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MRI

Magnetic resonance imaging

Iqra Ijaz
ror
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Name Iqra ijaz

Roll No 2433

Class BS (IV) Biochemistry

Session 2012-2016

Date

Topic Magnetic resonance imaging (MRI) and cancer diagnosis

Submitted to Dr. Abida Yasmin

Lahore College for Women University Lahore


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Table of contents

 Magnetic resonance imaging (MRI)


 Background of MRI scanner
 Basic principle of MRI
 Component of MRI
 Working of MRI scanner
 Safety
 Uses of MRI scan
 Benefits of MRI
 Disadvantages of MRI
 Cancer diagnosis
 Biopsy
 Endoscopy
 Blood test
 Bone marrow aspiration
 Pap test
 Sputum analysis and bronchial washing analysis
 Imaging studies
 X rays
 Computerized axial tomography
 Magnetic resonance imaging
 Genetic analysis
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Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging (MRI) is a spectroscopic imaging technique used in medical settings to
produce images of the inside of the human body. MRI is based on the principles of nuclear magnetic
resonance (NMR), which is a spectroscopic technique used to obtain microscopic chemical and
physical data about molecules. An MRI scan uses a large magnet, radio waves, and a computer to
create a detailed cross-sectional image of the patient's internal organs and structures. The scanner
itself typically resembles a large tube with a table in the middle, allowing the patient to slide into the
tunnel.

Background of the MRI scanner

The first full-body MRI scanner was created by Prof. Raymond Damadian in 1977 and took nearly 5
hours to produce the first ever full body scan of a human. Dr. Ramadan nicknamed the first MRI
scanner the "Indomitable" and it is currently housed in the Smithsonian Institute.

The idea for MRI was initially conceived by Damadian in 1971 after he recognized that under
nuclear magnetic resonance certain mouse tumors would display elevated relaxation times compared
with normal tissues in vitro.

Basic Principle of MRI

Magnetic resonance imaging (MRI) makes use of the magnetic properties of certain atomic nuclei.
An example is the hydrogen nucleus (a single proton) present in water molecules, and therefore in all
body tissues. The hydrogen nuclei behave like compass needles that are partially aligned by a strong
magnetic field in the scanner. The nuclei can be rotated using radio waves, and they subsequently
oscillate in the magnetic field while returning to equilibrium. Simultaneously they emit a radio
signal. This is detected using antennas (coils) and can be used for making detailed images of body
tissues. Unlike some other medical imaging techniques, MRI does not involve radioactivity or
ionizing radiation. The frequencies used (typically 40-130 MHz) are in the normal radiofrequency
range, and there are no adverse health effects. Very detailed images can be made of soft tissues such
as muscle and brain. The MRI signal is sensitive to a broad range of influences, such as nuclear
mobility, molecular structure, flow and diffusion. MRI is consequently a very flexible technique that
provides measures of both structure and function.

Component of MRI

 A magnet which produces a very powerful uniform magnetic field.


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 Gradient Magnets which are much lower in strength.


 Equipment to transmit radio frequency (RF).
 A very powerful computer system, which translates the signals transmitted by the coils.
The Magnet
The most important component of the MRI scanner is the magnet:
 The magnets currently used in scanners today are in the .5-tesla to 2.0-tesla range (5,000 to
20,000- gauss).
 Higher values are used for research.
 Earth magnetic field: 0.5-gauss.
There are three types of magnets used in MRI systems:
 Resistive magnets
 Permanent magnets
 Super conducting magnets (the most commonly used type in MRI scanners).

Fig 1: MRI scanner


In addition to the main magnet, the MRI machine also contains three gradient magnets. These
magnets have a much lower magnetic field and are used to create a variable field.
Working of MRI scanner

An MRI scanner contains two powerful magnets, which represent the most critical part of the
equipment. The human body is largely made of water molecules, which are comprised of hydrogen
and oxygen atoms. At the center of each atom lies an even smaller particle called a proton, which
serves as a magnet and is sensitive to any magnetic field. Normally the water molecules in our bodies
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are randomly arranged, but upon entering an MRI scanner, the first magnet causes the body's water
molecules to align in one direction, either north or south.

The second magnetic field is then turned on and off in a series of quick pulses, causing each
hydrogen atom to alter its alignment and then quickly switch back to its original relaxed state when
switched off. The magnetic field is created by passing electricity through gradient coils, which also
causes the coils to vibrate, resulting in a knocking sound inside the scanner.

Although the patient cannot feel these changes, the scanner can detect them and, in conjunction with
a computer, can create a detailed cross-sectional image for the radiologist to interpret.

What happened during MRI scan?

