At the same time, radiologists and clinicians have had to adjust to the pace of change.

Initial concepts MRI basics include formation of magnetic fields from electric currents in loops
of wire, the resonance phenomenon,the hydrogen proton and its frequency of precession, and
absorption of radiofrequency energy. These concepts can then be applied to learn about T1 and
T2 relaxation and contrast and how the acquisition parameters of echo time and repetition time
can be used to achieve these image contrasts. Basic pulse sequences include the spinecho,
multiecho spin-echo, turbo spin-echo, inversion-recovery, and gradient-recalled-echo sequences

Artifacts in magnetic resonance (MR) imaging result from the complex interaction of
contemporary imager subsystems, including the mainmagnet, gradient coils, radiofrequency (RF)
transmitter and receiver,and reconstruction algorithm used.We no longer look to MR imaging
only structural information,but also functional information of various kinds information about
blood flow,cardiac function,biochemical processes,tumor kinetics, and blood oxygen levels for
mapping of brain function. We have gone from the single receiver to the quadrature coil, to
multielement fast receivers and the RF chain has been completely revamped with phased-array
coil imaging and parallel imaging. The high magnetic field strengths and the highperformance
gradients have brought a new awareness of the issue of safety for both clinicians and patients.
The effects of exposure to magnetic fields and the compatibility of the many so-called MR-
compatible or MR-safe surgical implants and other tools are being reinvestigated at high field
strengths. The use of rapid imaging techniques such as echo-planar imaging and half-Fourier
rapid acquisition with relaxation enhancement, or RARE, along with the use of ultra-high-speed
gradients, has raised awareness and concern for the biologic effects of exposure. The main
subsystems are the magnet, gradient coil, RF generator, and computer, the last of which controls
the interplay between subsystems and the reconstruction, storage, and display of the images.
There are many sources of artifacts on MR images. These could broadly be classified as image
reconstruction–related, system-related, and physiology-related sources. Typically, image
reconstruction–related artifacts occur because of limitations intrinsicto the reconstruction
algorithm used by particular vendor. Filling of k-space is accomplished by acquiring frequency
encoded data samples for a given phase encoding step. Sampling is much quicker in the
frequency encoding direction than in the phase encoding direction,where the time between
adjacent samples is greater than or equal to the repetition time of the particular sequence (except
for fast SE and echoplanar imaging sequences). Low spatial frequencies are encoded in the
center of k-space and provide contrast resolution to the image, whereas high spatial frequencies
are encoded toward the edges of k-space and contribute to the spatial

resolution of the image. Fourier transform of k-space is then applied to convert the data into an
image. Each pixel in the resultant image is the weighted sum of all the individual
points in k-space. Therefore, the information in each pixel is derived from a fraction of every
point in k-space. On the basis of these facts, we can conclude that any disruption of k-space,
whether by motion, extraneous frequencies, or frequency spikes, has the potential to corrupt the
entire image.
Abbreviations: ADC-analog-to-digital converter, RF _ radiofrequency, TE _ echo time, TR _
repetition time

Initial Concepts

Production of a Magnetic Field

When an electron travels along a wire, a magnetic field is produced around the electron. When
an electric current flows in a wire that is formed into a loop, a large magnetic field will be
formed perpendicular to the loop.

Resonance

Resonance aids an efficient transfer of energy.

Hydrogen Protons

It is necessary to have a source of hydrogen protons (protons in the nuclei of hydrogen atoms,
which are associated with fat and water molecules) in order to form our MR signal. The
hydrogen proton is positively charged and spins about its axis. The hydrogen protons in our
body thus act like many tiny magnets. When the protons are placed in a strong magnetic field
(B0 ), a net magnetization will be produced parallel to the main magnetic field. This net
magnetization becomes the source of our MR signal and is used to produce MR images.
For typical 1.5-T superconducting cylindrical-bore magnets, the z direction is horizontal and
corresponds to the head-to-foot (or foot-to-head) direction. The plane perpendicular to this
direction is called the transverse plane or the x-y plane. For a patient who is headfirst and
supine in a superconducting magnet, the x direction is often chosen to be the left-right
direction of the patient and the y directionis often chosen to be the anterior-posterior
direction. Interestingly, the transverse plane matches the axial plane for typical 1.5-T magnets.

Precession

The proton precessional frequency is determined from the Larmor equation, in which the
frequency of precession, f, is equal to a constant times the main magnetic field strength .The
constant is called the gyromagnetic ratio and is a characteristic of each type of nuclei. For
hydrogen protons, the gyromagnetic ratio is equal to 42.6 MHz/T (megahertz per tesla). The
main magnetic field strength, B0, depends on the magnet design. For a typical superconducting
MR system, the magnetic field strength may be 1.5 T.The frequency of precession then will qual
2.6 MHz/T 1.5 T or about 64 MHz (64 million times per second).

Radiofrequency Energy
Radiofrequency (RF) energy comes in the form of rapidly changing magnetic and
electric fields generated by electrons traveling through loops of wire with the
direction of current flow rapidly changing back and forth at “radio frequencies.”
The magnetic field (generated by the flow of electrons) will also rapidly change
directions. For the MR system, this RF energy is transmitted by an RF transmit coil
(eg, body coil, head coil, knee coil). Typically, the RF is transmitted for a short
period of time; this is called an RF pulse. This transmitted RF pulse must be at the
precessional frequency of the protons (calculated via the Larmor equation) in order
for resonance to occur and for efficient transfer of energy from the RF coil to the
protons.

Absorption of RF energy. Left: Prior to an

RF pulse, the net magnetization (small black arrow) is
aligned parallel to the main magnetic field and the z
axis. Center and right: An RF pulse at the Larmor frequency
will allow energy to be absorbed by the protons,
thus causing the net magnetization to rotate away from
the z axis.
Longitudinal (T1) relaxation. Application of a 90° RF pulse causes longitudinal
magnetization to become zero. Over time, the longitudinal magnetization will
grow back in a direction parallel to the main magnetic field.
Absorption of RF Energy
Recall that when protons in our body are placed in the vicinity of a strong
magnetic field, the magnetic fields from these protons combine to form a
net magnetization. This net magnetization points in a direction parallel to the
main magnetic field (also called the longitudinal direction). As energy
is absorbed from the RF pulse, the net magnetization rotates away from the
longitudinal direction. The amount of rotation (termed the flip
angle) depends on the strength and duration of the RF pulse. If the RF pulse
rotates the net magnetization into the transverse plane, that is termed a 90° RF
pulse. If the RF pulse rotates the net magnetization 180° into the z direction, that
is termed a 180° RF pulse. The strength and/or duration of
the RF pulse can be controlled to rotate the net magnetization to any angle. We
will see that 90° and 180° RF pulses are important when discussing
the spin echo (SE) and that smaller flip angles are important when discussing fast
imaging techniques as in gradient-recalled-echo (GRE) imaging.
T1 Relaxation and Contrast
Net magnetization that is aligned with the longitudinal direction may be called
longitudinal magnetization. After a 90° RF pulse rotates the longitudinal
magnetization into the transverse plane, this magnetization may be called
transverse magnetization. After a 90° RF pulse, the longitudinal magnetization is
zero. The magnetization then begins to grow back in the longitudinal direction.
This is called longitudinal relaxation or T1 relaxation. The rate at which this
longitudinal magnetization grows back is different for protons associated with
different tissues and is the fundamental source of contrast in T1-weighted
images. T1 is a parameter that is characteristic of specific tissue (and also depends
on the main magnetic field strength) and is related to the rate of regrowth of
longitudinal magnetization. The net magnetization does not rotate back up
but rather increases in a direction always parallel to the longitudinal direction,
which is the direction of the main magnetic field. We can plot an example of this
effect. The definition of T1 is the time that it takes for the longitudinal
magnetization to reach 63% of its final value, assuming a 90° RF pulse (Fig 10). The
magnetization of tissues with different values of T1 will grow back in the
longitudinal direction at different rates.

White matter has a very short T1 time and relaxes rapidly. Cerebrospinal fluid
(CSF) has a long T1 and relaxes slowly. Gray matter has an intermediate T1 and
relaxes at an intermediate rate.

T2 Relaxation and Contrast

The description of T2 (or transverse) relaxation begins with the net magnetization
aligned with the z direction and a 90° RF pulse that rotates this net magnetization
into the transverse plane Recall that the net magnetization is made
up of contributions from many protons, which are all precessing. During the RF
pulse, the protons begin to precess together (they become “in phase”).
Immediately after the 90° RF pulse, the protons are still in phase but begin to
dephase due to several effects.
 Transverse (T2*) relaxation. Immediately after application of a 90° RF pulse,
transverse magnetization is maximized; it then begins to dephase due toseveral
processes (Spin-spin interactions ,Magnetic field inhomogeneities,Magnetic susceptibility
Chemical shift effects). The signals from these dephasing protons begin to cancel out,
and the MR signal decreases.

Definition of T1. T1 is a characteristic of tissue and is defined as the time that it

takes the longitudinal magnetization to grow back to 63% of its final value.
Definition of T2. T2 is a characteristic of tissue and is defined as the time that it
takes the transverse magnetization to decrease to 37% of its starting value.

T2-weighted contrast. Different tissues have different rates of T2 relaxation.

If an image is obtained at a time when the relaxation curves are widely separated,
T2-weighted contrast will be maximized.
Different tissues have different values of T2 and dephase at different
rates. White matter has a short T2 and dephases rapidly. CSF has a long T2 and
dephases slowly. Gray matter has an intermediate T2 and dephases intermediately.
Figures 16, 17. (16) Mechanism of spin echo. After transverse magnetization has
begun to dephase in the transverse plane, application of a 180° RF pulse will rotate
the proton spins to the opposite axis. This rotation will allow
the spins to rephase and form an echo.
(17) Formation of spin echoes. Application of a 90° RF pulse results in an
immediate signal (called a free induction decay [FID]), which rapidly dephases due
to T2* effects. Application of a 180° RF pulse will allow formation of an echo at a
time TE. Multiple 180° pulses will form multiple echoes.

The T1 and T2 relaxation processes occur simultaneously.

After a 90° RF pulse, to dephase in the transverse plane due to effects discussed
earlier (represented by some spins going faster than the average and some spins
going slower than the average) / dephasing of the transverse magnetization (T2
decay) occurs while the longitudinal magnetization grows backparallel to the
main magnetic field. After a few seconds, most of the transverse magnetization is
dephased and most of the longitudinal magnetization has grown back.
After a certain amount of time, if a 180° RF pulse is applied, the spins will rotate
over to the opposite axis. Now, rather than the spins continuing to dephase, the
spins will begin to rephase.The spins will come back together and the signal
measured with our receiver coil will increase, form a maximum signal, and then
decrease as the spins once again diphase. At this time, another 180° RF pulse could
be applied to rephase the spins again. The rephasing of the spins forms an “echo”
called a spin echo. The time between the peak of the 90° RF pulse and
the peak of the echo is called the time to echo or echo time (TE). Note that the
curve formed by connecting the peaks of the echoes represents decay by T2 effects
(spin-spin interactions), whereas the initial faster decay observed immediately
after the 90° RF pulse or during echo formation is due to T2* effects.
Pulse sequence diagram. A pulse sequence diagram can be used to show the
relative timing of certain events during an MR imaging acquisition. The timing of
RF pulses, the signal formed from these pulses,and the digitization of the signal is
shown. TE is shown as the time to the echo, and the repetition time (TR) is shown
as the time it takes to go through the pulse sequence once. This pulse sequence
uses a 90° RF pulse with a 180° RF pulse to rephase spins to form an echo. T1-
and T2-weighted images may be created with this pulse sequence. ADC _ analog-
to-digital converter; in all pulse sequence diagrams, G _ gradient.
The horizontal lines in the pulse sequence diagram indicate the relative timing of
events. Lines are shown for the timing of RF pulses, the signal formed from these
pulses, and when the signal is digitized for storage in the acquisition computer by
the analog-to-digital converter (ADC).
Contrast Formation

(19)Parameters for T1 weighting. Short TE (producing minimal T2 weighting) and

intermediate TR (producing maximal T1 weighting) will result in a T1-weighted
image. (20) Parameters for T2 weighting. Long TE (producing maximal T2
weighting) and long TR (producing minimal T1 weighting) will result in a T2-
weighted image. (21) Parameters for proton density weighting. Short TE
(producing minimal T2 weighting) and long TR (producing minimal
T1 weighting) will result in a proton density–weighted image.
When effects from T2 relaxation are minimized (curves not widely separated) and effects
from T1 relaxation are maximized (curves widely separated), we would produce a T1-
weighted image (Fig 19). If T1 effects are minimized and T2 effects are maximized, we would
produce a T2-weighted image (Fig 20). If both T1 and T2 effects are minimized, we will produce
an image with “proton density” or “spin density” weighting (Fig 21).

TE and TR
TE has already been described as the time between the peak of the 90° RF pulse
and the peak of the echo that is formed. Note that the 180° RF pulse occurs at
half of the echo time TE. A parameter not yet discussed is the repetition time or
TR. TR is the time that it takes to run through the pulse sequence one time.
The raw data have the same number of rows and columns as the reconstructed
image. For basic pulse sequences, one time through the pulse sequence
provides one row of raw data. We must repeat the pulse sequence as many times
as necessary to provide as many rows of data as are needed to reconstruct
the image. TR is the time it takes to go through the pulse sequence one time. In
order to acquire all rows of data, it will take a time equal to TR times ...

Basic Pulse Sequences

Several basic pulse sequences will now be discussed. The first pulse sequence will
be the spinecho sequence. Other pulse sequences will be compared to the spin-echo
sequence; the figures will highlight the differences between that pulse
sequence and the spin-echo sequence.

Spin Echo
The spin-echo pulse sequence can produce proton density weighting, T1
weighting, and T2 weighting. Typical values of TE and TR for T1 weighting (at
1.5 T) are TE _ 20 msec and TR _ 500 msec; the typical values for T2 weighting
are TE _ 80 msec and TR _ 2,000 msec. The 90° RF pulse produces an initial
signal (free induction decay), which is not used. The 180° RF pulse occurs at half
the TE time, and the echo is centered at TE. The ADC (analog-to-digital converter)
line indicates that the echo is digitized and stored in the computer as raw data.
However, instead of each echo forming a different image data set, all the
echoes are used to create a single image data set at a faster rate. A new
acquisition parameter will be introduced called the echo train length, which
is the number of echoes that are formed. Recall that the echo is digitized and the
data from this echo are used for one row of raw data. Recall also that the pulse
sequence must be repeated as many times as is needed to acquire all
the rows of raw data. In the turbo spin-echo sequence, if four echoes are
produced (each time through the pulse sequence), the digitized data
from these four echoes can be used for four different rows of raw data. If 256
rows of raw data are needed, and four rows of raw data are acquired
each time through the pulse sequence, then the sequence must be repeated only
64 times rather than 256 times. With TR the same as in a spinecho
sequence, this would result in a factor of four speed increase in data acquisition.
Likewise, an echo train length of eight or 16 will decrease
imaging time by a factor of eight or 16, respectively.The turbo spin-echo pulse
sequence can be used to produce T1 and T2 contrast weighting.
Each echo will still occur at a different TE and thus will really have a different
contrast weighting associated with it. However, there is a way that we
can use the echoes closest to our TE of interest to form the contrast weighting
that we desire.

Inversion Recovery
The inversion-recovery pulse sequence is useful for suppressing unwanted signals
in MR images (eg, signals from fat or fluid). Contrast weighting can still be
controlled through selection of TR and TE, as described earlier.
The difference between this and the spin-echo pulse sequence is the occurrence
of the 180° RF pulse prior to the regular spin-echo pulse sequence.
The 180° RF pulse causes an initial inversion of the longitudinal magnetization (so
that it is aligned in the z direction). The magnetization then begins to grow
back in the direction of the main magnetic field . The magnetization of different
tissues will grow back at different rates. When the signal from
the tissue to be suppressed crosses the zero axis, application of a 90° RF pulse will
rotate all other signals into the transverse plane. Since the signal
from the tissue at the zero point is zero, there is nothing to rotate into the
transverse plane. Thus, this tissue will not contribute any brightness to
the resulting image. The acquisition parameter TI (time of inversion)
is the time between the initial 180° RF pulse and the 90° RF pulse. Fat relaxes
relatively quickly, and a short TI of approximately 170 msec is used to suppress
signal from fat at a field strength of 1.5 T. This method can also be used
to suppress signal from other tissues that cross through the zero point by
appropriate application of TI for that tissue.

Inversion of the signal in the

inversion- recovery sequence. After initial inversion of the longitudinal
magnetization, T1 relaxation occurs and the signals from different tissues cross
the zero axis at different times. When the signal to be suppressed crosses the zero
axis, a 90° RF pulse will rotate all other signals into the transverse
plane for image formation. TI _ inversion time.
Gradient Recalled Echo
Initial inspection shows the difference between this sequence and the basic spin-
echo sequence to be an initial RF pulse flip angle of something less
than 90° (eg, 20° or 30°) and the lack of a 180° RF pulse. The smaller flip angle and
lack of 180° RF pulse allow the TR to be much shorter, resulting
in very fast imaging times. Even though there is no 180° RF pulse to produce a
spin echo, gradientpulses (which we have not discussed) can be
used to dephase and rephase the signal in thetransverse plane to form gradient
echoes. In this case, T2-weighted image contrast cannot be produced;
rather, T1 and T2* image contrast can be produced.

Gradient-recalled-echo pulse sequence.

This sequence is similar to the spin-echo sequence except that the initial RF pulse
is less than 90° and there is no 180° RF pulse. Signal dephasing and rephasing by
means of gradient pulses results in formation of a gradient echo, which is used to
produce T1- or T2*- weighted images.

DWI
The complex structural organization of the white matter of the brain can be
depicted in vivo in great detail with advanced diffusion magnetic resonance (MR)
imaging schemes. Diffusion MR imaging techniques are increasingly varied, from
the simplest and most commonly used technique—the mapping of apparent
diffusion coefficient values— to the more complex, such as diffusion tensor
imaging, q-ball imaging, diffusion spectrum imaging, and tractography. Current
clinical applications are based on many different types of contrast, such
as contrast in relaxation times for T1- or T2- weighted MR imaging, in time of
flight for MR angiography, in blood oxygen level dependency for functional MR
imaging, and in diffusion for apparent diffusion coefficient (ADC) imaging.

Characteristics of an MRI sequence

The architecture of a sequence consists of the essential components on one hand, and the various options, on the
other. The building blocks of the sequence are radiofrequency pulses and gradients.
The essential components for any imaging sequence are:

 An RF excitation pulse, required for the phenomenon of magnetic resonance

 Gradients for spatial encoding (2D or 3D), whose arrangement will determine how the k-space is filled
 A signal reading, combining one or a number of echo types (spin echo, gradient echo, hahn echo, stimulated
echo…) determining the type of contrast (the varying influence of relaxation times T1, T2and T2*).

The options consist of other radiofrequency pulses, gradients or variable reconstruction methods to:

 Either modify the contrast (preparing magnetization by inversion-recovery, fat saturation, magnetization
transfer…)
 or accelerate the sequence (partial Fourier plane filling, parallel acquisition, fast magnetization restoration…)
 or to reduce artifacts (flow compensation, synchronisation, presaturation bands …)

Finally, the user must choose the sequence parameters (TR, TE, flip angle, turbo factor, field of view matrix) to find
the best compromise between contrast, spatial resolution and speed.
With the exception of inversion-recovery, the optional techniques to modify the contrast of a sequence will be
examined in a dedicated chapter. Likewise, the treatment of artifacts and parallel imaging methods will be dealt with
in separate chapters.

Sequence classification
There are two main sequence families, depending on the type of echo recorded:

 spin echo sequences, characterized by the presence of a 180° rephasing RF pulse

 gradient echo sequences

Numerous variations have been developed within each of these families, mainly to increase acquisition speed:

 Fast spin echo sequences, Single shot FSE and Haste

 Gradient echo sequences with spoiling of residual transverse magnetization (spoiled gradient echo and ultrafast
gradient echo), a group of gradient echo sequences with steady state residual transverse magnetization (Steady
state gradient echo) and its derivatives (Contrast enhanced steady state gradient echo) and with balanced
gradients (Balanced steady state gradient echo), echoplanar (EPI).

Some sequences are hybrid, mixing spin echo and gradient echo (GRASE, SE-EPI).

Magnetic resonance angiography sequences (FBI, contrast-enhanced MRA, TOF, PC) perfusion imaging, diffusion
imaging (DW) and MR spectroscopy will be dealt with in separate chapters in the second part.

Sequences acronyms
Due to manufacturers each using their own terminology to denominate their sequences, there are no standard
denominations for each common type of sequence.
Here is a table of the equivalent manufacturers’ acronyms with the corresponding type of sequence.

