Mofazzal Sharif
MRI
HISTORY
The phenomenon of Nuclear Magnetic Resonance (NMR) was discovered in 1950s . It was not until the 1970s when Lauterbur introduced the concept of magnetic field gradients, that an image based on magnetic resonance could be produced. By the 1980s whole body magnets were being produced in England permitting the first in vivo images of human anatomy. Today the technique, known as MR imaging, is widespread and an estimated 20 million scans are performed worldwide each year. It provides images with excellent soft-tissue contrast which can be acquired in any imaging plane, and unlike CT it does not involve the use of ionizing radiation. Dr. MD. Mofazzal Sharif
Basic Nuclear Magnetic Resonance Atomic structure. Motion within the atom. MR active nucleus. The Hydrogen nucleus. Alignment. Precission. The Larmor Equation. Resonance. MR signal NMR Signal.(The Free Induction Decay) T1 Recovery. T2 Relaxation. Pulse timing parameter.
Dr. MD. Mofazzal Sharif
Normally, the direction that these tiny magnets (protons) point-in is randomly distributed.
Just as a compass aligns with the earth's magnetic field, a spinning proton placed near (or within) a large external magnetic field (called B) will align with the external field. At the atomic level, some of the protons align with the field and some actually align against the field.After canceling each other out the slight excess proton those will align in parallel with the external field is the net magnetic moment which give MR signal..
Contrast mechanism
Image obtained contrast by-- T1 recovery. T2 decay. Proton density.(No. of proton / unit volume of tissue)
Dr. MD. Mofazzal Sharif
In Fat
Slow molecular tumbling Magnetic moments of nuclei are able to relax in transverse plane quickly,regain their longitudinal magnetization quickly by exchanging their energy to neighbor NMV realigns rapidly with Bo from the transverse plane So fat has short T1 recovery time & short T2 Dr. MD. Mofazzal Sharif time(80ms.)
In water
Rapid molecular tumbling Magnetic moments of nuclei take long time to relax in transverse plane as they exchange their energy to neighbor in transverse plane slowly as well as regain their longitudinal magnetization slowly. NMV realigns slowly with Bo from the transverse plane So fat has long T1 recovery time & long T2 Dr. MD. Mofazzal Sharif time(200ms.)
T1 contrast
T1 time of fat is shorter than water NMV of fat realigns more rapidly than water So the longitudinal component of fat is larger than water in T1 time After 90o RF pulse There will be more transverse magnetization of fat than water Therefore high signal of fat in T1 time Fat appears bright in T1 contrast image (and water Dr. MD. Mofazzal Sharif due to low signal appears dark on a T1 contrast image)
T1
T2 contrast
T2 time of fat is shorter than water The transverse component of fat decay faster than water in T2 time There will be less transverse magnetization of fat than water Therefore low signal of fat in T2 time Fat appears black in T2 contrast image (and water due to high signal appears bright on a T2 contrast image)
Dr. MD. Mofazzal Sharif
T2
Proton Density
Weighting
To demonstrate either T1, PD or T2 contrast specific value of TR and TE are selected for a given pulse sequence.
T1 Weighting
T1 weighted image is one where the contrast depends predominantly on the difference in the T1 time between fat and water. The TR controls how each vector can recover before before it is excited by next RF pulse, so to have a T1 weighting image TR must be short enough so that neither fat nor water has sufficient time to to fully return to Bo. The TR if is too long both fat and water returns to Bo and recover their longitudinal magnetization fully (no contrast difference). TRControls T1 weighting. Short TR--- For T1 weighting image.
Dr. MD. Mofazzal Sharif
T2 weighting
T2 weighted image is one where the contrast depends predominantly on the difference in the T2 time between fat and water. The TE controls the amount of T2 decay that is allowed to occur before the signal received.To have a T2 weighting image TE must be long enough to give both fat and water time to decay. The TE if is too short both fat and water has time to decay.(no contrast difference). TR Controls T2 weighting. Long TR--- For T2 weighting image
Dr. MD. Mofazzal Sharif
PD weighting
Proton density weighting is always present. In order to achieve this the effect of T1 and T2 must be diminished . A long TR allows both fat and water fully recover their longitudinal magnetization and diminishes T1 weighting. A short TE does not give fat or water time to decay and therefore diminishes T2 weighting. In any image the contrast due to PD with T1 and T2 mechanisms occur simultaneously and contribute to image contrast.
