Magnetic Resonance Imaging

MRI
Basics

▪ An MRI (Magnetic Resonance Imaging) machine uses (commonly) an electromagnet, which is super-
cooled with liquid helium, to produce a static magnetic field which causes hydrogen nuclei in water
molecules in the body to align either in parallel or anti-parallel to the field. An image is generated by
the repeated application of an electromagnetic pulse-sequence (in the radio-frequency band), this cause
the nuclei to align (or 'flipping'), when the alignment decays it will induce a voltage in a conductive
loop placed near the area of interest (the part of the body which is being imaged). The voltage is
interpreted by the computer, which then will construct the image.
▪ MRI is similar to Computed Tomography (CT) as they both produce a 2-dimensional cross-section of the
body.
▪ CT machines employ x-rays which must be attenuated by the tissue in the body at varying degrees to
generate the contrast required for an image. The image quality is poor relative to MRI due to the
relatively uniform composition of tissues.
▪ An MRI demonstrates best tissues with a lot of hydrogen in them, so it is less suited to imaging bone;
however the differences in cancellous and cortical bone in addition to bone marrow can be discerned on
an MR image (depending on the factors chosen by the operator).
▪ As MRI does not using ionising radiation, it would ideally be the preferred method of imaging; it is safe
for the imaging of children. However, pregnancy is a possible contra-indication (especially in the first
trimester) due to unknown possible side-effects.
▪ Magnetic resonance imaging (MRI), formerly referred to as magnetic resonance tomography (MRT) and,
in scientific circles and as originally marketed by companies such as General Electric, nuclear magnetic
resonance imaging (NMRI) or NMR zeugmatography imaging, is a non-invasive method using nuclear
magnetic resonance to render images of the inside of an object.
▪ It is primarily used in medical imaging to demonstrate pathological or other physiological alterations of
living tissues.
▪ MRI also has uses outside of the medical field, such as detecting rock permeability to hydrocarbons and
as a non-destructive testing method to characterize the quality of products such as produce and timber.
▪ MRI should not be confused with the NMR spectroscopy technique used in chemistry, although both are
based on the same principles of nuclear magnetic resonance.
▪ In fact MRI is a series of NMR experiments applied to the signal from nuclei (typified by the hydrogen
nuclei in water) used to acquire spatial information in place of chemical information about molecules.
▪ The same equipment, provided suitable probes and magnetic gradients are available, can be used for both
imaging and spectroscopy.
▪ The scanners used in medicine have a typical magnetic field strength of 0.2 to 3 Teslas. Construction
costs approximately US$ 1 million per Tesla and maintenance an additional several hundred thousand
dollars per year.
▪ Medical Imaging MRI, or "NMR" as it was originally known, has only been in use since the 1980's.
Effects from long term, or repeated exposure, to the intense magnetic field are not well documented.
▪ Functional MRI detects changes in blood flow to particular areas of the brain. It provides both an
anatomical and a functional view of the brain.
 Nuclear spin
Nuclei with an odd mass or odd atomic number have "nuclear spin" (in a similar fashion to the spin of
electrons). This includes 1H and 13C (but not 12C). The spins of nuclei are sufficiently different that NMR
experiments can be sensitive for only one particular isotope of one particular element. The NMR
behaviour of 1H and 13C nuclei has been exploited by organic chemists since they provide valuable
information that can be used to deduce the structure of organic compounds. These will be the focus of our
attention. Since a nucleus is a charged particle in motion, it will develop a magnetic field. 1H and 13C have
nuclear spins of 1/2 and so they behave in a similar fashion to a simple bar magnet. In the absence of a
magnetic field, these are randomly oriented but when a field is applied they align parallel or anti-parallel
to the field. The more highly populated state is the lower energy spin state, which is in alignment to the
magnetic field.

Advantages and Disadvantages

Advantages

▪ It is a non-ionising radiation imaging modality.

▪ Can provide detailed images of the brain contrasting differing tissue types which comprise the brain
through multiple cross-sections.
▪ Relatively safe; painless; and non-invasive.
▪ For the most part, no special preparation is required of the patient (could be argued of the other imaging
modalities too). Patients will having eating and drinking restrictions for studies examining the gastro-
intenstial tract and associated organs and glands (an MRCP (Magnetic Resonance
Choliangiopancreatography) would be one instance) for example; but for the most part there will be few
pre-examination preparation procedures to follow.

Disadvantages

▪ MR machines are expensive to buy and run compared to other modalities such as Ultrasound (another
imaging modality which does not use ionising-radiation) or CT.
▪ Generally, it cannot be used in patients with metallic devices (pacemakers, although newer pacemakers
which are being fitted are 'MR-Safe'); it is not contra-indicated in patients with numerous types of
orthopaedic implants, however the operator must be aware of the heating of the prosthesis during the
scan; futhermore, it can be possible to undergo an MRI scan with metal surgical implants in soft-tissues,
however it is very dependent on the type of implant and where it is.
▪ It cannot be used with uncooperative patients (MR scans are highly sensitive to movement (due to k-
space filling, it can distort an the images from an entire scan sequence)) or those who are
claustrophobic; however, in the former case (and the latter one too), sedatives can be used if it is
deemed that the information gained from the MR scan sufficiently deems their application; furthermore,
open MR machines are in development by the major manufactures to address this issue.

Functional MRI (fMRI)

A fMRI scan showing regions of activation in orange, including the primary visual cortex (V1, BA17).
Functional MRI (fMRI) measures signal changes in the brain that are due to changing neural activity. The
brain is scanned at low resolution but at a rapid rate (typically once every 2-3 seconds). Increases in
neural activity cause changes in the MR signal via T2* changes; this mechanism is referred to as the
BOLD (blood-oxygen-level dependent) effect. Increased neural activity causes an increased demand for
oxygen, and the vascular system actually overcompensates for this, increasing the amount of oxygenated
hemoglobin (haemoglobin) relative to deoxygenated hemoglobin.

Because deoxygenated hemoglobin attenuates the MR signal, the vascular response leads to a signal
increase that is related to the neural activity. The precise nature of the relationship between neural activity
and the BOLD signal is a subject of current research. The BOLD effect also allows for the generation of
high resolution 3D maps of the venous vasculature within neural tissue. While BOLD signal is the most
common method employed for neuroscience studies in human subjects, the flexible nature of MR imaging
provides means to sensitize the signal to other aspects of the blood supply. Alternative techniques employ
arterial spin labeling (ASL) or weight the MRI signal by cerebral blood flow (CBF) and cerebral blood
volume (CBV). The CBV method requires injection of a class of MRI contrast agents that are now in
human clinical trials.

Principles
Modern 3 Tesla clinical MRI scanner. Medical MRI most frequently relies on the relaxation properties of
excited hydrogen nuclei in water and lipids. When the object to be imaged is placed in a powerful,
uniform magnetic field, the spins of atomic nuclei with a resulting non-zero spin have to arrange in a
particular manner with the applied magnetic field according to quantum mechanics. Nuclei of hydrogen
atoms (protons) have a simple spin 1/2 and therefore align either parallel or antiparallel to the magnetic
field

The spin polarization determines the basic MRI signal strength. For protons, it refers to the population
difference of the two energy states that are associated with the parallel and antiparallel alignment of the
proton spins in the magnetic field and governed by Boltzmann statistics. In a 1.5 T magnetic field (at
room temperature) this difference refers to only about one in a million nuclei since the thermal energy far
exceeds the energy difference between the parallel and antiparallel states. Yet the vast quantity of nuclei
in a small volume sum to produce a detectable change in field. Most basic explanations of MRI will say
that the nuclei align parallel or anti-parallel with the static magnetic field; however, because of quantum
mechanical reasons, the individual nuclei are actually set off at an angle from the direction of the static
magnetic field. The bulk collection of nuclei can be partitioned into a set whose sum spin are aligned
parallel and a set whose sum spin are anti-parallel.

