MRI magnetic resonance imaging for chest5.pptx

MRI CHEST, ABDOMEN
AND MR ANGIOGRAPHY
By K.Keerthana
2nd year post graduate

CARDIAC MRI
● Non invasive cardiac imaging .
● It tells about the structure and function of heart .
● The concept of T1W and T2W images are same in any other
mri but various Protocols are required for evaluation of cardiac
disease .

● Functional assessment - LV function LV and RV ESV EDV ,LVEF,
LV mass and also RV function .
● Gold standard for assessment for all these is CMRI ( accurate and
reproducible, 3D , no geometric assumptions )
● Normal shape of RV is triangular , LV is prolate ellipse .
Modalities in functional assessment :
1)CINE IMAGING ( steady state free precession )- shows the
contraction and relaxation of the heart in a real time .
Normal LVEF in CMRI - 55% or more , 50-55% considered low normal
Normal LVEF in ECHO (simpson’s method ) - 51%

2)Myocardial tagging - Each segment of LV myocardium is
represented by a grid to see myocardial fibres are contracting or
relaxing adequately or not .
● Grid pattern -Normal
● Homogeneous white -
demonstrate abnormal
areas of strain , infiltration
with cardiac deposits
( fibrosis / amyloid ) as in
HOCM/RCM .

Tissue characterisation : 4 modalities
● T1W ( for assessment of cardiomyopathy, provide info about
anatomy ) and T2W (edema )- water/ blood appears bright on
T2 W.
● EGE ( tells hyperaemia and capillary permeability-suggests
myocarditis)and LGE( tells about scar /fibrosis -
cardiomyopathy)
● T1 mapping , ECV quantification( advanced)
● T2 * imaging - tells about cardiac iron overload state in cardiac
hemosiderosis .

Clinical applications of cardiac MRI
● Congenital heart disease
● Valvular heart disease
● Cardiomyopathies
● Ventricular function
● Coronary artery disease
● Myocardial perfusion and viability
● Cardiac and pericardial masses
● Pericardial disease

Global
subendocardial
enhancement-
cardiac amyloidosis

Mid wall
hyperenhancement
restricted to
interventricular septum -
myocarditis

MR ANGIOGRAPHY (MRA )
● Contrast- enhanced and non contrast MRA
● Non contrast MRA : techniques used are time of flight MRA
and phase contrast MRA
Black blood imaging Bright blood imaging

● Black blood imaging can be used to differentiate vessel lumen
from the blood signal within lumen
● Identify various pathologies like aneurysms,vasculitis .
● Bright blood imaging used to visualise thrombus and stenotic or
regurgitant flow jets

● Time of flight MRA - useful for rapid blood flow like extracranial
carotids
● Phase contrast MRA - useful for studying small tortuous
intracranial vessels ( when the blood flow is slow. )
TOF -MRA PC-MRA

Contrast enhanced MRA
Of lower limb arteries

MR Angiography used to evaluate
● Arterial aneurysms
● Aortic dissection / coarctation
● Peripheral atherosclerosis
● Congenital heart disease
● Renal artery stenosis
● Stroke
● Thoracic outlet syndrome
● Carotid artery disease
● Av malformations

MRI CHEST
● Mediastinum - thymus protocol
● Thymic MRI used to distinguish surgical from non surgical
thymic lesions ( eg.thymic hyperplasia,thymic cysts,and
lymphoma.)

MRI ABDOMEN
Abdominal pain in pregnancy protocol :
● The use of MRI is considered safe in all trimesters of pregnancy
● The use of gadolinium contrast is relatively contraindicated in pregnancy
due to gadolinium crossing the placental barrier .
● The appendix is difficult to identify on MRI , in latter stages of
pregnancy. The presence of restricted diffusion in region of cecal pole
helps to diagnose acute appendicitis.
● Physiological hydronephrosis is seen in pregnancy, on right side .
● Dilated ovarian vein can be mistaken for an appendix.

MR ENTEROGRAPHY
● a/k/a MRI small bowel study ; Adv - no ionizing radiation.
Indications :
● Inflammatory bowel disease (and it’s complications stricture & fistula )
● Celiac disease
● Postoperative adhesions
● Radiation enteritis
● Scleroderma
● Small bowel malignancies
● Polyposis syndromes

MR ENTEROCLYSIS
● Invasive technique for MRI evaluation of small bowel , mostly
used for evaluation of crohn disease and it’s complications.
● No ionising radiation
● Superior in detection of mild small bowel superficial pathology
and jejunal disease .

ADRENAL GLAND PROTOCOL
● To assess indeterminate adrenal lesions , in particular, lipid
poor adenomas.

LIVER AND BILIARY TREE
● DWI - indications
● Hepatocellular carcinoma , metastasis, hepatoblastoma ,
embryonal sarcoma in children.

MRCP
● Visualises biliary and pancreatic tree non invasively without use of
contrast or radiation
Clinical applications of MRCP :
● Cystic diseases of bile duct ( choledochal cyst , choledochocele
and Caroli’s disease )
● Congenital anomalies ( pancreatic divisum )
● Choledocholithiasis
● Primary sclerosing cholangitis

● Post surgical complications ( like strictures , retained
stones ,biliary leak and fistula )
● Chronic pancreatitis
● Neoplastic lesions

MR ELASTOGRAPHY
● Used to assess liver stiffness
● To quantify and monitor liver fibrosis change with or without
therapy.
● Adv over usg technique - larger portion of the liver is sampled.

Anus and rectum
● Anal and rectal cancer tumours (to assess stage and
extension)
● For assessment of perianal fistula
● MR defecating proctography : dynamic study for evaluation
of the pelvic floor and pelvic organ prolapse, bladder base
descent ( cystocoele), vaginal vault descent ,
rectocele,intussusception .

MRI PELVIS
Uterus and ovaries
● Endometrial carcinoma
● Endometriosis
● Cervical carcinoma , ovarian carcinoma
Urological conditions
● Prostate MRI - active surveillance , locoregional prostate
cancer staging and recurrence.

MRI magnetic resonance imaging for chest5.pptx

MRI magnetic resonance imaging for chest5.pptx

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