Type of sequence Philips Siemens GE Hitachi Toshiba

Spin Echo (SE) SE SE SE SE SE

Multi echo SE Multi SE Multi écho SE SE Multi écho

MS

Fast SE Turbo SE Turbo SE Fast SE Fast SE Fast SE

Ultra fast SE SSH-TSE SSTSE SS-FSE FSE - (Super)FASE

ADA
UFSE HASTE DIET

IR IR IR/IRM IR IR IR

IR TSE TurboIR/TIRM FSE-IR FIR Fast IR

STIR STIR STIR STIR STIR STIR

STIR TSE Turbo STIR Fast STIR Fast Fast STIR

STIR

FLAIR FLAIR FLAIR FLAIR FLAIR FLAIR

FLAIR Turbo FLAIR Fast FLAIR Fast Fast FLAIR

TSE FLAIR

Gradient echo (GE) FFE GRE GRE GE FE

Spoiled GE T1-FFE FLASH SPGR RSSG RF-spoiled
FE
MPSPGR

T1-TFE   FGRE SARGE  

Ultra fast GE
   
T2-TFE Fast SPGR
TurboFLASH Fast FE
 
FMPSPGR
   
THRIVE
VIBE VIBRANT RADIANCE

FAME QUICK 3D

LAVA

Ultrafast GE with magnetization IR-TFE T1/T2- IR-FSPGR Fast FE

preparation TurboFLASH
DE-FSPGR

Steady state GE FFE FISP MPGR, TRSG FE

GRE

Contrast enhanced steady state T2-FFE T2 PSIF SSFP FE

GE

Balanced GE Balanced True FISP FIESTA BASG True SSFP

FFE

SE-Echo planar SE-EPI EPI SE SE EPI SE EPI SE EPI

GE-Echo planar FFE-EPI EPI Perf GRE EPI SG-EPI FE-EPI

TFE-EPI EPIFI

Hybrid echo GRASE TGSE Hybrid EPI

+  SPACE, VISTA, Cube, 3DVIEW 

Spin echo

Type of sequence Philips Siemens GE Hitachi Toshiba

Spin Echo (SE) SE SE SE SE SE

The spin echo sequence is made up of a series of events : 90° pulse – 180° rephasing pulse at TE/2 – signal reading
at TE. This series is repeated at each time interval TR (Repetition time). With each repetition, a k-space line is filled,
thanks to a different phase encoding. The 180° rephasing pulse compensates for the constant field heterogeneities to
obtain an echo that is weighted in T2 and not in T2*.

Gradients and phase in spin echo sequences

The rephasing lobe of the slice selection gradient, the phase encoding gradient and the dephasing lobe of the
readout gradient are applied simultaneously, immediately after the excitation pulse.
The slice selection gradient applied for the 180° pulse requires no rephasing lobe. However, two identical gradient
lobes are applied on either side of this gradient to eliminate the transverse magnetization created by the 180°
rephasing pulse on the edge of the slice (where the protons will in fact be submitted to a flip angle of less than 180°
due to the imperfect slice profile).

Duration of a spin echo sequence

Duration = TR ∙ NPy ∙ Nex
With

 TR = Repetition time
 NPy = Number of phase encoding steps
 Nex = Number of excitations

Contrast
A spin echo sequence has two essential parameters: TR and TE.
TR is the time interval between two successive 90° RF waves. It conditions the longitudinal relaxation of the explored
tissues (depending on T1). The longer the TR, the more complete the longitudinal magnetization regrowth (Mz tends
to M0). Reducing TR will weight the image in T1 as the differences between the longitudinal relaxation of the tissues’
magnetization will be highlighted . In classic spin echo, after TR time, a single k-space line will be acquired. TR
repetition is thus responsible for the duration of the sequence.

 TE is the time interval between the 90° flip and receipt of the echo, the signal being produced by transverse
magnetization. Transverse magnetization decreases according to the time constant T2 of each tissue (the field
heterogeneities [which give T2*] being compensated by the 180° flip applied at TE/2).

In the T2–weighted spin echo sequence the TR and TE parameters are optimized to reflect T2 relaxation.
When the TR is long (over 2000 milliseconds), longitudinal magnetization recovery is complete and on the following
flip, the influence of T1 on signal magnitude will be minimized. Associated with long TE (80 to 140 milliseconds), the
different tissues are better highlighted according to their T2.
Long T2 tissues will appear as a hypersignal, as opposed to short T2 structures, which will appear as a hyposignal.

 The proton density weighted spin echo sequence has optimized TR and TE parameters to minimize the influence of
both T2 and T1. The contrast obtained will depend on the density of the hydrogen nuclei (i.e. protons).
A long TR (over 2000 milliseconds), associated with a short TE (10 to 20 milliseconds) will relatively suppress both
the influence of T1 and the effect of T2 on signal magnitude.
Interest
Historically, spin echo was the first sequence to be used. It has been a benchmark for all subsequent developments,
namely in terms of contrast. The 180° rephasing pulse gives a « true T2 » signal rather than a T2*signal.
Choosing the right sequence parameters (TR and TE) will produce images weighted in T1, T2 or proton density. The
major disadvantage with T2 weighted spin echo sequences is linked to long TR resulting in prohibitive acquisition
times.
While spin echo sequences can be used in clinical practice to obtain good quality anatomical T1-weighted images,
faster types of sequence are preferred to obtain T2-weighted images.

Fast spin echo

Type of sequence Philips Siemens GE Hitachi Toshiba

Multi-echo SE Multi SE Multi écho Multi écho    

MS

Fast SE Turbo SE Turbo SE Fast SE Fast SE Fast SE

In fast spin echo sequences, the interval of time after the first echo, is used to receive the echo train, to fill the other
k-space lines in the same slice . Because of the reduced number of repetitions (TR) required, the k-space is filled
faster and slice acquisition time is reduced.
This is done by applying new 180° pulses to obtain a spin echo train. After each echo, the phase-encoding is
cancelled and a different phase-encoding is applied to the following echo.
The number of echoes received in the same repetition (during TR time) is called the Turbo Factor or Echo Train
Length (ETL).

Multi-echo SE sequences
These sequences allow several images of the same slice position without increasing overall acquisition time. The
advantage is that the images are obtained with a different contrast, which is useful in characterizing certain lesions
(for example, highlighting contrast at long TE for hepatic angioma, which appears as a relative hypersignal).
After the first echo is obtained, there is a free interval until the next TR. By applying a new 180° pulse, a new echo is
received, with the same phase encoding, to build the second image . The echo time of the 2 images differs and the
second image will be more T2 weighted than the first.
Typically, these sequences are used to obtain simultaneously PD- and T2-weighted images.

Contrast, resolution, scan time

The contrast in fast spin echo is modified in relation to a standard spin echo sequence. As the echoes are received at
different echo times, the echoes corresponding to the central k-space lines are the ones that will determine image
contrast. The moment at which theses echoes are acquired is called effective TE.
In T1 weighted sequences, the need to choose a short TR limits echo train length. This type of sequence is very
commonly used in T2 weighting, namely in pelvic imagery.

Fat signal in fast spin echo

Within lipid molecules a spin-spin coupling (J coupling) occurs between the atomic nuclei. This coupling shortens
relaxation time T2. Fast repetition of 180° pulses in fast spin echo sequences will perturb J coupling, causing fat T2 to
lengthen.
Thus, fat has a higher T2 signal in fast spin echo than in standard spin echo, the latter respecting J coupling.
A DIET (Delayed Interval Echo Train) sequence is a fast SE sequence where the delays between 180° pulses are
designed to respect J coupling: as a result, the fat maintains an appearance closer to that observed in a standard SE
sequence.
Interest and limits
The interest of fast SE sequences resides in their speed (around ten seconds) added to their low sensitivity to
magnetic susceptibility artifacts and magnetic field heterogeneities.
Modifications in contrast and fat signal must be taken into account in interpreting the images. The risk of artifacts and
the large quantity of radiofrequency energy deposited by 180° pulses restricts the parameters (TR, effective TE, echo
train length) of this type of sequence.
Fast spin echo can be combined with the technique developed for multi-echo sequences to obtain images faster with
different contrasts in the same zone of interest.

Ultrafast spin echo sequences

Type of sequence Philips Siemens GE Hitachi Toshiba

Ultrafast SE SSH-TSE SSTSE SS-FSE FSE - ADA (Super)FAS

UFSE HASTE E
DIET

 Generic diagram
The echo train technique can be pushed to the limit to fill the entire Fourier plane with a single 90° pulse (TR is thus
infinite) . These so-called « single-shot » sequences require the successive application of as many 180° pulses as
there are k-space lines to fill.
The sequence can be further accelerated, avoiding the need to register the latest echoes (whose signal is much
reduced by T2 relaxation) by partial k-space acquisition. Just over half the k-space lines are actually acquired and the
missing lines are calculated using k-space symmetry properties. This reduces acquisition time by a factor close to 2,
but to the detriment of the signal to noise ratio of the image.

 Contrast and scan time

Given the length of the echo train, the images obtained are highly T2 weighted, since the majority of k-space lines are
filled with long TE echoes.
With this type of sequences, a slice can be made in under a second.

Duration of an ultrafast spin echo sequence

 

Duration = TE • number of phase encodings to acquire

Interest and limits

These sequences are well adapted to imaging non-circulating liquid structures appearing as a T2-weighted
hypersignal (Cholangio-MRI and Uro-MRI) . Due to their rapidity, they have low sensitivity to movement and are
compatible with apnea (mobile structures: liver, abdomen, heart).
 The negative impact of very long echo trains is a decay in signal to noise ratio (weak signal from late echoes and very
high effective TE) with low spatial resolution and blurring in the phase encoding direction.

Inversion Recovery, STIR and FLAIR

Type of sequence Philips Siemens GE Hitachi Toshiba

IR IR IR/IRM IR IR IR
 IR TSE  TurboIR/TIRM  FSE-IR  FIR  Fast IR

STIR STIR STIR STIR STIR STIR

 STIR TSE  Turbo STIR  Fast STIR  Fast STIR  Fast STIR

FLAIR FLAIR FLAIR FLAIR FLAIR FLAIR

 FLAIR TSE  Turbo FLAIR  Fast FLAIR  Fast FLAIR  Fast FLAIR

Inversion-recovery is a magnetization preparation technique followed by an imaging sequence of the spin echo
type in its « standard » version .
 The sequence starts with a 180° RF inversion wave which flips longitudinal magnetization Mz in the opposite
direction (negative). Due to longitudinal relaxation, longitudinal magnetization will increase to return to its
initial value, passing through null value.
 To measure the signal, a 90° RF wave is applied to obtain transverse magnetization. The delay between the
180° RF inversion wave and the 90° RF excitation wave is referred to as the inversion time TI.
 As longitudinal regrowth speed is characterized by relaxation time T1, these sequences are weighted in T1.
Inversion-recovery also increases weighting of the associated imaging sequence (spin echo or gradient echo of
varying speeds).
 With this type of sequence, certain tissues have a negative signal. In terms of display, two possibilities exist :
 
 Either signal magnitude (amplitude in relation to 0) used for gray scale display: the more absolute the value of the tissue
signal (positive or négative), the stronger it will be.
 Or the gray levels will be distributed from the negative signal values to the positive values (with a null signal background
that will be gray rather than black): this is the « true » display type.
 
Another property of inversion-recovery sequences is linked to the choice of TI: if a TI is chosen such that the
longitudinal magnetization of a tissue is null, the latter cannot emit a signal (absence of transverse
magnetization due to the absence of longitudinal magnetization). The inversion-recovery technique thus allows
the signal of a given tissue to be suppressed by selecting a TI adapted to the T1 of this tissue .
 
Inversion-recovery can be combined with sequence types other than the standard spin echo. In particular, it can
be used with fast spin echo sequences, to save considerable time, as inversion-recovery requires relatively long
TR to allow magnetization the time to regrow. Iinversion-recovery also serves as magnetization preparation for
gradient echo sequences, to weight them in T1.
 

STIR sequences
In the standard STIR sequence, the spin echo sequence is completed by a previous 180° inversion pulse. Fat
has a short T1. Hence by choosing a short TI of 140 milliseconds, the fat signal can be suppressed . The
combination of short TI inversion-recovery and fast spin echo sequences reduces acquisition time to acceptable
limits for clinical practice.
 The advantage of these sequences is that they offer a fat signal suppression technique with low sensitivity to
magnetic field heterogeneities or to the effects of magnetic susceptibility in the presence of metal (orthopedic
prostheses in osteoarticular imaging for example). They can be used with T1 or T2 weighting (particularly in spin
echo sequences where fat appears as a hypersignal).
 This technique must not be used to suppress a fat signal gadolinium injection because gadolinium–enhanced
tissues have a shortened T1 and may be erased by short TI inversion-recovery (which is not specific to tissue but
to its relaxation time T1).

FLAIR sequences
The aim of a FLAIR sequence is to suppress liquid signals by inversion-recovery at an adapted TI. Water has a
long T1. Nulling of the water signal is seen at TI of 2000 milliseconds. . As in the case of the other inversion-
recovery sequences, an imaging sequence of the fast spin echo type is preferable to compensate the long
acquisition time linked to long TR.
 These sequences are routinely used in cerebral MRI for edema imaging.

Gradient echo
Type of sequence Philips Siemens GE Hitachi Toshiba

Gradient echo (GE) FFE GRE GRE GE FE

Characteristics
The gradient echo sequence differs from the spin echo sequence in regard to:

 the flip angle usually below 90°

 the absence of a 180° RF rephasing pulse

A flip angle lower than 90° (partial flip angle) decreases the amount of magnetization tipped into the transverse plane.
The consequence of a low-flip angle excitation is a faster recovery of longitudinal magnetization that allows shorter
TR/TE and decreases scan time.
The advantages of low-flip angle excitations and gradient echo techniques are faster acquisitions, new contrasts
between tissues and a stronger MR signal in case of short TR.
The flip angle determines the fraction of magnetization tipped in the transverse plane (which will produce the NMR
signal) and the quantity of magnetization left on the longitudinal axis.
If the flip angle decreases, the residual longitudinal magnetization will be higher and the recovery of magnetization for
a given T1 and TR will be more complete. On the other hand, the result of a lower flip angle excitation is a lower
tipped magnetization.

The actual decay of the transverse magnetization is due to several factors:

 spin-spin tissue-specific relaxation (T2) which is random

 B0 field inhomogeneities and magnetic susceptibility, which are static

As GE techniques use a single RF pulse and no 180° rephasing pulse, the relaxation due to fixed causes is not
reversed and the loss of signal results from T2* effects (pure T2 + static field inhomogeneities). The signal obtained is
thus T2*-weighted rather than T2-weighted. These sequences are thus more sensitive to magnetic susceptibility
artifacts than are spin echo sequences.

Gradient echo
As there is no 180° RF pulse, a bipolar readout gradient (which is the same as the frequency-encoding gradient) is
required to create an echo. The gradient echo formation results from applying a dephasing gradient before the
frequency-encoding or readout gradient.
The goal of this dephasing gradient is to obtain an echo when the readout gradient is applied and the data are
acquired. The dephasing stage of the readout gradient is in the inverse sign of the readout gradient during data
acquisition. Moreover, its dephasing effect is designed so that it corresponds to half of the dephasing effect of the
readout gradient during data acquisition. Consequently, during data acquisition, the readout gradient will rephase the
spins in the first half of the readout (by reversing the dephasing effect of the dephasing lobe), and the spins will
dephase in the second half (due to the dephasing effect of the readout gradient). The time during which the peak
signal is obtained is called Echo Time (TE).

Steady state
In gradient echo, TR reduction may cause permanent residual transverse magnetization in TR below T2: the
transverse magnetization will not have completely disappeared at the onset of the following repetition and will also be
submitted to the flip caused by the excitation pulse.
Two main classes of gradient echo sequence can be distinguished, depending on how residual transverse
magnetiztion is managed:

 gradient echo sequences with spoiled residual transverse magnetization

 steady state gradient echo sequences that conserve residual transverse magnetization and therefore participate
in the signal.

 Ferromagnetic materials generally contain iron, nickel, or cobalt. These materials include magnets, and various objects
one might find in a patient, such as aneurysm clips, parts of pacemakers, shrapnel, etc. 
These materials have a large positive magnetic susceptibility, i.e., when placed in a magnet field, the field strength is much
stronger inside the material than outside. Ferromagnetic materials are also characterized by being made up of clusters of
10^17 to 10^21 atoms called magnetic domains, that all have their magnetic moments pointing in the same direction. The
moments of the domains is random in unmagnetized materials, and point in the same direction in magnetized materials. 

Figure 1 illustrates the effect of a ferromagnetic material (grey circle) on the magnetic field flux lines (blue). 

The ability to remain magnetized when an external magnetic field is removed is a distinguishing factor compared to
paramagnetic, superparamagnetic, and diamagnetic materials. 

On MR images, these materials cause susceptibility artifacts characterized by loss of signal and spatial distortion. This can
occur with even fragments to small to be seen on plain x-ray. This is a common finding in a cervical spine MRI post anterior
fusion.

Spoiled gradient echo MRI is an MRI technique which destroys residual transverse magnetization at the end of each
excitation cycle.
Paramagnetic materials include oxygen and ions of various metals like Fe, Mg, and Gd. These ions have unpaired
electrons, resulting in a positive magnetic susceptibility. The magnitude of this susceptibility is less than one one-thousands
of that of ferromagnetic materials.
The effect on MRI is an increase in the T1 and T2 relaxation rates (decrease in the T1 and T2 times). The figure illustrates
the effect of a paramagnetic material (grey circle) on the magnetic field flux lines (blue).

 Gd is used as a in MR contrast agents. At the proper concentration, Gd contrast agents cause preferential T1 relaxation
enhancement, causing increase in signal on T1-weighted images. At high concentrations, as is sometimes seen in the
urinary bladder, loss of signal is seen instead, a result of the T2 relaxation effects dominating.

Superparamagnetic materials consist of individual domains of elements that have ferromagnetic properties in bulk. Their
magnetic susceptibility is between that of ferromagnetic and paramagnetic materials. 

The figure illustrates the effect of a superparamagnetic material (grey circle) on the magnetic field flux lines (blue). Examples
of superparamagnetic materials include iron containing contrast agents for bowel, liver, and lymph node imaging.
Diamagnetism is the property of materials that have no intrinsic atomic magnetic moment, but when placed in a magnetic
field weakly repel the field, resulting in a small negative magnetic susceptibility. Materials like water, copper, nitrogen,
barium sulfate, and most tissues are diamagnetic.
The figure illustrates the effect of a diamagnetic material (grey circle) on the magnetic field flux lines (blue). The weak
negative magnetic susceptibility contributes to the loss of signal seen in bowel on MRI after administration of barium sulfate
suspensions.

The Larmor frequency and equation are named after the Irish Physicist and MathematicianJoseph Larmor (1857-1942).
Protons and neutrons pair up in nuclei causing the cancellation of their individual angular momentum. All nuclei also have a
spin; those with an odd number of protons and/or neutrons will have a property call magnetic (dipole) moment. Magnetic
moment is characterized by it's alignment with an external magnetic field analogous to a small bar magnet. These particular
nuclei are also called dipoles because they have two poles like the north and south pole of a bar magnet. H-1 and P-31 are
examples of nuclei with an unpaired proton. N-14 is an example of a nucleus with both unpaired proton and neutron.

In addition to alignment of nuclei with a magnetic moment, application of an external magnetic field will produce a secondary
spin or wobble (precession) of nuclei around the main or static magnetic field. The precessional path around the magnetic
field is circular like a spinning top.
The Larmor or precessional frequency in MRI refers to the rate of precession of the magnetic moment of the proton
around the external magnetic field. The frequency of precession is related to the strength of the magnetic field, B0.
The precessional frequency of nuclei of a substance placed in a static magnetic field B0 is calculated from Larmor
Equation :
ω = γB
where ω is the Larmor frequency in MHz , γ is the gyromagnetic ratio in MHz/Tesla and B is the strength of the static
magnetic field in Tesla. Note that the gyromagnetic ratio is define in different ways by different authors. See the article
on gyromagnetic ratio. In this case a useful, simplified version is shown representing the Larmor frequency when B 0=1.
 The gyromagnetic ratio (MHz/T) for a few commonly measured or imaged isotopes are 1:
o H-1                   42.58
o F-19                 40.05
o Na-23               11.26
o P-31                 17.24

Magnets
Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Magnets used for MRI  are of three types: permanent, resistive and superconductive.
Permanent MRI magnets use permanently magnetized iron like a large bar magnet that has been twisted into a "C" shape
where the two poles are close together and parallel. In the space between the poles the magnetic field is uniform enough for
imaging. Up to 30 tons of iron may be needed, restricting their placement to rooms with a strong enough floor. Their low-field
strength of about 0.15-4 T restrict their use to imaging; being impractical for spectroscopy, chemical shift and susceptibility
imaging such as function brain imaging. Their magnetic field homogeneity is also sensitive to ambient temperature so room
temperature must be controlled carefully. The initial purchase price and operating costs are low compared to
superconductive magnets. These magnets can also be made with alloys such as neodymium markedly reducing the weight
of the magnet but at significant additional cost.

Resistive (air core) MRI magnets operate at room temperature using standard conductors such as copper in the shape of
a solenoid or Helmholtz pair coil. A solenoid is a cylindrical shape coil of wire. The uniform magnetic field is found inside the
coil, especially in the center. These magnets are relatively inexpensive to make but require a large constant flow of current
while magnetized and imaging. The coil has electrical resistance that requires cooling of the magnet. The operating costs
are high because of the large power requirements of the magnetic coils and associated cooling system.
Both permanent and resistive MRI scanners are limited to low-field applications, primarily open MRI and extremity scanners.
These magnets are useful for claustrophobic patients.