Dr. MD. Mofazzal Sharif
But practically what is happened? T2 decay faster due to 1. Magnetic field inhomogenicity 2. T2 decay itself This is called T2* decay which is the decay of the FID following following RF pulse.
Inhomogenicity
They are the areas within the within the magnetic field that do not exactly match the external magnetic field strength. Some areas have a magnetic strength less than main magnetic field processional frequency of the nuclei on that specific area decrease. Some areas have a magnetic strength more than main magnetic field processional frequency of the nuclei on that specific area increase. This rate of dephasing due to inhomogenicity is an exponential process.
Dr. MD. Mofazzal Sharif
The 180o pulse is an RF pulse that has sufficient energy to move the NMV through 180o . The 180o RF pulse flips these individual magnetic moment through 180o. The magnetic moment that formed the trailing edge before the 180o pulse form the leading edge prior to 180o pulse. The direction of precession remains the same and trailing edge begins to catch up the leading edge.At specific time later two edges are superimposed.The magnetic moment are now momentarily in phase. The spin echo now contains T1 & T2 information as T2* dephasing has been reduced.
To Summarize
Short TR short TE T1 Long TR long TE T2 Long TR short TE -- PD
In Spin Echo: Long TR-2000 ms Short TR-250-700 ms Long TE-60 ms+ Short TE-10-25 ms
Contrast values (Gradient echo) PD weighted: Small flip angle (no T1), long TR (no T1) and short TE (no T2*) T1 weighted: Large flip angle (70), short TR (less than 50ms) and short TE T2* weighted: Small flip angle, some longer TR (100 ms) and long TE (20 ms)
Gradient-echo MRI is capable of detecting millimeter-size paramagnetic blood products in brain parenchyma, and has a greater sensitivity than spin-echo sequences. Microhaemorrhages appear larger than they are due to the blooming effect (due to distortion of the local magnetic field). Microhaemorrhages are visible for many years because haemosiderin is stored in macrophages. Causes of Microhaemorrhages other than trauma include: hypertensive vasculopathy; cerebral amyliod angiopathy; cerebral cavernous malformations; cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL); and cerebral infarcts.
Dr. MD. Mofazzal Sharif
This 20 year-old female patient had a follow-up MRI after head injury 4 months previously. The axial gradient-echo (FLASH) sequence shows punctuate areas of signal loss at the grey-white interface in the frontal lobes.
Instrumentation
The Magnet RF Coils Gradients Coils
The Magnet
The main component of the MR scanner is the magnet itself. Higher magnetic field strength magnet has shorter scanning time (Aligning time less) and better resolution. (Because there are more excess protons available to make the MRI signal as MFS increases and there is better SNR). Magnet may be permanent , resistive or superconductive. But superconductive magnet is best for imaging but superconductivity needs better cooling. To maintain this cooling the magnet is enclosed and cooled by a cryogen containing liquid helium (sometimes also nitrogen) which has to be topped-up (added) on a monthly basis. Imperfections in the superconductive windings means that the scanner will lose its magnetic field strength 5-10 G per year. Far more serious thing happens, when the magnet suddenly loses its superconductivity and begins to heat Sharif causing the cryogens to boil up Dr. MD. Mofazzal and escape.
On the right is a picture of a 1.5 Tesla system, a Philips intera. Also shown in this picture is the RF head coil on the patient bed.
Other types of whole-body scanner include open systems which use vertically orientated field designs to reduce claustrophobia or enable surgical procedures to be carried Dr. MD. Mofazzal Sharif out.
RF Coils
This is used to transmit and receive RF pulse. Smaller the coil better the resolution. In order to optimize signal-to-noise ratio (SNR), the RF coils should cover only the volume of interest. This is because the coil is sensitive to noise from the whole volume while the signal comes from the slice of interest. The most homogenous coils are of a 'birdcage' design. Examples of these include the head and body coils. The body coil is integrated into the scanner bore and cannot be seen by the patient. Surface coils, as the name suggests, are used for imaging anatomy near to the coil. Quadrate or circularly-polarized coils comprise two coils 90 apart to improve SNR by a factor of 2.
Gradient Coil
This is separate coil used to modify the main magnetic field during scanning for short period of time without movement of the patient or the machine.
isocentre
Gradient in z-direction Gz
B0
Slice Selection
This is done by using the gradient coil. Protons alone the gradient field in the desired slice have different frequencies and send RF signals only from these frequencies which create an image. The slice thickness can be altered by using different gradient strengths or RF bandwidths. This slice selection is done alone the Z-axis. But to determine a point in a slice another two gradients are used. 1. Frequency encoding gradient. 2. Phase encoding gradient.