During an MRI scan, patient lies on a flat- bed that's moved into the scanner. Depending on the part
of patient’s body being scanned, he or she will be moved into the scanner either head first or feet
first.

The MRI scanner is operated by a radiographer, who is trained in carrying out imaging
investigations. They control the scanner using a computer, which is in a different room, to keep it
away from the magnetic field generated by the scanner.
Patient will be able to talk to the radiographer through an intercom and examiner be able to see you
on a television monitor throughout the scan.
At certain times during the scan, the scanner will make loud tapping noises. This is the electric
current in the scanner coils being turned on and off. Patient will be given earplugs or headphones to
wear.

It's very important to keep as still as possible during your MRI scan. The scan lasts 15 to 90 minutes,
depending on the size of the area being scanned and how many images are taken.

Uses of MRI scan

The development of the MRI scan represents a huge milestone for the medical world, as doctors,
scientists and researchers are now able to examine the insides of the human body accurately using a
non-invasive tool.

The following are just some of the examples where an MRI scan is used:

 Abnormalities of the brain and spinal cord


 Tumors, cysts, and other abnormalities in various parts of the body
 Injuries or abnormalities of the joints, such as back pain
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 Certain types of heart problems


 Diseases of the liver and other abdominal organs
 Causes of pelvic pain in women (e.g. fibroids, endometriosis)
 Suspected uterine abnormalities in women undergoing evaluation for infertility.

Purpose of doing MRI

Magnetic resonance imaging (MRI) is done for many reasons. It is used to find problems such as
tumors, bleeding, injury, blood vessel diseases, or infection. MRI also may be done to provide more
information about a problem seen on an X-ray, ultrasound scan, or CT scan. Contrast material may
be used during MRI to show abnormal tissue more clearly. An MRI scan can be done for the:

 Head. MRI can look at the brain for tumors, an aneurysm, bleeding in the brain, nerve injury, and
other problems, such as damage caused by a stroke. MRI can also find problems of
the eyes and optic nerves , and the ears and auditory nerves.
 Chest. MRI of the chest can look at the heart, the valves, and coronary blood vessels . It can show if
the heart or lungs are damaged. MRI of the chest may also be used to look for breast cancer.
 Blood vessels. Using MRI to look at blood vessels and the flow of blood through them is
called magnetic resonance angiography (MRA). It can find problems of the arteries and veins, such
as an aneurysm, a blocked blood vessel, or the torn lining of a blood vessel (dissection). Sometimes
contrast material is used to see the blood vessels more clearly.
 Abdomen and pelvis. MRI can find problems in the organs and structures in the belly, such as
the liver, gallbladder, pancreas, kidneys, and bladder. It is used to find tumors, bleeding, infection,
and blockage. In women, it can look at the uterus and ovaries. In men, it looks at the prostate.
 Bones and joints. MRI can check for problems of the bones and joints, such as arthritis, problems
with the temporomandibular joint , bone marrow problems, bone tumors, cartilage problems,
torn ligaments or tendons, or infection. MRI may also be used to tell if a bone is broken when X-ray
results are not clear. MRI is done more commonly than other tests to check for some bone and joint
problems.
 Spine. MRI can check the discs and nerves of the spine for conditions such as spinal
stenosis, disc bulges, and spinal tumors.

Safety

An MRI scan is a painless and safe procedure. Patient may find it uncomfortable if he or she
has claustrophobia, but most people find this manageable with support from the radiographer. Going
into the scanner feet first may be easier, although this is not always possible.
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MRI scans don't involve exposing the body to X-ray radiation. This means people who may be
particularly vulnerable to the effects of radiation, such as pregnant women and babies, can use them
if necessary.
However, not everyone can have an MRI scan. For example, they're not always possible for people
who have certain types of implants fitted, such as a pacemaker (a battery-operated device that helps
to control an irregular heartbeat).
Extensive research has been carried out into whether the magnetic fields and radio waves used
during MRI scans could pose a risk to the human body. No evidence has been found to suggest
there's a risk, which means MRI scans are one of the safest medical procedures currently available.
Benefits of MRI

 MRI is non-invasive and does not use radiation


 MRI does not involve radiation
 MRI contrasting agent is less likely to produce an allergic reaction that may occur when
iodine-based substances are used for x-rays and CT scans
 MRI gives extremely clear, detailed images of soft-tissue structures that other imaging
techniques cannot achieve
 MRI can easily create hundreds of images from almost any direction and in any orientation
 Unlike techniques that examine small parts of the body (i.e. ultrasound or mammography)
MRI exams can cover large portions of the body
 MRI can determine if a cancer has spread, and help determine the best treatment
Disadvantages of MRI

 MRI is expensive ($1000-$1500)


