Magnetic Resonance Imaging (MRI)

• Also called nuclear magnetic resonance imaging (NMRI), or magnetic resonance

tomography (MRT).
• MRI is a medical imaging technique or a radiology technique used to visualize internal
structures of the body in detail.
• MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of
atoms inside the body.
• Unlike CT scans or traditional X-rays, MRI does not use ionizing radiation.
• In many cases MRI gives different information about structures in the body than can be seen
with an X-ray, ultrasound, or CT scan.
• An MRI scan uses magnetism, radio waves, and a computer to produce images of body
structures.
• Reflecting the fundamental importance and applicability of MRI in medicine, Paul
Lauterbur of the University of Illinois at Urbana-Champaign and Sir Peter Mansfield of the
University of Nottingham were awarded the 2003 Nobel Prize in Physiology or Medicine
for their "discoveries concerning magnetic resonance imaging".

Principle:
• MRI is a test that uses a magnetic field and pulses of radio wave energy to make pictures of
organs and structures inside the body.
• Proton nuclear magnetic resonance (NMR) detects the presence of hydrogens (protons) by
subjecting them to a large magnetic field to partially polarize the nuclear spins, then exciting
the spins with properly tuned radio frequency (RF) radiation, and then detecting weak radio
frequency radiation from them as they "relax" from this magnetic interaction. The frequency
of this proton "signal" is proportional to the magnetic field to which they are subjected
during this relaxation process.
• The proton NMR signals are quite sensitive to differences in proton content that are
characteristic of different kinds of tissue.
• In the medical application known as Magnetic Resonance Imaging (MRI), an image of a
cross-section of tissue can be made by producing a well-calibrated magnetic field gradient
across the tissue so that a certain value of magnetic field can be associated with a given
location in the tissue. Since the proton signal frequency is proportional to that magnetic
field, a given proton signal frequency can be assigned to a location in the tissue. This
provides the information to map the tissue in terms of the protons present there. Since the
proton density varies with the type of tissue, a certain amount of contrast is achieved to
image the organs and other tissue variations in the subject tissue.

1 - SRV
• Since the MRI uses proton NMR, it images the concentration of protons. Many of those
protons are the protons in water, so MRI is particularly well-suited for the imaging of soft
tissue, like the brain, eyes, and other soft tissue structures in the head. The bone of the
skull doesn't have many protons, so it shows up dark. Also the sinus cavities image as a
dark region.
• Bushong's assessment is that about 80% of the body's atoms are hydrogen atoms, so most
parts of the body have an abundance of sources for the hydrogen NMR signals which make
up the magnetic resonance image.
• Water constitutes about two thirds of the human body weight, and this high water
content explains why magnetic resonance imaging has become widely applicable to
medicine. There are differences in water content among tissues and organs. In many
diseases the pathological process results in changes of the water content, and this is
reflected in the MRI. Water is a molecule composed of hydrogen and oxygen atoms. The
nuclei of the hydrogen atoms are able to act as microscopic compass needles. When the
body is exposed to a strong magnetic field, the nuclei of the hydrogen atoms are directed
into order – stand "at attention". When submitted to pulses of radio waves, the energy
content of the nuclei changes. After the pulse, a resonance wave is emitted when the
nuclei return to their previous state. The small differences in the oscillations of the nuclei
are detected. By advanced computer processing, it is possible to build up a three-
dimensional image that reflects the chemical structure of the tissue, including differences
in the water content and in movements of the water molecules. This results in a very
detailed image of tissues and organs in the investigated area of the body. In this manner,
pathological changes can be documented.