The magnetic dipole moment of the nuclei then precesses around the axial field. While the proportion is
nearly equal, slightly more are oriented at the low energy angle. The frequency with which the dipole
moments precess is called the Larmor frequency. The tissue is then briefly exposed to pulses of
electromagnetic energy (RF pulses) in a plane perpendicular to the magnetic field, causing some of the
magnetically aligned hydrogen nuclei to assume a temporary non-aligned high-energy state. Or in other
words, the steady-state equilibrium established in the static magnetic field becomes perturbed and the
population difference of the two energy levels is altered. The frequency of the pulses is governed by the
Larmor equation to match the required energy difference between the two spin states.

Applications[✎ edit | edit source]

Axial Brain MRI

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 thought to be harmless to the patient. It uses strong magnetic
fields and non-ionizing radiation in the radio frequency range. Compare this to CT scans and traditional
X-rays which involve doses of ionizing radiation and may increase the risk of malignancy, especially in a
fetus.

While CT provides good spatial resolution (the ability to distinguish two structures an arbitrarily small
distance from each other as separate), 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.

For example, with particular values of the echo time (TE) and the repetition time (TR), which are basic
parameters of image acquisition, a sequence will take on the property of T2-weighting. On a T2-weighted
scan, fat-, water- and fluid-containing tissues are bright (most modern T2 sequences are actually fast T2
sequences). 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.

https://pmj.bmj.com/content/postgradmedj/89/1050/209.full.pdf

https://pmj.bmj.com/content/89/1050/209#

Review

Understanding MRI: basic MR physics for physicians

 FREE

1. Stuart Currie1, 
2. Nigel Hoggard1, 
3. Ian J Craven1, 
4. Marios Hadjivassiliou2, 
5. Iain D Wilkinson1

Author affiliations
Abstract
More frequently hospital clinicians are reviewing images from MR studies of their patients
before seeking formal radiological opinion. This practice is driven by a multitude of factors,
including an increased demand placed on hospital services, the wide availability of the picture
archiving and communication system, time pressures for patient treatment (eg, in the
management of acute stroke) and an inherent desire for the clinician to learn. Knowledge of the
basic physical principles behind MRI is essential for correct image interpretation. This article,
written for the general hospital physician, describes the basic physics of MRI taking into account
the machinery, contrast weighting, spin- and gradient-echo techniques and pertinent safety
issues. Examples provided are primarily referenced to neuroradiology reflecting the subspecialty
for which MR currently has the greatest clinical application.
View Full Text

http://dx.doi.org/10.1136/postgradmedj-2012-131342

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Introduction
For years, access to images from MR studies was limited to the reporting radiologist with
clinicians seeing them briefly at multidisciplinary team meetings. That has now changed,
largely due to the introduction of the picture archiving and communication system. More
frequently, clinicians review MRI before seeking specialist radiological opinion.
However, knowledge of the basic physical principles underlying MRI acquisition is
fundamental to image interpretation.
This article, written for the general hospital physician, describes the basic physics of MRI
taking into account the machinery, contrast weighting, spin- and gradient-echo techniques
and pertinent safety issues. Examples provided are primarily referenced to
neuroradiology reflecting the subspecialty for which MR currently has the greatest
clinical application.

The equipment
The MR system comprises two main groups of equipment. The first is the control centre,
which is positioned where the operator sits. The control centre houses the ‘host’ computer
with its graphical user interface. Its associated electronics and power amplifiers are
usually situated in an adjacent room and connect to the second equipment group. This
second group of equipment is housed within the machine in which the patient lies. It
contains the parts of the MR system that generate and receive the MR signal and include
a set of main magnet coils, three gradient coils, shim coils and an integral radiofrequency
(RF) transmitter coil1 (figure 1). Due to the necessary use of RF electromagnetic waves or
radio waves (see below), the room that contains this second set of equipment needs to
keep potential sources of electromagnetic noise out and its own RF in. This is achieved
by enclosing the magnet and its associated coils within a special, copper-lined
examination room, forming what the Physics community calls a Faraday shield.

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Figure 1
Schematic demonstrating the relative positions of the different magnet coils
comprising the MR machine. The patient is positioned within the bore of the
machine and is surrounded by coils that lie concentric to each other and in the
following order (from furthest to closest to the patient): main magnet coils, gradient
coils and radiofrequency (RF) coils. For neuroimaging, a further RF coil is placed
around the patient's head to improve signal to noise ratio.
Magnets
Recall the principles of the Maxwell equations that indicate that when an electric current
flows through a wire, a magnetic field is induced around the wire. Resistance to the flow
of the electric current can be reduced to negligible levels if a special metal conductor is
cooled substantially. In this situation, lower resistance allows the use of high electric
currents to produce high-strength magnetic fields, with little heat disposition. This
principle is employed in the generation of superconducting magnets: the type of magnet
typically used in clinical MR systems. The main magnet coils, made of a superconducting
metal-alloy, are cooled (close to absolute zero, ∼4°K or −269°C) using expensive
cryogenic liquid helium.2
The main magnet coils generate a strong, constant magnetic field (B0) to which the
patient is exposed. The strength of the magnetic field is measured in units of Tesla, (T).
One Tesla is equivalent to approximately 20 000 times the earth's magnetic field.
Currently, most clinical MR systems are superconducting and operate at 1.5 T or 3 T.
Field strengths reaching 9.4 T have been used in human imaging, albeit typically in
research.
Gradient coils
The MR system uses a set coordinates to define the direction of the magnetic field.
Gradient coils representing the three orthogonal directions (x, y and z) lie concentric to
each other within the main magnet (figure 1). They are not supercooled and operate
relatively close to room temperature. Each gradient coil is capable of generating a
magnetic field in the same direction as B0, but with a strength that changes with position
along the x, y or z directions, depending on which gradient coil is used. The magnetic
field generated by the gradient coils is superimposed on top of B0 so that the main
magnetic field strength varies along the direction of the applied gradient field (figure 2).

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Figure 2
Image shown depicts the generation of a gradient in B0 in the Z direction. For a
standard clinical MR system, this is accomplished using two coils in which the
current flowing through them runs in opposite directions to each other (the so-called
Maxwell pair type). The magnetic field at the centre of one coil adds to the B0 field
while the magnetic field at the centre of the other subtracts from B0, thus creating a
gradient in the B0 field.29 X and Y gradient coils (not shown) generally have a figure-
8 configuration. (These designs have started to be superseded by ‘thumb-print’
designs, which produce the desired gradients over the patient, but minimise any
interfering field interacting with the main magnet's coils and containers.)
RF coils
RF coils, so named because the frequency of electromagnetic energy generated by them
lies within the megahertz range, are mounted inside the gradient coils and lie concentric
to them and to each other. They may be thought of as the ‘antenna’ of the MRI system
and accordingly they have two main purposes: to transmit RF energy to the tissue of
interest and to receive the induced RF signal back from the tissue of interest. 2
Some RF coils perform the dual role of transmission and reception of RF energy whereas
others transmit or receive only. For neuroimaging, a separate RF receiver coil that is
tailored to maximise the signal from the brain is usually applied around the patient's head
to detect the emitted MR signals.
The RF field is also referred to as the B1 field. When switched on, the B1 field combines
with B0 to generate MR signals that are spatially localised and encoded by the gradient
magnetic fields to create an MRI.1 The output signal picked up by the receive coil is
digitised and then sent to a reconstruction computer processor to yield the image after
complex mathematical manipulation.3
Shim coils
Localisation of the MR signal requires good homogeneity within the local magnetic field.
In other words, the more uniform the magnetic field the better. However, placement of an
object (including a patient) within the main B0 field creates local susceptibility effects
and reduces homogeneity. Shimming refers to adjustments made to the magnet to
improve its homogeneity. Shimming can be passive or active. Passive shimming is
achieved during magnet installation by placing sheets or little coins of metal at certain
locations at the edge of the magnet bore (close to where the RF and gradient coils lie).
Active shimming provides additional field correction around an object of interest through
the use of shim coils, which are activated by electric currents controlled by the host
computer, under the guidance of the scanner application software and the operator.
Homogeneity of and hence variation in B0 is quoted in parts per million (ppm), that is, a
fraction, of the static magnetic field over a specified spherical volume. For a 1 T system
with a homogeneity of 1 ppm over 40 cm, no two points within 20 cm of isocenter differ
by more than 0.000001 T.4

