevelopedtopermitthesafescanningofselectedimplantsandpacingdevices.
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Cardiovascularstentsareconsideredsafe,however.[81] Ferromagneticforeignbodiessuchasshellfragments,ormetallicimplantssuchassurgical prosthesesandferromagneticaneurysmclipsarealsopotentialrisks.Interactionofthe magneticandradiofrequencyfieldswithsuchobjectscanleadtotraumaduetomovement oftheobjectinthemagneticfieldorthermalinjuryfromradiofrequencyinductionheating oftheobject.[82] Titaniumanditsalloysaresafefromattractionandtorqueforcesproducedbythemagnetic field,thoughtheremaybesomerisksassociatedwithLenzeffectforcesactingontitanium implantsinsensitiveareaswithinthesubject,suchasstapesimplantsintheinnerear. IntheUnitedStatesaclassificationsystemforimplantsandancillaryclinicaldeviceshas beendevelopedbyASTMInternationalandisnowthestandardsupportedbytheUSFood andDrugAdministration:
MRConditional sign
MRSafesign
MRSafeThedeviceorimplantiscompletelynonmagnetic,nonelectrically conductive,andnonRFreactive,eliminatingalloftheprimarypotentialthreatsduring anMRIprocedure. MRConditionalAdeviceorimplantthatmaycontainmagnetic,electrically conductiveorRFreactivecomponentsthatissafeforoperationsinproximitytothe MRUnsafesign MRI,providedtheconditionsforsafeoperationaredefinedandobserved(suchas 'testedsafeto1.5teslas'or'safeinmagneticfieldsbelow500gaussinstrength'). MRUnsafeNearlyselfexplanatory,thiscategoryisreservedforobjectsthataresignificantly ferromagneticandposeaclearanddirectthreattopersonsandequipmentwithinthemagnetroom. Theveryhighstrengthofthemagneticfieldcanalsocause"missileeffect"accidents,whereferromagneticobjects areattractedtothecenterofthemagnet,andtherehavebeenincidentsofinjuryanddeath.[83][84]Toreducethe riskofprojectileaccidents,ferromagneticobjectsanddevicesaretypicallyprohibitedintheproximityoftheMRI scannerandpatientsundergoingMRIexaminationsarerequiredtoremoveallmetallicobjects,oftenbychanging intoagownorscrubs,andferromagneticdetectiondevicesareusedatsomesites.[85][86] Thereisnoevidenceforbiologicalharmfromevenverypowerfulstaticmagneticfields.[87]
Peripheralnervestimulation(PNS)
Therapidswitchingonandoffofthemagneticfieldgradientsiscapableofcausingnervestimulation.Volunteers reportatwitchingsensationwhenexposedtorapidlyswitchedfields,particularlyintheirextremities.[88][89]The reasontheperipheralnervesarestimulatedisthatthechangingfieldincreaseswithdistancefromthecenterofthe gradientcoils(whichmoreorlesscoincideswiththecenterofthemagnet).[90]AlthoughPNSwasnotaproblem fortheslow,weakgradientsusedintheearlydaysofMRI,thestrong,rapidlyswitchedgradientsusedin techniquessuchasEPI,fMRI,diffusionMRI,etc.arecapableofinducingPNS.AmericanandEuropean regulatoryagenciesinsistthatmanufacturersstaybelowspecifieddB/dtlimits(dB/dtisthechangeinfieldperunit time)orelseprovethatnoPNSisinducedforanyimagingsequence.AsaresultofdB/dtlimitation,commercial MRIsystemscannotusethefullratedpoweroftheirgradientamplifiers.
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Heatingcausedbyabsorptionofradiowaves
EveryMRIscannerhasapowerfulradiotransmittertogeneratetheelectromagneticfieldwhichexcitesthespins. Ifthebodyabsorbstheenergy,heatingoccurs.Forthisreason,thetransmitterrateatwhichenergyisabsorbedby thebodyhastobelimited(seeSpecificabsorptionrate).
Acousticnoise
SwitchingoffieldgradientscausesachangeintheLorentzforceexperiencedbythegradientcoils,producing minuteexpansionsandcontractionsofthecoilitself.Astheswitchingistypicallyintheaudiblefrequencyrange, theresultingvibrationproducesloudnoises(clickingorbeeping).Thisismostmarkedwithhighfield machines[91]andrapidimagingtechniquesinwhichsoundpressurelevelscanreach120dB(A)(equivalenttoa jetengineattakeoff),[92]andthereforeappropriateearprotectionisessentialforanyoneinsidetheMRIscanner roomduringtheexamination.[93]
Cryogens
AsdescribedinPhysicsofMagneticResonanceImaging,manyMRIscannersrelyoncryogenicliquidstoenable thesuperconductingcapabilitiesoftheelectromagneticcoilswithin.Thoughthecryogenicliquidsusedarenon toxic,theirphysicalpropertiespresentspecifichazards.[citationneeded] Anunintentionalshutdownofasuperconductingelectromagnet,aneventknownas"quench",involvestherapid boilingofliquidheliumfromthedevice.Iftherapidlyexpandingheliumcannotbedissipatedthroughanexternal vent,sometimesreferredtoasa'quenchpipe',itmaybereleasedintothescannerroomwhereitmaycause displacementoftheoxygenandpresentariskofasphyxiation.[94] Oxygendeficiencymonitorsareusuallyusedasasafetyprecaution.Liquidhelium,themostcommonlyused cryogeninMRI,undergoesnearexplosiveexpansionasitchangesfromaliquidtogaseousstate.Theuseofan oxygenmonitorisimportanttoensurethatoxygenlevelsaresafeforpatient/physicians.Roomsbuiltfor superconductingMRIequipmentshouldbeequippedwithpressurereliefmechanisms[95]andanexhaustfan,in additiontotherequiredquenchpipe. Becauseaquenchresultsinrapidlossofcryogensfromthemagnet,recommissioningthemagnetisexpensiveand timeconsuming.Spontaneousquenchesareuncommon,butaquenchmayalsobetriggeredbyanequipment malfunction,animpropercryogenfilltechnique,contaminantsinsidethecryostat,orextrememagneticor vibrationaldisturbances.[96][97]
Contrastagents
Mainarticle:MRIcontrastagent Themostcommonlyusedintravenouscontrastagentsarebasedonchelatesofgadolinium.Ingeneral,these agentshaveprovedsaferthantheiodinatedcontrastagentsusedinXrayradiographyorCT.Anaphylactoid reactionsarerare,occurringinapprox.0.030.1%.[98]Ofparticularinterestisthelowerincidenceof
