MRI brain (summary)
This is a basic article for medical students and other non-radiologists
MRI brain is a specialist investigation that is used for the assessment of a number of neurological conditions. It is the main method to investigate conditions such as multiple sclerosis and headaches, and used to characterize strokes and space-occupying lesions.
Reference article
This is a summary article; we do not have a more in-depth reference article.
Summary
- indications
- confirmation of stroke
- assessment of intracranial tumor
- chronic headache
- seizure disorder
- important pathology
- benefits
- multiplanar assessment of the brain
- exceptionally detailed images of the brain
- different sequences allow assessment of different pathology
- no ionizing radiation (especially important in children)
- limitations
- much longer investigation (20-40 minutes)
- less available (longer waiting list)
- patients may be claustrophobic
- contraindicated in patients with some metallic implants
- most pacemakers are not MRI-compatible
- procedure
- patient positioned on the MRI couch
- head coil positioned over their head
- patient moved into the center of the magnet
- sequences acquired
- similar tests
- CT head
- first-line investigation in most acute situations
- CT head with contrast
- initial assessment of intracranial lesions
- CT head
About MRI
Different pulses and different signals provide a variety of sequences and images that we use. Unlike CT where we describe "density", images are described by signal intensity ("hyper-" bright, "hypo-" dark).
- T1
- provides the most anatomically-relevant images
- fluid (in CSF and orbits) is dark
- grey matter is darker than the white matter
- T2
- standard sequence
- fluid is bright
- white matter is darker than grey
- FLAIR (fluid attenuation inversion recovery)
- commonly used sequence
- similar to T2, but the fluid is darker or "suppressed"
- useful for areas of edema or inflammation
- used to identify plaques in multiple sclerosis (especially periventricular)
- DWI and ADC (diffusion-weighted imaging and apparent diffusion coefficient)
- these "blocky" images show how easily water moves around
- restricted diffusion occurs in stroke, abscesses and cellular tumors
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