Obtaining MR signals
Origin of the MR signal: protons and ‘little bar magnets’
The primary origin of the MR signal used to generate almost all clinical images comes
from hydrogen nuclei. Hydrogen nuclei consist of a single proton that carries a positive
electrical charge. The proton is constantly spinning and so the positive charge spins
around with it. Recall that a moving electrical charge is called a current and that an
electrical current generates a magnetic field. Thus, protons have their own magnetic
fields and behave like little bar magnets (figure 3).

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Figure 3
Protons possess a positive charge and are constantly spinning around their own
axes. This generates a magnetic field making protons similar to bar magnets. This
figure is only reproduced in colour in the online version.
The magnetic field for each proton is known as a magnetic moment. Magnetic moments
are normally randomly orientated. However, when an external magnetic field (B 0) is
applied they align either with (parallel) or against (antiparallel) the external field. The
preferred state of alignment is the one that requires the least energy: that is, parallel to B 0.
Accordingly more protons align with B0 than against it. The difference in the number of
protons aligning parallel and antiparallel to B0 is typically very small but ultimately
depends on the strength of B0 as well as the temperature of the sample. As a rough
estimate, for about 10 million protons aligning parallel to B0, there are approximately 10 
000 007 aligning antiparallel to the external magnetic field.5
Precession
When put in an external static magnetic field, the overall effect on a group of protons
(that individually are aligned either parallel or antiparallel to B0) means that the group of
spins classically move in a particular way called precession. Precession can be likened to
the movement of a spinning top. When spun, the top wobbles but does not fall over and
the axes of the top circles form a cone shape (figure 4).

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Figure 4
When exposed to an external magnetic field, protons precess. The movement of
precession can be likened to the wobbling motion seen when a spinning top is spun.
The handle of the spinning top follows a circular path. This figure is only
reproduced in colour in the online version.
The speed of precession, that is, how many times the protons precess per second, is
measured as the precession frequency (also named the Larmor frequency, ω0, in MHz)
and determined by the Larmor equation:
γ Is a constant for a particular nuclear species (eg hydrogen) termed the gyromagnetic
ratio. Its value for the proton is 42.6 MHz/T. The Larmor equation indicates that
precession frequency is proportional to the strength of the magnetic field.
Longitudinal magnetisation
Protons precessing parallel to B0 begin to cancel each other out in all directions bar one:
the direction of the z-axis, along B0 (figure 5A). The result is a sum magnetic field or sum
magnetisation, often given the symbol M, with the value M0. It is characteristically shown
as a vector. As this sum magnetisation parallels the external magnetic field it is also
referred to as longitudinal magnetisation (figure 5B).

