Magnetic Resonance Imaging
Magnetic Resonance Imaging
Magnetic Resonance Imaging
MRI Advantages
We would like to extend our special thanks to the authors and members of the ESR Education Committee who
and Disadvantages
have contributed to this eBook, to Carlo Catalano, Andrea Laghi and András Palkó who initiated this project, and to
the ESR Office, in particular Bettina Leimberger and Danijel Lepir, for all their support in realising this project. Take Home Messages
We hope that this e-book may fulfil its purpose as a useful tool for undergraduate academic radiology teaching. References
European Society of Radiology, Bénédicte MA Delattre, Andrea Laghi, András Kincses, Minerva Becker (2024) References
eBook for Undergraduate Education in Radiology: Magnetic Resonance Imaging. DOI 10.26044/esr-
undergraduate-ebook-24 Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Chapter Outline
MRI System
MRI Principle
Hyperlinks Compare
The Spin Echo Sequence
The Gradient
Echo Sequence
Artefacts in MRI
References
Attention
Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Chapter Outline
eBook for Undergraduate Education in Radiology
MRI System
Based on the ESR Curriculum for Undergraduate Radiological Education
MRI Principle
Chapter: Magnetic Resonance Imaging The Spin Echo Sequence
The Gradient
Author Echo Sequence
Bénédicte MA Delattre (1)
Other Sequences: The
Andrea Laghi (2) MRI Jungle
András Kincses (3,4)
Minerva Becker (1) Contrast Agents in MRI
Artefacts in MRI
Affiliation
MRI Advantages
(1) Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva University, Geneva, Switzerland and Disadvantages
(2) Sapienza University, Rome, Italy
(3) Department of Radiology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary Take Home Messages
(4) Institute of Biophysics, HUN-REN Biological Research Centre, Szeged, Hungary
References
benedicte.delattre@hug.ch
Test Your Knowledge
andrea.laghi@uniroma1.it
a.kincses08@gmail.com
minerva.becker@hug.ch
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
MRI Principle
• MRI System • Other Sequences : The MRI Jungle
The Basics Inversion Recovery (IR)
The Spin Echo Sequence
Safety and Access Restriction Diffusion Weighted Imaging (DWI)
Components of the MRI System Diffusion Tensor Imaging (DTI)
Time-of-Flight (ToF) The Gradient
Functional MRI (fMRI)
• MRI Principle
Spectroscopy
Echo Sequence
Signal Production
Relaxation Other Sequences: The
• Contrast Agents in MRI
Signal Reception
Spatial Encoding – Z Direction Perfusion Imaging (PI)
MRI Jungle
Spatial Encoding – X and Y Directions
Relationship between Signal and Image Contrast Agents in MRI
Gradients and MRI Noise • Artefacts in MRI
Artefacts in MRI
• The Spin Echo Sequence • MRI Advantages and Disadvantages
What is an Echo? MRI Advantages
Importance of TE & TR for Contrast? • Take-Home Messages and Disadvantages
MRI sequences: Why Are They so Long?
MRI Principle
The Gradient
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
* Ferromagnetic objects contain : MRI accident on a 1.5T MR system. A floor polishing machine was attracted by the Take Home Messages
- Iron, Cobalt, Nickel magnetic field. It could only be removed by ramping down the magnetic field. Shown
- Alloys of these components is the back side (head end) of the MRI. Reproduced from: References
https://commons.wikimedia.org/wiki/File:MRI_accident_on_a_1.5_Tesla_MR_system.jpg
Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
References
Artefacts in MRI
N
MRI Advantages
• There is a natural abundance of H2O in biological tissues and, and Disadvantages
therefore, an abundance of H1.
H2O
• H1 mainly occurs in water in the human body. Take Home Messages
Spin 1/2
• Human body composition => ~ 60% - 70% water (2 H1)
References
• H1 has a large magnetic moment.
