Oral Radiology
ALTERNATIVE AND
SPECIALIZED IMAGING
MODALITIES (Part 4)
OMD-361
LECTURE ILOs
• Illustrate the principle of MRI
• Recognize its technique, advantages, disadvantages, indication and
limitations.
MAGNETIC RESONANCE
IMAGING
• MRI totally replaces conventional X-ray-
generating equipment and film.
• Essentially it involves the behavior of protons
in a magnetic field.
What is MRI?
• MRI is simply a technique that is used to create sectional
pictures of the soft tissues of the human body as if it was
cut in slices (tomography )
• It is based on the application of strong magnetic fields
followed by pulses of radio waves (Radiofrequency RF),
and observing its effect on the tissues at a nuclear level
(Nuclear Magnetic Resonance Imaging –NMRI)
The basic principles and
idea of MRI
• Hydrogen atom is considered the most abundant (widely
spread) element in the body as it is the main constituencies
of water molecule.
• The patient is placed in a very strong magnetic field, the
protons (hydrogen atoms) of the examined tissues tend to
align themselves in the same direction of this field.
• A radio waves are then applied at 90 degrees (perpendicular)
to this applied magnetic field.
The basic principles and idea
(Cont.)
• The protons absorb energy from this radio waves and tend to
rotate or spin away from the magnetic field
• The applied radio waves tend to be turned off, then some of the
energy absorbed by the protons are released in the form of another
radio waves signals proportional to the absorbed energy.
• These released signals are detected by special detectors , fed into a
computer and converted into visual images.
Philips Gyroscan Intera
• The simplest atom is hydrogen, consisting
of one proton in the nucleus and one
orbiting electron.
• It is the hydrogen protons that are used to
create the MRI image.
Hydrogen Nucleus
Most abundant
Yields strongest MR signal
:Normally
The patient’s hydrogen protons spin on an
axis, so a magnetic field surrounds them
and they behave like small magnets.
These small magnets are aligned
randomly. So they completely cancel
themselves and no net magnetism exists
around the tissues
I-Magnetization
• First, the patient is subjected to a
strong magnetic field , the
protons rearrange to
Low energy state parallel
(many)
• High energy state anti-parallel B0
(few)
• So there is a net magnetic field
that grows in the longitudinal
Magnetic Field Strengths
Measured in Tesla or Gauss
Usual MRI field strength ranges from 0.5 to 2.0 Tesla
One tesla is equal to 10,000 gauss
Earth’s magnetic field is about 0.00005 Tesla (0.5 Gauss)
1 Tesla = 20000 earth magnetic field
B-Precession
They precess or “wobble”
Precession:
when a spinning object is
subjected to force, it tends
to rotate, or wobble
around that force
II-Excitation
Radio- wave pulse (radiofrequency) is then
introduced in a direction perpendicular to that of
the main magnetic field, causes 2 things:
1. Protons precess away from the direction of the
main magnetic field and become lying in the
horizontal plane
2. The protons become in phase (have the same
direction in any given time)
What happens when the radiowaves
?are pulsed into the patient
The excited hydrogen protons do
two things:
First, 90° Tipping of the NMV. i.e.
longitudinal magnetic moment
decreases.(spin-lattice
relaxation)
Secondly, their spins synchronize.
They spin in phase with each
other. i.e. the
transverse magnetic moment
increases.(spin-spin relaxation)
Receiver Coils
Send or “broadcast” the RF pulse
Receive or “pick up” the MR signals
Types: Body coils, head coils, and a variety
of surface coils
RF COILS
• BODY COIL • HEAD COIL
Radiofrequency Pulse
RF pulse is an electromagnetic wave
Caused by a brief application of an
alternating electric current
z
x
z
x
y
y
z
x
z
x
y
III-Relaxation
Now, the radio-frequency is stopped, while the
initial magnetic field is maintained, The protons
re-radiate the absorbed energy and the protons
return to the low energy, unexcited (relaxed )
state
The relaxation process can be divided into two
parts: T1 and T2 relaxation.
TR - REPETITION TIME
Time from the application of one RF pulse to another RF
pulse
TE - ECHO TIME
Time from the application of the RF pulse to the peak of
the signal induced in the coil
T1 WEIGHTING
•A short TR and short TE will result in a T1 weighted image
•Excellent for demonstrating anatomy
T2 WEIGHTING
•A long TR and long TE will result in a T2 weighted image
•Excellent for demonstrating pathology
MANY OTHER DIFFERENT TYPES OF IMAGES THAT COMBINE ABOVE
AND INCLUDE OTHER PARAMETERS
Fluids have a long T l (i.e. they take a long time to re-establish their
longitudinal magnetic moment),
produce a weak signal
and appear dark
fat behaves in the opposite
manner and has a short Tl, produces a strong signal and appears white
T1 is defined as the time it takes for the longitudinal magnetization to
come back to its initial value (spin-lattice relaxation time)
T1 WEIGHTED
IMAGE
Fluids
such as CSF have a long T2 (i.e. they de-phase slowly) and
give a strong signal and appear white.
Fat has a short T2, produces a weak signal and appears
dark.
T2 is defined as the time for the transverse magnetization to
decrease to zero (spin-spin relaxation time)
T2 WEIGHTED
IMAGE
T2 Decay T1 Decay
Transverse Relaxation Longitudinal Relaxation
Fluids appear white on T2 Fluids appear dark on T1
weighted images. weighted images.
(Water images)
Fat appears dark on a T2 Fat appears white on a T1
weighted image. weighted image
(Fat images)
Show disease well. Show normal anatomy
A long TR and long TE A short TR and short TE
Advanta
ges
• Ionizing radiation is not used
• No adverse effects
• Image manipulation
• High resolution images in all planes
• Excellent differentiation between different soft tissues
• Excellent differentiation between normal and abnormal tissues.
Disadvant
ages
• Bone does not give an MR signal, a signal is only
obtainable from bone marrow
• Scanning time can be long
• demanding on the patient
• motion artifacts
• It is contraindicated in patients with
• surgical clips
• cardiac pacemakers
• cochlear implants
• first trimester of pregnancy
Disadvanta
ges
• Equipment tends to be claustrophobic and
noisy
• Equipment is very expensive
• Facilities are not widely available
Main Indications for MRI
in the Head and Neck
• Assessment of
intracranial lesions
particularly those
involving
• posterior cranial fossa
• pituitary gland
• spinal cord
Main Indications for MRI in the
Head and Neck
• TMJ Investigations to show the soft tissue
components of the joint including the disc
position. MRI may be indicated:
• When doubting internal derangement
• Preoperatively before disc surgery.
Anterior Disc Displacement with Reduction
Anterior Disc Displacement without
Reduction
Rheumatoid Arthritis
Proton Density Autopsy specimen
Main Indications for MRI in the Head
and Neck
• Tumor staging
• site
• size
• extent
Fracture +
Hemosinus
What is your opinion ?
Tongue base
carcinoma
The end
result
