1. CHUỖI XUNG SPIN ECHO
1.1. Nguyên lý
Trước hết ta giả định một ví dụ thú vị để minh họa cho nguyên lý tạo ảnh của chuỗi xung Spin Echo (SE). Đây là một cuộc thi Marthon trên một cung đường từ A đến B. Có nhiều vận động viên tham gia, trong đó tốc độ của các vận động viên này rất không đồng đều, có người chạy nhanh như máy bay phản lực, có người chạy chậm như rùa nhưng đều có chung một đặc điểm là hằng định, không thay đổi. Mục đích của cuộc thi không phải là xem ai sẽ về đích sớm nhất mà là sẽ có bao nhiêu vận động viên về đích sau một khoảng thời gian ấn định. Ban tổ chức thì muốn càng có nhiều vận động viên về đích càng tốt.
a. Sau khi xuất phát từ A để đi đến đích B, các vận động viên có tốc độ khác nhau thì ở các vị trí khác nhau.
b. Tại thời điểm TE/2, trọng tài thay đổi quyết định, chọn đích đến là A, yêu cầu các vận động viên quay trở lại
Từ điểm xuất phát A, khi trọng tài ra hiệu lệnh bắt đầu chạy thì các vận động viên đồng loạt di chuyển về phía B. Do sự không đồng nhất về tốc độ nên các vận động viên có các vị trí khác nhau. Vận động viên có tốc độ càng lớn thì càng ở xa điểm xuất phát A, vận động viên có tốc độ càng nhỏ thì càng ở gần điểm xuất phát A. Sau khoảng thời gian TE/2, trọng tài đột ngột thay đổi ý định, muốn trọn A là đích chứ không phải là B nữa, yêu cầu các vận động viên quay lại để cán đích A.
Ngay lập tức, các vận động viên phải quay 180 độ hướng về A và cũng sau khoảng thời gian đúng bằng TE/2, toàn bộ các vận động viên đều cán đích A. Ban tổ chức thì vui mừng vì số vận động viên cán đích là lớn nhất. Như vậy, quyết định quay 180 độ của ông trọng tài đã làm triệt tiêu sự không đồng nhất về tốc độ của các vận động viên, dù chạy nhanh hay chậm thì cuối cùng cũng đều về đích sau cùng một khoảng thời gian.
Chuỗi xung SE có nguyên lý tương tự vậy, trong đó mỗi spin được ví như một vận động viên, trọng tài được ví như sóng RF. Từ trạng thái ban đầu trong từ trường tĩnh Bo, dùng một sóng RF 90° kích thích để Mo bị lệch một góc 90° trong mặt phẳng – xy. Khi RF ngừng kích thích, quá trình thư duỗi T2 và T2* bắt đầu, các spin ở các vị trí khác nhau thì có tốc độ thư duỗi khác nhau và không đồng nhất, lệch pha (dephase). Khi thư duỗi T2, T2* diễn ra được một khoảng thời gian TE/2 thì tiếp tục kích thích bằng một sóng RF 180° để đảo ngược toàn bộ vị trí của các spin. Tiếp sau khoảng thời gian TE/2 nữa, toàn bộ các spin sẽ trở về trạng thái đồn pha (in phase) ban đầu, lúc này tín hiệu echo được ghi lại với cường độ lớn nhất do có nhiều spin trong trạng thái đồng pha nhất.
(1) Trạng thái từ trường tĩnh Bo;
(2) RF 90° kích thích Mo lệch góc 90° để nằm trong phẳng phẳng – xy;
(3) Thư duỗi T2 và T2* bắt đầu, Mxy suy giảm dần;
(4) tại thời điểm TE/2 kích thích bằng RF 180;
(5) Sau khoảng thời gian TE/2 tiếp theo, toàn bộ các spin lại ở trạng thái in phase ban đầu và tín hiệu thu được là lớn nhất
1.2. Đặc điểm
Trong chuỗi xung SE, sóng đảo ngược RF 180° có vai trò làm triệt tiêu sự không đồng nhất về trạng thái tiến động của các spin, hay nói cách khác RF 180° đã loại bỏ ảnh hưởng của thư duỗi T2, chỉ còn lại thư duỗi T2. Đặc điểm của chuỗi xung SE là có chất lượng hình ảnh rất tốt do tín hiệu echo thu được là từ các spin là tối đa và tình trạng từ trường tĩnh không đồng nhất (T2) đã bị loại bỏ bởi sóng đảo ngược RF 180. Tuy nhiên, chuỗi xung này có nhược điểm là thời gian tạo ảnh kéo dài và nhậy cảm với các nhiễu ảnh do chuyển động (motion arftifacts). Trong ứng dụng lâm sàng, xung SE thường được thực hiện để tạo ảnh T1-weighted và PD-weighted, trong đó PDW thường được sử dụng hơn vì khi chụp xương, khớp thì ít bị tác động bởi nhịp thở hoặc các chuyển động khác có thể tạo ra motion artifacts.
