--_.

unsaturated

partially saturated

::t )::< ):':(, -..c ¥

TR TR TR TR TR
90· 90· 90· 90· 90· 90·

FIGURE 14-19. Partial saturation of tissues occurs because the repetition time between
excitation pulses does not completely allow for full return to equilibrium, and the longi-
tudinal magnetization (Mz) amplitude for the next radiofrequency pulse is reduced. After
the first excitation pulse, a steady-state equilibrium is reached, wherein the tissues become
partially saturated and produce a constant transverse magnetization of less amplitude. Tis-
sues with long T1 experience a greater saturation than do tissues with short n.

Contrast in an image is proportional to the difference in signal intensity between

adjacent pixels in the image, corresponding to two different voxels in the patient.
The details of how images are produced spatially in MRI are discussed in Chapter
15. However, the topic of contrast can be discussed here by understanding how the
signal changes for different tissue types and for different pulse sequences. The sig-
nal, S, produced by an NMR system is proportional to other factors as follows:
Sex: PHf(v)[1 - e-TRlTI] e-TEIT2

where PH is the spin (proton) density,f(v) is the signal arising from fluid flow (dis-
cussed in Chapter 15), Tl and T2 are physical properties of tissue, and TR and TE
are pulse sequence controls on the MRI machine (Fig. 14-20).

TR
_-~---
I- _.~ •..
(~
TE
I- -I
90° 180° 90°

RF
~ ~ (~
pulses

Signal
out
------+-(---
FIGURE 14-20. Spin echo pulse sequence timing is initiated with a gO-degree pulse, fol-
lowed by a 180-degree pulse applied at time TE/2. The peak echo signal occurs at the
echo time, TE. The signal is acquired during the evolution and decay of the echo. After a
delay time allowing recovery of Mz, (the end of the TR period) the sequence is repeated
many times (e.g., 128 to 256 times) to acquire the information needed to build an image.
The repetition time, TR, is the time between gO-degree initiation pulses.
 The equation shows that for the same values ofTR and TE (i.e., for the same
pulse sequence), different values ofTl or T2 (or of PH or f(v)) will change the sig-
nal S. The signal in adjacent voxels will be different when Tl or T2 changes
between those two voxels, and this is the essence of how contrast is formed in MR!.
Importantly, by changing the pulse sequence parameters TR and TE, the contrast
dependence in the image can be weighted toward Tl or toward T2.

11 Weighting
A "Tl-weighted" spin echo sequence is designed to produce contrast chiefly based
on the Tl characteristics of tissues by de-emphasizing T2 contributions. This is
achieved with the use of a relatively short TR to maximize the differences in longi-
tudinal magnetization during the return to equilibrium, and a short TE to mini-
mize T2 dependency during signal acquisition. In the longitudinal recovery and
transverse decay diagram (Fig. 14-21A), note that the TR time on the abscissa of

Image
Longitudinal recovery (T1)
Mz intensity
1 ,----- -..--------------

2000 3000 4000 5000

Time (ms)

FIGURE 14-21. A: Longitudinal recovery (left)

and transverse decay (right) diagrams (with
quite different time scales) show four brain tis-
sues and their corresponding T1 and T2 relax-
ation constants. T1-weighted contrast requires
the selection of a TR that emphasizes the differ-
ences in the T1 characteristics of the tissues (e.g.,
TR = 500 msec) and reduces the T2 characteristics
(e.g., TE :0; 15 msec). B: The T1-weighted spin
echo axial brain image obtained with TR = 549
msec and TE = 11 msec demonstrates bright
image intensity for short-T1 tissues (white mat-
ter and fat) and dark intensity for long-T1 tis-
sues (cerebrospinal fluid).
the figure on the left (longitudinal recovery) intersects the individual tissue curves
and projects over to the figure on the right (transverse decay). These values repre-
sent the amount of magnetization that is available to produce the transverse signal,
and therefore the individual tissue curves on right-hand figure start at this point at
time T = O.The horizontal projections (arrows) graphically demonstrate how the TI
values modulate the overall MRI signal. When TR is chosen to be 400 to 600 msec,
the difference in longitudinal magnetization relaxation times (Tl) between tissues
is emphasized. Four common cerebral tissues-fat, white matter, gray matter,
CSF-are shown in the diagrams. The amount of transverse magnetization (which
gives rise to a measurable signal) after the 90-degree pulse depends on the amount
of longitudinal recovery that has occurred in the tissue of the excited sample. Fat,
with a short TI, has a large signal, because the short TI value allows rapid recovery
of the Mz vector. The short TI value means that the spins rapidly reassume their
equilibrium conditions. White and gray matter have intermediate TI values, and
CSF, with a long TI, has a small signal. For the transverse decay (T2) diagram in
Fig. 14-2IA, a 180-degree RF pulse applied at time TE/2 produces an echo at time
TE. A short TE preserves the TI signal differences with minimal transverse decay,
which reduces the signal dependence on T2. A long TE is counterproductive in
terms of emphasizing TI contrast, because the signal becomes corrupted with T2
decay. Tl-weighted images therefore require a short TR and a short TE for the spin
echo pulse sequence. A typical Tl-weighted axial image of the brain acquired with
TR = 500 msec and TE = 8 msec is illustrated in Fig. 14-21B. Fat is the most
intense signal (shortest Tl); white matter and gray matter have intermediate inten-
sities; and CSF has the lowest intensity (longest TI). A typical spin echo TI-
weighted image is acquired with a TR of about 400 to 600 msec and a TE of 5 to
20 msec.

