How to Learn MRI An Illustrated Workbook

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1 How to Learn MRI An Illustrated Workbook Exercise : Advanced Brain Sequences Teaching Points: Learn about Susceptibility Weighted Imaging and how to produce these images. Learn about Axial Fast Inversion Recovery and how to produce Axial Fast Inversion Recovery images using different Inversion Time values. Learn about D TOF MRA and how to produces these images.

2 Fig. Head coil Step : Preparing the head coil Place the 8-Channel head coil on the table, and put a cushion pad in the coil and a sanitary sheet on top of it. Step : Positioning the volunteer Place the volunteer on a head-first position, which means that the coil base should be close to the magnet bore (Fig.). Cover him/her with a blanket, remember the ear plugs and squeeze-ball, and put a cushion under the knees to relieve back pressure. Sometimes we use medical tape to immobilize the head further (See fig.). Fig. Friend s Head in coil Step : Landmark the Brain Landmark at the superior edge of eyebrows. Fig. Tape Technique (Note: You can also tape the chin for even better prevention of motion.)

3 Step 4: Three Plane Localizer Click New Series in Rx Manager, select INRX, and then click View Edit. Set the parameters (Fig.4). Check if the coil type is 8 Channel Head Coil. Click Save series, Download, Prep Scan, and then Scan. Fig.4 Plane localizer parameter Information s Site Accession Number Position Supine ID Name Head Neck/Cervical Entry Coil Head First 8HRBRAIN Auto Start Chest Thoracic Upper Extremities Series Description -plane localizer Abodomen/Lumbar Pelvis LowerExtremities Other Plane Pulse Seq Imaging Options -Plane Fiesta Seq, Fast Grad D Psd Name Full Info HIS/RIS TE(s) per scan TE Scan Timing Additional Parameters Aquisition Timing Graphic RX OFF Image Enhance Users CVs Screen Freq NEX Freq DIR Flow Comp Direction Shim Unswap Auto TE TR Acqs Before Pause.00 Correct Contrast Amf ml Inv. Time 0 0 Agent TI Flip Angle Echo Train Length Bandwidth Scanning Range 5 48 Center Spacing S/I R/L A/P Bandwidth.. # s: Table Delta 0.00

4 Step 5: Asset Calibration Copy and Paste Plane loc on your Rx Manager then click View Edit. Set your parameters and fill up the Position, Imaging Parameters, Acquisition Timing, and Scan Timing (Fig.5). Click Graphic Rx and be sure to prescribe enough slices to cover the whole brain. Click Save Series, Download, Prep Scan, and then click Scan. Fig.5 Calibration sequence parameter Information s Site Accession Number Position Supine ID Name Head Neck/Cervical Entry Coil Head First 8HRBRAIN Auto Start Chest Thoracic Upper Extremities Series Description Calibration Scan Abodomen/Lumbar Pelvis LowerExtremities Other Plane Pulse Seq Imaging Options Axial gradient Echo Fast Calib Grad Calib Psd Name Full Info HIS/RIS TE(s) per scan TE Scan Timing Additional Parameters Aquisition Timing Graphic RX OFF Image Enhance Users CVs Screen Freq NEX Freq DIR Flow Comp Direction Shim AVP Auto TE TR Acqs Before Pause Correct Contrast Amf ml Inv. Time 0 0 Agent TI Flip Angle Echo Train Length Bandwidth Bandwidth Spacing Scanning Range 5 48 Start End s: Actual End S/I R/L A/P I0.0 S S Table Delta 0.00

5 Susceptibility-weighted Imaging (SWI) 4 SWI is a method that measures susceptibility difference between tissues resulting to phase differences. It takes advantage of signal loss intensity created by disturbance of a homogenous magnetic field and phase information to accentuate the paramagnetic properties of blood products. This sequence is particularly used to visualize the venous vessels of the brain and to detect hemorrhage. Studies showed that this is also sensitive to the presence of iron, forms of calcification, and air. Step 6: Susceptibility Weighted Imaging (SWI) Copy and Paste AXL DWI on your Rx Manager then click View Edit. Set your parameters (Fig.6). Go to Graphic Rx and adjust the localizer to slices (Fig.7). Click Save Series, Download, Prep Scan, and then click Scan.. Fig.6 SWI sequence parameter Information s Site Accession Number Position Supine ID Name Head Neck/Cervical Entry Coil Head First 8HRBRAIN Auto Start Chest Thoracic Upper Extremities Series Description SWI Abodomen/Lumbar Pelvis LowerExtremities Other Plane Pulse Seq Imaging Options Axial Gradient Echo EPI, Asset Grad D Psd Name Full Info HIS/RIS Shots TE 5.0 Scan Timing Additional Parameters Aquisition Timing Graphic RX OFF Image Enhance Users CVs Screen Freq NEX Freq DIR Flow Comp Direction Shim R/L Auto TE TR Inv. Time ASSET.00 Ph Locs Before Pause.00 Amf Agent Correct Contrast ml TI Flip Angle Echo Train Length Bandwidth Bandwidth Spacing Scanning Range 4 99 Start End s: S/I R/L A/P S99.5 I L. 0.0 L. 0.0 Table Delta 0.00

