MRI BRAIN SEQUENCES

Source: Mike Korso: https://www.youtube.com/watch?v=mOt2FeGHjaY

dr. Frank Gaillard https://www.youtube.com/watch?v=DYXEGY-X1n8

-dr. R. Risa Marissa-

PULSE SEQUENCE

 MRI SEQUENCE
 A SEQUENCE OF EVENTS THAT HAPPENS INSIDE THE MRI MACHINE THAT GIVES YOU YOUR IMAGE

 EACH PULSE SEQUENCE CONSISTS OF 2 BASIC COMPONENSTS:

 RADIOFREQUENCY COMPONENTS
 ACQUISITION PHASE

 HOW DOES IT WORKS:

 GIVE ENERGY TO OUR SYSTEM OR TISSUE BY EXCITE PROTON SPINS USING RF ENERGY
 TURN OFF THE SOURCE OF ENERGY
 OBSERVE THE ENERGY THAT WE GET BACK FROM THAT EXCITED TISSUE DUE TO RELAXATION OF THE PROTON SPINS BACK INTO
ALIGNMENT WITH THE MAGNET (RATE OF RELAXATION)

 DIFFERENCES IN RATE OF RELAXATION AND DIFFERENT TISSUES GIVE US OUR CONTRAST

T1 VS T2

 WITHIN A SEQUENCE, WATER AND FAT ARE OPPOSITE SIGNAL INTENSITIES

 BETWEEN SEQUENCES T1 VS T2, A GIVEN SUBSTANCE WILL HAVE OPPOSITE INTENSITIES
 T1 WEIGHTED T2 WEIGHTED
 TR SHORT, TE SHORT  TR LONG, TE LONG
 EXAMINE THE RELATIONSHIP BETWEEN  GRAY MATTER MORE HYPERINTENSE, WHITE
WHITE MATTER AND GRAY MATTER: MATTER DARK
 WM BRIGHT, GREY DARK  CSF BRIGHT
 CSF DARK
 BLOOD PRODUCT, FAT, SOME PROTEIN
MATERIAL AND CONTRAST ENHANCEMENT
T1

 HOW TO RECOGNIZE:
 FAT IS BRIGHT
 AREA A LOT OF MYELIN (WHITE MATTER)
SHOW UP BRIGHT

 WATER (CSF) IS DARK

 NEW BLOOD IS BRIGHT
 USEFUL FOR
 ANATOMIC DETAIL
 VASCULAR CHANGES +C
 DISRUPTION OF BBB +C
T2

 HOT TO RECOGNIZE IT
 FAT IS DARK (BUT IN T2 FSE FAT IS BRIGHT)
 WATER (CSF) IS BRIGHT
 FLOW (EX/ BLOOD VESSELS) IS DARK
 (FLOW VOID: THERE’S FLUID IS MOVING AT HIGH
VELOCITY SO IT’S GOING TO BE DARK)

 USEFUL FOR
 ANATOMIC DETAIL (ESPECIALLY CSF SPACES)
 PICKING UP MOST LESIONS KIND OF IN
GENERAL, BUT IT CAN’T DISTINGUISH LESION
FROM CSF (LESIONS OR EDEMA REALLY CLOSE
TO CSF SPACES, BECAUSE THEY’LL BOTH BE
BRIGHT)
PROTON DENSITY

 INTERMEDIATE SEQUENCE BETWEEN T1-T2

 LONG TR BUT SHORT TE
 VERY USEFULL EARLY ERA OF MRI TO EXAMINING WHITE MATTER
 MAKING WM LESION EASIER TO IDENTIFY THAN ON T2 OR T1
 ALREADY SUPERSEDED BY FLAIR IMAGING
 IT RARELY PROTON DENSITY PERFORMED IN MODERN-DAY PROTOCOLS
 IT PARTICULARLY USEFUL IN MSK
OTHER SEQUENCES BY MODIFY T1 OR T2
MODIFY THE T1
 ADD GADOLINIUM (+C) AND THEN PERFORM T1WI – SEE
ANY CONTRAST ENHANCEMENT
 FAT SUPPRESED/SATURATED: TO HELP DETERMINE IS IT
HYPERINTENSE DUE TO CONTRAST OR FAT ITSELF IN FAT
TUMOR (EX/ LIPOMA)  FAT HYPOINTENSE, CONTRAST
REMAIN HYPERINTENSE
 IN FAT SAT: SUBCUTAN.SCALP HYPOINTENSE, SCALP
REMAIN HYPERINTENSE DUE TO POST CONTRAST
 T1 + C + FAT SAT:
 ROUTINE TO REMOVE THE AMOUNT OF FAT IN THE BODY (NOT
ROUTINE IN BRAIN MRI (INTRAPARENCHYMAL LESIONS FAT SAT
USUALLY NOT PERFORMED)
 BRAIN MRI THAT INDICATE FOR TUMOR THAT INVOLVING THE
SKUL OR SKULL BASE WHERE EXTRACRANIAL EXTENION IS BEING
SOUGHT  SKULL MENINGIOMAS, CPA MASSES WHERE
EXTRACRANIAL SPREAD IS PRESENT
MODIFY THE T2
 FLUID ATTENUATION  T2 FLAIR (LOOK ALIKE T1 IT IS
BECAUSE ATTENUATION OF CSF, BUT IT IS T2 SINCE THE
RELATIONSHIP OF GM AND WM)
 T2+ FAT SAT = PART OF GRE
 NOT PARTICULARLY TO FAT SUPPRESS, BUT TO MORE
SUSCEPTIBLE TO PARAMAGNETIC EFFECTS
 ALSO MORE COMMONLY IN THE ORBIT (EXTRAOCULAR
MUSCLE AND OPTIC NERVE SURROUND BY FAT) OR BASE
OF SKULL TO EXAMINE STRUCTURES THAT ARE OTHERWISE
CLOSELY RELATED TO FAT
 IT USEFULL TO EXAMINING CSF LEAK
 GRE/SWI/T2*
 HAVE SIGNAL LOSS DUE TO PARAMAGNETIC OR
DIAMAGNETIC EFFECTS
FLAIR
(FLUID ATTENUATION INVERSION RECOVERY)

