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Magnetic Resonance Imaging (MRI)

Also called nuclear magnetic resonance imaging (NMRI), or magnetic resonance


tomography (MRT).
MRI is a medical imaging technique or a radiology technique used to visualize
internal structures o the !ody in detail.
MRI ma"es use o the property o nuclear magnetic resonance (NMR) to image
nuclei o atoms inside the !ody.
#nli"e $T scans or traditional %&rays, MRI does not use ionizing radiation.
In many cases MRI gives di'erent inormation a!out structures in the !ody than
can !e seen (ith an %&ray, ultrasound, or $T scan.
An MRI scan uses magnetism, radio (aves, and a computer to produce images o
!ody structures.
Re)ecting the undamental importance and applica!ility o MRI in medicine,
Paul Lauterbur o the #niversity o Illinois at #r!ana&$hampaign and Sir Peter
Mansfeld o the #niversity o Nottingham (ere a(arded the 2003 Nobel Prize
in Phsiolog or Medicine or their *discoveries concerning magnetic
resonance imaging*.
Princi!le"
MRI is a test that uses a magnetic +eld and pulses o radio (ave energy to ma"e
pictures o organs and structures inside the !ody.
Proton nuclear magnetic resonance (NMR) detects the presence o
hydrogens (protons) !y su!,ecting them to a large magnetic +eld to partially
polarize the nuclear spins, then e-citing the spins (ith properly tuned radio
requency (R.) radiation, and then detecting (ea" radio requency radiation
rom them as they *rela-* rom this magnetic interaction. The requency o this
proton *signal* is proportional to the magnetic +eld to (hich they are su!,ected
during this rela-ation process.
#he !roton NMR signals are $uite sensiti%e to di&erences in !roton
content that are characteristic o' di&erent (inds o' tissue.
In the medical application "no(n as Magnetic Resonance Imaging (MRI), an
image o a cross&section o tissue can !e made !y producing a (ell&cali!rated
magnetic +eld gradient across the tissue so that a certain value o magnetic +eld
can !e associated (ith a given location in the tissue. /ince the proton signal
requency is proportional to that magnetic +eld, a given proton signal requency
can !e assigned to a location in the tissue. This provides the inormation to map
the tissue in terms o the protons present there. /ince the proton density varies
(ith the type o tissue, a certain amount o contrast is achieved to image the
organs and other tissue variations in the su!,ect tissue.
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/ince the MRI uses proton NMR, it images the concentration o' !rotons.
Many o those protons are the protons in (ater, so MRI is particularly (ell&suited
or the imaging o' so't tissue) li(e the brain) ees) and other so't tissue
structures in the head. The !one o the s"ull doesn2t have many protons, so it
sho(s up dar". Also the sinus cavities image as a dar" region.
3ushong2s assessment is that a!out 456 o the !ody2s atoms are hydrogen
atoms, so most parts o the !ody have an a!undance o sources or the
hydrogen NMR signals (hich ma"e up the magnetic resonance image.
*ater constitutes about t+o thirds o' the human bod +eight) and this
high +ater content e,!lains +h magnetic resonance imaging has
become +idel a!!licable to medicine- #here are di&erences in +ater
content among tissues and organs- In man diseases the !athological
!rocess results in changes o' the +ater content) and this is re.ected in
the MRI- *ater is a molecule com!osed o' hdrogen and o,gen atoms-
#he nuclei o' the hdrogen atoms are able to act as microsco!ic
com!ass needles- *hen the bod is e,!osed to a strong magnetic feld)
the nuclei o' the hdrogen atoms are directed into order / stand 0at
attention0- *hen submitted to !ulses o' radio +a%es) the energ
content o' the nuclei changes- 1'ter the !ulse) a resonance +a%e is
emitted +hen the nuclei return to their !re%ious state- #he small
di&erences in the oscillations o' the nuclei are detected- 2 ad%anced
com!uter !rocessing) it is !ossible to build u! a three3dimensional
image that re.ects the chemical structure o' the tissue) including
di&erences in the +ater content and in mo%ements o' the +ater
molecules- #his results in a %er detailed image o' tissues and organs in
the in%estigated area o' the bod- In this manner) !athological changes
can be documented-
Scanner"
MRI scanning uses magnetism, radio (aves, and a computer to produce images
o !ody structures.
It does not use radiation (-&rays).
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The MRI scanner is a large tu!e surrounded !y a giant circular magnet.
The patient is placed on a movea!le !ed that is inserted into the magnet.
The magnet creates a strong magnetic +eld that aligns the protons o hydrogen
atoms, (hich are then e-posed to a !eam o radio (aves.
This spins the various protons o the !ody, and they produce a aint signal that is
detected !y the receiver portion o the MRI scanner.
The receiver inormation is processed !y a computer, and an image is produced.
