PRESENTOR- Dr.

Bhargavi

MODERATOR- Prof Dr. Rama Krishna Rao Baru

Steps of Creating an MR image:
 1. The patient lies on a table surrounded by
a very large magnet.

 2. A magnetic field causes alignment of the

hydrogen atoms in the patient’s body.

 3. Radio waves are sent to a selected part

of the body.

 4. Radio waves interact with the hydrogen

atoms in that part of the body.
Steps of Creating an MR image:

 5. The radio waves are turned off, and the

hydrogen atoms in the selected area
produce radio wave signals.

 6. The MR scanner detects the radio wave

signals

 7. The MR scanner assembles an image of

the body.
Magnetic Resonance Imaging (MRI):
 MRI and CT have some common features.
Both produce cross-sectional images of the
body, and use computers to assemble
these images. They differ, however, in that
MRI uses a strong magnetic field and radio
waves, rather than X-rays to obtain images.


 Magnetic Resonance Imaging (MRI):
 What is sent into the body to create a
medical image?
 Energy
 What is detected in order to create a
medical image?
 Changes in the energy sent into the body
 What form of energy is used in CT?
 X-Rays
 What two forms of energy are used in MRI?
 1. Magnetic field 2. Radio Waves
 Magnetic Field:
 The area around a magnet in which
magnetic force can be measured.

 Radio Waves:
 Low-energy radiation as compared with
high-energy radiation (X-rays)

 Alignment:
 Orientation; in MRI, most hydrogen atoms in
the body align in the same direction as the
magnetic field.
 What is a magnetic Field?

 Magnets exert a force which attracts or repels

objects around them in a particular direction. A
magnetic field is the area around a magnet in
which magnetic force can be measured. MRI uses
very strong magnetic fields.

 A magnetic field has a particular strength and

direction that can be measured. This is represented
by a vector referred to as the symbol Bo .

 The direction of the vector indicates the direction

of the magnetic field. The length of the vector
represents the strength of the magnetic field, which
is measured in the following units:
 What is a magnetic Field?
 * Tesla (T)
 * Kilogauss (KG)
 * Gauss (G)

 One Tesla is equal to 10 Kilogauss, or 10,000 Gauss.

For example:
 * 0.35 T = 3.5 KG = 3,500 G
 * 0.5 T = 5 KG = 5,000 G
 * 1.5 T = 15 KG = 15,000 G
 Tesla (T) is the unit most often used to measure
magnetic field strengths used in MRI. Magnetic
field strengths commonly used in MRI include 1.5 T
and 0.35 T.
 Radio Waves:
 MRI uses radio waves, also called radio
frequency radiation (RF radiation), to
provide a signal which is sent into the
patient’s body. The basic imaging signal
emitted from the patient’s body is also a
radio wave.

 Radio waves have low frequency and long

wavelength Conversely, X-rays, at the
opposite end of the electromagnetic
spectrum, have high frequency and short
wavelength.
 RF Pulses and MRI:
 An RF pulse is a group of radio waves set
to a specific frequency. It provides a
short burst of radio frequency energy.

 In MRI, patients are first exposed to a

strong magnetic field and then to a
series of RF pulses.
 Characteristics That Affect MR
Images:
Fixed at time of scan:
 * Magnetic field strength
 * Number of Hydrogen atoms in body tissues
 * Chemical environment of hydrogen atoms
 (for scan without contrast agent)

Can be changed at time of scan:

 * Chemical environment of hydrogen atoms
 (for scan with contrast agent)
 * Sequence of radio waves sent to the hydrogen
atoms.
 Chemical environment: the chemicals that surround
a specific particle.
MRI CONTRAST AGENTS
Contrast enhancement in MR imaging is the
process of maximizing the difference of signal
intensity b/w two tissues and is achieved by
either increasing or decreasing the signal
intensity of a tissue relative to another.

