MRI Quiz Flashcards
The amount of diffusion weighting is determined by:
- Strength of the diffusion gradients
- Duration of the gradients
- Time between gradient pulses
Common problems in DWI
- Sensitivity to magnetic susceptibility when using echo planar readout
- Bulk patient motion
- Low SNR
Contrast in Diffusion Weighted Imaging (DWI) depends on:
- Degree to which molecular mobility is impaired (water restriction)
- Sensitivity of the sequence to Brownian motion (rate of water diffusion, more sensitive than T1 or T2)
- Direction of water diffusion.
Chiari Malformation CSF Flow Study - flow during systole
Bright white
Chiari Malformation CSF Flow Study - flow during diastole
Black
Acoustic Neuroma Scans
- 3mm Axial/Coronal T1 pre and post
- T2 3D volume
- Center at level of EAM
Chiari Malformation Scans
- Sagittal
- Thin, 3mm or less
- T2 for CSF
Pituitary Adenoma Scans
- Thin Sagittal and Coronal (3mm or less)
- DCE or basic T1 perfusion thin Coronal
- Small FOV T2 Coronal useful for CSF superior to pit
- Scan rapidly after contrast (tumors appear as low signal compared to enhanced pituitary gland)
Diplopia Scans
Thin cuts through orbits, usually 3mm Axial/Coronal and including FS pre and post contrast
Bell’s Palsy
A form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) that results in the inability to control facial muscles on the affected side
MS Scans
- Thin slice FLAIR high res Axial/Sagittal
- Delayed post contrast T1
Vertebral arteries
- Originate for subclavian arteries
- Passes through transverse foramen of C6 to C1
- Joins to form basilar artery at the base of medulla oblongata
Increasing the VENC (velocity encodings) value will:
Allow more arterial vessels to be visualized
The insulae play a role in:
Usually linked to emotion or the regulation of the body’s homeostasis:
- Perception
- Motor control
- Self awareness
- Cognitive functioning
- Interpersonal experience
Inverted V sign (T2 hyperintense)
Subacute Combined Degeneration
Level of Conus Medullaris
T12-L1
What images are mandatory in cervical spine imaging for evaluation of cord anatomy (H sign), investigating extramedullary disease, and/or the discrimination of osteophytes vs. disc herniation?
Axial gradient echo T2*
Mandatory sequence in Abdominal MRI protocol
- T1 In/Out Phase
- Evaluate for fatty liver, adrenal adenoma, and other conditions with increased lipid content
Hemosiderin, hemochromatosis best visualized:
MR imaging of the liver with T2* GE (iron deposit, hypointense on T2* and T2)
MR enterography
-Sequences embedded with acceleration factors are essential in this exam, such as high resolution LAVA/THRIVE/VIBE
sequences in the Coronal and Axial planes
-IV gadolinium differentiates chronic from active disease
Standard in Prostate MRI protocol
Small FOV, high resolution T2 in all three planes
Silicone Only
All tissues suppressed EXCEPT silicone using fat and water suppression simultaneously
Silicone Suppression
A T1 Isotropic Voxel technique (THRIVE) with an Inversion Delay time long enough to suppress the signal from silicone
The branches of the abdominal aorta, from proximal (superior) to distal are:
Celiac, superior mesenteric, renal, and inferior mesenteric arteries
The common iliac veins join together to form:
IVC
Disease that is characterized by narrowing of the aorta:
Aortic coarctation (occasionally abbreviated CoA: Coarctation of Aorta)
Most optimal planes for TOF subclavian arteries
Axial/Sagittal
The anterior tibial artery leads into the:
Dorsalis pedis artery
The first major branch of the abdominal aorta is the celiac trunk, which branches into the ________ arteries
Gastric, hepatic and splenic
The _________ transports deoxygenated blood from the posterior walls of the thorax and abdomen into the superior vena cava vein
Azygos vein
The hepatic portal vein is a vessel in the abdominal cavity that drains blood:
From the gastrointestinal tract and spleen to capillary beds in the liver
The hepatic portal vein is formed by the:
Confluence of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, gastric, and cystic veins
The four muscles that form the rotator cuff are:
Supraspinatus, infraspinatus, teres minor, and subscapularis (SITS)
Best plane for median nerve:
Axial
Median nerve branches:
- Off the brachial plexus down to wrist
- Only nerve passing through the carpal tunnel
Optimal imaging plane to demonstrate the carpal bones and the interosseous ligaments:
Coronal
Kienbock’s disease
Condition of osteomalacia in the lunate bone of the wrist, an avascular necrosis (death and fracture of bone tissue due to interruption of blood supply) with fragmentation and collapse of the lunate
Triangular Fibro-Cartilage Complex optimal imaging plane
Coronal
Supraspinatus
- Originates above the spine of the scapula and inserts on the greater tuberosity of the humerus
- Abducts, or elevates, the shoulder joint
Infraspinatus
- Originates below the spine of the scapula, in the infraspinatus fossa, and inserts on the posterior aspect of the greater tuberosity of the humerus
- Externally rotates the shoulder joint
Teres Minor
- Originates on the lateral scapula border and inserts on the inferior aspect of the greater tuberosity of the humerus
- Externally rotates the shoulder joint
Subscapularis