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Figure 5
Longitudinal magnetisation. For simplicity protons are now shown as vectors. (A)
The magnetic moments of protons precessing in the external magnetic field begin to
cancel each other out. Opposing protons A and A′ and B and B′ ‘neutralise’ each
other leaving a net number of protons lying parallel to B0. Protons precessing
parallel to B0 also begin to cancel each other out. C (pointing to the left) and C′
(pointing to the right) oppose and neutralise each other. This occurs in all directions
bar one: the direction of the z-axis, along B0. The result is a sum magnetic field that
is typically depicted as a vector (B). This figure is only reproduced in colour in the
online version.
The patient essentially becomes a magnet with a magnetic vector aligned with B0. The
magnetic force of the patient (as it stands) cannot be measured as it is in the same
direction as the external field. What is required is a magnetisation that lies at an angle to
B0.
RF pulses and transverse magnetisation
With the patient in the magnet and possessing longitudinal magnetisation, RF pulses are
switched on and off. The purpose of the RF pulse is to disturb the protons so that they fall
out of alignment with B0. This disturbance occurs through the transference of energy
from the RF pulse to the protons. This can only occur when the RF pulse has the same
frequency as the precessional frequency of the protons, a phenomenon called resonance;
hence the term magnetic resonance imaging.5 Accordingly, RF pulses are set at the
Larmor frequency.
The activation of an RF pulse has two main effects on the protons. First, some protons
gain energy and move to the higher energy state of being antiparallel to B0. Consequently,
opposing ‘little bar magnets’ (those parallel and antiparallel to B0) once again cancel each
other out, resulting in a reduction in overall longitudinal magnetisation. Second, the RF
pulse causes the protons to move in phase (ie, in the same direction, at the same time)
with each other rather than in random directions. The result is transverse magnetisation in
which a new magnetisation vector is created in the x–y plane and moves in line with the
precessing protons at the Larmor frequency.
The transverse magnetisation vector is a moving magnetic field (rotating at the Larmor
frequency) and, as such, if a conductive receiver coil is placed in proximity, an
alternating voltage will be induced across it. This in turn generates an electrical current,
which can be picked up (like an antenna would pick up radio waves) forming an MR
signal. As soon as the RF pulse is switched off the protons start to fall out of phase with
each other and also return to a lower energy state, that is, the protons relax. Relaxation
occurs in two different ways. Transverse magnetisation begins to disappear, a process
called transverse (or T2 (‘Time’ 2)) relaxation and the longitudinal magnetisation starts to
return to its original value, a process termed longitudinal (or T1 (‘Time’ 1)) relaxation
(figure 6).
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Figure 6
Recovery of longitudinal magnetisation following a 90° radiofrequency (RF) pulse.
(A) Protons aligned with B0 produce a sum vector with longitudinal magnetisation.
(B) When an RF pulse is switched on longitudinal magnetisation decreases and
transverse magnetisation propagates. Alternatively, it can be said that the sum
magnetisation ‘tilts’ to the side. An RF pulse that abolishes longitudinal
magnetisation to zero while inducing transverse magnetisation is called a 90°
(saturation) pulse as the sum magnetisation vector is seen to tilt or flip 90°.
Immediately following an RF pulse, protons precess in phase in the transverse
plane, depicted by a single vector (arrow) in the lower circle. (C) After the 90° RF
pulse, protons fall out of phase (now multiple vectors in the lower circle), transverse
magnetisation decreases and longitudinal magnetisation begins to recover. During
this process, the whole system continues precessing and so the sum vector takes a
spiralling motion (D). Recovery of longitudinal magnetisation is termed T1
relaxation and loss of transverse magnetisation is called T2 relaxation. This figure is
only reproduced in colour in the online version.
T1 relaxation and T1 values
T1 relaxation is the process whereby protons exchange energy with their surroundings to
return to their lower energy state and in doing cause the restoration of longitudinal
magnetisation. The rate at which this occurs is dependent on the tumbling rate of the
molecule in which the proton resides. Tumbling rate describes the rate of molecular
motion. As molecules tumble they generate a fluctuating magnetic field to which protons
in neighbouring molecules are subjected. Energy exchange (and therefore T1 relaxation)
is more favourable when this fluctuating magnetic field is close to the Larmor frequency.
Different molecules have different tumbling rates and as a result they also differ in their
efficiency at T1 relaxation. Free water (unbound/unrestricted) has a small molecular size
and tumbles much too quickly to be effective at T1 relaxation. Similarly, hydrogen
protons bound to large macromolecules (eg, membrane lipids) tumble very slowly and
also demonstrate low efficiency at T1 relaxation. Accordingly, both free water (4000 
msec) and bound hydrogen have relatively long T1 relaxation times. Conversely, when
water is partially bound (to proteins for example) its tumbling rate can be slowed to a rate
more in line with the Larmor frequency. As a result, the T1 value of bound or structured
water is much less than free water (∼400–800 msec).4 ,6 Fat typically has a short T1
value. This is because the carbon bonds at the ends of the fatty acids have frequencies
near the Larmor frequency, allowing effective energy transfer.5
As T1 relaxation requires an exchange of energy between protons and their surroundings
it is also termed spin–lattice relaxation. The term lattice is a throwback to early nuclear
MR studies in solids, in which the external environment was literally a crystalline lattice
of molecules.4
As not all protons return to their original energy state at the same time, T1 relaxation is
more of a continuous process. Plotting the recovery of longitudinal magnetisation over
time (after the RF pulse is switched off) produces an exponential curve, called the T1
curve. It is difficult to exactly pinpoint the end of longitudinal relaxation and so T1 (and
similarly for T2) is not defined as the time of completion of longitudinal relaxation.
Rather, T1 is a time constant that is used to describe how fast the process of T1 relaxation
takes. Specifically, T1 is the time taken for longitudinal magnetisation to regrow from 0
to (1−e−1), or approximately 63% of its final value. 1/T1 defines the longitudinal
relaxation rate7 (figure 7a).
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Figure 7
T1, T2 and T2* relaxation. (A) T1 curve: Plotting the recovery of longitudinal
magnetisation over time following the switching off of a radiofrequency (RF) pulse
results in a T1 curve. (B) T2 curve: An 180° refocusing pulse acts to ‘combat’ the
effects of external magnetic field inhomogeneity by rephasing the protons. This
results in a temporary gain in signal intensity at time echo time (TE) termed spin
echo. A sequence of 180° pulses results in a chain of spin echoes. Each subsequent
echo will be of lower intensity due to T2 effects. A curve connecting the spin echo
intensities is the T2 curve. (C) T2* curve: This curve results when 180° refocusing
pulses are not used. The signal decays much faster due to T2* effects. TR, repetition
time. This figure is only reproduced in colour in the online version.
T2 and T2* relaxation
Transverse relaxation describes the process whereby protons fall out of phase in the x–y
plane and transverse magnetisation decreases and disappears. There are two causes for
this loss of phase coherence. The first, T2 relaxation results from slowly fluctuating
magnetic field variations (inhomogeneity) within the local tissue. That is, the magnetic
spin of protons is influenced by small magnetic fields from neighbouring nuclei. This
results in the random fluctuation of the Larmor frequency of individual protons causing
an exchange of energy between proton spins, which leads to loss of phase coherence
across a population of protons.8 The internal inhomogeneity of spins (protons)
influencing other neighbouring spins have lead to the term spin–spin relaxation also
being used for T2 relaxation.
The second cause of loss of phase coherence is due to inhomogeneity within B 0.
Magnetic field variations result in slightly different Larmor frequencies for protons at
different locations within the field. Unlike the random process of T2 relaxation, this de-
phasing is caused by a constant and is potentially reversible. T2* (T2 star) relaxation is
the name given to describe the effects that result from the combination of T2 relaxation
and the de-phasing that results from inhomogeneity in B0. T2* relaxation determines the
actual rate of decay observed when measuring a free induction decay (FID) signal (see
later for details).
T2 is a constant describing the time taken for transverse magnetisation to decay to e −1, or
about 37% of its initial value. Spin–spin interaction governs the speed of T2 relaxation
and hence influences the T2 values for different tissues. Free water (eg, cerebrospinal
fluid), comprising rapidly moving small molecules that are relatively far apart, will have
less spin–spin interaction and therefore longer T2 values compared with water-based
tissues that have a large macromolecular content (eg, grey matter), giving them more
time to interact or ‘chat’ with each other.
In contrast to T1 relaxation, where energy transfer from the spin system must occur, T2
relaxation may proceed with or without overall energy loss. For human tissue transverse
relaxation is typically a much faster process than longitudinal relaxation; hence, T2
values are always less than or equal to T1. For biological tissues, T1 is approximately 5–
10 times longer than T2 (300–2000 msec vs 30–150 msec, respectively).4
Free induction decay
When an RF pulse is switched off, T1 and T2 relaxation occur simultaneously and
independently. The protons continue to precess and the sum magnetisation vector follows
a spiralling path whereby its direction and magnitude are constantly changing. Hence, an
electrical signal is generated in a suitable receiver coil. The MR signal generated from the
spiralling sum magnetisation vector is termed FID. It has its greatest magnitude
immediately after the RF pulse is switched off and then decreases as both relaxation
processes occur. It also has a constant frequency (resonant frequency) and consequently
the FID signal takes the form of a sine wave with a rapidly decaying envelope (figure 8).
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Figure 8
Free induction decay. Transverse magnetisation (with all protons rotating in phase)
is at its greatest following an initial 90° excitatory radiofrequency (RF) pulse. Its
amplitude (along with signal intensity) then decreases as the protons begin to lose
phase coherence. The resultant decay signal is termed free induction decay. This
figure is only reproduced in colour in the online version.
An FID is most commonly depicted with a 90° pulse but a RF pulse of any flip angle can
create an FID because some components of the longitudinal magnetisation are always
tipped into the transverse plane. Theoretically, a 180° RF pulse should refrain from
generating an FID. However, in practice, all 180° pulses are imperfect and produce FID
signals.4
FID is subjected to further disruption (de-phasing) by the magnetic field gradients that
are used to localise and encode the MR signal. Consequently the signal generated by FID
is not usually measured in MRI. Instead, it is common practice to generate and measure
the MR signal in the form of an echo: typically a spin echo (SE) or a gradient echo
(GRE). Echoes can be appreciated by considering how T1- and T2-weighted images are
formed.
T1-weighted images
Contrast between tissues allows adjacent structures to be differentiated from one another.
Contrast is determined by signal intensities, which in turn are governed (at least partly)
by the T1 and T2 relaxation times of tissues within an image. An image in which the
difference in signal intensity between tissues is predominantly due to differences in tissue
T1 relaxation time is called a T1-weighted image. T1-weighted images are generated
predominantly by manipulating the time between two RF excitation pulses, the so-called
repetition time (TR) (figure 9).