6 5 Fig.7 Graphic Rx for SWI sequence Graphic Rx X Erase Selected Erase All Reset Center Loc Ref Lines Fallback to SO Report Cursor Update All Keep W/L Display Normal.0 ZOOM Copy Rx... Select Series Select image... Localized image -, Accel. Bar: * SAT Fat Fat Classic SPECIAL Graphic Rx Scan Plane: Axial : Spacing Water Freq DIR: R/L Shime Vol Shim : locs Before Pause: TR: Hide Shim Minimum TR: 05.5 Start: L5. A7.6 S0.5 s End: L5. A7.6 S0.5 Fig.8 Susceptibility Weighted Images 4 Susceptibility weighted sequence is sensitive to the disruptive susceptibility effect of calcium, bone, and blood breakdown products ferritin and hemosiderin. Areas of increased susceptibility appear black on these images.

7 6 Inversion Recovery This is a pulse sequence that produces signals, representing the longitudinal magnetization after the application of 80 radiofrequency (RF) pulse that rotates the magnetization into the negative plane. Inversion time (TI) is the time between the 80 pulse and the following 90 pulse. After the TI, the signal is rephrased with 80 pulse when a further 90 RF pulse tilts some or all of the z-magnetization into the xy-plane. This sequence provides a very strong contrast between tissues with different T relaxation times or to suppress tissues like fluid or fat. RF SS PE FE Inversion Time (TI) E.A. O.S - - E.A. O.S Step 7: Axial Fast Inversion Recovery Copy and Paste SWI on your Rx Manager then click View Edit. Click Pulse Sequence (Fig.9) and choose Fast Spin Echo for the Pulse Sequence Family and FSE-IR for the Pulse Sequence (Fig.0). Complete the rest of the parameters, using a TE of 0 ms, TR of 4,000 ms, and Inversion time (TI) of 65 ms (Fig.9). Go to Graphic Rx and adjust the localizer to slices (Fig.). Click Save Series, Download, Prep Scan, and then click Scan. Repeat the same procedure to create AXL FAST IR 540 with Inv. Time equal to 540 ms, AXL FAST IR 00 with Inv. Time equal to 00 ms, and AXL FAST IR 50 with Inv. Time equal to 50ms to see different suppression effects.

8 Fig.9 Axial Fast Inversion Recovery parameter with Inv. Time of 65 ms 7 Information s Site Accession Number Position Supine ID Name Head Neck/Cervical Entry Coil Head First 8HRBRAIN Auto Start Chest Thoracic Upper Extremities Series Description AXL FAST IR 65 Abodomen/Lumbar Pelvis LowerExtremities Other Plane Pulse Seq Imaging Options Oblique IR Seq, Fast Grad D Psd Name Full Info HIS/RIS TE(s) per scan TE 0.0 Scan Timing Additional Parameters Aquisition Timing Graphic RX OFF Image Enhance Users CVs Screen Freq NEX Freq DIR Flow Comp Direction Shim A/P Auto TE TR Inv. Time TI Flip Angle Echo Train Length Bandwidth Bandwidth Spacing Scanning Range 5 48 Start End s: Acqs Before Pause R.5 R.6.00 Amf Agent Correct Contrast S/I R/L A/P 0.0 S S5.0 ml Cardiac s 0 Table Delta 0.00 Fig.0 Pulse Sequence window of Axial Fast Inversion Recovery Plane : Oblique Imaging : D Pulse Seq Family Echo Planar Imaging Pulse Sequence FRFSE-XL None ASSET Multi No Wrap Fast Spin Echo FSE-IR Blood Suppression Respiratory Gating/Triggering Gradient Echo FSE-XL Cardiac Gating/Tiggering Sequential MNS SSFSE Classic Square Pixel Propeller Spin Echo Spiral SSFSE-IR TFlair TFlair Extended Dynamic Range Flow Compensation Full Echo Train Tailored RF ZIP04 ZIP5 Vascular PSD Name: BRAVO SWIFT BREASE TMAP COSMIC TRICKS LAVA-XV VIBRANT MR-Echo Accept