Dr. MD. Mofazzal Sharif
Frequency Encoding
It sends RF pulse after slice selection gradient. This is done along the Y-axis direction. Protons alone the Y-gradient field in the desired slice have different frequencies and send RF signals only from Y-axis which create an image.
Phase encoding
Phase encoding gradient sends RF pulse after frequency encoding. This is done along the X-axis direction. Protons alone the X-gradient field in the desired slice have different frequencies and send RF signals only from X-axis which create an image.
The signal in X- axis after FT is represented as lines. These are called K- space.
Fourier Transform (FT): By this process computer can analyze a mixture of signals that come out of a slice and determine the intensity of the component that have different frequencies phases.
3.5 2.5 1.5 0.5 -0.5 -1.5 -2.5 -3.5 S1 S1 S2 S1 S3 S2 S3
S1 has amplitude a and frequency f S2 has a/2 and 3f S3 = S1 + S2 S3 is two sine waves of different frequency and amplitude The FT is shown
S(t) = a0 + a1sin(w1t + f1) + a2sin(w2t + f2) + ...
Spin-echo sequence
Gradient Echoes
A second type of echo important in MRI is the gradient echo. In contrast to the SE it is formed by applying a gradient and then reversing the direction of this gradient. It does not require a 180 RF pulse meaning that one advantage is faster imaging time. However, the images are inherently T2* weighted as the decay due to B0 inhomogeneities is not recovered, and they are therefore prone to susceptibility artifacts.
Dr. MD. Mofazzal Sharif
Other Sequences
The majority of the many other sequences in common use are variations of the above two. For instance a Multi-Spin Echo simply uses more than one 180o pulse to create separate echo images at increasingly longer echo times. The sequence can be used to measure T2 by fitting the signal decay at each echo time.
A subtle but important difference in the Fast Spin-Echo sequence is that echoes are closely spaced so, the signal at each echo can be used to form a single image. Therefore in real time the total phase-encoding needed to be performed can be done much faster. The factor by which the sequence is speeded up compared to a normal SE sequence is given by the echo-train length (the number of echoes which are individually phaseencoded). The greater this number or the bigger the spacing between the echoes, then the poorer the quality of the final image.
One final sequence worth considering is Echo-Planar Imaging or EPI. To fully appreciate the utility of EPI we must first consider kspace. K-space is an array of numbers whose FT gives the MR image. Each row (or line) in k-space corresponds to the echo data collected with each application of the phase-encoding gradient. The cells in k-space DO NOT equate one-to-one with the pixels in the image; in fact each cell contains information about every image pixel. Rows near to the centre of k-space correspond to low-order (small amplitude) phase encoding steps and are therefore related to the bulk of the image signal/contrast. The edges of k-space correspond to high-order gradient steps, where the image detail can be found. To fully image an object data in the whole of k-space must be collected. By acquiring only part of k-space (or fewer 'lines') the scan will be much faster but image quality will be compromised.
Dr. MD. Mofazzal Sharif
The image in the middle was acquired with full kspace, while for the left hand image only the outer edges of k-space were collected and as a result only the edges or detail are present in the image. Conversely by acquiring only the central portion of k-space (right image) more of the signal is produced but the detail is missing.
Figure: (above) Examples of images obtained with full and partial k-space.
Various MR Techniques
Although MR delivers excellent soft-tissue contrast sometimes there is a need to administer exogenous contrast usually an intravenous injection of some paramagnetic agent, most commonly Gd-DTPA.
The effect of this agent is to shorten the relaxation time of local spins causing a decrease in signal on T2-weighted images and an increase on T1weighted images.
Dr. MD. Mofazzal Sharif
The example in the Figure shows brain images both before and after contrast allow disruptions in the blood-brain barrier to be investigated. The increased vascularity of tumors produces a preferential uptake of contrast agent and the technique can be used to better visualize these from surrounding normal tissue. Furthermore if MR scans are repeatedly acquired following the contrast injection, the dynamic nature of contrast uptake can be examined, which may improve the differentiation of benign and malignant disease.
