Original Editor - Rachael Lowe
Magnetic resonance imaging (MRI)
MRI (Magnetic Resonance Imaging) scanning is a medical investigation that uses an exceptionally strong magnet and radio frequency waves to generate image of your body. A magnetic resonance imaging instrument (MRI scanner), or "nuclear magnetic resonance (NMR) imaging" scanner as it was originally known, uses powerful magnets to polarise and excite hydrogen nuclei (single proton) in water molecules in human tissue, producing a detectable signal which is spatially encoded, resulting in images of the body.
MRI scan has wide range of application in medical diagnosis .
Neuroimaging:MRI is the investigative tool of choice for neurological cancers as it is more sensitive than CT for small tumors and offers better visualization of the posterior fossa. The contrast provided between grey and white matter makes it the optimal choice for many conditions of the central nervous system including demyelinating diseases, dementia, cerebrovascular disease, infectious diseases and epilepsy
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 include spinal imaging, assessment of joint disease and soft tissue tumors
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.
Liver and gastrointestinal 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 T2-weighted sequence in magnetic resonance cholangiopancreatography (MRCP)
MRI uses three electromagnetic fields: a very strong (on the order of units of teslas) static magnetic field to polarize the hydrogen nuclei, called the static field; a weaker time-varying (on the order of 1 kHz) field(s) for spatial encoding, called the gradient field(s); and a weak radio-frequency (RF) field for manipulation of the hydrogen nuclei to produce measurable signals, collected through an RF antenna.
During an MRI scan, you lie on a flat bed that is moved into the scanner. Depending on the part of your body being scanned, you will be moved into the scanner either head first or feet first.
The MRI scanner is operated by a radiographer, who is trained in carrying out X-rays and similar procedures. They control the scanner using a computer, which is in a different room to keep it away from the magnetic field generated by the scanner.
You will be able to talk to the radiographer through an intercom and they will be able to see you on a television monitor throughout the scan.
At certain times during the scan, the scanner will make loud tapping noises. This is the electric current in the scanner coils being turned on and off. You will be given earplugs or headphones to wear.
It is very important that you keep as still as possible during your MRI scan. The scan will last between 15 and 90 minutes, depending on the size of the area being scanned and how many images are taken
Advantages and disadvantages of MRI
Advantages of MRI
- Better visualisation of tissues
- Better distinction of abnormalities
- Multi-Plane imaging
- No radiation
Disadvantages of MRI
- Extensive amount of time for accurate images
- Movement artefact (image distortion)
- 10% of patients can’t tolerate due to claustrophobia
Common Abbreviations Used for MRI
FS – Fat Suppressed
- FATSAT – Fat Saturation
- STIR - Short Inversion Recovery Time Imaging
- FSE – Fast Spin Echo
- Gad – Gadolinium
Hybrid MRI Sequences occurs with manipulation to the type and frequency of radio frequency and cause echoes. A gradient echo adds sensitivity or iron-complexes such as articular cartilage defects and haemorrhaging in muscle, but conversely decreases resolution on metal hardware (such as pins or screws) from a surgery. Spin echo adds the benefit of increased tissue contrast and better visualisation of meniscal tears. Stimulated echo reduce interference of signal and therefore may be used to look at specific molecular movements within tissue.
T1 Weighted MRI
- Demonstrates good anatomic structures
- Fat and meniscal tears appear bright white
- Water, CSF, muscle, tendons, and ligaments appears light to dark grey
- Air and cortical bone appears dark
T2 Weighted MRI
- Demonstrates contrast between normal and abnormal (can identify abnormal lesions of fluid)
- Water and CSF appears bright white
- Fat, muscle, tendons, ligaments and cartilage appear light to dark gray
- Air and cortical bone appears dark (unless fluid is in the lung)
Proton density images
- An image simply of the density of protons
- A more dense area of protons will appear white (cortical bone, bone marrow)
- A less dense region will appear darker (fluids, soft tissues)
Contraindications for MRI
- Pacemakers, aneurysm clips, cochlear implants, and orbital foreign bodies
- Projectiles in the room (includes oxygen tanks, IV poles, stethoscopes, hair pins, etc)
Difference between MRI and CT:
Like CT, MRI traditionally creates a two dimensional image of a thin "slice" of the body and is therefore considered a tomographic imaging technique. Modern MRI instruments are capable of producing images in the form of 3D blocks, which may be considered a generalisation of the single-slice, tomographic, concept. Unlike CT, MRI scans do not use X-rays so the possible concerns associated with X-ray pictures and CT scans (which use X-rays) are not associated with MRI scans.. For example, because MRI has only been in use since the early 1980s, there are no known long-term effects of exposure to strong static fields (this is the subject of some debate; see 'Safety' in MRI) and therefore there is no limit to the number of scans to which an individual can be subjected, in contrast with X-ray and CT. However, there are well-identified health risks associated with tissue heating from exposure to the RF field and the presence of implanted devices in the body, such as pace makers. These risks are strictly controlled as part of the design of the instrument and the scanning protocols used.
Because CT and MRI are sensitive to different tissue properties, the appearance of the images obtained with the two techniques differ markedly. In CT, X-rays must be blocked by some form of dense tissue to create an image, so the image quality when looking at soft tissues will be poor. In MRI, while any nucleus with a net nuclear spin can be used, the proton of the hydrogen atom remains the most widely used, especially in the clinical setting, because it is so ubiquitous and returns a large signal. This nucleus, present in water molecules, allows the excellent soft-tissue contrast achievable .
- Wikipedia,fckLRthe free encyclopedia http://en.wikipedia.org/wiki/Magnetic_resonance_imaging
- ACR–ASNR–SPR PRACTICE GUIDELINE FOR THE PERFORMANCE AND fckLRINTERPRETATION OF MAGNETIC RESONANCE IMAGING (MRI) OF THE fckLRBRAIN http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/MRI_Brain.pdf
- "ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging". Journal of the American College of Radiology 3 (10): 751–771. 2006.
- Helms, C (2008). Musculoskeletal MRI. Saunders. ISBN 1416055347.
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- Frydrychowicz A, Lubner MG, Brown JJ, Merkle EM, Nagle SK, Rofsky NM, Reeder SB (2012). "Hepatobiliary MR imaging with gadolinium-based contrast agents". J Magn Reson Imaging 35 (3): 492–511. doi:10.1002/jmri.22833. PMC 3281562. PMID 22334493.
- Go to NHS Choices homepageYour health, your choices http://www.nhs.uk/conditions/MRI-scan/Pages/Introduction.aspx
- patient co uk trusted medical information and support http://www.patient.co.uk/health/mri-scan