 HOW TO RECOGNIZE
 T2 + FREE FLOWING WATER (CSF) IS DARK
 NON FREE FLOWING WATER IS BRIGHT
 FAT IS DARK
 USEFUL FOR:
 SAME AS T2
 DELINEATING OF LESIONS NEAR VENTRICLES
 EDEMA WILL BE BRIGHT; CSF WILL BE DARK
(BECAUSE CSF IS FREE FLOWING, EDEMA IS NOT
FREE FLOWING)
 IMPROVE GREY-WHITE DIFFERENTIATION
GRE (GRADIENT ECHO, SUSCEPTIBILITY WEIGHTED IMAGING, T2*)

 HOW TO RECOGNIZE IT:

 METALS (EX. BLOOD AND CALCIUM)ARE
DARK
 USEFULL FOR:
 EARLY HEMORRHAGE
 SO OLD HEMORRHAGE SECONDARY TO
DEPOSITION OF HEMOSIDERIN
DIFFUSION WEIGHTED

 EXTENSION OF DIFFUSION:
 DTI (DIFFUSION TENSOR
 THERE’S 2 MAIN SEQUENCES IMAGING/TRACTOGRAPHY)
 DWI: DIRTY SEQUENCES MADE UP OF BOTH  WATER MOLECULES MOTION IS RESTRICTED
TRUE DIFFUSION INFORMATION AND T2 ALONG WHITE MATTER TRACTS, SO WE CAN
INFORMATION SEE WM TRACTS CROSSING FROM ONE
FRONTAL LOBE TO CORPUS CALLOSUM
 NOT REALLY MAINSTREAM
DWI (DIFFUSION WEIGHTED IMAGING)
 THE ONLY SEQUENCE THAT CAN PICK UP ON EARLY
ISCHEMIA DUE TO AN ISCHEMIC STROKE
 IT CAN BE PERFORMED VERY-VERY QUICKLY
 HOW WE RECOGNIZE IT:
 FLUID RESTRICTION (CYTOTOXIC EDEMA) BRIGHT
 DWI BASICALLY MEASURING THE BROWNIAN MOTTION
OF WATER MOLECULES (THE ONLY WATER MOLECULES
IN THE EXTRACELLULAR SPACE)  ISCHAEMIA  AREA
THAT AFFECTED ARE GOING TO START SWELLING
(CYTOTOXIC EDEMA), THE EXTRACELLULAR SPACE
STARTS TO SHRINK AND THAT GIVES OUR THEORITICAL
WATER MOLECULES IN THAT SPACE LESS SPACE TO
MOVE AROUND (RESTRICTED)  HYPERINTESE WHICH
IS INDICATIVE OF FLUID RESTRICTION, SECONDARY TO
CYTOTOXIC EDEMA, SECONDARY TO A LIKELY
ISCHEMIC STROKE
 MUST CORRELATE WITH ADC (APPARENT DIFFUSION
COEFFICIENT)
 ADC IS LIKE RAW DATA  LAY EACH OTHER WITH DWI
SUCH AS PANCAKE LAYER (DWI, ADC, DWI, ADC, ETC)
 IF THERE’S A VERY HIGH INTENSITY IN T2 CAN SHINE
THROUGH THE PANCAKE STACK, TRICK YOU INTO
THINKING YOU’VE GOT AN AREA OF ISCHAEMIA, BUT
WHEN YOU CHECK THE RAW DATA (ADC) YOU
WOULDN’T SEE IT
 FLUID RESTRICTION IS DARK
 RULE OUT “T2 SHINE THROUGH”
 USEFUL FOR
 ISCHEMIA
 ABSCESS
 SEIZURES
OTHER SEQUENCES

FLOW SENSITIVE SEQUENCES MISCELLANEOUS

 MRA: WITHOUT CONTRAST, RELIES ON  MR SPECTROSCOPY
BLOOD BRINGING WITH IT SIGNAL  BRAIN TUMOR OR MASS WORK UP
 MR VENOGRAPHY  FUNCTIONAL MRI
 PULSATIVE FLOW OF CSF IN CISTERNA (CSF  IMAGES………
FLOW STUDIES)