Fat Suppression
An important technique in MRI is fat suppression i.e. removing the high signal fat component from the image. There are many ways in which this can be achieved but each method relies on either the resonant frequency (chemical shift) or relaxation time differences between water and fat. In the Chemical selective saturation method a preparatory pulse sequence is acquired which utilizes a narrow bandwidth RF pulse to excite the fat peak alone. The fat magnetization is then deliberately dephased in the transverse plane leaving only the water availableMofazzal subsequent detection. Dr. MD. for Sharif
Another common method is the STIR sequence (Short TI Inversion Recovery). This sequence uses a 180 RF pulse to invert water and fat spins, then waits a given time (about 180 ms at 1.5 Tesla) for the more rapidly-recovering fat peak to reach the null point (i.e. the point at which it passes through the transverse plane). At this point a 90 'inspection' pulse flips the magnetization into the transverse plane so that the fat peak is zero but the water peak, which still had a negative z component, is measured. The disadvantage of this technique is that the timing of the sequence has to be fixed, so the weighting in the final image cannot be altered. SPIR, or Spectral Presaturation with Inversion Recovery, is a combination of the two previous methods, only the fat is excited and then inverted as in the STIR method. The Dixon method involves acquiring images with fat and water in or out of phase and performing an image subtraction.
Figure: Example of an axial breast image pre and post fat suppression.
An example of fat suppression (using the first method) is given in the Figure for the breast. The bright fat signal in the left has been removed in the right image permitting a better visualizationDr. MD. Mofazzal Sharif of breast parenchyma.
MR Angiography
One of the biggest growing areas for MRI is angiography. In normal circumstances flow effects cause unwanted artifacts, but in MRA these phenomena are used advantageously to permit the non-invasive imaging of the vascular tree. Techniques can be generally divided into 'white' or 'black' blood methods depending on whether moving spins (blood) appear brighter or darker than stationary tissue. In high-velocity signal loss, blood which has moved inbetween the 90 and 180 pulses will not produce a signal and appears darker than tissue which has experienced both pulses.
Dr. MD. Mofazzal Sharif
A short TR is used so that spins in the imaging slice become quickly saturated (recover to a constant value) but 'fresh' spins flowing into this slice have their full magnetization available and therefore emit a high signal. This technique works best over thin sections and when blood flow is perpendicular to the imaging plane. Another increasingly used method is simply to take advantage of the high signal from i.v. contrast-agents. Although current clinical agents are extracellular, and quickly distribute into the extravascular space, accurate timing of the imaging sequence following the contrast injection can provide excellent results. The image in the Figure on the right is an example of what can be achieved. Other techniques include stepping or moving table MRA, where multiple MD. Mofazzal Sharif (called table positions Dr. stations) are used to image peripheral arteries.
Functional MRI
Functional MRI is a technique for examining brain activation which unlike PET (Positron Emission Tomography)and is non-invasive with relatively high spatial resolution. The most common method utilizes a technique called BOLD (Blood Oxygen Level Dependent) contrast. This is an example of endogenous contrast, making use of the inherent signal differences in blood oxygenation content. In the normal resting state, a high concentration of deoxyhaemoglobin attenuates the MR signal due to its paramagnetic nature. However, neuronal activity, in response to some task or stimulus, creates a local demand for oxygen supply which increases the fraction of oxyhaemoglobin causing a signal increase on T2 or T2*-weighted images.
Dr. MD. Mofazzal Sharif
The patient is subjected to a series of rest and task intervals, during which MR images are repeatedly acquired. The signal changes during this time course are then examined on a pixelby-pixel basis to test how well they correlate with the known stimulus pattern. Pixels that demonstrate a statistically significant correlation are highlighted in colour and overlayed onto a grayscale MRI image to create an activation map of the brain. The location and extent of activation is linked to the type of task or stimulus performed, for example a simple thumbfinger movement task will produce activation in the primary motor cortex.
Functional MRI
In this case a patient was asked to perform a finger-thumb movement for 30 s, repeated three times and interspersed with 30 s periods of rest. Post-processing on a computer established which pixels in the brain had 'activated' during this task and these are displayed in orange. The plot on the right illustrates that the pattern of signal change in this region (shown in blue) closely followed the stimulus pattern (red). fMRI is widely used as a research tool for examining brain function. Clinically, it is finding application in the surgical or radiotherapy planning of patients with tumors to ensure that vital functions are preserved following these interventions.
Functional MRI
Figure: Example of motor cortex activation Dr. MD. Mofazzal Sharif in a patient study.
