MAGNETIC RESONANCE IMAGING

A. Principles of Magnetic Resonance Imaging

Magnetic resonance imaging* (MRI) is a noninvasive examination technique that
provides anatomic and physiologic information. Similar to computed tomography (CT), MRI
is a computerbased cross-sectional imaging modality. The physical principles of MRI are
totally different from those of CT and conventional radiography. MRI creates images of
structures through the interactions of magnetic fields and radio waves with tissues without
the use of ionizing radiation.
MRI was originally called nuclear magnetic resonance (NMR) imaging, with the word
nuclear indicating that the nonradioactive atomic nucleus played an important role in the
technique. This term was dropped because of public apprehension about nuclear energy and
nuclear weapons—neither of which is associated with MRI in any way.
B. Comparison of Magnetic Resonance Imaging and Conventional Radiography
MRI provides cross-sectional images and serves as a useful addition to conventional
x-ray techniques. On a radiograph, all body structures exposed to the x-ray beam are
superimposed into one “flat” image. In many instances, multiple projections or contrast
agents are required to distinguish one anatomic structure or organ clearly from another.
Cross-sectional imaging techniques such as ultrasonography, CT, and MRI more easily
separate the various organs because there is no superimposition of structures. Multiple
slices (cross sections) or three-dimensional volumes are typically required to cover a single
area of the body.
In addition to problems with overlapping structures, conventional radiography is
limited in its ability to distinguish types of tissue. In radiographic techniques, contrast (the
ability to discriminate between two different tissue densities) depends on differences in x-
ray attenuation within the object and the ability of the recording medium (e.g., film or digital
detectors) to detect these differences. It is difficult for radiographs to detect small
attenuation changes. Typically conventional radiographs can distinguish only tissues with
large differences in attenuation of the x-ray beam (air, fat, bone, and metal). Soft tissue
structures such as the liver and kidneys cannot be separated by differences in x-ray
attenuation alone. For these structures, differences are magnified through the use of
contrast agents.
However, multislice helical CT, with its superior resolving power, is much more
sensitive to these small changes in x-ray attenuation and is able to distinguish the liver from
the kidneys on the basis of their differing x-ray attenuation and by position.
By manipulating completely different physical principles (interactions of matter with
magnetic fields and radio waves), MRI is able to distinguish very small contrast differences
among tissues.
C. Historical Development
In the mid-1940s, Felix Bloch, working at Stanford University, and Edward Purcell,
working at Harvard University, discovered the principles of nuclear magnetic resonance.
Their work led to the use of nuclear magnetic spectroscopy for the analysis of complex
molecular structures and dynamic chemical processes. This process is still in use today for
the nondestructive testing of chemical compounds. In 1952, Bloch and Purcell were jointly
awarded the Nobel Prize in physics for their development of new ways and methods for
nuclear magnetic precision measurements.
 In 1969, Raymond Damadian proposed the first MRI body scanner. He discovered
that the relaxation times of tumors differed from the relaxation times of normal tissue. This
finding suggested that images of the body might be obtained by producing maps of
relaxation rates. In 1973, Paul Lauterbur published the first crosssectional images of objects
obtained with MRI techniques. These first images were crude, and only large objects could
be distinguished. Mansfield further showed how the signals could be mathematically
analyzed, which made it possible to develop useful imaging techniques. Mansfield also
showed how extremely fast imaging could be achieved. Since that time, MRI technology has
advanced rapidly. Very small structures are commonly imaged quickly and with increased
resolution and contrast. In 2003, the Nobel Prize in physiology or medicine was jointly
awarded to Lauterbur and Mansfield for their discoveries in MRI.
D. Physical Principles
1. SIGNAL PRODUCTION
The structure of an atom is often compared with the structure of the solar system,
with the sun representing the central atomic nucleus and the planets representing the
orbiting electrons. MRI uses properties of the nucleus to generate the signal that
contains the information used to construct the image. Clinical MRI scanners “image”
hydrogen because it is the most abundant element in the body and is the strongest
nuclear magnet on a per-nucleus basis.
Elements with odd atomic numbers, such as hydrogen, have magnetic properties
causing them to act like tiny bar magnets (Fig. 30-1). Ordinarily, in the absence of a
strong magnetic field, these protons point in random directions, as shown in Fig. 30-2,
creating no net magnetization. At this point they are not useful for imaging. If the body
is placed within a strong uniform magnetic field, the protons will attempt to align
themselves in one of two orientations, with the field (parallel) or against the field
(antiparallel). A slight majority will align with, or parallel to, the main magnetic field, also
called the longitudinal plane, causing the tissues to be magnetized or have a slight net
magnetization.
The protons do not line up precisely with the external field but at an angle to the
field causing them to rotate around the direction of the magnetic field in a manner
similar to the wobbling of a spinning top. This wobbling motion, depicted in Fig. 30-3, is
called precession and occurs at a specific frequency (rate) for a given atom’s nucleus in a
magnetic field of a specific strength. These precessing protons can only absorb energy if
that energy is presented at same frequency they are wobbling. In MRI, radiofrequency
(RF) pulses at that specific precessional frequency are used. The absorption of energy by
the precessing protons is referred to as resonance. This resonant frequency, called the
Larmor frequency, varies depending on the field strength of the MRI scanner. At a field
strength of 1.5 tesla, the frequency is approximately 63 MHz; at 1 tesla, the frequency is
approximately 42 MHz; at 0.5 tesla, the frequency is approximately 21 MHz; and at 0.2
tesla, the frequency is approximately 8 MHz.
When the RF pulse, at the Larmor frequency, is applied, the protons absorb the
energy resulting in a reorientation of the net tissue magnetization into a plane
perpendicular to the main field. This is known as the transverse plane. The protons in
the transverse plane also precess at the same resonant frequency. The precessing
protons (a moving magnet) in the tissues create an electrical current, the MRI signal, in
the receiving coil or antenna. This follows Faraday’s law of induction, in which a moving
magnetic field (hydrogen protons) induces electrical current in a coil of wire (RF antenna
or RF coil).
 The MRI signal is picked up by this sensitive antenna or coil, amplified, and
processed by a computer to produce a sectional image of the body. This image, similar
to the image produced by a CT scanner, is a digital image that is viewed on a computer
monitor. Because this is a digital image, it can be manipulated, or postprocessed, to
produce the most acceptable image. Additional processing can be performed on a three-
dimensional workstation if applicable, and hard copies can be produced if necessary.
Many other odd-numbered nuclei in the body are being used in MRI. Nuclei from
elements such as phosphorus and sodium may provide useful or differing diagnostic
information than hydrogen nuclei, particularly in efforts to understand the metabolism
of normal and abnormal tissues. Metabolic changes may prove to be more sensitive and
specific in detecting abnormalities than the more physical and structural changes
recognized by hydrogen-imaging MRI. Nonhydrogen nuclei may also be used for
combined imaging and spectroscopy, in which small volumes of tissue may be analyzed
for chemical content.