The signal of MRI arises from the relaxations of

the protons
 Lauterbur etal –
First described the feasibility of
paramagnetic substances for tissue
differentiation by altering the proton
relaxation times.
Uses of C.M in MR :
To differentiate structures
To highlight anatomical spaces
To provide additional specificity in
describing regions of abnormal
signal
To depict tissue vascularity &
perfusion
 Mechanism of contrast
enhancement in MRI :
In conventional and CT, image contrast is
generated by different attenuation of the x-
ray beam by the tissues of the body.

In MR contrast agents act by altering the tissue

relaxation rates by changing the local
magnetic environment.
 In conventional & CT, image contrast is
generated by different attenuation of
the X-ray beam by the tissues of the
body.
 MR is unique in that there are multiple
parameters responsible for signal
intensity.
 So the contrast agent must have the
ability to influence these parameters at
low concentration to minimize dose and
potential toxicity.
1. Proton density
2. T1 & T2 relaxation times
3. Magnetic susceptibility
4. Diffusion & Perfusion
 Spin density : Can’t altered significantly by a
contrast agent.
Relaxivity:
The efficiency by which the agent
enhances the proton relaxation rates of
water.
Two relaxivity parameters that are unique
to each tissue are T1 and T2.
T1 - the longitudinal /spin lattice relaxation
time.
T2 – the transverse/spin relaxation
time.
Contrast enhancement depends upon the
alteration of these two relaxivity parameters.
 They can be categorized on the basis of
relative change each impart on either T1 &
T2.

T1 agents / positive relaxation agents :

Predominantly affects T1 relaxation.
Enhanced T1 relaxation results in increased
signal intensity on T1WI.

T2agents / negative relaxation agents :

Predominantly affects T2 relaxation.
T2 shortening causes decreased signal
intensity on T2WI.
T1 Relaxation agents:
MC used agents are paramagnetic
substances of these gadolinium is most
frequently used.
 Gadolinium :
Belongs to lanthanide metal group.
It is complexed with various ligands that act
as chelating agents.
Has high spin contrast number which
produces a desirable relaxivity contrast
agents.
 3 agents have been approved by FDA.
They are
1. Gd-Hp-DO3A (Gadoteridol)/Pro Hance)
– non Ionic

2. Gd-DTPA (Gadopentetate
dimeglumine/
Magnavist) – Ionic

3. Gd-DTPA –BMA
(Gadodiamide/Omniscan) –
Non Ionic.
 These function as extra cellular contrast
agents
 Rapidly excreted by glomerular filtration
with half lives b/w 1-2hrs.
 Agents are distributed only when there is a
break in the BBB/in the slowly flowing
veins.
 These agents also cause T2 shortening but
only at higher doses.
 As these are excreted by kidney, caution
should be exercised in renal impaired pts.
 Dose – 0.1 – 0.3 mm/kg body wt.
 Adverse reactions:

› 3 to 5% mostly nausea and hives.

› Anaphylactoid like reactions - rare.
› Transient rise of serum bilirubin and iron (some
concern in pts of hemolytic anemia)
› Contra indicated during pregnancy (cross
placenta and are excreted in breast milk.)
› Can be safely given in compromised renal
function however removal of the contrast by
dialysis is recommended in case of severe
renal impairement.
 Super para magnetic agents

 Of the ferrite particles, magnetite (Fe3O4)

is used commonly.

 These are crystalline oxides with particle

size ranges from 0.5 – 1microns.

 Used in the study of liver, spleen & GIT.

 Ability of a substance to become
magnetized in an external magnetic
field.
a. diamagnetic – negligible effect
b. Paramagnetic
c. Super paramagnetic – very large
positive susceptibility effect.
d. Ferro magnetic
Organ and tissue directed
contrast agents:

More specific the accumulation of

contrast agent in the target tissue better
is the resultant lesion/ tissue contrast.
Liver specific agents:
T2 agents which are coated iron oxide ( SPIO
/ USPIO) particles.
Mechanism of action – ferrite particles are
taken up by phagocytes of liver and spleen
where they cause rapid dephasing and
hence decreased signal intensity.

