What is an MRI scan?

An MRI (or magnetic resonance imaging) scan is a radiology technique that uses magnetism, radio waves, and a
computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet.
The patient is placed on a moveable bed that is inserted into the magnet. The magnet creates a strong magnetic field
that aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various
protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. The
receiver information is processed by a computer, and an image is produced.

The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the
body. For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy of the images.

When are MRI scans used?

An MRI scan can be used as an extremely accurate method of disease detection throughout the body. In the head,
trauma to the brain can be seen as bleeding or swelling. Other abnormalities often found include brain
aneurysms, stroke, tumors of the brain, as well as tumors or inflammation of the spine.

Neurosurgeons use an MRI scan not only in defining brain anatomy but in evaluating the integrity of the spinal cord
after trauma. It is also used when considering problems associated with the vertebrae or intervertebral discs of the
spine. An MRI scan can evaluate the structure of the heart and aorta, where it can detect aneurysms or tears.

It provides valuable information on glands and organs within the abdomen, and accurate information about the
structure of the joints, soft tissues, and bones of the body. Often, surgery can be deferred or more accurately directed
after knowing the results of an MRI scan.

How MRI works

The body is largely composed of water molecules. Each water molecule has
two hydrogen nuclei or protons. When a person goes inside the powerful magnetic field of
the scanner, the magnetic moments of some of these protons changes, and aligns with the
direction of the field.
In an MRI machine a radio frequency transmitter is briefly turned on, producing
an electromagnetic field. The photons of this field have just the right energy, known as the
resonance frequency, to flip the spin of the aligned protons in the body. As the intensity and
duration of application of the field increase, more aligned spins are affected. After the field is
turned off, the protons decay to the original spin-down state and the difference in energy
between the two states is released as a photon. It is these photons that produce the
electromagnetic signal that the scanner detects. The frequency the protons resonate at
depends on the strength of the magnetic field. As a result of conservation of energy, this
also dictates the frequency of the released photons. The photons released when the field is
removed have an energy — and therefore a frequency — due to the amount of energy the
protons absorbed while the field was active.
It is this relationship between field-strength and frequency that allows the use of nuclear
magnetic resonance for imaging. Additional magnetic fields are applied during the scan to
make the magnetic field strength depend on the position within the patient, in turn making
the frequency of the released photons dependent on position in a predictable manner.
Position information can then be recovered from the resulting signal by the use of a Fourier
transform. These fields are created by passing electric currents through specially-
wound solenoids, known as gradient coils. Since these coils are within the bore of the
scanner, there are large forces between them and the main field coils, producing most of the
noise that is heard during operation. Without efforts to dampen this noise, it can approach
130 decibels (dB) with strong fields [7] (see also the subsection on acoustic noise).
An image can be constructed because the protons in different tissues return to their
equilibrium state at different rates, which is a difference that can be detected. By changing
the parameters on the scanner, this effect is used to create contrast between different types
of body tissue or between other properties, as in fMRI and diffusion MRI.
Contrast agents may be injected intravenously to enhance the appearance of blood
vessels, tumors or inflammation. Contrast agents may also be directly injected into a joint in
the case of arthrograms, MRI images of joints. Unlike CT, MRI uses no ionizing radiation and
is generally a very safe procedure. Nonetheless the strong magnetic fields and radio pulses
can affect metal implants, including cochlear implants and cardiac pacemakers. In the case
of cochlear implants, the US FDA has approved some implants for MRI compatibility. In the
case of cardiac pacemakers, the results can sometimes be lethal,[8] so patients with such
implants are generally not eligible for MRI.
MRI is used to image every part of the body, and is particularly useful for tissues with many
hydrogen nuclei and little density contrast, such as the brain, muscle, connective tissue and
most tumors.

In clinical practice, MRI is used to distinguish pathologic tissue (such as a brain tumor) from
normal tissue. One advantage of an MRI scan is that it is believed to be harmless to the
patient. It uses strong magnetic fields and non-ionizing radiation in the radio frequency
range, unlike CT scans and traditional X-rays, which both use ionizing radiation.
While CT provides good spatial resolution (the ability to distinguish two separate structures
an arbitrarily small distance from each other), MRI provides comparable resolution with far
better contrast resolution (the ability to distinguish the differences between two arbitrarily
similar but not identical tissues). The basis of this ability is the complex library of pulse
sequences that the modern medical MRI scanner includes, each of which is optimized to
provide image contrast based on the chemical sensitivity of MRI.

Effects of TR, TE, T1 and T2 on MR signal.

For example, with particular values of the echo time (TE) and the repetition time (TR), which
are basic parameters of image acquisition, a sequence takes on the property of T2-
weighting. On a T2-weighted scan, water- and fluid-containing tissues are bright (most
modern T2sequences are actually fast T2 sequences) and fat-containing tissues are dark. The
reverse is true for T1-weighted images. Damaged tissue tends to develop edema, which
makes a T2-weighted sequence sensitive for pathology, and generally able to distinguish
pathologic tissue from normal tissue. With the addition of an additional radio frequency
pulse and additional manipulation of the magnetic gradients, a T2-weighted sequence can be
converted to a FLAIR sequence, in which free water is now dark, but edematous tissues
remain bright. This sequence in particular is currently the most sensitive way to evaluate the
brain for demyelinating diseases, such as multiple sclerosis.
The typical MRI examination consists of 5–20 sequences, each of which are chosen to
provide a particular type of information about the subject tissues. This information is then
synthesized by the interpreting physician.