.or some procedures, contrast agents, such as gadolinium, are used to increase
the accuracy o the images.
/ingle MRI images are called slices.
The images can !e stored on a computer or printed on +lm.
8ne e-am produces dozens or sometimes hundreds o images.
(a) Magnetic feld
MRI scans require a magnetic +eld (ith t(o properties9
uniorm +eld density
strength
The magnetic +eld cannot vary more than 0:05,555 o 06 and +eld strength
ranges (depending on the scanner) rom 5.7 to ; teslas in strength in scanners
currently used clinically, (ith research scanners investigating higher +eld
strengths such as < teslas.
The lo(er +eld strengths can !e achieved (ith permanent magnets, (hich are
oten used in *open* MRI scanners or claustropho!ic patients.
=igher +eld strengths can !e achieved only (ith superconducting magnets. An
MRI (ith a ;.5 tesla strength magnet may !e reerred to as a *33# MRI* or *33
tesla MRI*
/ince the gradient coils are (ithin the !ore o the scanner, there are large orces
!et(een them and the main +eld coils, producing most o the hammering noise
that is heard during operation. >ithout e'orts to damp this noise, it can
approach 0;5 deci!els (d3) (ith strong +elds.
(b) 4ontrast agents and im!lants
MRI contrast agents may !e in5ected intra%enousl to enhance the
appearance o !lood vessels, tumors or in)ammation.
$ontrast agents may also !e directl in5ected into a 5oint in the case o
arthrograms9 MRI images o ,oints.
The most commonly used intravenous contrast agents are !ased on chelates o
gadolinium. Recently, a ne( contrast agent named gado,etate, !rand name
6o%ist (#/) or Primo%ist (?#), (as approved or diagnostic use.
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(c) Portable instruments
@orta!le magnetic resonance instruments are availa!le or use in education and
+eld research. #sing the principles o ?arth2s +eld NMR, they have no po(erul
polarizing magnet, so that such instruments can !e small and ine-pensive. /ome
can !e used or !oth ?.NMR spectroscopy and MRI imaging. The lo( strength o
the ?arth2s +eld results in poor signal to noise ratios (/NR), requiring long scan
times to capture spectroscopic data or !uild up MRI images. =o(ever, the
e-tremely lo( noise )oor o S78I93based MRI detectors and the lo( density
o thermal noise in the lo(&requency operating range (tens o "ilo=ertz) may
result in usa!le /NR approaching that o mid&+eld conventional instruments.
.urther, the ultra&lo( +eld technologies ena!le electron spin resonance
detection, and potentially imaging, at sae operating requencies.
Research (ith atomic magnetometers has addressed the possi!ility o cheap and
porta!le MRI instruments (ithout a large magnet.
(d) 2asic MRI scans"
T0&(eighted MRIA T7&(eighted MRIA TB7&(eighted MRIA T/pin density (eighted
MRI.
(e) S!ecialized MRI scans"
Ciusion MRIA Magnetization transer MRIA T0rho or T0D MRIA .luid attenuated
inversion recovery (.EAIR)A Magnetic resonance angiographyA Magnetic
resonance gated intracranial $/. dynamics (MR&FIEC)A Magnetic resonance
spectroscopyA .unctional MRI (MRI)A Real&time MRIA Interventional MRIA Radiation
therapy simulationA $urrent density imaging ($CI)A Magnetic resonance guided
ocused ultrasoundA Multinuclear imagingA /uscepti!ility (eighted imaging (/>I)A
@repolarized MRI or @MRI.
(') :ther s!ecialized MRI techni$ues"
Ne( methods and variants o e-isting methods are oten pu!lished (hen they
are a!le to produce !etter results in speci+c +elds. ?-amples o these recent
improvements are T ;
23+eighted turbo s!in3echo (T2 #S6 MRI)) double in%ersion reco%er
MRI (9IR3MRI) or !hase3sensiti%e in%ersion reco%er MRI (PSIR3MRI), all
o them a!le to improve imaging o !rain lesions. Another e-ample is M@&RAF?
(magnetization&prepared rapid acquisition (ith gradient echo), (hich improves
images o multiple sclerosis cortical lesions.
Procedure"
A strong magnetic +eld is created !y passing an electric current through the (ire
loops.
>hile this is happening, other coils in the magnet send and receive radio (aves.
This triggers protons in the !ody to align themselves.
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8nce aligned, radio (aves are a!sor!ed !y the protons, (hich stimulate
spinning.
?nergy is released ater *e-citing* the molecules, (hich in turn emits energy
signals that are pic"ed up !y the coil.
This inormation is then sent to a computer (hich processes all the signals and
generates it into an image.
The +nal product is a ;&C image representation o the area !eing e-amined.
