MRI NOTES

FINALS
Contrast Enhancement in MRI improves
the ff:
1. Detection
2. Delineation
3. Tumor characterization
4. Interpretation (reading)
Classification of MR Contrast Media
A. Parenteral (Intravenous)
B. Oral
A. Parenteral Agents based on Relaxivity
1. Positive Relaxation Agents (T1
Agents)
- Increase in signal intensity in T1WI
- Ex. Gadolinium
2. Negative Relaxation Agent (T2
Agents)
- Decrease in signal intensity in T2WI
- Ex. Iron Oxide paticles
B. Parenteral Agents based on Susceptibility
1. Paramagnetic Agents (Positive
Agents)
- Used in perfusion studies
- Ex. Gadolinium most common CM
2. Superparamagnetic Agents
3. Ferromagnetic Agents
- Ex. Iron Oxide
Mechanism of MR Contrast Enhancement
1. Spin Density
2. Relaxivity (T1, T2)
3. Magnetic Susceptibility
4. Diffusion & perfusion of CM
Dipole-Dipole Interaction
- Phenomenon by which excited
protons are affected by nearby
excited protons/electrons
Gadolinium (Gd)
- Rare earth metal of lanthanide
group w/ atomic # of 64
- Accumulation of free Gd ions result to
toxicity
Chelates
- Combined w/ Gd to prevent its
toxicity by rapid & total renal
excretion
- Substances that have the high affinity
for metal ions that makes them less
toxic & facilitate their excretion
2 Groups of Chelates
I.
LINEAR
a. Gd-DTPA Gadopentetate
Dimeglumine (Magnevist,
Magniscan)
b. Gd-DTPA BMA Gadodiamide
(Omniscan)

MEGANFUQS

c. Gd Bismethoxyethylamide,
Gadoversatamide (Optimask)
II.

MACROCYCLIC
a. Gd-HP-DO3A Gadoteridol
(Prohance)
b. Gd-DOTA Gadoterate Meglumine
(Dotarem)
c. Gd-D03A Botrol Gadobutrol
(Gadovist)

2 Combinations that Prevent Toxicity

1. Gd Chelates
2. Dysprosium Chelates
Other MRI Contrast Agents
1. Iron Oxide
2. Mn-DPDF Magnafodipir trisodium
3. Dysprosium Chelates (Dy-HP-DO3A)
- More superior than Gd Chelates
Adverse Reaction to Gadolinium
1. Nausea
2. Headache
3. Anaphylaxis
Patients prone to Gd Reaction
1. History of Allergy
2. Asthmatics
3. Previous drug reactions
4. Iodinated Compound reactions
Oral Contrast Agents
1. Positive
- Manganese Chloride
- Gd-DTPA
- Oil Emulsion
2. Negative
- Barium Sulfate
ROLES OF
1. CNS

2. CNS

CM IN MRI
Neoplasms
Tumor identification
Margin delineation
Invasion
Enhancement
Recurrence vs. Necrosis
Infections
Lesion characterization
Assessment of lesion activity
Acute vs. Chronic
Monitor progression vs. Regression

3. Ischemic CNS Diseases

Temporal dating
Characterization
4. Spine
Scar vs. Disc
Tumor vs. Syrinx
2 types of Syrinx

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a. Congenital
b. Traumatic
5. Body

Viable vs. Necrotic lesion

ID active infection
ID recurrent neoplasm
Benign vs. Malignant

MRI IMAGE DESCRIPTIONS

Hyperintense - brightest
- High [H+]
- Short T1
- Long T2
Isointense - same
Hypointense less bright/low signal
- Low [H+]
- Long T1
- Short T2
Air Intensity always black
Standard MRI Appearance
- w/o use of CM but can visualize BV
*All fluid containing structures appear bright
in T2WI
BASIC MRI IMAGES
Water
- Long T1 & T2
- Dark in T1WI
- Bright in T2WI

