Clinical MR Imaging - E.

Jackson

Primary Indications

Clinical MR Imaging
Most common applications are in neuroimaging (brain and spine) Neoplasia, stroke, multiple sclerosis, disk disease, etc.

Edward F. Jackson, PhD Department of Imaging Physics

Other common applications Sports injury and other imaging studies of joints (menisci, etc.) Chest/Abdomen/Pelvis imaging Extremity imaging Non-invasive and/or minimally-invasive MR angiography Functional imaging (rapidly developing field)

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MR Image Contrast Mechanisms

Image contrast in MRI depends on an extensive list of intrinsic and extrinsic parameters. Intrinsic parameters include:
proton density spin-lattice relaxation time (T1) spin-spin relaxation time (T2) chemical environment velocity diffusion perfusion temperature saturation pulses inversion pulses flow compensation pulses (GMN) diffusion sensitization pulses
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Neuroimaging
Anatomic/pathologic imaging sequences: Spin-echo (SE) sequences primarily for T1-weighted scans preand post-contrast agent administration. Some sites still use SE sequences for proton density-weighted scans. Few still use SE for T2-weighted imaging. Fast spin-echo (FSE) sequences are used at the majority of sites for T2-weighted imaging with and/or without fat suppression. Some sites use FSE sequences for proton density-weighted imaging as well. In brain, fast FLAIR sequences are now very commonly used and, in many sites, have replaced the formerly ubiquitous proton density-weighted images.
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Extrinsic parameters include:

echo time (TE) repetition time (TR) flip angle () contrast agents

FSE vs Conventional SE
Advantages: Speed of acquisition, particularly for T2- and density-weighted images. Decreased susceptibility artifacts. Disadvantages: Increased SAR. Decreased susceptibility-based contrast. Potential T2-blurring in the phase-encoding direction. Fat is brighter than on SE images.
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Fast Spin Echo - Advantages

1) Speed Can acquire faster image sets, or improve the SNR or resolution of a given image in the same amount of time (or less) required for SE imaging. 2) Decreased susceptibility artifacts Dramatically less artifacts at interfaces such as tissue/air or tissue/bone in T2-weighted images as compared to GRE. Even less susceptibility artifacts than obtained with SE imaging.
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Clinical MR Imaging - E. Jackson

Fast Spin Echo - Disadvantages

1) Increased specific absorption rate (SAR) The use of multiple 180o pulses in rapid succession deposits significant RF energy into the patient and may actually limit the speed advantage of the FSE sequence. (A 180o pulse contains 4x the energy of a 90o pulse.) 2) Less susceptibility-dependent contrast The decreased susceptibility artifacts come at some price. In FSE images, contrast due to substances such as iron is less than that obtained with comparable SE sequences. This has limited FSE acceptance in some centers for intracranial imaging, since ironcontaining structures are not as well-visualized (nor is paramagnetic deoxyhemoglobin).
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Fast Spin Echo - Disadvantages

3) T2-blurring Increased blurring in the phase-encoding direction when using short TEeff values. The effect is more evident for tissues with short T2 values. The effect can be decreased by increasing the number of phase-encoding steps, and/or decreasing the ETL. Both of these options, however, come at a price. The effect can also be decreased by decreasing the echo spacing (time between consecutive 180o pulses).
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Fast Spin Echo - T2-weighting

All FSE images demonstrate more T2-weighting for a given TEeff than a SE sequence with the same value for TE. The amount of T2weighting increases with ETL since increasing the value of ETL increases the contribution of more heavily-weighted echoes to the resulting TEeff image. This effect is lessened by decreasing ETL, but this decreases the efficiency of the FSE sequence. For dual echo (PD/T2) acquisitions on scanners, truer PD images are obtained if the split-echo train mode is used.
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Fast Spin Echo - Fat

Fat is more hyperintense on FSE images than on SE images acquired using matched acquisition parameters. The effect is primarily due to decreased J-modulation signal dephasing in FSE images as compared to MEMP images. (Repeated 180o pulses act similar to the classic CPMG sequence for minimizing Jmodulation effects.)

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Substance

T1-weighted +++ ++ (variable) +++ +++ -++ +/+++ ---no signal no signal

T2-weighted + variable ++ ---minimal effect +++ +++ ++ +++ ++ + (complex) + (complex) ++ --no signal no signal

Proton density-weighted ++ variable ++ -isointense minimal effect ++ ++ isointense isointense ++ + (complex) + (complex) ++ -no signal no signal