Superconductive MRI magnets use a solenoid shaped coil made of alloys such as niobium/titanium or niobium/tin
surrounded by copper. These alloys have the property of zero resistance to electrical current when cooled down to about
10o Kelvin. The coil is kept below this temperature with liquid He. The power supply is connected on either side of a short
heated segment of the coil and the current to the coil is gradually increased over several hours until the desired magnet field
is reached. The heated segment is allowed to coil to superconducting temperature and the power supply removed and taken
away. The current continues in the closed loop of the coil for years without significant decline. A resulting property is that the
magnetic field is always present. 
The surrounding copper acts as an insulator at low temperatures compare to the zero resistance of the alloy. The copper
also protects the alloy coil from being destroyed in case of a quench of the magnet. A quench can occur if the helium levels
drop too low or if a large ferromagnetic object is brought into the fringe field of the magnet. A quench results in loss of
superconductivity with a large amount of heat produced by the current and rapid boiling off of cryogens. The gas produced is
vented out of the room but can occasionally enter the scanner room with life-threatening consequences. Quenches and the
constant magnetic field are a couple of the safety issues that are discussed elsewhere.

 The cost of cryogen replacement is reduced on modern magnets that incorporate a refrigeration system called a "cold head"
to condense the cryogen gas. Startup cost for the scanner can run up to about $1.5 millon for a 1.5 T MRI. Site preparation
can frequently run several $100,000's that includes room RF shielding, possible magnetic shielding, floor reinforcement,
vibration mitigation and adequate power supply.

Superconducting magnets at 1.5 T and above allow functional brain imaging, MR spectroscopy and superior SNR and/or
improved time and spatial resolution. Magnets above 1.5 T have addition challenges from RF heating of the subject, and
increased artifacts from susceptibility and RF penetration among others.
Quenching refers to rapid expulsion of liquid cryogen used to maintain the MR magnet in superconducting state.
Discussion
Modern MRI scanners contain superconducting magnets which have very low energy consumption, made possible by
maintaining internal subzero temperatures by way of a 'cryogen bath' of liquid helium. In the event that somebody pushes
the emergency stop button or there is equipment fault, the liquid helium boils off rapidly accompanied by a lound banging or
hissing sound, safely expelled from the building by means of vents.
RF coils
RF (radiofrequency) coils are the "antenna" of the MRI system that broadcasts the RF signal to the patient and/or receives
the return signal. RF coils can transmit and receive (transceiver) or receive-only, in which case the body coil is used as a
transmitter. The body coil supplies a more uniform RF field than many smaller coils but requires more energy to do so; a
detriment at higher field strengths (3T+).
 Surface coils are the simplest design of coil. They are simply a loop of wire, either circular or rectangular, that is placed over
the region of interest (see figure). The depth of the image of a surface coil is generally limited to about one radius. Surface
coils may be used for spines, shoulders, TMJ's, and other relatively small body parts close to the skin surface.

 Helmholtz pair coils consist of two circular coils parallel to each other. They are used as the z gradient coils in MRI
scanners allowing localization in the z direction (head to foot in a horizontal magnet). They are may also used occasionally
as RF coils for pelvis imaging and cervical spine imaging.

 Paired saddle coils are commonly used for imaging of the extremities such as the knee. These coils provide better
homogeneity of the RF in the area of interest than a surface of Helmholtz pair and are used as volume coils, unlike surface
coils. Paired saddle coils are also used for the x and y gradient coils. By running current in opposite directions in the two
halves of the gradient coil, the magnetic field is made stronger near one and weaker near the other.

The bird cage coil provides the best RF homogeneity of all the RF coils. It has the appearance of a bird cage; hence, its
name. This coil is commonly used as a transceiver coil for imaging of the head. This type of coil is also used occasionally for
imaging of the extremities.

Gradient coils
Gradient coils are used to produce deliberate variations in the main magnetic field (Bo). There are three sets of gradient
coils, one for each direction. The variation in the magnetic field permits localization of image slices as well as phase
encoding and frequency encoding. The set of gradient coils for the z axis are Helmholtz pairs, and for the x and y axes,
paired saddle coils.

Gradient coils need to provide linear gradations of the magnetic field. When turned on, one end or side the bore of the
magnet has a lesser strength and the other a greater strength than the static main magnetic field. Drop off of the z gradient
near the bore of the magnet can cause misplacement of objects in the image if signal is detected beyond the gradients. This
should not happen with appropriate engineering.

Comparing 1.5T vs 3T MRI systems identifies in a number of differences:

 increased signal to noise ratio (SNR)
 increased spatial resolution
 increased temporal resolution
 increased specific absorption rate (SAR)
 increased acoustic noise
Signal to noise ratio
Theoretically signal increases proportional to the square of the static field strength whereas noise increases linearly. This
implies that in a perfect system SNR of a 3.0T system would be twice as good as at 1.5T. In reality, due to increase in
susceptibility effects in most tissues the actual improvement is only in the 30-60% range (instead of 100%). With this
increased SNR, the spatial resolution and/or acquisition time can be improved depending on which is more important for the
particular case.
Specific absorption rate (SAR)
SAR is defined as the amount of radiofrequency energy (joules) deposited tissues (kg). The limit set by the FDA is an
amount which results in increase of 1 degree centigrade in any tissue 2. SAR is proportional to the static field (B0) to the
power of 2, meaning a 3.0T system and 4 times as much as a 1.5T system. Additionally SAR is proportional to:
 B0 squared
 pulse duration and length
 pulse number
 slice number
 flip angle
The last of the above, results in standard spin echo sequences which have 90 degree flips depositing to much energy. As a
result there is a greater use of gradient echo sequences. Unfortunately these are imaging T2* not T2 and therefore are more
susceptible to local field artefacts. Largely, these problems have been overcome with modern units.
Acoustic noise
Rapid gradient switching leads to increase in the intensity of the acoustic noise, which has required better insulation of both
the unit itself and the room.

Signal processing

Fourier transform is a mathematical operation which converts a time domain signal into a frequency domain signal.
Discussion
Fourier transform is integral to all modern imaging, and is particularly important in MRI. The signal received at the detector
(receiver coils in MRI, piezoelectric disc in ultrasound and detector array in CT) is a complex periodic signal made of a large
number of constituent frequencies (i.e., bandwidth). This can be visualized as multiple sine and or cosine waves along a
time-axis. Fourier transform represents the same data over a frequency-axis. A common example is the MR spectroscopy
image in which different molecules are at different frequencies along the x-axis.

K space is an abstract concept and refers to a data matrix containing the raw MRI data. This data is subjected to
mathematical function or formula called a transform to generate the final image. A discrete Fourier or fast Fourier
transform 1-3 is generally used though other transforms such as the Hartley 4 can also work.
Discussion
A single slice corresponds to a k space plane acquired in real-time. Each point on the k space contains specific frequency,
phase (x,y coordinates) and signal intensity information (brightness). Inverse FT is applied after k space acquisition to derive
the final image. Each pixel in the resultant image is the weighted sum of all the individual points in the k-space. Hence,
disruption of any point in the k-space translates into some form of final image distortion, determined by the frequency- and
phase-related data stored in that particular point.  In general:

 central regions of the k space encode contrast information

 peripheral regions of the k space encode spatial resolution

Relevance
Knowledge of the k space is essential as it relates to different techniques of image acquisition and explains several MRI
artifacts.

Signal to noise ratio (SNR) is a generic term, which in radiology is measure of how much true signal (e.g. reflecting actual
anatomy) versus how much noise (e.g. random quantum mottle etc...) a particular image has, which results in a grainy
appearance. 
Each modality has its own source of noise and ways to maximise signal. 
Radiographic interpretation
Plain film radiography
In X-rays, the larger number of photons absorbed, the greater the SNR, the less noisy the image. The use of high kV and
intensifying screens would reduce the number of photons and radiation dose to patients, therefore reducing the SNR.
Conversely, measures to increase the SNR, such as by increasing the mAs, would increase the patient dose.

CT
Content pending

MRI
The SNR is measured frequently by calculating the difference in signal intensity between the area of interest and the
background (usually chosen from the air surrounding the object). In air, any signal present should be noise. The difference
between the signal and the background noise is divided by the standard deviation of the signal from the background-- an
indication of the variability of the background noise. 

SNR is proportional to the volume of the voxel and to the square root of the number or averages and phase steps (assuming
constant sized voxels). Since averaging and increasing the phase steps takes time, SNR is related closely to the acquisition
time. 

In MRI, the SNR can be improved by :

 volume acquisition as compared to 2D imaging, but imaging time would be increased.

 spin echo sequences as compared to gradient echo.
 decreasing the noise by reducing the bandwidth, using surface coils and  increasing number of excitations
 increasing the signal by decreasing the TE (time to echo) and increasing the TR (time to repeat), slice thickness or
field of view
Additionally, SNR can be improved by tweaking scan parameters. Assuming all other factors remain the same, SNR can be
improved by:  

 increasing the field of view (FOV)

 decreasing the matrix size
 increasing the slice thickness
Ultrasound
Content pending

Spatial resolution MRI

Dr Jeremy Jones and Dr J Yeung et al.

Spatial resolution determines how "sharp" the image looks. Low resolution will give either fuzzy edges, or a pixelly
appearance to the image.

In MRI, spatial resolution is defined by the size of the imaging voxels. Since voxels are three dimensional rectangular solids,
the resolution is frequently different in the three different directions. The size of the voxel and therefore the resolution
depends on matrix size, the field-of-view (FOV), and the slice thickness. The matrix size is the number of frequency
encoding steps, in one direction; and the number of phase encoding steps, in the other direction of the image plane.
Assuming everything else is constant, increasing the number of frequency encodings or the number of phase steps results
in improved resolution. The frequency encoding depends of how rapidly the FID signal is sampled by the scanner.
Increasing the sampling rate results in no time penalty. Increasing the number of phase steps increases the time of the
acquisition proportionately. This is why images that have fewer phase encodings than frequency encodings, e.g., 128x256
or 192x256 will be used.
The FOV is the size of the area that the matrix of phase and frequency encoding cover. Dividing the FOV by the matrix size
gives you the in-plane voxel size; hence, increasing the FOV in either direction increases the size of the voxels and
decreases the resolution. Decreasing the FOV improves the resolution.
The depth of the voxel is determined by the slice thickness. This is almost always the largest dimension of the voxel in 2D
imaging. Therefore, the resolution perpendicular to the image plane is the poorest. This is related to the maximum strength
of the z-gradient coils as well as time restraints limiting the number of slices available. 3-D imaging utilizing phase encoding
in the z direction is capable of smaller slice thickness than 2-D imaging but carries a time penalty proportional to the number
of slices.
The time of acquisition for a conventional spin echo or gradient echo sequence is the product of the repetition time, phase
encoding steps, and number of averages (TR x phase steps x NEX). For example, with a one second TR, 128 phase steps,
and two averages we would get an acquisition time of about 1 x 128 x 2= 256 seconds or 4 minutes and 16 seconds. The
actual time will be slightly longer. 
Fast spin echo and fast gradient echo sequences perform more than one phase encoding step per repetition time, resulting
in reduce acquisition time by the number of phase step per repetition time. (Needs more on other sequences)

Trade-offs exist when changing imaging parameters to obtain the best images possible. The SNR, resolution, and
acquisition time, are all interrelated. Changing one effects the others. An important job of the radiologist and MR
radiographer is to decide what factors are more important for an examination of a particular body part, patient and suspected
abnormality.
 When looking at the pituitary or cranial nerves, for example, you may want to sacrifice some SNR or longer acquisition time
for improved spatial resolution. On the other hand, in a claustrophobic of patient in pain who may be moving around, you
may sacrifice both resolution and SNR for the shortest possible examination time. The table summarizes the trade offs
between SNR, resolution, time, maximum number of slices and distance covered.

Summary of imaging parameter trade-offs

Increase Parameters below SNR Resolution Acquisition Time Distance Covered Max. Number of Slices

FOV  +    -       nc        nc         nc

NEX  +       nc    +        nc         nc

Slice Thick  +    -       nc        +         nc

Gap  +    -       nc        +         nc

TR  +       nc    +        nc     +

TE  -       nc       nc        nc     -

Matrix size  -    +    +        nc         nc

Bandwidth  -       nc       nc        nc     +

Magnet strength  +       nc       nc        nc         nc

Zero filling interpolation (ZIP) is the substitution of zeroes for unmeasured data points in order to increase the matrix size
of the new data prior to Fourier transformation of MR data. This results in pixels smaller than the actual resolution of the
image. The zero filling occurs in the periphery of k-space rather than the center where most of the signal comes from. 
For example

 scan matrix 256 x 256

 reconstruction matrix 512 x 512
Application
zero filling processes can be very practical in everyday clinical usage by reducing scanning times without much loss in
resolution or SNR, since zero filled points contain neither signal nor noise. Hence SNR is unaffected. 1
Zero filling is also used in MR spectroscopy, adding zeros to the end of the FID prior to Fourier transform. This results in
increased frequency resolution in the resulting spectrum allowing chemical peaks to be more easily resolved. 2

MRI pulse sequences

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Magnetic resonance imaging (MRI) is able to achieve its striking ability to image tissues in various ways by manipulating the
various electromagnetic fields it is able to generate. The pattern in these fields are changed is known as a pulse sequence.
There are many (hundreds - see MRI pulse sequence abbreviations) of various pulse sequences each changing the
appearances of tissue. 
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 
These can be grouped as follows:

 spin echo sequences

o T1 weighted image
o T2 weighted image
 inversion recovery sequences
o short tau inversion recovery (STIR)
o fluid attenuation inversion recovery (FLAIR)
o turbo inversion recovery magnitude (TIRM)
 gradient echo sequences
o spoiled gradient echo MRI
o steady-state free precession
 fat suppressed imaging sequences
 pulse sequence parameters
 diffusion weighted sequences
o diffusion tensor imaging
 saturation recovery sequences
 echo-planar pulse sequences
 metal artifact reduction sequence
 spiral pulse sequences
 MR angiography (and venography)
o contrast-enhanced MRA
o non-contrast-enhanced MRA[+]
 MR spectroscopy (MRS)
o Hunter's angle
 MR perfusion
o time to peak (TTP)
o mean transit time (MTT)
o cerebral blood volume (CBV)
o cerebral blood flow (CBF)
o negative enhancement integral (NEI)
 functional MRI
 MR artefacts[–]
o MR hardware and room shielding
 herringbone artifact
 Moire fringes
 zebra stripes
 central point artifact
  RF overflow artifacts
 inhomogeneity artifacts
 zipper artifact
o MR software
 slice-overlap artifact aka cross-talk artifact
 cross excitation
o patient and physiologic motion
 phase-encoded motion artefact
 entry slice phenomenon
o tissue heterogeneity and foreign bodies
 black boundary artifact
 magic angle effect
 susceptibility artifact / magnetic susceptibility artifact
 chemical shift artifact
 india ink artifact
o Fourier transform and Nyqvist sampling theorem
 Gibbs artifact / truncation artifact
 zero-fill artfact
 aliasing / wrap around artifact
MRI contrast agents have become an indispensable part of modern magnetic resonance imaging. Although MRI was
initially hoped to provide a means of making definitive diagnoses noninvasively, it has been found that the addition of
contrast agents in many cases improves sensitivity and/or specificity. 

Contrast agents
Contrast agents can be grouped in many different ways. One way is to consider them according to the compartments in
which they distribute. 

 gastrointestinal MRI contrast agents

 intravenous MRI contrast agents
 intravascular (blood pool) MRI contrast agents
 tumor-specific MRI contrast agents
 hepatobiliary MRI contrast agents
 reticuloendothelial MRI contrast agents
 MRI contrast agent safety
T1 weighted image (also referred to as T1WI) is one of the basic pulse sequences in MRI and demonstrates the differences
in the T1 relaxation time of tissues.
The T1WI relies upon the longitudinal relaxation of the net magnetisation vector (NMV). T1 weighting tend to have
short TE and TR times.
Fat has a large longitudinal and transverse magnetization, and appears bright on a T1 weighted image. Conversely, water
has less longitudinal magnetization prior to a RF pulse, and therefore has less transverse magnetization after a RF pulse.
Thus, water has low signal and appears dark.
A paramagnetic contrast agent, e.g. a gadolinium-containing compound, may be administered, resulting in alteration of the
signal displayed by tissues in which it is absorbed.

Summary
 TR: short
 TE: short
 fat: bright
 fluid: dark
T2 weighted image (also referred to as T2WI) is one of the basic pulse sequences in MRI and demonstrates the differences
in the T2 relaxation time of tissues.
The T2WI relies upon the transverse relaxation of the net magnetisation vector (NMV). T2 weighting tend to have
long TE and TR times.
Paramagnetic contrast agents, e.g. gadolinium-containing compounds, do not have nearly as significant effect as they do
in T1WI.

Summary
 TR: long
 TE: long
 fat: intermediate-bright
 fluid: bright

Inversion recovery pulse sequences are used to give heavy T1-weighting. The basic part of an inversion recovery
sequence is a 180 degree RF pulse that inverts the magnetization followed by a 90 degree RF pulse that brings the residual
longitudinal magnetization into the x-y or transverse plane where it can be detected by an RF coil.
 In imaging, the signal is usually refocused with a 180 degree pulse as in a spin echo sequence.The time between the initial
180 degree pulse and the 90 degree pulse is the inversion time (TI). A diagram of the sequence is shown to the right.

- Short tau inversion recovery (STIR ) also called short T1 inversion recovery is a fat suppression technique with an
inversion time TI = T1 ln2 where the signal of fat is zero. This equates to approximately 140 ms at 1.5 T.
To distinguish two tissue components with this technique, the T1 values must be different. FLAIRis a similar technique to
suppress water. 
Inversion-recovery imaging allows homogeneous and global fat suppression and can be used with low-field-strength
magnets. However, this technique is not specific for fat, and the signal intensity of tissue with a long T1 and tissue with a
short T1 may be ambiguous.

- Fluid attenuation inversion recovery (FLAIR) is a special inversion recovery sequence with longT1 to remove the
effects of fluid from the resulting images.1 
The T1 time of the FLAIR pulse sequence is adjusted to the relaxation time of the component that should be suppressed.
For fluid suppression the inversion time (long T1) is set to the zero crossing point of fluid, resulting in the signal being
'erased'.1

This type of sequence is particularly useful in the detection of subtle changes at the periphery of the hemispheres and in the
periventricular region close to CSF.

The usefulness of FLAIR sequences has been evaluated in diseases of the central nervous system such as 2-4 :
 infarction
 multiple sclerosis
 subarachnoid haemorrhage
 head injuries, and others.
- A TIRM or Turbo inversion recovery magnitude sequence is type of  inversion recovery MRI pulse sequence.
It has be shown to be superior in the asseesment of osteomyelitis in bone 1 and in the asessment of head and neck
tumours 2.

Gradient echo sequences

Dr Jeremy Jones and Dr Usman Bashir et al.

Gradient echo sequences are an alternative technique to spin echo sequences,differing from it in two principle points :
 utilization of gradient fields to generate transverse magnetization
 flip angles of less than 90°
Compared to the spin echo and inversion recovery sequences, gradient echo sequences are more versatile. Not only is the
basic sequence varied by adding dephasing or rephasing gradients at the end of the sequence, but there is a significant
extra variable to specify in addition to the usual TR and TE. This variable is the flip or tip angle of the spins. 
Flip angle
The flip angle is usually at or close to 90 degrees for a spin echo sequence but commonly varies over a range of about 10 to
80 degrees with gradient echo sequences. For the basic gradient echo sequence FLASH (figure 1) the larger tip angles give
more T1 weighting to the image and the smaller tip angle give more T2 or actually T2* weighting to the images. 

Gradient echo
The gradient echo is generated by the frequency-encode gradient, except that it is used twice in succession, and in opposite
directions: it is used in reverse at first to enforce transverse dephasement of spinning protons and then right after, it is used
as a readout gradient (like in spin echo MRI) to re-align the dephased protons and hence acquire signal.

Because low flip angles are used, there is some retention of the original longitudinal magnetization as opposed to the 90°
pulse used in spin echo, which completely eliminates the longitudinal magnetization. As a result, the build up time for
longitudinal magneitzation is significantly reduced for the subsequent pulses , allowing faster image acquisition in GE.

Another important feature of GE is that the dephasement of spinning protons occurs as a result of  T2* decay  which is more
rapid than the T2 decay process underlying Spin Echo sequence (leading to shorter TE) and is susceptible to static field
inhomogeneities (leading to compounded influence of degraded blood products, and metal objects on the signal ).   

Image characteristics
Images from other gradient echo sequences such as GRASS and FISP have less intuitive tissue contrast characteristics
than FLASH. The FLASH and SPGR sequences show better tissue contrast between white matter and grey matter in the
brain and spinal cord than GRASS or FISP and are preferred when the time of acquisition does not have to be very short.
GRASS and FISP maintain better SNR than FLASH at short TR times and are therefore preferred with breath-holding
techniques, for example.

A vector magnetization diagram of the gradient echo sequence is shown below. Note that the spins are refocused by
reversing the direction of the spins rather than flipping them over to the other side of the x-y plane as occurs with the spin
echo sequence. Gradient refocusing of the spins takes considerably less time than 180 degree RF pulse refocusing. One big
disadvantage of gradient echo sequences is the loss of signal from static magnetic field inhomogeneity. This occurs to a
lesser degree with spin echo sequences (and for a different reason). Magnetic susceptibility artifacts are therefore more
pronounced on gradient echo sequences that on spin echo sequences.

- Spoiled gradient echo MRI is an MRI technique which destroys residual transverse magnetization at the end of each
excitation cycle. 