9 8 Fig. Graphic Rx for Axial Fast Inversion Recovery Graphic Rx X Erase Selected Erase All Reset Center Loc Ref Lines Fallback to SO Report Cursor Update All Keep W/L Display Normal.0 ZOOM Copy Rx... Select Series Select image... Localized image -, Accel. Bar: * SAT Fat Fat Classic SPECIAL Graphic Rx Scan Plane: Axial : Spacing Water Freq DIR: R/L Shime Vol Shim : locs Before Pause: 0 TR: 4.0 Hide Shim Minimum TR: 4.0 Start: L.9 A. S8. s End: L.9 A. I.0 Fig. Axial Fast Inversion Recovery with different Inv. Time (TI) (a) 65 ms (b) 540 ms (c) 00 ms (d) 50 ms Fast Inversion Recovery is usually used to suppress signal from certain tissues in conjunction with T weighting so that water and pathology return a high signal. Time Of Flight (TOF) MRA Time of flight (TOF) MRA is the effect of allowing blood to flow into or out of a slice between excitations. The vessel contrast or flow-related enhancement is proportional to the velocity. Fully magnetized spins in the moving blood continuously enter the imaging slice generating a higher MR signal in contrast to the low signal intensity of the stationary tissue

10 9 Step 8: Axial D TOF MRA Copy and Paste AXL FAST IR 65 on your Rx Manager then click View Edit. Go to Pulse Sequence (Fig.). Choose Axial for the Plane, D for the Imaging, Vascular for the Pulse Sequence Family, and Fast TOF GRE for the Pulse Sequence (Fig.4). Complete the rest of the parameters (Fig.). Go to Graphic Rx and adjust the localizer to slices (Fig.5). Click Save Series, Download, Prep Scan, and then click Scan. Fig. Axial D TOF MRA parameter Information s Site Accession Number Position Supine ID Name Head Neck/Cervical Entry Coil Head First 8HRBRAIN Auto Start Chest Thoracic Upper Extremities Series Description AXL D TOF MRA Abodomen/Lumbar Pelvis LowerExtremities Other Plane Pulse Seq Imaging Options Axial Vasc TOF Fast Grad D Psd Name Full Info HIS/RIS TE(s) per scan TE Scan Timing Additional Parameters Aquisition Timing Minimum Graphic RX OFF Image Enhance Users CVs Screen Freq NEX Freq DIR Flow Comp Direction Shim A/P Auto TE TR Inv. Time Vascular Screen Acqs Before Pause.00 Correct Contrast Amf Agent ml TI Flip Angle Echo Train Length Bandwidth Bandwidth Overlap Locs Scanning Range 9 48 Start End s: I5.5 S/I L/R Center P/A Center S80. L.0 A6. L.0 A6. Locs per Slab Table Delta 0.00

11 0 Fig.4 Pulse Sequence window for Axial D TOF MRA Plane : Axial Imaging : D Pulse Seq Family Fast Spin Echo Pulse Sequence Fast TOF-GRE None ASSET No Wrap Respiratory Gating/Triggering Gradient Echo Fast TOF-SPGR Cardiac Gating/Tiggering Smart Prep Vascular Contrast Extended Dynamic Range Square Pixel TOF-GRE Fluoro Trigger ZIP x TOF-SPGR IR Prepared ZIP x 4 Multi Station ZIP04 Multi ZIP5 Navigator PSD Name: BRAVO SWIFT BREASE TMAP COSMIC TRICKS LAVA-XV VIBRANT MR-Echo Accept Fig.5 Graphic Rx for Axial D TOF MRA Graphic Rx X Erase Selected Reset Center Loc Ref Lines Erase All Fallback to SO Report Cursor Update All Display Normal Keep W/L.0 ZOOM Copy Rx... Select Series Select image... Localized image -, Accel. Bar: * SAT Fat Fat Classic SPECIAL Water Shime Vol Graphic Rx Shim : Scan Plane: Axial : Overlap Locs Freq DIR: A/P locs Before Pause: TR:.00 0 Hide Shim Minimum TR: 5.7 Start: L.0 A6. I5.5 s End: L.0 A6. S80. Locs per Slab

12 Fig.6 Axial D TOF MRA Step 9: Clean up Suggested Readings: aging&ei=ra9ws9e8g5_czqs06-sycw&cd=#v=onepage&q=susceptibility%0weighted%0 imaging&f=false NWS4-BFKrSyQTg9fzxDg&cd=#v=onepage&q=fast%0inversion%0recovery&f=false source=bl&ots=nwemufsnzt&sig=poskmkvb0wcpipiulumnh9tu5je&hl=en&ei=ijfls66qooft8q adyfxsag&sa=x&oi=book_result&ct=result&resnum=6&ved=0cc0q6aewbtgk#v=onepage&q=ir- FSE%0imaging&f=false

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