Brain imaging, magnetic resonance imaging of the head or skull, cranial magnetic resonance tomography (MRT), neurological MRI - they describe all the same radiological imaging technique for medical diagnostic.
Magnetic resonance imaging of the human brain includes the anatomic description and the detection of lesions. Special techniques like diffusion weighted imaging, functional magnetic resonance imaging (fMRI) and spectroscopy provide also information about the function and chemical metabolites of the brain. MRI provides detailed pictures of brain and nerve tissues in multiple planes without obstruction by overlying bones. Brain MRI is the procedure of choice for most brain disorders. It provides clear images of the brainstem and posterior brain, which are difficult to view on a CT scan. It is also useful for the diagnosis of demyelinating disorders (disorders such as multiple sclerosis (MS) that cause destruction of the myelin sheath of the nerve).
With this noninvasive procedure also the evaluation of blood flow and the flow of cerebrospinal fluid (CSF) is possible. Different MRA methods, also without contrast agents can show a venous or arterial angiogram. MRI can distinguish tumors, inflammatory lesions, and other pathologies from the normal brain anatomy. However, MRI scans are also used instead other methods to avoid the dangers of interventional procedures like angiography (DSA - digital subtraction angiography) as well as of repeated exposure to radiation as required for computed tomography (CT) and other X-ray examinations.
A (birdcage) bird cage coil achieves uniform excitation and reception and is commonly used to study the brain. Usually a brain MRI procedure includes FLAIR, T2 weighted and T1 weighted sequences in two or three planes.

See also Fetal MRI, Fluid Attenuation Inversion Recovery (FLAIR), Perfusion Imaging and High Field MRI.
See also Arterial Spin Labeling.

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).

The brain tissue is provided with a tight endothelial layer on vessels that acts as a filter for substances that reach the brain through the blood stream. This filter is called the blood brain barrier.
The blood brain barrier is responsible for the absence of contrast agent enhancement in normal brain tissue after administration of the iodinated or paramagnetic contrast media used in brain MRI and computed tomography (CT) diagnostic. The absence of contrast uptake in normal tissue provides the basis for differentiation from pathological brain tissue, which is conversely characterized by a disruption of the blood brain barrier.

See also Contrast Enhanced MRI, MRI Safety, Adverse Reaction.

(BOLD) In MRI the changes in blood oxygenation level are visible. Oxyhaemoglobin (the principal haemoglobin in arterial blood) has no substantial magnetic properties, but deoxyhaemoglobin (present in the draining veins after the oxygen has been unloaded in the tissues) is strongly paramagnetic. It can thus serve as an intrinsic paramagnetic contrast agent in appropriately performed brain MRI. The concentration and relaxation properties of deoxyhaemoglobin make it a susceptibility , e.g. T2 relaxation effective contrast agent with little effect on T1 relaxation.
During activation of the brain, the oxygen consumption of the local tissue increase by approximately 5% with that the oxygen tension will decrease. As a consequence, after a short period of time vasodilatation occurs, resulting in a local increase of blood volume and flow by 20 - 40%. The incommensurate change in local blood flow and oxygen extraction increases the local oxygen level.
By using T2 weighted gradient echo EPI sequences, which are highly susceptibility sensitive and fast enough to capture the three-dimensional nature of activated brain areas will show an increase in signal intensity as oxyhaemoglobin is diamagnetic and deoxyhaemoglobin is paramagnetic. Other MR pulse sequences, such as spoiled gradient echo pulse sequences are also used.
As the effects are subtle and of the order of 2% in 1.5 T MR imaging, sophisticated methodology, paradigms and data analysis techniques have to be used to consistently demonstrate the effect.
As the BOLD effect is due to the deoxygenated blood in the draining veins, the spatial localization of the region where there is increased blood flow resulting in decreased oxygen extraction is not as precisely defined as the morphological features in MRI. Rather there is a physiological blurring, and is estimated that the linear dimensions of the physiological spatial resolution of the BOLD phenomenon are around 3 mm at best.

Contrast enhanced MRI is a commonly used procedure in magnetic resonance imaging. The need to more accurately characterize different types of lesions and to detect all malignant lesions is the main reason for the use of intravenous contrast agents.
Some methods are available to improve the contrast of different tissues. The focus of dynamic contrast enhanced MRI (DCE-MRI) is on contrast kinetics with demands for spatial resolution dependent on the application. DCE-MR imaging is used for diagnosis of cancer (see also liver imaging, abdominal imaging, breast MRI, dynamic scanning) as well as for diagnosis of cardiac infarction (see perfusion imaging, cardiac MRI). Quantitative DCE-MRI requires special data acquisition techniques and analysis software.
Contrast enhanced magnetic resonance angiography (CE-MRA) allows the visualization of vessels and the temporal resolution provides a separation of arteries and veins. These methods share the need for acquisition methods with high temporal and spatial resolution.
Double contrast administration (combined contrast enhanced (CCE) MRI) uses two contrast agents with complementary mechanisms e.g., superparamagnetic iron oxide to darken the background liver and gadolinium to brighten the vessels. A variety of different categories of contrast agents are currently available for clinical use.
Reasons for the use of contrast agents in MRI scans are:
Common Indications:
Brain MRI : Preoperative/pretreatment evaluation and postoperative evaluation of brain tumor therapy, CNS infections, noninfectious inflammatory disease and meningeal disease.
Spine MRI : Infection/inflammatory disease, primary tumors, drop metastases, initial evaluation of syrinx, postoperative evaluation of the lumbar spine: disk vs. scar.
Breast MRI : Detection of breast cancer in case of dense breasts, implants, malignant lymph nodes, or scarring after treatment for breast cancer, diagnosis of a suspicious breast lesion in order to avoid biopsy.

For Ultrasound Imaging (USI) see Contrast Enhanced Ultrasound at Medical-Ultrasound-Imaging.com. See also Blood Pool Agents, Myocardial Late Enhancement, Cardiovascular Imaging, Contrast Enhanced MR Venography, Contrast Resolution, Dynamic Scanning, Lung Imaging, Hepatobiliary Contrast Agents, Contrast Medium and MRI Guided Biopsy.