- Steady-state free precession MRI (SSFP) is a type of gradient echo MRI pulse sequence in which a steady, residual
transverse magnetization (Mxy) is maintained between successive cycles. The sequence is noted for its superiority in
dynamic / cine assessment of cardiac function.

Discussion
To understand SSFP (and all MR imaging for that matter), the first thing to bear in mind is that the magnetization vector has
two components: Mz and Mxy. Both are at 90° to eachother and excitation pulses which flip the vector result in conversion of
one component into the other. Added to this interconversion is the spontaneous regrowth and decay of M z and Mxy governed
by T1 and T2 intervals respectively. Over several sequences, a steady-state of equilibrium is achieved, with constant
magnitudes of Mz and Mxy at the beginning of the cycle.
A steady-state is achieved in tissues with a sufficiently long T2 interval, by keeping the TR shorter than T2.

Types of image formed

At steady state, two signal types are present:
  T1 / T2* weighted : the mixed steady-state signal - subjected to refocusing gradient; this generates the FID (typical
of a GRE sequence)
 T2 weighted : the residual Mxy at the beginning of the next pulse; the α flip (50°- 80° in typical GRE) results in spin-
echo (analogous to the 180° refocusing pulse used in spin-echo)

Applications
 cardiac imaging
 fetal imaging
 abdominal imaging

Fat suppressed imaging

Dr Jeremy Jones and Dr MT Niknejad et al.

Fat suppression is commonly used in magnetic resonance (MR) imaging to suppress the signal from adipose tissue or
detect adipose tissue.1 
Due to short relaxation times, fat has a high signal on magnetic resonance images (MRI). This high signal, easily recognized
on MRI, may be useful to characterize a lesion.2 
However, small amounts of lipids are more difficult to detect on conventional MRI. In addition, the high signal due to fat may
be responsible for artifacts such as ghosting and chemical shift. The high signal can also mask subtle contrast difference in
non-fatty tissue by filling the dynamic range of the receiver with mostly fat signal. Lastly, a contrast enhancing tumor may be
hidden by the surrounding fat. These problems have prompted development of fat suppression techniques in MRI. 3 
Fat may be suppressed on the basis of its difference in resonance frequency with water by means of frequency selective
pulses (CHESS) or phase contrast techniques (by same mechanism as black boundary or india ink artifacts), or on the basis
of its short T1 relaxation time by means of inversion recovery sequences (STIR technique) or the Dixon method. 5 Lastly,
hybrid techniques combining several of these fat suppression techniques such as SPIR (spectral presaturation with
inversion recovery) are also possible.3,6
Selection of a fat suppression technique should depend on the purpose of the fat suppression (contrast enhancement vs
tissue characterization) and the amount of fat in the tissue being studied, the field strength of the magnet and the
homogeneity of the main magnetic field.

Diffusion weighted imaging

Dr Jeremy Jones and Dr Usman Bashir et al.

Diffusion weighted imaging (DWI) is a form of MR imaging based upon the diffusion of water molecules within a voxel.
Diffusion weighted imaging is based upon the random Brownian motion of water molecules within the voxel. As opposed to
free diffusion of water kept inside a container, diffusion of water inside a voxel of brain tissue, for example, is hindered
primarily by cell membrane boundaries. The greater the cellularity, the greater the diffusion restriction, e.g. tumors.

Clinical application
DW imaging has a major role in the following clinical situations 3-5: 
 early identification of ischemic stroke
 differentiation of acute from chronic stroke
 differentiation of acute stroke from other stroke mimics
 differentiation of epidermoid cyst from arachnoid cyst
 differentiation of abscess from necrotic tumors
 assessment of cortical lesions in CJD
 differentiation of herpes encephalitis from diffuse temporal gliomas
 assessment of the extent of diffuse axonal injury
 grading of gliomas and meningiomas (need further study)
 assessment of active MS plaque (old plaques will not be bright)
Physics
Figure 1 depicts a spin echo sequence with diffusion gradients added. The gradient coil used to produce the diffusion need
not be a separate gradient or gradients from those used for spatial encoding. The degree of diffusion weighting is dependent
primarily on the area under the diffusion gradients and on the interval between the gradients. Other factors include the effect
of the spatial localization gradients and the size of the voxels. Diffusion tensor imaging is an extension of diffusion
weighted imaging (DWI) which allows data profiling based upon white matter tract orientation
DWI is based on the measurement of brownian motion of water molecules. This motion is restricted by membranous
boundaries. In white matter, diffusion follows the 'pathway of least resistance' along the white matter tract; this direction of
maximum diffusivity along the white-matter fibers is projected into the final image.

Saturation recovery sequences

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Saturation recovery (SR) sequences are rarely used for imaging now. Their primary use at this time is as a technique to
measure T1 times more quickly than an inversion recovery pulse sequence. Saturation recovery sequences consist of
multiple 90 degree RF pulses at relatively short repetition times (TR). An example of a SR sequence is shown below.
Residual longitudinal magnetization after the first 90 degree RF pulse is dephased by a spoiling gradient (in this case with
the slice select gradient). Longitudinal magnetization that develops during the TR period after the dephasing gradient is
rotated into the transverse plane by another 90 degree pulse. A gradient echo is acquired immediately after this. The signal
will reflect T1 differences in tissues because of different amounts of longitudinal recovery during the TR period.

Echo planar imaging

Dr Jeremy Jones and Dr Usman Bashir et al.

Echo planar imaging is performed using a pulse sequence in which multiple echoes of different phase steps are acquired
using rephasing gradients instead of repeated 180o RF pulses following the 90° / 180° in a spin-echo sequence. This is
accomplished by rapidly reversing the readout or frequency- encoding gradient. This switching or reversal may also be done
in a sinusoidal fashion. Echo planar sequences may use entirely gradient echos or may combine a spin echo with the train
of gradient echos as illustrated in the diagram to the right. 
In a single-shot echo planar sequence, the entire range of phase encoding steps,   usually up to 128, are acquired in one
TR. In multi-shot echo-planar imaging, the range of phase steps is equally divided into several "shots" or TR periods. For
example an image with 256 phase steps could be divided into 4 shots of 64 steps each. 
As a result an image can be acquired in 20 - 100 msec, allowing excellent temporal resolutionsuch as that required in
cardiac imaging. Each subsequent echo results in a progressively T2-weighted signal. 
Benefits
 reduced imaging time
 decreased motion artifact,
 ability to image rapid physiologic processes of the human body.
Drawbacks
 Sensitive to susceptibility effects
 Sensitive to main magnetic field inhomogeneity
 Long gradient echo train causes greater T2* weighting
 Requires high-performance gradients
Applications
 cardiac imaging
 abdominal imaging, i.e., breath-hold sequences and 3D MR angiography
 diffusion imaging
 perfusion imaging
 functional imaging
Metal artifact reduction sequence
Dr Jeremy Jones and Dr Jan Frank Gerstenmaier et al.

A metal artifact reduction sequence (MARS) is intended to reduce the size and intensity of susceptibility artifacts resulting
from magnetic field distortion.
A number of simple changes to the scan protocol can greatly reduce artifacts. Examples are:

 STIR for fat suppression (spectral fat suppression performs better in a homogeneous field)
 spin echo instead of gradient echo where possible
 shorter echo spacing
 smaller water-fat sift
 thinner slices
 maintain good SNR

Spiral pulse sequences

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Spiral scanning in MRI is unlike spiral scanning in CT where the x-ray tube is continuously rotating and data is continuously
being acquired. In MRI the word "spiral" refers to the pattern of sampling k-space. In conventional imaging sequences
including spin echo and gradient echo and in fast imaging sequences, a line or multiple lines of k-space in the frequency
direction are acquired consecutively. In spiral scanning, k-space is acquired in a spiral trajectory. The entire k-space can be
acquired during a single acquisition, or interleaved using more than one acquisition. 
This sequence allows faster image acquisition than the fast echo sequences but is slower thanecho-planar imaging. Spiral
scanning tends to have fewer artifacts than echo-planar imaging since adjacent points in k-space are acquired in close
temporal proximity. The figures to the right show how the acquisition of data in k-space is done with conventional sequences
and with spiral scanning.

MR angiography
Dr Jeremy Jones and Dr Usman Bashir et al.

MR Angiography is an alternative to conventional angiography and CT angiography, eliminating the need for iodinated
contrast media and ionizing radiation. It has evolved into several techniques with different advantages and applications:
 contrast enhanced MR angiography
 non-contrast enhanced MR angiography
Contrast enhanced MR angiography is a technique involving 3D spoiled gradient-echo (GE) sequences, with
administration of Gd-based contrast. It can be utilised to assess vascular structures of almost any part of the body. It's key
features are as follows:
 T1- weighted spoiled gradient-echo sequence (flip angle 25° - 50° allows  T1-weighting)
 central k-space acquisition corresponding to arterial phase of the study maximizes preferential visualization of
arteries
 use of Gd-based contrast to shorten T1-interval of the blood which appears bright as a result
Non contrast enhanced MR angiography is performed in several ways including:
 time of flight angiography
 phase contrast angiography
 three-dimensional (3D) electrocardiograph-triggered half-Fourier fast spin echo
Generally, these techniques are time-consuming as compared with contrast enhanced MR angiography.

+ Time of flight angiography

Dr Jeremy Jones and Dr Usman Bashir et al.
Time of flight angiography (TOF) is an MRI technique to visualize flow within vessels, without the need to administer
contrast. It  is based on the phenomenon of flow-related enhancement of spins entering into an imaging slice. As a result of
being unsaturated, these spins give more signal that surrounding stationary spins. 
With 2-D TOF, multiple thin imaging slices are acquired with a flow-compensated gradient-echo sequence. These images
can be combined by using a technique of reconstruction such as maximum intensity projection (MIP), to obtain a 3-D image
of the vessels analogous to conventional angiography.

With 3-D TOF, a volume of images is obtained simultaneously by phase-encoding in the slice-select direction. An
angiographic appearance can be generated using MIP, as is done with 2-D TOF. Several 3-D TOF volumes can be
combined to visualize longer segments of vessels. 3-D TOF angiography will allow greater spatial resolution in the slice-
select direction than 2-D TOF; however, with thick volumes and slow flowing blood, loss of signal is seen with the 3-D TOF
method.

Key points
 short TR
 image-plane kept perpendicular to flow-direction

Potential pitfalls
 slow flow or flow from a vessel parallel to the scan-plane, may become de-saturated just like stationary tissue,
resulting in signal loss from the vessel
 turbulent flow may undergo spin-dephasing and unexpectedly short T2 relaxation - again resulting in signal loss from
the vessel
 acquisition times are relatively long.
 retrograde arterial flow may be obscured if venous saturation bands have been applied.
 artifacts : ghosting, susceptibility artifact
 very T1 bright signal will be visible (e.g. haemorrhage)

+ Phase contrast imaging

Dr J. Ray Ballinger et al.

Phase contrast imaging is an MRI technique that can be used to visualise moving fluid. It is typically used for MR
venography as a non-IV-contrast requiring technique. 
Spins that are moving in the same direction as a magnetic field gradient develop a phase shift that is proportional to the
velocity of the spins. This is the basis of phase-contrast angiography. In the simplest phase-contrast pulse sequence, bipolar
gradients (two gradients with equal magnitude but opposite direction) are used to encode the velocity of the spins.
Stationary spins undergo no net change in phase after the two gradients are applied. Moving spins will experience a
different magnitude of the second gradient compared to the first, because of its different spatial position. This results in a net
phase shift. This information can be used directly to determine the velocity of the spins. Alternatively, the image can be
subtracted from one acquired without the velocity encoding gradients to obtain an angiogram.

 + TRICKS
MR spectroscopy
Dr Maxime St-Amant and Dr Frank Gaillard et al.

MR spectrosopy (MRS) allows tissue to be interrogated for the presence and concentration of various

metabolites. Grossman and Yousem said "If you need this to help you, go back to page 1; everything except Canavan has
low NAA, high Choline" 1. This is perhaps a little harsh, however it is fair to say that MRS often does not add a great deal to
an overall MR study but does increase specificity, and may help in improving our ability to predict histological grade.
Physics
The basic principle that enables MR spectroscopy (MRS) is the fact that the electron cloud around an atom shields the
nucleus from the magnetic field to a greater or lesser degree. This naturally therefore results in slightly resonant frequencies,
which in turn return a slightly different signal.

When we see spectra in general radiology practice, this is usually of protons, although phosphorus can also be targeted to
examine ATP.

If raw signal was processed then the spectra would be dominated by water, which would make all other spectra invisible.
Water suppression is therefore part of any MRS sequence, either via Inversion Recovery or Chemical shift selective
(CHESS). If water suppression is not successful then a general slope to the base line can be demonstrated, changing the
relative heights of peaks.

Magnetic resonance spectroscopy (MRS) is performed with a variety of pulse sequences. The simplest sequence consists of
a 90 degree RF pulse without any gradients with reception of the signal by the RF coil immediately after the single RF pulse.
Many sequences used for imaging can be used for spectroscopy also (such as the spin echo sequence). The important
difference between an imaging sequence and a spectroscopy sequence is that for spectroscopy, a read out gradient is not
used during the time the RF coil is receiving the signal from the person or object being examined. Instead of using the
frequency information (provided by the read out or frequency gradient) to provide spatial or positional information, the
frequency information is used to identify different chemical compounds. This is possible because the electron cloud
surrounding different chemical compounds shields the resonant atoms of spectroscopic interest to varying degrees
depending on the specific compound and the specific position in the compound. This electron shielding causes the observed
resonance frequency of the atoms to slightly different and therefore identifiable with MRS.

History
Magnetic resonance spectroscopy (MRS) of intact biological tissues was first reported by two groups: Moon and
Richards using P-31 MRS to examine intact red blood cells in 1973, and Hoult et al. using P-31 MRS to examine excised leg
muscle from the rat in 1974.  

Peaks
[Editor: These should all gradually migrate to their own articles]
N-acetylaspartate (NAA)
 resonates at 2.0 ppm chemical shift
NAA is an acetylated amino acid which is found in high concentrations in neurons and is a marker of neuronal viability. It is
therefore reduced in any process that destroys neurons.

For more information refer to the article: N-acetylaspartate

Creatine
 resonates at 3.0 ppm chemical shift
Found in metabolically active tissues (brain, muscle, heart) important in storage and transfer of energy. Tends to be
maintained at a relatively constant level, and is predominantly used as a convenient internal standard, although it also
reduces in gliomas.

For more information refer to the article: Creatine

Choline
 resonates at 3.2 ppm chemical shift
Precursor to acetylcholine and cell membrane components. In MRS it is a marker of cellular membrane turnover, and is
therefore elevated in neoplasms, demyelination and gliosis. In the setting of gliomas, choline will be elevated beyond the
margins contrast enhancement in keeping with cellular infiltration.

For more information refer to the article: Choline

Lactate
 resonates at 1.3 ppm chemical shift, with a characteristic double peak at long TEs. It is however superimposed on
the lipid band, and using an intermediate TE (e.g. 144ms) will invert only lactate allowing it to be distinguished.
Marker of anaerobic metabolism (no peak is seen in normal spectra). It is therefore elevated in necrotic areas (eg: higher
grade tumours) and infections / inflammatory infiltrates.

For more information refer to the article: Lactate

Lipids
 resonates at 1.3 ppm chemical shift
Marker severe tissue damage with liberation of membrane lipids, as is seen in infarction.

For more information refer to the article: Lipids

Glutamine / GABA
 resonates at 2.2-2.4 ppm chemical shift
Neurotransmitters, seen in excess in gliomas.

For more information refer to the article: Glutamine and GABA

Alanine
 resonates at 1.48 ppm chemical shift
Seen in meningiomas.
For more information refer to the article: Alanine
Myo-inositol
 resonates at 3.5 ppm chemical shift
 seen in Progressive multifocal leukoencephalopathy (PML).
 reduced in Hepatic encephalopathy.
 elevated in Alzheimer's disease.
 elevated in Down syndrome 4.
 elevated in regions of gliosis 5, for example in congenital CMV infection.
For more information refer to the article: Myo-inositol

Spectra in specific conditions

Glioma
MRS can help increase our ability to predict grade. As the grade increases NAA and creatine decrease and choline, lipids
and lactate increase.
Non-glial tumours 
May be difficult but in general non-glial tumours will not have little if any NAA. In the setting of gliomas, choline will be
elevated beyond the margins contrast enhancement in keeping with cellular infiltration.

Radiation effects 
Distinguishing radiation change and tumour recurrence can be problematic. In recurrent tumour choline will be elevated,
whereas in radiation change, NAA, choline and creatine will all be low.

Ischaemia and infarction 

Lactate will increase as the brain switches to anaerobic metabolism. When infarction takes place then lipids are released
and peaks appear.

Infection 
As in all processes which destroy normal brain tissue, NAA is absent. Within bacterial abscess cavities, lactate, alanine,
cytosolic acid and acetate are elevated / present.

Of note choline is low or absent in toxoplasmosis, whereas it is elevated in lymphoma, helping to distinguish the two.
White matter diseases
 progressive multifocal leukoencephalopathy (PML) may demonstrate elevated myo-inositol.
  Canavan disease characteristically demonstrates elevated NAA.
Hepatic encephalopathy 
Markedly reduced myo-inositol, and to a lesser degree choline. Glutamine is increased.

Mitochondrial disorders
 Leigh syndrome : elevated choline, reduced NAA and occasionally elevated lactate.
Mnemonic
My ChoCrNaaLa (think of a new chocolate energy bar or something)
 My : Myoinisitol 3.3
 Cho : Choline 3.2
 Cr : Creatine 3.0
 Naa : Naa 2.0
 L : Lactate 1.3
Prostate MRS
In prostate MRS, a citrate peak is looked for at 2.6 ppm. For more information go to: MR spectroscopy in prostate cancer

+ Hunter's angle
Dr Jeremy Jones and Dr Umamaheswara Reddy V et al.

Hunter's angle is a term coined from a neurosurgeon, Hunter Sheldon, at Huntington Medical Research Institutes. He
placed his comb on the spectrum at approximately a 45š angle and connected several of the peaks. If the angle and peaks
roughly corresponded to the 45š angle, the curve was considered probably normal . If the peaks strayed off the comb's
angle, the curve was abnormal. This is a quick, useful method to read MRS and determine normal from abnormal. It is
important to remember, however, that this angle was used with STEAM spectra from the brain 
Hunter's angle is the line formed by the metabolites in MR spectroscopy.
Metabolites Myoinositol ,Choline ,Creatine and N-Acetyl aspartate peaks are ascending in normal spectrum, any alteration in
the ascending nature of the peaks means spectrum is abnormal.

Hunters angle is alternative of doing complex ratios and analysis of the spectra

! MR perfusion[–]
o time to peak (TTP)
o mean transit time (MTT)
o cerebral blood volume (CBV)
o cerebral blood flow (CBF)
o negative enhancement integral (NEI)

Functional MRI
Dr J. Ray Ballinger and Dr Frank Gaillard et al.

Functional magnetic resonance imaging (fMRI) is a technique used to obtain functional information by visualising cortical
activity. fMRI detects subtle alteration in blood flow in response to stimuli or actions.
It is used in two broad ways:

1. clinical practice
o typically in pre-surgical patients 
o aimed at localising eloquent areas (e.g. speech, motor)
2. research 
o often cohort of patients (often normals)
o aimed at elucidating novel neural networks
fMRI is technically challenging to perform as the techniques used to visualise cortical activity (typically BOLD imaging) rely
on minute changes in a low signal to noise ratio (SNR)environment. 
Technical requirements
 1.5T or higher MRI
 excellent quality assurance
 appropriate software
 appropriate paradigms and ability to deliver visual and auditory stimuli and record motor response
 cooperative patients

Study design
There are two most commonly employed testing designs:

1. block design
2. event related design 
Block design uses repeated blocks of activity (paradigm) separated by blocks of inactivity of alternative activity.  This is by
far the most frequently used study design in clinical fMRI. 

Event related design involves individual events rather than blocks, and can be randomly distributed during the study. 

Paradigms
The activity performed or stimulus received by the patient is termed a paradigm, and each is designed to elicit a specific
cortical response. Numerous paradigms have been developed of various complexity. In the clinical setting four paradigms
(with modifications according to the clinical situation) suffice for most indications. 

1. visual paradigm
2. motor paradigm
3. speech paradigm
4. memory paradigm

MR artefacts
MR hardware and room shielding:
Herringbone artifact (also called as crisscross artifact or corduroy artifact) is an MRI artifact , it appears as a fabric of
herring bone . Artefact is scattered all over the image in a single slice or multiple slices .
Causes
 electromagnetic spikes by gradient coils
 fluctuating power supply
 RF pulse discrepencies

Moire fringes are an interference pattern most commonly seen when doing gradient echo images with the body coil.
Because of lack of perfect homogeneity of the main magnetic field from one side of the body to the other, aliasing of one
side of the body to the other results in superimposition of signals of different phases that alternatively add and cancel. This
causes the banding appearance and is similar to the effect of looking though two screen windows.