Scanner:

• MRI scanning uses magnetism, radio waves, and a computer to produce images of body
structures.
• It does not use radiation (x-rays).
• The MRI scanner is a large tube surrounded by a giant circular magnet.
• The patient is placed on a moveable bed that is inserted into the magnet.
2 - SRV
• The magnet creates a strong magnetic field that aligns the protons of hydrogen atoms,
which are then exposed to a beam of radio waves.
• This spins the various protons of the body, and they produce a faint signal that is detected
by the receiver portion of the MRI scanner.
• The receiver information is processed by a computer, and an image is produced.
• For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy
of the images.
• Single MRI images are called slices.
• The images can be stored on a computer or printed on film.
• One exam produces dozens or sometimes hundreds of images.
(a) Magnetic field
• MRI scans require a magnetic field with two properties:
 uniform field density
 strength
• The magnetic field cannot vary more than 1/10,000 of 1% and field strength ranges
(depending on the scanner) from 0.2 to 3 teslas in strength in scanners currently used
clinically, with research scanners investigating higher field strengths such as 7 teslas.
• The lower field strengths can be achieved with permanent magnets, which are often used in
"open" MRI scanners for claustrophobic patients.
• Higher field strengths can be achieved only with superconducting magnets. An MRI with a
3.0 tesla strength magnet may be referred to as a "3-T MRI" or "3-tesla MRI"
• Since the gradient coils are within the bore of the scanner, there are large forces between
them and the main field coils, producing most of the hammering noise that is heard during
operation. Without efforts to damp this noise, it can approach 130 decibels (dB) with strong
fields.
(b) Contrast agents and implants
• MRI contrast agents may be injected intravenously to enhance the appearance of blood
vessels, tumors or inflammation.
• Contrast agents may also be directly injected into a joint in the case of arthrograms: MRI
images of joints.
• The most commonly used intravenous contrast agents are based on chelates of gadolinium.
Recently, a new contrast agent named gadoxetate, brand name Eovist (US) or Primovist
(EU), was approved for diagnostic use.
(c) Portable instruments
• Portable magnetic resonance instruments are available for use in education and field
research. Using the principles of Earth's field NMR, they have no powerful polarizing

3 - SRV
 magnet, so that such instruments can be small and inexpensive. Some can be used for both
EFNMR spectroscopy and MRI imaging. The low strength of the Earth's field results in poor
signal to noise ratios (SNR), requiring long scan times to capture spectroscopic data or build
up MRI images. However, the extremely low noise floor of SQUID-based MRI detectors
and the low density of thermal noise in the low-frequency operating range (tens of
kiloHertz) may result in usable SNR approaching that of mid-field conventional
instruments. Further, the ultra-low field technologies enable electron spin resonance
detection, and potentially imaging, at safe operating frequencies.
• Research with atomic magnetometers has addressed the possibility of cheap and portable
MRI instruments without a large magnet.
(d) Basic MRI scans:
• T1-weighted MRI; T2-weighted MRI; T*2-weighted MRI; TSpin density weighted MRI.
(e) Specialized MRI scans:
• Diffusion MRI; Magnetization transfer MRI; T1rho or T1ρ MRI; Fluid attenuated inversion
recovery (FLAIR); Magnetic resonance angiography; Magnetic resonance gated intracranial
CSF dynamics (MR-GILD); Magnetic resonance spectroscopy; Functional MRI (fMRI); Real-
time MRI; Interventional MRI; Radiation therapy simulation; Current density imaging
(CDI); Magnetic resonance guided focused ultrasound; Multinuclear imaging; Susceptibility
weighted imaging (SWI); Prepolarized MRI or PMRI.
(f) Other specialized MRI techniques:
• New methods and variants of existing methods are often published when they are able to
produce better results in specific fields. Examples of these recent improvements are T*
2-weighted turbo spin-echo (T2 TSE MRI), double inversion recovery MRI (DIR-MRI) or
phase-sensitive inversion recovery MRI (PSIR-MRI), all of them able to improve imaging
of brain lesions. Another example is MP-RAGE (magnetization-prepared rapid acquisition
with gradient echo), which improves images of multiple sclerosis cortical lesions.

