Background Image: http:// www.ruf.rice.edu/~pomeran/images/brainmri.jpg

1. Magnetic Resonance Imaging http://www.gehealthcare.com/euen/oncology/images/breast-health/onc_breast_pulmo_500.jpg http://www.gehealthcare.com/euen/oncology/images/breast-health/onc_breast_bonemetasta_500.jpg http://www.gehealthcare.com/euen/oncology/images/breast-health/onc_breast_wholemri.jpg Background Image: http://www.ruf.rice.edu/~pomeran/images/brainmri.jpg

2. Magnetic Resonance Imaging - Outline • Review nuclear magnetic moments and the precession of the magnetization vector about the static magnetic field. • Hit the sample with a pulse of RF energy at a specific frequency called the Larmor frequency and make the magnetization vector undergo nutation. • Nutation is the changing of the precession angle (with respect to the external field) by applying another force to the system (the RF pulse) and this varies the longitudinal component of the magnetization. • Investigate the relaxation times of the transverse and longitudinal magnetization vectors for the time varying spin states. • Briefly look at the ideas behind image formation, • which is a complex process. Physics of Radiology, Anthony Wolbarst

3. Origin of the MRI Signal - A review • So, we have that the protons align in an external magnetic field and that their angular momentum causes them to precess about the external field. • Putting these protons into the external magnetic field produces a two state system of • energies that are split by the external field (the Zeeman Effect). • A RF pulse applied perpendicular to the external field and this causes absorption of photons by nuclei in the low energy state and the spin vector of the protons flips and this causes a nutation of the magnetization vector that is precessing about the external field. • The protons are all in precessing in phase and when the RF field is switched off the protons relax and transition back to lower energy states with an emission of energy. • But how do you know that for a given proton system in a static magnetic field that the frequency of the RF is identical to the Larmor precession frequency? • If and only if the RF happens to be oscillating at the Larmor frequency then I can cause the net magnetization vector to precess at larger and larger angles (away from the static field) until it is swinging in a transverse plane. • This is the resonance of NMR and can be detected with a detection coil of wire

4. Magnetization Physics of Radiology, Anthony Wolbarst Physics of Radiology, Anthony Wolbarst A single nuclei precesses about the magnetic field at frequency f0 (the Larmor frequency). For a collection of nuclei the magnetization vector (which represents the net magnetic moment precesses about the applied field. In the externally applied field the magnetic moments try to align with the field. There is a difference in numbers of nuclei in the spin up versus spin down states and the difference in number gives rise to the magnetization. Here the difference is illustrated.

5. Nutation – The Resonance in NMR A tangentially applied force (one that is 90o to the external force) causes nutation and the object precesses at a larger angle with respect to the applied force. Here for the top, the external force is gravity, and the tangential force is say tension in an attached string. For the proton precessing in a magnetic field, the external force is due to the magnetic field and the tangential force is a 90o RF pulse. I’m applying a perpendicular B field to the static field in NMR. If the frequency of this field BRF is above or below the Larmour frequency not much happens. If it is at the Larmour frequency then I case a resonance in the system. Physics of Radiology, Anthony Wolbarst

6. Origin of the MR Signal Physics of Radiology, Anthony Wolbarst • The magnetization vector M precessing about the external magnetic field has both a longitudinal component (parallel to the applied field) and a transverse component (perpendicular to the applied field). • For M along the “z-axis” there is no change in voltage (or induced current) in the detection coil. • For M precessing in or near the transverse plane the changing magnetic field produces a voltage across (and a current through) the detection coil that changes in time. • The shape is periodic and the amplitude of the voltage (and current) change as M moves in and out of the transverse plane (relaxations). • This only happens if you hit the proton sample at the correct frequency – system is tunable and the system is said to be in resonance! Physics of Radiology, Anthony Wolbarst

7. 1 Dimensional Imaging: T1 Spin Relaxation • When the RF is “off” the system tends to return to equilibrium (actually a thermal equilibrium) and the nuclear spins tend to relax. • There is a rate of relaxation that occurs with this process • depends on the magnetization vector. • The magnetization vector has a longitudinal component (Mz) • and a transverse component (Mxy) and thus can have a • longitudinal and transverse nuclear spin relaxations. • Immediately after an external static magnetic field is switched • on the magnetization of the protons grows from zero (no • spins aligned with B) to it’s final equilibrium value (a net • magnetization with more protons in the lower energy state) • after some time. • Since the low energy configuration is when the proton dipoles • align with the field, there are generally more of them in the low energy state than the high energy state. • We arbitrarily define a time T1 as the time required to get 63% of the way from zero magnetization to full magnetization, or equilibrium. Physics of Radiology, Anthony Wolbarst