Image contrast with spin density weighting relies mainly on differences in the num-
ber of magnetizable protons per volume of tissue. At thermal equilibrium, those tis-
sues with a greater spin density exhibit a larger longitudinal magnetization. Very
hydrogenous tissues such as lipids and fats have a high spin density compared with
proteinaceous soft tissues; aqueous tissues such as CSF also have a relatively high
spin density. Fig. 14-22A illustrates the longitudinal recovery and transverse decay
diagram for spin density weighting. To minimize the TI differences of the tissues,
a relatively long TR is used. This allows significant longitudinal recovery so that the
transverse magnetization differences are chiefly those resulting from variations in
spin density (CSF > fat> gray matter> white matter). Signal amplitude differences
in the FID are preserved with a short TE, so the influences of T2 differences are
minimized. Spin density-weighted images therefore require a long TR and a short
TE for the spin echo pulse sequence. Fig. 14-22B shows a spin density-weighted
image with TR = 2,400 msec and TE = 30 msec. Fat and CSF display as a relatively
bright signal, and a slight contrast inversion between white and gray matter occurs.
A typical spin density-weighted image has a TR between 2,000 and 3,500 msec and
a TE between 8 and 30 msec. This sequence achieves the highest overall signal and
the highest signal-to-noise ratio (SNR) for spin echo imaging; however, the image
contrast is relatively poor, and therefore the contrast-to-noise ratio is not necessar-
ily higher than with a TI- orT2-weighted image.
 Image
Longitudinal recovery (T1 )
intensity
Mz 1,

E'
~
~':1
0'7j
Fat .,._.-._.,;-.:,,:--."7':-
,Whit, , .
c:: . , ..••
=iij 0.6 ' /Gray ....·····
" " CSF
~ 0.5 . , .
~ 0.4
~
! /
I I
.'
...-

Qj o.3li / .
0:: 0.2 '! ,' .
" .
0.1 .

o
o 1000 2000 3000 4000 5000 200 300
TR Time (ms) Time (ms)

FIGURE 14-22. A: Proton density-weighted

contrast requires the use of a long TR (e.g., more
than 2,000 msec), to reduce T1, and a short TE
(e.g., less than 35 msec), to reduce T2 influence
in the acquired signals. B: The proton density-
weighted axial spin echo brain image, obtained
with TR = 2,400 msec and TE = 30 msec, shows
reduced contrast compared with the T1-
weighted images (but an overall higher signal
amplitude). Tissues with higher spin density
(e.g., fat, (SF) have higher image intensity.

T2 Weighting
T2 weighting follows directly from the spin density weighting sequence: Reduce Tl
effects with a long TR, and accentuate T2 differences with a longer TE. The T2-
weighted signal is usually the second echo (produced by a second ISO-degree pulse)
of a long- TR spin echo pulse sequence (the first echo is spin density weighted, with
short TE, as explained in the previous section). Generation ofT2 contrast differ-
ences is shown in Fig. 14-23A. Compared with a Tl-weighted image, inversion of
tissue contrast occurs (CSF is brighter than fat instead of darker), because short- Tl
tissues usually have a short T2, and long-Tl tissues have a long T2. Tissues with a
longT2 (e.g., CSF) maintain transverse magnetization longer than short-T2 tissues,
and thus result in higher signal intensity. A T2-weighted image (Fig. 14-23B),
demonstrates the contrast inversion and high tissue contrast features, compared
with the Tl-weighted image (Fig.14-21B). As TE is increased, more T2 contrast is
 Image
intensit)

Gray
White
Fat

1000 2000 3000 4000 5000 300

Time (ms) Time (ms)

FIGURE 14-23. A: T2-weighted contrast

requires the use of a long TR (e.g., more than
2,000 msec), to reduce T1 influences, and a long
TE (e.g., more than 80 msec), to allow for T2
decay differences to evolve. B: The T2-weighted
spin echo axial brain image, obtained with TR =
2,400 msec and TE = 90 msec, has bright image
intensity for long- T2 tissues such as cere-
brospinal fluid and dark intensity for short-T2
tissues such as white matter and fat.

achieved, at the expense of a reduced transverse magnetization signal. Even with low
signal, window width and window level adjustments (see Chapter 4) remap the sig-
nals over the full range of the display, so that the overall perceived intensity is sim-
ilar for all images. The typical T2-weighted sequence uses a TR of approximately
2,000 to 4,000 msec and a TE of 80 to 120 msec.