*or(ing o' MRI machine
MRI machines ma"e use o the act that !ody tissue contains lots o (ater, and
hence protons (
0
= nuclei), (hich (ill !e aligned in a large magnetic +eld. ?ach
(ater molecule has t(o hydrogen nuclei or protons. >hen a person is inside the
po(erul magnetic +eld o the scanner, the average magnetic moment o many
protons !ecomes aligned (ith the direction o the +eld. A radio requency
current is !rie)y turned on, producing a varying electromagnetic +eld. This
electromagnetic +eld has ,ust the right requency, "no(n as the resonance
requency, to !e a!sor!ed and )ip the spin o the protons in the magnetic +eld.
Ater the electromagnetic +eld is turned o', the spins o the protons return to
thermodynamic equili!rium and the !ul" magnetization !ecomes realigned (ith
the static magnetic +eld. Curing this rela-ation, a radio requency signal
(electromagnetic radiation in the R. range) is generated, (hich can !e measured
(ith receiver coils.
Inormation a!out the origin o the signal in ;C space can !e learned !y applying
additional magnetic +elds during the scan. These additional magnetic +elds can
!e used to generate detecta!le signals only rom speci+c locations in the !ody
(spatial e-citation) and:or to ma"e magnetization at di'erent spatial locations
precess at di'erent requencies, (hich ena!les "&space encoding o spatial
inormation. The ;C images o!tained in MRI can !e rotated along ar!itrary
orientations and manipulated !y the doctor to !e !etter a!le to detect tiny
changes o structures (ithin the !ody. These +elds, generated !y passing
electric currents through gradient coils, ma"e the magnetic +eld strength vary
depending on the position (ithin the magnet. 3ecause this ma"es the requency
o the released radio signal also dependent on its origin in a predicta!le manner,
the distri!ution o protons in the !ody can !e mathematically recovered rom the
signal, typically !y the use o inverse .ourier transorm.
@rotons in di'erent tissues return to their equili!rium state at di'erent rela-ation
rates. Ci'erent tissue varia!les, including spin density, T0 and T7 rela-ation
times, and )o( and spectral shits, can !e used to construct images. 3y
changing the settings on the scanner, this e'ect is used to create contrast
!et(een di'erent types o !ody tissue or !et(een other properties, as in MRI
and di'usion MRI.
The MRI e-amination requires specialized equipment that uses a po(erul,
constant magnetic +eld, rapidly changing local magnetic +elds, radiorequency
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energy, and dedicated equipment including a po(erul computer to create very
clear pictures o internal !ody structures.

1d%antages"
?ven though the spatial resolution o MRI is not as great as a conventional -&ray
+lm, its contrast resolution is much !etter or tissue. MRI can create more
detailed images o' the human bod than are !ossible +ith <3ras-
Rapid scanning and computer reconstruction give (ell&resolved images o
organs.
The image and resolution produced !y MRI is quite detailed and can detect tiny
changes o structures (ithin the !ody.
1!!lications"
MRI provides good contrast !et(een the di'erent sot tissues o the !ody, (hich
ma"es it especially useul in imaging the !rain, muscles, the heart, and cancers
compared (ith other medical imaging techniques such as $T or %&rays. #nli"e $T
scans or traditional %&rays, MRI does not use ionizing radiation.
MRI is used to image every part o the !ody, and is particularly useul or tissues
(ith many hydrogen nuclei and little density contrast, such as the !rain, muscle,
connective tissue and most tumors.
/equential sections rom an MRI o the !rain, concurrently sho(ing slices
through transverse, sagittal, and coronal planes (let to right).

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@ara&sagittal MRI o the head, (ith aliasing artiacts (nose and orehead
appear at the !ac" o the head)
In clinical practice, MRI is used to distinguish pathologic tissue (such as a !rain
tumor) rom normal tissue.
8ne advantage o an MRI scan is that it is harmless to the patient. It uses strong
magnetic +elds and non&ionizing electromagnetic +elds in the radio requency
range, unli"e $T scans and traditional %&rays, (hich !oth use ionizing radiation.
>hile $T provides good spatial resolution (the a!ility to distinguish t(o separate
structures at a small distance rom each other), MRI provides compara!le
resolution (ith ar !etter contrast resolution (the a!ility to distinguish the
di'erences !et(een t(o similar !ut not identical tissues). The !asis o this
a!ility is the comple- li!rary o pulse sequences that the modern medical MRI
scanner includes, each o (hich is optimized to provide image contrast !ased on
the chemical sensitivity o MRI.
6&ects o' #R and #6 on MR signal
.or e-ample, (ith particular values o the echo time (T?) and the repetition time
(TR), (hich are !asic parameters o image acquisition, a sequence ta"es on the
property o T7&(eighting. 8n a T7&(eighted scan, (ater& and )uid&containing
tissues are !right (most modern T7 sequences are actually ast T7 sequences)
and at&containing tissues are dar". The reverse is true or T0&(eighted images.
