PATIEN PREPARATION

& MRI READING

GA.Indirawati
Dep/SMF Radiologi
FK UNAIR / RSUD
Dr.Soetomo
INTRODUCTION
How is the MRI image created ?
Patient is placed in a scanner that generates a very strong magnetic field
RF waves are pulsed in, scattering the nuclei in all directions
These differential relaxation rates are used to create MR images
Type of magnetization
Longitudinal magnetization
 T1 relaxation ( or recovery ) :
time for the tissue to recover to its longitudinal state

T2 relaxation ( or decay )
time for the tissue to regain its transverse orientation
In summary
TR and TE
Changing the TR & TE will alter how the image is
weighted

TR : repetition time between 2 RF pulses

influence the amount of T1 weighting

TE : echo time between 1 pulse & its resultant echo

influence the amount of T2 weighting
Differentiating between T1WI & T2WI
By looking TR & TE By looking image : fluid

T1 : short TR ( < 1000 mS) T1 : low SI

short TE ( < 20 ms )
T2 : high SI
T2 : long TR ( > 2000 ms )
long TE ( > 40 ms ) ( bladder , CSF )
MRI scanner components
Main magnet
Hydrogen nuclei Proton

( Interchangeable term )

MRI could be used to evaluate many different

nuclei BUT

Clinical MRI scanner are based on hydrogen

nuclei
Today : most scanners have a magnetic field between
0.5 3 Tesla

1 T = 10.000 gauss ( G)
( the earth magnetic field is only 50 micro T / 0.5 gauss )

So Strong !!
30.000 X
MRI CONTRAST AGENT
GADOLINIUM

Heavy metal ion

Chelated to different compund eg : acid diethylene

triamine pentaacetic acid ( DTPA

Relatively save , water soluble

Used the same way like contrast CT ( IV, IA )

Contrast injection
Entering blood pools
Gadolinium effects :

Shorten T1 relaxation time

Causing brighter signal intensity

Stuctures that become bright after contrast
injection are tipically

1. Vascular ( tumours)

2. Inflammation

Described as : ENHANCING
SIDE EFFECT

Mild

Moderate

Severe

Contrast agent
Cerebral infarction
Hypointense T1

Hyperintense T2
Cerebral bleeding
Depents on
Onset
Oxy Hb
Clot
size
 Hyperacute : -
Acute ( 12- 48 hrs ) : Oxy Hb _ deoxy Hb
Interm T1 , Hypo T2
Subacute : deoexy _ met Hb
Hyper T1 , Hypo T2
Late subacute : extracell meth Hb
Hyper T1, T2
Chronic phase : hemosiderin
low T1, prominent low T2
MRCP
Pancreatic mass
ACL tear
Spondylitis
MRA
MRI SAFETY ISSUES

No harmful biological effect from exposure to magnetic

field below 10 T ( currently at 3 T )

Safe as long as proper safety precaution are taken care

No known short - term or long - term tissue damage

CLAUSTROPHOBIA

Need sedation

Open air scanner

MRI Safety Issues

FERROMAGNETIC OBJECTS inside the patient

Can be moved by the magnetic field

Could damage adjacent tissues

Can be heated and cause burns

MRI safety issues

These objects include
( medically inserted items )

1. Cerebral aneurysm clips

2. Vascular coils, filter & stent
3. Surgical clip, staples & pin
4. Implant & prothese
5. Heart valves
6. Orthopedic & dental devices
etc

MRI Safety Issues

 Foreign bodies :
bullet , shrapnel , metal in the eye

Ferromagnetic objects outside the patient :

oxygen tank
scissors
metallic tools

MR safe equipment
MECHANICAL or ELECTRICAL DEVICES

Pace maker
Cardiac defribillator
Insulin pumps
Implantable drug infusion pumps
Cochlear implant

MRI Safety Issues

PREGNANT PATIENT

The effect of MRI in fetus are not definitely known

By some : absolute contra indication in the 1st trimester
American College of Radiology ;
can undergo MRI in any stage if the risk benefit
ratio to the patient weighs in favor
Gd contrast injection is contraindicated

MRI Safety Issues

NEPHROGENIC SYSTEMIC FIBROSIS

In patient with preexisting renal dysfunction are at great

risk
Caution : patient with eGFR between 30 60 ml /min
Avoid : eGFR < 30 ml/min
No special p
ITEMS TO BE REMOVED IN MRI ROOM
Credit card
Magnetic card
Hearing aid
Mobile phone
Metal jewelry
Hair pin
Watch
Coin, key
Belt , zipper , button
DIAGNOSTIC APPLICATION
Musculoskeletal sytem
bone / bone marrow
spine
disk
joint
tendon
muscle
ligament
meniscus
 Neurologic system
brain ( posterior fossa )
white matter disease
dementia
vascular
 Abdomen
Liver
Biliary system
Kidney , bladder
Female pelvic
Male pelvic
Advantages
Superior contrast between different soft
tissue

High resolution than CT

No ionizing radiation

3D data aquisition
Disadvantages
Machine more expensive than CT

More artefacts than CT

Some patients are unable due to certain

sensitive equipment

Can not be used for treatment planning

Have a nice
day