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WHAT ARE THE KEY SEQUENCES IN
NEURORADIOLOGY IMAGING?
Or – How do I evaluate a plain MRI of the head?
This lecture is to be used for educational purposes only.
Images “borrowed” from the World Wide Web.
Eliel Ben-David, M.D.
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Three Key Questions
1. Is it real?
2. Is it bad?
3. What is it?
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Is it real? - True Pathology vs. Artifact
zipper artifact
herringbone artifact
zebra stripes
Moire fringes
central point artifact
RF overflow artifacts
inhomogeneity artifacts
cross-talk artifact
cross excitation
phase-encoded motion artifact
entry slice phenomenon
black boundary artifact
magic angle effect
magnetic susceptibility artifact
chemical shift artifact
dielectric effect artifact
Gibbs artifact/truncation artifact
zero-fill artifact
aliasing/wrap around artifact
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11. Know Thy Artifact
• MR hardware and room shielding
• MR software
• Patient and physiologic motion
• Tissue heterogeneity and foreign bodies
• Fourier transform and Nyquist sampling theorem
http://radiopaedia.org/articles/mri-artifacts
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Is it bad? – Normal or Abnormal
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http://headneckbrainspine.com/index.php
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What is it?
• Take what lives there and make it abnormal.
• Know the regional pathology/pathophysiology.
• Compare unknown to known.
• How do these pathologies appear on MRI?
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Contrast
• Tissue definition/Spatial resolution
• Conspicuity of pathology
Where is it easier to identify the stroke?
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Basic Contrasts
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T1 contrast
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Basic Neuro Sequences
• Four Shades of Gray – T1
Black
Dark
Intermediate
White
No protons / excited protons
• Air
• Dense Calcification/Cortical Bone
Fluid (CSF)
(Protein)
Brain Tissue
Fat
Gadolinium
Methemoglobin
GM
WM
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Sagittal T1
Black
Dark
Intermediate
White
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Sagittal T1
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T1 contrast
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T1+Gd T1
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T2 contrast
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Basic Neuro Sequences
• Four Shades of Gray – T2
Black
Dark
Intermediate
White
No protons / excited protons
• Air
• Dense Calcification
• Flow voids
(Protein)
Bound water tissues (muscle)
Brain Tissue
Free water
Fat
Oxyhemoglobin
WM
GM
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T2
Black
Dark
Intermediate
White
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T2
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T2
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3D T2 imaging
CISS/FIESTA
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FLAIR / STIR
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FLAIR / STIR
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Basic Neuro Sequences
• Four Shades of Gray – FLAIR
Black
Dark
Intermediate
White
Free water
Brain Tissue
T2 bright tissue that isn't free
water.
WM
GM
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FLAIR
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FLAIR
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FLAIR T2
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STIR T2
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Diffusion Weighted Imaging
Black
Dark
Intermediate
White
Non fluid-restricted tissue
Fluid-restricted tissue (maybe)
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DWI
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Diffusion Weighted Imaging
Dephasing
Gradient
Rephasing
Gradient H20
H20
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Not all that shines is gold
DWI
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Diffusion Weighted Imaging - ADC
Apparent Diffusion Coefficient – ADC MAP •A measure of magnitude of diffusion
Black
Dark
Intermediate
White Not Fluid Restriction (T2 Shine Through)
True Fluid Restriction
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ADC
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T2* Images
Imaging of tissues which cause non-homogeneous magnetic
susceptibility effects
• Calcium
• Hemosiderin
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T2*
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Know your:
• Physics
• Neuroanatomy
• Artifacts
Ask yourself:
• Is it real?
• Is it bad?
• What is it?
Sequences
• T1
Gd
• T2
• FLAIR
• DWI
• T2*
Summary
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http://www.einstein.yu.edu/labs/michael-lipton/education-
training/introducing-mri/
http://radiopaedia.org/articles/mri-artifacts
http://headneckbrainspine.com/index.php