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nephrotoxicity,comparedwithiodinatedagents,whengivenatusualdosesthishasmadecontrastenhanced MRIscanninganoptionforpatientswithrenalimpairment,whowouldotherwisenotbeabletoundergocontrast enhancedCT.[99] Althoughgadoliniumagentshaveprovedusefulforpatientswithrenalimpairment,inpatientswithsevererenal failurerequiringdialysisthereisariskofararebutseriousillness,nephrogenicsystemicfibrosis,whichmaybe linkedtotheuseofcertaingadoliniumcontainingagents.Themostfrequentlylinkedisgadodiamide,butother agentshavebeenlinkedtoo.[100]Althoughacausallinkhasnotbeendefinitivelyestablished,currentguidelinesin theUnitedStatesarethatdialysispatientsshouldonlyreceivegadoliniumagentswhereessential,andthatdialysis shouldbeperformedassoonaspossibleafterthescantoremovetheagentfromthebodypromptly.[101][102]In Europe,wheremoregadoliniumcontainingagentsareavailable,aclassificationofagentsaccordingtopotential riskshasbeenreleased.[103][104]Recently,anewcontrastagentnamedgadoxetate,brandnameEovist(US)or Primovist(EU),wasapprovedfordiagnosticuse:thishasthetheoreticalbenefitofadualexcretionpath.[105]
Pregnancy
NoeffectsofMRIonthefetushavebeendemonstrated.[106]Inparticular,MRIavoidstheuseofionizing radiation,towhichthefetusisparticularlysensitive.However,asaprecaution,currentguidelinesrecommendthat pregnantwomenundergoMRIonlywhenessential.Thisisparticularlythecaseduringthefirsttrimesterof pregnancy,asorganogenesistakesplaceduringthisperiod.TheconcernsinpregnancyarethesameasforMRIin general,butthefetusmaybemoresensitivetotheeffectsparticularlytoheatingandtonoise.However,one additionalconcernistheuseofcontrastagentsgadoliniumcompoundsareknowntocrosstheplacentaandenter thefetalbloodstream,anditisrecommendedthattheirusebeavoided.[citationneeded] Despitetheseconcerns,MRIisrapidlygrowinginimportanceasawayofdiagnosingandmonitoringcongenital defectsofthefetusbecauseitcanprovidemorediagnosticinformationthanultrasoundanditlackstheionizing radiationofCT.MRIwithoutcontrastagentsistheimagingmodeofchoiceforpresurgical,inuterodiagnosis andevaluationoffetaltumors,primarilyteratomas,facilitatingopenfetalsurgery,otherfetalinterventions,and planningforprocedures(suchastheEXITprocedure)tosafelydeliverandtreatbabieswhosedefectswould otherwisebefatal.[citationneeded]
Claustrophobiaanddiscomfort
Despitebeingpainless,MRIscanscanbeunpleasantforthosewhoareclaustrophobicorotherwiseuncomfortable withtheimagingdevicesurroundingthem.OlderclosedboreMRIsystemshaveafairlylongtubeortunnel.The partofthebodybeingimagedmustlieatthecenterofthemagnet,whichisattheabsolutecenterofthetunnel. Becausescantimesontheseolderscannersmaybelong(occasionallyupto40minutesfortheentireprocedure), peoplewithevenmildclaustrophobiaaresometimesunabletotolerateanMRIscanwithoutmanagement.Some modernscannershavelargerbores(upto70cm)andscantimesareshorter.Thismeansthatclaustrophobiacould belessofanissue,andmorepatientsmaynowfindMRItobeatolerableprocedure.[citationneeded] Nervouspatientsmayfindthefollowingstrategieshelpful: Advancepreparation visitingthescannertoseetheroomandtopracticelyingonthetable
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visualizationtechniques chemicalsedation generalanesthesia Copingwhileinsidethescanner havingalovedoneintheroomtoholdhands,givereassurance,etc. holdinga"panicbutton" closingtheeyesaswellascoveringthem(e.g.,withawashclothoreyemask) ManynewerMRIsystemsplaceadiagonalmirrorabovetheeyestoallowthepatienttolookdownthetunnel ratherthanattheborewallimmediatelyabovetheirface.[citationneeded] Alternativescannerdesigns,suchasopenoruprightsystems,canalsobehelpfulwheretheseareavailable. Thoughopenscannershaveincreasedinpopularity,theyproduceinferiorscanqualitybecausetheyoperateat lowermagneticfieldsthanclosedscanners.However,commercial1.5teslaopensystemshaverecentlybecome available,providingmuchbetterimagequalitythanpreviouslowerfieldstrengthopenmodels.[107] Forbabiesandotheryoungchildren,chemicalsedationorgeneralanesthesiaarethenorm,asthesesubjects cannotbeexpectedorinstructedtoholdstillduringthescanningsession.Obesepatientsandpregnantwomen mayfindtheMRImachinetobeatightfit.Pregnantwomenmayalsohavedifficultylyingontheirbacksforan hourormorewithoutmoving.[citationneeded]
Guidance
Safetyissues,includingthepotentialforbiostimulationdeviceinterference,movementofferromagneticbodies, andincidentallocalizedheating,havebeenaddressedintheAmericanCollegeofRadiology'sWhitePaperonMR Safety,whichwasoriginallypublishedin2002andexpandedin2004.TheACRWhitePaperonMRSafetyhas beenrewrittenandwasreleasedearlyin2007underthenewtitleACRGuidanceDocumentforSafeMR Practices(http://www.acr.org/SecondaryMainMenuCategories/quality_safety/MRSafety/safe_mr07.aspx). InDecember2007,theMedicinesandHealthcareProductsRegulatoryAgency(MHRA),aUKhealthcare regulatorybody,issuedtheirSafetyGuidelinesforMagneticResonanceImagingEquipmentinClinicalUse (http://www.mhra.gov.uk/home/idcplg? IdcService=GET_FILE&dDocName=CON2033065&RevisionSelectionMethod=LatestReleased). InFebruary2008,theJointCommission,aUShealthcareaccreditingorganization,issuedaSentinelEventAlert #38(http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_38.htm),theirhighestpatientsafety advisory,onMRIsafetyissues. InJuly2008,theUnitedStatesVeteransAdministration,afederalgovernmentalagencyservingthehealthcare needsofformermilitarypersonnel,issuedasubstantialrevisiontotheirMRIDesignGuide,[108]whichincludes physicalandfacilitysafetyconsiderations.