Camaged tissue tends to develop edema, (hich ma"es a T7&(eighted sequence
sensitive or pathology, and generally a!le to distinguish pathologic tissue rom
normal tissue. >ith the addition o an additional radio requency pulse and
additional manipulation o the magnetic gradients, a T7&(eighted sequence can
!e converted to a .EAIR sequence, in (hich ree (ater is no( dar", !ut
edematous tissues remain !right. This sequence in particular is currently the
most sensitive (ay to evaluate the !rain or demyelinating diseases, such as
multiple sclerosis.
The typical MRI e-amination consists o HJ75 sequences, each o (hich is chosen
to provide a particular type o inormation a!out the su!,ect tissues. This
inormation is then synthesized !y the interpreting physician.
Molecular imaging o disease !iomar"ers !y MRI9
MRI has the advantages o having very high spatial resolution and is very
adept at morphological imaging and unctional imaging. MRI does have
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several disadvantages though. .irst, MRI has a sensitivity o around 05K;
mol:E to 05KH mol:E (hich, compared to other types o imaging, can !e very
limiting. This pro!lem stems rom the act that the di'erence !et(een atoms
in the high energy state and the lo( energy state is very small. .or e-ample,
at 0.H teslas, a typical +eld strength or clinical MRI, the di'erence !et(een
high and lo( energy states is appro-imately L molecules per 7 million.
Improvements to increase MR sensitivity include increasing magnetic +eld
strength, and hyperpolarization via optical pumping or dynamic nuclear
polarization. There are also a variety o signal ampli+cation schemes !ased
on chemical e-change that increase sensitivity.
To achieve molecular imaging o disease !iomar"ers using MRI, targeted MRI
contrast agents (ith high speci+city and high rela-ivity (sensitivity) are
required. To date, many studies have !een devoted to developing targeted&
MRI contrast agents to achieve molecular imaging !y MRI. $ommonly,
peptides, anti!odies, or small ligands, and small protein domains, such as
=?R&7 aM!odies, have !een applied to achieve targeting. To enhance the
sensitivity o the contrast agents, these targeting moieties are usually lin"ed
to high payload MRI contrast agents or MRI contrast agents (ith high
rela-ivities.
It is used to +nd pro!lems such as tumors, !leeding, in,ury, !lood vessel
diseases, or inection.
MRI also may !e done to provide more inormation a!out a pro!lem seen on an
%&ray, ultrasound scan, or $T scan.
$ontrast material may !e used during MRI to sho( a!normal tissue more clearly.
An MRI scan can !e done or the9
=ead. MRI can loo" at the !rain or tumors, an aneurysm, !leeding in the
!rain, nerve in,ury, and other pro!lems, such as damage caused !y a stro"e.
MRI can also +nd pro!lems o the eyes and optic nerves, and the ears and
auditory nerves.
$hest. MRI o the chest can loo" at the heart, the valves, and coronary !lood
vessels. It can sho( i the heart or lungs are damaged. MRI o the chest may
also !e used to loo" or !reast or lung cancer.
3lood vessels. #sing MRI to loo" at !lood vessels and the )o( o !lood
through them is called magnetic resonance angiography (MRA). It can +nd
pro!lems o the arteries and veins, such as an aneurysm, a !loc"ed !lood
vessel, or the torn lining o a !lood vessel (dissection). /ometimes contrast
material is used to see the !lood vessels more clearly.
A!domen and pelvis. MRI can +nd pro!lems in the organs and structures in
the !elly, such as the liver, gall!ladder, pancreas, "idneys, and !ladder. It is
used to +nd tumors, !leeding, inection, and !loc"age. In (omen, it can loo"
at the uterus and ovaries. In men, it loo"s at the prostate.
3ones and ,oints. MRI can chec" or pro!lems o the !ones and ,oints, such as
arthritis, pro!lems (ith the temporomandi!ular ,oint, !one marro( pro!lems,
!one tumors, cartilage pro!lems, torn ligaments or tendons, or inection. MRI
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may also !e used to tell i a !one is !ro"en (hen %&ray results are not clear.
MRI is done more commonly than other tests to chec" or some !one and
,oint pro!lems.
/pine. MRI can chec" the discs and nerves o the spine or conditions such as
spinal stenosis, disc !ulges, and spinal tumors.
It is a procedure used in hospitals to scan patients and determine the severity o
certain in,uries.
In general, MRI creates pictures that can sho( di'erences !et(een healthy and
unhealthy tissue.
Coctors use MRI to e-amine the !rain, spine, ,oints (e.g., "nee, shoulder, (rist,
and an"le), a!domen, pelvic region, !reast, !lood vessels, heart and other !ody
parts.
2enefts and Ris(s
#nli"e $T, MRI uses no ionizing radiation and is generally a %er sa'e
!rocedure.