2. SIGNIFICANCE OF THE SIGNAL

Conventional radiographic techniques, including CT, produce images based on a
single property of tissue: x-ray attenuation or density. MR images are more complex
because they contain information about differing properties of tissue—proton density,
relaxation rates, and flow phenomena. Each property contributes to the overall strength
of the MRI signal. Computer processing converts signal strength to shades of gray on the
image. Strong signals are represented by white in the image, and weak signals are
represented by black.
One determinant of signal strength is the number of precessing protons in a given
volume of tissue. Signal strength that depends on the concentration of protons is
termed proton density. Most soft tissues, including fat, have a similar number of protons
per unit volume; therefore, the use of proton density characteristics alone poorly
separates these tissues. Some tissues have few hydrogen nuclei per unit of volume;
examples include the cortex of bone and air in the lungs. These tissues have a weak
signal as a result of low proton density and can be easily distinguished from other
tissues.
MRI signal intensity also depends on the relaxation times of the nuclei. Relaxation is
the release of energy by the excited protons. Excited nuclei relax through two processes.
The process of nuclei releasing their excess energy to the general environment or lattice
(the arrangement of atoms in a substance) is called spin-lattice relaxation. The rate of
this relaxation process is measured in milliseconds and is labeled as T1. Spin-spin
relaxation is the release of energy by excited nuclei through interaction among
themselves. The rate of this process is also measured in milliseconds but is labeled as T2.
The rates of relaxation (T1 and T2) occur at different rates in different tissues. The
environment of a hydrogen nucleus in the spleen differs from that of one in the liver;
therefore, their relaxation rates differ, and the MRI signals created by these nuclei differ.
The different relaxation rates in the liver and spleen result in different signal intensities
and appearances on the image, enabling the viewer to discriminate between the two
organs. Similarly, fat can be separated from muscle, and many tissues can be
distinguished from others, based on the relaxation rates of their nuclei. The most
important factor in tissue discrimination is the relaxation time.
The signals produced by MRI techniques contain a combination of proton density,
T1, and T2 information. It is possible, however, to obtain images “weighted” toward any
one of these three parameters by stimulating the nuclei with certain specific radio-wave
pulse sequences. In most imaging sequences, a short T1 (fast spinlattice relaxation rate)
produces a high MRI signal on T1-weighted images. Conversely, a long T2 (slow spin-spin
relaxation rate) generates a high signal on T2-weighted images.
The final property that influences image appearance is flow. For complex physical
reasons, moving substances usually have weak MRI signals. (With some specialized pulse
sequences, the reverse may be true; see the discussion of magnetic resonance
angiography [MRA] later in the chapter.) With standard pulse sequences, flowing blood
in vessels produces a low signal and is easily discriminated from surrounding stationary
tissues without the need for the contrast agents required by regular radiographic
techniques. Stagnant blood, such as an acute blood clot, typically has a high MRI signal
in most imaging schemes as a result of its short T1 and long T2. The flow sequences of
MRI may facilitate the assessment of vessel patency or the determination of the rate of
blood flow through vessels (Fig. 30-4).
E. Equipment
MRI requires a patient area (magnet room), an equipment room, and an operator’s console.
A separate diagnostic workstation is optional.
1. CONSOLE
The operator’s console is used to control the imaging process (Fig. 30-5). Sitting at the
console allows the operator to interact with the system’s computers and electronics to
manipulate all necessary examination parameters and perform the appropriate
examination. Images are viewed on a computer monitor to ensure that the examination
is of appropriate diagnostic quality. Images can be manipulated here, and hard copies of
the exam can be produced if necessary. An independent or three-dimensional
workstation may be used to perform additional imaging manipulation or post processing
when required.