This leads to loss of signal of the background

normal tissue on T2WI against which focal
liver lesions like metastasis (which don’t
contain kupffer cells) can be seen as higher
signal intensity.
3 agents :
Feromoxide / AMI -25 –
› FDA approved RE system contrast.
› Biodegradable, cleared by RES (half life
8min)
› IV dose – 10 to 15 micro gr / kg
› Side effects – backache, flushing and
hypotension
Magentite (resovit / SHU – 555) –
Other SPIO in phase III clinical trial.
Dose – 40ug.
AMI 227 :
– 3rd R.E.S agent
› Ultra small iron oxide particles (USPIO)
› Small size (17 – 20mm) results in long blood
half life of 200hrs and greater T1 effect.
› Also considered a blood pool agent.
Hepatobiliary agents:
These components share the property of
substantial hepatic uptake & biliary
excretion.
These agents cause preferential T1
enhancement beginning with in minutes and
lasting for 2hrs
2 gaddinium chalates with hepatobiliary
excretion are:
GD- BOPTA (Gado benate dimeglumine).
GD-EOB-DTPA.
Mn-DPDP(mangafodipir trisodium)–
approved by FDA.
› These agents have biodistribution confined
to the lumen of the bowel with no or only
limited absorption.
› The approach to opacification of the GI
tract involves either
 Positive contrast agents – which
increase the signal intensity of intestinal
lumen
 Negative contrast agents – which
decrease signal intensity of intestinal
lumen
 Posive Contrast Media :
ex. Ferric ammonium citrate (geritol,
OMR).
Manganse containing agents.
GD DTPA & oil emulsions.
Disadvantages:
Degradation of image due to motion
(pretreatment with Glucagon is needed)
Negative contrast agents:

1. SPIO particles , ie OMP and

Ferumoxsil or AMI-121.
2. USPIO – AMI-227.

These can potentially mask the pathology

in the intestinal wall due to loss of signal
caused by magnatic susceptibility.
 Reversibly binds to plasma albumin
achieving a substantial improvement in
magnitude and duration of blood pool
enhancement.
 Susceptibility agents –
 SPIO
 USPIO
 Magnetite.
Predominantly have t2 effects.
 Spin density contrast agents like perfluoroctyl
bromide (PFOB) – can be used as negative
contrast enhancement agents.

 Using magnetizationtransfer, enhancement

caused by gadolinium can be better
appreciated.

 High dose applications – around

0.3mmol/kg. body wt for better detection of
lesions..
 Although originally thought to be
nonnephrotoxic, gadolinium-
based contrast media have
recently been reported to be
associated with acute renal
failure; the mechanism and the
underlying renal injury are not
completely understood.
 The risk of gadolinium-induced
nephrotoxicity is, however, strongly
suggested by more recent experimental
and clinical studies.
 Nephrotoxicity, diagnosed by laboratory
parameters including -
increased serum creatinine,
decreased creatinine clearance, or
elevated tubular cell enzymuria,
was induced in the mouse, rat, rabbit,
dog, and pig by intravascular injection
of various gadolinium chelates
 Clinical data suggest several
associations that impact clinical
practice:
* The higher the dose of contrast, the
greater the chance of developing NSF

* The greater the severity of renal

disease, the greater the chance of
developing NSF

* Cumulative doses of contrast seem to

increase the incidence of NSF
 Nephrogenic systemic fibrosis (NSF) is a
scleroderma / myxoderma-like condition
that causes painful scarring, tightening,
thickening, and discoloration of the skin. It
also affects the lungs, myocardium,
diaphragm, and striated muscle.
 NSF can be debilitating and fulminant in
about 5% of cases and can lead to
immobility and death within weeks to
months. There is no known cure, with
occasional improvement noted following
renal transplantation.