MRI of the lumbar spine, with its multiplanar 3 dimensional imaging capability, is currently the preferred modality for establishing a diagnosis. MRI scans and magnetic resonance myelography have many advantages compared with computed tomography and/or X-ray myelography in evaluating the lumbar spine. MR imaging scans large areas of the spine without ionizing radiation, is noninvasive, not affected by bone artifacts, provides vascular imaging capability, and makes use of safer contrast agents (gadolinium chelate).
Due to the high level of tissue contrast resolution, nerves and discs are clearly visible. MRI is excellent for detecting degenerative disease in the spine. Lumbar spine MRI accurately shows disc disease (prolapsed disc or slipped disc), the level at which disc disease occurs, and if a disc is compressing spinal nerves. Lumbar spine MRI depicts soft tissues, including the cauda equina, spinal cord, ligaments, epidural fat, subarachnoid space, and intervertebral discs. Loss of epidural fat on T1 weighted images, loss of cerebrospinal fluid signal around the dural sac on T2 weighted images and degenerative disc disease are common features of lumbar stenosis.

Common indications for MRI of the lumbar spine:
Lumbar spine imaging requires a special spine coil. often used whole spine array coils have the advantage that patients do not need other positioning if also upper parts of the spine should be scanned. Sagittal T1 and T2 weighted FSE sequences are the standard views. With multi angle oblique techniques individually oriented transverse images of each intervertebral disc at different angles can be obtained.

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

(MRA) Magnetic resonance angiography is a medical imaging technique to visualize blood filled structures, including arteries, veins and the heart chambers. This MRI technique creates soft tissue contrast between blood vessels and surrounding tissues primarily created by flow, rather than displaying the vessel lumen. There are bright blood and black blood MRA techniques, named according to the appearance of the blood vessels. With this different MRA techniques both, the blood flow and the condition of the blood vessel walls can be seen. Flow effects in MRI can produce a range of artifacts. MRA takes advantage of these artifacts to create predictable image contrast due to the nature of flow.
Technical parameters of the MRA sequence greatly affect the sensitivity of the images to flow with different velocities or directions, turbulent flow and vessel size.
This are the three main types of MRA:
All angiographic techniques differentially enhance vascular MR signal. The names of the bright blood techniques TOF and PCA reflect the physical properties of flowing blood that were exploited to make the vessels appear bright. Contrast enhanced magnetic resonance angiography creates the angiographic effect by using an intravenously administered MR contrast agent to selectively shorten the T1 of blood and thereby cause the vessels to appear bright on T1 weighted images.
MRA images optimally display areas of constant blood flow-velocity, but there are many situations where the flow within a voxel has non-uniform speed or direction. In a diseased vessel these patterns are even more complex. Similar loss of streamline flow occurs at all vessel junctions and stenoses, and in regions of mural thrombosis. It results in a loss of signal, due to the loss of phase coherence between spins in the voxel.
This signal loss, usually only noticeable distal to a stenosis, used to be an obvious characteristic of MRA images. It is minimized by using small voxels and the shortest possible TE. Signal loss from disorganized flow is most noticeable in TOF imaging but also affects the PCA images.
Indications to perform a magnetic resonance angiography (MRA):
Conventional angiography or computerized tomography angiography (CT angiography) may be needed after MRA if a problem (such as an aneurysm) is present or if surgery is being considered.

See also Magnetic Resonance Imaging MRI.

(MTC) This MRI method increases the contrast by removing a portion of the total signal in tissue. An off resonance radio frequency (RF) pulse saturates macromolecular protons to make them invisible (caused by their ultra-short T2* relaxation times). The MRI signal from semi-solid tissue like brain parenchyma is reduced, and the signal from a more fluid component like blood is retained.
E.g., saturation of broad spectral lines may produce decreases in intensity of lines not directly saturated, through exchange of magnetization between the corresponding states; more closely coupled states will show a greater resulting intensity change. Magnetization transfer techniques make demyelinated brain or spine lesions (as seen e.g. in multiple sclerosis) better visible on T2 weighted images as well as on gadolinium contrast enhanced T1 weighted images.
Off resonance makes use of a selection gradient during an off resonance MTC pulse. The gradient has a negative offset frequency on the arterial side of the imaging volume (caudally more off resonant and cranially less off resonant). The net effect of this type of pulse is that the arterial blood outside the imaging volume will retain more of its longitudinal magnetization, with more vascular signal when it enters the imaging volume. Off resonance MTC saturates the venous blood, leaving the arterial blood untouched.
On resonance has no effect on the free water pool but will saturate the bound water pool and is the difference in T2 between the pools. Special binomial pulses are transmitted causing the magnetization of the free protons to remain unchanged. The z-magnetization returns to its original value. The spins of the bound pool with a short T2 experience decay, resulting in a destroyed magnetization after the on resonance pulse.

See also Magnetization Transfer.

Magnevist® is a paramagnetic ionic contrast agent for use in magnetic resonance imaging. Contrast enhanced MRI with Magnevist® allows additional diagnostic information of tumors, inflammation and vascular lesions and the determination or differentiation of such lesions.
The contrast enhancing effect is produced by the di-N-methylglucamine salt of gadopentetate (Gd-DTPA), the gadolinium complex of diethylenetriamine pentaacetic acid. Magnevist® has the strongest effect on T1 weighted images, by increasing T1 signal intensity in tissues where Magnevist® has accumulated.

WARNING: NEPHROGENIC SYSTEMIC FIBROSIS Gadolinium-based contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in patients with acute or chronic severe renal insufficiency (glomerular filtration rate less than 30 mL/min/1.73m²), or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period.

See also Ionic Intravenous Contrast Agents and Gadopentetate Dimeglumine.

Paramagnetic materials attract and repel like normal magnets when subject to a magnetic field. This alignment of the atomic dipoles with the magnetic field tends to strengthen it, and is described by a relative magnetic permeability greater than unity. Paramagnetism requires that the atoms individually have permanent dipole moments even without an applied field, which typically implies a partially filled electron shell. In pure Paramagnetism (without an external magnetic field), these atomic dipoles do not interact with one another and are randomly oriented in the absence of an external field, resulting in zero net moment.
Paramagnetic materials in magnetic fields will act like magnets but when the field is removed, thermal motion will quickly disrupt the magnetic alignment. In general, paramagnetic effects are small (magnetic susceptibility of the order of 10^-3 to 10^-5).
In MRI, gadolinium (Gd) one of these paramagnetic materials is used as a contrast agent. Through interactions between the electron spins of the paramagnetic gadolinium and the water nuclei nearby, the relaxation rates (T1 and T2) of the water protons are increased (T1 and T2 times are decreased), causing an increase in signal on T1 weighted images.

See also contrast agents, magnetism, ferromagnetism, superparamagnetism, and diamagnetism.