Zebra stripes / artifacts appear as alternating bright and dark bands in a MRI image. The term has been used to describe
several different kind of artifacts causing some confusion.
Artifacts that have been described as a zebra artifact include the following:

 Moire fringes1,2
 Zero-fill artifact3,4
 Spike in k-space5
Zebra stripes have been described associated with susceptibility artifacts6
In CT there is also a zebra artifact from 3D reconstructions7 and a zebra sign from hemorrhage in the cerebellar sulci8.
It therefore seems prudent to use "zebra" with a term like "stripes" rather than "artifacts".
The central point artifact is a focal dot of increased signal in the center of an image. It is caused by a constant offset of the
DC voltage in the receiver. After Fourier transformation, this constant offset gives the bright dot in the center of the image as
shown in the diagram.
The axial MRI image of the head shows a central point artifact projecting in the pons in the center of the image.

Correction and prevention

 Repeating the sequence may get rid of the artifact.
 Maintain constant temperature in scanner and equipment room for receiver amplifiers.
 Software to estimate DC offset and adjust the data in k-space.
 Call service engineer for recalibration.

RF overflow artefact cause a nonuniform, washed-out appearance to an image. This artifact occurs when the signal
received by the scanner from the patient is too intense to be accurately digitized by the analog-to-digital converter.
Autoprescanning usually adjusts the receiver gain to prevent this from occurring but if the artifact still occurs, the receiver
1 2
gain can be decreased manually  . Post-processing methods also exist but may be time consuming  .

 inhomogeneity artifacts

MR software:
The slice-overlap artefact (also known as cross-talk artefact) is a name given to the loss of signal seen in an image from
a multi-angle, multi-slice acquisition, as is obtained commonly in the lumbar spine. It should not be confused with cross
excitation which although similar in causation, is not due to angled images. 
If the slices obtained at different disk spaces are not parallel, then the slices may overlap. If two levels are done at the same
time, e.g., L4-5 and L5-S1, then the level acquired second will include spins that have already been saturated. This causes a
band of signal loss crossing horizontally in your image, usually worst posteriorly.The dark horizontal bands in the bottom of
the following axial image through the lumbar spine demonstrates this artifact.

As long as the saturated area stays posterior to the spinal canal it causes no harm.

Cross-excitation artifact is a type of MRI artifact and refers to loss of signal within a slice due to pre-excitation from RF
pulse meant for an adjacent slice.
The frequency profile of the RF pulse is imperfect; this means that during slice selection there is some degree of excitation
of the adjacent slices as well. If that adjacent slice is imaged during the same TR (i.e., multi-slice imaging) or soon after (i.e.,
imaging without leaving a gap), it will be partially saturated to begin with, and the resulting signal will be reduced. This
phenomenon is more conspicuous in inversion recovery (180°) sequences

Remedy
 leaving a minimum gap of 1/3 slice thickness when imaging contiguous slices
 interleaving between slices
 employing 3D imaging if  volume imaging is required
 Using optimized pulse sequences that have a time penalty of a higher minimum TE and reduced number of slices for
a given TR.
Patient and physiologic motion:
Phase-encoded motion artefact is one of many MRI artefact, and occurs as a result of tissue / fluid moving during the scan
and manifests as ghosting in the direction of phase encoding, usually in the direction of short axis of the image (i.e left to
right on axial or coronal brains, and anterior to posterior on axial abdomen). 
These artefacts may be seen from arterial pulsations, swallowing, breathing, peristalsis, and physical movement of a patient.
When projected over anatomy it can mimic pathology, and needs to be recognized. Motion that is random such as the
patient moving produces a smear in the phase direction. Periodic motion such as respiratory or cardiac/vascular pulsation
produces discrete, well defined ghosts. The spacing between these ghosts is related to the TR and frequency of the motion.
Motion artifacts can be distinguished from Gibbs or truncation artifacts because they extend across the entire FOV, unlike
truncation artifacts that diminish quickly away from the boundary causing them.

Ways of identifying phase artefact include:

1. identifying known moving / flowing structures and noting that the artefact is in line with them (horizontal or vertical
depending on phase encoding orientation)
2. matching shape of ghost to that of flowing vessel (e.g round psuedolesion due to aorta ghost)
3. wide windowing to see repetitive ghost beyond confines of anatomy
4. they can be distinguished from Gibbs or truncation artifacts because they extend across the entire FOV, unlike
truncation artifacts that diminish quickly away from the boundary causing them
Solutions to phase mismapping include:

 cardiac / respiratory gating

 spatial presaturation bands placed over moving tissues (e.g. over anterior neck in sagittal cervical spines) 
 spatial presaturation bands placed outside the FOV, especial before the entry or after the exit slice for reducing
ghosting from vascular flow - arterial and venous
 scanning prone to reduce abdominal excursion
 switching phase and frequency directions
 increasing the number of signal averages
 Shorten the scan time when motion is from patient moving.

Entry slice phenomenon occurs when unsaturated spins in blood first enter into a slice or slices. It is characterized by
bright signal in a blood vessel (artery or vein) at the first slice that the vessel enters. Usually the signal is seen on more than
one slice, fading with distance. This mechanism is used in a positive fashion to generate flight MR angiograms.
 This artifact has been confused with thrombosis with disastrous results. The characteristic location and if
necessary, the use of gradient echo flow techniques can be used to differentiate entry slice artifacts from
occlusions.
 Spatial saturation bands place before the first slice and after the last can be used to eliminate this artifact. 

Tissue heterogeneity and foreign bodies:

Black boundary artifact or india ink artifact is an artificially created black line located at fat-water interfaces such as those
between muscle and fat. This results in a sharp delineation of the muscle-fat boundary that is sometimes visually appealing
but not an anatomical structure. 
Case 1 is a coronal image through the upper body with an echo time of 7 ms. A black line is seen surrounding the muscles
of the shoulder girdle as well as around the liver.

This artifact occurs in gradient echo sequences as a result of selecting an echo time (TE) in which the fat and water spins
(located in the same pixel at an interface) are out of phase, cancelling each other. At 1.5 T, the 3.5 PPM difference in
frequency between water and saturated fat results in cancellation of spins at 4.5 ms multiples, starting at about 2.3 ms; for
example at 6.8 ms, 11.3 ms, and 15.9 ms. This artifact does not occur with spin echo sequence as the spins are rephased
by the 180o refocusing gradient.
To avoid this artifact, TE's close to 4.5 ms, 9 ms, 13.6 ms, should be chosen or fat suppression used. Using a SE sequence
instead of GE will also eliminate the artifact.

The magic angle is an MRI artefact which occurs on sequences with a short TE (less than 32ms;T1W sequences, PD
sequences and gradient echo sequences). 
It is confined to regions of tightly bound collagen at 54.74° from the main magnetic field (Bo), and appears hyper intense,
thus potentially being mistaken for tendonopathy.
In tightly bound collagens, water molleules are restricted usually causing very short T2 times, accounting for the lack of
signal. When molecules lie at 54.74° there is lengthening of T2 times (don't understand why, but it involves 'bipolar coupling')
with corresponding increase in signal.
Typical sites include :

 proximal part of the posterior cruciate ligament (PCL)

 peroneal tendons as they hook around the lateral malleolus.
 cartilage can also be affected e.g. femoral condyles
 supraspinatus tendon
 triangular fibrocartilage complex (if the patient is imaged with the arm elevated)
It appears that at 3.0T the effects are reduced.

Tends to occur only on short TE sequences (e.g. T1, GRE, PD) - sequences with a longer TE (e.g. T2 including FSE T2)
can be used to avoid this artefact.

Other non-pathologic causes of high signal within tendons include near tendon insertions, and/or where the tendon
normally fans out or merges with other tendons.

Magnetic susceptibility artifact refers to a distortion in the MR image especially seen while imaging metallic orthopedic
hardware or dental work. This results from local magnetic field inhomogeneities introduced by  the metallic object into the
otherwise homogeneous external magnetic field B0. These local magnetic field inhomogeneities are known as magnetic
susceptibility and are a property of the object being imaged.
In terms of magnetic susceptiblity, most materials can be classified as diamagnetic, paramagnetic, superparamagnetic, or
ferromagnetic.

Water is considered (weakly) diamagnetic.

Paramagnetic materials, which have unpaired electrons, concentrate local magnetic forces and thus increase the local
magnetic field, i.e, have increased magntic susceptibility
Superparamagnetic materials contain particles with a much stronger magnetic susceptibility than that of paramagnetic
materials.  Eg, SPIO (superparamagnetic iron oxide) has been used in liver imaging
Ferromagnetic materials contain large solid or crystalline aggregates of molecules with unpaired electrons exhibit
“magnetic memory,” by which a lingering magnetic field is created after their exposure to an external magnetic field.
Examples of ferromagnetic metals include iron, nickel, and cobalt, all of which distort magnetic fields, thereby causing
severe artifacts on MR images
Chemical shift artefact or misregistration is a type of MRI artifact. It is a common finding on some MRI sequences, and
used in MRS.
Chemical shift is due to the differences between resonance frequencies between fat and water. It occurs in the frequency
encode direction where a shift in the detected anatomy occurs because fat resonates at a slightly lower frequency than
water. Essentially it is due to the effect of the electron cloud to a greater or lesser degree shielding the nucleus from the
external static magnetic field (Bo). The Larmor frequency which determines the frequency at which a particular nucleus
resonates is established at the nucleus, and therefore different tissues will have slightly different Larmor frequencies
depending on their chemical composition. 
A chemical shift artifact can occur in the slice select direction for an analogous reason to the frequency encoded artifact.
Since the slice position depends on the frequency of the spins, the "fat image" is shifted compared to the "water image". The
slice thickness is larger than the shift of the water and fat images making it difficult to detect the effect on routine imaging 3.
The amount of chemical shift is often expressed in arbitrary units known as parts per million (ppm) of the main magnetic field
strength. It's value is always independent of the main field strength and equals 3.5 ppm for fat and water, however the
precessional frequency is proportional to the main magnetic field strength B0, for example, at 1.5 T the difference in
precessional frequency is 224 Hz. That is, fat precesses 224 Hz less than water. At 1.0 T this difference is 147Hz at lower
field strengths (0.5 T or less), it is usually insignificant

In MRS the shift in Lamor frequency allows separation of different chemical peaks. The actual amount of chemical shift as
an absolute value is difficult to measure, so instead it is represented relative to a reference, and expressed in parts per
million (ppm).
In MRI, both spin echo sequences (SE) and gradient echo sequences (GE) may demonstrate chemical shift misregistration
or mismapping. The mismapping will occur in the frequency encoding direction, and show up as a bright band on one side
and a dark band on the other side of a fat-soft tissue interface.
In addition to mismapping, GE sequences can show another type of chemical shift induced artifact known as the black
boundary or india ink artifact. In the artifact a black line is seen in all directions at fat-water interfaces.  In pixels with roughly
equal amounts of fat and water, the fat and water spins are 180o out of phase at certain echo times because of their
chemical shift or frequency difference causing cancellation of signal.
These effects can be used to confirm, for example, the presence of fat in a lesion.

 chemical shift increases with magnetic field strength.

 chemical shift increases with decreasing gradient strength.
 chemical shift depends upon the bandwidth; narrower the bandwidth higher is the chemical shift. Increasing the
bandwidth will decrease the artifact.
 fat suppressed imaging can be used to eliminate the chemical shift misregistration and the black boundary artifact.
 use of a spin echo sequence instead of a gradient echo can eliminate the black boundary artifact but not chemical
shift misregistration.

The so-called india ink artifact also known as the black boundary artifact is an MRI feature seen on out-of-phase imaging
and represents signal drop out in voxels that contain both fat and non-fat components. As such it is seen surrounding
interfaces, lending the image an appearance as if someone has outlined these interfaces with ink. 

Fourier transform and Nyqvist sampling theorem:

Gibbs artifact / truncation artifact is a type of MRI artifact. It refers to a series of lines in the MR image parallel to abrupt and
intense changes in the object at this location, such as the CSF-spinal cord and the skull-brain interface 
The MR image is reconstructed from k-space which is a finite sampling of the signal subjected to inverse Fourier transform
in order to obtain the final image. At high-contrast boundaries (jump discontinuity in mathematical terms) the Fourier
transform corresponds to an infinite number of frequencies, and since sampling is finite the discrepancy appears in the
image in the form of a series of lines. These can appear in both phase-encode and frequency-encode direction.
The more encoding steps, the less intense and narrower the artifacts. The diagram shows the Gibbs effects resulting from
Fourier transforming a sharp change in image intensity. Image 1 shows prominent light and dark line along the sides that
fade as they approach the top and bottom of the phantom. Image 2 shows minimal artifact seen uniformly around the
periphery of the phantom as a result of increasing the matrix in the phase direction.

Remedy
 increasing the matrix size (i.e. sampling frequency for the frequency direction and number of phase encoding steps
for the phase direction)
 use of smoothing filters (2-D Exponential filtering, Gegenbauer reconstruction etc.)
 If fat is one of the boundaries, use of fat suppression

Zero fill artefact is one of many MRI artefacts and is due to data in the K-space array missing or set to zero during
scanning. The abrupt change from signal to no signal results in artifacts in the images showing alternating bands of shading
and darkness, often in an oblique direction.
A spike in k-space as from an electrostatic spark is another artifact that causes oblique stripes.

Aliasing / wrap around artifact in MRI (also known as wrap-around) is a common MRI artifact that occurs when the field of
view (FOV) is smaller than the body-part being imaged. The part of the body that lies beyond the edge of the FOV is
projected on to the other side of the image. 
This can be corrected, if necessary, by oversampling the data. In the frequency direction, this is accomplished by sampling
the signal twice as fast. In the phase direction, the number of phase-encoding steps must be increased with a longer study
as a result.
Case 1 demonstrates axial T2-weighted images of the brain that demonstrate aliasing. The first image shows wrap-around
with the back of the head projected over the front because the phase-encoded direction is anterior-posterior and the FOV is
too small. The second image has the phase and frequency directions reversed resulting in absence of the aliasing artifact.
Oversampling was used in the frequency direction to eliminate the aliasing.

More detail
The basis of aliasing lies in "analog-to-digital conversion" wherein the continuous MR signal picked by the receiver coil is
converted into its digital counterpart for presentation as a grey-scale image. This ubiquitously involves sampling of the
continuous signal at pre-defined intervals. For greater fidelity in signal conversion, the sampling rate should be at least twice
the highest frequency within the signal (Nyquist rate). At lower sampling rates, high frequency signals become
indistinguishable from lower frequency signals, i.e., they become aliases.

 In MRI, spatial localization within a single image depends upon the frequency signature of the MR signal originating from
that portion. Within a given bandwidth, higher frequency signals generally come from the periphery of the image and are
aliased over the lower frequency (relatively) central portion of the image. Aliasing in MRI can occur in both phase and
frequency axis.

Remedy
Aliasing in MRI can be compensated for by:

 enlarging the field of view (FOV)

 using pre-saturation bands on areas outside the FOV
 anti-aliasing software
 Switching the  phase and frequency directions
 Use a surface coil to reduce the signal outside of the area of interest

MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

MRI contrast agents have become an indispensable part of modern magnetic resonance imaging. Although MRI was
initially hoped to provide a means of making definitive diagnoses noninvasively, it has been found that the addition of
contrast agents in many cases improves sensitivity and/or specificity. 

History
Paul Lauterbur and his associates were the first to demonstrate the feasibility of using paramagnetic contrast agents to
improve tissue discrimination in MRI 1. 
Contrast agents
Contrast agents can be grouped in many different ways. One way is to consider them according to the compartments in
which they distribute. 

 gastrointestinal MRI contrast agents

 intravenous MRI contrast agents
 intravascular (blood pool) MRI contrast agents
 tumor-specific MRI contrast agents
 hepatobiliary MRI contrast agents
 reticuloendothelial MRI contrast agents
 MRI contrast agent safety

Paramagnetic contrast agents are use to enhance MRI images and display areas of hypervascularity and associated
pathology. They have their strongest effect in T1 weighted imaging because they predominantly alter the T1 relaxation
time in the tissues in which they have accumulated.
MRI imaging relies upon the signal generated from the behaviour of water protons. The relaxation of these water protons is
affected by surrounding tissues and, when a paramagnetic contrast agent has been absorbed in its vicinity, the relaxation of
water protons is enhanced.
The paramagnetic contrast agents generate a magnetic field 1000 times stronger than water protons. The interaction
between the contrast agent and the water proton is exactly the same as the corresponding interactions with other molecules
except that the magnitude of their magnetic interaction has a much greater effect on the relaxation time.
Commonly used contrast agents include:

 Gadovist®
 MultiHance®
 Omniscan®
 OptiMARK®.
There is an association between the use of paramagnetic contrast agents in patients with renal failure and nephrogenic
systemic fibrosis (NSF).

MRI contrast agent safety

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Though safer than the frequently used iodinated contrast agents used in x-ray and CT studies, there are safety issues with
MRI contrast agents as well. Paramagnetic metal ions suitable as MR contrast agents are all potentially toxic when injected
IV at or near doses needed for clinical imaging. With chelation of these ions, acute toxicity is reduced and elimination rate is
increased thereby reducing the chance of long term toxicity.
Intravenous gadolinium contrast agent safety
See also: nephrogenic systemic fibrosis
The most commonly reported reactions associated with the injection of Gd-DTPA are: headache (6.5%), injection site
coldness (3.6%), injection site pain or burning (2.5%), and nausea (1.9%). Recent adverse rates for Gd-DTPA are lower
than this and comparable to those of Gadodiamide and Gadoteridol (1.4%-3% for headache, nausea, and dizziness; <1% for
the others). The safety factor or ratio (ratio of the LD50 to the imaging dose) may be used to assess the relative acute
toxicity of contrast agents. The elimination half-life for the Gd containing contrast agents range from 1.25-1.6 hours.

Gadolinium containing contrast agents usually have no effect on blood chemistries and hematologic studies except transient
elevation of serum iron and bilirubin levels. These elevations peaked at 4 to 6 hours post injection and returned to baseline
values in 24 to 48 hours. The mechanism of these elevations is uncertain but may be related to mild hemolysis. A 10%-11%
increase in the activated partial thromboplastin time and thrombin time occurs in vitro with inhibition of platelet aggregation.
The platelet aggregation inhibition is less than that seen with iodinated ionic contrast material and no bleeding problems are
reported clinically. 

Deoxygenated sickle erythrocytes align perpendicular to a magnetic field in in vitro studies raising the possibility of occlusive
complications in patients with sickle cell anemia. No clinical reports of this potential problem have been found 1. 
Transient and mild drop blood pressure is reported in both animals and humans. A study of 1,068 patients reports
hypotension in 0.3% of the subjects and other symptoms such as syncope probably associated with hypotension in 0.8%.
Most of these symptoms occur 25-85 minutes after the injection.

Reports of several episodes of severe anaphylactoid reactions after IV injection of Gd- DTPA are published. The frequency
of these reactions is about 1 in 100,000 doses. Potential risk factors may include a history of asthma and significant reaction
to previously administered iodinated contrast material. It is suggested that the threshold for injecting Gd be raised, in those
patients, based on an individual risk/benefit ratio. Prophylactic pharmacotherapy with antihistamines and corticosteriods,
such as Greenberger's protocol, is suggested for high risk patients prior to contrast injections 2.
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 

Gastrointestinal MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.
Gastrointestinal MRI contrast agents are varied and can be either positive or negative agents. Acceptance of the use of
MR in abdominal imaging has been limited in part by difficulty in distinguishing bowel from intraabdominal masses and
normal organs. The use of enteric contrast agents can aid in this problem and a number of compounds have been used. GI
contrast agents can be divided into positive agents (appearing bright on MRI) or negative agents (appearing dark on MRI).
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 
Positive contrast agents
Positive GI contrast agents can be divided into three categories: 

1. paragmagnetic agents (e.g., Gd-DTPA solutions) - (see paramagnetism)

2. short T1-relaxation agents (e.g., mineral oil)
3. combination agents containing both
Paramagnetic Agents
Proposed paramagnetic, positive GI contrast agents include ferric chloride, ferric ammonium citrate, and gadolinium-DTPA
(with and without mannitol). Paramagnetic materials cause both T1 and T2 shortening. 

At low concentrations used for bowel opacification, the T1 shortening dominates the signal intensity. This results in high
intensity on T1-weighted, T2-weighted and gradient echo images. At high concentrations, T2 shortening causes decreased
signal in all but very short echo sequences. This resembles the effect seen with superparamagnetic iron oxide (see Negative
GI Contrast Agents). At intermediate concentrations, a mixture of T1 and T2 shortening results in increased signal on T1-
weighted images and decreased signal on T2-weighted images. 

Ferric ammonium citrate and Gd-DTPA with mannitol are safe and effective in humans, but both have minor side effects.
Ferric iron can cause teeth staining, gastric irritation, nausea, diarrhea, and constipation. Mannitol can nausea, vomiting,
and diarrhea. Gd-DTPA without mannitol is well tolerated but usually fails in opacify the entire small bowel. It also needs to
be buffered when used orally since this chelate is not very stable at the low pH found in the stomach 1.
Short T1-relaxation Agents
Short T1 relaxation time GI contrast agents include mineral oil, oil emulsions, and sucrose polyester. In these materials,
protons contained in -CH2- groups relax at a faster rate than those in water resulting in a short T1 time. This gives a bright
signal in the bowel on T1-weighted sequences. Of these materials only oil emulsions have been used successfully in
humans. These are palatable and produce homogeneous opacification of the stomach and small bowel, but are absorbed in
the distal small bowel and fail to fill the colon. This is circumvented by using a contrast enema when the colon must be better
visualized. 

