ASSIGNEMENT

ON

MRI AND CT SCAN

SUBMITTED TO: - SUBMITTED BY:-

MR. HARI PRASATH MR. SUMIT PRAJAPATI
LECTURE DEP. MEDICAL M.SC 2nd YEAR
SURGICAL (SNC) MED. SURG. DEP. (SNC)
 MAGNETIC RESONANCE IMAGING

INTRODUCTION

Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or

magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to
image the anatomy and the physiological processes of the body in both health and disease.
MRI scanners use strong magnetic fields, radio waves, and field gradients to form images of
the body.

Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio
wave energy to make pictures of organs and structures inside the body. In many cases, MRI
gives different information about structures in the body than can be seen with an X-ray,
ultrasound, or computed tomography (CT) scan. MRI also may show problems that cannot be
seen with other imaging methods.

PURPOSES

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

MRI has a wide range of applications in medical diagnosis and over 25,000 scanners are
estimated to be in use worldwide. MRI has an impact on diagnosis and treatment in many
specialties although the effect on improved health outcomes is uncertain. Since MRI does not
use any ionizing radiation, its use is generally favored in preference to CT when either
modality could yield the same information. (In certain cases, MRI is not preferred as it can be
more expensive, time consuming, and claustro phobia exacerbating). MRI is in general a safe
technique but the number of incidents causing patient harm has risen. Contraindications to
MRI include most cochlear implants and cardiac pacemakers, shrapnel and metallic foreign
bodies in the eyes. The safety of MRI during the first trimester of pregnancy is uncertain, but
it may be preferable to other options. The sustained increase in demand for MRI within the
healthcare industry has led to concerns about cost effectiveness and over diagnosis.

NEUROIMAGING

MRI is the investigative tool of choice for neurological cancers, as it has better
resolution than CT and offers better visualization of the posterior fossa. The contrast
provided between grey and white matter makes it the best choice for many conditions
of the central nervous system, including demyelinating diseases, dementia,
cerebrovascular disease, infectious diseases and epilepsy. Since many images are
taken milliseconds apart, it shows how the brain responds to different stimuli;
researchers can then study both the functional and structural brain abnormalities in
psychological disorders. MRI is also used in mriguided stereotactic surgery and
radiosurgery for treatment of intracranial tumors, arteriovenous malformations and
other surgically treatable conditions.

CARDIOVASCULAR
Cardiac MRI is complementary to other imaging techniques, such as
echocardiography, cardiac CT and nuclear medicine. Its applications include
assessment of myocardial ischemia and viability, cardiomyopathies, myocarditis, iron
overload, vascular diseases and congenital heart disease.

MUSCULOSKELETAL

Applications in the musculoskeletal system includes spinal imaging, assessment of

joint disease and soft tissue tumors.

LIVER AND GASTROINTESTINAL IMAGING MRI

Hepatobiliary MR is used to detect and characterize lesions of the liver, pancreas and
bile ducts. Focal or diffuse disorders of the liver may be evaluated using diffusion
weighted, opposed phase imaging and dynamic contrast enhancement sequences.
Extracellular contrast agents are widely used in liver MRI and newer hepatobiliary
contrast agents also provide the opportunity to perform functional biliary imaging.
Anatomical imaging of the bile ducts is achieved by using a heavily T2weighted
sequence in magnetic resonance cholangiopancreatography (MRCP). Functional
imaging of the pancreas is performed following administration of secretin. MR
enterography provides noninvasive assessment of inflammatory bowel disease and
small bowel tumors. MRcolonography can play a role in the detection of large polyps
in patients at increased risk of colorectal cancer.

FUNCTIONAL MR
Functional MRI (fMRI) is used to understand how different parts of the brain respond
to external stimuli or passive activity in a resting state. Blood oxygenation level
dependent (BOLD) fMRI measures the hemodynamic response to transient neural
activity resulting from a change in the ratio of oxyhemoglobin and deoxyhemoglobin.
Statistical methods are used to construct a 3D parametric map of the brain indicating
those regions of the cortex which demonstrate a significant change in activity in
response to the task. fMRI has applications in behavioral and cognitive research as
well as in planning neurosurgery of eloquent brain areas.

ONCOLOGY

MRI is the investigation of choice in the preoperative staging of rectal and prostate
cancer, and has a role in the diagnosis, staging, and follow up of other tumors.

