Rectal staging is necessary for the preoperative assessment of intra- and extramural tumor infiltration or the decision for adjuvant radio-chemotherapy. One indication of MRI with luminal contrast enhancement is small bowel enteroclysis after duodenal intubation for visualization of inflammatory bowel wall thickening and other complications.
"Double contrast" enhancement of the bowel lumen is the administration of plain water or water with methylcellulose along with heavily T2 weighted sequences or contrast enhanced T1 weighted sequences.
Several oral contrast agents have been used for small bowel MRI: Mannitol, metamucil, locust bean gum, and PEG. All provide sufficient bowel distension and homogeneity, but suffer from side effects such as diarrhea. The volume of PEG or mannitol administered must be not too large in order to achieve the best compromise between distension and acceptance by the patient.
MR colonography with positive bowel lumen enhancement requires higher concentrations of paramagnetic agents compared to the available dedicated enteral contrast agents, IV compounds are used to dope water enemas for this purpose.
Some investigators advocate negative bowel enhancement with Contrast Agents to suppress high signal bowel content in MRCP ( Magnetic resonance cholangiopancreaticography ). The use of a mixture of metamucil and 20 ml of gadolinium chelate provides good homogeneity and good tolerance without diarrhea.

(MRS / MRSI - Magnetic Resonance Spectroscopic Imaging) A method using the NMR phenomenon to identify the chemical state of various elements without destroying the sample. MRS therefore provides information about the chemical composition of the tissues and the changes in chemical composition, which may occur with disease processes.
Although MRS is primarily employed as a research tool and has yet to achieve widespread acceptance in routine clinical practice, there is a growing realization that a noninvasive technique, which monitors disease biochemistry can provide important new information for the clinician.
The underlying principle of MRS is that atomic nuclei are surrounded by a cloud of electrons, which very slightly shield the nucleus from any external magnetic field. As the structure of the electron cloud is specific to an individual molecule or compound, then the magnitude of this screening effect is also a characteristic of the chemical environment of individual nuclei.
In view of the fact that the resonant frequency is proportional to the magnetic field that it experiences, it follows that the resonant frequency will be determined not only by the external applied field, but also by the small field shift generated by the electron cloud. This shift in frequency is called the chemical shift (see also Chemical Shift). It should be noted that chemical shift is a very small effect, usually expressed in ppm of the main frequency. In order to resolve the different chemical species, it is therefore necessary to achieve very high levels of homogeneity of the main magnetic field B0. Spectra from humans usually require shimming the magnet to approximately one part in 100. High resolution spectra of liquid samples demand a homogeneity of about one part in 1000.
In addition to the effects of factors such as relaxation times that can affect the NMR signal, as seen in magnetic resonance imaging, effects such as J-modulation or the transfer of magnetization after selective excitation of particular spectral lines can affect the relative strengths of spectral lines.
In the context of human MRS, two nuclei are of particular interest - H-1 and P-31. (PMRS - Proton Magnetic Resonance Spectroscopy) PMRS is mainly employed in studies of the brain where prominent peaks arise from NAA, choline containing compounds, creatine and creatine phosphate, myo-inositol and, if present, lactate; phosphorus 31 MR spectroscopy detects compounds involved in energy metabolism (creatine phosphate, adenosine triphosphate and inorganic phosphate) and certain compounds related to membrane synthesis and degradation. The frequencies of certain lines may also be affected by factors such as the local pH. It is also possible to determine intracellular pH because the inorganic phosphate peak position is pH sensitive.
If the field is uniform over the volume of the sample, "similar" nuclei will contribute a particular frequency component to the detected response signal irrespective of their individual positions in the sample. Since nuclei of different elements resonate at different frequencies, each element in the sample contributes a different frequency component. A chemical analysis can then be conducted by analyzing the MR response signal into its frequency components.

See also Spectroscopy.

Quick Overview

Ferromagnetic metal will cause a magnetic field inhomogeneity, which in turn causes a local signal void, often accompanied by an area of high signal intensity, as well as a distortion of the image. They create their own magnetic field and dramatically alter precession frequencies of protons in the adjacent tissues. Tissues adjacent to ferromagnetic components become influenced by the induced magnetic field of the metal hardware rather than the parent field and, therefore, either fail to precess or do so at a different frequency and hence do not generate useful signal. Two components contribute to susceptibility artifact, induced magnetism in the ferromagnetic component itself and induced magnetism in protons adjacent to the component.
Artifacts from metal may have varied appearances on MRI scans due to different type of metal or configuration of the piece of metal. The biocompatibility of metallic alloys, stainless steel, cobalt chrome and titanium alloy is based on the presence of a constituent element within the alloy that has the ability to form an adherent oxide coating that is stable, chemically inert and hence biocompatible. In relation to imaging titanium alloys are less ferromagnetic than both cobalt and stainless steel, induce less susceptibility artifact and result in less marked image degradation.

Remove the metal when possible or take a not so sensitive sequence (a SE or another sequence with a rephasing 180° pulse).

See also Susceptibility Artifact.

Adiabatic RF pulses are amplitude and frequency modulated pulses that are insensitive to the effects of B1-inhomogeneity and frequency offset (conventional RF pulses used in MRI are only amplitude modulated). Due to an extended application time adiabatic RF pulses are mostly used in NMR imaging applications.

(bFFE) A FFE sequence using a balanced gradient waveform. A balanced sequence starts out with a RF pulse of 90° or less and the spins in the steady state. Before the next TR in the slice phase and frequency encoding, gradients are balanced so their net value is zero. Now the spins are prepared to accept the next RF pulse, and their corresponding signal can become part of the new transverse magnetization. Since the balanced gradients maintain the transverse and longitudinal magnetization, the result is, that both T1 and T2 contrast are represented in the image. This pulse sequence produces images with increased signal from fluid, along with retaining T1 weighted tissue contrast. Because this form of sequence is extremely dependent on field homogeneity, it is essential to run a shimming prior the acquisition. A fully balanced (refocused) sequence would yield higher signal, especially for tissues with long T2 relaxation times.

See Steady State Free Precession and Gradient Echo Sequence.