Fat suppression is the process of utilizing specific MRI parameters to remove the deleterious effects of fat from the resulting images , e.g. with STIR, FAT SAT sequences, water selective (PROSET WATS - water only selection, also FATS - fat only selection possible) excitation techniques, or pulse sequences based on the Dixon method.
Spin magnetization can be modulated by using special RF pulses. CHESS or its variations like SPIR, SPAIR (Spectral Selection Attenuated Inversion Recovery) and FAT SAT use frequency selective excitation pulses, which produce fat saturation.
Fat suppression techniques are nearly used in all body parts and belong to every standard MRI protocol of joints like knee, shoulder, hips, etc. Imaging of, e.g. the foot can induce bad fat suppression with SPIR/FAT SAT due to the asymmetric volume of this body part. The volume of the foot alters the magnetic field to a different degree than the smaller volume of the lower leg affecting the protons there. There is only a small band of tissue where the fat protons are precessing at the frequency expected, resulting in frequency selective fat saturation working only in that area. This can be corrected by volume shimming or creating a more symmetrical volume being imaged with water bags.
Even with their longer scan time and motion sensitivity, STIR (short T1/tau inversion recovery) sequences are often the better choice to suppress fat. STIR images are also preferred because of the decreased sensitivity to field inhomogeneities, permitting larger fields of views when compared to fat suppressed images and the ability to image away from the isocenter.
See also Knee MRI.
Sequences based on Dixon turbo spin echo (fast spin echo) can deliver a significant better fat suppression than conventional TSE/FSE imaging.

Short name: AMI-25, generic name: Ferumoxide (SPIO)
Ferumoxides are superparamagnetic (T2*) MRI contrast agents, so the largest signal change is on T2 and T2* weighted images.
The agent distributes relatively rapidly to organs with reticuloendothelial cells primarily the liver, spleen and bone marrow. The liver shows decreased signal intensity, as does the spleen and marrow. The agent is taken up by the normal liver, resulting in increased CNR between tumor and normal liver. Hepatocellular lesions, such as adenoma or focal nodular hyperplasia, contain reticuloendothelial cells, so they will behave similar to the liver, with decreased signal on T2 weighted images. On T1 images, there is typically some circulating contrast agent, and blood vessels show increased signal intensity.
Current MRI protocols involve T1 weighted breath-hold gradient echo images of the liver, and fast spin echo T2 weighted pictures. This requires about 15 minutes. The patient is then removed from the scanner, and the contrast agent administered. After contrast administration, the same pulse sequences are again repeated.

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.

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.

MR myelography is studying the spinal canal and subarachnoid space by high-resolution MRI with a technique in which a sequence with strong T2 weighting is used to provide high contrast between the "dark" spinal cord and its nerves and the surrounding "bright" cerebrospinal fluid. MR myelography as part of an entire MR examination has virtually replaced X-ray myelography. Used sequences are T2 weighted fast spin echo pulse sequences or a refocused gradient echo pulse sequence with strong T2 weighting.

See also the related poll result: 'MRI will have replaced 50% of x-ray exams by'