Procedure:
• A strong magnetic field is created by passing an electric current through the wire loops.
• While this is happening, other coils in the magnet send and receive radio waves.
• This triggers protons in the body to align themselves.
• Once aligned, radio waves are absorbed by the protons, which stimulate spinning.
• Energy is released after "exciting" the molecules, which in turn emits energy signals that are
picked up by the coil.
• This information is then sent to a computer which processes all the signals and generates it
into an image.
• The final product is a 3-D image representation of the area being examined.

4 - SRV
 Working of MRI machine
• MRI machines make use of the fact that body tissue contains lots of water, and hence
protons (1H nuclei), which will be aligned in a large magnetic field. Each water molecule has
two hydrogen nuclei or protons. When a person is inside the powerful magnetic field of the
scanner, the average magnetic moment of many protons becomes aligned with the direction
of the field. A radio frequency current is briefly turned on, producing a varying
electromagnetic field. This electromagnetic field has just the right frequency, known as the
resonance frequency, to be absorbed and flip the spin of the protons in the magnetic field.
After the electromagnetic field is turned off, the spins of the protons return to
thermodynamic equilibrium and the bulk magnetization becomes realigned with the static
magnetic field. During this relaxation, a radio frequency signal (electromagnetic radiation in
the RF range) is generated, which can be measured with receiver coils.
• Information about the origin of the signal in 3D space can be learned by applying additional
magnetic fields during the scan. These additional magnetic fields can be used to generate
detectable signals only from specific locations in the body (spatial excitation) and/or to
make magnetization at different spatial locations precess at different frequencies, which
enables k-space encoding of spatial information. The 3D images obtained in MRI can be
rotated along arbitrary orientations and manipulated by the doctor to be better able to detect
tiny changes of structures within the body. These fields, generated by passing electric
currents through gradient coils, make the magnetic field strength vary depending on the
position within the magnet. Because this makes the frequency of the released radio signal
also dependent on its origin in a predictable manner, the distribution of protons in the body
can be mathematically recovered from the signal, typically by the use of inverse Fourier
transform.
• Protons in different tissues return to their equilibrium state at different relaxation rates.
Different tissue variables, including spin density, T1 and T2 relaxation times, and flow and
spectral shifts, can be used to construct images. By changing the settings on the scanner, this
effect is used to create contrast between different types of body tissue or between other
properties, as in fMRI and diffusion MRI.
• The MRI examination requires specialized equipment that uses a powerful, constant
magnetic field, rapidly changing local magnetic fields, radiofrequency energy, and
dedicated equipment including a powerful computer to create very clear pictures of internal
body structures.

Advantages:
• Even though the spatial resolution of MRI is not as great as a conventional x-ray film, its
contrast resolution is much better for tissue. MRI can create more detailed images of the
human body than are possible with X-rays.
• Rapid scanning and computer reconstruction give well-resolved images of organs.
• The image and resolution produced by MRI is quite detailed and can detect tiny changes of
structures within the body.

5 - SRV
 Applications:
• MRI provides good contrast between the different soft tissues of the body, which makes it
especially useful in imaging the brain, muscles, the heart, and cancers compared with other
medical imaging techniques such as CT or X-rays. Unlike CT scans or traditional X-rays,
MRI does not use ionizing radiation.
• MRI is used to image every part of the body, and is particularly useful for tissues with many
hydrogen nuclei and little density contrast, such as the brain, muscle, connective tissue and
most tumors.

Sequential sections from an MRI of the brain, concurrently showing slices through
transverse, sagittal, and coronal planes (left to right).

Para-sagittal MRI of the head, with aliasing artifacts (nose and forehead appear at the
back of the head)

• In clinical practice, MRI is used to distinguish pathologic tissue (such as a brain tumor) from
normal tissue.
• One advantage of an MRI scan is that it is harmless to the patient. It uses strong magnetic
fields and non-ionizing electromagnetic fields in the radio frequency range, unlike CT scans
and traditional X-rays, which both use ionizing radiation.
• While CT provides good spatial resolution (the ability to distinguish two separate structures
at a small distance from each other), MRI provides comparable resolution with far better

6 - SRV
 contrast resolution (the ability to distinguish the differences between two similar but not
identical tissues). The basis of this ability is the complex library of pulse sequences that the
modern medical MRI scanner includes, each of which is optimized to provide image
contrast based on the chemical sensitivity of MRI.