2. EQUIPMENT ROOM
The equipment room houses all the electronics and computers necessary to complete
the imaging process. The RF cabinet controls the transmission of the radiowave pulse
sequences. The gradient cabinet controls the additional timevarying magnetic fields
necessary to localize the MRI signal. The array processors and computers receive and
process the large amount of raw data received from the patient and constructs the
images the operator sees on the operator’s console.
3. MAGNET ROOM
The magnet is the major component of the MRI system in the scanning room. This
magnet must be large enough to surround the patient and any antennas (coils) that are
required for radio-wave transmission and reception. Antennas are typically wound in the
shape of a positioning device for a particular body part. These are commonly referred to
as coils, or RF antennas. As the patient lies on the table, coils are either placed on,
under, or around the part to be imaged. Once positioned the patient is advanced into
the center of the magnet (isocenter) (Fig. 30-6).
Various magnet types may be used to provide the strong uniform magnetic field
required for imaging, as follows:
 Resistive magnets are simple but large electromagnets consisting of coils of
wire. A magnetic field is produced by passing an electrical current through the
wire coils. High magnetic fields are produced by passing a large amount of
current through numerous coils. The electrical resistance of the wire produces
 heat and limits the maximum magnetic field strength of resistive magnets. The
heat produced is conducted away from the magnet by a cooling system.
 Superconductive (cryogenic) magnets are also electromagnets. Their wire loops
are cooled to very low temperatures with liquid helium to reduce electrical
resistance. This permits higher magnetic field strengths than produced by
resistive magnets.
 Permanent magnets are a third source for producing the magnetic field. A
permanent magnet has a constant field that does not require additional
electricity or cooling. The early permanent magnets were extremely heavy even
compared with the massive superconductive and resistive units. Because of their
weight, these magnets were difficult to place for clinical use. With
improvements in technology, permanent magnets have become more
competitive with the other magnet types. The magnetic field of permanent
magnets does not extend as far away from the magnet (fringe field) as do the
magnetic fields of other types of magnets. Fringe fields are a problem because
of their effect on nearby electronic equipment.

Various MRI systems operate at different magnetic field strengths. Magnetic

field strength is measured in tesla (T) or gauss (G). Most MRI examinations are
performed with field strengths ranging from 0.2 to 3 tesla. Resistive systems
generally do not exceed 0.6 tesla, and permanent magnet systems do not exceed 0.3
tesla. Higher field strengths require superconductive technology, with popular field
strengths of 1.5 tesla and 3 tesla. Most research has concluded that field strengths
used for diagnostic clinical imaging do not produce any substantial harmful effects.

Regardless of magnet type, MRI units are a challenge to install in hospitals.

Current units are quite heavy—up to 10 tons for resistive and superconductive
magnets and approximately 100 tons for some permanent magnets. Some
institutional structures cannot support these weights without reinforcement. In
addition, choosing a location for the MRI unit can be difficult because of magnetic
fringe fields. With resistive and superconductive magnets, the fringe field extends in
all directions and may interfere with nearby electronic or computer equipment, such
as television monitors and other electronic devices. In addition, metal objects
moving near the magnetic fringe field, such as automobiles or elevators, may cause
ripples in the field, similar to the ripples caused by a pebble thrown into a pond.
These ripples can be carried into the center of the magnet, where they distort the
field and ruin the images. Efforts are made to shield the magnetic fringe field to
prevent its extension beyond the MRI suite. Shielding will limit the effects of the
magnetic field on metal objects or electronic devices and their effect on the
magnetic field.
 Stray radio waves present another difficulty in the placement of MRI units. The radio
waves used in MRI may be the same as the radio waves used for other nearby radio
applications. Stray radio waves can be picked up by the MRI antenna coils and interfere
with normal image production. MRI facilities require specially constructed rooms to
shield the receiving antennas from outside radio interference, adding to the cost of the
installation. Specialty units have become available for limited applications. One example
is an extremity MRI scanner (Fig. 30-7). This unit is designed so that the patient can sit
comfortably in a chair while having an extremity or musculoskeletal joint imaged. These
units are lightweight (approximately 1500 lb) and take up less space than conventional
MRI scanners, and they produce good image quality (Fig. 30-8)