SAFETY IMPLANTS

All patients are reviewed for contraindications prior to MRI scanning. Medical
devices and implants are categorized as MR Safe, MR Conditional or MR Unsafe:
MR Safe
 The device or implant is completely nonmagnetic, nonelectrically conductive,
and nonRF reactive, eliminating all of the primary potential threats during an
MRI procedure.

 MRConditional

A device or implant that may contain magnetic, electrically conductive or

RFreactive components that is safe for operations in proximity to the MRI,
provided the conditions for safe operation are defined and observed (such as
'tested safe to 1.5 teslas' or 'safe in magnetic fields below 500 gauss in
strength').

 MRUnsafe

Objects that are significantly ferromagnetic and pose a clear and direct threat to
persons and equipment within the magnet room. The MRI environment may
cause harm in patients with MR Unsafe devices such as cochlear implants and
most permanent pacemakers. Several deaths have been reported in patients
 with pacemakers who have undergone MRI scanning without appropriate
precautions.

MRI EEG

 In research settings, structural MRI or functional MRI (fMRI) can be combined

with EEG (electroencephalography) under the condition that the EEG
equipment is MR compatible. Although EEG equipment (electrodes, amplifiers
and peripherals)

GENOTOXIC EFFECTS

 There is no proven risk of biological harm from any aspect of a MRI scan,
including very powerful static magnetic fields, gradient magnetic fields, or
radio frequency waves.[43][44] Some studies have suggested possible genotoxic

 Peripheral nerve stimulation (PNS)

 Heating caused by absorption of radio waves

 Acoustic noise

 Cryogens

 Claustrophobia and discomfort

PREGNANCY

No effects of MRI on the fetus have been demonstrated. [62] In particular, MRI avoids
the use of ionizing radiation, to which the fetus is particularly sensitive. However, as a
precaution, current guidelines recommend that pregnant women undergo MRI only
when essential. This is particularly the case during the first trimester of pregnancy, as
organogenesis takes place during this period.

MRI VERSUS CT

MRI and computed tomography (CT) are complementary imaging technologies and
each has advantages and limitations for particular applications. CT is more widely
used than MRI in OECD countries with a mean of 132 vs. 46 exams per 1000
population performed respectively. A concern is the potential for CT to contribute to
radiation induced cancer and in 2007 it was estimated that 0.4% of current cancers in
the United States were due to CTs performed in the past, and that in the future this
figure may rise to 1.5–2% based on historical rates of CT usage. An Australian study
found that one in every 1800 CT scans was associated with an excess cancer. An
advantage of MRI is that no ionizing radiation is used and so it is recommended over
CT when either approach could yield the same diagnostic information. However,
although the cost of MRI has fallen, making it more competitive with CT, there are
not many common imaging scenarios in which MRI can simply replace CT, although
this substitution has been suggested for the imaging of liver disease. The effect of low
doses of radiation on carcinogenesis are also disputed. Although MRI is associated
with biological effects, these have not been proven to cause measurable harm.

PROCEDURE

To perform a study, the person is positioned within an MRI scanner which forms a
strong magnetic field around the area to be imaged. In most medical applications,
protons (hydrogen atoms) in tissues containing water molecules are used to create a
signal that is processed to form an image of the body. First, energy from an oscillating
magnetic field is temporarily applied to the patient at the appropriate resonance
frequency. The excited hydrogen atoms emit a radio frequency signal which is
measured by a receiving coil. The radio signal can be made to encode position
information by varying the main magnetic field using gradient coils. As these coils are
rapidly switched on and off they create the characteristic repetitive noise of an MRI
scan. The contrast between different tissues is determined by the rate at which excited
atoms return to the equilibrium state. Exogenous contrast agents may be given
intravenously, orally or intra articularly.

CONTRAST

Image contrast may be weighted to demonstrate different anatomical structures or

pathologies. Each tissue returns to its equilibrium state after excitation by the
independent processes of T1 (spinlattice) and T2 (spinspin) relaxation.

CONTRAST AGENTS

MRI for imaging anatomical structures or blood flow do not require contrast agents as
the varying properties of the tissues or blood provide natural contrasts. However, for
more specific types of imaging the most commonly used intravenous contrast agents
are based on chelates of gadolinium.

References
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