TheEuropeanPhysicalAgentsDirective
TheEuropeanPhysicalAgents(ElectromagneticFields)DirectiveislegislationadoptedbytheEuropean ParliamentandCouncilon29April2004.Originallyscheduledtoberequiredbytheendof2008,eachindividual statewithintheEuropeanUnionmustincludethisdirectiveinitsownlawbytheendof2012.Somemember
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nationspassedcomplyinglegislationandarenowattemptingtorepealtheirstatelawsinexpectationthatthefinal versionoftheEUPhysicalAgentsDirectivewillbesubstantiallyrevisedpriortotherevisedadoption date.[citationneeded] Thedirectiveappliestooccupationalexposuretoelectromagneticfields(notmedicalexposure)andwasintended tolimitworkersacuteexposuretostrongelectromagneticfields,asmaybefoundnearelectricitysubstations, radioortelevisiontransmittersorindustrialequipment.However,theregulationsimpactsignificantlyonMRI, withseparatesectionsoftheregulationslimitingexposuretostaticmagneticfields,changingmagneticfieldsand radiofrequencyenergy.Fieldstrengthlimitsaregiven,whichmaynotbeexceeded.Anemployermaycommita criminaloffensebyallowingaworkertoexceedanexposurelimit,ifthatishowthedirectiveisimplementedina particularmemberstate.[citationneeded] Thedirectiveisbasedontheinternationalconsensusofestablishedeffectsofexposuretoelectromagneticfields, andinparticulartheadviceoftheEuropeanCommissions'sadvisor,theInternationalCommissiononNon IonizingRadiationProtection(ICNIRP).TheaimsoftheDirective,andtheICNIRPguidelinesitisbasedon,are topreventexposuretopotentiallyharmfulfields.Theactuallimitsinthedirectiveareverysimilartothelimits advisedbytheInstituteofElectricalandElectronicsEngineers,withtheexceptionofthefrequenciesproducedby thegradientcoils,wheretheIEEElimitsaresignificantlyhigher.[citationneeded] ManyMemberStatesoftheEUalreadyhaveeitherspecificEMFregulationsor(asintheUK)ageneral requirementunderworkplacehealthandsafetylegislationtoprotectworkersagainstelectromagneticfields.In almostallcasestheexistingregulationsarealignedwiththeICNIRPlimitssothatthedirectiveshould,intheory, havelittleeffectonanyemployeralreadyfulfillingthelegalresponsibilities.[citationneeded] Theintroductionofthedirectivehasbroughttolightanexistingpotentialissuewithoccupationalexposuresto MRIfields.Atpresent,littleisknownaboutthenumberortypesofMRIpracticesthatmightleadtoexposuresin excessofthelevelsofthedirective.[109][110]ThereisajustifiableconcernamongstMRIpractitionersthatifthe directiveweretobeenforcedmorevigorouslythanexistinglegislation,theuseofMRImightberestricted,orthe workingpracticesofMRIpersonnelmighthavetochange. Intheinitialdraftastaticfieldstrengthlimitof2Twasspecified.Thishassincebeenremovedfromthe regulations,andwhilstitisunlikelytoberestoredwithoutastrongjustification,somerestrictiononstaticfields maybereintroducedafterthematterhasbeenconsideredmorefullybyICNIRP.Theeffectofsuchalimitmight betorestricttheinstallation,operationandmaintenanceofMRIscannerswithmagnetsof2Tandstronger.Asthe increaseinfieldstrengthhasbeeninstrumentalindevelopinghigherresolutionandhigherperformancescanners, thiswouldbeasignificantstepback.[citationneeded] IndividualgovernmentagenciesandtheEuropeanCommissionhavenowformedaworkinggrouptoexaminethe implicationsofthedirectiveonMRIandtotrytoaddresstheissueofoccupationalexposurestoelectromagnetic fieldsfromMRI.[citationneeded]
Seealso
Earth'sfieldNMR(EFNMR) Electronspinresonance(spinphysics)
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Historyofbrainimaging Jemris(opensourceMRIsimulator) Magneticimmunoassay Magneticparticleimaging(MPI) Magneticresonanceelastography MagneticResonanceImaging(journal) Magneticresonancemicroscopy Medicalimaging Molecularbreastimaging Nephrogenicfibrosingdermopathy Neuroimagingsoftware NobelPrizecontroversies Nuclearmagneticresonance(NMR) Relaxation(NMR) Robinsonoscillator Rabicycle Virtopsy
References
1. ^Sheil,W.C."MagneticResonanceImaging(MRIScan)"(http://www.medicinenet.com/mri_scan/article.htm). MedicineNet.com.Retrieved27April2012. 2. ^SquireLF,NovellineRA(1997). Squire'sfundamentalsofradiology(5thed.).HarvardUniversityPress.p.36. ISBN0674833392. 3. ^ a b c d"MagneticResonance"(http://www.magneticresonance.org).EuropeanMagneticResonanceForum/TRTF. Retrieved01May2013. 4. ^"Ctscanvsmri:Comparisonchart"(http://www.diffen.com/difference/CT_Scan_vs_MRI).Diffen.Retrieved27 April2012. 5. ^Shiel,W.C."MagneticResonanceImaging(MRIScan)"(http://www.medicinenet.com/mri_scan/article.htm). MedicineNet.com.Retrieved25April2012. 6. ^"MRIContrastAgent"(http://www.oceannanotech.com/nav.php?qid=9).OceanNanoTech.Retrieved27April2012. 7. ^Hendee,WilliamRMorgan,ChristopherJ(1984)."MagneticResonanceImagingPartIPhysicalPrinciples". WestJMed. 141(4):491500.PMC1021860(//www.ncbi.nlm.nih.gov/pmc/articles/PMC1021860).PMID6506686 (//www.ncbi.nlm.nih.gov/pubmed/6506686). 8. ^SasakiM,EharaS,NakasatoT, etal. (April1990)."MRoftheshoulderwitha0.2Tpermanentmagnetunit". AJR AmJRoentgenol 154(4):7778.doi:10.2214/ajr.154.4.2107675(http://dx.doi.org/10.2214%2Fajr.154.4.2107675). PMID2107675(//www.ncbi.nlm.nih.gov/pubmed/2107675). 9. ^CounterSA,OlofssonA,BorgE,BjelkeB,HggstrmA,GrahnHF(September2000)."Analysisofmagnetic resonanceimagingacousticnoisegeneratedbya4.7Texperimentalsystem". ActaOtolaryngol. 120(6):73943. doi:10.1080/000164800750000270(http://dx.doi.org/10.1080%2F000164800750000270).PMID11099151 (//www.ncbi.nlm.nih.gov/pubmed/11099151). 10. ^Luechinger,R.Duru,F.Candinas,R.Boesiger,P.(2004)."Safetyconsiderationsformagneticresonanceimaging ofpacemakerandICDpatients". HerzschrittmachertherapieundElektrophysiologie 15:7381.doi:10.1007/s00399 00404015(http://dx.doi.org/10.1007%2Fs0039900404015). 11. ^Scott,GreigChronik,Blaineetal.(2001)."APrepolarizedMRIScanner"(http://cds.ismrm.org/ismrm
22/29
27/09/13
12. 13.
14. 15.
16.
17.
18. 19.
20. 21. 22. 23. 24. 25. 26.
27.
28. 29. 30. 31. 32.