Neuroimaging
Anatomic/pathologic imaging (cont): For improved detection of the presence of blood (hemosiderin, ferritin, deoxyhemoglobin), T2*-weighted gradient recalled echo imaging sequences are sometimes used. On these images, the susceptibility effects of the blood products yield areas of hypointensity. (On T1-weighted SE images, blood products such as methemoglobin have paramagnetic effects that yield hyperintense appearance.) In general, the appearance of blood on MRI is complex and the relative intensity on T1-, T2-, and T2*weighted images depends on the age of the bleed. T2*-weighted images are also used sometimes in spine/disk imaging for myelographic effect (susceptibility losses in vertebral bodies).
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Fat and yellow marrow Proteinaceous material Intracellular methemoglobin Extracellular methemoglobin Deoxyhemoglobin Hemosiderin Melanin Calcium (some states) Paramagnetic contrast agent Cyst Edema Vitreous humor Cerebrospinal fluid Multiple sclerosis plaques Tumors (most) Abscess Infarct Iron (e.g. in globus pallidus) Air Cortical bone

Clinical MR Imaging - E. Jackson

Paramagnetic Contrast Agent Effects

200 % Increase in Contrast 160 120 80 40 0 0 0.2 0.4 [Gd] (mM) 0.6 0.8 1

Brain MRI - Anaplastic Astrocytoma

T1 SE T2 FSE FLAIR

T1 SE +Gd

Percent increase in contrast, [ (SGd - Sno Gd) / Sno Gd ]x100, for gray matter as a function of Gd-DTPA concentration for a SE sequence with TR/TE = 400ms/18ms.
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Brain MRI - Hematoma

Brain MRI - Orbits

T1 SE

T2 FSE

T1 SE + Gd + Fat Sat
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T1 SE + Gd

Brain MRI - Face

Spine MRI

T2 FSE

T1 SE

T1 SE + Gd + Fat Sat T1 SE T1 SE
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T2 FSE

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Clinical MR Imaging - E. Jackson

Neuroimaging
Anatomic/pathologic imaging (cont):
Vascular anatomy (Magnetic Resonance Angiography) High resolution imaging of fast flow, e.g., circle of Willis. 3D Time-of-Flight (TOF) with MT and ramped RF Slower arterial and venous flow 2D TOF or Phase contrast MRA Very slow and/or tortuous flow, e.g., aneurysm or slow venous Phase contrast MRA Quantitative flow measurements (arterial or venous) Phase contrast MRA (cine if necessary)
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Carotid MRA

2D TOF MRA
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Circle of Willis MRA

3D TOF + MT + Ramped RF

Neuroimaging
Functional imaging (requires high speed imaging, e.g., EPI):
Perfusion imaging
Dynamic Susceptibility Measurement (Bolus contrast infusion) Can provide relative cerebral blood volume and flow measures.

Diffusion imaging
Most common use is in acute stroke imaging. Coupled with perfusion imaging, may allow for evaluation of the ischemic penumbra. May also be useful in white matter tract evaluation.

Task activation mapping (BOLD fMRI) Dynamic contrast imaging of contrast agent T1-effects (can be done w/o EPI and measures uptake rates of contrast agents)
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Body Imaging
Most of the same sequences used in neuroimaging are used in body imaging as well. T1-weighted gradient recalled echo (GRE) sequences, however, are used much more frequently in body imaging than in neuroimaging.
Provide the ability to acquire T1-weighted images in breath-holds to greatly minimize motion artifacts. (Typically, RF spoiling is used to decrease the T2*-weighting that occurs due to residual transverse magnetization in GRE acquisitions with the short repetition times used to reduce scan times.) In-phase / out-of-phase GRE imaging are sometimes useful for evaluating fatty infiltration of liver and/or adrenals.

Body MRI - Pelvis

L R

Axial T1 SE Axial T2 FSE

Axial T1 SE + Gd

GRE sequences are also commonly used to evaluate flow (due to the dramatic flow-related enhancement in short TR GRE acquisitions.)
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Clinical MR Imaging - E. Jackson

Body MRI - Pelvis

T1 FMPSPGR

Body MRI - Abdomen

T1 SE w/Gd & Fat Sat R L T2 FSE + Fat Sat

T1 BH FMPSPGR Coronal T1 SE
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Sag T2 FSE w/Fat Sat

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Fast Gradient Echo Imaging

FMPSPGR sequence

Single-Shot Fast Spin-Echo

Single-Shot FSE Sequence

Top: TE / TR = 4.2 / 110 ms (FWIP) Bottom: TE / TR = 1.8 / 110 ms (FWOP) Both: BW = 32 kHz 8-6 mm sections with 2 mm gaps 256 x 128 matrix 1 NEX St:SI
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Tacq = 0:22 min TE / TR = 98.4 / ms BW = 32 kHz 23-6 cm sections with 2 mm gap FOV = 34 x 27 cm 256 x 128 matrix 0.5 NEX
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Single-Shot Fast Spin-Echo

Single-Shot FSE Sequence
Tacq = 0:02 min TE / TR = 879 / 2046 ms BW = 32 kHz Single 50 mm slab 34 x 34 cm FOV 256 x 256 matrix 0.5 NEX
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MR Cholangiopancreatography (MRCP)

SSFSE, Single 20 mm slab, 0:02 min

SSFSE, 27 3 mm slices + MIP, 0:21 min

Images courtesy of GE Medical Systems

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Clinical MR Imaging - E. Jackson

