magnetic resonance imaging dr mohamed el safwany, md
TRANSCRIPT
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Magnetic Resonance ImagingMagnetic Resonance Imaging
Dr Mohamed El Safwany, MD.
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Intended learning outcomeIntended learning outcome
►The student should learn at the end of The student should learn at the end of this lecture MRI basics .this lecture MRI basics .
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►Oxygen, hydrogen, carbon, nitrogen Oxygen, hydrogen, carbon, nitrogen elements constitute 96 % of human body elements constitute 96 % of human body mass. mass. ►Oxygen is 65 % of body mass; carbon is Oxygen is 65 % of body mass; carbon is 18.5 %, 18.5 %, hydrogen 9.5 %hydrogen 9.5 %, nitrogen 3.2 %., nitrogen 3.2 %.►Let us ignore all elements but Let us ignore all elements but Hydrogen.Hydrogen.
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►Simplest element with atomic number Simplest element with atomic number of 1 and atomic weight of 1of 1 and atomic weight of 1
►When in ionic state (H+), it is nothing When in ionic state (H+), it is nothing but a proton.but a proton.
►Proton is not only positively charged, Proton is not only positively charged, but also has magnetic spin (wobble)!but also has magnetic spin (wobble)!
►MRI utilizes this magnetic spin property MRI utilizes this magnetic spin property of protons of hydrogen to elicit of protons of hydrogen to elicit images!!images!!
►We are magnets!We are magnets!
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► The protons (i.e. The protons (i.e. Hydrogen ions) in Hydrogen ions) in body are spinning in body are spinning in a hap hazard a hap hazard fashion, and cancel fashion, and cancel all the magnetism. all the magnetism. That is our natural That is our natural state!state!
►We need to We need to discipline them firstdiscipline them first
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►Magnetic field strength: 0.3 – 7 T Magnetic field strength: 0.3 – 7 T (2500 times more than earth’s (2500 times more than earth’s magnetic field). Average field strength magnetic field). Average field strength – 1.5 T– 1.5 T
►Open magnet – less field strength, less Open magnet – less field strength, less claustrophobicclaustrophobic
►Closed magnet – more field strength, Closed magnet – more field strength, claustrophobicclaustrophobic
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Proton alignmentProton alignment► Compass aligns Compass aligns
with the earthwith the earth► In a similar fashion,In a similar fashion,►Our body protons Our body protons
(hydrogen) align (hydrogen) align with this external with this external magnetic field.magnetic field.
►Now, we are Now, we are disciplined disciplined (spinning in line (spinning in line with each other!) with each other!)
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►Radio frequency pulses in resonance Radio frequency pulses in resonance push the aligned protons (H+) to a push the aligned protons (H+) to a higher energy level.higher energy level.
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Radio Frequency pulseRadio Frequency pulse
►Same as Radio waves – high Same as Radio waves – high wavelength, low energy wavelength, low energy electromagnetic waveselectromagnetic waves
►Radiofrequency coilsRadiofrequency coils Act as transmitter and receiverAct as transmitter and receiver Different types of coilsDifferent types of coils
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►The higher energy gained by the The higher energy gained by the protons is retransmitted (NMR signal)protons is retransmitted (NMR signal)
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ImagesImages
► T1WIT1WI► T2WIT2WI► PDWIPDWI►DWIDWI► ADCADC►GEGE► Perfusion imagesPerfusion images► fMRIfMRI
► BOLD imagesBOLD images►MRAMRA►MRVMRV► Post-Gd imagesPost-Gd images► Volumetric imagesVolumetric images►MR arthrogramsMR arthrograms► FLAIRFLAIR► STIRSTIR► Etc etc etcEtc etc etc
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T1-weighted contrast
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T2-weighted contrast
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Tissue AppearanceTissue Appearance
WTWT FATFAT H2OH2O MUSCMUSC LIGLIG BONEBONE
T1T1 BB DD II DD DD
Proton Proton DensityDensity
II II II DD DD
T2T2 II BB II DD DD
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sequence exercisesequence exercise
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Which sequence is it? T2Which sequence is it? T2
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Which sequence is it? T1Which sequence is it? T1
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Which sequence is it? FLAIRWhich sequence is it? FLAIR
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Which sequence is it? DWIWhich sequence is it? DWI
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Which sequence is it? ADCWhich sequence is it? ADC
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Which sequence is it? GEWhich sequence is it? GE
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Which sequence is it? PostGdWhich sequence is it? PostGd
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Which sequence is it? MRVWhich sequence is it? MRV
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Which sequence is it?, 3D Which sequence is it?, 3D MRVMRV
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Which sequence is it? MRAWhich sequence is it? MRA
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Which sequence is it? T2Which sequence is it? T2
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Which sequence is it? T1Which sequence is it? T1
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Which sequence is it? STIRWhich sequence is it? STIR
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Which sequence is it? MR Which sequence is it? MR arthrogramarthrogram
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Before entering tunnel, there isBefore entering tunnel, there is a checklist! a checklist!