2001/PDF3/0610.pdf). Proc.Intl.Soc.Mag.Reson.Med9:610. ^ a bLevy,Dawn(20Mar2001)."Twomagnetsarecheaperthanone:Stanfordengineersconstructaninexpensive MRIscanner"(http://news.stanford.edu/pr/01/mri321.html).StanfordUniversity.Retrieved26April2012. ^VenookRD,MatterNI,RamachandranM, etal. (July2006)."Prepolarizedmagneticresonanceimagingaround metalorthopedicimplants". MagnResonMed 56(1):17786.doi:10.1002/mrm.20927 (http://dx.doi.org/10.1002%2Fmrm.20927).PMID16724303(//www.ncbi.nlm.nih.gov/pubmed/16724303). ^Carr,Herman(1952). FreePrecessionTechniquesinNuclearMagneticResonance(PhDthesis).Cambridge,MA: HarvardUniversity.OCLC76980558(//www.worldcat.org/oclc/76980558). ^Carr,HermanY.(July2004)."FieldGradientsinEarlyMRI". PhysicsToday(AmericanInstituteofPhysics) 57 (7):83.Bibcode:2004PhT....57g..83C(http://adsabs.harvard.edu/abs/2004PhT....57g..83C).doi:10.1063/1.1784322 (http://dx.doi.org/10.1063%2F1.1784322). ^ EncyclopediaofNuclearMagneticResonance(http://books.google.com/?id= OBvMgEACAAJ&dq=Encyclopedia%20of%20Nuclear%20Magnetic%20Resonance) 1.Hoboken,NJ:Wileyand Sons.1996.p.253. ^MacWilliamsB(November2003)."Russianclaimsfirstinmagneticimaging". Nature 426(6965):375. Bibcode:2003Natur.426..375M(http://adsabs.harvard.edu/abs/2003Natur.426..375M).doi:10.1038/426375a (http://dx.doi.org/10.1038%2F426375a).PMID14647349(//www.ncbi.nlm.nih.gov/pubmed/14647349). ^"BestRegardstoAlfredNobel"(http://www.inauka.ru/english/article36919.html).Retrieved20091016. ^DamadianR(March1971)."Tumordetectionbynuclearmagneticresonance". Science 171(3976):11513. Bibcode:1971Sci...171.1151D(http://adsabs.harvard.edu/abs/1971Sci...171.1151D). doi:10.1126/science.171.3976.1151(http://dx.doi.org/10.1126%2Fscience.171.3976.1151).PMID5544870 (//www.ncbi.nlm.nih.gov/pubmed/5544870). ^"Themanwhodidnotwin"(http://www.smh.com.au/articles/2003/10/16/1065917548433.html).SydneyMorning Herald.20031017.Retrieved20070804. ^"ScanandDeliver"(http://opinionjournal.com/taste/?id=110001844l).WallStreetJournal.20020614.Retrieved 20070804. ^"ApparatusAndMethodForDetectinCancerInTissue"(http://www.google.com/patents?id= AZAAAAEBAJ&printsec=abstract#v=onepage&q&f=false).UnitedStatesPatentandTrademarkOffice. ^"NSFhistory"(http://www.sri.com/policy/csted/reports/techin/mri3.html).Sri.com.Retrieved20111128. ^"ScientistClaimsExclusionFromNobelPrizeforMRI"(http://articles.latimes.com/2003/oct/11/science/sciflap11). LosAngelesTimes.20031108.Retrieved20130213. ^"DoesDr.RaymondDamadianDeservetheNobelPrizeforMedicine?"(http://www.highbeam.com/doc/1P1 89000528.html).TheArmenianReporter.20031108.Retrieved20070805. ^LauterburPC(1973)."ImageFormationbyInducedLocalInteractions:ExamplesofEmployingNuclearMagnetic Resonance". Nature 242(5394):1901.Bibcode:1973Natur.242..190L (http://adsabs.harvard.edu/abs/1973Natur.242..190L).doi:10.1038/242190a0 (http://dx.doi.org/10.1038%2F242190a0). ^ a bFillerA(October2009)."Magneticresonanceneurographyanddiffusiontensorimaging:origins,history,and clinicalimpactofthefirst50,000caseswithanassessmentofefficacyandutilityinaprospective5000patientstudy group". Neurosurgery 65(4Suppl):A2943.doi:10.1227/01.NEU.0000351279.78110.00 (http://dx.doi.org/10.1227%2F01.NEU.0000351279.78110.00).PMC2924821 (//www.ncbi.nlm.nih.gov/pmc/articles/PMC2924821).PMID19927075(//www.ncbi.nlm.nih.gov/pubmed/19927075). ^LauterburPC(1974)."Magneticresonancezeugmatography". PureandAppliedChemistry 40:14957. doi:10.1351/pac197440010149(http://dx.doi.org/10.1351%2Fpac197440010149). ^"FirstMRIandultrasoundscanning"(http://benbeck.co.uk/firsts/scanning.htm).BenjaminS.Beck. ^"The"Indomitable"MRI"(http://www.smithsonianmag.com/sciencenature/object_jun00.html?c=y&page=2). SmithsonianInstitution. ^DamadianR,GoldsmithM,MinkoffL(1977)."NMRincancer:XVI.FONARimageofthelivehumanbody". Physiol.Chem.Phys. 9(1):97100,108.PMID909957(//www.ncbi.nlm.nih.gov/pubmed/909957). ^SijbersJ,ScheundersP,BonnetN,VanDyckD,RamanE(1996)."Quantificationandimprovementofthesignal
23/29
27/09/13
33.
34. 35.
36.
37. 38. 39. 40. 41.
42. 43.
44.
45.
46. 47.
48. 49.
50.
51.
tonoiseratioinamagneticresonanceimageacquisitionprocedure". MagnResonImaging 14(10):115763. Bibcode:1977Natur.270..722H(http://adsabs.harvard.edu/abs/1977Natur.270..722H).doi:10.1038/270722a0 (http://dx.doi.org/10.1038%2F270722a0).PMID9065906(//www.ncbi.nlm.nih.gov/pubmed/9065906). ^SijbersJ,ScheundersP,BonnetN,VanDyckD,RamanE(1996)."Quantificationandimprovementofthesignal tonoiseratioinamagneticresonanceimageacquisitionprocedure". MagnResonImaging 14(10):115763. doi:10.1016/S0730725X(96)002196(http://dx.doi.org/10.1016%2FS0730725X%2896%29002196). PMID9065906(//www.ncbi.nlm.nih.gov/pubmed/9065906). ^http://icmic.rad.jhmi.edu/icmicpersonnel/BIOBottomleyP.pdf ^VaughanT,DelaBarreL,SnyderC, etal. (December2006)."9.4ThumanMRI:preliminaryresults". MagnReson Med 56(6):127482.doi:10.1002/mrm.21073(http://dx.doi.org/10.1002%2Fmrm.21073).PMID17075852 (//www.ncbi.nlm.nih.gov/pubmed/17075852). ^QianC,MasadIS,RosenbergJT, etal. (August2012)."Avolumebirdcagecoilwithanadjustableslidingtuner ringforneuroimaginginhighfieldverticalmagnets:exandinvivoapplicationsat21.1T". J.Magn.Reson. 221:110 6.Bibcode:2012JMagR.221..110Q(http://adsabs.harvard.edu/abs/2012JMagR.221..110Q). doi:10.1016/j.jmr.2012.05.016(http://dx.doi.org/10.1016%2Fj.jmr.2012.05.016).PMID22750638 (//www.ncbi.nlm.nih.gov/pubmed/22750638). ^"FONARpressrelease"(http://www.fonar.com/news/101603.htm). ^H.F.Judso(20October2003)."NoNobelPrizeforwhining"(http://www.nytimes.com/2003/10/20/opinion/no nobelprizeforwhining.html). NewYorkTimes. ^ Medicalimagingexplanations.TheInstitutionofEngineeringandTechnology. ^"T1Weighted"(http://www.mrtip.com/serv1.php?type=db1&dbs=T1%20Weighted),www.mrtip.com ^LeBihanD,BretonE,LallemandD,GrenierP,CabanisE,LavalJeantetM(November1986)."MRimagingof intravoxelincoherentmotions:applicationtodiffusionandperfusioninneurologicdisorders". Radiology 161(2): 4017.PMID3763909(//www.ncbi.nlm.nih.gov/pubmed/3763909). ^"DiffusionInaging"(http://wwwmrsrl.stanford.edu/research.html).StanfordUniversity.Retrieved28April2012. ^MoseleyME,CohenY,MintorovitchJ, etal. (May1990)."Earlydetectionofregionalcerebralischemiaincats: comparisonofdiffusionandT2weightedMRIandspectroscopy". MagnResonMed 14(2):33046. doi:10.1002/mrm.1910140218(http://dx.doi.org/10.1002%2Fmrm.1910140218).PMID2345513 (//www.ncbi.nlm.nih.gov/pubmed/2345513). ^BorthakurA,MellonE,NiyogiS,WitscheyW,KneelandJB,ReddyR(November2006)."SodiumandT1rhoMRI formolecularanddiagnosticimagingofarticularcartilage". NMRBiomed 19(7):781821.doi:10.1002/nbm.1102 (http://dx.doi.org/10.1002%2Fnbm.1102).PMC2896046(//www.ncbi.nlm.nih.gov/pmc/articles/PMC2896046). PMID17075961(//www.ncbi.nlm.nih.gov/pubmed/17075961). ^DeCoeneB,HajnalJV,GatehouseP, etal. (1992)."MRofthebrainusingfluidattenuatedinversionrecovery (FLAIR)pulsesequences". AJNRAmJNeuroradiol 13(6):155564.PMID1332459 (//www.ncbi.nlm.nih.gov/pubmed/1332459). ^Haacke,EMarkBrown,RobertFThompson,MichaelVenkatesan,Ramesh(1999). Magneticresonanceimaging: Physicalprinciplesandsequencedesign.NewYork:J.Wiley&Sons.ISBN0471351288. ^RidgwayJP,SmithMA(June1986)."Atechniqueforvelocityimagingusingmagneticresonanceimaging". BrJ Radiol 59(702):6037.doi:10.1259/0007128559702603(http://dx.doi.org/10.1259%2F0007128559702603). PMID3708269(//www.ncbi.nlm.nih.gov/pubmed/3708269). ^NjemanzePC,BeckOJ(1989)."MRgatedintracranialCSFdynamics:evaluationofCSFpulsatileflow". AJNRAm JNeuroradiol 10(1):7780.PMID2492733(//www.ncbi.nlm.nih.gov/pubmed/2492733). ^RosenY,LenkinskiRE(July2007)."Recentadvancesinmagneticresonanceneurospectroscopy". Neurotherapeutics 4(3):33045.doi:10.1016/j.nurt.2007.04.009(http://dx.doi.org/10.1016%2Fj.nurt.2007.04.009). PMID17599700(//www.ncbi.nlm.nih.gov/pubmed/17599700). ^GolderW(June2004)."Magneticresonancespectroscopyinclinicaloncology". Onkologie 27(3):3049. doi:10.1159/000077983(http://dx.doi.org/10.1159%2F000077983).PMID15249722 (//www.ncbi.nlm.nih.gov/pubmed/15249722). ^ThulbornKR,WatertonJC,MatthewsPM,RaddaGK(February1982)."Oxygenationdependenceofthetransverse
24/29
27/09/13
52.
53.
54.
55.
56.
57.
58.
59.
60. 61. 62. 63.
64.
65.
relaxationtimeofwaterprotonsinwholebloodathighfield". Biochim.Biophys.Acta 714(2):26570. doi:10.1016/03044165(82)903336(http://dx.doi.org/10.1016%2F03044165%2882%29903336).PMID6275909 (//www.ncbi.nlm.nih.gov/pubmed/6275909). ÎUyanik,PLindner,DShah,NTsekosIPavlidis(2013)ApplyingaLevelSetMethodforResolvingPhysiologic MotionsinFreeBreathingandNongatedCardiacMRI.FIMH,2013,[1] (http://www.cpl.uh.edu/files/publications/conf_paper_videos/c66.pdf) ^ClineHE,SchenckJF,HynynenK,WatkinsRD,SouzaSP,JoleszFA(1992)."MRguidedfocusedultrasound surgery". JComputAssistTomogr 16(6):95665.doi:10.1097/0000472819921100000024 (http://dx.doi.org/10.1097%2F0000472819921100000024).PMID1430448 (//www.ncbi.nlm.nih.gov/pubmed/1430448). ^ReichenbachJR,VenkatesanR,SchillingerDJ,KidoDK,HaackeEM(July1997)."Smallvesselsinthehuman brain:MRvenographywithdeoxyhemoglobinasanintrinsiccontrastagent" (http://radiology.rsnajnls.org/cgi/pmidlookup?view=long&pmid=9205259). Radiology 204(1):2727.PMID9205259 (//www.ncbi.nlm.nih.gov/pubmed/9205259). ^WattjesMP,LutterbeyGG,GiesekeJ, etal. (January2007)."Doubleinversionrecoverybrainimagingat3T: diagnosticvalueinthedetectionofmultiplesclerosislesions"(http://www.ajnr.org/cgi/pmidlookup? view=long&pmid=17213424). AJNRAmJNeuroradiol 28(1):549.PMID17213424 (//www.ncbi.nlm.nih.gov/pubmed/17213424). ^NelsonF,PoonawallaAH,HouP,HuangF,WolinskyJS,NarayanaPA(October2007)."Improvedidentification ofintracorticallesionsinmultiplesclerosiswithphasesensitiveinversionrecoveryincombinationwithfastdouble inversionrecoveryMRimaging". AJNRAmJNeuroradiol 28(9):16459.doi:10.3174/ajnr.A0645 (http://dx.doi.org/10.3174%2Fajnr.A0645).PMID17885241(//www.ncbi.nlm.nih.gov/pubmed/17885241). ^NelsonF,PoonawallaA,HouP,WolinskyJS,NarayanaPA(November2008)."3DMPRAGEimproves classificationofcorticallesionsinmultiplesclerosis". Mult.Scler. 14(9):12149.doi:10.1177/1352458508094644 (http://dx.doi.org/10.1177%2F1352458508094644).PMC2650249 (//www.ncbi.nlm.nih.gov/pmc/articles/PMC2650249).PMID18952832(//www.ncbi.nlm.nih.gov/pubmed/18952832). ^BrantZawadzkiM,GillanGD,NitzWR(March1992)."MPRAGE:athreedimensional,T1weighted,gradient echosequenceinitialexperienceinthebrain"(http://radiology.rsnajnls.org/cgi/pmidlookup? view=long&pmid=1535892). Radiology 182(3):76975.PMID1535892(//www.ncbi.nlm.nih.gov/pubmed/1535892). ^XueS,QiaoJ,PuF,CameronM,YangJJ(2013)."Designofanovelclassofproteinbasedmagneticresonance imagingcontrastagentsforthemolecularimagingofcancerbiomarkers". WileyInterdiscipRevNanomed Nanobiotechnol 5(2):16379.doi:10.1002/wnan.1205(http://dx.doi.org/10.1002%2Fwnan.1205).PMID23335551 (//www.ncbi.nlm.nih.gov/pubmed/23335551). ^"TerranovaMRIEarth'sFieldMRIteachingsystem"(http://www.magritek.com/terranova.html).Magritek.com. Retrieved20100802. ^http://www.freshpatents.com/dt20110901ptan20110210738.php ^NASATechnicalBrief(http://www.techbriefs.com/component/content/article/6598) ^SavukovIM,RomalisMV(April2005)."NMRdetectionwithanatomicmagnetometer". Phys.Rev.Lett. 94(12): 123001.arXiv:physics/0411163(//arxiv.org/abs/physics/0411163).Bibcode:2005PhRvL..94l3001S (http://adsabs.harvard.edu/abs/2005PhRvL..94l3001S).doi:10.1103/PhysRevLett.94.123001 (http://dx.doi.org/10.1103%2FPhysRevLett.94.123001).PMID15903914 (//www.ncbi.nlm.nih.gov/pubmed/15903914).Laysummary(http://neurophilosophy.wordpress.com/2006/09/06/hi rescheapportablemri/) Neurophilosophy(September6,2006). ^RafteryD(August2006)."MRIwithoutthemagnet". Proc.Natl.Acad.Sci.U.S.A. 103(34):126578. Bibcode:2006PNAS..10312657R(http://adsabs.harvard.edu/abs/2006PNAS..10312657R). doi:10.1073/pnas.0605625103(http://dx.doi.org/10.1073%2Fpnas.0605625103).PMC1568902 (//www.ncbi.nlm.nih.gov/pmc/articles/PMC1568902).PMID16912110(//www.ncbi.nlm.nih.gov/pubmed/16912110). ^WuY,CheslerDA,GlimcherMJ, etal. (February1999)."MultinuclearsolidstatethreedimensionalMRIofbone andsyntheticcalciumphosphates". Proc.Natl.Acad.Sci.U.S.A. 96(4):15748.Bibcode:1999PNAS...96.1574W (http://adsabs.harvard.edu/abs/1999PNAS...96.1574W).doi:10.1073/pnas.96.4.1574
25/29
27/09/13
66.