8. 1 Dimensional Imaging: T1 Spin Relaxation • The main interest in MRI is NOT the equilibrium state itself, but the moving toward equilibrium through nuclear spin relaxation and the rate at which this occurs. • Equilibrium is when the RF field is off. • So, when the external B-field is turned ON there is a time, T1, that characterizes how long it takes for the net magnetization to grow from zero to its equilibrium value of more protons aligned than anti-aligned with the external field. • Actually T1 is defined to be 63% of this total time. • For pure water at body temperature, T1is several seconds in a 1.5T field while its protons in water in tissue it’s much shorter, say by 5 to 10 times. • When a sample of nuclei in a magnetic field are disturbed from equilibrium the magnitude and direction of the magnetization vector vary with time.

9. 1 Dimensional Imaging: T1 Spin Relaxation • T1 is called the longitudinal relaxation time. • It characterizes the re-growth of the longitudinal component of the magnetization and involves transitions between the spin-up and spin-down states. • 1/T1 is the rate at which the system comes into thermal equilibrium. • The RF pulse disturbs the system and as the RF oscillates in time, M changes with time and we could use this to measure T1. • To measure T1 we do a saturation- recovery pulse sequence and keep track of Mz(t). Physics of Radiology, Anthony Wolbarst Physics of Radiology, Anthony Wolbarst

10. 1 Dimensional Imaging: T1 Spin Relaxation • The RF pulse disturbs the system of nuclei from equilibrium. • When the system is disturbed the magnetization vector, M(t), changes with time. • Suppose that you have a sample of water and you put it between the poles of a magnet, which provides an external field. • The protons in the sample orient themselves along or against the external field (with more aligned with the field) and over time the magnetization reaches an equilibrium value of M0 according to • This is called the longitudinal magnetization, or the component of the magnetization lying along the “z-axis”. (Remember M precesses about the B field.) • The system relaxes into this equilibrium state. • The actual time T1 depends on cellular physiology and pathologic conditions.

11. T1 Mapping • We can map out Mz for different environments of tissues. • Each tissue has a different T1 relaxation time, determined • by its physiological characteristics. • The longitudinal component of M, Mz, detected in the detector coils produces intensities that are proportional to the Mz from the different tissues. • The MRI map reflected the difference between two regions in the value of Mz and the difference occurs because the T1’s are not the same for all tissues. • Fatty tissue equilibrates more readily than say white/gray matter in the brain because the magnetic environments are • different. The shorter T1 the brighter the signal. • The contrast in the figure are due to differences in T1 • relaxation times and this is said to be T1-weighted.

12. T1 weighted images http://www.gehealthcare.com/usen/mr/products/Profile/neuro_img_gal.html http://www.gehealthcare.com/usen/mr/products/Profile/neuro_img_gal.html Left image is a T1 weighted sagittal image of the human brain showing left hemisphere, lateral ventricles, cerebellum and sinus cavities. The right image is also a sagittal image of the cervical spine. You can also clearly see the spinal cord and part of the cerebellum.

13. Magnetic Resonance Imaging - Image formation & reconstruction • The MRI image reflects spatial distribution of T1, T2 or proton density within a slice of tissue. • This involves the NMR signal from differing volume elements of protons caries information that allows for its localization within the body. • The static magnetic field points along the patients body, taken to be the z-axis. • The transverse plane is a slice through the body, generally. • Other slices, like coronal or sagittal are possible with good image resolution. • Most commercial machines have resolutions on the order of a millimeter. • The most critical and expensive component is the main magnet with fields in the 0.3 – 1.5T range. • The fields need to be stable and very uniform over the imaging region – not trivial.