Spin Echo Parameters

Table 14-5 lists the typical contrast weighting values ofTR and TE for spin echo
imaging. For situations intermediate to those listed, mixed-contrast images are the
likely outcome. For conventional spin echo sequences, both a spin density and a
T2-weighted contrast signal are acquired during each TR by acquiring two echoes
with a short TE and a long TE (Fig. 14-24).
TABLE 14-5. SPIN ECHO PULSE SEQUENCE CONTRAST
WEIGHTING PARAMETERS •.

TR (msec) 400-600 1,500-3,500 1,500-3,500

TE (msec) 5-30 5-30 60-150

I, TR
0 10 ms 45 ms 2500 ms

I I 1 1

0
90
0
180 0
180 900

TE,= 20 ms TE2= 90 ms
,I ,I

FIGURE 14-24. Multiple echo pulse sequence can produce spin density and T2-weighted
contrast from the first and second echoes during the same TR. In this diagram, TEl = 20
msec and TE2 = 90 msec.

Inversion recovery, also known as inversion recovery spin echo, emphasizes Tl

relaxation times of the tissues by extending the amplitude of the longitudinal recov-
ery by a factor of two. An initial ISO-degree RF pulse inverts the Mz longitudinal
magnetization of the tissues to -Mz• Mter a delay time known as the time a/inver-
sion (TI), a 90-degree RF pulse rotates the recovered fraction of Mz spins into the
transverse plane to generate the FID. A second ISO-degree pulse at time TE/2 pro-
duces an echo signal atTE (Fig. 14-25). TR in this case is the time between lBO-degree
initiation pulses. As with the spin echo pulse sequence, a TR less than about 5 X TI
of the tissues causes a partial saturation of the spins and a steady-state equilibrium
of the longitudinal magnetization after the first three to four excitations in the
sequence. The echo amplitude of a given tissue depends on TI, TE, TR, and the
magnitude (positive or negative) of Mz•
The signal intensity at a location (x,y) in the image matrix is approximated as
follows:

5 DC PH/(V)(l - 2e-TIITJ + e-TRlTl)

where j(v) is a function of motion (e.g., blood flow) and the factor of 2 arises from
the longitudinal magnetization recovery from -Mz to Mz. Note the lack of T2
dependence in this approximation of S (in fact, there is some T2 decay.) The time
 TR
TE