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Figure 9
Repetition time (TR) and T1-weighting. Consider the following example in which
two tissues, fat and fluid are being imaged where fat has shorter transverse and
longitudinal relaxation times than fluid. An initial 90° radiofrequency (RF) pulse is
switched on and off, time passes (TR), a second 90° RF pulse is switched on and off,
MR signal is then sampled and an image is generated. As MR signal sampling
occurs after the switching off of the second RF pulse, the signal intensity will be
determined by the amount of transverse magnetisation at that point. This in turn
will be governed by the value of longitudinal magnetisation of the two tissues
immediately before the second 90° RF pulse is switched on. Choosing a long TR (eg,
1500 msec) would allow the tissues to recover their longitudinal magnetisation fully
with no appreciable difference in the value of longitudinal magnetisation existing
between the tissues. In this situation, the application of a second RF pulse with
subsequent MR signal sampling would result in no discernible difference in MR
signal between the tissues as the transverse magnetisation values for the tissues are
essentially equal (A) (ie, no signal contrast). Choosing a short TR (20 msec) means
that at the time of applying a second 90° RF pulse tissues with a long T1 (fluid) will
show less recovery in longitudinal magnetisation than tissues with a short T1 (fat).
The tissues will possess different transverse magnetisation values (B) and, thus, will
generate different signal intensities and allow greater contrast between tissues (C).
This figure is only reproduced in colour in the online version.
The preceding example was simplified for ease of understanding. It should be appreciated
that many parameters influence signal intensity and hence tissue contrast but in the
example used T1 had the greatest influence. Contrast in images obtained at long TR will
not be influenced by T1 but instead may be influenced by differences in the T2 or proton
density of the tissues in question. Factors that influence MR signal intensity are listed in
the box.
Box 1 

Factors that influence MR signal intensity

● Proton density

● T1
● T2
● Flow (eg, blood flow)
● Pulse sequence
● Repetition time
● Echo time
● Inversion time
● Magnetic susceptibility (including contrast media)
T2-weighted images
Recall that protons lose phase coherence following an RF pulse as a result of spin–spin
interactions within the tissues (T2 relaxation) and because of inhomogeneity within the
local static magnetic field (T2* relaxation). De-phasing caused by T2 relaxation is a
random, irreversible process whereas the de-phasing caused by magnetic field
inhomogeneity is potentially reversible.1 Application of an 180° RF pulse following an
initial 90° RF pulse rotates the protons through 180°, effectively making the protons ‘turn
around’ and precess, still in the x–y plane, but in the opposite direction. Local field
inhomogeneity remains and protons with a slightly faster Larmor frequency begin to
catch up with slower protons. Eventually the protons come back into phase, which results
in an increase in the amplitude of the MR signal. Maximum signal amplitude is reached
at the echo time (TE). To achieve maximal signal, the 180° RF pulse must be applied at
time TE/2. As the protons (spins) bounce back or echo following the application of the
180° RF refocusing pulse, the signal obtained is given the name SE (figure 10).
Continued inhomogeneity in the static magnetic field means that protons will continue to
lose phase coherence following an 180° RF refocusing pulse; however, it is possible to
repeat the 180° RF refocusing pulse and obtain further SEs. Over time, the amplitude
from each SE will decrease due to T2 effects. A curve connecting the SE intensities is
called the T2 curve. T2* curve is the curve that results if 180° RF refocusing pulses are
not used, that is, a curve that depicts the de-phasing caused by T2* effects (figure 7b and
c).

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Figure 10
Spin echo. Following a 90° excitatory radiofrequency (RF) pulse with consequent
transverse magnetisation, protons begin to de-phase (A–C) and signal amplitude
decreases. Application of an 180° RF pulse at time TE/2 causes the protons to
precess in the opposite direction. Protons that were initially ‘in front’ now find
themselves at the back but begin to ‘catch’ the other protons, which are precessing
at a slighter slower frequency (D–F). At time TE the protons regain phase, resulting
in a stronger net transversal magnetisation and thus a stronger signal. This signal
re-emergence is termed spin echo. This figure is only reproduced in colour in the
online version.
Tissues have different T2 values. Brain for example has a shorter T2 than cerebrospinal
fluid. TE is the time interval between the 90° RF pulse and the SE. It is one of the
parameters whose value can be chosen by the operator of the MR machine in order to
influence the signal intensities (hence contrast) between tissues. A much stronger signal
is received when short TE (as opposed to long TE) is employed. However, at short TE
(eg, <30 msec), differences in T2 have little influence on tissue contrast. Accordingly,
T2-weighted images of the brain are obtained at long TE (eg, 80 msec) (figure 11).

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Figure 11
Echo time (TE) and T2-weighting. T2 curves for two different tissues are shown.
Tissue B has a shorter T2 relaxation time than tissue A. The difference in signal
intensity between the tissues is more discernible at long TE than at short TE. RF,
radiofrequency. This figure is only reproduced in colour in the online version.
A heavily T2-weighted image could be obtained at longer TE but loss of MR signal
would impact on the signal to noise ratio making images potentially subdiagnostic.
Factors influencing SE contrast and weighting
Imaging parameters influencing the MR signal in the SE sequence include TE and TR.
Values for both of these parameters are purposely chosen by the operator in order to
influence the tissue weighting of the image. Short TR and short TE generates a T1-
weighted image; short TR allows differences in longitudinal magnetisation to develop
before the next 90° excitation pulse while short TE limits the T2 effects. Long TR and
long TE produces a predominantly T2-weighted image; long TR allows recovery of
longitudinal magnetisation (thus limiting T1 effects) while at long TE T2 effects become
pronounced. A different type of image is produced at long TR and short TE. Long TR
and short TE limit T1 and T2 effects, respectively. When this occurs, the signal is
predominantly influenced by the proton density of the tissues (figure 12A–C).

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Figure 12
Examples of typical clinical MRI. (A). Sagittal T1-weighted image. Note that fat
(around scalp and neck) is bright and cerebrospinal fluid (CSF) is dark. (B) Axial
proton density image. Note minimal contrast between grey matter and CSF. (C)
Axial T2-weighted image. Note that CSF is bright. (D) Same image as (A) but
following gadolinium administration. Note the dural venous sinuses appear bright
due to T1 shortening. (E) Axial fluid attenuated inversion recovery image. Note
suppression of the CSF signal. (F) Axial gradient echo T2* image. Same patient as in
(C). Note the increase conspicuity of multiple dark foci due to magnetic
susceptibility of haemosiderin deposition in a patient with amyloid angiopathy.
It should be appreciated that the choice of imaging parameters for all MRI sequences can
influence the sensitivity of the test for the pathology in question. For example, the
sensitivity for the detection of lesions in multiple sclerosis is dependent on TE (lesion
visibility decreases with increasing TE).9
Gradient echo
SE sequences with their relatively long TR and TE are time consuming. This limits the
number of patients who can be scanned in a session and also risks movement artefact by a
restless patient. Conversely, GRE sequences, which replace the 180° refocusing RF pulse
with magnetic field gradients, are relatively short. However, they do produce different
contrasts. Magnetic field gradients produce a change in field strength and thus a change
in Larmor frequency along a particular direction. Application of a gradient pulse after an
initial RF pulse causes protons to rapidly de-phase along the direction of the gradient
resulting in rapid decline in the FID signal. This loss of phase coherence can be reversed
by applying a second magnetic field gradient with a slope of equal amplitude but in
opposite direction to the first. As a result, protons move back into phase and return a
signal called GRE. TE is the time taken between the beginning of FID (ie, generation of
transverse magnetisation) following the initial RF pulse to the point at which the GRE
reaches its maximum amplitude (figure 13).
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Figure 13
Gradient echo. An excitatory radiofrequency (RF) pulse causes transverse
magnetisation and initiation of a free induction decay signal. This signal rapidly de-
phases following the application of a magnetic field gradient. Application of a
second magnetic field gradient with a slope of equal amplitude but in opposite
direction to the first causes some rephasing. The signal increases again at time TE to
a maximal signal termed a gradient echo. The maximum amplitude of the gradient
echo is dependent on the specified TE and the T2* relaxation rate of the tissues in
question. This figure is only reproduced in colour in the online version.
Differences between SE and GRE
Several differences exist between the two techniques. First, TE can be shorter with GRE
as only one RF pulse is used. Second, GRE sequences are typically used with low flip
angle excitations (eg, 5°–40°) as opposed to the 90° flip angle used in SE. As a
consequence, longitudinal magnetisation is not completely abolished with GRE and will
provide reasonable signal even at very short TR. This combination of short TE and short
TR permits rapid signal acquisition with GRE imaging. The price of short acquisition
time in GRE, however, is greater signal loss in the presence of magnetic susceptibility
effects. Gradient reversal refocuses only those spins that have been de-phased by the
action of the gradient itself and unlike SE, where phase shifts resulting from local
magnetic field inhomogeneity are minimised through the 180° RF pulse, this
inhomogeneity persists in GRE. Hence, image contrast in GRE is influenced by T2*
effects and is not confined to true T2 relaxation.10
In GRE imaging, T1- and T2*-weighted images can be obtained by manipulating the flip
angle, TE and TR. This is discussed further in the section on magnetic susceptibility.