Diffusion-Weighted MRI
Diffusion refers to the random motion of molecules along a concentration gradient. Diffusion-weighted MRI uses the motion of spins to produce signal changes. Here, Gradients with equal amplitude but opposite polarity are applied over a given interval. Stationary tissue will be dephased and rephased equally, whereas spins which have moved during the interval will suffer a net dephasing and signal loss. Signal attenuation will depend on the degree of diffusion and the strength and timing of the gradients, the latter expressed by the gradient factor or b-factor.
Dr. MD. Mofazzal Sharif
Although a wide area of research, the major clinical use for DWI at the moment remains in stroke, where cell swelling caused by ischemia leads to changes which can be demonstrated with DW-MRI much sooner than with conventional MRI.
MR Spectroscopy
MR Spectroscopy is a technique for displaying metabolic information from an image. It relies on the inherent differences in resonant frequency or the chemical shift that exists due to different chemical environments. MR signal is measured and a spectrum plotting amplitude against frequency is displayed. By using a standard reference the chemical species of each peak can be determined. For proton MRS, the reference compound is Tetramethylsilane (TMS). All chemical shifts are expressed as frequency differences from this compound giving a field-independent parts per million (ppm) scale. Using this standard gives water its characteristic peak at 4.7 ppm. Spectra of any 'MR visible' nucleus can be obtained (e.g. 31P, 17F, 13,C) so long as the RF coil is tuned to the specific resonant frequency. In proton MRS, an important consideration is the concentration differences between the metabolites of interest and the overwhelming fat and water peaks which need to be suppressed prior to acquisition.
Dr. MD. Mofazzal Sharif
Since MRS relies on detecting frequency differences another method is needed to localize the signal. Most methods use the intersection of three sliceselect RF pulse to excite a volume of interest (called a voxel). Multiple voxels can be acquired by using phase encoding in each of the desired dimensions. This technique, called Chemical shift imaging, is useful in isolating individual peaks and displaying the integrated area as a colour scale to produce a metabollic map.
Dr. MD. Mofazzal Sharif
Figure: Example of single voxel proton MRS in normal and malignant brain tissue.
The example in the Figure below illustrates the potential clinical use of MRS. The spectrum on the left was acquired in normal healthy brain tissue and displays the characteristic high N-AcetylAspartate peak (NAA). On the right is a spectrum taken from a slightly enlarged but otherwise normal looking part of the Medulla, which did not show any enhancement with Gadolinium. In this case the NAA peak is absent indicating loss of viable tissue, and the chorine peak is elevated, which is indicative of the high cell proliferation in tumors
Artifacts
Phase-wrap or 'Aliasing' Aliasing can occur in either the phase or frequency direction but is mainly a concern in the phase direction. This effect occurs whenever there is an object or patient anatomy outside the selected field-of-view but within the sensitive volume of the coil.
Chemical Shift
This artifact arises due to the inherent differences in the resonant frequency of the two main components of an MR image: fat and water. It is only seen in the frequency direction.
Susceptibility
The susceptibility of a material is the tendency for it to become magnetized when placed in a magnetic field. Materials with large differences in susceptibility create local disturbances in the magnetic field resulting in nonlinear changes of resonant frequency, which in turn creates image distortion and signal changes. The problem is severe in the case of ferromagnetic materials but can also occur at air-tissue boundaries. This example was acquired in a patient who had permanent dental work. It did not create any problems for the patient but the huge differences in susceptibility caused major distortions and signal void in the final image.
Dr. MD. Mofazzal Sharif
Susceptibility
Other Artefacts
An RF or zipper artifact is caused by a breakdown in the integrity of the RF-shielding in the scan room. Interference from an RF source causes a line or band in the image, the position and width of which is determined by the frequencies in the source.
A Criss-cross or Herringbone artifact occurs when there is an error in data reconstruction. In this example in the breast two window levels have been used to display the artifact clearly.
A DC-offset leads to the central point artifact, a bright spot at the centre of the image.
Safety
Although MRI is completely safe, it is instructive to consider how the scanner interacts with the patient. To put this section into historical context, in 1980 there were concerns about using field strengths as little as 0.35 T but within 6 years this 'safe' limit had moved up to 2.0 T. Similarly, gradient performances were limited to 3 T/s in the mid-1980s whereas today MRI is routinely performed with gradients exceeding 50 T/s. What follows is a summary of each particular safety issue associated with MRI is intended to be educational and certainly should not be misconstrued: MRI is entirely safe
Dr. MD. Mofazzal Sharif