• The magnetic property of H1 is used to mainly image the water Test Your Knowledge
distribution of tissues in the body with MRI. S
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Alignment parallel or anti-parallel to the magnetic field, corresponds to two different energy states. Most protons align The Gradient
parallel to B0 as this requires less energy than the antiparallel alignment. The net magnetization is created by the𝑀𝑀 Echo Sequence
fraction of spin in excess in one of the energy states :
Other Sequences: The
MRI Jungle
Artefacts in MRI
MRI Advantages
and Disadvantages
References
B0 EXAMPLE : fraction in excess Test Your Knowledge
@ 3T ~10 on 106 !
Outside the magnetic field Inside the magnetic field
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Signal Production
Chapter Outline
Excitation … MRI System
MRI Principle
• To create a signal from the tissue, a radiofrequency (RF) wave is used. It is tuned to the resonance frequency of the Signal Production
spins called « Larmor frequency » f, defined by :
f = gB0 The Spin Echo Sequence
• Where g is the gyromagnetic ratio (g = 42.58 MHz/T) and B0 the magnetic field strength.
• At 1.5T, f = 64 MHz The Gradient
• At 3T, f = 128 MHz … and relaxation Echo Sequence
MRI Advantages
𝑀𝑀 𝑀𝑀 𝑀𝑀 𝑀𝑀 Signal emission and Disadvantages
Initial state RF excitation at Tilted magnetization from a flip
equilibrium Larmor frequency angle alpha As soon as RF excitation stops, magnetization returns Take Home Messages
to equilibrium by a mechanism of relaxation. The
signal loss accompanying the relaxation process can References
B0 be reversed with different techniques and the
reversed signal can be recorded! Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
z
Relaxation
Chapter Outline
Relaxation is happening by two simultaneous but distinct processes. MRI System
Spin energy is dispersed into its environment (mainly nucleus and other atoms), the MRI Principle
T1 relaxation magnetization is recovering its initial state along B0 (longitudinal magnetization). The
mechanism by which Mz exponentially relaxes from a higher energy state to
y Relaxation
Mz
thermodynamic equilibrium is also called spin-lattice relaxation. x The Spin Echo Sequence
M0 The Gradient
𝑀𝑀 Echo Sequence
63 % M0
𝑀𝑀 𝑀𝑀
𝑀𝑀 Other Sequences: The
MRI Jungle
T1 relaxation time t Contrast Agents in MRI
Magnetization flipped in the transverse plane is reduced due to spin dephasing. Phase coherence is lost, reducing net Artefacts in MRI
T2 relaxation magnetization in the x-y plane (while net magnetization is re-growing in the z direction through T1 relaxation !). The
mechanism by which Mxy exponentially decays towards its equilibrium value is also called spin-spin relaxation.
MRI Advantages
Mxy and Disadvantages
37 % M0 𝑀𝑀 𝑀𝑀 𝑀𝑀 References
𝑀𝑀
Test Your Knowledge
T2 relaxation time t
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Relaxation
Chapter Outline
T1 is the the time constant for regrowth of Mz (longitudinal magnetization) MRI System
T2 is the time constant for decay/dephasing of Mx,y (transverse magnetization) MRI Principle
T1 and T2 relaxation times depend on the environment, they are characteristic for different tissues ! Relaxation
Artefacts in MRI
MRI Advantages
and Disadvantages
References
Signal Reception
Chapter Outline
MRI System
The periodic signal accompanying the relaxation of the excited net magnetization can be recorded by a coil. MRI Principle
Signal Reception
Artefacts in MRI
y
+ - MRI Advantages
x 𝑀𝑀 Inductive current created by time varying and Disadvantages
magnetization
Take Home Messages
References
Signal Reception
Chapter Outline
• Dedicated coils are used for each application : MRI System
• Modern receiving coils contain several small coils (also called channels), each one receiving the emitted signal. Such configurations
help to achieve high signal to noise ratio, as well as a large coverage of the anatomy to investigate. MRI Principle
Signal Reception
The Gradient
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
References
Volume excited by the RF tuned at Addition of magnetic field varying in z direction To spatially select signal coming from one slice, we The Gradient
w0 (without any gradient) with the z-gradient tune the RF to the corresponding modified
Echo Sequence
frequency, here w2 for example.
Other Sequences: The
MRI Jungle
Artefacts in MRI
MRI Advantages
and Disadvantages
References
MRI Advantages
F220, w1 and Disadvantages
F256, w256 At this step, the signal received is not yet
Take Home Messages
an image but a complex combination of
varying phase and frequency signals.
