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Introduction to MRI Head Imaging

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Presentation on theme: "Introduction to MRI Head Imaging"— Presentation transcript:

1 Introduction to MRI Head Imaging
Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University of Oklahoma Health Sciences Center January 16, 2015


3 Objectives Describe the pros and cons of MRI versus CT when imaging the head Discuss some common MRI sequences Illustrate the appearance of acute ischemic stroke on various MRI head sequences Present MRI head imaging of other common neurological diagnoses 3

4 Principles of Magnetic Resonance Imaging
Uses a magnet and radio waves to create an image based on changes in alignment of protons in the tissue Terminology Hyperintense (bright, white) Hypointense (dark, black)

5 Advantages of MRI over CT Head
No radiation Can image in multiple planes (axial, sagital, coronal, oblique) Superior soft tissue imaging Can image some vessels without contrast (MRA head) Many different sequences allow for specialized imaging Can image the brainstem and cerebellum

6 Disadvantages of MRI vs CT Head
Inferior bone imaging Cost Longer study time Images degraded by motion Can not image patient with pacemaker, claustrophobia, metallic foreign bodies (bullet)

7 Axial T1 T1 looks like a CT CSF is black (hypointense) orbit pons

8 Sagital T1 atrophy corpus collosum pons cerebellum

9 Coronal with contrast (gadolinium)
With contrast can see hyperintensity of the blood vessels Good for visualization of hyppocampi

10 Axial T2 T2 has white (hyperintense)CSF lateral ventricles
frontal horn occipital horn

11 DWI brainstem Breakdown of blood brain barrier acute ischemic stroke acute demyelination acute trauma Right pontine ischemic infarction T2 shine through

12 T2* acute ICH (gradient echo) Blood will appear black (hypointense)

13 Acute Ischemic Stroke DWI T1

14 Acute Ischemic Stroke T2 FLAIR (fluid-attenuated inversion recovery)

15 Acute Ischemic Stroke T2*
petechial hemorrhages within the ischemic tissue

16 MRA (LMCA patent) anterior cerebral artery middle cerebral artery L R
Image can be rotated, left is not always on the right side of the screen, must look at labels anterior cerebral artery middle cerebral artery L R internal corotid artery

17 Normal Pressure Hydrocephalus
Central atrophy (large ventricles) out of proportion to peripheral atrophy (minimal atrophy)

18 Meningioma Extraaxial brain tumor (outside of the brain) displacing
Enhances with gadolinium Has a dural tail

19 Multiple Sclerosis Periventricular white matter hyperintensities, some of which enhance, from National MS Center

20 GAD with NSF Puts patients at risk for nephrogenic systemic fibrosis
Fibrosis of skin, eyes, organs Gadolinium can not be administered in patients: Glomerular filtration rate (GFR) of 30 or less On dialysis

21 Questions Thank you OU Neurology

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