A novel approach to retrograde opacification of the colon has been shown in rats with a nonabsorbable fat substitute,
sucrose polyester but no human trials for this use have been done 2.
Combination Contrast Agents
Combinations of oil emulsion and paramagnetic substances may be used as bowel contrast agents. These include an
emulsion containing corn oil and ferric ammonium citrate, and an emusion containing baby formula with ferrous sulfate.
These are palatable mixtures that distribute uniformly in the bowel, however signal is lost in the distal small bowel in adults,
because of absorption of both the oil and the iron. Unlike in adults, the faster transit through the small bowel in infants
delivers bright contrast to the colon. The advantage of this combination over oil emulsions alone is the enhancement of
signal on T1-weighted and especially T2-weighted images.

Negative contrast agents

Negative GI contrast materials can be divided into three categories: 

1. diamagnetic agents (see diamagnetism)

2. superparamagnetic agents (see superparamagnetism)
3. perfluorochemicals
Diamagnetic Contrast Agents
Two diamagnetic agents have been tested for use as a negative GI contrast agent. The first was a combination of clay
minerals found in a popular antidiarrheal medication, Kaopectate. This mixture of kaolin and bentonite is thought to facilitate
the relaxation rate of protons in water molecules. The water molecules next to the surface of the clay are continually
exchanging position with molecules away from the surface resulting in phase dispersion that also causes loss of signal.
When used in volunteers, this mixture causes loss of signal in the stomach and duodenum resulting in improved
visualization of the pancreas. Distribution in the small bowel is reported to be nonuniform 3-4.
The second diamagnetic contrast agent causing loss of signal in the bowel is barium sulfate suspension. The decrease in
signal seen is a result of two processes: 

1. replacement of water protons by barium; and 

2. magnetic susceptibility effects around the barium particals. 
Testing of a conventional barium sulfate suspension (60% wt/wt) in volunteers and patients gives encouraging results. Our
in vitro and volunteer studies at higher concentrations of barium sulfate show that the 170% to 220% wt/vl suspensions give
greater loss of signal than the original barium tested. The loss of signal from barium sulfate suspensions does not match that
seen with superparamagnetic iron oxide described below, however barium suspensions are currently readily available and
probably will be much less expensive 3-4.
Superparamagnetic Contrast Agents
There are several preparations of superparamagnetic agents can be used as oral MRI contrast agents. These include
magnetite albumin microspheres, oral magnetic particles (Nycomed A/S, Oslo, Norway), and superparamagnetic iron oxide
(AMI121, Advanced Magnetics, Cambridge, Mass.). These three contain small iron oxide crystals approximately 250 to 350
angstroms in diameter and are mixtures of Fe2O3 and Fe3O4. The small size of the crystals contributes to their large
magnetic moment without significant residual magnetization after removal from the magnetic field, i.e., they are
superparamagnetic, not ferromagnetic. These crystals are embedded in an inert material, albumin matrix in the first case, a
monodispersed polymer in the second, and an inert silicon polymer in the third. The inert materials reduce absorption and
therefore, toxicity from the iron. They also help to suspend the particles in solution 5.
Marked loss of signal in the stomach and small bowel results in excellent visualization of the pancreas, anterior renal
margins and para-aortic regions. Decrease in the phase encoded artifacts from respiratory and peristaltic motion of the
stomach and small bowel are noted. At certain concentrations and volumes, metallic artifacts are seen in the distal small
bowel and colon on delayed imaging. These may be related to settling and concentration of the particles. Optimization of the
dose of contrast agent and addition of more suspending agents may overcome this problem. Agents such as cellulose or
polyethylene glycol may be added to enhance relaxation and thereby allow reduction in the concentration of iron oxide
needed. This may reduce the artifacts 5.
Perfluorochemicals
Diamagnetic and paramagnetic effects are not the only mechanisms for reducing signal in the bowel. The absence of mobile
protons will give this effect as seen with barium sulfate suspended in D2O, carbon dioxide, and perfluorochemicals. CO2
from effervescent granules is moderately well tolerated by patients but shows inhomogeneous distribution in the small
bowel, and requires the use of glucagon to decrease peristalsis.

Perfluorochemicals are organic compounds in which the protons are replaced by fluorine. This results in an absence of
signal in the bowel. Perfluoroctylbromide(PFOB)(C8F17Br) is the only perfluorochemical that has been investigated for oral
use in humans to date. It is commercially available now as perflubron (Imagent GI, Alliance), but at high cost. Potential
advantages are a rapid transit through the small bowel because of its low surface tension, the lack of taste or odor making it
palatable, and the absence of any known side effects. PFOB is immiscible as are all perfluorochemicals that are in their pure
or "neat" state. This may be an advantage because PFOB cannot be diluted by bowel contents, however, miscible agents
that mix with fluid in the bowel may give more uniform filling of the GI tract. Emulsifying PFOB, as is done for intravascular
use of perfluorochemicals, may overcome this potential problem.
Positive vs Negative contrast agents
The question of which type of contrast enhancement of the bowel is the best, positive or negative, is sill debated. We may
find a positive or negative oral contrast agent better depending on the specific organ or disease suspected and the pulse
sequence used.

Two disadvantages of positive oral contrast agents are ghosting artifacts because of respiratory and peristaltic motion, and
loss of signal from dilution with secretions and retained fluid in the bowel. One method of reducing ghosting artifacts is to
use a pharmaceutical, such as glucagon or scopolamine, to reduce bowel motion. This increases the invasiveness of the
procedure. Other methods include the use of breath holding pulse sequences and first order flow compensation. Further
refinements of pulse techniques probably will make breath holding sequences more popular for abdominal MRI. This will
decrease artifacts from both peristalsis and breathing.

Dilution of positive contrast agents occurs in the upper GI tract if they are miscible with water because of gastrointestinal
secretions. This allows for the use of a small dose, but will cause loss of signal intensity as the concentration decreases.
Immiscible positive agents using oils, especially nonabsorbable ones, will not experience the loss of signal with dilution.
They will probably require a larger volume to replace any residual bowel contents. 

Another disadvantage of a positive oral contrast agent is the possibility of residual material in the bowel simulating a mass
when surrounded by bright signal. The opposite is also true. A bright mass (such as a lipoma) might be obscured by the
contrast agent.

An advantage of positive oral contrast agents is the availability of several of these materials at this time. These include ferric
ammonium citrate, pediatric formula, and homemade oil emulsions. Positive agents are also inexpensive (except for
gadolinium solutions) and are safe to use.

Disadvantages of negative oral contrast materials include their high cost and lack of general availability (except for CO2 and
barium), and limited evaluations of safety on large number of patients. The expense may decrease with greater use of these
contrast materials and with competition between manufacturers.Metallic artifacts are seen when iron oxide concentrations,
ideal for spin echo sequences, are used with gradient echo sequences. This is because gradient echo sequences have
greater sensitivity to magnetic field inhomogeneity. Also there were some metallic artifacts seen in the colon on delayed (24
hour) imaging with the iron oxide preparations that probably can be eliminated as discussed above.

Lack of a fat plane between the negative contrast filled bowel and low signal intensity organs may make it difficult to
distinguish normal contours. An example of this is the plane between the stomach and the pancreas on T2-weighted
sequences. The majority of pathology appears bright on T2-weighted sequences and should be seen, however.

Advantages of negative oral contrast materials are several. The lack of signal in the bowel removes a source of ghosting
artifacts from spin echo sequences that may be present with positive agents. The loss of signal is fairly independent of
concentration of superparamagnetic iron oxide suspensions on spin echo sequences so that dilution should not be a
problem. The perfluorochemicals are immiscible with water and will not encounter dilution problems either.

Intravenous MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Intravenous MRI contrast agents include chelates of paramagnetic ions, both ionic and nonionic. The particulates,
sequestered in the liver, spleen, and lymph nodes, the intravascular agents, confined to the blood pool, and tumour specific
agents are discusses separately (see bottom). 
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 
Paramagnetic metal ions suitable as MR contrast agents are all potentially toxic when injected IV at or near doses needed
for clinical imaging. With chelation of these ions, acute toxicity is reduced and elimination rate is increased thereby reducing
the chance of long term toxicity.
Ionics
Chelates of paramagnetic ions Cr and Gd with EDTA were first used however EDTA was of relatively low stability resulting
in toxicity in animals 1. Chelates with a higher stability constant have since been used successfully such as Gd-DTPA .
Gd-DTPA was the first intravenous MR contrast agent to be approved for human use (Magnevist, Berlex Labs). Gd has a
large magnetic moment, exceeded only by Dysprosium(III) and Holmium(III), explaining its paramagnetic properties at low
concentrations. This large magnetic moment is related to its seven unpaired orbital electrons. Gd-DTPA has similar
pharmacokinetics as iodinated contrast agents. It is distributed in the intravascular and extracellular fluid spaces, does not
cross an intact blood-brain-barrier, and is excreted rapidly by glomerular filtration 2.
Nonionics
The development of nonionic contrast agents for MRI has paralleled that for iodinated contrast materials. Ionic chelates are
also hyperosmolar and some of their side effects may be attributed to this property.

Gadodiamide
Gadodiamide (Omniscan, Winthrop Pharm.) is a nonionic complex with two-fifths of the osmolality of Gd-DTPA. It has a
median lethal dose of 34 mmol/kg resulting in a safety ratio of 2-3 times that of Gd-DOTA, and 3-4 times that of Gd-DTPA.
No abnormal serum bilirubin levels occur, however elevated serum iron levels occurred with an incidence of 8.2% in one
study of 73 patients.The efficacy of this contrast is similar to that of Gd-DTPA 3.
Gadoteridol 
Gadoteridol (Prohance, Squibb) is the third intravenous contrast agent on the market. It is a low osmolar, nonionic contrast
as is Gadodiamide. Indications for use and efficacy are similar to the other agents 4.
Intravenous MRI contrast agent safety
Intravenous MRI contrast agent safety and Nephrogenic systemic fibrosis are discussed separately. 

Gadolinium (Gd) chelates are paramagnetic agents that are injected intravenously during MR imaging.
Gd molecules shorten spin-lattice relaxation time (T1) of voxels in which they are present. As a result, on T1-weighted
images they have a brighter signal. This can have a number of utilities:
 detection of focal lesions, i.e. tumour, abscess, metastasis
 imaging of vessels in MR angiography
 characterization of liver lesions, e.g. hepatoma, haemangioma, based on enhancement characteristics

Intravascular (blood pool) MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Intravascular MRI contrast agents normally remain confined to the intravascular space, compared to Gd-DTPA which
distributes throughout the extracellular fluid space. This is a result of intravascular agents having a molecular weight of
approximately 70,000 and above, compared to a molecular weight of 590 for Gd-DTPA. 
There are several advantages of intravascular agents:

 they can assess perfusion in areas of ischemia and provide information about capillary permeability in areas of
reperfusion
 they can show the extent of tumor neovascularity and associated permeability changes
 they are useful in studies requiring prolonged imaging. 
Three types of intravascular contrast agents will be discussed separately: 

Gd-DTPA labeled albumin- Gd-DTPA labeled albumin is an intravascular MRI contrast agent. Gd-DTPA is covalently
bonded to albumin in ratios from 16:1 to 31:1 providing excellent enhancement of liver, spleen, myocardium, brain, and slow
moving blood of rats and rabbits. The albumin has a molecular weight of about 92,000 and a biological half-life of 88
minutes. The dose of Gd-DTPA required when bound to albumin is 0.062 mmol/kg compared to usual doses of the chelate
alone of 0.1-0.2 mmol/kg. No adverse reactions are reported, but in vivo retention of the gadolinium for several weeks in
liver and bone raises concerns of long term toxicity.
Gd-DTPA labeled dextran- Gd-DTPA labeled dextran is an intravascular MRI contrast agent. Dextran is a polysaccharide
consisting of a polymer of glucose molecules with a molecular weight between 75,000-100,000. Dextran has a high level of
safety and is broken down more rapidly than albumin. Approximately 15 Gd-DTPA molecules are attached to each dextran
molecule with an easily hydrolyzable bond. It is hoped that this will reduce the long term in vivo retention seen with Gd-
labeled albumin. The trade off is a shorter biological half-life of 43 minutes. In a rat model, satisfactory enhancement of liver,
spleen, kidneys, myocardium, and brain is seen for up to 1 hour. The dose of dextran Gd-DTPA in these studies was 0.01-
0.05 mmol/kg 1. 
A variation of this contrast agent has been commercialized as Riovist (Schering) 2.

 chromium-labeled red blood cells- Chromium labeled red blood cells is an intravascular MRI contrast agent. The
use of 51Cr-labeled RBC's in nuclear medicine suggested the use of paramagnetic Cr(III)-labeled RBC's as an
intravascular contrast agent for MRI. In dogs, significant enhancement of the liver and spleen is noted with minimal
enhancement of the kidneys. The blood volume to be replaced with labeled RBC's in these studies corresponding to
about one unit in humans. The survival half-life of labeled cells is 4.7 days compared to 16.6 days for unlabeled cells.
Free Cr may contribute to the enhanced relaxation rates of the liver and spleen. Short term toxicity appears to be
low, but further studies are necessary.

Tumour specific MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Tumor specific MRI contrast agents are pharmaceuticals that are targeted to tumors, either specifically or nonspecifically.
Monoclonal antibodies are targeted to specific tumors such as adenocarcinoma of the colon. Metalloporphyrins exhibit
affinity for many tumor types including carcinoma, sarcoma, neuroblastoma, melanoma and lymphoma.
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 
Monoclonal antibodies
 Monoclonal antibodies (McAb) are used successfully in nuclear medicine for localization of tumors but an initial attempt at
extending this use to MRI with paramagnetic (Gd3+) labeled antibodies was unsuccessful because of the estimated 800-fold
lesser sensitivity of MRI. This problem can be addressed in several ways: 1) increasing the number of paramagnetic ions
attached to the McAb; 2) attaching several paramagnetic ions to a macromolecule that in turn is attached to a McAb; 3)
using more antibodies or those with an affinity to many antigenic sites per cell or both; and 4) using a superparamagnetic
particle attached to the McAb. Implanted human colon carcinoma tumors in mice have been successfully imaged by using
monoclonal antibodies with a large number of Gd-DTPA molecules attached.

Additional studies report the use of very small magnetite particles coated with McAb. The magnetite cores are 10-20 nm in
diameter with a total particle diameter of 20-32 nm. The magnetic moment of these superparamagnetic particles is about
1000 times that of comparable paramagnetic particles. This allows the use of 1-10 nmol concentrations of the McAb coated
magnetite particles. Mixed success has been obtained in rodents with implanted neuroblastoma and human colon
carcinoma.

Metalloporphyrins
The metalloporphyrin most commonly used as a MRI contrast agent is Mn(III)TPPS4 (manganese(III) tetra-[4-
sulfanatophenyl] porphyrin) because of its low toxicity (compared to Fe(III)TPPS4 for example). A safety ratio of about 6:1 is
estimated in mice. This material appears to work best with tumors that are isointense to surrounding structures on T1-
weighted sequences. Incidentally, the fluorescent and tumor localizing characteristics of porphyrin derivatives have been
exploited in phototherapy of tumors.
Nitroxides
Nitroxide stable free radicals or nitroxyl spin labels as they may be called, are chemically stable organic compounds that
have an unpaired electron that results in paramagnetic properties. They generally consist of a six- member ring piperidine
derivative or a five-member ring pyrroxamide derivative. The pharmacokinetics of nitroxides are similar to iodinated contrast
agents and Gd- DTPA. They do not cross an intact blood brain barrier and undergo glomerular filtration as a dominant route
of elimination. Their ease of conjugation to various biomolecules makes them attractive for targeting to various organ
systems. Nitroxides are chemically stable and show limited in vivo metabolism. Their relaxation effects in vivo can be
eliminated almost immediately by IV injection of sodium ascorbate, a strong reducing agent. This will allow an unenhanced
MR study to be performed immediately after a contrast enhanced study, if the contrast study is not satisfactory alone.

The early ionic derivatives of piperidine have a 38 minute half-life and a safety ratio of between 8:1 and 100:1. Nonionic
pyrrolidine derivatives are formulated with a longer half-life of 45-50 minute in dogs, estimated to be about 2 hours in
humans. The LD50 in mice of this nonionic formulation is about 25 mmol/kg, making it twice as safe as earlier ionic
piperidinyl preparations. Mutation and toxicity studies show no evidence of genetic or other cellular damage in mammalian
cell preparations.

Larger molecular weight nitroxides exhibit increased relaxation rates as do paramagnetic ions attached to macromolecules.
This phenomenon occurs when attaching five-membered nitroxide rings to fatty acids. The fatty acids attach to human
serum albumin, either in vitro or in vivo, resulting in a significant increase in relaxation rate. Safety studies and clinical trials
need to be performed before nitroxides will be available for use. 

Ferrioxamine methanesulfonate
Ferrioxamine methanesulfonate is a paramagnetic contrast agent that has undergone phase I and phase II clinical trials for
use as an IV and retrograde contrast agent for the kidneys, ureters and bladder. It is more stable than Gd-DTPA, though its
relaxivity is somewhat less, as expected from it having 5 unpaired electrons, vs 7 unpaired electrons for Gd-DTPA. 80% is
eliminated by renal excretion and 20% by hepatic excretion. Ferrioxamine undergoes renal excretion by glomerular filtration
but is actively reabsorbed in the tubules. This results in a longer plasma half-life than Gd-DTPA (128 min. vs 20 min. in rats).

In clinical imaging the long plasma half-life allows enhancement of the kidneys for 60 minutes with little change in intensity.
Significant improvement in detectability of lesions in the kidneys is demonstrated over unenhanced controls. Side effects
include epigastric distress and transient burning at the injection site. Increase in serum iron levels and a transient elevation
of serum liver enzymes (SGOT/SGPT) have been reported.

Hepatobiliary MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Hepatobiliary MRI contrast agents are desirable for several reasons: to detect mass lesions such as metastases within the
liver; to evaluate functional status of the liver in diffuse hepatocellular diseases such as cirrhosis; and to obtain high
resolution images of the gallbladder and biliary tree.
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 
Three advantages of a hepatobiliary contrast agent over a particulate agent targeted for Kupffer cells exist. First of all, there
are many more hepatocytes than Kupffer cells (78% vs. 2% by volume) in the liver, improving uptake efficiency of contrast
material. Second, the biliary ducts are opacified by excreted contrast material, eliminating confusion of normal bile ducts
from focal abnormalities as may occur with particulate agent contrast materials. Third, the contrast agent is rapidly excreted
from the body reducing potential toxicity. In contrast, materials phagocytized by the reticuloendothelial system (including
Kupffer cells) remain in the body for a long period of time.

The uptake and excretion of contrast material allows visual assessment of basic hepatocyte function. The biliary
opacification will allow functional information to be obtained as with radionuclide hepatobiliary studies but with significantly
higher spatial resolution.
Manganese chloride
Manganese chloride (MnCl2) is a prototype hepatobiliary contrast agent. IV and oral administration in animals results in a
rapid decrease in the T1 relaxation time of the liver, spleen, kidneys, heart, and bile causing a bright signal on T1-weighted
images. In its ionic state, Mn+2, it is relatively toxic. In imaging doses of 0.2 mmol/kg, it caused severe hypotension and
ventricular fibrillation in dogs. Cerebral damage results from chronic manganese toxicity. Mn can be used in the form of a
chelate with diminished toxicity for hepatobiliary imaging in humans.

Hepatobiliary chelates
 Chelates used as hepatobiliary contrast agents consist of a paramagnetic ion bound to an organic ligand, forming a
complex that shows affinity for hepatocytes. This type of complex is desirable to increase uptake of the contrast agent by the
hepatocytes and to reduce toxicity of the paramagnetic metal ion as is done with gadolinium. Possible chelates for
hepatobiliary imaging include Fe-EHPG and derivatives, Gd-HIDA, Cr-HIDA, B-19036, and Mn-DPDP.

Fe-EHPG (Iron(III) ethylenebis-(2-hydroxyphenylglycine)) is a structural analog of the radionuclide 99mTc- iminodiacetate

(Tc-IDA) used for hepatobiliary imaging in nuclear medicine. Fe-EHPG is a very stable complex over a large pH range
making it likely to be nontoxic. Fe-EHPG has been shown to improve visualization of small and medium-sized, blood-borne
liver metastases in mice. To my knowledge no clinical studies with this material have been performed.

Chromium diethyl HIDA meglumine (Cr-HIDA) is another analog of a hepatobiliary radiopharmaceutical that has been tested
in rats and rabbits. Excretion was 45%-77% after one hour. The dose required to give significant increased signal in the liver
(0.25 mmol/kg) results in a safety ratio in mice of 6:1, compared to 100:1 for Gadolinium-DTPA. This low ratio for Cr-HIDA
precludes clinical use.

An octadentate chelate of gadolinium coded B-19036 (Bracco Industria Chimica S.p.A., Milan, Italy) may be used as a
hepatobiliary contrast agent. It is a highly stable complex with an LD50 in mice comparable to Gd-DTPA. It has yet to be
tested in humans.

Manganese(II)-dipyridoxal diphosphate (Mn-DPDP) is a manganese chelate derived from vitamin B6, pyridoxal-5-
phosphate. It shows efficacy in detecting small liver metastases in rabbits and has undergone phase I clinical trials showing
it to be safe and effective in enhancing the signal intensity of the liver. It has a safety ratio of 200:1 in rats which is somewhat
better than that for Gd-DTPA. Unlike Fe-EHPG and its derivatives whose uptake by hepatocytes depend on their lipophilic
attraction to the cell membrane, Mn-DPDP is recognized by a vitamin B6 transport system in the cell membrane.