References
MRI Advantages
and Disadvantages
References
The Gradient
Echo Sequence
References
The Gradient
180° refocusing RF pulse
90° excitation RF pulse Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
References
Gfrequency References
TR Dephasing in frequency direction, gradient is
applied to compensate the rephasing Test Your Knowledge
produced during the echo.
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
References
MRI Principle
T1-weighted image T2-weighted image
TE / TR = 8.5 / 470 ms Fatty marrow is TE / TR = 100 / 3400 ms The Spin Echo Sequence
« bright» Importance of TE
and TR for Contrast
Bright fat Bright fat
Gray matter is The Gradient
« light grey » Echo Sequence
Gray matter is
« medium grey » Other Sequences: The
MRI Jungle
Dark fluid Bright fluid
(CSF) (CSF) Contrast Agents in MRI
Artefacts in MRI
White matter is White matter is
«light grey » « medium grey »
MRI Advantages
and Disadvantages
Example for a T1 sequence : TR = 500 ms, 128 matrix size, 10 slices : Other Sequences: The
Acquisition time = 0.5 sec * 128 * 10 = 10 min 40 sec ! MRI Jungle
MRI Advantages
and Disadvantages
In practice, several techniques have been developed to accelerate sequence acquisition :
Typical acquisition time for a 2D sequence covering the whole brain is 2 to 4 minutes. Take Home Messages
Gfrequency References
MRI Advantages
and Disadvantages
37 % M0
Take Home Messages
T2* is always ≤ T2 !
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
The Gradient
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
IR-prepared 3D T1-weighted GRE sequence: Fluid Attenuated IR (FLAIR) : Inversion pulse is STIR : Inversion pulse removes signal References
Inversion pulse increases white matter/grey used to remove signal from cerebrospinal fluid. from fat. Hyperintense signal due to
matter contrast (this image is acquired after Hyperintense signal in white matter lesions is fluids or oedema is more visible. Test Your Knowledge
contrast agent injection). more visible.
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
The Gradient
One of the successes of MRI is the ability to detect cellular oedema in the very Echo Sequence
early stages of a stroke, before any other type of imaging modality can show the
stroke. Other Sequences: The
MRI Jungle
Diffusion
Weighted Imaging
<= Diffusion-weighted Images (b1000) in a normal brain (A) and
in a patient with stroke in the middle cerebral artery territory (B). Contrast Agents in MRI
Artefacts in MRI
In stroke, due to hypoperfusion, there is failure of the
sodium/potassium pumps of cell membranes in the affected MRI Advantages
areas. This creates an influx of intracellular water, thus decreasing and Disadvantages
diffusion movement (“restricted diffusion”). On MRI, there is an
increased signal on the DWI image. Take Home Messages
Water diffusion in the brain is constrained by fibres, The MRI signal is sensitive to the preferential direction of motion of water MRI Principle
molecules. This can be used to «track» fibres and depict white matter tracts. The anatomical orientation of axons and fibres is
coded with colours on DTI images, each colour corresponding to a specific direction of the fibres: The Spin Echo Sequence
• Red => transverse orientation
• Green => anterior-posterior or posterior-anterior The Gradient
• Blue => craniocaudal orientation Echo Sequence
Fibre tracts are then reconstructed depending on the clinical question using a dedicated software. Quantitative measures can be
obtained, e.g., measuring the fractional anisotropy (FA) which is thought to reflect fibre density, myelination and axonal diameter. Other Sequences: The
MRI Jungle
Diffusion
Tensor Imaging
Artefacts in MRI
MRI Advantages
and Disadvantages
The Gradient
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
Image illustrating white matter abnormalities in adolescents with
Example of a left temporo-insular low-grade glioma (LGG) and generalised anxiety disorder (GAD). Voxels are overlaid on the white
fibre tract involvement. 3D reconstruction of the tumour, which Take Home Messages
matter skeleton (green). The regions of significant FA reduction in
involves the fronto-occipital longitudinal fasciculus. comparison to adolescents without GAD are shown in red.