Image construction
Localising and encoding MR signals
The MR signal is localised in three dimensions using three separate magnetic field
gradients termed (1) slice-selection gradient, (2) phase-encoding gradient (GP) and (3)
frequency-encoding gradient (GF).
Slice-selection gradient
Slice localisation is achieved by using gradient coils to generate a gradient field
orientated along a chosen axis. This gradient field alters the strength of B 0 in the chosen
direction, so that protons within the gradient field have different Larmor frequencies
(figure 14A).
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Figure 14
Image construction. (A) Step 1: Slice selection. A slice-selecting gradient (GS) is
applied at the same time as the excitatory radiofrequency (RF) pulse. In this
example, the brain is being imaged and GS is applied along the z-axis, parallel with
B0. This means that different cross sections of the brain experience magnetic fields
of differing strength. Accordingly protons will precess at different Larmor
frequencies depending on their position along the gradient. Selecting an RF pulse
(or range of RF pulse frequencies) that matches the Larmor frequency of the
protons will determine the slice location. (B) Step 2: Phase encoding. Protons are in
phase after the RF pulse is applied. Applying a phase-encoding gradient along the y-
axis causes the protons to increase their speed of precession relative to the strength
of the magnetic field to which they are exposed. In this example, speed increases
from top to bottom. This is depicted on the right of the schematic, which shows rows
of protons with different precession speeds. When the gradient is switched off, all
protons are once again exposed to the same magnetic field and as such they have the
same frequency; only now, they are out of phase. (It may help to think of the
protons giving of the same signal frequency but at different times.) (C) Step 3:
Frequency encoding. A further magnetic field frequency-encoding gradient is
applied to help differentiate the signal from different protons by way of differing
frequencies. In this example, the protons from the bottom row in step 2 (above) have
been exposed to a gradient applied along the x-axis. While the protons are in phase,
they now have different frequencies, allowing their differentiation in the third (x)
plane. During the frequency-encoding step, the signal is measured (digitally
sampled) at time TE, the point of maximal signal. The signal comprises a range of
frequencies (or bandwidth) that correspond to the Larmor frequencies of the proton
magnetic moments at their different locations along the gradient.1 In this example,
the orientation of the three gradients defined a slice perpendicular to the z-axis.
Different slice orientations can be achieved by allocating the gradients to a different
axis. Combining gradients along two or more axes for each localisation task allows
angled slices to be obtained. This figure is only reproduced in colour in the online
version.
Typically, the RF pulse is applied as a small range of frequencies (bandwidth) rather than
as a single frequency. This excites a slice of a certain thickness. Slice thickness can be
altered in two ways: (1) by changing the bandwidth of the RF pulse or (2) by changing
the steepness of the gradient field.
With a given slice selectively excited, the signals arising from each slice element (pixel)
within that section need to be spatially encoded. This is achieved using phase- and
frequency-encoding gradients.
Phase-encoding gradient
Following an excitatory RF pulse, the protons precess in phase. Applying a new gradient
magnetic field will make some of the protons precess faster than others depending on
their position within the gradient. When the gradient is switched off, all protons will
express the same precession frequency and will emit the same signal but they will no
longer be in phase and this allows the protons to be differentiated. The gradient applied is
called the GP and the direction of application is termed the phase-encoding direction.
Thus, spin phases will vary linearly over the phase-encode direction (figure 14B).
Frequency-encoding gradient
The GF is applied following and perpendicular to the phase-encoding gradient. It causes
the protons to rotate at different frequencies according to their relative position along the
gradient, permitting differentiation of the signal in a third plane (figure 14C).
Two additional gradient pulses are typically used in this three-step process, one
immediately after the slice-selection gradient and the other immediately before the G F.
These pulses are used to counteract any de-phasing of the transverse magnetisation that
may be caused by the imaging gradients and ensures that maximum echo (sampling
signal) is achieved.
It should be emphasised that RF pulses excite all protons in a slice simultaneously and
that a single echo signal is recorded from the entire slice for one phase-encoding step.
Thus, to acquire sufficient phase-encoding information for a signal to be assigned to each
location within the slice, the pulse sequence (comprising slice selection, frequency
encoding and phase encoding) is repeated many times. During each repetition, the same
slice selection and frequency encoding are performed but the strength of the phase-
encoding gradient is increased by equal increments. Each repetition of the phase-
encoding step generates a signal echo that is digitised and stored in a raw data matrix
called ‘k-space’. Data points in k-space represent the spatial frequencies content of an
MRI. Data in k-space are converted into an image using a mathematical tool called a
Fourier transform.

Image acquisition time

As each phase-encoding step requires a new pulse sequence the total image acquisition
time will depend on the product of TR (time interval between pulse sequences) and
NP (number of phase-encoding steps). Conventional pulse sequences such as SE and GRE
acquire only one phase-encoding step (one line of k-space) per TR, making the image
acquisition time considerably long. This limitation is overcome by faster imaging
techniques that acquire multiple lines of k-space per TR. The so-called Turbo (or fast) SE
and GRE techniques are now commonplace in MRI.
Turbo SE
The turbo SE (TSE) sequence applies multiple 180° pulses after an initial 90° pulse (as
opposed to the single 180° pulse used in a conventional SE sequence). Each 180° pulse
generates an echo, which (after phase encoding) is used to fill a new line of k-space. The
number of 180° refocusing pulses (and, thus, the number of echoes generated) during one
TR of the TSE sequence is termed the echo train length (ETL), echo factor or turbo
factor. ETL specifies the factor by which the pulse sequence is accelerated (eg, an ETL of
16 means that the TSE sequence is 16 times faster than a conventional SE sequence).
The signal amplitude of each successive echo generated by the TSE sequence will be
smaller than the last by way of T2 decay effects. The echoes will also have different TEs.
This means that in the traditional sense, a single TE does not exist for the TSE sequence.
Instead, an effective TE or pseudo TE is ascribed. The effective TE is defined as that of
the echo, which is acquired closest to the centre of k-space (with the smallest G P) as this
is the echo that has the greatest influence on image contrast. 1
Echo-planar imaging
Echo-planar imaging (EPI) is a fast MRI technique in which the rapid oscillation of high-
amplitude gradients is used to generate multiple GREs per TR. In single-shot EPI all of
the phase-encoding steps are acquired in a single TR. Multi-shot EPI uses a few TRs to
acquire all phase-encoding steps.
3D encoding
Although the selection of a set of slices encodes data in all three dimensions in space, the
slice thickness (often several millimetres) is often much greater than the inplane pixel
resolution (often <1 mm). The initial slice-encoding step can be replaced by a further
(termed secondary) phase-encoding iteration, along what was the slice-encoding
direction. Instead of a set of slices (that may include slice gaps!), the inclusion of
secondary phase encoding often produces a true 3D dataset comprised of voxels (3D
pixels) whose dimensions can be <1 mm×1 mm×1 mm. This is often useful when user
manipulation of data in all three perpendicular or oblique planes is necessary (eg, for
intraoperative surgical guidance). Performing more phase-encoding steps has a cost: time.
As a result, the majority of true 3D sequences tend to be GREs with short TR or TSEs
with high ETL factors.11