67.
68.
69.
70.
71.
72.
73. 74.
75.
76.
77.
78.
79.
(http://dx.doi.org/10.1073%2Fpnas.96.4.1574).PMC15521(//www.ncbi.nlm.nih.gov/pmc/articles/PMC15521). PMID9990066(//www.ncbi.nlm.nih.gov/pubmed/9990066). ^MietchenD,AberhanM,ManzB, etal. (2008)."ThreedimensionalMagneticResonanceImagingoffossilsacross taxa". Biogeosciences 5:25.Bibcode:2008BGeo....5...25M(http://adsabs.harvard.edu/abs/2008BGeo....5...25M). doi:10.5194/bg5252008(http://dx.doi.org/10.5194%2Fbg5252008). ^BrennerDJ,HallEJ(November2007)."Computedtomographyanincreasingsourceofradiationexposure". N. Engl.J.Med. 357(22):227784.doi:10.1056/NEJMra072149(http://dx.doi.org/10.1056%2FNEJMra072149). PMID18046031(//www.ncbi.nlm.nih.gov/pubmed/18046031). ^SchwenzerNF,BantleonR,MaurerB, etal. (November2007)."DetectionofDNAdoublestrandbreaksusing gammaH2AXafterMRIexposureat3Tesla:aninvitrostudy". JMagnResonImaging 26(5):130814. doi:10.1002/jmri.21138(http://dx.doi.org/10.1002%2Fjmri.21138).PMID17969164 (//www.ncbi.nlm.nih.gov/pubmed/17969164)."Neitherexposuretothestaticmagneticfieldalonenortotheapplied imagingsequencesshowedsignificantdifferencesinH2AXexpressionbetweenexposedandshamexposedcells.X raytreatedcellsaspositivecontrolshowedasignificantincreaseinH2AXexpression." ^"NephrogenicSystemicFibrosis" (http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/Nephrogenic%20Sy stemic%20Fibrosis.pdf). ACRManualonContrastMaterial.AmericanCollegeofRadiology.Retrieved13October 2012. ÂllenED,ByrdSE,DarlingCF,TomitaT,WilczynskiMA(July1993)."Theclinicalandradiologicalevaluationof primarybrainneoplasmsinchildren,PartII:Radiologicalevaluation". JNatlMedAssoc 85(7):54653. PMC2568155(//www.ncbi.nlm.nih.gov/pmc/articles/PMC2568155).PMID8350377 (//www.ncbi.nlm.nih.gov/pubmed/8350377). ^DeckMD,HenschkeC,LeeBC, etal. (March1989)."Computedtomographyversusmagneticresonanceimaging ofthebrain.Acollaborativeinterinstitutionalstudy". ClinImaging 13(1):215.doi:10.1016/08997071(89)901204 (http://dx.doi.org/10.1016%2F08997071%2889%29901204).PMID2743188 (//www.ncbi.nlm.nih.gov/pubmed/2743188). ^"ResearchAreas:PrepolarizedMRIforImagingNearMetalImplants"(http://www mrsrl.stanford.edu/research.html).StanfordUniversity.Retrieved26April2012."PrepolarizedMRIisanovelmethod ofMRIthatusestwoinexpensiveelectromagnetstomakeanMRIstudyofthehumanbody.Byusinginexpensive electromagnets,thisnewmethodallowsforhighqualityimagingatnearlyanorderofmagnitudecostreduction relativetoconventionalMRI.Thetotalscannerhardwarecostisabout$50,000,includingmanufacturer'smaterials, laborandprofit." ^StamfordHospitalpricequotationOctober2008,StamfordCTUS ^Goldstein,WayneM.Gordon,AlexanderC.Branson,JillJaspersonSimmons,ChristopherBerland,Kimberly Willsey,DanielS.Andrews,AmandaL.(March59,2008)."OverUtilizationofMRIintheOsteoarthritisPatient" (http://www.ibji.com/images/lyftenbloggie/poster_goldstein_2008aaos.pdf).AnnualMeetingAAOS.SanFrancisco. ^CurrentProceduralTerminologycode#70553"2010MedicarePartBNationalSummaryDataFile" (https://explore.data.gov/HealthandNutrition/PartBNationalSummaryDataFileCY2010/5vgw8z3q).Data.gov, AnOfficialWebsiteoftheUnitedStatesGovernment. ÊharaS,NakajimaY,MatsuiO(August2008)."RadiologyinJapanin2008". AJRAmJRoentgenol 191(2):328 9.doi:10.2214/AJR.07.3940(http://dx.doi.org/10.2214%2FAJR.07.3940).PMID18647897 (//www.ncbi.nlm.nih.gov/pubmed/18647897). ^ConsumerReportsAmericanCollegeofPhysicians."FiveThingsPhysiciansandPatientsShouldQuestion" (http://choosingwisely.org/wpcontent/uploads/2012/04/5things_12_factsheet_Amer_College_Phys.pdf).presentedby ABIMFoundation. ChoosingWisely(ConsumerReports).RetrievedAugust14,2012. ^ConsumerReportsAmericanCollegeofPhysicians(April2012)."Imagingtestsforlowerbackpain:Whyyou probablydon'tneedthem"(http://consumerhealthchoices.org/wpcontent/uploads/2012/04/HighValueCareBack PainACP.pdf).presentedby AnnalsofInternalMedicine. HighValueCare(ConsumerReports).RetrievedAugust 14,2012. ^"Physicsofmagneticresonanceimaging"(http://www.myms.org/mri_physics.htm).MyMS.org.Retrieved27
26/29
27/09/13
80. 81. 82. 83.