Reticuloendothelial MRI contrast agents

Dr Jeremy Jones and Dr J. Ray Ballinger et al.

Reticuloendothelial MRI contrast agents can best be discussed in terms of those used for liver and spleen imaging and
those for lymph node imaging.
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 

Liver and spleen

The use of Gd-DTPA with routine imaging sequences of the liver is unsatisfactory. Particulate contrast agents targeted to
the reticuloendothelial system (RES) of the liver and spleen, achieve the goals of improved detection and localization in the
liver. This is analogous to the use of 99mTc-sulfur colloid in nuclear liver scans.

Two major cell types can be targeted for hepatic imaging. Hepatocytes comprise about 78% of the liver by volume, and
Kupffer cells of the reticuloendothelial system comprise about 2% by volume. Originally, particulate contrast agents were
targeted for the RES but recently ultra-small particles have been used that bind to a specific receptor site on the hepatocyte
cell membrane.

 gadolinium oxide & magnetite

 superparamagnetic iron oxide
  liposomes
Gadolinium Oxide
Gadolinium oxide is a the prototype particulate contrast agent. This material accumulates in the liver and spleen of rabbits in
both Kupffer cells and in the sinusoidal vascular spaces and effectively increases T1 and T2 relaxation as desired. The
safety ratio (LD50/Imaging dose) is only about 7:1 raising concerns of acute and chronic toxicity. It is therefore precluded
from clinical use 1.
Magnetite (Fe3O4)
Magnetite is another prototype particulate contrast agent initially tested in dogs. It is a predecessor to coated particles used
in clinical studies 2.
Superparamagnetic Iron Oxide
As with its use as an oral contrast agent, superparamagnetic iron oxide (SPIO) causes marked shortening T2 relaxation time
resulting in a loss of signal in the liver and spleen with all commonly used pulse sequences. The most common form of iron
oxide used is magnetite, which is a mixture of Fe2O3 and FeO. A mixture using Fe3O4 instead of FeO may also be used.
Three mechanisms have been postulated to explain the relaxation enhancement of SPIO 3.
SPIO particles for parenteral use are coated with various substances to facilitate uptake by the reticuloendothelial system.
These coatings have included albumin, a hydrophilic polymer, starch, and dextran.

The following problems that can arise with detecting small lesions in the liver using SPIO: 

1. small lesions may be indistinguishable from the flow void in small blood vessels seen in cross-section
2. aortic pulsation artifacts are more noticeable
3. the one hour delay between injection and imaging make it impractical to decide at the last minute to give contrast.
Liposomes
A liposome is a spherical vesicle consisting of one or more bilayer phospholipid membranes or lamella. Liposomes for
hepatic imaging range in size from about 20 nm to 400 nm diameter. Reasons to use liposomes as a carrier for
paramagnetic contrast materials include: 

1. changing the interaction between water molecules and the contrast agent
2. changing the rate of removal of the contrast agent from the blood pool
3. targeting specific organ systems, e.g., liver, spleen, and bone marrow. 
Paramagnetic materials can be incorporated into either the aqueous inner chamber or the bilayer membrane. Encapsulation
of superparamagnetic iron oxide particles into liposomes (Ferrosomes) has been reported. Both Gd-DTPA and MnCl2 can
be encapsulated into the aqueous inner chamber of liposomes 4.
Liposomes are taken up only by the Kupffer cells. Once in the Kupffer cells, Mn+2 or Gd-DTPA is slowly released and
diffuses into adjacent hepatocytes, resulting in enhancement of normal liver but not malignancies.

Stable nitroxide free radicals have been attached to phospatidylcholine, a common constituent of liposome lamellae. They
may also be attached to derivatives of the fatty acid, stearic acid, as have the DTPA chelates of Mn and Gd. This results in a
lipophilic side chain that allows incorporation into the liposome membrane.

Lymph nodes
 Two clinical problems common to CT and MR imaging are: 1) distinguishing unenlarged metastatic lymph nodes from
normal lymph nodes; and 2) differentiating enlarged metastatic nodes from benign hyperplastic nodes. Differentiation of
metastases from fibrosis, lipomatosis and cysts is possible with resected lymph nodes in a 4.7T magnet using voxels of size
0.1 by 0.1 by 1.0 mm; however, gradient strength and switching capabilities are not adequate in clinical imagers to obtain
the necessary spacial resolution. This inadequacy of clinical imagers is circumvented by the use of USPIO.

USPIO particles with a mean diameter of 80 nm may be injected into the interstitium of the foot pad of rats. After a suitable
delay, marked loss of signal of normal lymph nodes is seen. Metastatic nodes show less uptake resulting in less decrease in
signal, allowing differentiation of normal-sized, metastatic nodes from uninvolved, normal nodes. From experience with
conventional lymphangiography, this route of injection is unlikely to opacify all the abdominal lymph nodes 5.
USPIO particles, with a median diameter less than 10 nm, will localize in lymph nodes following an IV injection. This material
does not undergo uptake by the RE system as rapidly as larger particles, resulting in a longer plasma half-life in rats (81
minutes, vs 6 minutes). This factor and its small size allow transcapillary passage either into the interstitium and then to the
lymph nodes or directly into the lymph nodes. In the rat model, IV injection of USPIO allows differentiation of normal lymph
nodes from normal size metastatic nodes based on differences in signal characteristics. MR microscopy of excised lymph
nodes, performed at 9.4T shows the USPIO to be associated with macrophages in the medullary sinuses.

MRI safety
Dr Jeremy Jones and Dr J. Ray Ballinger et al.

MRI scanners, although free from potentially cancer inducing ionising radiation found in plain radiography and CT, have a
host of safety issues which must be taken very seriously. These can be divided into:

1. main magnetic field

2. varying magnetic (gradient) fields
3. radiofrequency
NOTE: This article has been transferred from mritutor.org and was last updated in March 5, 1996. Review and edit pending. 
Main magnetic field
The main magnetic field of a 1.5 T magnet is about 30,000 times the strength of the earth's magnetic field. It is strong
enough to pull fork-lift tines off of machinery, pull heavy-duty floor buffers and mop buckets into the bore of the magnet, pull
stretchers across the room and turn oxygen bottles into flying projectiles. Deaths have occurred from trauma as a result of
these effects. Smaller objects such as pagers, bobby pins and pens have been known to be pulled off the person carrying
them.

The strong field also effects common devices such as pacemakers and watches. The magnetic reed switch in modern
pacemakers is disturbed by strong magnetic fields resulting in possible deleterious effects to the patient with one implanted.
Mechanic watches will "freeze up" in a strong field, sometimes permanently.

Many intracranial aneurysm clips are ferromagnetic and as a result experience a torque or twisting in a magnetic field. Not
everyone with an aneurysm clip experiences a fatal hemorrhage when placed in a magnet, but several cases have been
reported. 

Some types of heart valves (e.g., Star-Edwards) are torqued in a magnetic field: however, this torque is less than the
stresses that occur normally as a result of blood flow. Therefore heart valves are now considered not to be an absolute
contraindication for MRI.

More of an annoyance than a safety problem is the ability of the magnetic field of a MRI machine to erase the information
contained on the magnetic strip on ATM and credit cards. This may occur a short distance inside of the scanner room of a
MRI machine.

Some metallic objects that are usually safe near an MRI machine are gold jewelry and eyeglass frames. 

Varying Magnetic (Gradient) Fields

Varying magnetic fields are necessary in order to obtain images from MRI scanners. Changing magnetic field induce
electrical currents in conductors ( this is how an electrical generator works). In patients with metal in their body, the potential
exists for electrical currents being induced in the metal with subsequent heating. This may occur with metal foreign bodies or
some surgical implants. It does not universally occur and some patients with hip prostheses, for example, may be scanned
without harm. 
Very rapidly changing magnetic fields as may be achieved with echo planar imaging can cause nerve stimulation. This
stimulation can effect motor nerves with resulting muscle contraction as well as the retina with resulting flickering lights
called "magnetophosphenes".

Radio-frequency
The radio frequency power that is capable of being produced matches that of many small radio stations (15-20 kW). As a
result there is the presence of heating effects from the RF. In most pulse sequences, the heating is insignificant and does
not exceed the FDA guidelines. New pulse sequences such as for echo planar imaging and some spectroscopy localization
techniques are capable of exceeding the FDA guidelines. Monitoring of the power deposition in patients is a requirement for
FDA approval of clinical MRI scanners.

Potential for electrical shock exists with RF coils so proper grounding and insulation of coils is necessary. Any damage to
coils or their cables needs prompt attention. Also looping of the cable to a coil can result in burns to patients that come into
contact with them. It is best to avoid all contact with the RF coil cables.
Neuroanatomy and Cortical / Landmarks of Functional Areas
Sensorimotor Cortex
Transverse Sections
The precentral gyrus fuses with the superior frontal gyrus at the very upper
convexity .The precentral gyrus is the most posterior part of the frontal lobe that
extends inferiorly to the Sylvian fi ssure . At the apex, the pre- and postcentral
gyri form the paracentral lobule as they fuse. Making a little detour to a lateral
view the cingulate sulcus ascends at the medial interhemispheric surface dorsal
to the paracentral lobule (pars marginalis) and thus separates it from the
precuneus . This intersection can be appreciated on axial sections as the
“bracket”-sign that borders the postcentral gyrus . Somatotopographically, the
apex harbours the cortical representation the lower extremity. Following its
course along the lower portion of the gyrus adjacent to the Sylvian superficial
convexity (from medial–posterior–superior
to lateral–anterior–inferior), the cortical surface of the
precentral gyrus increases at its posterior margin, building
the omega-shaped motor hand knob; Within this primary motor cortex (M1)
of the hand, there is an additional somatotopic order of
the individual digits .From medial to lateral, the hand is organized
beginning with digit 5 (D5), to the thumb representation
(D1) being the most lateral .The motor hand knob is another typical landmark of
the precentral gyrus ; however, as the CS and the
postcentral gyrus follow this course, there is also an
omega-shaped structure in the postcentral gyrus (harboring
the somatosensory hand area). However, as
described above, the ap-dimension of the postcentral
gyrus /is smaller compared to the precentral gyrus , thus often enabling a
differentiation/. Somatotopographically,the cortical somatosensory
representation follows the distribution of the precentral gyrus . Lateral to the
SFG , the medial frontal gyrus zigzags posteriorly and points towards the motor
hand knob . Beginning at this “junction” and lateral–inferior to this landmark, the
ap-diameter of the PreCG decreases, but it increases again along the lower
convexity.
This is the primary motor cortex (M1) of lip representation and tongue
movements. Previously, the anatomy of the frontal lobe has been
described partially. As the course of the medial frontal gyrus can be followed
nicely on axial sections, the lateral inferior aspect of the frontal lobe represents
the inferior frontal gyrus. Anterior to the preCG the prefrontal motor areas can
be found. The inferior frontal gyrus borders and overhangs the insula anteriorly.
This part is the frontal operculum harbouring the motor speech area of Broca.
The lateral ventricles with its anterior and posterior horn can easily be depicted
on axial sections due to its typical form and typical signal caused by cortico- spinal
fl uid. Their shape is formed through, the head of the caudate nucleus lateral to
the anterior horn, the thalamus lateral at its waist (III. ventricle) and posteriorly
by the fi bers of the anterior–posteriorly running optic radiation and left–right
running fibers of the splenium . Lateral to these structures, descending
corticospinal fibers pass the internal capsule and follow a certain somatotopic
organization. The internal capsule is framed medial by the head of the caudate
nucleus , the third ventricle and the thalamus (at the posterior aspect of the third
ventricle) and lateral by the globus pallidum. From medial to lateral towards the
insula the globus pallidus, putamen and claustrum within the lentiform nucleus
can be differentiated. In the anterior limb and the genu of the internal capsule,
corticospinal fi bers from the tongue, lip and face descend, whereas, in the
posterior limb, fi bers from the upper extremity, body and fi nally lower extremity
are found.

Sagittal Sections
The corpus callosum represents the biggest connection between the two
hemispheres. The frontal aspect is the genu , the medial part is the body and the
most rostral part is the splenium. The corpus callosum encases the lateral
ventricles. At the base the anterior commissure can be identifi ed as a roundish
structure. Sometimes, the posterior commissure (pc) can also be defi ned, which
represents a bundle of white fi bers crossing the midline, at the dorsal aspect of
the upper end of the cerebral aqueduct. Previously slice orientation of most fMRI
studies had been performed according to this ac-pc line in order to have a
reference system.
From the base to the apex, the corpus callosum is abutted by the callosal sulcus
and the cingulate gyrus.The gyrus abutting the cingulate sulcus is the medial
part of the SFG . In the region (at the medial cortical surface) framed by vertical
lines perpendicular to the ac (Vac) or pc (Vpc) the sup plementary motor area
(SMA) is harboured in the cigulate gyrus and superior frontal gyrus. As described
above, the cingulated sulcus ascends at the medial interhemispheric surface
dorsal to the paracentral lobule ;pars marginalis and thus separates it from the
precuneus .This intersection can be nicely appreciated on axial sections
as the “bracket”-sign that borders the postcentral gyrus .The postcentral gyrus is
already a part of the parietal lobe. The precuneus is located dorsal to the
postcentral sulcus. There is another important landmark that separates the
parietal lobe from the occipital lobe (cuneus , the parieto-occipital sulcus ). It can
be easy recognized in sagittal views, as the dorsal sulcus that follows an inferior–
anterior to superior–posterior course, posterior to the ascending part of the
cingulate sulcus . In mid-sagittal sections the motor hand knob [a] can again be
recognized as a “hook” that rises out of the parenchyma and points dorsally.
Further, laterally the sensorimotor cortex overhangs the insula . The Sylvian fi
ssue that separates the frontal lobe and the temporal lobe has an inferior–
anterior to superior–posterior course. At its anterior margin, it ascends into the
anterior horizontal ramus , and more dorsally into the anterior ascending
ramus of the frontal operculum, that also overhangs the anterior aspect of the
insula . The anterior horizontal ramus separates the pars orbitalis from the pars
triangularis , whereas the anterior ascending ramus separates the pars
triangularis from the pars opercularis of the frontal operculum of the inferior
frontal gyrus and thus form a “M”. The pars opercularis of the frontal operculum
of the inferior frontal lobe harbours Broca’s area. At its posterior margin, the
pars opercularis is delimited by the anterior subcentral sulcus. At the base of the
sensorimotor strip the precentral and postcentral gyrus fuse . This junction is
delimited dorsally by the posterior subcentral sulcus. Movement of
the lips or tongue induce an increase in BOLD signal at this portion . The
base of the sensorimotor area has, depending on anatomical
variations, a “K”- or “N”-shape that is built by the anterior subcentral sulcus and
inferior precentral sulcus, the precentral gyrus, posterior subcentral sulcus,
postcentral gyrus and postcentral sulcus that again borders the angular gyrus .The
posterior part of the Sylvian fi ssure separates – following its superior–posterior
course - ascends into the posterior ascending ramus flanked by the anterior
and posterior aspect of the supramarginal gyrus that has a horseshoe
appearance.
Fig. 2.2 Axial T2-weighted TSE MR images. 1 superior frontal gyrus; 2 medial frontal gyrus; 3
precentral gyrus; 4 postcentral gyrus; 5 “pars bracket,” cingulated sulcus; 6 precuneus, parietal
lobe; 7 intraparietal sulcus; 8 interhemispheric fi ssure; a hand knob; b paracentral lobule

Fig. 2.3 Sagittal FLAIR

image at the midline. 1 superior frontal gyrus; 5 “pars bracket,” cingulate sulcus; 6 precuneus,
parietal lobe; 23 body of the corpus callosum; 24 anterior commissure; 25 parieto-occipital
sulcus; 27 calcarine fi ssure; b paracentral lobule; 28 cuneal point
The Insula
The insula is covered by the superior temporal gyrus , the frontal operculum and
the base of the sensorimotor strip. Its anatomy is best depicted in sagittal
sections.
Sagittal Sections
The insula is separated by the CS that runs from the superior–posterior towards
the inferior–anterior located apex of the insula into an anterior lobule
and a posterior lobule. The anterior lobule consists of three gyri (anterior, medial
and posterior short insular gyri), the posterior lobule consists of two gyri, the
anterior long insular gyrus and the posterior long insular gyrus separated by the
postcentral gyrus .From a neurofunctional point of view, the insula has various
functional areas. The anterior lobule was found to cause word fi nding diffi culties
during electrical stimulation in epilepsy surgery, and to be responsible for speech
planning . Speech apraxia is induced through lesions in the left precentral gyrus of
the insula whereas the right anterior lobule becomes activated during vocal
repetition of nonlyrical tunes. Stimulation of the right insula increases
sympathetic tone and stimulation of the left insula increases parasympathetic
tone, possibly playing a role in cardiac mortality in left insular stroke. Finally
visual-vestibular interactions have been found to name a few systems.
Transverse Sections
The insular cortex is delimited medially by the globus pallidus, putamen and
claustrum (lentiform nucleus ) and separated by a small border of white matter
(extreme capsula ). The gyri can be differentiated by counting each knob starting
ventrally at the anterior peri-insular sulcus that abuts the pars opercularis
of the frontal operculum of the inferior frontal gyrus. Five knobs can be defi ned
(anterior, medial and posterior short insular gyrus; anterior and posterior long
insular gyrus).
Fig. 2.4 Sagittal FLAIR images. 1 superior frontal gyrus; 3 precentral gyrus; 4 postcentral gyrus;
5 “pars bracket,” cingulated sulcus; 6 precuneus, parietal lobe; 7 intraparietal sulcus; 9 pars
opercularis, inferior frontal lobe, frontal operculum; 19 insula (anterior, posterior short insular
gyri, anterior and posterior long insular gyri); 33 medial frontal gyrus; 35a posterior ascending
ramus of the sylvian fi ssure; 35b sylvian fi ssure; 35c anterior horizontal ramus of the sylvian fi
ssure; 35d anterior ascending ramus of the sylvian fi ssure; 36 central sulcus of the insula; 37
supramarginal gyrus; 38 angular gyrus; a hand knob

Fig. 2.5 Axial T2-weighted TSE MR and sagittal FLAIR images.

3 precentral gyrus; 4 postcentral gyrus; 7 intraparietal sulcus; 8 interhemispheric fi
ssure; 9 pars opercularis, inferior frontal lobe, frontal operculum; 10 Heschl’s gyrus; 11
Heschl’s sulcus; 12 planum temporale; 13 superior temporal sulcus; 14 head of the
caudate nucleus; 15 thalamus; 16 internal capsule; 17 globus pallidum, putamen,
claustrum (lentiform nucleus); 18 extreme capsule; 19 insula (anterior, posterior short
insular gyri, anterior and posterior long insular gyri); 34 superior temporal gyrus; 35a
posterior ascending ramus of the sylvian fi ssure; 37 supramarginal gyrus;
38 angular gyrus; 39 pars triangularis, frontal operculum, inferior frontal gyrus; 40 pars
orbitalis, frontal operculum, inferior frontal gyrus; 41 medial temporal gyrus
Speech Associated Frontal Areas
Transverse Sections
In axial sections the insula can be found easily. From medial (ventricles) to lateral,
the globus pallidus, putamen and claustrum,within the lentiform nucleus, can be
differentiated followed by the extreme capsula and the cortex of the insula . The sylvian
fi ssure separates the insula from the temporal lobe. As stated above, the insula –
taking anatomic variations into account –has four to fi ve knobs (anterior, medial and
posterior short insular gyrus divided, by the CS, from the anterior and posterior long
insular gyrus). The insula is covered by the superior temporal gyrus , the
frontal operculum and the base of the sensorimotor strip. After identifying the anterior
short gyrus of the anterior lobule of the insular cortex, on a transverse view, the anterior
border between the insula and inferior frontal lobe is the anterior peri-insular sulcus. It
abuts the insula on one hand and the pars opercularis of the frontal operculum of the
inferior frontal gyrus on the other. The pars opercularis has a triangular
shape in axial sections and covers the anterior part of the insula . It can be followed into
the anterior cranial fossa where it abuts the gyrus orbitalis that runs parallel to the gyrus
rectus. The convolution anterior to the pars opercularis on the lateral surface is
the pars triangularis , separated by the anterior ascending ramus
of the sylvian fi ssure.
Sagittal Sections
Beginning at the lateral border of the brain there is the sylvian fi ssure
that runs anterior–inferior to posterior–superior.Previously, the posterior margins have
been described. The Sylvian fi ssure separates the temporal lobe from the frontal lobe.
At its anterior margin, it ascends into the anterior horizontal ramus and
more dorsally into the anterior ascending ramus of the frontal operculum that also
overhangs the anterior aspect of the insula. The anterior horizontal ramus separates
the pars orbitalis from the pars triangularis , whereas the anterior ascending
ramus separates the pars triangularis from the pars opercularis of the frontal
operculum of the inferior frontal gyrus that form an “M” . The pars opercularis of the
frontal operculum of the inferior frontal lobe harbours Broca’s area.
At its posterior margin the pars opercularis is delimited by the anterior subcentral
sulcus.