900
180 0

readout refocusing pulse

RF
pulses
~~~~~~--n~
Signal
out

FIGURE 14-25. Inversion recovery spin echo sequence begins with a 1aO-degree "exci-
tation" pulse to invert the longitudinal magnetization, an inversion time (TI) delay,
and then a gO-degree "readout" pulse to convert recovered Mz into Mxy• A refocusing
1aO-degree pulse creates the echo at time TE for signal acquisition, and then the
sequence is repeated after a time TR between 1aO-degree excitation pulses.

of inversion, TI, controls the contrast between tissues (Fig. 14-26). TheTE must be
kept shon to avoid mixed-contrast images and to minimize T2 dependency. TR
determines the amount of longitudinal recovery between 180-degree excitation
pulses.
The inversion recovery sequence produces "negative" longitudinal magnetiza-
tion that results in negative (in phase) or positive (out of phase) transverse magne-

Image
intensity
Mxy
~-----
. -' -' -' :: •• -~~ =./ -' -
;·;!!~

....
I
Fat
---

White
--~
Gray

_ .. ~

Signal intensity is dependent on T1 (with short TE)

TI Contrast is dependent on TI
~t
-Mz
180
pulse
0
l 90
pulse
0

Inversion Time

FIGURE 14-26. The inversion recovery longitudinal recovery diagram shows the 2x Mz range pro-
vided by the 1aO-degree excitation pulse. A gO-degree readout pulse at time TI and a 1aO-degree
refocusing pulse at time TE/2 from the readout pulse form the echo at time TE. The time scale is not
explicitly indicated on the x-axis, nor is the 1aD-degree refocusing pulse. A short TE is used to reduce
T2 contrast characteristics.
tization when a short TI is used. The actual signals are encoded in one of two ways:
(a) a magnitude (absolute value) signal flips negative Mz values to positive values,
or (b) a phase signal preserves the full range of the longitudinal magnetization from
-Mz to +M" and the relative signal amplitude is displayed from dark to bright
across the dynamic range of the image display. The first (magnitude) method is
used most often, for reasons described later.

Short Tau Inversion Recovery

Short tau inversion recovery, or STIR, is a pulse sequence that uses a very short TI
and magnitude signal processing (Fig. 14-27A). In this sequence, there are two
interesting outcomes: (a) materials with short Tl have a lower signal intensity (the
reverse of a standard Tl-weighted image), and (b) all tissues pass through zero
amplitude (Mz = 0), known as the bounce point or tissue null. Because the time
required to reach the bounce point is known for a variety of tissue types, judicious
TI selection can suppress a given tissue signal (e.g., fat).
Analysis of the equations describing longitudinal recovery with this excita-
tion reveals that the signal null (Mz = 0) occurs at TI = In(2) X Tl, where In is
the natural log and In(2) = 0.693. For fat suppression, the null occurs at a time
equal to 0.693 X 260 msec = 180 msec (where Tl "" 260 msec at 1.5 T). A typi-
cal STIR sequence uses a TI of 140 to 180 msec and a TR of2,500 msec. Com-
pared with a Tl-weighted examination, STIR "fat suppression" reduces distract-
ing fat signals (see Fig. 14-27B) and eliminates chemical shift artifacts (explained
in Chapter 15).

Fluid Attenuated Inversion Recovery

The use of a longer TI reduces the signal levels of CSF and other tissues with long
Tl relaxation constants, which can be overwhelming in the magnitude inversion
recovery image. Fluid attenuated inversion recovery, the FLAIR sequence, reduces
CSF signal and other water-bound anatomy in the MR image by using a TI selected
at or near the bounce point of CSF. This permits a better evaluation of the anatomy
that has a significant fraction of fluids with long Tl relaxation constants. Nulling
of the CSF signal requires TI = In(2) X 3,500 msec, or about 2,400 msec. A TR of
7,000 msec or longer is typically employed to allow reasonable Mz recovery (see Fig.
14-27C).

MR contrast schemes for clinical imaging use the spin echo or a variant of the spin
echo pulse sequences for most examinations. Comparisons of the contrast charac-
teristics are essential for accurate differential diagnoses and determination of the
extent of pathology. This is illustrated with brain images obtained with Tl, proton
density, T2, and FLAIR contrast sequences (Fig. 14-28).
 Transverse decay (T2) Image
intensit~

FIGURE 14-27. A: The short tau inversion

recovery (STIR) and fluid attenuation inversion
recovery (FLAIR) techniques use inversion recov-
ery with magnitude longitudinal magnetization
signals. This allows tissues to be nulled at the
"bounce point" and is a method by which to
apply selective tissue suppression based on
inversion time (TI) and T1 values. Note the
reduced fat signal for STIRand the reduced cere-
brospinal fluid «(SF) signal for FLAIR. B: A STIR
sequence (TR = 5,520 msec, TI = 150 msec, TE =
27.8 msec) and comparison T1 sequence (TR =
750 msec, TE = 13.1 msec) shows the elimination
of fat signal. C: A FLAIR sequence (TR = 10,000
= =
msec, TI 2,400 msec, TE 150 msec) shows the
suppression of (SF in the image, caused by selec-
tion of a TI with which (SF is de-emphasized.
FIGURE 14-28. Magnetic resonance sequences produce variations in contrast for delineation of
anatomy and pathology, including n, proton density (PD), T2, and fluid attenuation inversion recov-
ery (FLAIR) sequences. The images illustrate the characteristics of n with high fat signal; PD with
high signal-to-noise ratio (SNR) yet low contrast discrimination; T2 with high signal and contrast for
long-T2 tissues; and FLAIR, with fluid-containing tissues clearly delineated as a low signal. All images
assist in the differential diagnosis of disease processes.