84. 85.
86. 87.
88.
89.
90.
91. 92.
93.
94.
95.
96.
April2012. ^"NanocoatedimplantscutMRIscandangers01June2003"(http://www.newscientist.com/article.ns?id=dn3771). NewScientist.Retrieved20111128. ^JostC,KumarV(October1998)."AreCurrentCardiovascularStentsMRISafe?". JInvasiveCardiol 10(8):477 479.PMID10762825(//www.ncbi.nlm.nih.gov/pubmed/10762825). ^"Magneticresonancesafetypolicyofucsf"(http://www.radiology.ucsf.edu/patientcare/patientsafety/mri/policy). UniversityofCalifornia,SanFrancisco.Retrieved28April2012. ^RandalC.Archibold,"HospitalDetailsFailuresLeadingtoM.R.I.Fatality (http://query.nytimes.com/gst/fullpage.html?res=9C04E4D91731F931A1575BC0A9679C8B63)," TheNewYorkTimes, August22,2001 ^DonaldG.McNeilJr,"M.R.I.'sStrongMagnetsCitedinAccidents (http://www.nytimes.com/2005/08/19/health/19magnet.html)," TheNewYorkTimes,August19,2005. ^"ACRGuidanceDocumentforSafeMRPractices:2007" (http://www.acr.org/SecondaryMainMenuCategories/quality_safety/MRSafety/safe_mr07.aspx).Retrieved2August 2010. ^"MRIDesignGuide"(http://www.Mednovus.com/downloads/VA_MRI_Design_Guide08.pdf).Retrieved2August 2010. ^FormicaD,SilvestriS(April2004)."Biologicaleffectsofexposuretomagneticresonanceimaging:anoverview". BiomedEngOnline 3:11.doi:10.1186/1475925X311(http://dx.doi.org/10.1186%2F1475925X311). PMC419710(//www.ncbi.nlm.nih.gov/pmc/articles/PMC419710).PMID15104797 (//www.ncbi.nlm.nih.gov/pubmed/15104797). ^CohenMS,WeisskoffRM,RzedzianRR,KantorHL(May1990)."Sensorystimulationbytimevaryingmagnetic fields". MagnResonMed 14(2):40914.doi:10.1002/mrm.1910140226 (http://dx.doi.org/10.1002%2Fmrm.1910140226).PMID2345521(//www.ncbi.nlm.nih.gov/pubmed/2345521). ^BudingerTF,FischerH,HentschelD,ReinfelderHE,SchmittF(1991)."Physiologicaleffectsoffastoscillating magneticfieldgradients". JComputAssistTomogr 15(6):90914.doi:10.1097/0000472819911100000001 (http://dx.doi.org/10.1097%2F0000472819911100000001).PMID1939767 (//www.ncbi.nlm.nih.gov/pubmed/1939767). ^ReillyJP(March1989)."Peripheralnervestimulationbyinducedelectriccurrents:exposuretotimevarying magneticfields". MedBiolEngComput 27(2):10110.doi:10.1007/BF02446217 (http://dx.doi.org/10.1007%2FBF02446217).PMID2689806(//www.ncbi.nlm.nih.gov/pubmed/2689806). ^"TheEvolutionofMagneticResonanceImaging:3TMRIinClinicalApplications" (http://www.eradimaging.com/site/article.cfm?ID=426),TerryDugganJahns,www.eradimaging.com ^PriceDL,DeWildeJP,PapadakiAM,CurranJS,KitneyRI(February2001)."Investigationofacousticnoiseon15 MRIscannersfrom0.2Tto3T". JMagnResonImaging 13(2):28893.doi:10.1002/1522 2586(200102)13:2<288::AIDJMRI1041>3.0.CO2P(http://dx.doi.org/10.1002%2F1522 2586%28200102%2913%3A2%3C288%3A%3AAIDJMRI1041%3E3.0.CO%3B2P).PMID11169836 (//www.ncbi.nlm.nih.gov/pubmed/11169836). ^TheOpenUniversity2007: UnderstandingCardiovascularDiseases,coursebookforthelesson SK121 Understandingcardiovasculardiseases(http://www3.open.ac.uk/courses/bin/p12.dll?C01SK121),printedbyCambridge UniversityPress,ISBN9780749226770(canbefoundatOUW(http://www.ouw.co.uk/)),pages220and224. ^KanalE,BarkovichAJ,BellC, etal. (June2007)."ACRguidancedocumentforsafeMRpractices:2007". AJRAm JRoentgenol 188(6):144774.doi:10.2214/AJR.06.1616(http://dx.doi.org/10.2214%2FAJR.06.1616). PMID17515363(//www.ncbi.nlm.nih.gov/pubmed/17515363). ÎnternationalElectrotechnicalCommission2008: MedicalElectricalEquipmentPart233:Particularrequirements forbasicsafetyandessentialperformanceofmagneticresonanceequipmentformedicaldiagnosis,manufacturers'trade standards [2](http://webstore.iec.ch/Webstore/webstore.nsf/0/EC11496F487C406DC125742C000B2805),publishedby InternationalElectrotechnicalCommission,ISBN2831896266(canbefoundforpurchaseat[3] (http://webstore.iec.ch/Webstore/webstore.nsf/0/EC11496F487C406DC125742C000B2805)). ^"CryogenAwarenessQuenchingandMRISafetyTraining"(http://www.falckproductions.com/resources/mri
27/29
27/09/13
97. 98.
99. 100.
101.
102. 103. 104. 105.
106. 107.
108. 109.
110.
