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Looking at the Interior of Human
Body and Understanding its
Physiology and Function:
Role of Magnetic Resonance
Imaging (MRI)
utkARSh veRMA
KVJNU
Medical Imaging Techniques
X-Ray Imaging
Contrast: Density, Atomic Number
X-ray
source

December 22nd, 1895
Wilhelm Roentgen

Detector

Object
“Builder survives
nailgun accident”
X-Ray - Digital
X ray tube
Computerized Tomography

Comparison of CT with the Anatomy
Computerized Tomography

Pyogenic liver abscess

Focal fatty degeneration of liver
Calcaneus fracture following CT Guided surgery
Before

After
Atom
Molecu
Atomic
le
Nucleus
our magnetic spy !
Courtesy: Prof. Richard R Ernst
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

Magnetic Resonance Imaging
•

High-resolution morphological
picture(anatomical structures)

•

Superior soft tissue contrast

•

Multi-planar imaging capability

•

MR images from protons present

water and fat of human tissues
•

Noninvasive – NO ionizing radiation
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

T1 - weighted
Axial View

T1 - weighted
Coronal View

T1 - weighted
Sagittal View
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

Effect of T2 relaxation on Contrast in MRI

Mineral water

Municipal water
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

T1 - weighted - Axial

Tissues
Fat
WM
GM
CSF

T2 - weighted - Axial

PD
Light Gray
Gray
Light Gray
Gray

T1W
White
Light Gray
Gray
Black

Proton Density - Axial

T2W
Gray
Dark Gray
Gary
White
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

High-Resolution - Image Details
Sella Sagittal
Diagnostic MR
15
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

Anaplastic astrocytoma

Metastatic brain

Glioblastoma

Low grade astroglia

Mixed Glioma

Low grade astrocytoma
MRI in the Diagnosis of Breast & Prostate Cancer
Breast -T1 - weighted

Breast - T2 - weighted

Prostate
T2 – weighted – Normal

Prostate
T2 – weighted - Tumor
Functional
Studies
3D dynamic CE
MRI of Breast

Time

Signal-Time Curves (contrast enhancement)
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

DTI- Diffusion
Tractography

Diffusion – weighted MRI

Volunteer

Patient
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

CT

T2

DWI

Sensitivity of DWI for hyperacute stroke demonstrated in
57-year old patient. Unremarkable CT and T2 MRI. DWI
demonstrates hyperintense signal in left postcentral gyrus.
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

Whole spine MRI

Cervical Spine Cord
compression
MR Angiography
22
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

MR Angiography - MRA

MRI of head and cervical

MRA - aortic arch to circle of Willis
Monitoring Brain
Functions

24
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR
MRI vs. fMRI
MRI studies brain anatomy.

Functional MRI (fMRI)
studies brain function.
Cerebral lateralization of function happen in a few abilities
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

Motor cortex activation
Both hands

Visual cortex activation
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

fMRI during Sad
and Happy moods
Activation
in Amygdla
and Hippocampus
Liar versus Non-liar

THE TRUTH BE TOLD? [left] When the author was asked whether he had ever feigned illness to
escape an obligation, his prefrontal cortex showed no unusual activity.
LIAR, LIAR? [right] When the author was asked whether he had ever padded an expense report, his
prefrontal cortex became highly active [areas highlighted with hot colors].
Courtesy: Prof. Richard R Ernst
Diffusion MRI in Breast Cancer
Responder

Poor responder
Pre therapy
1.07 x 10-3 mm2/s

0.98 x 10-3 mm2/s

II NACT
1.26 x 10-3 mm2/s

1.05 x 10-3 mm2/s

III NACT
1.60 x 10-3 mm2/s

1.20 x 10-3 mm2/s
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

An
intraoperative
image
performed
revealing
residual
tumor

CE
images
show
location
of the
tumor

Magnet
lowered
tumor
resection
performed

Intra Operative MRI-1

Magnet
positioned
and
preoprative
images
obtained
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

MRI
demonstrates
complete
resection of
tumor

Intra Operative MRI-2

Navigational
method
enables the
surgeon to
precisely
locate the
residual
tumor

Surgery
continues
using the guidance
of
intraoperative
navigation
Matrix coil technology
Peripheral
Angio coil

Head coil

MRI Scanner
Bilateral carotid coil

Bilateral carotid coil

Breast array coil for biopsy

Whole body MRI/A
ALL INDIA INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT OF NMR