References
Reproduced from: Ius T et al. Risk Assessment by Pre-surgical Tractography in Reproduced from: Liao, M. et al. White matter abnormalities in adolescents with generalized
Left Hemisphere Low-Grade Gliomas. Front Neurol. 2021 Feb 15;12:648432. doi: anxiety disorder: a diffusion tensor imaging study. BMC Psychiatry 14, 41 (2014).
10.3389/fneur.2021.648432. https://doi.org/10.1186/1471-244X-14-41 Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
MRI Advantages
and Disadvantages
A C References
TOF image : Maximum Intensity Projection (MIP) of the polygon of Willis: axial (A), Test Your Knowledge
coronal (B) and sagittal (C) views.
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
*
determine if an area is impacted by surgery or if a and Broca’s area. Figure The Gradient
lesion is located in immediate vicinity of an area courtesy José Manuel Echo Sequence
that needs to be resected. Baiao Boto, Division of
BOLD imaging is based on the principle that if a Neuroradiology, Geneva Other Sequences: The
task leads to an increase in the activity of a University Hospitals. MRI Jungle
specific brain region, there is an initial drop in Functional MR
oxygenated haemoglobin and an increase in CO2
and deoxygenated haemoglobin. After a delay of Contrast Agents in MRI
Example of BOLD fMRI
a few seconds, the increased cerebral blood flow maps obtained in a
(CBF) delivers a surplus of oxygenated Artefacts in MRI
patient with a high-grade
haemoglobin, which “washes away” glioma and right-sided
deoxyhaemoglobin. finger tapping. The MRI Advantages
contralateral (left) and Disadvantages
Oxygenated and deoxygenated haemoglobin
*
sensorimotor cortex is
differ significantly with respect to their most strongly activated. Take Home Messages
paramagnetic properties. Figure courtesy José
T2* sequences are used to detect these Manuel Baiao Boto, References
differences, which are in the range of 1-5%. Division of
Neuroradiology, Geneva Test Your Knowledge
University Hospitals.
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
A
MRS obtained in a patient with
a high-grade glioma in the right B Other Sequences: The
MRI Jungle
basal ganglia (A) showing
metabolite changes. As the MR Spectroscopy
tumour grade increases, NAA
and Cho decrease whereas Contrast Agents in MRI
lipids (Lip) and lactate (Lac)
increase. Normal MRS
Artefacts in MRI
metabolites in the left basal
ganglia (B). Measurements on
the left are used as control. MRI Advantages
Note that the normal Cho, Cr and Disadvantages
and NAA peaks are on a line
which has a 45-degree angle Take Home Messages
with the x- axis (Hunter’s angle).
Figure courtesy José Manuel
References
Baiao Boto, Division of
Neuroradiology, Geneva
University Hospitals. Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Artefacts in MRI
MRI Advantages
and Disadvantages
Accumulation of Gd in central nervous system (CNS), basically in the basal ganglia, was reported in patients with The Spin Echo Sequence
multiple administrations of Gd-chelates (2014).
The Gradient
Echo Sequence
The trans-metalation reaction is a possible mechanism by which the Gd ion is extracted from the chelate by another
cation. It has been shown that Gd-chelates with a linear configuration are more at risk to accumulate in the CNS Other Sequences: The
than macrocyclic chelates => see e book chapter on contrast media. MRI Jungle
This is the reason why the European Medicines Agency recommended to suspend or limit the use of commercially Contrast Agents in MRI
available linear Gd-based contrast agents.
Artefacts in MRI
Even though Gd accumulation is now well described, there is no evidence of clinical short- or long-term effects. MRI Advantages
Precaution principle has to be applied by reducing amount and frequency of Gd injection when possible. and Disadvantages
References
Kanda T, Ishii K, Kawaguchi H, et al. High signal intensity in the dentate nucleus and globus pallidus on unenhanced Test Your Knowledge
T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast
material. Radiology 2014; 270:834-841. (Landmark first report of Gd accumulation in the brain).