Body MRI - Knee

Body Imaging - Extremity

T2 FSE

T1 SE

3D TOF + Gd

T1 SE

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T2 FSE

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Body Imaging - Extremity - Femur

T1 SE Coronal T2 FSE Sagittal w/Fat Sat

Body Imaging - Extremity

Coronal T1 SE

T2 FSE Axial

Axial T1 SE + Gd
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Axial T1 SE + Gd

Axial T1 GRE
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Axial T1 SE + Gd

Body Imaging - Extremity

Sagittal T1 SE Sagittal T2 FSE w/FatSat Coronal T1 SE

Body Imaging - Breast

T2 FSE

Axial T1 SE
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Axial T1 SE + Gd

T1 SE T2 FSE w/H2OSat + STIR

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T2 FSE w/H2O Sat + STIR

Clinical MR Imaging - E. Jackson

Body Imaging
Vascular imaging
Phase contrast and 2D TOF MRA acquisitions are often used in body imaging as they are in neuroimaging. Bolus contrast agent-enhanced MRA, however, has greatly expanded the use of MRA in the body.
Tight bolus of Gd-based contrast agent shortens T1 of blood, making it the brightest tissue in breath-hold T1-weighted spoiled GRE scans (if the bolus delivery is tightly timed with the MRA acquisition).

Bolus Contrast MRA

Pre-saturation bands are now useless to select arterial vs venous vessels. Timing is now critical to get good arterial phase images Best guess Timing bolus (1-2cc bolus with multiphase fast gradient echo) SmartPrep and other automated techniques Impossible to get clean venous phase images.
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Extremity MRA, e.g., runoffs is becoming more common. (Bolus contrast MRA is making significant impacts here, too.)
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Bolus Contrast MRA

Maximum Intensity Projection
Enhanced FGRE 3D (efgre3d) Single breath-hold acquisition Tacq= 0:22 min Coronal plane acquisition 28-2 mm sections with 2x slice ZIP
(50% retrospective slice overlap=>48 total images)

Bolus Contrast MRA

TE / TR = 1.4 / 7.3 ms Flip Angle = 55o 32 x 26 cm FOV 256 x 128 matrix, 1 NEX BW = 32 kHz
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Bolus Contrast MRA

Extremity Bolus Contrast Agent MRA

Images courtesy of GE Medical Systems

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Clinical MR Imaging - E. Jackson

Body Imaging
Functional imaging (difficult due to motion): Most commonly based on dynamic T1-weighted image acquisitions using breath-hold spoiled GRE sequences. Applications in breast, cervical/uterine, prostate. Dynamic susceptibility techniques are limited due to the absence of a blood brain barrier. (Currently FDAapproved contrast agents are relatively small molecular weight (~550 daltons) and some leakage cross the vascular endothelium occurs even during first pass.)
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MRI Artifacts
Most common artifacts Motion-induced (blood flow, respiration, etc) artifacts Aliasing or wrap-around artifact Metal object artifacts Chemical shift artifacts Truncation artifacts System-related artifacts Distortions (gradient and static field inhomogeneities) RF coil problems and radiofrequency interference Receiver/memory/array processor problems
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Motion Artifacts
Stationary objects with applied gradient => linear phase accrual, corrected by refocusing pulses Moving objects with applied gradient => nonlinear phase accrual, not corrected by refocusing pulses (typically) Most common motion artifacts: Respiratory Blood flow (especially pulsatile)

Motion Artifacts
Respiration Left: No correction Right: Multiple NEX averaging Blood Flow Left: No correction Right: Superior and inferior SAT pulses
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Motion Artifacts

Motion Artifacts

Uncontrolled Coughing

Swallowing Left: Motion artifact corrupted Right: Motion artifact eliminated using anterior SAT pulse
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Peristaltic Motion
Left: No correction Right: Glucagon injection
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Clinical MR Imaging - E. Jackson

Aliasing or Wrap-Around Artifacts

FOV
Aliased to lower frequency

Aliasing or Wrap-Around Artifacts

Aliased to higher frequency

-fmax

f0

fmax Aliased image

f aliased = f true 2 f Nyquist

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Left: No correction

Right: No Phase Wrap

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Aliasing Artifacts

Metal Object Artifacts

Braces

Metal studded belt

Metal Implants
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Metal Object Artifacts

Metal Object Artifacts

Braces - Middle and right: out-of-slice artifact

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Effect of Metal on FatSat

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Dental Work & Hemosiderin

Clinical MR Imaging - E. Jackson

Chemical Shift Artifact

Truncation Artifacts

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Gradient Amplifier Failure

Radiofrequency Interference
Frequency-encoding direction

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Spike Noise Artifacts

References
Several examples of the applications of MRI to neuroimaging and body imaging have been provided. Other extensive examples are contained in: Magnetic Resonance Imaging, D. Stark and W. Bradley, 2nd edition, Mosby Yearbook. Clinical Magnetic Resonance Imaging, R. Edelman and J. Hesselink, Saunders.

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