(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.

(FSE) In the pulse sequence timing diagram, a fast spin echo sequence with an echo train length of 3 is illustrated. This sequence is characterized by a series of rapidly applied 180° rephasing pulses and multiple echoes, changing the phase encoding gradient for each echo.
The echo time TE may vary from echo to echo in the echo train. The echoes in the center of the K-space (in the case of linear k-space acquisition) mainly produce the type of image contrast, whereas the periphery of K-space determines the spatial resolution. For example, in the middle of K-space the late echoes of T2 weighted images are encoded. T1 or PD contrast is produced from the early echoes.
The benefit of this technique is that the scan duration with, e.g. a turbo spin echo turbo factor / echo train length of 9, is one ninth of the time. In T1 weighted and proton density weighted sequences, there is a limit to how large the ETL can be (e.g. a usual ETL for T1 weighted images is between 3 and 7). The use of large echo train lengths with short TE results in blurring and loss of contrast. For this reason, T2 weighted imaging profits most from this technique.
In T2 weighted FSE images, both water and fat are hyperintense. This is because the succession of 180° RF pulses reduces the spin spin interactions in fat and increases its T2 decay time. Fast spin echo (FSE) sequences have replaced conventional T2 weighted spin echo sequences for most clinical applications. Fast spin echo allows reduced acquisition times and enables T2 weighted breath hold imaging, e.g. for applications in the upper abdomen.
In case of the acquisition of 2 echoes this type of a sequence is named double fast spin echo / dual echo sequence, the first echo is usually density and the second echo is T2 weighted image. Fast spin echo images are more T2 weighted, which makes it difficult to obtain true proton density weighted images. For dual echo imaging with density weighting, the TR should be kept between 2000 - 2400 msec with a short ETL (e.g., 4).
Other terms for this technique are:
Turbo Spin Echo
Rapid Imaging Spin Echo,
Rapid Spin Echo,
Rapid Acquisition Spin Echo,
Rapid Acquisition with Refocused Echoes

(PWI - Perfusion Weighted Imaging) Perfusion MRI techniques (e.g. PRESTO - Principles of Echo Shifting using a Train of Observations) are sensitive to microscopic levels of blood flow. Contrast enhanced relative cerebral blood volume (rCBV) is the most used perfusion imaging. Both, the ready availability and the T2* susceptibility effects of gadolinium, rather than the T1 shortening effects make gadolinium a suitable agent for use in perfusion imaging. Susceptibility here refers to the loss of MR signal, most marked on T2* (gradient echo)-weighted and T2 (spin echo)-weighted sequences, caused by the magnetic field-distorting effects of paramagnetic substances.
T2* perfusion uses dynamic sequences based on multi or single shot techniques. The T2* (T2) MRI signal drop within or across a brain region is caused by spin dephasing during the rapid passage of contrast agent through the capillary bed. The signal decrease is used to compute the relative perfusion to that region. The bolus through the tissue is only a few seconds, high temporal resolution imaging is required to obtain sequential images during the wash in and wash out of the contrast material and therefore, resolve the first pass of the tracer. Due to the high temporal resolution, processing and calculation of hemodynamic maps are available (including mean transit time (MTT), time to peak (TTP), time of arrival (T0), negative integral (N1) and index.
An important neuroradiological indication for MRI is the evaluation of incipient or acute stroke via perfusion and diffusion imaging. Diffusion imaging can demonstrate the central effect of a stroke on the brain, whereas perfusion imaging visualizes the larger 'second ring' delineating blood flow and blood volume. Qualitative and in some instances quantitative (e.g. quantitative imaging of perfusion using a single subtraction) maps of regional organ perfusion can thus be obtained.
Echo planar and potentially echo volume techniques together with appropriate computing power offer real time images of dynamic variations in water characteristics reflecting perfusion, diffusion, oxygenation (see also Oxygen Mapping) and flow.
Another type of perfusion MR imaging allows the evaluation of myocardial ischemia during pharmacologic stress. After e.g., adenosine infusion, multiple short axis views (see cardiac axes) of the heart are obtained during the administration of gadolinium contrast. Ischemic areas show up as areas of delayed and diminished enhancement. The MRI stress perfusion has been shown to be more accurate than nuclear SPECT exams. Myocardial late enhancement and stress perfusion imaging can also be performed during the same cardiac MRI examination.

(ADC) A diffusion coefficient to differentiate T2 shine through effects or artifacts from real ischemic lesions. In the human brain, water diffusion is a three-dimensional process that is not truly random because the diffusional motion of water is impeded by natural barriers. These barriers are cell membranes, myelin sheaths, white matter fiber tracts, and protein molecules.
The apparent water diffusion coefficients can be calculated by acquiring two or more images with a different gradient duration and amplitude (b-values). The contrast in the ADC map depends on the spatially distributed diffusion coefficient of the acquired tissues and does not contain T1 and T2* values.
The increased sensitivity of diffusion-weighted MRI in detecting acute ischemia is thought to be the result of the water shift intracellularly restricting motion of water protons (cytotoxic edema), whereas the conventional T2 weighted images show signal alteration mostly as a result of vasogenic edema.
The reduced ADC value also could be the result of decreased temperature in the nonperfused tissues, loss of brain pulsations leading to a decrease in apparent proton motion, increased tissue osmolality associated with ischemia, or a combination of these factors. The lower ADC measurements seen with early ischemia, have not been fully established, however, a lower apparent ADC is a sensitive indicator of early ischemic brain at a stage when ischemic tissue remains potentially salvageable.

See also Diffusion Weighted Imaging and Diffusion Tensor Tractography.

This family of sequences uses a balanced gradient waveform. This waveform will act on any stationary spin on resonance between 2 consecutive RF pulses and return it to the same phase it had before the gradients were applied. A balanced sequence starts out with a RF pulse of 90° or less and the spins in the steady state. Prior to the next TR in the slice encoding, the phase encoding and the frequency encoding direction, 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. If the balanced gradients maintain the longitudinal and transverse 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 (like T2 weighted sequences), along with retaining T1 weighted tissue contrast. Balanced sequences are particularly useful in cardiac MRI. Because this form of sequence is extremely dependent on field homogeneity, it is essential to run a shimming prior the acquisition.
Usually the gray and white matter contrast is poor, making this type of sequence unsuited for brain MRI. Modifications like ramping up and down the flip angles can increase signal to noise ratio and contrast of brain tissues (suggested under the name COSMIC - Coherent Oscillatory State acquisition for the Manipulation of Image Contrast).
These sequences include e.g. Balanced Fast Field Echo (bFFE), Balanced Turbo Field Echo (bTFE), Fast Imaging with Steady Precession (TrueFISP, sometimes short TRUFI), Completely Balanced Steady State (CBASS) and Balanced SARGE (BASG).