Magnetic susceptibility
Magnetic susceptibility describes the extent to which a substance becomes magnetised
when placed in an external magnetic field. It results primarily from the interaction
between electrons within the substance and the external magnetic field. More
specifically, orbital and delocalised electrons within the substance produce circulating
currents in response to the field. These currents generate internal magnetisation (M i)
within the substance that either augments or opposes the local external magnetic
field.4 The result is either positive susceptibility, whereby the magnetic field local to the
substance is increased, or negative susceptibility in which the magnetic field local to the
substance is decreased. Substances with negative susceptibility are termed diamagnetic;
those with positive susceptibility are called paramagnetic.
Most biological tissues including water cause very weak diamagnetism and as such
induce negligible susceptibility effects. Conversely, matter such as iron, nickel and cobalt
show extreme positive susceptibility and are termed ferromagnetic. Superparamagnetic is
used to describe a substance with positive magnetic susceptibility that lies between
paramagnetism and ferromagnetism (eg, small ferrous sulphate particles).
Intravenous contrast
Gadolinium, a rare-earth metal and paramagnetic substance, is used as an intravenous
MR contrast medium. Its strong paramagnetic properties result from the numerous
unpaired electrons that exist within its inner shells. These unpaired electrons can interact
with adjacent resonating protons and cause the protons to relax more rapidly. This results
in a shortening of both longitudinal and transverse relaxation with consequent reduction
in the T1 and T2 values of the tissues in which it accumulates. This is depicted by an
increase in signal in T1-weighted images and a decrease in signal in T2-weighted images.
In practice, the signal increase detected on T1-weighted imaging is better appreciated
than any corresponding signal decrease in T2-weighted imaging and makes T1-weighted
imaging the method of choice for intravenous contrast studies. Furthermore, as
gadolinium-based contrast agents shorten T1, it is possible to also shorten TR and, hence,
reduce overall scan time (figure 12D).
Exploiting magnetic susceptibility using GRE imaging
Susceptibility differences among tissues and materials are more conspicuous on T2*-
weighted GRE rather than SE imaging (recall that susceptibility differences promote
magnetic field inhomogeneity that result in faster T2* relaxation, leading to signal
intensity loss on GRE images; conversely, the 180° refocusing pulse in SE compensates
for this). GRE sequences can be made more sensitive to T2* decay through the
manipulation of imaging parameters such as TR, TE and the flip angle. As T2* decay
commences with the excitation pulse and progresses with time, a longer TE will result in
greater signal loss. A low flip angle reduces the influence T1 has on the subject matter (as
longitudinal magnetisation remains close to the fully relaxed state) and allows the T2*
effects to dominate. Similarly, T1 effects are limited with a long TR. Hence, T2* GRE
imaging is obtained at long TE, long TR and low flip angle. T2* sensitivity also increases
with field strength and voxel size.12 T2*-weighted sequences are particularly useful in the
detection of haemorrhage and blood products (deoxyhaemoglobin, methaemoglobin and
haemosiderin are paramagnetic). Various pathologies may be detected using this imaging
modality including arteriovenous malformations, cavernomas, superficial siderosis,
intraparenchymal/intratumoural haemorrhage and amyloid angiopathy (figure 12F). The
literature also supports the use of T2*-weighted imaging for the differentiation of
vestibular schwannomas from meningiomas as in most schwannomas,
microhaemorrhages can be detected.13

Other factors that may influence signal intensity

TI: the inversion recovery sequence
The inversion recovery sequence uses a 180° pulse followed by a 90° pulse. The 180°
pulse inverts longitudinal magnetisation so that the sum magnetisation aligns antiparallel
to B0. Following the 180° pulse, the inverted longitudinal magnetisation begins to shorten
and return to its original position. Application of a 90° pulse causes the longitudinal
magnetisation to flip to the transverse plane and allows a signal to be recorded. The
strength of the signal is dependent on the magnitude of longitudinal magnetisation just
before the 90° pulse was applied. Hence, the signal obtained by inversion recovery is
dependent on the T1 properties of the tissues being examined. Inversion time (TI) is the
time interval between the 180° and the 90° pulses (figure 15A).
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Figure 15
Inversion recovery. (A) Inversion of the sum longitudinal magnetisation vector
following an 180° radiofrequency (RF) pulse. A further 90° RF pulse flips the
recovering sum vector into the transverse plane allowing a signal to be obtained.
The magnitude of the signal is dependent on the amount of T1 recovery that had
occurred before the 90° pulse and, hence, on the inversion time (time between the
180° and 90° pulses). (B) T1 relaxation curves for fat and water demonstrating the
recovery of longitudinal magnetisation following an 180° RF pulse. Application of a
90° RF pulse at the null point leads to signal suppression of a chosen tissue. This
figure is only reproduced in colour in the online version.
Following the 180° pulse there will be a time when longitudinal magnetisation passes
through the transverse plane. Application of a 90° pulse at this point will result in a signal
void (the protons will be flipped out of the orientation at which their signal can be
recorded). Accordingly, this point is termed the null point. Knowledge of the null point
for a particular tissue can be used to suppress the signal from that tissue (figure 15B).
Fluid attenuated inversion recovery (FLAIR) sequences are frequently used in
neuroimaging to suppress the signal from cerebrospinal fluid (figure 12D). This has the
particular advantage of making periventricular lesions much more conspicuous. As a
further bonus, the combination of long TE and a TI can provide both T2-weighted
contrast (aiding the delineation of, for example, ischaemia or inflammation) and T1-
weighted contrast (showing gadolinium-chelate deposition where there is a leaky blood–
brain barrier). Gadolinium enhanced FLAIR sequences are being used with increasing
frequency in neuroscience centres. They can be particularly useful in the detection of
subtle tumours or for assessing multiple sclerosis. Short TI inversion recovery is used
commonly throughout radiology subspecialties to suppress fat signal. Other fat-
suppression techniques are available.14
Flow
When imaging a slice through a vessel containing flowing blood, the blood within the
slice at the time of an excitatory RF pulse will be influenced by the radiowave. However,
by the time the MR signal is sampled, the blood influenced by the radiowave will have
been replaced by blood flowing into the slice that has not undergone magnetisation. Thus,
no signal will be obtained from the vessel and it will appear black on the image: the so-
called flow-void phenomenon.
This is not the only way in which flow influences signal intensity and merely constitutes
an introduction as in reality the subject is far more complex. For example, a signal may
still be obtained from vessels that contain slow flowing blood and this to the
inexperienced looking at a single sequence of images may be interpreted as thrombosis.
Detailed articles describing MRI in relation to flow and articles relating to MRI artefacts
can be found in the literature.15 ,16