Can’t we NOT believe this? Science or Faith???
MRI Whole body

MRI Spine

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Magnetic resonance imaging (mri)

  • 1. Looking at the Interior of Human Body and Understanding its Physiology and Function: Role of Magnetic Resonance Imaging (MRI) utkARSh veRMA KVJNU
  • 3. X-Ray Imaging Contrast: Density, Atomic Number X-ray source December 22nd, 1895 Wilhelm Roentgen Detector Object “Builder survives nailgun accident”
  • 4. X-Ray - Digital X ray tube
  • 6. Computerized Tomography Pyogenic liver abscess Focal fatty degeneration of liver
  • 7. Calcaneus fracture following CT Guided surgery Before After
  • 8. Atom Molecu Atomic le Nucleus our magnetic spy ! Courtesy: Prof. Richard R Ernst
  • 9.
  • 10. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR Magnetic Resonance Imaging • High-resolution morphological picture(anatomical structures) • Superior soft tissue contrast • Multi-planar imaging capability • MR images from protons present water and fat of human tissues • Noninvasive – NO ionizing radiation
  • 11. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR T1 - weighted Axial View T1 - weighted Coronal View T1 - weighted Sagittal View
  • 12. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR Effect of T2 relaxation on Contrast in MRI Mineral water Municipal water
  • 13. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR T1 - weighted - Axial Tissues Fat WM GM CSF T2 - weighted - Axial PD Light Gray Gray Light Gray Gray T1W White Light Gray Gray Black Proton Density - Axial T2W Gray Dark Gray Gary White
  • 14. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR High-Resolution - Image Details Sella Sagittal
  • 16. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR Anaplastic astrocytoma Metastatic brain Glioblastoma Low grade astroglia Mixed Glioma Low grade astrocytoma
  • 17. MRI in the Diagnosis of Breast & Prostate Cancer Breast -T1 - weighted Breast - T2 - weighted Prostate T2 – weighted – Normal Prostate T2 – weighted - Tumor
  • 18. Functional Studies 3D dynamic CE MRI of Breast Time Signal-Time Curves (contrast enhancement)
  • 19. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR DTI- Diffusion Tractography Diffusion – weighted MRI Volunteer Patient
  • 20. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR CT T2 DWI Sensitivity of DWI for hyperacute stroke demonstrated in 57-year old patient. Unremarkable CT and T2 MRI. DWI demonstrates hyperintense signal in left postcentral gyrus.
  • 21. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR Whole spine MRI Cervical Spine Cord compression
  • 23. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR MR Angiography - MRA MRI of head and cervical MRA - aortic arch to circle of Willis
  • 25. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR
  • 26. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR
  • 27. MRI vs. fMRI MRI studies brain anatomy. Functional MRI (fMRI) studies brain function.
  • 28. Cerebral lateralization of function happen in a few abilities
  • 29. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR Motor cortex activation Both hands Visual cortex activation
  • 30. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR fMRI during Sad and Happy moods Activation in Amygdla and Hippocampus
  • 31. Liar versus Non-liar THE TRUTH BE TOLD? [left] When the author was asked whether he had ever feigned illness to escape an obligation, his prefrontal cortex showed no unusual activity. LIAR, LIAR? [right] When the author was asked whether he had ever padded an expense report, his prefrontal cortex became highly active [areas highlighted with hot colors].
  • 33. Diffusion MRI in Breast Cancer Responder Poor responder Pre therapy 1.07 x 10-3 mm2/s 0.98 x 10-3 mm2/s II NACT 1.26 x 10-3 mm2/s 1.05 x 10-3 mm2/s III NACT 1.60 x 10-3 mm2/s 1.20 x 10-3 mm2/s
  • 34. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR An intraoperative image performed revealing residual tumor CE images show location of the tumor Magnet lowered tumor resection performed Intra Operative MRI-1 Magnet positioned and preoprative images obtained
  • 35. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR MRI demonstrates complete resection of tumor Intra Operative MRI-2 Navigational method enables the surgeon to precisely locate the residual tumor Surgery continues using the guidance of intraoperative navigation
  • 36. Matrix coil technology Peripheral Angio coil Head coil MRI Scanner Bilateral carotid coil Bilateral carotid coil Breast array coil for biopsy Whole body MRI/A
  • 37. ALL INDIA INSTITUTE OF MEDICAL SCIENCES DEPARTMENT OF NMR Can’t we NOT believe this? Science or Faith??? MRI Whole body MRI Spine