Effects of TR and TE on MR signal

• For example, with particular values of the echo time (TE) and the repetition time (TR),
which are basic parameters of image acquisition, a sequence takes on the property of T2-
weighting. On a T2-weighted scan, water- and fluid-containing tissues are bright (most
modern T2 sequences are actually fast T2 sequences) and fat-containing tissues are dark.
The reverse is true for T1-weighted images. Damaged tissue tends to develop edema, which
makes a T2-weighted sequence sensitive for pathology, and generally able to distinguish
pathologic tissue from normal tissue. With the addition of an additional radio frequency
pulse and additional manipulation of the magnetic gradients, a T2-weighted sequence can
be converted to a FLAIR sequence, in which free water is now dark, but edematous tissues
remain bright. This sequence in particular is currently the most sensitive way to evaluate the
brain for demyelinating diseases, such as multiple sclerosis.
• The typical MRI examination consists of 5–20 sequences, each of which is chosen to provide
a particular type of information about the subject tissues. This information is then
synthesized by the interpreting physician.
• Molecular imaging of disease biomarkers by MRI:
 MRI has the advantages of having very high spatial resolution and is very adept at
morphological imaging and functional imaging. MRI does have several disadvantages
though. First, MRI has a sensitivity of around 10−3 mol/L to 10−5 mol/L which,
compared to other types of imaging, can be very limiting. This problem stems from the
fact that the difference between atoms in the high energy state and the low energy state
is very small. For example, at 1.5 teslas, a typical field strength for clinical MRI, the
difference between high and low energy states is approximately 9 molecules per 2
million. Improvements to increase MR sensitivity include increasing magnetic field
strength, and hyperpolarization via optical pumping or dynamic nuclear polarization.
There are also a variety of signal amplification schemes based on chemical exchange that
increase sensitivity.
 To achieve molecular imaging of disease biomarkers using MRI, targeted MRI contrast
agents with high specificity and high relaxivity (sensitivity) are required. To date, many
studies have been devoted to developing targeted-MRI contrast agents to achieve
molecular imaging by MRI. Commonly, peptides, antibodies, or small ligands, and small
7 - SRV
 protein domains, such as HER-2 affibodies, have been applied to achieve targeting. To
enhance the sensitivity of the contrast agents, these targeting moieties are usually linked
to high payload MRI contrast agents or MRI contrast agents with high relaxivities.
• 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 or lung 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.
• It is a procedure used in hospitals to scan patients and determine the severity of certain
injuries.
• In general, MRI creates pictures that can show differences between healthy and unhealthy
tissue.
• Doctors use MRI to examine the brain, spine, joints (e.g., knee, shoulder, wrist, and ankle),
abdomen, pelvic region, breast, blood vessels, heart and other body parts.

