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.

There are different types of contraindications that would prevent a person from being examined with an MRI scanner. MRI systems use strong magnetic fields that attract any ferromagnetic objects with enormous force. Caused by the potential risk of heating, produced from the radio frequency pulses during the MRI procedure, metallic objects like wires, foreign bodies and other implants needs to be checked for compatibility. High field MRI requires particular safety precautions. In addition, any device or MRI equipment that enters the magnet room has to be MR compatible. MRI examinations are safe and harmless, if these MRI risks are observed and regulations are followed.

Safety concerns in magnetic resonance imaging include:

It is important to remember when working around a superconducting magnet that the magnetic field is always on. Under usual working conditions the field is never turned off. Attention must be paid to keep all ferromagnetic items at an adequate distance from the magnet. Ferromagnetic objects which came accidentally under the influence of these strong magnets can injure or kill individuals in or nearby the magnet, or can seriously damage every hardware, the magnet itself, the cooling system, etc.. See MRI resources Accidents.
The doors leading to a magnet room should be closed at all times except when entering or exiting the room. Every person working in or entering the magnet room or adjacent rooms with a magnetic field has to be instructed about the dangers. This should include the patient, intensive-care staff, and maintenance-, service- and cleaning personnel, etc..
The 5 Gauss limit defines the 'safe' level of static magnetic field exposure. The value of the absorbed dose is fixed by the authorities to avoid heating of the patient's tissue and is defined by the specific absorption rate. Leads or wires that are used in the magnet bore during imaging procedures, should not form large-radius wire loops. Leg-to-leg and leg-to-arm skin contact should be prevented in order to avoid the risk of burning due to the generation of high current loops if the legs or arms are allowed to touch. The patient's skin should not be in contact with the inner bore of the magnet.
The outflow from cryogens like liquid helium is improbable during normal operation and not a real danger for patients.
The safety of MRI contrast agents is tested in drug trials and they have a high compatibility with very few side effects. The variations of the side effects and possible contraindications are similar to X-ray contrast medium, but very rare. In general, an adverse reaction increases with the quantity of the MRI contrast medium and also with the osmolarity of the compound.

See also 5 Gauss Fringe Field, 5 Gauss Line, Cardiac Risks, Cardiac Stent, dB/dt, Legal Requirements, Low Field MRI, Magnetohydrodynamic Effect, MR Compatibility, MR Guided Interventions, Claustrophobia, MRI Risks and Shielding.

The definition of a scan is to form an image or an electronic representation. The MRI scan uses magnetic resonance principles to produce extremely detailed pictures of the body tissue without the need for X-ray exposure or other damaging forms of radiation.
MRI scans show structures of the different tissues in the body. The tissue that has the least hydrogen atoms (e.g., bones) appears dark, while the tissue with many hydrogen atoms (e.g., fat) looks bright. The MRI pictures of the brain show details and abnormal structures (brain MRI), for example, tumors, multiple sclerosis lesions, bleedings, or brain tissue that has suffered lack of oxygen after a stroke. A cardiac MRI scan demonstrates the heart as well as blood vessels (cardiovascular imaging) and is used to detect heart defects with e.g., changes in the thickness and infarctions of the muscles around the heart. With MRI scans, nearly all kind of body parts can be tested, for example the joints like knee and shoulder, lumbar, thoracic and cervical spine, the pelvis including fetal MRI, and the soft parts of the body such as the liver, kidneys, and spleen. The MRI procedure includes three to nine imaging sequences and may take up to one hour.

See also Lumbar Spine MRI, MRI Safety and Open MRI.

MRI can be indicated for use in pregnant women if other forms of diagnostic imaging are inadequate or require exposure to ionizing radiation such as X-ray or CT.
As a safety precaution, MR scanning should be avoided in the first three months of pregnancy.
Similar considerations hold for pregnant staff of a magnetic resonance department. An epidemiological study (by Kanal, et al.) concluded that data collected from MRI technologists were negative with respect to any statistically significant elevations in the rates of spontaneous abortion, infertility and premature delivery.
However, also for psychological reasons, it might be a wise precaution that pregnant staff members do not remain in the scan room during actual scanning.
There have been several reports (results could not be reproduced) that static magnetic fields may provoke genetic mutations, changes in growth rate and leukocyte count and other effects. No reports have been published that persons exposed to magnetic fields, including staff at MR departments, have a higher incidence of genetic damage to their children than found in the average population.
This research needs further investigation and for this purpose pregnancy should be considered a relative contraindication for MR spectroscopy and MRI procedures.
Taking into account that clinical MR imaging devices operate at field strengths of between 0.2 and 2.0 T, higher field strengths need more investigation.

Today, there is no sign that MR can harm the fetus or embryo (MRI is used for fetal MRI - fetography). However, if a MRI examination is ordered, there should be a strict indication for this examination.

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