- Originates on the anterior surface of the scapula, sitting directly over the ribs, and inserts on the lesser tuberosity of the humerus
- Works to depress the head of the humerus allowing it to move freely in the glenohumeral joint during elevation of the arm
How to apply metal artifact reduction
- Use TSE/FSE instead of GE
- Use STIR instead of FS
- Wider rBW
- No PI or image uniformity correction (they rely on GE based reference scan)
- Thin slices/small pixel/large matrix
- High TSE factor/ETL (multiple 180° RF pulses further compensate for metal artifacts)
- Add NEX/NSA to buy back signal
Knee collateral ligament imaging plane
Coronal
ACL tear positioning
15 deg external rotation
Knee cruciate ligament imaging place
Sagittal
Shoulder MRI landmark
Coracoid process
A useful sequence for the evaluation of bone contusions or fractures is:
STIR
Carpal tunnel imaging plane
Axial
TOF MRA uses:
T1 gradient echoes with TR and FA (flip angle) selections to suppress signal from stationary tissues, visualizing flowing blood by flow-related enhancement
PC MRA uses:
T2 gradient echoes that rely on velocity-induced phase shifts for vascular signal
Laminar flow
Blood flow that is at different but consistent velocities across a vessel
Spiral flow
Blood flow where the direction of flow is spiral
Vortex flow
Blood flow that is initially laminar, then intersects a vessel stenosis or stricture, becoming high velocity central flow and spiral near the walls of the vessel
Turbulent flow
Blood flow within a vessel that is characterized by different velocities that fluctuate randomly
In TOF MRA, to minimize signal from background tissues, TE should be selected that enable the signals from:
Fat and water to be out-of-phase
3D TOF (time of flight) MRA is typically used to visualize smaller vessels, and utilizes thinner slices, but yields:
Less suppression of background tissues than 2D TOF
Two factors that increases intravoxel dephasing and reduces signal in TOF MRA
- Longer TE
- Larger voxel
Phase Contrast MRA
- Relies on velocity induced phase shifts to distinguish between moving protons and stationary protons
- Produces the most background tissue suppression
- Usually has the longest imaging times (compared to 2D TOF and 3D TOF)
- Provides both directional and velocity information from flowing blood
- The most useful technique to evaluate slow flow within a vessel
- The velocity or speed of the vessel(s) of interest determines the signal intensities in phase contrast MR angiography (PCA)
Increasing the VENC (velocity encodings) value will allow:
More arterial vessels to be visualized
Vertebral arteries originate from the:
Right and left subclavian arteries
A Contrast Enhanced MRA Runoff of the Lower Extremities would require coverage to include:
Iliac bifurcation down to and including the dorsalis pedis artery
The optimal technique to visualize the Circle of Willis would be:
3D TOF
The __________ of blood is responsible for the bright blood signal in time of flight MR angiography
Flow
In order to obtain a time of flight MRA of the IVC a presaturation band would be placed:
Superior
The degree of stenosis ___________ with time-of-flight MRA
May be overestimated
Gradient amplitude
Strength of the gradient
Gradient rise time
Time it takes for the gradient to reach its full amplitude (microseconds)
Gradient slew rate
- Speed rate of ascent or descent of a gradient from zero to its maximum amplitude, either positive or negative (amplitude divided by rise time, mT/m/msec or T/m/sec)
- The strength of the gradient over a specific distance
To convert vendor spatial gradient map into manufacturer conditions chart:
1 Tesla/meter = 100 Gauss / cm
Duty cycle
Time the gradients are on during a TR period, “gradient working time”
Parameter changes affecting the pulse duty cycle include:
- Increased # slices
- Fat suppression pulses (SPAIR requires increased TR compared to SPIR)
- Presaturation slabs/bands
- Increased ETL
180° RF pulse is ____ times the power of the initial 90° RF pulse
Four
Doubling field strength results in ____fold increase in SAR potential
Four
(SAR is proportional to the power of 2 for the resonant frequency)
Managing SAR
- Avoid shortest TR
- Minimize use of presaturation slabs/FS pulses, use least # of slices within TR period
- Shortest ETL possible
- Use PI techniques
- Use longer and lower amplitude transmit RF pulses (increases scan time)
- Consider Transmit/Receive coil (significant increase in scan time)
Utilization of surface coils (linear coils) yields:
-More localized, smaller FOV (field of view) capability, with increased SNR
SNR penetration depth for surface coil
1/2 coil diameter
When going from a linear coil to a quadrature (CP) coil, SNR is increased by:
40%
Doubling the magnetic field strength will:
Double SNR
In a superconducting magnet, the magnetic field strength is increased by:
Increasing the turns of wire, current in the wires, or by reducing the spacing between the wires
System Performance Testing (SPT), or PIQT (Periodic Image Quality Test)
Inherent manufacturer quality mechanism by which a technologist, physicist or field service engineer might evaluate the performance of an MRI system
Center Frequency
To ensure integrity of MR system operating frequency, at which all system coils will be tuned to
Transmit gain is a quality measure evaluating for?