14. Magnetic Resonance Imaging - Image formation & reconstruction • The RF coils are used to produce and detect the MRI signals. • The weak resonance signals produced with in the body are amplified, digitized and computer manipulated to generate an image. • The orientation of the RF coils (which some are able to be manipulated) generate other slices of the body. Bxy Bz An Introduction to MRI Physics and Analysis Michael Jay Schillaci, PhD

15. Magnetic Resonance Imaging - Image formation & reconstruction • The RF signals from the detector coils give information about the magnetization vector in the transverse plane as a function of time. • We scan over a section of tissue and compare the • signals received in the detector coils and • “actually” calculate the magnetization. • The value of the magnetization gives us a measure • of T1 as well as spatial information about the • proton density and magnetic field environments • of the nuclei. • The differences in T1 times provide contrast. • The signals are mixtures of many frequency photons. • The signals are “deconvoluted” and analyzed using Fourier analysis. Then they are reconstructed to form an image. This is a highly non-trivial process, but it works along the same lines as CT. Physics of Radiology, Anthony Wolbarst

16. Magnetic Resonance Imaging - Image formation & reconstruction • Integrate magnetization to get MRI signal • Select a z “slice” and form image of xy plane variations where S is the intensity • Contrast is due to differences in magnetization intensities in space • Image at several times • Scanner acquires K-Space weights (Fourier transforms of frequencies.) • Construct image and average slices from differences in T1. Horizontal density Vertical density   An Introduction to MRI Physics and Analysis Michael Jay Schillaci, PhD

17. Magnetic Resonance Imaging - Image formation & reconstruction T1 Weighted Image (T1WI) (Gray Matter – White Matter) T2 Weighted Image (T2WI) (Gray Matter – CSF Contrast) T2 scans are almost the photographic negative of T1 scans. We make dark areas white and white areas dark to enhance fluid filled areas. An Introduction to MRI Physics and Analysis Michael Jay Schillaci, PhD

18. T1 and T2 Relaxation • Recall that M has a component in the transverse plane as well, Mxy. • As M oscillates (and Mz relaxes back to equilibrium and then away,) the transverse magnetization also changes. • The signal in the detection coil decreases with time due to T1 relaxation effects. • The transverse magnetization decays exponentially with time approximately according to • T2 is called the spin-spin or transverse relaxation time. • Of course this all assumes that everything is perfect. • Inhomogeneities in the magnetic fields effect T2. • The net magnetization vector is not constant in length but can vary due to the inhomogeneous magnetic fields.

19. Imaging the Brain with MRI Clinically Oriented Anatomy 5th Edition, Moore & Dalley

20. Imaging the Brain with MRI - Anatomy Hypothalamus Thalamus Corpus Callosum Lateral Ventricle Cerebellum 4th Ventricle Optic Nerve Cisterna Magna Trachea http://www.neomed.edu/DEPTS/NEUR/atlas/Sagittal/MRI/Sagittal1/Sagittal1Frame.htm Spinal Chord Medulla Oblongata

21. Imaging the Brain with MRI - Cerebral Spinal Fluid • The human brain and spinal cord are surrounded by cerebral spinal fluid. Normally, cerebral spinal fluid is produced primarily in the two lateral ventricles (small chambers in the brain). This fluid drains through the third and fourth ventricles and is circulated around the brain and spinal cord, and thus acts as a cushion for the brain. • Protects the brain and spinal cord against impact to the bony surrounding structures. This protective function depends mainly on buoyancy, effectively making the weight of the brain 1/30th of its actual weight. CSF also ensures that there is an equal distribution of pressure on the nervous tissue. • It allows variations in blood volume in the cranial cavity. If the blood pressure increases, CSF volume decreases, thus preventing a build-up of pressure. • It acts as a diffusion medium for neurotransmitters and neuroendocrinesustances.

22. Imaging the Brain with MRI - Cisterna Magna http://education.yahoo.com/reference/gray/subjects/subject/193 http://www.neomed.edu/DEPTS/NEUR/atlas/Sagittal/MRI/Sagittal1/Sagittal1Frame.htm • Cerebrospinal fluid produced in the fourth ventricle drains into the cisterna magna via the lateral apertures and median aperture. • Cisterns are receptacles for holding liquid.

23. Imaging the Knee with MRI - Anatomy of the Knee http://orthoinfo.aaos.org/topic.cfm?topic=a00297 http://thesebonesofmine.wordpress.com/category/bone-basics/ • Anterior view of the right leg. • Anterior Cruciate Ligament (ACL) is in the center of the knee joint. Its function is to prevent the forward sliding of the tibia on the femur.

24. Imaging the Knee with MRI - MRI of the Knee http://orthoinfo.aaos.org/topic.cfm?topic=a00297 http://towerorthopaedics.com/acl-reconstruction Normal view of the ACL Torn ACL – Striated fibrous tear

25. Imaging the Knee with MRI - ACL Reconstruction • Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on. • Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used. • There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopedic surgeon to help determine which is best for you. • Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.