Hình 3.
a. Xung T1W SE; b. Xung PD SE; c. Xung T2W SE
1.3. Hiệu ứng black-blood
Hiệu ứng black-blood còn được gọi là hiệu ứng outflow, đề cập đến sự tăng tương phản tự nhiên giữa dòng chảy trong lòng mạch và mô xung quanh, nói cách khác những dòng chảy nhanh thì không có tín hiệu trên các chuỗi xung SE do có TE kéo dài. Đây là một điểm khác biệt của chuỗi xung SE với các chuỗi xung khác. Nguyên nhân của hiệu ứng black-blood bao gồm hai ý chính:
– Toàn bộ hoặc hầu như toàn bộ các huyết cầu đã rời khỏi vị trí tạo ảnh (lớp cắt) trong thời gian TE dài, tại thời điểm thu tín hiệu thì đã được các huyết cầu khác thay thế. Do vậy các spin trong lòng mạch tại thời điểm thu tín hiệu của lớp cắt đó không phá tín hiệu do không bị ảnh hưởng của sóng đảo ngược RF 180.
– Tại một số khu vực có dòng chảy rối (turbulent), sự mất tín hiệu càng gia tăng do trạng thái lệch pha liên tục xảy ra, các spin không thể trong trạng thái đồng pha (in phase).
Dựa trên cơ sở hình thành hiệu ứng black-blood, chúng ta có thể giải thích tại sao trong một số tình huống chúng ta vẫn thấy tín hiệu trong lòng mạch trên các xung SE: Dòng chảy chậm (sinh lý hoặc bệnh lý): các huyết cầu không trôi mất khỏi lớp cắt trong thời gian TE.
Khi một đoạn mạch máu đủ dài nằm trọn vẹn trong mặt phẳng thực hiện lớp cắt đó và tốc độ dòng chảy không quá nhanh.
Huyết khối trong lòng mạch: các huyết cầu tạo thành huyết khối, không di chuyển và khi đó sẽ bị sóng RF 180° kích thích và phát tín hiệu echo. Mặt khác, khi huyết khối đủ lớn cũng sẽ làm dòng chảy chậm hơn do tắc nghẽn.
Hiệu ứng này còn được ứng dụng trong tạo ảnh cộng hưởng từ tim.
Dựa trên cơ sở hình thành hiệu ứng black-blood, chúng ta có thể giải thích tại sao trong một số tình huống chúng ta vẫn thấy tín hiệu trong lòng mạch trên các xung SE: Dòng chảy chậm (sinh lý hoặc bệnh lý): các huyết cầu không trôi mất khỏi lớp cắt trong thời gian TE. Khi một đoạn mạch máu đủ dài nằm trọn vẹn trong mặt phẳng thực hiện lớp cắt đó và tốc độ dòng chảy không quá nhanh. Huyết khối trong lòng mạch: các huyết cầu tạo thành huyết khối, không di chuyển và khi đó sẽ bị sóng RF 180° kích thích và phát tín hiệu echo. Mặt khác, khi huyết khối đủ lớn cũng sẽ làm dòng chảy chậm hơn do tắc nghẽn. Hiệu ứng này còn được ứng dụng trong tạo ảnh cộng hưởng từ tim.
a. Hiệu ứng black-blood tại vị trí ĐM thân nền và ĐM cảnh trong đoạn xoang hang trên T2W SE.
b. Trên hình ảnh T1W SE không tiêm thuốc đối quang từ, thấy một đoạn ĐM não giữa bên trái có tín hiệu.
c. Đối chiếu trên hình ảnh T1W SE sau tiêm thuốc đối quang từ thấy các mạch máu này tăng tín hiệu rõ Hồng
1.4. Multislice
Trong các chuỗi xung có thời gian cắt lớp và TR kéo dài như SE, người ta sử dụng một kỹ thuật tạo ảnh gọi là multiscle (đa lớp cắt) nhằm mục đích rút ngắn thời gian thăm khám. Hay nói cách khác, đây là một kỹ thuật tận dụng thời gian. Trong kỹ thuật này, người ta thực hiện liên tiếp các lớp cắt khác trong khi thực hiện TR của lớp cắt trước đó. Hiện nay, đối với tạo ảnh T1W SE với TR khoảng 500 msc, người ta có thể thực hiện được 12 lớp cắt khác nhau thay vì chỉ cắt 1 lớp trong cùng một thời gian. Đối với T2W SE thì con số đó là 30, do TR của T2W SE kéo dài 2000-4000 msc.