The gradient recalled echo (GRE) technique uses a magnetic field gradient to
induce the formation of an echo, instead of the ISO-degree pulses discussed ear-
lier. A gradient magnetic field changes the local magnetic field to slightly higher
and slightly lower strength and therefore causes the proton frequencies under its
influence to precess at slightly higher and lower frequencies along the direction of
the applied gradient. For an FID signal generated under a linear gradient, the
transverse magnetization dephases rapidly as the gradient is continually applied.
If the gradient polarity is instantaneously reversed after a predetermined time, the
spins will rephase and produce a gradient echo; its peak amplitude occurs when the
opposite gradient (of equal strength) has been applied for the same time as the
initial gradient. Continually applying this latter (opposite) gradient allows the
echo to decay, during which time the signal can be acquired (Fig. 14-29).
The GRE is not a true spin echo technique but a purposeful dephasing and
rephasing of the FID. Magnetic field (Bo) inhomogeneities and tissue susceptibili-
ties (magnetic field inhomogeneities caused by paramagnetic or diamagnetic tis-
sues or contrast agents) are emphasized in GRE, because the dephasing and
rephasing occur in the same direction as the main magnetic field and do not can-
cel the inhomogeneity effects, as the ISO-degree refocusing RF pulse does. Fig-
ures 14-17 and 14-29 (the rotating frame diagram) may be compared to illustrate
the direction of the Mxy vector of the FID and the echo. With spin echo tech-
niques, the FID and echo vectors form in opposite directions, whereas with GRE
they form in the same direction. Unlike the image produced by spin echo tech-
niques, the GRE sequence has a significant sensitivity to field nonuniformity and
magnetic susceptibility agents. The decay of transverse magnetization is therefore
a strong function ofT2*, which is much shorter than the "true" T2 seen in spin
echo sequences. The "echo" time is controlled either inserting a time delay
between the negative and positive gradients or by reducing the amplitude of the
 Rotating frame
../

FIGURE 14-29. Gradient imaging techniques use a magnetic field gradient instead of a 180-
degree radiofrequency pulse to induce the formation of an "echo." Dephasing the transverse mag-
netization spins with an applied gradient of one polarity and rephasing the spins with the gradient
reversed in polarity produces a "gradient recalled echo." Note that the rotating frame depicts the
magnetic moment vector of the echo in the same direction as the free induction decay (FID) relative
to the main magnetic field, and therefore extrinsic inhomogeneities are not cancelled.

reversed (usually positive) gradient, thereby extending the time for the rephasing
process to occur.
A major variable determining tissue contrast in GRE sequences is the flip angle.
Depending on the desired contrast, flip angles of a few degrees to more than 90
degrees are applied. With a short TR, smaller flip angles are used because there is
less time to excite the spin system, and more transverse magnetization is actually

Qi c
""0 0
:J ._
~m
C1.N
E+::o
(1l (])
c
~~
OlE
'00 (])
""0 (/)
•...
(])
N (])
.- >
- (/)
(1l C
E (1l
o.=:
z
0.0 0.0
0.0 1.0 1.5 2.0 0.0
TR (sec)

FIGURE 14-30. Transverse magnetization as a function of TR and the flip angle. For small flip
angles and short TR, the transverse magnetization is actually higher than for larger flip angles.
generated with smaller flip angles than with a larger flip angle. This occurs because
magnetization quickly builds up in the tissue sample. Figure 14-30 shows a plot of
the signal amplitude of the transverse magnetization versus TR as a function of flip
angle. Notice the lower signal amplitude for the larger flip angles with TR less than
200 msec. Tissue contrast in GRE pulse sequences depends on TR, TE, and the flip
angle, as discussed in the following sections.

Gradient Recalled Echo Sequence with Long TR

(>200 msec)

For the GRE sequence with "long" TR (>200 msec) and flip angles greater than 45
degrees, contrast behavior is similar to that of spin echo sequences. The major dif-
ference is the generation of signals based on T2* contrast rather than on T2 con-
trast, because the gradient echo does not cancel Bo inhomogeneities, as a spin echo
technique does. In terms of clinical interpretation, the mechanisms ofT2* contrast
are different from those of T2, particularly for MRI contrast agents. A long TE
tends to show the diffirences between T2* and T2 rather than the improvement of
T2 contrast, as would be expected in a spin echo sequence. Tl weighting is achieved
with a short TE (less than 15 msec).
For flip angles less than 30 degrees, the small transverse magnetization ampli-
tude reduces the Tl differences among the tissues. Proton density differences are
the major contrast attributes for short TE, whereas longer TE provides T2*
weighting. In most situations, GRE imaging is not useful with the relatively long
TR, except when contrast produced by magnetic susceptibility differences is
desired.

Steady-state precession refers to equilibration of the longitudinal and transverse

magnetization from pulse to pulse in an image acquisition sequence. In all stan-
dard imaging techniques (e.g., spin echo, inversion recovery, generic GRE
sequences), the repetition period TR of RF pulses is too short to allow recovery
of longitudinal magnetization equilibrium, and thus partial saturation occurs.
When this steady-state partial saturation occurs, the same longitudinal magneti-
zation is present for each subsequent pulse. For very short TR, less than the T2*
