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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
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DISCLOSURES
FINANCIAL DISCLOSURE
Nothing to disclose
UNLABELED/UNAPPROVED USES
DISCLOSURE
Nothing to disclose
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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
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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)
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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
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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)
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Axial T1
orbit
pons
T1 looks like a CT
CSF is black
(hypointense)
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Sagital T1
atrophy
corpus collosum
pons
cerebellum
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Coronal with contrast (gadolinium)
With contrast can see
hyperintensity of the blood
vessels
Good for visualization of
hyppocampi
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Axial T2
T2 has white
(hyperintense)CSF
lateral ventricles
frontal horn
occipital horn
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DWI brainstem
Breakdown of blood brain barrier
acute ischemic stroke
acute demyelination
acute trauma
Right
pontine
ischemic
infarction
T2 shine
through
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T2* acute ICH
(gradient echo)
Blood will appear black
(hypointense)
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Acute Ischemic Stroke
DWI
T1
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Acute Ischemic Stroke
T2
FLAIR
(fluid-attenuated inversion
recovery)
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Acute Ischemic Stroke
T2*
petechial hemorrhages
within the ischemic
tissue
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MRA (LMCA patent)

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
R
L
internal
corotid
artery
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Normal Pressure Hydrocephalus
 Central atrophy (large
ventricles) out of proportion to
peripheral atrophy (minimal
atrophy)
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Meningioma
 Extraaxial brain tumor
(outside of the brain) displacing
The brain)
Enhances with gadolinium
Has a dural tail
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Multiple Sclerosis
Periventricular white matter hyperintensities, some of which
enhance, from National MS Center
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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
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Questions
Thank you
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