Lấy một ví dụ minh họa, một người phải chạy thử hết 20 đĩa nhạc CD, mỗi đĩa nhạc CD có dung lượng kéo dài 10 phút. Nếu chạy thử lần lượt từng đĩa CD một thì sẽ mất rất nhiều thời gian, anh ta chọn giải pháp trong vừa bật đĩa thứ nhất thì tiếp tục bật các đĩa tiếp theo. Do vậy trong cung một thời gian chạy thử đĩa thứ nhất anh ta đã có thể tận dụng khoảng thời gian phải ngồi chờ thực hiện chạy thử nhiều đĩa khác.
Nguyên lý kỹ thuật tạo ảnh đa lớp multislice cho các chuỗi xung có TR kéo dài như Spin Echo.
1.5. Tên thương mại
Một số nhà cung cấp hệ thống tạo ảnh cộng hưởng từ thiết kế chuỗi xung SE cho sản phẩm của mnh, có thể có những tên gọi cùng kỹ thuật tạo ảnh khác nhau, đôi khi gây nhầm lẫn và khó hiểu cho người làm.
Tên thương mại chuỗi xung SE của một số nhà cung cấp.
2. CHUỖI XUNG IR
Chuỗi xung IR (inversion recovery) có bản chất là một SE, nhưng trước khi dùng xung RF 90, người ta dùng một xung RF – 180° kích thích để cho toàn bộ vector Mo bị đảo chiều từ chiều dương sang chiều âm của trục – z. Chú ý rằng, do Mo không bị lệch khỏi trục – z (FA=0) nên toàn bộ Mo trở thành Mz, không có Mxy nên cũng sẽ không có thư duỗi T2 trong giai đoạn này. Sau khi RF – 180° ngừng kích thích, Mz phục hồi dần dần theo thư duỗi T để trở lại trạng thái ban đầu trên trục – Z, và trong khi phục hồi, Mz sẽ phải đi qua vị trí zero.
Trong khi thư duỗi T1 xảy ra, tiếp tục dùng xung RF 90° và RF 180° để kích thích theo trình tự các thời điểm như ở Spin Echo. Khoảng thời gian từ khi phát xung RF – 1800 đến khi phát xung RF180° được gọi là thời gian đảo ngược TI (time inversion), đây là thông số rất quan trọng trong tạo ảnh của chuỗi xung IR. Việc lựa chọn TI ở thời điểm nào trong khi diễn ra thư duỗi T1 sẽ quyết định tính chất tạo ảnh, ví dụ TI rất ngắn thì sẽ trở thành xung STIR hoặc TI rất dài thì sẽ trở thành xung FLAIR. Chuỗi xung IR thường được sử dụng để tạo tương phản cho ảnh T1-weighted, ví dụ như tương phản chất trắng – chất xám của hệ thần kinh trung ương, hoặc tạo tương phản cho ảnh xóa mỡ (STIR). Ngoài ra, cũng được sử dụng để tạo tương phản cho ảnh T2 weighted (FLAIR).
(a) Mz trong trạng thái tĩnh;
(b) Xung RF – 180° làm đảo ngược Mz từ chiều dương sang chiều âm, độ lớn không thay đổi;
(c) Mz phục hồi dần dần theo thư duỗi T1, không có thư duỗi T2 do góc lệch bằng không;
(d) Mz phục hồi dần trở lại chiều dương của trục z
a.Tương phản chất trắng-chất xám hệ trên chuỗi xung IR
b. So sánh với tương phản T1W
c. So sánh với tương phản FLAIR
3.CHUỖI XUNG FLAIR
FLAIR (fluid – attenuated inversion recovery) là chuỗi xung có bản chất tương tự xung IR trong đó, thời gian đảo ngược TI được lựa chọn ở đúng thời điểm Mz của nước phục hồi từ chiều âm của trục- z về đến không (zero). Giá trị của TI trong FLAIR rất dài, khoảng 1.700 – 2.000 msc tại từ trường 1.5T. Do tại thời điểm Mz của nước có giá trị bằng không nên khi kích thích RF 90° thì thành phần Mxy của nước luôn luôn không xuất hiện trong toàn bộ quá trình tạo ảnh về sau, mọi tín hiệu của nước đều bị xóa. Kết quả là nước sẽ không có tín hiệu trên ảnh FLAIR.