Accuracy of flip angles
Field strength at magnet isocenter is measured in units of:
Tesla
The local RF coil used to image a human brain is typically located/kept in the __________
Magnet room
High field scanners typically have field strengths greater than or equal to
1.5 Tesla
What is the daily/weekly QA/QC indicator testing for the accuracy of the magnetic field in determining coil tuning and consistent magnetic field strength?
Center frequency
Precessional Frequency
Defined as the resonant frequency, and is equal to the product of the magnetic field and the gyromagnetic ratio
Larmor equation for precessional frequency:
42.57 MHz per Tesla
1 Newton per ampere-meter =
1 Tesla [T]
1 Coulomb =
6.24 X 10 18e-
1 Coulomb/second =
1 ampere
The difference in chemical shift is approximately 3.5 parts-per-million (ppm) which at 1 Tesla corresponds to a frequency difference between that of fat and water of approximately:
147 Hz
Faraday’s law of induction states that a changing magnetic field will induce:
A voltage
Ferromagnetic
- Iron and iron-like substances that can generate a relatively strong magnetic field
- Stainless steel, iron, nickel, etc.
Paramagnetic
- Very weak magnetic field
- Gadolinium is used as a contrast
Diamagnetic
No magnetic field
Magnetic susceptibility
Extent to which a material or tissue becomes magnetized in an external magnetic field
Magnetic permeability
How well a material attracts the imaginary lines of the magnetic field
T1 relaxation
- Nuclei give up their energy to surrounding tissues
- SPIN-LATTICE RELAXATION
T2 relaxation
-SPIN-SPIN RELAXATION
When thermal equilibrium is reached
There are more hydrogen protons in the low energy state
____________ states that a changing magnetic field will induce a voltage
Faraday’s law of induction
What is defined as the excess number of hydrogen protons aligned with the static magnetic field direction (B0)?
Longitudinal magnetization
The difference in chemical shift is approximately ______ parts-per-million
3.5 ppm
Immediately following the application of the 90° RF pulse, the transverse magnetization is:
Non-zero
Tort
- In common law jurisdictions, is a wrong that involves a breach of a civil duty (other than a contractual duty) owed to someone else
- May be defined as a personal injury; or as “a civil action other than a breach of contract”
Civil law
Law that pertains to private legal rights and matters
To establish a claim of malpractice, four conditions must be proved true:
- The defendant had a duty to provide reasonable care to the patient
- The patient has sustained some type of loss or injury
- The defendant is the party responsible for the loss
- The loss is attributable to negligence or improper practice
Tau
The time between the pulses (btwn 90ºRF - 180ºRF and 180ºRF - echo) in spin echo (also known as 1/2 TE)
_________ gradient – magnetic field gradient applied during the moment when the echo is formed
Readout
_______________ is defined as the range or spectrum of frequencies (minimum to maximum processed frequency) of a pulse sequence acquired by an RF system
Bandwidth
________ is defined as the ratio of the magnetic moment (field strength) of a rotating charged particle, such as an electron, to its angular momentum (frequency)
Gyromagnetic ratio
The linear increased or decreased change in the magnetic field of a certain orientation is defined as a _________
Gradient
________ is comprised of the components of the magnetization in the imaging object after excitation, sampled from the receiver coil signal and stored as a function of time during the data acquisition of an MR imaging sequence
Raw data
DSC
Dynamic Susceptibility Contrast, or better known as T2* gradient Perfusion imaging
Patients in need of MRI IV gadolinium contrast should first have their glomerular filtration rate (GFR) checked if they:
- Are over the age of 60
- Have a history of hypertension
- Have a history of diabetes
- Have a history of renal disease
Sedated patient must always be monitored with a:
Pulse oximeter
A pediatric patient undergoing an MRI with conscious sedation should be given:
NPO for 4 hours before sedation
Tachycardia / Bradycardia
>100 BPM / <60 BPM
Normal pulse rate
About 60-100 BPM
Normal oxygen saturation levels
Approximately 95-100%
Patient develops severe bronchospasms after the injection of contrast
Epinephrine
Febrile
Pertaining to or marked by fever; feverish
The effects of time varying magnetic fields can include all of the following EXCEPT:
Warmth and/or increase in body temperature
When moving blood enters a magnetic field, an effect on the ECG seen as a “T wave swelling” or spike occurs, also known as:
Magnetohydrodynamic effect
Contrast reactions are very rare in MRI injections, at a rate of:
~1% or less than 1%
FDA limits for whole body SAR
4 W/kg over 15 min
FDA limits for head SAR
3 W/kg over 10 minutes
As the flip angle is doubled, the RF absorption (deposition) increases by:
Factor of 4
FDA guidelines dictate a level of concern when RF energy absorption produces an increase in body temperature of:
1° Celsius
Risk factors of MR exposure with regards to SAR include all of the following:
- Obesity
- Hypertension
- Cardiovascular disease
- Elderly
- Sedatives/Diuretics
- Diabetes
RF energy is:
Low energy, non-ionizing radiation
The FDA limit on time varying magnetic fields is:
Once the patient experiences peripheral nerve stimulation
SE T1 Parameter
TR: 350-700 ms
TE: 10-30 ms
SE PD Parameter
TR: 1500-3000 ms
TE: 10-30 ms
SE T2 Parameter
TR: 2000-6000 ms
TE: 70-120 ms
TR is directly proportional to:
Scan time
When increasing NEX/NSA, SNR (signal-to-noise ratio) increases by:
Square root (√) of the % increase
Reducing the FOV by a factor of 2 will reduce the voxel volume by:
Factor of 4
Spin Echo / Gradient Echo (2D) Scan Time Formula
TR x Phase Matrix x NEX
Fast Spin Echo Scan Time Formula
TR x Phase Matrix x NEX / ETL
Gradient Echo Scan Time Formula
TR x Phase Matrix x NEX x # of Slices
Pixel Size Formula
Field of View / Matrix
Pixel Area Formula
Phase Pixel Size x Freq Pixel Size (answer squared)
Voxel Volume Formula
Pixel Area x Slice Thickness (answer cubic)
T1 weighted ETL
Approx 2-7
PD weighted ETL
Approx 3-12
T2 weighted ETL
Approx 10-40
Increasing ETL will:
Reduces number of slices
Echo Spacing
Time between successive 180º echoes in a fast
spin echo pulse sequence (a typical FSE sequence can have an echo
spacing of 5 ms to 20 ms, approximately)
Number of rows of k-space filled per TR period in a SE sequence
1
Number of rows filled per TR period in a FSE
Same as ETL or TSE factor
Collecting the low frequency (high amplitude signal) data points in k-space at the
start of the scan (in a spiral fashion)
Elliptic Centric K-space Filling
During dynamic enhanced imaging for vasculature or visceral structures, contrast
is administered and k-space is filled with:
Centric K-space Filling (to ensure that the contrast enhancement is well visualized)
For the 180º pulse immediately
prior to the echo chosen as the effective TE, the phase encoding is at its:
Lowest
Acquiring a bit more than half the phase dimension k-space samples, then
interpolating the data with zeroes for the remaining half:
Half Fourier, Partial Fourier, Halfscan, or Zero Fill (made possible due to the symmetry in k-space data)
Only half the views of k-space are filled in the
frequency axis, an acceleration technique used to shorten TR and TE:
Partial or Fractional Echo (advantageous in rapid and EPI imaging, in addition
to CE MRA and faster T1 images)
Time increase for NSA/NEX
Directly proportional
Halving FOV cuts SNR to:
25% of the original value, due to the pixel size reduction by a factor of
4 (phase and frequency dimensions)
Doubling FOV increases SNR to:
400% of the original value, due to the pixel size increase by a
factor of 4 (phase and frequency dimensions)
K-space is typically filled:
One line at a time
If the repetition time (TR) is doubled, the scan time will:
Double
Each line of k-space is defined by the:
Phase encoding gradient