Fat
- Short T1 & T2
- Bright in T1WI
- Dark T2WI

Air
- Aalways black

Bone Cortex
- Dark in T1 & T2WI

Bone Medulla
- Depends on fat content

Brain
- White Matter bright in T1WI
- Gray Matter brighter due to water
content

Blood
- Dark in Spin Echo
- Bright in GRE

Calcification
- Dark

MRA
-

Rapid data acquisition

Unwanted tissue saturated

Routine MRI Studies of the BRAIN

MEGANFUQS

Axial, coronal, sagittal

5-10mm
T1 & T2 (axial)
T2 (coronal)

Slice thickness of PCE

- Sagittal & coronal images (2-4 mm)
CSF
- Hypointense (T1WI)
- Hyperintense (T2WI)
CM
- Gd, IV, 0.1 mml/kg
- Slow infusion, flowing blood does not
enhance
MRI Scans obtained parallel to AML
AML - Radiographic baseline
MRI in CNS TRAUMA (PD T2WI)
1. Shear injury
2. Non-hemorrhagic contusion
3. Subdural Hemorrhage (SDH)
MRI HEMATOMAS
1. Acute (<1 wk old) iso to hypoI in T1WI
2. Subacute (>1-<4wks) variable
3. Chronic (>1month) iso to hypoI
Brain Edema
- Hyperintense in PD & T2
- Hypointense in T1WI
Brain Hemorrhage
- MRI sensitive to detect subacute &
chronic intracranial bleed
Brain Tumors
- Axial, coronal, sagittal
1. Astrocytoma low in T1, high in T2
2. Oligodendrogliomas mixed
1. Ependymoma mixed
2. Glioblastoma mixed
3. Metastasis best detected w/ Gd study
4. Meningioma mixed
5. Lymphomas variable
6. Craniopharyngioma solid, cyst, cal
Brain Infections
1. Meningioma
- Initially normal findings
(hyperintense)
- Enhancement (peripheral)
2. Empyema
- Hyperintense
3. Abscess mixed
4. TB Meningitis
- Hyperintense
CVD
1. Acute Infarct hyperintese
2. Chronic infarct hypointense
MRI of SPINE
- GRASS & FISP
- Axial & Sagittal

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ST of 4-5mm
Body Isointense in T1WI
SC isodense in T1

III.

1. Pancreatitis
- Hypointense T1WI
- Hyperintense T2WI
2. Cyst
- Dark in T1WI
- Bright T2WI

MRI of HEART
- Mass
- Thrombus
- Post MI evaluation
CINE Imaging cardiac cycle imaging
IV.
MUSCULOSKELETAL
- T1WI intramedullary tumor extent
- T1WI soft tissue extension & cortical
involvement
- STIR tumors
MRI of SHOULDER
- Axial, coronal, sagittal
- 3-4mm ST
- Tears appear Hyperintense
MRI of Knee
- Knee is full extension
- 15 degrees external rotation
- 3mm ST
THE ABDOMEN in MRI
I.

LIVER
- Intermediate intensity parenchyma
1. Hemangioma
- Hypointense (T1WI)
- Hyperintense (T2WI)
- Use SE Sequence
2. Hepatocellular Carcinoma
- Hyperintense in T2WI
3. Liver metastasis
- MRI is most sensitive study w/ use of
Gd

II.

BILIARY TREE
Bile
- Hyperintense (fasting state)
- Hypointense TI; Hyperintense T2
(Non-fasting state)

MEGANFUQS

PANCREAS
- Hyperintense; SE T1WI

V.

VI.

SPLEEN
- Hypointense
- STIR
KIDNEYS
- Intermediate intensity
- FLASH for renal masses
PELVIC STUDY
- Use surface coils
a. Male
- Scrotal MRI uses circular loop coil
- Prostate gland uses endorectal coil
3 Regions of the Prostate Gland
1. Central Zone low signal; hypo
2. Peripheral zone high ;
hyper
3. Stroma low ; hypo
b. Female (T2WI used)
- Sagittal Plane ideal for uterine
zonal anatomy & vaginal anatomy
Endometrium HyperI
Myometrium HypoI
Serosa HyperI

Ovaries
- Stroma low signal; hypo
- Follicles high signal; hyper
UB (use T2WI)
- Muscular wall hypointense
- Urine hyperintense

BSRT 3