decay constant, persistent transverse magnetization also occurs. During each pulse
sequence repetition a portion of the transverse magnetization is converted to
longitudinal magnetization and a portion of the longitudinal magnetization is
converted to transverse magnetization. Under these conditions, steady-state lon-
gitudinal and transverse magnetization components coexist at all times in a
dynamic equilibrium. Acronyms for this situation include GRASS (gradient
recalled acquisition in the steady state), FISP (fast imaging with steady-state pre-
cession), FAST (Fourier acquired steady state), and other acronyms given by the
MRI equipment manufacturers.
The user-defined factors that determine the amount of transverse magnetiza-
tion created by each RF pulse and the image contrast in steady-state imaging
include TR, TE, and flip angle. Steady-state imaging is practical only with short and
 very shortTR. In these two regimes, flip angle has the major impact on the contrast
"weighting" of the resultant images.

Small Flip Angles. With small flip angles from 5 to 30 degrees, the amplitude of
longitudinal magnetization is very small, resulting in a very small transverse mag-
netization. Therefore, Tl relaxation differences between tissues are small. For the
same reasons, T2* decay differences are small, particularly with a short TE. Spin
density weighting is the single most important factor for short TR, small flip angle
techniques.

Moderate Flip Angles. With moderate flip angles of 30 to 60 degrees, a larger lon-
gitudinal magnetization produces a larger transverse magnetization, and tissues with
a long Tl have more signal saturation. This produces some Tl weighting. For the
same reason, tissues with long T2* generate a higher signal amplitude. Because Tl
and T2 for most tissues are correlated (i.e., long Tl implies long T2), the contrast
depends on the difference in T2/Tl ratio between the tissues. For example,
parenchyma tissue contrast is reduced (e.g., white versus gray matter), because the
T2/Tl ratios are approximately equal. On the other hand, the T2/Tl ratio for CSF
is relatively high, which generates a large signal difference compared with the
parenchyma and produces a larger signal.

Large Flip Angles. For flip angles in the range of 75 to 90 degrees, almost com-
plete saturation of the longitudinal magnetization occurs, reducing the Tl tissue
contrast. Conversely, a large transverse steady-state magnetization produces greater
T2* weighting and reduces spin density differences. The contrast for short TR, large
flip angle techniques depends on T2* and Tl weighting.
The echo time, TE, also influences the contrast. The descriptions of flip angle
influence assume a very short TE (e.g., less than 5 msec). As TE increases, a greater
difference in T2* decay constants occurs and contributes to the T2* contrast in the
Image.

Steady-State Gradient Recalled Echo Contrast Weighting

Table 14-6 indicates typical parameter values for contrast desired in steady state
and GRE acquisitions. The steady-state sequences produce T2* and spin density
contrast. A GRASS/FISP sequence using TR = 35 msec, TE = 3 msec, and flip
angle = 20 degrees shows unremarkable contrast, but blood flow shows up as a

Flip angle (degrees) 45-90 30-50 5-15 5-15 5-30

TR (msec) 200-400 10-50 200-400 100-300 100-300
TE (msec) 3-15 3-15 30-50 10-20 5-15
FIGURE 14-31. A steady-state gradient recalled echo (GRASS) sequence (TR = 24 msec,
TE = 4.7 msec, flip angle = 50 degrees) of two slices out of a volume acquisition is shown.
Contrast is unremarkable for white and gray matter because of a T2fT1 weighting depen-
dence. Blood flow appears as a relatively bright signal. MR angiography depends on
pulse sequences such as these to reduce the contrast of the anatomy relative to the vas-
culature.

bright signal (Fig. 14-31). This technique enhances vascular contrast, from which
MR angiography sequences can be reconstructed (see Chapter 15).

With very short TR steady-state acquisitions, Tl weighting cannot be achieved to

any great extent, owing to either a small difference in longitudinal magnetization
with small flip angles, or dominance of the T2* effects for larger flip angles pro-
duced by persistent transverse magnetization. The T2* influence can be reduced
by using a long TR (usually not an option), or by "spoiling" (destroying) the
steady-state transverse magnetization by adding a phase shift to successive RF
pulses during the acquisition. (Both the transmitter and receiver must be phase
locked for this approach to work.) By shifting the residual transverse components
out of phase, the buildup of the transverse steady-state signal does not occur,
effectively eliminating the T2* dependency of the signal. Although small T2*
contributions are introduced by the gradient reversal, mostly Tl-weighted contrast
is obtained. Short TR, short TE, moderate to large flip angle, and spoiled trans-
verse magnetization produces the greatest Tl contrast. Currently, spoiled trans-
verse magnetization gradient recalled echo (SPGR) is used in three-dimensional
volume acquisitions because of the extremely short acquisition time allowed by
the short TR of the GRE sequence and the good contrast rendition of the
anatomy provided by Tl weighting (Fig. 14-32).
MR contrast agents (e.g., gadolinium) produce greater contrast with Tl-
weighted spoiled GRE techniques than with a comparable Tl-weighted spin echo
sequence because of the greater sensitivity to magnetic susceptibility of the con-
trast agent. The downside of spoiled GRE techniques is the increased sensitivity