8 - SRV
 Benefits and Risks
• Unlike CT, MRI uses no ionizing radiation and is generally a very safe procedure.
• Nonetheless the strong magnetic fields and radio pulses can affect metal implants,
including cochlear implants and cardiac pacemakers.
• There are many electronically activated devices that have approval from the US FDA to
permit MRI procedures in patients under highly specific MRI conditions.
• In the case of cochlear implants, the US FDA has approved some implants for MRI
compatibility.
• In the case of cardiac pacemakers, the results can sometimes be lethal, so patients with such
implants are generally not eligible for MRI.
• Despite being painless, MRI scans can be unpleasant for those who are claustrophobic or
otherwise uncomfortable with the imaging device surrounding them. Older closed bore
MRI systems have a fairly long tube or tunnel. The part of the body being imaged must lie at
the center of the magnet, which is at the absolute center of the tunnel. Because scan times on
these older scanners may be long (occasionally up to 40 minutes for the entire procedure),
people with even mild claustrophobia are sometimes unable to tolerate an MRI scan without
management. Some modern scanners have larger bores (up to 70 cm) and scan times are
shorter. This means that claustrophobia could be less of an issue, and more patients may
now find MRI to be a tolerable procedure.
• One advantage of an MRI scan is that it is harmless to the patient. It uses strong magnetic
fields and non-ionizing electromagnetic fields in the radio frequency range.
• MRI has the advantages of having very high spatial resolution.
• A number of features of MRI scanning can give rise to risks. These include:
 Powerful magnetic fields
 Radio waves
 Cryogenic liquids
 Noise
 Claustrophobia
• In addition, in cases where MRI contrast agents are used, these also typically have
associated risks.
• Overuse: Medical societies issue guidelines for when physicians should use MRI on patients
and recommend against overuse. MRI can detect health problems or confirm a diagnosis,
but medical societies often recommend that MRI not be the first procedure for creating a
plan to diagnose or manage a patient's complaint. A common case is to use MRI to seek a
cause of low back pain; the American College of Physicians, for example, recommends
against this procedure as unlikely to result in a positive outcome for the patient.
Nevertheless, MRI has the advantage of not utilizing ionizing radiation to create medical
images, unlike other imaging modalities such as CT and conventional radiography.

9 - SRV
• Magnetic field: Some types of medical implants are generally considered contraindications
for MRI examinations, while others may be acceptable for patients under high specific MRI
conditions. Patients are therefore always asked for complete information about all implants
before entering the room for an MRI scan. Several deaths have been reported in patients
with pacemakers who have undergone MRI scanning without appropriate precautions. To
reduce such risks, implants are increasingly being developed to make them able to be safely
scanned, and specialized protocols have been developed to permit the safe scanning of
selected implants and pacing devices. Cardiovascular stents are considered safe, however.

MR-Safe sign MR-Conditional sign MR-Unsafe sign

Ferromagnetic foreign bodies such as shell fragments, or metallic implants such as surgical
prostheses and ferromagnetic aneurysm clips are also potential risks. Interaction of the
magnetic and radio frequency fields with such objects can lead to trauma due to movement
of the object in the magnetic field or thermal injury from radio-frequency induction heating
of the object.
Titanium and its alloys are safe from attraction and torque forces produced by the magnetic
field, though there may be some risks associated with Lenz effect forces acting on titanium
implants in sensitive areas within the subject, such as stapes implants in the inner ear.
In the United States a classification system for implants and ancillary clinical devices has
been developed by ASTM International and is now the standard supported by the US Food
and Drug Administration:
 MR-Safe — The device or implant is completely non-magnetic, non-electrically
conductive, and non-RF reactive, eliminating all of the primary potential threats during
an MRI procedure.
 MR-Conditional — A device or implant that may contain magnetic, electrically
conductive or RF-reactive components that is safe for operations in proximity to the
MRI, provided the conditions for safe operation are defined and observed (such as
'tested safe to 1.5 teslas’ or ‘safe in magnetic fields below 500 gauss in strength’).
 MR-Unsafe — Nearly self-explanatory, this category is reserved for objects that are
significantly ferromagnetic and pose a clear and direct threat to persons and equipment
within the magnet room.
The very high strength of the magnetic field can also cause "missile-effect" accidents, where
ferromagnetic objects are attracted to the center of the magnet, and there have been
incidents of injury and death. To reduce the risk of projectile accidents, ferromagnetic
objects and devices are typically prohibited in the proximity of the MRI scanner and patients
undergoing MRI examinations are required to remove all metallic objects, often by changing
into a gown or scrubs, and ferromagnetic detection devices are used at some sites.
There is no evidence for biological harm from even very powerful static magnetic fields.