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Artefacts in MRI
MRI Advantages
and Disadvantages
References
T2*-weighted DSC MRI perfusion in a patient with a glioblastoma. A. TICs obtained in different regions of interest (ROIs). B. rCBV colour map and the
corresponding axial contrast enhanced T1 weighted image showing increased tumour perfusion. Figure courtesy José Manuel Baiao Boto, Division of
Neuroradiology, Geneva University Hospitals. Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
A B C
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
References
T1-weighted Dynamic Contrast Enhanced (DCE) PWI in a patient with a diffusely infiltrating left parotid tumour. A. Time resolved dynamic sequence.
B. ROIs placed for measurements (carotid artery, parotid tumour, muscle). C. Time-intensity curves (TIC)s in the different regions of interest shown
in B. TIC colours correspond to the ROIs indicated in B. Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
The Gradient
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
MRI Principle
The Gradient
• Not all implants are allowed in the Echo Sequence
• Non ionising modality suitable for follow-up
magnetic field
examinations Other Sequences: The
• Not suitable for claustrophobic patients MRI Jungle
• Excellent soft tissue contrast (ligaments,
(larger bore available nowadays)
tendons, muscles, brain grey and white Contrast Agents in MRI
• Noisy and generally long examinations
matter, …)
• More expensive than CT or X-ray Artefacts in MRI
• Different type of contrast images available
• Requires good knowledge of the
(sensitive to fluid, with fat suppression, …) MRI Advantages
technique (sequence optimization and
• Good image resolution, 2D images in any and Disadvantages
artefact mitigation)
orientation and 3D images possible Take Home Messages
• Anatomical but also functional imaging
possible (diffusion, perfusion, fMRI, MRS, …) References
• It provides excellent soft tissue contrast and offers unique anatomical and functional The Spin Echo Sequence
information.
The Gradient
• Some restrictions or contraindications exist for patients with implanted material or devices. Echo Sequence
• The main magnet is used to magnetize the tissues. Other Sequences: The
MRI Jungle
• Radiofrequency is applied to tip magnetization out of equilibrium states.
• Gradients are added to encode the spatial origin of the signal. Contrast Agents in MRI
• Finally, the acquired signal requires a Fourier transform to obtain the final image. Artefacts in MRI
• Images can be sensitive to T1 and T2 relaxation of the tissues by appropriately tuning TE and TR MRI Advantages
of the sequence. and Disadvantages
• Two main type of sequences are the spin echo and the gradient echo sequences. Take Home Messages
• Contrast agents can be used to enhance pathology visualization; they are mainly Gadolinium- References
based.
Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
Excellent websites to understand the MRI technique and all its related questions : MRI Principle
• https://www.imaios.com/en/e-mri
• https://mriquestions.com/index.html The Spin Echo Sequence
MR Pulse Sequences: What Every Radiologist Wants to Know but Is Afraid to Ask Take Home Messages
Richard Bitar, General Leung, Richard Perng, Sameh Tadros, Alan R. Moody, Josee Sarrazin, Caitlin McGregor, Monique
Christakis, Sean Symons, Andrew Nelson, and Timothy P. Roberts References
RadioGraphics 2006 26:2, 513-537
Test Your Knowledge
Chapter:
eBook for Undergraduate Education in Radiology
MR Imaging
MRI Principle
1- Some objects will be attracted by an uncontrollable force into the MRI scanner bore due to the main magnetic field; these
are : The Spin Echo Sequence
a) Ferromagnetic objects (Iron, nickel, cobalt and their alloys)
b) Metallic objects (all that are electrically conductive) The Gradient
c) All medical implants without exception Echo Sequence
2- Which element of the MRI system allows encoding spatial origin of the signal emitted : Other Sequences: The
a) Main magnet MRI Jungle
b) Radiofrequency
c) Gradients x,y,z Contrast Agents in MRI
2- Which element of the MRI system allows encoding spatial origin of the signal emitted : Other Sequences: The
a) Main magnet MRI Jungle
b) Radiofrequency
c) Gradients x,y,z Contrast Agents in MRI
Chapter Outline
All material used (including intellectual property and illustration elements) either MRI System
originates from the authors, the authors were entitled to use the material by applicable MRI Principle
law or have obtained a transferable license from the copyright holder. The Spin Echo Sequence
The Gradient
Echo Sequence
Artefacts in MRI
MRI Advantages
and Disadvantages
References