to other artifacts such as chemical shift and magnetic field inhomogeneities, as
well as a lower SNR.
 FIGURE 14-32. A spoiled transverse magnetization gradient recalled echo
(SPGR)sequence (TR = 8 msec, TE = 1.9 msec, flip angle = 20 degrees) of two
slices out of a volume acquisition is shown. The ability to achieve T1 contrast
weighting is extremely useful for rapid three-dimensional volume imaging.
Bright blood (lower portion of each image) and magnetic susceptibility arti-
facts are characteristic of this sequence.

Moving fluid (vascular and CSF) has an appearance in MR images that is compli-
cated by many factors, including flow velocity, vessel orientation, laminar versus
turbulent flow patterns, pulse sequences, and image acquisition modes. Flow-
related mechanisms combine with image acquisition parameters to alter contrast.
Signal due to flow covers the entire gray scale of MR signal intensities, from "black-
blood" to "bright-blood" levels, and flow can be a source of artifacts. The signal
from flow can also be exploited to produce MR angiographic images.
Low signal intensities (flow voids) are often a result of high-velocity signal loss
(HVSL), in which protons in the flowing blood move out of the slice during echo
reformation, causing a lower signal (see discussion of slice selection methods in
Chapter 15). Flow turbulence can also cause flow voids, by causing a dephasing of
spins in the blood with a resulting loss of the magnetic moment in the area of tur-
bulence. With HVSL, the amount of signal loss depends on the velocity of the mov-
ing fluid. Pulse sequences to produce "black blood" in images can be very useful in
cardiac and vascular imaging. A typical black-blood pulse sequence uses a "double
inversion recovery" method, whereby a nonselective ISO-degree RF pulse is initially
applied, inverting all spins in the body, and is followed by a selective ISO-degree RF
pulse that restores the magnetization in the selected slice. During the inversion
time, blood outside of the excited slice with inverted spins flows into the slice, pro-
ducing no signal; therefore, the blood appears dark.
Flow-related enhancement is a process that causes increased signal intensity due
to flowing spins; it occurs during imaging of a volume of tissues (see Chapter 15).
Even-echo rephasing is a phenomenon that causes flow to exhibit increased signal
on even echoes in a multiple-echo image acquisition. Flowing spins that experience
two subsequent ISO-degree pulses (even echoes) generate higher signal intensity
due to a constructive rephasing of spins during echo formation. This effect is
prominent in slow laminar flow (e.g., veins show up as bright structures on even-
echo images).
Flow enhancement in gradient echo images is pronounced for both venous and
arterial structures, as well as CSF. The high intensity is caused by the wash-in
(between subsequent RF excitations) of fully unsaturated spins (with full magneti-
zation) into a volume of partially saturated spins caused by the short TR used with
gradient imaging. During the next excitation, the signal amplitude resulting from
the moving unsaturated spins is about IO times greater than that of the nonmoving
saturated spins. With gradient echo techniques, the degree of enhancement depends
on the velocity of the blood, the slice or volume thickness, and the TR. As blood
velocity increases, unsaturated blood exhibits the greatest signal. Similarly, a thin-
ner slice or decreased repetition time results in higher flow enhancement. In arter-
ial imaging of high-velocity flow, it is possible to have bright blood throughout the
imaging volume of a three-dimensional acquisition if unsaturated blood can pene-
trate into the volume without experiencing an RF pulse.

PerfUsion of tissues via the capillary bed permit the delivery of oxygen and nutrients to
the cells and removal of waste (e.g., CO2) from the cells. Conventional perfusion mea-
surements are based on the uptake and wash-out of radioactive tracers or other exoge-
nous tracers that can be quantified from image sequences using well-characterized
imaging equipment and calibration procedures. For MR perfusion images, exoge-
nous and endogenous tracer methods are used. Freely diffusible tracers using nuclei
such as 2H (deuterium), 3He, 170, and 19Fare employed in experimental procedures
to produce differential contrast in the tissues. More clinically relevant are intravas-
cular blood-pool agents such as gadolinium-diethylenetriaminepentaacetic acid
(Gd-DTPA), which modify the relaxation of protons in the blood in addition to
producing a shorter T2*. Endogenous tracer methods do not use externally added
agents, but instead depend on the ability to generate contrast from specific excita-
tion or diffusion mechanisms. For example, labeling of inflowing spins ("black-
blood" perfusion) uses protons in the blood as the contrast agent. Tagged
(labeled) spins outside of the imaging volume perfuse into the tissues, resulting in
a drop in signal intensity, a time course of events that can be monitored by quan-
titative measurements.
Blood oxygen level-dependent (BOLD) and "functional MR" imaging rely on
the differential contrast generated by blood metabolism in active areas of the brain.
In flow of blood and conversion of oxyhemoglobin to deoxyhemoglobin (a para-
magnetic agent) increases the magnetic susceptibility in the localized area and
induces signal loss by reducing T2*. This fact allows areas of high metabolic activ-
ity to produce a correlated signal and is the basis of functional MRI (fMRI). A
BOLD sequence produces an image of the head before the application of the stim-
ulus. The patient is subjected to the stimulus and a second BOLD image is