safety/cryogenawarenessquenchingandyourmrimachine/).FalckProductions.Retrieved10July2012. ^"GEHealthCare"(http://www.gehealthcare.com/usen/mr/docs/SPV8_Avoiding_Quench.pdf).GE.Retrieved10July 2012. ^MurphyKJ,BrunbergJA,CohanRH(October1996)."Adversereactionstogadoliniumcontrastmedia:areviewof 36cases". AJRAmJRoentgenol 167(4):8479.doi:10.2214/ajr.167.4.8819369 (http://dx.doi.org/10.2214%2Fajr.167.4.8819369).PMID8819369(//www.ncbi.nlm.nih.gov/pubmed/8819369). ^"ACRguideline(http://www.guideline.gov/summary/summary.aspx?doc_id=8283),2005" ^ThomsenHS,MorcosSK,DawsonP(November2006)."Isthereacausalrelationbetweentheadministrationof gadoliniumbasedcontrastmediaandthedevelopmentofnephrogenicsystemicfibrosis(NSF)?". ClinRadiol 61(11): 9056.doi:10.1016/j.crad.2006.09.003(http://dx.doi.org/10.1016%2Fj.crad.2006.09.003).PMID17018301 (//www.ncbi.nlm.nih.gov/pubmed/17018301). ^"FDADrugSafetyCommunication:Newwarningsforusinggadoliniumbasedcontrastagentsinpatientswith kidneydysfunction"(http://www.fda.gov/Drugs/DrugSafety/ucm223966.htm). InformationonGadoliniumBased ContrastAgents.U.S.FoodandDrugAdministration.23December2010.Retrieved12March2011. ^"FDAPublicHealthAdvisory:GadoliniumcontainingContrastAgentsforMagneticResonanceImaging (http://www.fda.gov/cder/drug/advisory/gadolinium_agents.htm)" ^[4](http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dID=35149&noSaveAs=0&Rendition=WEB) ^"ismrm.orgMRIQuestionsandAnswers"(http://www.ismrm.org/special/EMEA2.pdf)(PDF).Retrieved201008 02. ^"ResponsetotheFDA'sMay23,2007,NephrogenicSystemicFibrosisUpdate1Radiology" (http://radiology.rsna.org/content/246/1/11.full? searchid=1&HITS=10&hits=10&sortspec=relevance&resourcetype=HWCIT&maxtoshow=&RESULTFORMAT=&au thor1=kanal&FIRSTINDEX=0).Radiology.rsna.org.20070912.Retrieved20100802. ÂlorainyIA,AlbadrFB,AbujameaAH(2006)."AttitudetowardsMRIsafetyduringpregnancy". AnnSaudiMed 26(4):3069.PMID16885635(//www.ncbi.nlm.nih.gov/pubmed/16885635). ^"SiemensIntroducesFirst1.5TeslaOpenBoreMRI" (http://www.medical.siemens.com/webapp/wcs/stores/servlet/PressReleaseView~q_catalogId~e_1~a_catTree~e_1000 05,13839,17712~a_langId~e_1~a_pageId~e_50677~a_storeId~e_10001.htm).Medical.siemens.com.20040729. Retrieved20100802. ^"MRIDesignGuide"(http://www.cfm.va.gov/til/dGuide.asp).UnitedStatesDepartmentofVeteransAffairs.April 2008.Retrieved12October2012. ^BassenH,SchaeferDJ,ZarembaL,BushbergJ,ZiskinM,FosterKR(December2005)."IEEECommitteeonMan andRadiation(COMAR)TechnicalInformationStatement'exposureofmedicalpersonneltoelectromagneticfields fromopenmagneticresonanceimagingsystems'". HealthPhys 89(6):6849. doi:10.1097/01.HP.0000172545.71238.15(http://dx.doi.org/10.1097%2F01.HP.0000172545.71238.15). PMID16282801(//www.ncbi.nlm.nih.gov/pubmed/16282801). ^HSE2007,RR570:Assessmentofelectromagneticfieldsaroundmagneticresonance(MRI)equipment (http://www.hse.gov.uk/research/rrpdf/rr570.pdf).MCLTLtd,London
Furtherreading
GuadalupePortalAliosviRodriguezWholebodymagneticresonanceimaginginearlydiagnosisin TrinidadBMJ(2010)ISSN17561833url=http://www.bmj.com/rapidresponse/2011/12/19/rewhole bodymagneticresonanceimaging Simon,MerrillMattson,JamesS(1996).ThepioneersofNMRandmagneticresonanceinmedicine:The storyofMRI.RamatGan,Israel:BarIlanUniversityPress.ISBN0961924314. Haacke,EMarkBrown,RobertFThompson,MichaelVenkatesan,Ramesh(1999).Magneticresonance imaging:Physicalprinciplesandsequencedesign.NewYork:J.Wiley&Sons.ISBN0471351288.
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LeeSC,KimK,KimJ,etal.(June2001)."OnemicrometerresolutionNMRmicroscopy".J.Magn. Reson.150(2):20713.Bibcode:2001JMagR.150..207L (http://adsabs.harvard.edu/abs/2001JMagR.150..207L).doi:10.1006/jmre.2001.2319 (http://dx.doi.org/10.1006%2Fjmre.2001.2319).PMID11384182 (//www.ncbi.nlm.nih.gov/pubmed/11384182).
Externallinks
APeerReviewed,CriticalIntroduction(http://www.magneticresonance.org/).EuropeanMagnetic ResonanceForum(EMRF)/TheRoundTableFoundation(TRTF)PeterA.Rinck(editor) AGuidedTourofMRI:Anintroductionforlaypeople (http://www.magnet.fsu.edu/education/tutorials/magnetacademy/mri/)NationalHighMagneticField Laboratory TheBasicsofMRI(http://www.cis.rit.edu/htbooks/mri/).Underlyingphysicsandtechnicalaspects. Video:WhattoExpectDuringYourMRIExam(http://www.imrser.org/PatientVideo.html)fromthe InstituteforMagneticResonanceSafety,Education,andResearch(IMRSER) InternationalSocietyforMagneticResonanceinMedicine(http://www.ismrm.org) SrinivasM,HeerschapA,AhrensET,FigdorCG,deVriesIJ(July2010)."(19)FMRIforquantitativein vivocelltracking".TrendsBiotechnol.28(7):36370.doi:10.1016/j.tibtech.2010.04.002 (http://dx.doi.org/10.1016%2Fj.tibtech.2010.04.002).PMC2902646 (//www.ncbi.nlm.nih.gov/pmc/articles/PMC2902646).PMID20427096 (//www.ncbi.nlm.nih.gov/pubmed/20427096). BluePlaquecommemoratingthemanufactureofthefirstcommercialMRIwholebodyscanneratOsney Mead,Oxford(http://www.oxfordshireblueplaques.org.uk/plaques/mri.html) RoyalInstitutionLectureMRI:AWindowontheHumanBody (http://www.vega.org.uk/video/programme/73) AnimalImagingDatabase(AIDB)(http://aidb.crbs.ucsd.edu/sand/index.jsp) HowMRIworksexplainedsimplyusingdiagrams (http://www.howequipmentworks.com/physics/medical_imaging/mri/magnetic_resonance_imaging.html) Retrievedfrom"http://en.wikipedia.org/w/index.php?title=Magnetic_resonance_imaging&oldid=574173710" Categories: Americaninventions Discoveryandinventioncontroversies 1973introductions Magneticresonanceimaging Thispagewaslastmodifiedon23September2013at12:32. TextisavailableundertheCreativeCommonsAttributionShareAlikeLicenseadditionaltermsmayapply. Byusingthissite,youagreetotheTermsofUseandPrivacyPolicy. WikipediaisaregisteredtrademarkoftheWikimediaFoundation,Inc.,anonprofitorganization.
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SequentialsectionsfromanMRIof thebrain,concurrentlyshowing slicesthroughtransverse,sagittal, andcoronalplanes(lefttoright).

ParasagittalMRIofthehead,with aliasingartifacts(noseandforehead appearatthebackofthehead)

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

RaymondDamadian's"Apparatusand methodfordetectingcancerin tissue."

Magnetic resonance imaging - Wikipedia, the free encyclopedia

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Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

AfMRIscanshowingregionsof activationinorange,includingthe primaryvisualcortex(V1,BA17).

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

Magnetic resonance imaging - Wikipedia, the free encyclopedia

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