Magnetic Resonance Imaging (MRI) Practice Test

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In imaging the spine, why is contrast enhancement used with T1 weighted images to rule out metastatic lesions?

Metastatic lesions present as hypointense structures
Normal cord structures enhance while metastatic lesions do not
Metastatic lesions enhance and normal cord does not
Only normal cord structures enhance

The correct answer is: Metastatic lesions enhance and normal cord does not

Using contrast enhancement with T1-weighted images is crucial in imaging the spine to effectively rule out metastatic lesions because metastatic lesions typically show enhancement due to their abnormal vascularity and the permeability of the blood-brain barrier in these areas. When contrast material is introduced, it highlights these lesions, making them appear bright on T1-weighted images, which assists radiologists in differentiating between normal and abnormal tissues. Normal spinal cord structures usually do not enhance in the same way because they have a different vascular composition and maintain a more intact blood-brain barrier, leading to less pronounced or no enhancement in comparison to metastatic lesions. This distinction is essential; hence, enhanced areas in a T1-weighted image can indicate the presence of a metastatic lesion. In summary, the ability of metastatic lesions to enhance with contrast while normal cord structures do not allows for more accurate identification and assessment of potential lesions, which is a key application of this imaging technique.