 MRI will not be able to find all cancers (i.e. breast cancers indicated by microcalcifications)
 MRI cannot always distinguish between malignant tumors or benign disease (such as breast
fibroadenomas), which could lead to a false positive results
 MRI is not painful, but the patient must remain still in an enclosed machine, which may be a
problem for claustrophobic patients
 An undetected metal implant in a patient’s body may be affected by the strong magnet of the
MRI unit
 There is a small chance that a patient could develop an allergic reaction to the contrasting
agent, or that a skin infection could develop at the site of injection
 If a patient chooses to be sedated for the scanning, there is a slight risk associated with using
the sedation medication
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Cancer Diagnosis

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread
to other parts of the body. Not all tumors are cancerous; benign tumors do not spread to other parts of
the body. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough,
unexplained weight loss and a change in bowel movements. While these symptoms may indicate
cancer, they may have other causes. Over 100 cancers affect humans.

There are several methods of diagnosing cancer. With advances in technologies that understand
cancers better, there is a rise of number of diagnostic tools that can help detect cancers. Once
suspected, diagnosis is usually made by pathologists and oncopathologists and imaging radiologists.

Some types of cancer, particularly lymphomas, can be hard to classify, even for an expert. Most
cancers need a second opinion regarding diagnosis before being sure of the diagnosis or stage and
type.

The most common diagnostic methods include:

Biopsy

This is a test where a small sample of tissue is taken from the suspected cancer with the help of a fine
tipped needle (fine needle aspiration – FNA), or with a thicker hollow needle (core biopsy) or by
surgical excision. The tissues are then examined under a microscope for the presence of cancer cells.
Depending on tumor location, some biopsies can be done on an outpatient basis with only local
anesthesia.

Sentinel node biopsy

This is a procedure where the closest and most important nodes near the cancer are surgically excised
and examined. Since sentinel nodes are the first location that cancer is likely to spread, only these
lymph nodes that likely contain cancer cells.

Endoscopy

In this imaging technique a thin, flexible tube with a tiny camera on the end is inserted into the body
cavities. This allows the doctors to view the suspicious area. There are many types of scopes, each
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designed to view particular areas of the body. For example, a colonoscope looks at the colon and
large intestine and a laparoscope is used to look within the abdomen etc.

Blood tests

Blood tests can be performed to detect the normal blood cells as well as for specific tumor markers.
Some tumors release substances called tumor markers, which can be detected in the blood. A blood
test for prostate cancer determines the amount of prostate specific antigen (PSA). Higher than normal
PSA levels can indicate cancer. Similarly in ovarian cancer a tumor marker CA-125 is released.

Bone marrow aspiration

These show a picture of the bone marrow that may be affected in leukemias and blood cancers.

Pap test

Pap test (Pap smear) is a routine test where a sample of cells from a woman’s cervix is examined
under the microscope. This helps identify changes in the cells that could indicate cervical cancer or
other conditions.

Sputum analysis and bronchial washing analysis

The cells of the sputum and bronchial secretions are analyzed under the microscope for signs of lung
and other respiratory cancers.

Imaging studies

There are several imaging techniques. These include X rays, CT scans, MRI scans of various parts of
the body.

X-rays are the most common imaging techniques and they may be made more specific by using a
Barious enema. This is used for detection of stomach and small intestinal growths and cancers.
Mammogram is an X-ray of the breasts used to screen for and/or detect breast lumps and growths.

A CAT scan (computerized axial tomography) uses radiographic beams to create detailed
computerized pictures. It is more precise than a standard X-ray.
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An Magnetic Resonance Imaging (MRI) uses a powerful magnetic field to create detailed
computer images of the body’s soft tissue, large blood vessels and major organs. Both CT scan and
MRI can also be used with contrast radio-labelled dyes to obtain a more clear and specific picture of
the cancer.

An Ultrasound uses high-frequency sound waves to determine if a suspicious lump is solid or fluid.
These sound waves are transmitted into the body and converted into a computerized image.

Bone scan is specifically used to identify and locate new areas of cancer spread to the bone.
Normally a Positron imaging test (PET scan) is used. A Gallium scan is another nuclear medicine
test in which a special camera takes pictures of tissues of the body after a special radioactive tracer is
injected into a vein. The cancerous areas light up under the scanner.

Genetic analysis

Cytogenetic analysis involves analysis of blood or bone marrow cells for organizations of
chromosomes. This shows up any genetic mutations.

Fig 2: MRI scan showing Cancer in brain


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References

 Ray, H. H., William, G. B. J., and Christopher, J. L., MRI the basics, 3rd edition. Wolters
Kluwer Health (2010).
 www. Medicinenet.com/mri_scan/article.htm
 Sunder. S. R., MRI a conceptual overview, springer (1998).