Thêm một điểm lưu ý nữa là trong xung FLAIR, do TI kéo dài, trong khi hầu như toàn bộ tín hiệu của nước (dịch não tủy) đã bị xóa do thư duỗi T1 = 0 thì tín hiệu của các tổ chức xung quanh (chất trắng, chất xám, khối u,…) lại ở trạng thái rất tốt do tốc độ thư duỗi T1 của các tổ chức này ngắn hơn của nước rất nhiều. Do đặc điểm này, xung FLAIR thường được ứng dụng để xóa dịch não tủy, tạo sự tương phản giữa nhu mô não bình thường với nhu mô não bệnh lý hoặc những tụ dịch bất thường, không giống với dịch não tủy.
a. Trạng thái tĩnh, Mz (T1) của nước dài hơn Mz (T1) của mỡ
b. Xung RF-180° làm đảo ngược Mz của nước và mô mỡ
c. Mz của nước và mỡ phục hồi với tốc độ khác nhau (T1 khác nhau)
d. Tại thời điểm Mz của nước trở về đến gốc tọa độ (zero). Chọn TI sao cho xung RF 90° kích thích đúng thời điểm này
e. Toàn bộ Mz của mỡ chuyển thành Mxy nằm trong mặt phẳng – xy. Không có Mxy của nước
f. Thư duỗi T2 (Mxy) xảy ra chỉ còn của mỡ (và nhu mô não). Nước không có thư duỗi T2, không có tín hiệu.
4.CHUỖI XUNG STIR
STIR (short IT inversion recovery) cũng là chuỗi xung có bản chất tương tự xung FLAIR (IR) nhưng trong đó thời gian đảo ngược TI được lựa chọn ở đúng thời điểm Mz của mỡ phục hồi từ chiều âm của trục – z về đến không (zero). Giá trị của TI trong STIR rất ngắn, khoảng 150msc tại từ trường 1.5T. Chuỗi xung STIR được ứng dụng để xóa tín hiệu của tổ chức mỡ, tức là tổ chức mỡ sẽ trống tín hiệu trên hình ảnh cộng hưởng từ.
5. CHUỖI XUNG GRADIENT ECHO.
5.1. Nguyên lý
Chuỗi xung Gradient echo cũng có khi được gọi với các tên khác là GRE (gradient – recalled echo) hoặc FFE (fast field echo). Bản thân tên gọi của chuỗi xung này đã nói lên một phần nguyên lý của nó, chuỗi xung GRE chủ yếu sử dụng hệ thống chênh từ Gradient để tạo ra tín hiệu echo hơn là sử dụng RF180° để tạo ra echo như chuỗi xung SE. Đầu tiên, GRE cũng sử dụng một sóng RF kích thích để Mo lệch đi một góc nhất định (thường < 90°) để quá trình thư duỗi T1, T2 và T2* diễn bình thường như trong xung Spin echo. Khi Mxy đang suy giảm trong mặt phẳng – xy, sử dụng Gragradient mã hóa tần số (Gradient-X) để tạo ra một sự chênh từ âm (negative gradient) phá vỡ trạng thái cùng pha (phase coherrent) của các spin đang tiến động rồi sau đó đột ngột từ chênh từ âm, chuyển sang trạng thái chênh từ dương (positive gradient) để đưa toàn bộ các spin trở lại trạng thái đồng pha và thu tiến hành thu tín hiệu.
(1) Trạng thái từ trường tĩnh;
(2) Dùng sóng RF kích thích để Mo có góc lệch 90°. Để đơn giản hóa, hình minh họa đã chọn góc lệch 90° còn trong thực tế thì góc lệch của GRE thường < 90;
(3) Gradient-X tạo một chênh từ âm để phá vỡ trạng thái đồng pha;
(4) Gradient tạo chênh từ dương để đưa các spin trở lại trạng thái đồng pha;
(5) Toàn bộ Mxy đã phục hồi hoàn toàn trong trạng thái đồng pha ban đầu. Tiến hành thu tín hiệu echo ở thời điểm này.