Nonetheless the strong magnetic felds and radio !ulses can a&ect metal
im!lants) including cochlear im!lants and cardiac !acema(ers.
There are many electronically activated devices that have approval rom the #/
.CA to permit MRI procedures in patients under highly speci+c MRI conditions.
In the case o cochlear implants, the #/ .CA has approved some implants or
MRI compati!ility.
In the case o cardiac pacema"ers, the results can sometimes !e lethal, so
patients (ith such implants are generally not eligi!le or MRI.
Cespite !eing !ainless, MRI scans can !e unpleasant or those (ho are
claustro!hobic or other+ise uncom'ortable (ith the imaging device
surrounding them. 8lder closed !ore MRI systems have a airly long tu!e or
tunnel. The part o the !ody !eing imaged must lie at the center o the magnet,
(hich is at the a!solute center o the tunnel. 3ecause scan times on these older
scanners may !e long (occasionally up to G5 minutes or the entire procedure),
people (ith even mild claustropho!ia are sometimes una!le to tolerate an MRI
scan (ithout management. /ome modern scanners have larger !ores (up to
<5 cm) and scan times are shorter. This means that claustropho!ia could !e less
o an issue, and more patients may no( +nd MRI to !e a tolera!le procedure.
8ne advantage o an MRI scan is that it is harmless to the patient. It uses
strong magnetic +elds and non&ionizing electromagnetic +elds in the radio
requency range.
MRI has the advantages o having %er high s!atial resolution.
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A num!er o eatures o MRI scanning can give rise to ris"s. These include9
@o(erul magnetic +elds
Radio (aves
$ryogenic liquids
Noise
$laustropho!ia
In addition, in cases (here MRI contrast agents are used, these also typically
have associated ris"s.
:%eruse9 Medical societies issue guidelines or (hen physicians should use MRI
on patients and recommend against overuse. MRI can detect health pro!lems or
con+rm a diagnosis, !ut medical societies oten recommend that MRI not !e the
+rst procedure or creating a plan to diagnose or manage a patient2s complaint.
A common case is to use MRI to see" a cause o lo( !ac" painA the American
$ollege o @hysicians, or e-ample, recommends against this procedure as
unli"ely to result in a positive outcome or the patient. Nevertheless, MRI has the
advantage o not utilizing ionizing radiation to create medical images, unli"e
other imaging modalities such as $T and conventional radiography.
Magnetic feld9 /ome types o medical implants are generally considered
contraindications or MRI e-aminations, (hile others may !e accepta!le or
patients under high speci+c MRI conditions. @atients are thereore al(ays as"ed
or complete inormation a!out all implants !eore entering the room or an MRI
scan. /everal deaths have !een reported in patients (ith pacema"ers (ho have
undergone MRI scanning (ithout appropriate precautions. To reduce such ris"s,
implants are increasingly !eing developed to ma"e them a!le to !e saely
scanned, and specialized protocols have !een developed to permit the sae
scanning o selected implants and pacing devices. $ardiovascular stents are
considered sae, ho(ever.
MR&/ae sign MR&$onditional sign MR&#nsae
sign
.erromagnetic oreign !odies such as shell ragments, or metallic implants such
as surgical prostheses and erromagnetic aneurysm clips are also potential ris"s.
Interaction o the magnetic and radio requency +elds (ith such o!,ects can lead
to trauma due to movement o the o!,ect in the magnetic +eld or thermal in,ury
rom radio&requency induction heating o the o!,ect.
Titanium and its alloys are sae rom attraction and torque orces produced !y
the magnetic +eld, though there may !e some ris"s associated (ith Eenz e'ect
orces acting on titanium implants in sensitive areas (ithin the su!,ect, such as
stapes implants in the inner ear.
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In the #nited /tates a classi+cation system or implants and ancillary clinical
devices has !een developed !y A/TM International and is no( the standard
supported !y the #/ .ood and Crug Administration9
MR3Sa'e N The device or implant is completely non&magnetic, non&
electrically conductive, and non&R. reactive, eliminating all o the primary
potential threats during an MRI procedure.
MR34onditional N A device or implant that may contain magnetic,
electrically conductive or R.&reactive components that is sae or operations
in pro-imity to the MRI, provided the conditions or sae operation are de+ned
and o!served (such as 2tested sae to 0.H teslasO or Psae in magnetic +elds
!elo( H55 gauss in strengthO).
MR38nsa'e N Nearly sel&e-planatory, this category is reserved or o!,ects
that are signi+cantly erromagnetic and pose a clear and direct threat to
persons and equipment (ithin the magnet room.
