Knee and shoulder MRI exams are the most commonly requested musculoskeletal MRI scans. Other MR imaging of the extremities includes hips, ankles, elbows, and wrists. Orthopedic imaging requires very high spatial resolution for reliable small structure definition and therefore places extremely high demands on SNR.
Exact presentation of joint pathology expects robust and reliable fat suppression, often under difficult conditions like off-center FOV, imaging at the edge of the field homogeneity or in regions with complex magnetic susceptibility.
MR examinations can evaluate meniscal dislocations, muscle fiber tears, tendon disruptions, tendinitis, and diagnose bone tumors and soft tissue masses. MR can also demonstrate acute fractures that are radiographically impossible to see. Evaluation of articular cartilage for traumatic injury or assessment of degenerative disease represents an imaging challenge, which can be overcome by high field MRI applications. Currently, fat-suppressed 3D spoiled gradient echo sequences and density weighted fast spin echo sequences are the gold-standard techniques used to assess articular cartilage.
Open MRI procedures allow the kinematic imaging of joints, which provides added value to any musculoskeletal MRI practice. This technique demonstrates the actual functional impingements or positional subluxations of joints. In knee MRI examinations, the kinematical patellar study can show patellofemoral joint abnormalities.

See also Open MRI, Knee MRI, Low Field MRI.

(LAVA) The MRI technique LAVA is based on a 3 dimensional spoiled gradient echo pulse sequence. The optimized inversion pulse and a new fat suppression technique (called segmented special) provides enhanced image contrast and uniform fat suppression. Array spatial sensitivity encoding technique (ASSET) with partial data filling and shorter TR/TE enables to use short breath holds for dynamic liver imaging with multiple phases.

Liver imaging can be performed with sonography, computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound is, caused by the easy access, still the first-line imaging method of choice; CT and MRI are applied whenever ultrasound imaging yields vague results. Indications are the characterization of metastases and primary liver tumors e.g., benign lesions such as focal nodular hyperplasia (FNH), adenoma, hemangioma and malignant lesions (cancer) such as hepatocellular carcinomas (HCC). The decision, which medical imaging modality is more suitable, MRI or CT, is dependent on the different factors. CT is less costly and more widely available; modern multislice scanners provide high spatial resolution and short scan times but has the disadvantage of radiation exposure.
With the introduction of high performance MR systems and advanced sequences the image quality of MRI for the liver has gained substantially. Fast spin echo or single shot techniques, often combined with fat suppression, are the most common T2 weighted sequences used in liver MRI procedures. Spoiled gradient echo sequences are used as ideal T1 weighted sequences for evaluating of the liver. The repetition time (TR) can be sufficiently long to acquire enough sections covering the entire liver in one pass, and to provide good signal to noise. The TE should be the shortest in phase echo time (TE), which provides strong T1 weighting, minimizes magnetic susceptibility effects, and permits acquisition within one breath hold to cover the whole liver. A flip angle of 80° provides good T1 weighting and less of power deposition and tissue saturation than a larger flip angle that would provide comparable T1 weighting.
Liver MRI is very dependent on the administration of contrast agents, especially when detection and characterization of focal lesions are the issues. Liver MRI combined with MRCP is useful to evaluate patients with hepatic and biliary disease.
Gadolinium chelates are typical non-specific extracellular agents diffusing rapidly to the extravascular space of tissues being cleared by glomerular filtration at the kidney. These characteristics are somewhat problematic when a large organ with a huge interstitial space like the liver is imaged. These agents provide a small temporal imaging window (seconds), after which they begin to diffuse to the interstitial space not only of healthy liver cells but also of lesions, reducing the contrast gradient necessary for easy lesion detection. Dynamic MRI with multiple phases after i.v. contrast media (Gd chelates), with arterial, portal and late phase images (similar to CT) provides additional information.
An additional advantage of MRI is the availability of liver-specific contrast agents (see also Hepatobiliary Contrast Agents). Gd-EOB-DTPA (gadoxetate disodium, Gadolinium ethoxybenzyl dimeglumine, EOVIST Injection, brand name in other countries is Primovist) is a gadolinium-based MRI contrast agent approved by the FDA for the detection and characterization of known or suspected focal liver lesions.
Gd-EOB-DTPA provides dynamic phases after intravenous injection, similarly to non-specific gadolinium chelates, and distributes into the hepatocytes and bile ducts during the hepatobiliary phase. It has up to 50% hepatobiliary excretion in the normal liver.
Since ferumoxides are not eliminated by the kidney, they possess long plasmatic half-lives, allowing circulation for several minutes in the vascular space. The uptake process is dependent on the total size of the particle being quicker for larger particles with a size of the range of 150 nm (called superparamagnetic iron oxide). The smaller ones, possessing a total particle size in the order of 30 nm, are called ultrasmall superparamagnetic iron oxide particles and they suffer a slower uptake by RES cells. Intracellular contrast agents used in liver MRI are primarily targeted to the normal liver parenchyma and not to pathological cells. Currently, iron oxide based MRI contrast agents are not marketed.
Beyond contrast enhanced MRI, the detection of fatty liver disease and iron overload has clinical significance due to the potential for evolution into cirrhosis and hepatocellular carcinoma. Imaging-based liver fat quantification (see also Dixon) provides noninvasively information about fat metabolism; chemical shift imaging or T2*-weighted imaging allow the quantification of hepatic iron concentration.

See also Abdominal Imaging, Primovistâ„¢, Liver Acquisition with Volume Acquisition (LAVA), T1W High Resolution Isotropic Volume Examination (THRIVE) and Bolus Injection.

For Ultrasound Imaging (USI) see Liver Sonography at Medical-Ultrasound-Imaging.com.

(MEDIC) MEDIC is a heavily T2* weighted spoiled gradient echo sequence with multiple echoes. MEDIC uses a series of identically phase encoded gradient echoes, sampled per line in k-space. Unipolar frequency encoding gradients are used to achieve flow compensation and to avoid off resonance effects. For each echo the magnitude images are reconstructed and postprocessed by using a sum of squares algorithm to improve the signal to noise ratio. The increased receiver bandwidth reduces the T2* effects and impairment of the spatial resolution.
The multi echo data image combination sequence is potentially useful in imaging of cartilage in joints.

(PSIF) A heavily T2* weighted contrast enhanced gradient echo (mirrored FISP) technique. Because TE is relatively long, there are much flow artifacts and less signal to noise. In normal gradient echo techniques a FID-signal results after the RF pulses. This FID is rephased very fast and just before the next FID follows a spin echo signal. The SE is spoiled in FLASH sequences, but with PSIF sequences, only the SE is measured, not the FID.