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Department of Radiology University of California San Diego John R. Hesselink, M.D. MR Imaging of the Brain
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MR System Components Computer Gradient Amplifier Receiver Transmitter Digitizer RF Coil Gradient RF Coil Gradient Magnet
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MR Imaging Proton density T1 relaxation time T2 relaxation time Flow effects Source of Signal and Contrast
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Spin-echo Pulse Sequence Single Echo T1-weighted RF Signal TR TE 1 st echo 2 nd echo
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Spin-echo Pulse Sequence Dual Echo T2-weighted 1 st echo 2 nd echo RF Signal TR TE
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T2-Weighted Images
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Proton Density Weighted Images
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Normal FLAIR Images TR = 6000 msec, TI = 2000 msec, TE = 102 msec
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T1-Weighted Images
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MR Signal of Brain Lesions
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Solid Brain Lesion PDW T2W T1W
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Cystic Lesion T2W T1W FLAIR 236
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Subacute Hemorrhage PDW T1W T2W
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Acute Hemorrhage T2WFLAIR T1W GRE
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History: 9 y/o boy with prior head trauma 466
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Hemorrhage Sequence Gradient-echo
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PDW Fat or Lipoma T2W T1W
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MR Signal Intensities T2WIPD/FLAIRT1WI Solid massBright Dark CystBrightDark Subacute bloodBright Acute & chronic blood Dark Gray FatDarkBright
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Acute Stroke Sequence Diffusion Weighted Imaging
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MR Angiography
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Dx: Anaplastic astrocytoma > GBM MR Spectroscopy
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Brain Screening Protocol Sagittal T1-weighted images Axial T2-weighted images Axial FLAIR images Diffusion-weighted images Gradient-echo images Axial T1-weighted images Gadolinium: Axial & Coronal T1
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History: 46 y.o. man with headaches & increasing confusion 2 1 T2W PDW
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{Page 2} 5 3 4 T1W T1W / Gd T1W
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Dx: Meningioma & right MCA infarct Increasing confusion {Page 3} 76
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Student Cases "May the FORCE be with you!"
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History: 69 y/o man with nausea & memory deficits for several weeks 413 Case 1
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Dx: Glioblastoma {Page 2}
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History: 5 y/o girl with seizures 361 Case 2
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{Page 2}
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Dx: Amoebic abscesses {Page 3}
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History: 62 y.o. man with mumbling speech 26 2 1 Case 3
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{Page 2} 3 4
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Mumbling speech {Page 3} 5 6
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Dx: Enhancing subacute infarct {Page 4} 8 7
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2 1 History: 48 y.o. male with a sensorineural hearing loss Case 4
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Dx: Acoustic neuroma {Page 2} 5 4 3
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History: 48 y.o. man with headaches & confusion 32 1 2 Case 5
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{Page 2} 4 3
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{Page 3} 7 6 5
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Dx: Brain metastases - Lung carcinoma {Page 4} 10 98
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History: 36 y.o. man with seizures 2 1 Case 6
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History: Seizures {Page 2} 5 4 3
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Dx: AVM & basilar tip aneurysm {Page 3} 8 7 6
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History: 62 y/o woman with headaches Case 7
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Dx: Arachnoid cyst {Page 2}
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History: 27 y.o. man with increasing confusion & lethargy 5 2 1 Case 8
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Confusion and lethargy {Page 2} 3 4
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Dx: Herpes simplex encephalitis {Page 3} 6 5
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History: 72 y.o. woman with headaches 49 3 2 1 Case 9
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Dx: Parasagittal meningioma {Page 2} 54 6
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History: 55 y/o female with motor weakness, double vision, & emotional lability 272 Case 10
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{Page 2}
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Dx: Chronic multiple sclerosis; Incidental sebaceous cyst left posterior scalp {Page 3}
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History: 42 y/o female with chronic headaches 549 Case 11
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{Page 2}
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Dx: TB meningitis - HIV + {Page 3}
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History: 75 y.o. male with dysmetria in upper extremities 1 2 Case 12
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{Page 2} 3 5 4
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Dx: Lipoma {Page 3} 8 6 7
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History: Young male with increasing somnolence and irritability 11/20 - 2 1 3
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Dx: Planum Meningioma in a dog 4 {Page 2} 6 5
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