acquired. Because the BOLD sequence produces images that are highly dependent
on blood oxygen levels, areas of high metabolic activity will be enhanced when the
prestimulus image is subtracted, pixel by pixel, from the poststimulus image. These
fMRI experiments determine which sites in the brain are used for processing data.
Stimuli in fMRI experiments can be physical (finger movement), sensory (light
flashes or sounds), or cognitive (repetition of "good" or "bad" word sequences). To
improve the SNR in the fMRI images, a stimulus is typically applied in a repetitive,
periodic sequence, and BOLD images are acquired continuously. Areas in the brain
that demonstrate time-dependent activity and correlate with the time-dependent
application of the stimulus are coded using a color scale and are overlaid onto a
gray-scale image of the brain for anatomic reference.
Diffusion depends on the random motion of water molecules in tissues. Inter-
action of the local cellular structure with the diffusing water molecules produces
anisotropic, directionally dependent diffusion (e.g., in the white matter of brain
tissues). Diffusion-weighted sequences use a strong MR gradient (see Chapter 15)
applied to the tissues to produce signal differences based on the mobility and direc-
tionality of water diffusion. Tissues with more water mobility have a greater signal

FIGURE 14-33. Diffusion-

weighted image contrast illus-
trates gray scale-encoded dif-
fusion coefficients of the
brain. (This image corresponds
to the images in Figs. 14-21
through 14-23 and 14-27C).
loss than those of lesser water mobility. The in vivo structural integrity of certain
tissues (healthy, diseased, or injured) can be measured by the use of diffusion-
weighted imaging (DWl), in which water diffusion characteristics are determined
through the generation of apparent diffusion coefficient (ADC) maps (Fig. 14-33).
ADC maps of the spine and the spinal cord have shown promise in predicting and
evaluating pathophysiology before it is visible on conventional Tl- orT2-weighted
images. DWl is also a sensitive indicator for early detection of ischemic injury. For
instance, areas of acute stroke show a drastic reduction in the diffusion coefficient
compared with nonischemic tissues. Diagnosis of multiple sclerosis is a potential
application, based on the measurements of the diffusion coefficients in three-
dimensional space.
Various acquisition techniques are used to generate diffusion-weighted con-
trast. Standard spin-echo and echo planar image (EPr, see Chapter 15) pulse
sequences with diffusion gradients are common. Obstacles to diffusion weighting
are the extreme sensitivity to motion of the head and brain, which is chiefly caused
by the large pulsed gradients required for the diffusion preparation, and eddy cur-
rents, which reduce the effectiveness of the gradient fields. Several strategies have
been devised to overcome the motion sensitivity problem, including common elec-
trocardiographic gating, motion compensation methods, and eddy current com-
pensation.

Magnetization transfer contrast is the result of selective observation of the inter-

action between protons in free water molecules and protons contained in the
macromolecules of a protein. Magnetization exchange occurs between the two
proton groups because of coupling or chemical exchange. Because the protons
exist in slightly different magnetic environments, the selective saturation of the
protons in the macromolecule can be excited separately from the bulk water by
using narrow-band RF pulses (because the Larmor frequencies are different). A
transfer of the magnetization from the protons in the macromolecule partially sat-
urates the protons in bulk water, even though these protons have not experienced
an RF excitation pulse. Reduced signal from the adjacent free water protons by
the saturation "label" affects only those protons having a chemical exchange with the
macromolecules and improves image contrast in many situations (Fig. 14-34). This
technique is used for anatomic MR imaging of the heart, the eye, multiple scle-
rosis, knee cartilage, and general MR angiography. Tissue characterization is also
possible, because the image contrast in part is caused by the surface chemistry of
the macromolecule and the tissue-specific factors that affect the magnetization
transfer characteristics.
MR pulse sequences allow specific contrast differences between the tissues to
be generated by manipulating the magnetization of the tissues in well-defined ways.
The next chapter (Chapter 15) discusses the methods of signal acquisition and
image reconstruction, as well as image characteristics, artifacts, quality control, and
magnetic field safety and bioeffects.
412 Section II: Diagnostic Radiology

Macromolecule Hydration
Bulk Water
.
Layer .
I I H.,H
:~,H H.,H: 0
10 --I:
I )H.Ji
OHI H. /{ I H.,H
1 0 0H.,HI H.,H
1 0 1 0
IH.,HI-(,H I 0
~,HO H. n
H.,H
0
H.,H
0
A: ,H • 01I H.,H
)
H3~,H I 0
1 11. ,H0 H.I,H
H.,H
O~,H~ H.,H H.,H
IH.,H° I 0
0 0
10H.,H1
: H.,H O.
I 0 H.,H
:
I
»~,H H.,H
0
H.,H
0
IH.,HO I
Protons bound to 1 0 I
0

macromolecule I I

RF Excitation
(off-resonance pulse)

FIGURE 14-34. Magnetization transfer contrast is implemented with an off-

resonance radiofrequency pulse of about 1,500 Hz from the Larmor fre-
quency. Excitation and dephasing of hydrogen atoms on the surface of macro-
molecules is transferred via the hydration layer to adjacent "free water"
hydrogen atoms. A partial saturation of the tissues reduces the signals that
would otherwise compete with signals from blood flow.

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