10 - SRV
• Peripheral nerve stimulation (PNS): The rapid switching on and off of the magnetic field
gradients is capable of causing nerve stimulation. Volunteers report a twitching sensation
when exposed to rapidly switched fields, particularly in their extremities. The reason the
peripheral nerves are stimulated is that the changing field increases with distance from the
center of the gradient coils (which more or less coincides with the center of the magnet).
Although PNS was not a problem for the slow, weak gradients used in the early days of
MRI, the strong, rapidly switched gradients used in techniques such as EPI, fMRI, diffusion
MRI, etc. are indeed capable of inducing PNS. American and European regulatory agencies
insist that manufacturers stay below specified dB/dt limits (dB/dt is the change in field per
unit time) or else prove that no PNS is induced for any imaging sequence. As a result of
dB/dt limitation, commercial MRI systems cannot use the full rated power of their gradient
amplifiers.
• Heating caused by absorption of radio waves: Every MRI scanner has a powerful radio
transmitter to generate the electromagnetic field which excites the spins. If the body absorbs
the energy, heating occurs. For this reason, the transmitter rate at which energy is absorbed
by the body has to be limited.
• Acoustic noise: Switching of field gradients causes a change in the Lorentz force
experienced by the gradient coils, producing minute expansions and contractions of the coil
itself. As the switching is typically in the audible frequency range, the resulting vibration
produces loud noises (clicking or beeping). This is most marked with high-field machines
and rapid-imaging techniques in which sound pressure levels can reach 120 dB(A)
(equivalent to a jet engine at take-off), and therefore appropriate ear protection is essential
for anyone inside the MRI scanner room during the examination.
• Cryogens: Many MRI scanners rely on cryogenic liquids to enable the superconducting
capabilities of the electromagnetic coils within. Though the cryogenic liquids used are non-
toxic, their physical properties present specific hazards.
An unintentional shut-down of a superconducting electromagnet, an event known as
"quench", involves the rapid boiling of liquid helium from the device. If the rapidly
expanding helium cannot be dissipated through an external vent, sometimes referred to as a
'quench pipe', it may be released into the scanner room where it may cause displacement of
the oxygen and present a risk of asphyxiation.
Oxygen deficiency monitors are usually used as a safety precaution. Liquid helium, the
most commonly used cryogen in MRI, undergoes near explosive expansion as it changes
from a liquid to gaseous state. The use of an oxygen monitor is important to ensure that
oxygen levels are safe for patient/physicians. Rooms built for superconducting MRI
equipment should be equipped with pressure relief mechanisms and an exhaust fan, in
addition to the required quench pipe.
Because a quench results in rapid loss of cryogens from the magnet, recommissioning the
magnet is expensive and time-consuming. Spontaneous quenches are uncommon, but a
quench may also be triggered by an equipment malfunction, an improper cryogen fill
technique, contaminants inside the cryostat, or extreme magnetic or vibrational
disturbances.