The very high strength o the magnetic +eld can also cause *missile&e'ect*
accidents, (here erromagnetic o!,ects are attracted to the center o the
magnet, and there have !een incidents o in,ury and death. To reduce the ris" o
pro,ectile accidents, erromagnetic o!,ects and devices are typically prohi!ited in
the pro-imity o the MRI scanner and patients undergoing MRI e-aminations are
required to remove all metallic o!,ects, oten !y changing into a go(n or scru!s,
and erromagnetic detection devices are used at some sites.
There is no evidence or !iological harm rom even very po(erul static magnetic
+elds.
Peri!heral ner%e stimulation (PNS)" The rapid s(itching on and o' o the
magnetic +eld gradients is capa!le o causing nerve stimulation. 1olunteers
report a t(itching sensation (hen e-posed to rapidly s(itched +elds, particularly
in their e-tremities. The reason the peripheral nerves are stimulated is that the
changing +eld increases (ith distance rom the center o the gradient coils
((hich more or less coincides (ith the center o the magnet). Although @N/ (as
not a pro!lem or the slo(, (ea" gradients used in the early days o MRI, the
strong, rapidly s(itched gradients used in techniques such as ?@I, MRI, di'usion
MRI, etc. are indeed capa!le o inducing @N/. American and ?uropean regulatory
agencies insist that manuacturers stay !elo( speci+ed d3:dt limits (d3:dt is the
change in +eld per unit time) or else prove that no @N/ is induced or any
imaging sequence. As a result o d3:dt limitation, commercial MRI systems
cannot use the ull rated po(er o their gradient ampli+ers.
=eating caused b absor!tion o' radio +a%es" ?very MRI scanner has a
po(erul radio transmitter to generate the electromagnetic +eld (hich e-cites
the spins. I the !ody a!sor!s the energy, heating occurs. .or this reason, the
transmitter rate at (hich energy is a!sor!ed !y the !ody has to !e limited.
1coustic noise9 /(itching o +eld gradients causes a change in the Eorentz
orce e-perienced !y the gradient coils, producing minute e-pansions and
contractions o the coil itsel. As the s(itching is typically in the audi!le
requency range, the resulting vi!ration produces loud noises (clic"ing or
!eeping). This is most mar"ed (ith high&+eld machines and rapid&imaging
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techniques in (hich sound pressure levels can reach 075 d3(A) (equivalent to a
,et engine at ta"e&o'), and thereore appropriate ear protection is essential or
anyone inside the MRI scanner room during the e-amination.
4rogens9 Many MRI scanners rely on cryogenic liquids to ena!le the
superconducting capa!ilities o the electromagnetic coils (ithin. Though the
cryogenic liquids used are non&to-ic, their physical properties present speci+c
hazards.
An unintentional shut&do(n o a superconducting electromagnet, an event
"no(n as *quench*, involves the rapid !oiling o liquid helium rom the device. I
the rapidly e-panding helium cannot !e dissipated through an e-ternal vent,
sometimes reerred to as a 2quench pipe2, it may !e released into the scanner
room (here it may cause displacement o the o-ygen and present a ris" o
asphy-iation.
8-ygen de+ciency monitors are usually used as a saety precaution. Eiquid
helium, the most commonly used cryogen in MRI, undergoes near e-plosive
e-pansion as it changes rom a liquid to gaseous state. The use o an o-ygen
monitor is important to ensure that o-ygen levels are sae or patient:physicians.
Rooms !uilt or superconducting MRI equipment should !e equipped (ith
pressure relie mechanisms and an e-haust an, in addition to the required
quench pipe.
3ecause a quench results in rapid loss o cryogens rom the magnet,
recommissioning the magnet is e-pensive and time&consuming. /pontaneous
quenches are uncommon, !ut a quench may also !e triggered !y an equipment
malunction, an improper cryogen +ll technique, contaminants inside the
cryostat, or e-treme magnetic or vi!rational distur!ances.
4ontrast agents9 The most commonly used intravenous contrast agents are
!ased on chelates o gadolinium. In general, these agents have proved saer
than the iodinated contrast agents used in %&ray radiography or $T.
Anaphylactoid reactions are rare, occurring in appro-. 5.5;J5.06. 8 particular
interest is the lo(er incidence o nephroto-icity, compared (ith iodinated
agents, (hen given at usual dosesNthis has made contrast&enhanced MRI
scanning an option or patients (ith renal impairment, (ho (ould other(ise not
!e a!le to undergo contrast&enhanced $T.
Although gadolinium agents have proved useul or patients (ith renal
impairment, in patients (ith severe renal ailure requiring dialysis there is a ris"
o a rare !ut serious illness, nephrogenic systemic +!rosis, (hich may !e lin"ed
to the use o certain gadolinium&containing agents. The most requently lin"ed is
gadodiamide, !ut other agents have !een lin"ed too. Although a causal lin" has
not !een de+nitively esta!lished, current guidelines in the #nited /tates are that
dialysis patients should only receive gadolinium agents (here essential, and that
dialysis should !e perormed as soon as possi!le ater the scan to remove the
agent rom the !ody promptly. In ?urope, (here more gadolinium&containing
agents are availa!le, a classi+cation o agents according to potential ris"s has
!een released. Recently, a ne( contrast agent named gado,etate, !rand name
6o%ist (#/) or Primo%ist (?#), (as approved or diagnostic use9 this has the
theoretical !ene+t o a dual e-cretion path.
