MRI interpretation
Specialised MRI sequences

Key points

  • Specialised MRI images can be produced in order to answer specific clinical questions

Specialised MRI images are frequently used in specific clinical settings to highlight structures or pathological processes.

Here are some common examples.

STIR image – Spondylodiscitis

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STIR image – Spondylodiscitis

  • STIR (Short Tau Inversion Recovery) images are highly water-sensitive and the timing of the pulse sequence used acts to suppress signal coming from fatty tissues – so ONLY WATER is bright
  • A combination of standard T1 images and STIR images can be compared to determine the amount of fat or water within a body part
  • In these MRI images abnormal signal is seen in the vertebral bodies and intervertebral disc
  • Abnormal low signal on the T1 image and abnormal high signal on the STIR image – indicates abnormal fluid
  • These are typical appearances of spondylodiscitis (also known as discitis)

FLAIR images – Multiple sclerosis

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FLAIR images – Multiple sclerosis

  • FLAIR images (Fluid Attenuated Inversion Recovery) are commonly used in brain imaging
  • The signal from free fluid – such as cerebrospinal fluid (CSF) in the ventricles – is suppressed (compare with the T2 image)
  • High signal seen on these images indicates a pathological process such as infection, tumour, or areas of demyelination – as in this patient with multiple sclerosis

T2*(gradient echo) images – Haemangioma

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T2*(gradient echo) images – Haemangioma

  • T2* images (pronounced ‘T2 star’ – also known as ‘gradient echo’ images) can be used to highlight the presence of blood products – such as in this cerebral haemangioma (arrows)

Diffusion weighted imaging – Infarct (brain)

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Diffusion weighted images – Infarct (brain)

  • Diffusion Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) images are viewed together
  • Areas of high signal on the DWI images and low signal on the ADC images indicate 'restricted diffusion' - an indicator of a pathological process of cell death such as infarction, cancer, or abscess formation
  • Restricted diffusion in a wedge-shaped region of the brain (arrow) is a characteristic finding of a recent cerebral infarct
  • These images also show smaller areas of restricted diffusion due to recent lacunar infarcts (arrowheads)