11 - SRV
• Contrast agents: The most commonly used intravenous contrast agents are based on
chelates of gadolinium. In general, these agents have proved safer than the iodinated
contrast agents used in X-ray radiography or CT. Anaphylactoid reactions are rare,
occurring in approx. 0.03–0.1%. Of particular interest is the lower incidence of
nephrotoxicity, compared with iodinated agents, when given at usual doses—this has made
contrast-enhanced MRI scanning an option for patients with renal impairment, who would
otherwise not be able to undergo contrast-enhanced CT.
Although gadolinium agents have proved useful for patients with renal impairment, in
patients with severe renal failure requiring dialysis there is a risk of a rare but serious
illness, nephrogenic systemic fibrosis, which may be linked to the use of certain gadolinium-
containing agents. The most frequently linked is gadodiamide, but other agents have been
linked too. Although a causal link has not been definitively established, current guidelines
in the United States are that dialysis patients should only receive gadolinium agents where
essential, and that dialysis should be performed as soon as possible after the scan to remove
the agent from the body promptly. In Europe, where more gadolinium-containing agents
are available, a classification of agents according to potential risks has been released.
Recently, a new contrast agent named gadoxetate, brand name Eovist (US) or Primovist
(EU), was approved for diagnostic use: this has the theoretical benefit of a dual excretion
path.
• Pregnancy: No effects of MRI on the fetus have been demonstrated. In particular, MRI
avoids the use of ionizing radiation, to which the fetus is particularly sensitive. However, as
a precaution, current guidelines recommend that pregnant women undergo MRI only when
essential. This is particularly the case during the first trimester of pregnancy, as
organogenesis takes place during this period. The concerns in pregnancy are the same as for
MRI in general, but the fetus may be more sensitive to the effects—particularly to heating
and to noise. However, one additional concern is the use of contrast agents; gadolinium
compounds are known to cross the placenta and enter the fetal bloodstream, and it is
recommended that their use be avoided.
• There are no known harmful effects from the strong magnetic field used for MRI. But the
magnet is very powerful. The magnet may affect pacemakers, artificial limbs, and other
medical devices that contain iron. The magnet will stop a watch that is close to the magnet.
Any loose metal object has the risk of causing damage or injury if it gets pulled toward
the strong magnet.
• Metal parts in the eyes can damage the retina.
• Iron pigments in tattoos or tattooed eyeliner can cause skin or eye irritation.
• An MRI can cause a burn with some medication patches.
• There is a slight risk of an allergic reaction if contrast material is used during the MRI. But
most reactions are mild and can be treated using medicine.
• Test is not done when:
 Pregnancy. An MRI test usually is not done during pregnancy. But MRI may be done to
get more information about a possible problem that cannot be seen clearly with
ultrasound.
12 - SRV
  Medical devices that use electronics, such as a pacemaker or medicine infusion pump.
The MRI magnet may cause problems with these devices, and that may keep one from
having an MRI.
 Medical devices that have metal in them. The metal might make some of the detailed
MRI pictures blurry. This may prevent the doctor from seeing the organ that is being
looked at. For example, an intrauterine device (IUD) with metal may prevent doctor
from seeing the uterus clearly.
 Inability to remain still during the test.
 Obesity. A person who is very overweight may not fit into standard MRI machines.
• MRI has been shown to be extremely safe as long as proper safety precautions are taken.
• In general, the MRI procedure produces no pain and causes no known short-term or long-
term tissue damage of any kind.
• The powerful magnetic field of the scanner can attract certain metallic objects known as
“ferromagnetic” objects, causing them to move suddenly and with great force towards the
center of the MR system. This may pose a risk to the patient or anyone in the way of the
object. Therefore, great care is taken to prevent ferromagnetic objects from entering the
MR system room. It is vital to remove metallic objects in advance of an MRI exam, including
watches, jewelry, and items of clothing that have metallic threads or fasteners.
• MRI facilities have screening procedures that, when carefully followed, will ensure that the
MRI technologist and radiologist knows about the presence of metallic implants and
materials so that special precautions can be taken. In some unusual cases the examination
may be canceled because of concern related to a particular implant or device. For example, if
an MRI is ordered, it may be cancelled if the patient has a ferromagnetic aneurysm clip
because of the risk dislodging the clip from the blood vessel. Also, the magnetic field of the
scanner can damage an external hearing aid or cause a heart pacemaker to malfunction. If
a bullet or other metallic fragment in present in the body there is a potential risk that it
could change position, possibly causing injury.
• Some conditions may make MRI examination inadvisable:
 Heart pacemaker
 Cerebral aneurysm clip (metal clip on a blood vessel in the brain)
 Pregnancy
 Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain
medication), or implanted nerve stimulators ("TENS") for back pain
 Metal in the eye or eye socket
 Cochlear (ear) implant for hearing impairment
 Implanted spine stabilization rods
 Severe lung disease (such as tracheomalacia or bronchopulmonary dysplasia)
 Gastroesophageal reflux

13 - SRV
  Weight of more than 300 pounds
 Inability to lie on back for 30 to 60 minutes
 Claustrophobia (fear of closed or narrow spaces)
Despite these concerns, MRI is rapidly growing in importance as a way of diagnosing and
monitoring congenital defects of the fetus because it can provide more diagnostic
information than ultrasound and it lacks the ionizing radiation of CT. MRI without contrast
agents is the imaging mode of choice for pre-surgical, in-utero diagnosis and evaluation of
fetal tumors, primarily teratomas, facilitating open fetal surgery, other fetal interventions,
and planning for procedures (such as the EXIT procedure) to safely deliver and treat babies
whose defects would otherwise be fatal.