►No mobiles, no credit cards, please!No mobiles, no credit cards, please!► Known potential safety concerns due to Known potential safety concerns due to
large static magnetic field:large static magnetic field: Internal cardiac pacemakersInternal cardiac pacemakers Steel cerebral aneurysm clips (ferromagnetic)Steel cerebral aneurysm clips (ferromagnetic) Small steel slivers embedded in eyeSmall steel slivers embedded in eye Cochlear implantsCochlear implants Stents anywhere in the bodyStents anywhere in the body
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Clinical Aspects of MRIClinical Aspects of MRI
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Advantages of MRIAdvantages of MRI
1.1. No ionizing radiation & no short/long-No ionizing radiation & no short/long-term effects demonstrated term effects demonstrated
2.2. Variable thickness, any planeVariable thickness, any plane
3.3. Better contrast resolution & tissue Better contrast resolution & tissue discriminationdiscrimination
4.4. Various sequences to play with to Various sequences to play with to characterise the abnormal tissuecharacterise the abnormal tissue
5.5. Many details without I.V contrastMany details without I.V contrast
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Disadvantages of MRIDisadvantages of MRI
►Time consumingTime consuming►Not easily available (long waiting list)Not easily available (long waiting list)
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►MRI has limitations:MRI has limitations: BoneBone AirAir Time consumingTime consuming
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MRMR
► FasterFaster► Less expensiveLess expensive► Less sensitive to Less sensitive to
patient movementspatient movements► Easier in Easier in
claustrophobicsclaustrophobics► Acute haemorrhageAcute haemorrhage► CalcificationCalcification► Bone detailsBone details► Foreign bodyForeign body
► No ionising radiationNo ionising radiation► Greater details, hence Greater details, hence
more sensitive and more sensitive and more specificmore specific
► Any plane scanningAny plane scanning► Contrast less allergicContrast less allergic► No beam hardening No beam hardening
artefactartefact
CTCT
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Indications (almost Indications (almost everything)everything)
► AnatomyAnatomy► Congenital Congenital
anomaliesanomalies►Hereditary and Hereditary and
metabolic diseasesmetabolic diseases► InfectionsInfections►DemyelinationDemyelination► Vascular eventVascular event► TumoursTumours
► TraumaTrauma►DementiaDementia►HydrocephalusHydrocephalus► Cranial nervesCranial nerves► ArteriogramsArteriograms► VenogramsVenograms► Skull baseSkull base► Pituitary glandPituitary gland
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Vascular MRIVascular MRI
►Peripheral vascular arteriogram with or Peripheral vascular arteriogram with or without I.V contrastwithout I.V contrast
►Aortogram Aortogram DissectionDissection
►Pulmonary arteriogramPulmonary arteriogram When CT is contraindicatedWhen CT is contraindicated
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Cardiac MRICardiac MRI
►Coming in a big wayComing in a big way►Very useful in congenital heart Very useful in congenital heart
diseases, cardiomyopathiesdiseases, cardiomyopathies►Evidence is emerging in the evaluation Evidence is emerging in the evaluation
of myocardial infarctionof myocardial infarction
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Breast MRIBreast MRI
►Problem solvingProblem solving Breast implantsBreast implants RecurrenceRecurrence Multifocal diseaseMultifocal disease
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Foetal MRIFoetal MRI
►Assessment of congenital anomaliesAssessment of congenital anomalies►Placental abnormalitiesPlacental abnormalities►Twin assessmentTwin assessment
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Text BookText Book
►David Sutton’s RadiologyDavid Sutton’s Radiology►Clark’s Radiographic positioning and Clark’s Radiographic positioning and
techniquestechniques
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AssignmentAssignment
►Two students will be selected for Two students will be selected for assignment.assignment.
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QuestionQuestion
►Define differences between CT and Define differences between CT and MRI?MRI?
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Thank YouThank You
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