Auditory Cortex and Speech

Associated Temporo-Parietal Areas
Transverse Sections
From medial to lateral towards the insula the globus pallidus, putamen and claustrum
within the lentiform nucleus can be differentiated. Between the lentiform nucleus [17]
and the cortex of the insula the extreme capsula is depicted as a small rim of white
matter. The sylvian fi ssure separates the insula from the temporal lobe. This is an
easy defi nable landmark on axial views. The insula – taking anatomic variations into
account – has four to fi ve knobs (anterior, medial and posterior short insular gyrus
divided by the CS from the anterior and posterior long insular gyrus). Posterior to the
convolution that represents the section of the posterior long insular gyrus, a gyrus in the
superior temporal lobe can be identifi ed with a dorso-medial to anterior–lateral course,
called the transverse temporal gyrus or Heschl’s gyrus. This is the primary
auditory cortex. Number and size may vary however, this is another good landmark that
is easy to defi ne. Heschl’s gyrus might be interrupted by the sulcus intermedius of
Beck. Two gyri on the right and only one on the left hemisphere can be found
frequently. Heschl’s sulcus, which borders Heschl’s gyrus posteriorly is the anterior
border of the planum temporale . Although direct cortical stimulation intraoperatively
may cause speech disturbances in this area, the planum temporale represents, more
likely, the auditory association cortex. The planum temporale extents on the superior
surface of the temporal lobe and is delimited laterally by the superior temporal
sulcus , posterior by the posterior ascending ramus and/or descending ramus of the
sylvian fi ssure and medially in the depth of the sylvian fi ssure, which is
less well defi ned. These borders are easier depicted in sagittal views; however, in
transverse sections, remaining in the same plane in which Heschl’s gyrus [10] can be
found, the superior temporal sulcus is the next biggest sulcus posterior
to Heschl’s sulcus . Heschl’s gyrus bulgesinto the sylvian fi ssure . The sylvian fi ssure
can therefore also be followed in ascending axial images.At the parieto-temporal
junction, sulci such as the sylvian fi ssure or the superior temporal sulcus [13] ascend
whereas the sulcus intermedius primus descends. This hampers anatomical description
in axial sections.
Ascending in axial slice order, the superior temporal sulcus diminishes. As Heschl’s
gyrus bulges into the sylvian fi ssure, the sylvian fi ssure can be followed on its course
as posterior ascending ramus up to the level of the cella media of the lateral ventricles
(in bicommissural orientation), as a big intersection posterior to Heschl’s sulcus [11].
The posterior ascending ramus of the sylvian fi ssure is imbedded in the supramarginal
gyrus which again is separated from the angular gyrus by the sulcus intermedius
primus. Descending in axial slice order, pre- and postcentral gyri can be identifi ed as
described above. The next sulcus dorsal to the postcentral sulcus is the intraparietal
sulcus which can be followed from the medial apical surface, laterally and dorsally
in the parietal lobe. Laterally, it ends above the sulcus intermedius primus and abuts the
angular gyrus . Size of the planum temporale varies depending on sex, handedness
and hemispherical dominance. Activation in functional imaging studies was found in
verb generation tasks listening to tones, words and tone sequences.
Sagittal Sections
According to its dorso-medial to anterior–lateral course , the transverse temporal gyrus
or Heschl’s gyrus abuts the base of the inferior sensorimotor strip (most likely the
postcentral gyrus) at the lateral aspect and the posterior long gyrus of the insula [19] in
more medially located sections. It is erected into the sylvian fi ssure . Heschl’s sulcus ,
which borders Heschl’s gyrus posteriorly, is the anterior border of the planum
temporale . The planum temporale extends on the superior surface of the temporal
lobe and is delimited laterally by the superior temporal sulcus posteriorly by the
posterior ascending ramus and/or descending ramus of the sylvian fi ssure and medially
in the depth of the sylvian fi ssure, which is less well defi ned . The sylvian fi ssure can
be followed from the anterior ascending and horizontal rami in
he frontal operculum of the inferior frontal gyrus, dorsally to the ascending and
descending rami at the temporo-parietal junction. Medially it is fl anked by
the insula , laterally by the superior temporal gyrus and inferior parts of the pre- and
postcentral gyrus. Parallel to the sylvian fi ssure , the superior temporal
gyrus also demonstrates an anterior–posterior course. The posterior ascending ramus
of the sylvian fi ssure is imbedded in the supramarginal gyrus which has a horseshoe
appearance. Posterior to the supramarginal gyrus , the superior–inferior running
sulcus intermedius primus separates it from the angular gyrus . The superior temporal
sulcus ] ascends at its posterior end and diminishes.
Coronal Sections
In coronal views, the sylvian fi ssure separating the temporal lobe from the insula and
the frontal lobe can easily be seen. Originating from the temporal lobe,
Heschl’s gyrus points towards the insula (not shown).

Visual Cortex
Sagittal Sections
At the medial surface of the occipital lobe, there is a sulcus that zigzags anterior–
posteriorly called the calcarine sulcus , along which the visual cortex is located. The
calcarine sulcus separates the superior lip from the inferior lip of the visual cortex.

Fig. 2.6 Axial T2-weighted TSE MR and sagittal FLAIR

images. 1 superior frontal gyrus; 3 precentral gyrus; 4 postcentral gyrus; 5 “pars bracket,”
cingulate sulcus; 6 precuneus, parietal lobe; 7 intraparietal sulcus; 8 interhemispheric fi ssure; 9
pars opercularis, inferior frontal lobe, frontal operculum; 10 Heschl’s gyrus; 12 planum
temporale; 14 head of the caudate nucleus; 15 thalamus; 16 internal capsule; 17 globus pallidum,
putamen, claustrum (lentiform nucleus); 18 extreme capsule; 19 insula (anterior, posterior short
insular gyri, anterior and posterior long insular gyri); 33 medial frontal gyrus; 34 superior
temporal gyrus; 35a posterior ascending ramus of the sylvian fi ssure;36 central sulcus of the
insula
1.One пример того, как градиенты поля могут помочь в решении проблем выбора
среза . Помните, что РЧ импульса мы используем, чтобы протоны прецессируют
должны иметь ту же частоту, частоту ларморовскимпротонов . Здесь, однако,
протоны имеют разные частоты ларморовским в зависимости от их расстояния по
Y- оси.
РЧ импульса показано имеет частоту, равную частоте ларморовской протонов
сидит на оси Х , но это быстрее, чем те , слева от оси Х и медленнее, чем с
правой стороны. Результатом является то, что только те, по оси Х прецессировать
в существенным образом , и таким образом мы будет только измеримый сигнал от
них. Это один из способов , что МРТ срезы могут быть приобретены. Если такие
методы, как бы это было не возможно , все тело пациента будет посылать сигнал
на один раз, и это не было бы возможным реконструировать отдельные вокселы .
Другие методы , используемые для достижения пространственное различение
сигналы называются фазового кодирования и частотой кодирования . Хотя они
несколько сложнее, чем методики, показанной здесь, они оба основаны на
принципе, чтоградиент поля изменяется ларморовой частоты протонов по
отношению друг к другу.
2.Field градиенты не только полезны для различения сигналов пространственно ,
они также могут быть использованы для создания эхо. Здесь РЧ импульса
вращает протонов в XY- плоскости. Чистая дипольных начинается большая , но в
итоге распада , так как протоны испытываютбольшее магнитное поле
прецессирующие быстрее.
Однако позже , градиент меняет направление . Протонов , которые были
прецессирующие медленнее и сел за теперьбыстрые , в то время как протоны ,
которые были быстро и обогнал теперь медленно. В конце концов , они
становятся реконструированный ичистая становится большой дипольный снова ,
создавая другой измеряемый сигнал называетсяэхом.
3.As большинство детей учиться играть с магнитами , два магнита положив его на
стол со своими северными полюсами обращены друг к другу , как правило, будет
вращаться в соответствие . Немагнитного диполя протона не отличается. Так
обстоит дело с этим протоном , который был помещен в магнитное поле , как
показанозеленой стрелкой. Ее дипольный ,оранжевая стрелка , будет испытывать
силу, которая тянет его в соответствие с общим магнитным полем.
Это может показаться на первый взгляд простая, но не забывайте, что , как волчок
, этого протона вращается . Как гравитация делаетгироскопа прецессируют как
она тянет его вниз , это магнитное поле сделает протон прецессируют она тянет
его вверх. Результатом является характерным движением посмотреть здесь.
Протона действительно вращаются для выравнивания с магнитным полем , но
прецессирует как она делает это .
Это кажется тривиальным , но это понятие фундаментальное : если протоны не
прецессируют , не было бы такого понятия, как МРТ или ЯМР. Это потому, что
несколько протонов прецессирующие вместе производит колебания магнитного
поля, которые являются измеримыми. Позже графика будет лучше
продемонстрировать это, но важно, чтобы сейчас принять два важных принципа :
1. Протоны прецессировать когда в магнитном поле . Частота, на
которойпрецессирует называется ларморовой частоты.
2 . Это вызываетколебательное магнитное поле, которое может быть измерена.
4.Magnetic полей и движущихся электрических зарядов тесно взаимосвязаны.
Заряд, движущийся в магнитном поле, будет кривой , и заряд, движущийся по
кривой создаст магнитное поле. На самом деле, все магнитные поля - в том числе
в МРТ , земли , и те из магнитов для холодильника - это результат вращения
обвинения.
Магнитные поля генерируются в МРТ электрическими катушками. Форма катушка
заставляет протекающие по их двигаться по кругу, и это создает магнитное поле .
Катушка влево имеет постоянный , постоянный ток ( DC). Таким образом, он
производит постоянное магнитное поле . Катушка вправо имеетпеременный ток
(AC) и его магнитное поле осциллирует с током. Обратите внимание, что , когда
ток равен нулю, нет магнитное поле, когда направление тока меняется и
магнитного поля.
Кроме того,катушки, которая подвергается воздействию магнитного поля будет
иметь ток пропускается через него. Это, как антенны работают. Электромагнитное
излучение , которое является просто бегущей пара полей , одним электрическим и
магнитным один , индуцирует ток в катушке, которая может быть измерена .
5.To получить лучший взгляд на радиочастотный импульс , мы сняли мяч
представление протона и оставил только ее дипольный как показанооранжевой
стрелкой . РЧ импульс приходит со стороны, и магнитное поле
испытываютпротона от РЧ импульса показаназеленой стрелкой вдоль оси у.
Напомним, по-прежнему существует магнитное поле действует на протон в
направлении+ Z- оси.
Протона еще следует правилам прецессии , но магнитное поле он испытывает
стала более сложной . До сих пор прецессирует вокруг оси Z. , но оно также
прецессирующие из-за магнитного поля, вызванного РЧ импульса . Поскольку
ларморовой частоты соответствует РЧ импульсов , импульсный ВЧ пики вдоль оси
ординат , магнитный диполь 90 градусов в направлении по часовой стрелке . Это
то, что заставляет вращаться протон от равновесия в едином порядке . В этой
графики, это означает, что магнитное поле, создаваемое -импульс всегда
нажатием дипольных от нас.
Если частота пульса и РФ ларморовскую частоту протона были разные, протон
будет колебаться несколько, но не будет вращаться от равновесия.
Теперь важно оценить эти новые принципы :
1. Скорость, с которойпротон прецессирует , называется ларморовской частоты.
2 . Протон , который испытываетРЧ импульс , который имеет частоту, равную
частоте ларморовской его будет вращаться от равновесия.
Оба метода используются в МРТ . Пациент подвергается воздействию магнитных
полей, создаваемых катушками , и электромагнитное излучение от пациента
измеряется с помощью антенн.
6.Magnetic градиентов поля не являются единственным способом сделатьэхо.
Аналогичный эффект может быть достигнут при использовании РЧ импульсов.
Как и раньше,начальные 90 градусов импульс поворачивает протонов от
равновесия. Как только они будут десинхронизировано ,измеряемый сигнал
уменьшается. Позже, на 180 градусов импульс поворачивает протонов вокруг оси
ординат . Вместо ускорениямедленных протонов и замедление быстрые ,180
градусный импульс изменяет порядок . Медленные были помещены в передней
ибыстрыми были размещены в тылу. Как только они догнать,эффект эха видел.
Это трудно различить в этом графическом , но на следующий демонстрирует, как
180 градусный импульс решает эту задачу немного более четко.
7.Теперь , что мы понимаем , что магнитные поля протонов прецессируют сделать
, как мы можем измерить сигнал, что результаты , и как эти сигналы затухают , мы
можем приступить к изучению способов, чтобы использовать это . Поскольку
протон только делает измеримой магнитных полей , когда она прецессирует ,
было бы полезно иметь возможность заставить ее от равновесия и сделать его
прецессии . В состоянии покоя , большинство протоны поворачивается для
выравнивания с магнитным полем . Нам нужно , чтобы подтолкнуть их от этого ,
чтобы они могли прецессировать Вернуться к равновесию и сделатьизмеряемый
сигнал , как они.
К сожалению, как с гироскопами , то самое, что делаетизмеряемый сигнал -
прецессирующими - делает колебание протона в неловкое образом, если мы
добавляем другое постоянное магнитное поле . Мы хотим , чтобы иметь
возможность быстро и точно вращать протона от Z- оси к любой угол мы хотим.
Решение состоит в том , чтобы выставить протона в магнитное поле , которое
называется радиочастотной (РЧ) импульсов . Этот импульс должен
переключаться на той же частоте , как протон прецессирует , ларморовой частоты
.
В результате, как показано на рисунке , является то, что протон " прецессирует в
то время как прецессирующим ", и отлично поворачивается вниз в XY- плоскости.
Если бы мы продолжалипульс, он будет продолжать вращаться до
отрицательного Z- оси и назад снова . Используя эту технику, мы можем вращать
протона к точным углом к оси Z- мы желаем. Как только импульс РФ остановлена,
протон прецессируют обратно до + Z- оси.
8.Further манипуляции магнитных диполей в данном объеме может быть
достигнуто путем изменения статическое магнитное поле, действующее на
протоны . Как показано награфикезеленые стрелки увеличивающегося размера ,
величина магнитного поля испытывают этих протонов увеличивается , как вы
идете вверх по Y- оси. Поскольку большее магнитное поле будет оказывать
большее усилие на протоны , они будут прецессировать быстрее. Этот факт
используется во многих интересных способов , некоторые из которых будут
рассмотрены в этой статье. Основная идея состоит в том, что многие проблемы
могут быть преодолены путем изменения ларморовой частоты групп протонов
путем изменения магнитного поля в заданном направлении.
9.T2 распада определяется как распад перпендикулярном - компонент вектора
магнитного и определяется уравнением
B ( T) = B0 * E ^ ( -t/T2 )
В этом графики, перпендикулярной компонентывектора является таким же, как
XY- компонента. Показано несколько протонов в том же магнитном поле .
Протонов в графическом всех есть похожие, но несколько различных частот
Лармора. В результате их диполей , который первоначально выравнивать,
постепенно начинают указывать в различных направлениях. Когда это происходит
, их диполей эффективно компенсируют друг друга .
Это явление приводит к потере сигнала , потому что сигнал, измеренный МКС -
колебание результирующий магнитный диполь , не дипольный отдельных
протона. Если все протоны прецессируют в соответствие , их диполей сложить
для создания большого магнитного диполя , что прецессия в XY- плоскости - и
таким образом создает флуктуации магнитного поля достаточно большой, чтобы
измерить.
10.Это рисунке показана же T2 распада как и раньше, но теперь все отдельные
диполи протона показаны проходящими от начала координат , и мы наблюдаем от
положительного Z- оси. Графическое лучше демонстрирует, как много диполей
при выравнивании результата в большую чистую диполь. Однако , так как их
немного отличаются частотами ларморовским заставить их разойтись , они
теряют их выравнивания и вызывают XY- компонент к снижению.

Напомним :
В случае T1 распад, если слишком много диполей протон начать указывают в Z-
направлении , суммаXY- компонентами отдельных диполей слишком малы, чтобы
быть измерено , даже если они выровнены. В случае T2 распад, если слишком
много диполей протона направлены в разные стороны , отдельные диполи будут
уравновешивать друг друга , даже если они по большей части сидят вдоль XY-
плоскости. В действительности , оба явления приводят к ослаблению сигнала .
11.Это слайд показывает, что протон не сидит спокойно в пространстве. Из-за
теплового взаимодействия , его ориентации и положения постоянно меняются.
Графическое не был произведен , имитируя явления , которые вызывают
случайные движения протонов, но просто , вызывая его ориентации на хаотически
меняются . Значение этого является то, что графики , показанные здесь, все , в
некоторой степени , неточны. Протоны не шаров с тонко разграниченных объем ,
магнитные поля не стрелы идвижений, описываемых происходить гораздо
быстрее и с разной пропорции друг к другу.
Цель этих графиков не показыватьточное описание физической реальности, но
эффективно передавать динамику концепций, описанных . Как и во всех таких
моделей , это всегда важно , чтобы думать о них как более качественный , чем
количественный .
12.The возврата дипольного к равновесию описывается математически как два
компонента: Т1 и Т2.
T1 распада описывает, каким образом параллельно - составляющей магнитного
поля возвращается к равновесию. Она определяется уравнением
B ( T) = B0 * (1- е ^ ( -t/T1 ) )
Важно только понять, из этого уравнения , что чем больше T1 , тем больше
времени требуется для дипольных , чтобы вернуться , чтобы перестроить с
магнитным полем .
В этом графические ( и во всех графика в этой статье ) ,параллельно - компонента
вектора такой же, какZ- компонента. Показанадипольных прецессирующим от + х -
х до+ Z- оси. XY- компоненты дипольного показана всем прецессии и
прослеживается в синий цвет.
Хотя T1 определяется по отношению к Z- компонент , важно помнить, что T1
распада влияет на XY- компонент , потому что, как было сказано ранее, это
прецессия XY- компонент, который поддается измерению .
Таким образом , чем больше T1 , тем большесигнал от данного протона остаться.
Протона с коротким T1 , однако, повернет вспять к Z- оси очень быстро, и сигнал
измеряется от такой протон распадается быстро.
13.Here ,отдельных диполей все были перемещены в начало координат. Обратите
внимание, что на 180 градусов импульс поворачивает диполей вокруг оси ординат
. Это не только восстанавливает Z- компонента на большее значение , но
изменяет порядок прецессии так , что эхо имеет самое высокое возможное XY-
компонента.
Ранее , графические показал протонов с разными частотами ларморовским из-за
градиента магнитного поля , но помните, что это десинхронизации происходит,
даже если мы попытаемся применить однородном магнитном поле , и которые мы
называем это явление T2 .
Одна большая разница между эхо градиента и спинового эха в том, что спин-эхо
меняет Z- компонент потери, в то время как градиент эхо может только
обратнаяXY- компонент десинхронизации . Интересно, что в результате
последовательности спинового эха может быть повторен несколько раз с
небольшим распада сигнала.
14.Most студентов учат, что протоны имеют заряд и что они также имеют угловой
момент -причудливый способ сказать , что они вращаются . Большинство
студентов также учат , что протоны имеют магнитный диполь. Эти два понятия
неразрывно связаны , но это , как правило, не рассматриваются в основные
классы химии.

Первое заблуждение, что необходимо решить , что протоны пунктов. В самом

деле, они охватывают определенный объем . Во-вторых, их заряд не
сосредоточены все в их центре , но распространяется , хотя и неравномерно , на
протяжении всего их объема. Посколькупротон имеет заряд в его объем , и он
вращается , он не будет эффективно заряд вращающийся по кругу. Это ничем не
отличается от случаякатушки или земля вращается, и это является причиной,
протоны создают магнитный диполь , который просто другое слово для магнитного
поля она создает. Сравните это протонов к катушке на предыдущем слайде ,
чтобы увидеть сходство .
15.Inversion восстановление в первую очередь касается релаксации T1 и
используется, чтобы аннулировать сигнал от субпопуляции протонов. Начиная с
180 градусного импульса , повернутые протоны имеют практически нулевое XY-
компонент , они испытывают только T1 распада поZ- оси. Отдельные протоны
действительно прецессируют сXY- компонентом, но 180 градусного импульса не
обязательно выровнять их . Они указывают на нескольких случайных
направлениях , и таким образом они компенсируют друг друга .
Если еще 90 градусный импульс доставлены точно в срок , как чистый магнитный
диполь целевых кресты субпопуляции через XY- плоскости , протоны вращаются
все в XY- плоскости , но они будут иметьXY- компонент, который будет
продолжать испытывать T1 распада без производство любых измеримых сигнала.
Между тем, тканях с большими или меньшими значениями T1 будет вращаться в
XY- плоскости с магнитудой больше единицы, и будет прецессировать обычно и
производятизмеряемый сигнал . Результатом является то, что тот же образ может
быть получен, но целевой субпопуляции будут отображаться как гипоинтенсивные
на конечное изображение .
Рисунке показаны следующие три отдельные последовательности :
1. 90 градусного импульса происходит до Z- компонент проходит через нуль .
Таким образом, можно повернуть в XY- плоскости и создает измеряемый сигнал .
2 . 90 градусного импульса occurse прав, когдаZ- компонент проходит через нуль .
Таким образом, он не имеет чистой XY- компонент после вращения и не создает
никакого сигнала .
3 . 90 градусного импульса происходит послеZ- компонент проходит через нуль .
Таким образом, она вращается обратно в XY- плоскости и производит
измеряемый сигнал .
Примеры последовательностей ИК включают жидкие Инверсия Затухание