Finally, a word on safety

Safety issues regarding clinical MRI can be broadly divided into those that result from
the exposure to magnetic fields and those resulting from intravenous contrast
administration.
Exposure to magnetic fields
Each of the three types of magnetic field (static, gradient and RF) that the patient is
exposed to during an examination carries a potential risk to patient safety. With regard to
the static magnetic field (B0), the main safety issue involves the attraction of
ferromagnetic material towards the magnet. Material external to the patient (such as keys
or coins) may become projectiles within the scanning room, putting the patient and staff
(and machinery) at risk of being hit. Static magnetic fields can also exert mechanical
forces on ferromagnetic components within implanted medical devices such as
pacemakers, aneurysmal clips and cardiac defibrillators. Devices may rotate or dislodge,
potentially resulting in serious patient harm.17 Higher static magnetic fields lead to greater
forces on ferromagnetic materials.18 Control of access to the magnet room is crucial in
minimising associated risks.
Excessive noise and potential auditory damage are the main concerns with gradient
fields. Rapid alterations of currents within the gradient coils, in the presence of a strong
magnetic field, generate significant force. This force acts upon the gradient coils and
manifests as loud tapping or knocking sounds.19 Temporary hearing loss has been
reported using conventional sequences.20 Due to the risk of damage caused by acoustic
noise it is common practice for the patient to wear protective ear wear (often headphones
and earplugs). Gradient magnetic fields also have the potential to induce voltages on
pacing wires that may cause oversensing and undersensing. Excitation of peripheral
nerves has also been reported.21
RF pulses may lead to local tissue heating through the dissipation of energy. Typically
this is negligible (<1°C) in clinical imaging but is potentially serious in patients with
implantable devices. A pacemaker lead, for example, may act as an antenna and
concentrate RF energy, resulting in dramatic local heating, tissue damage and cardiac
dysfunction.22
A devise must have undergone prior testing within MR electromagnetic fields for it to be
deemed safe. Booklets listing MR compatible objects/devises are available and are
typically held in the MR scanner room. More and more MR compatible medical devices
and equipment are being generated. Most tertiary centres now have MR-safe anaesthetic
equipment and recent studies have reported favourably on the early outcome of MR
compatible pacemakers.17
Intravenous contrast agents
Gadolinium-based contrast agents are generally well tolerated. A recent study suggests an
adverse reaction rate of 0.46%.23 A rare but serious complication that may occur in
patients with severe renal impairment is nephrogenic systemic fibrosis. 24 Although a
systemic condition, cutaneous manifestations tend to dominate with a lower-limb
cellulitic-like picture occurring early. Painful and pruritic, plaque-like ‘woody’ induration
of the skin occurs later in the course of the disease with the legs more commonly affected
than the arms and torso. The face is spared.25 These cutaneous manifestations may lead to
contractures and limit mobility. nephrogenic systemic fibrosis may also affect the liver,
lungs, muscles, heart and nerves.26 Death rate may be as high as 28%.27 Despite ongoing
research the exact mechanisms underlying the condition remain unclear. No universally
effective treatment has been identified and prevention (mainly through limiting the use of
high-dose gadolinium-based contrast agents and/or maximising renal function in patients
with renal failure) represents current recommendations.25
Anaphylaxis resulting from gadolinium-based contrast agents is rare, with an estimated
incidence of 0.02%.23 ,28 ,29 This compares favourably to the incidence with iodinated
contrast media used with CT (0.03%–0.16%).29 Patients with a pre-existing allergy to
other contrast agents (such as iodine) may confer a greater risk of anaphylaxis to
gadolium-based contrast agents, thus highlighting the need for a thorough screening
questionnaire prior to any contrast administration.23 ,25
Pregnancy and breast feeding
Large doses of gadolinium-based contrast agents have been shown to cause
postimplantation fetal loss, retarded development, increased locomotive activity and
skeletal and visceral abnormalities in animal experiments.19 Any deleterious effects to
humans are unconfirmed. However, gadolinium-based contrast agents can cross the
placenta and appear in the fetal bladder from where they are excreted but enter the fetal
system again through the swallowing of amniotic fluid. This makes it difficult to
ascertain exact fetal half-life measurements for these agents. 30 Currently, it is
recommended that gadolinium-based contrast should only be administered after careful
risk–benefit assessment.25
The amount of contrast absorbed by an infant's gastrointestinal tract following breast
feeding is believed to be negligible (<1% of the recommended intravenous infant dose)
and as such no additional precautions are thought necessary for breastfeeding
mothers.31 Some centres advise informed consent, however, with an option to stop breast
feeding (with continued expression and discarding of the milk) for 24 h following
maternal administration.31

Summary
This article has outlined the fundamental physical principles involved in clinical MRI.
Key imaging parameters and sequences have been described, including their influence on
image contrast and acquisition time. Important safety issues have also been addressed.
Main messages
● More frequently hospital clinicians are reviewing images from MR studies of their
patients before seeking formal radiological opinion.
● Knowledge of the basic physical principles behind MRI is essential for correct
image interpretation.
● The use of MRI as an investigative tool will only increase in clinical medicine.
 

Current research questions

● Can advanced MR imaging techniques fulfill their potential as specific and
sensitive biomarkers of disease?
● Will new image reconstruction algorithms (that move on from the simple Fourier
transform) generate improved, artifact-free images that can be applied in clinical
radiology?
 
Key references
● Elster A. Questions and answers in magnetic resonance imaging. St Louis:
Mosby-Year Book, 1994.
● Chavhan GB, Babyn PS, Thomas B, et al. Principles, techniques, and applications
of T2*-based MR imaging and its special
applications. Radiographics 2009;29:1433–49.
● Bley TA, Wieben O, Francois CJ, et al. Fat and water magnetic resonance
imaging. J Magn Reson Imaging 2010;31:4–18.
● Ivancevic MK, Geerts L, Weadock WJ, et al. Technical principles of MR
angiography methods. Magn Reson Imaging Clin N Am 2009;17:1–11.
● Coskun O. Magnetic resonance imaging and safety aspects. Toxicol Ind
Health 2011;27:307–13.

Multiple choice questions (True (T)/False (F); Answers after the

references)
●

A. The room housing the MR machine is typically lined with copper?

B. Clinical MR systems typically use superconducting magnets?
C. The main magnetic coils generate a strong constant magnetic field referred to as
B1?
D. Gradient coils are cooled, close to absolute zero, using cryogenic liquid helium?
E. Shim coils are used to reduce inhomogeneity?
●

A. When placed in an external magnetic field protons move in a particular way called
precession?
B. The speed of precession is determined by the Larmor equation?
C. The Larmor equation indicates that precession frequency is proportional to
magnetic field strength?
D. Longitudinal magnetisation refers to a sum magnetisation that parallels the
external magnetic field?
E. Longitudinal magnetisation can be directly measured to create an MR signal?
●
A. Activation of a 90° radiofrequency pulse flips the sum magnetisation vector to the
right creating transverse magnetisation?
B. T1 relaxation is the process whereby protons exchange energy with their
surroundings to return to their lower energy state and in so doing cause the restoration of
transverse magnetisation?
C. T2 relaxation results from inhomogeneity within the local tissue?
D. T2* relaxation determines the actual rate of decay observed when measuring a free
induction decay signal?
E. T2 is a constant describing the time taken for transverse magnetisation to decay to
about 63% of its initial value?
●

A. Short TR and short TE generate a predominantly T1-weighted image?

B. Long TR and long TE produce a predominantly T2-weighted image?
C. Short TR and long TE are used to generate a proton density image?
D. Spin echo sequences generally have greater magnetic susceptibility effects than
gradient echo sequences?
E. Gradient echo sequences use a 90° saturation pulse followed by a 180° refocusing
pulse?
●

A. Substances with negative magnetic susceptibility are termed paramagnetic?

B. Iron is termed ferromagnetic because of its extreme negative magnetic
susceptibility?
C. The signal obtained by inversion recovery is dependent on the T1 properties of the
tissues being examined?
D. Excessive noise and potential auditory damage are the main concerns with
radiofrequency coils?
E. Gadolinium-based contrast agents have an adverse reaction rate of about 0.5%?

Answers
●

A. T
B. T
C. F - B0
D. F - main magnet
E. T
●

A. T
B. T
C. T
D. T
E. F - need transverse magnetisation
●

A. T
B. F - longitudinal magnetisation
C. T
D. T
E. F - 37%
●

A. T
B. T
C. F - long TR, short TE
D. F - fewer
E. F - this is SE
●

A. F - diamagnetic
B. F - because of its extreme positive magnetic susceptibility
C. T - but also provides T2 contrast because of long TE
D. F - gradient coils
E. T
Linkes

http://drcmr.dk/Docs/MRI_English_a4.pdf

https://pmj.bmj.com/content/postgradmedj/89/1050/209.full.pdf

https://pmj.bmj.com/content/89/1050/209#