CT vs MRI
• The use of X-rays, a type of ionizing radiation, in computed tomography (CT) allows for
examination of tissues composed of elements of a higher atomic number than the
surrounding tissues. MRI, in contrast, uses non-ionizing radio frequency (RF) signals to
acquire images and is best suited for soft tissue (although MRI can also be used to visualize
bones, teeth and even fossils).
• Since CT scans use ionizing radiation (X-rays) to produce images, there is a risk of damage
to DNA that can subsequently cause cancer. In 2007, it was estimated that 0.4% of current
cancers in the United States were due to CTs performed in the past, and that in the future
this figure may increase to as high as 1.5–2% based on past rates of CT usage. Unlike CT,
MRI does not use ionizing radiation, although it is associated with other risks.
• Contrast in CT images is generated purely by X-ray attenuation, while a variety of
properties may be used to generate contrast in MR images. By varying the scanning
parameters, tissue contrast can be altered to enhance different features in an image (see
Applications for more details). Both CT and MR images may be enhanced by using contrast
agents. Contrast agents for CT contain elements of a high atomic number relative to the
tissue being investigated, such as iodine or barium, while contrast agents (such as
gadolinium and manganese) for MRI have paramagnetic properties that are used to alter
tissue relaxation times. Commonly used MRI contrast agents may be contraindicated in
people with significant permanent or transient kidney dysfunction.
• CT and MRI scanners are able to generate multiple two-dimensional cross-sections
(tomographs, or "slices") of tissue and three-dimensional reconstructions. MRI can generate
cross-sectional images in any plane (including oblique planes). In the past, CT was limited
to acquiring images in the axial plane (or near axial plane), and so these images were called
Computed Axial Tomography scans (CAT scans). However, the development of multi-
detector CT scanners with near-isotropic resolution allows the CT scanner to produce data
that can be retrospectively reconstructed in any plane with minimal loss of image quality.
For purposes of tumor detection and identification in the brain, MRI is generally superior.
However, in the case of solid tumors of the abdomen and chest, CT is often preferred as it
less affected by motion artifacts. Furthermore, CT usually is more widely available, faster,
and less expensive.
14 - SRV
• MRI is also best suited for cases when a patient is to undergo several exams in the short
term, since it does not expose the patient to the hazards of ionizing radiation. However MRI
is usually contraindicated if the patient has any type of medical implant, such as vagus
nerve stimulators, implantable cardioverter-defibrillators, loop recorders, insulin pumps,
cochlear implants, deep brain stimulators, metallic foreign bodies (e.g., shrapnel or shell
fragments), or metallic implants such as surgical prostheses. These devices can malfunction
or heat up during an MRI scan, so CT scans are considered the safer option for these
patients.
• While CT provides good spatial resolution (the ability to distinguish two separate
structures at a small distance from each other), MRI provides comparable resolution with
far better contrast resolution (the ability to distinguish the differences between two
similar but not identical tissues).
• It uses strong magnetic fields and non-ionizing electromagnetic fields in the radio frequency
range, unlike CT scans and traditional X-rays, which both use ionizing radiation.
• While CT provides good spatial resolution (the ability to distinguish two separate structures
at a small distance from each other), MRI provides comparable resolution with far better
contrast resolution (the ability to distinguish the differences between two similar but not
identical tissues). The basis of this ability is the complex library of pulse sequences that the
modern medical MRI scanner includes, each of which is optimized to provide image
contrast based on the chemical sensitivity of MRI.
• The most commonly used intravenous contrast agents are based on chelates of
gadolinium. In general, these agents have proved safer than the iodinated contrast agents
used in X-ray radiography or CT.

15 - SRV