07 & /R1
Pregnanc9 No e'ects o MRI on the etus have !een demonstrated. In
particular, MRI avoids the use o ionizing radiation, to (hich the etus is
particularly sensitive. =o(ever, as a precaution, current guidelines recommend
that pregnant (omen undergo MRI only (hen essential. This is particularly the
case during the +rst trimester o pregnancy, as organogenesis ta"es place during
this period. The concerns in pregnancy are the same as or MRI in general, !ut
the etus may !e more sensitive to the e'ectsNparticularly to heating and to
noise. =o(ever, one additional concern is the use o contrast agentsA gadolinium
compounds are "no(n to cross the placenta and enter the etal !loodstream,
and it is recommended that their use !e avoided.
There are no (no+n harm'ul e&ects 'rom the strong magnetic feld used
or MRI. 3ut the magnet is very po(erul. The magnet ma a&ect
!acema(ers) artifcial limbs) and other medical de%ices that contain
iron. The magnet (ill sto! a +atch that is close to the magnet. Any loose
metal ob5ect has the ris( o' causing damage or in5ur i' it gets !ulled
to+ard the strong magnet.
Metal parts in the eyes can damage the retina.
Iron pigments in tattoos or tattooed eyeliner can cause s(in or ee irritation.
An MRI can cause a burn +ith some medication !atches.
There is a slight ris( o' an allergic reaction i contrast material is used during
the MRI. 3ut most reactions are mild and can be treated using medicine.
#est is not done +hen9
Pregnanc. An MRI test usually is not done during pregnancy. 3ut MRI may
!e done to get more inormation a!out a possi!le pro!lem that cannot !e
seen clearly (ith ultrasound.
Medical de%ices that use electronics, such as a pacema"er or medicine
inusion pump. The MRI magnet may cause pro!lems (ith these devices, and
that may "eep one rom having an MRI.
Medical de%ices that ha%e metal in them. The metal might ma"e some o
the detailed MRI pictures !lurry. This may prevent the doctor rom seeing the
organ that is !eing loo"ed at. .or e-ample, an intrauterine device (I#C) (ith
metal may prevent doctor rom seeing the uterus clearly.
Inabilit to remain still during the test.
:besit. A person (ho is very over(eight may not +t into standard MRI
machines.
MRI has !een sho(n to !e e,tremel sa'e as long as !ro!er sa'et
!recautions are ta(en.
In general, the MRI procedure produces no !ain and causes no (no+n short3
term or long3term tissue damage o' an (ind.
The po(erul magnetic +eld o the scanner can attract certain metallic
ob5ects (no+n as >'erromagnetic? ob5ects, causing them to move suddenly
0; & /R1
and (ith great orce to(ards the center o the MR system. This may pose a ris"
to the patient or anyone in the (ay o the o!,ect. Thereore, great care is
ta(en to !re%ent 'erromagnetic ob5ects 'rom entering the MR system
room. It is vital to remove metallic o!,ects in advance o an MRI e-am, including
(atches, ,e(elry, and items o clothing that have metallic threads or asteners.
MRI acilities have screening !rocedures that, (hen careully ollo(ed, (ill
ensure that the MRI technologist and radiologist "no(s a!out the presence o
metallic implants and materials so that special precautions can !e ta"en. In
some unusual cases the e-amination may !e canceled !ecause o concern
related to a particular implant or device. .or e-ample, i an MRI is ordered, it
may !e cancelled i the patient has a erromagnetic aneurysm clip !ecause o
the ris" dislodging the clip rom the !lood vessel. Also, the magnetic +eld o the
scanner can damage an e,ternal hearing aid or cause a heart !acema(er
to mal'unction. I a !ullet or other metallic ragment in present in the !ody
there is a potential ris" that it could change position, possi!ly causing in,ury.
Some conditions ma ma(e MRI e,amination inad%isable9
=eart pacema"er
$ere!ral aneurysm clip (metal clip on a !lood vessel in the !rain)
@regnancy
Implanted insulin pump (or treatment o dia!etes), narcotics pump (or pain
medication), or implanted nerve stimulators (*T?N/*) or !ac" pain
Metal in the eye or eye soc"et
$ochlear (ear) implant or hearing impairment
Implanted spine sta!ilization rods
/evere lung disease (such as tracheomalacia or !ronchopulmonary dysplasia)
Fastroesophageal re)u-
>eight o more than ;55 pounds
Ina!ility to lie on !ac" or ;5 to I5 minutes
$laustropho!ia (ear o closed or narro( spaces)
Cespite these concerns, MRI is rapidly gro(ing in importance as a (ay o
diagnosing and monitoring congenital deects o the etus !ecause it can provide
more diagnostic inormation than ultrasound and it lac"s the ionizing radiation o
$T. MRI (ithout contrast agents is the imaging mode o choice or pre&surgical,
in&utero diagnosis and evaluation o etal tumors, primarily teratomas,
acilitating open etal surgery, other etal interventions, and planning or
procedures (such as the ?%IT procedure) to saely deliver and treat !a!ies (hose
deects (ould other(ise !e atal.
4# %s MRI
0G & /R1
The use o %&rays, a type o ionizing radiation, in computed tomography ($T)
allo(s or e-amination o tissues composed o elements o a higher atomic
num!er than the surrounding tissues. MRI, in contrast, uses non&ionizing radio
requency (R.) signals to acquire images and is !est suited or sot tissue
(although MRI can also !e used to visualize !ones, teeth and even ossils).
/ince $T scans use ionizing radiation (%&rays) to produce images, there is a ris"
o damage to CNA that can su!sequently cause cancer. In 755<, it (as
estimated that 5.G6 o current cancers in the #nited /tates (ere due to $Ts
perormed in the past, and that in the uture this +gure may increase to as high
as 0.HJ76 !ased on past rates o $T usage. #nli"e $T, MRI does not use ionizing
radiation, although it is associated (ith other ris"s.
$ontrast in $T images is generated purely !y %&ray attenuation, (hile a variety
o properties may !e used to generate contrast in MR images. 3y varying the
scanning parameters, tissue contrast can !e altered to enhance di'erent
eatures in an image (see Applications or more details). 3oth $T and MR images
may !e enhanced !y using contrast agents. $ontrast agents or $T contain
elements o a high atomic num!er relative to the tissue !eing investigated, such
as iodine or !arium, (hile contrast agents (such as gadolinium and manganese)
or MRI have paramagnetic properties that are used to alter tissue rela-ation
times. $ommonly used MRI contrast agents may !e contraindicated in people
(ith signi+cant permanent or transient "idney dysunction.
$T and MRI scanners are a!le to generate multiple t(o&dimensional cross&
sections (tomographs, or *slices*) o tissue and three&dimensional
reconstructions. MRI can generate cross&sectional images in any plane (including
o!lique planes). In the past, $T (as limited to acquiring images in the a-ial
plane (or near a-ial plane), and so these images (ere called $omputed A-ial
Tomography scans ($AT scans). =o(ever, the development o multi&detector $T
scanners (ith near&isotropic resolution allo(s the $T scanner to produce data
that can !e retrospectively reconstructed in any plane (ith minimal loss o
image quality. .or purposes o tumor detection and identi+cation in the !rain,
MRI is generally superior. =o(ever, in the case o solid tumors o the a!domen
and chest, $T is oten preerred as it less a'ected !y motion artiacts.
.urthermore, $T usually is more (idely availa!le, aster, and less e-pensive.
MRI is also !est suited or cases (hen a patient is to undergo several e-ams in
the short term, since it does not e-pose the patient to the hazards o ionizing
radiation. =o(ever MRI is usually contraindicated i the patient has any type o
medical implant, such as vagus nerve stimulators, implanta!le cardioverter&
de+!rillators, loop recorders, insulin pumps, cochlear implants, deep !rain
stimulators, metallic oreign !odies (e.g., shrapnel or shell ragments), or
metallic implants such as surgical prostheses. These devices can malunction or
heat up during an MRI scan, so $T scans are considered the saer option or
these patients.
>hile 4# !ro%ides good s!atial resolution (the abilit to distinguish t+o
se!arate structures at a small distance 'rom each other), MRI provides
com!arable resolution +ith 'ar better contrast resolution (the abilit to
0H & /R1
distinguish the di&erences bet+een t+o similar but not identical
tissues).
It uses strong magnetic +elds and non&ionizing electromagnetic +elds in the
radio requency range, unli"e $T scans and traditional %&rays, (hich !oth use
ionizing radiation.
>hile $T provides good spatial resolution (the a!ility to distinguish t(o separate
structures at a small distance rom each other), MRI !ro%ides com!arable
resolution +ith 'ar better contrast resolution (the abilit to distinguish
the di&erences bet+een t+o similar but not identical tissues). The !asis
o this a!ility is the comple- li!rary o pulse sequences that the modern medical
MRI scanner includes, each o (hich is optimized to provide image contrast
!ased on the chemical sensitivity o MRI.
The most commonly used intra%enous contrast agents are based on
chelates o' gadolinium. In general, these agents have proved sa'er than the
iodinated contrast agents used in %&ray radiography or $T.
0I & /R1