Để dễ hiểu hơn, ta quay trở lại ví dụ về cuộc chay Marathon đã kể ở trên. Thay vì việc yêu cầu các vận động viên quay 180° để trở lại A, trọng tài cho các vận động viên uống cùng một loại thuốc tăng lực ngay trên đường chạy (Gradient-X), vận động viên nào càng yếu thì được uống càng nhiều. Nhưng dù có uống bao nhiêu thuốc đi nữa thì vẫn có sự khác biệt về tốc độ của các vận động viên. Kết quả là khi hết thời gian thi đấu (TE), cũng có nhiều vận động viên về đích ở cùng một thời điểm nhưng không phải tất cả.
5.2. Đặc điểm
Trong GRE cũng do không sử dụng xung nghịch đảo (RF -180) để loại bỏ thư duỗi T2* – thư duỗi xảy ra do sự không đồng nhất về phase của các spin tại lớp cắt — nên tương phản T2* weighted trong GRE là tương phản do T2* quyết định. Khi muốn tạo ảnh tương phản T2W thì cần chọn TE dài, khi đó T1 sẽ bị tối thiểu hóa. Hình ảnh T2W rất hữu ích trong phát hiện sự có mặt của các khoáng chất (vôi hóa), kim loại nói chung và sắt nói riêng (các sản phẩm giáng hóa của máu) trong mô. Một số loại thuốc đối quang từ có gắn sắt được sử dụng trong tương phản T2W. Ngược lại, khi muốn tạo ảnh tương phản T1W thì cần chọn TE càng ngắn càng tốt, vì khi TE ngắn thì T2 sẽ bị tối thiểu hóa.
Do không sử dụng sóng đảo ngược (RF-180) nên TR trong các chuỗi xung GRE rất ngắn, mà TR lại là yếu tố chính quyết định thời gian cắt lớp tạo ảnh cộng hưởng từ. Do đó các chuỗi xung GRE được gọi là các chuỗi xung nhanh, có thời gian cắt lớp ngắn hơn SE và IR rất nhiều. Cũng vì lý do này mà GRE ít bị các nhiễu ảnh gây ra bởi chuyển động (motion artifacts).
a. XungT1W GRE; b. Xung T2W GRE; c. So sánh với T2W SE
TR trong GRE rất ngắn nên trong chu kỳ tiếp theo thì thư duỗi T1 cũng sẽ rất ngắn, làm cho Mz được phục hồi ít hơn, sẽ dẫn đến trạng thái bão hòa. Để khắc phục nhược điểm này, trong các chuỗi xung GRE, người ta sử dụng RF sao cho góc lệch nhỏ, khi đó Mz sẽ có giá trị lớn hơn.
5.3. Spoiled GRE
Ngoài góc lệch nhỏ, một kỹ thuật khác được sử dụng để tăng biên độ Mz gọi là “Spolling”. Kỹ thuật này được thực hiện bằng cách kéo dài thời gian hoạt động của gradient chênh từ chọn lớp cắt (Gradient-X, Y, Z) để đưa các spin vào trạng thái lệch pha (dephase) nhiều hơn trước khi các spin trở lại đồng pha (in phase) để được kích thích RF tiếp theo. Một số kỹ thuật Spoiled GRE được sử dụng phổ biến là SPGR (spoiled gradient echo), FLASH (fast low angle shot). Độ tương phản trong các ảnh spoiled GRE như sau:
T1W tăng lên cùng do TR giảm
T1W tăng lên khi góc lệch FA giảm
T2*W tăng lên khi TE tăng.
Trong kỹ thuật tạo ảnh Spoiled GRE, có thể thực hiện chương trình cắt lớp 2D hoặc 3D. Với chương trình cắt lớp 3D, Spoiled GRE cho phép thực hiện các lớp cắt mỏng và liên tiếp, không có khoảng trống giữa các lớp cắt (gap=0) và khi đó thì có thể thực hiện tái tạo đa bình diện.
6.CHUỖI XUNG SSFP.
Một loại loại đặc biệt của chuỗi xung GRE là chuỗi xung SSFP (steady-state free precession), tạm dịch là chuỗi xung tiến động tự do trong trạng thái từ trường tĩnh. SSFP là một dạng xung GRE nhưng không được thực hiện “spoiling” (unspoiled GRE), trong đó một phần những spin không đạt được trạng thái đồng pha ở chu kỳ TR này sẽ được bảo tồn trong chu kỳ TR kế tiếp. Giống như những vận động viên thi chạy không về đích được trong cuộc đua này sẽ được bảo tồn cho vòng thi kế tiếp vậy. Kết quả là Mxy được tạo ra bởi RF này sẽ góp phần tạo ra Mxy trong các chu kỳ RF kế tiếp, tín hiệu echo vì thế cũng sẽ được tăng lên mà không cần phải “spoiling”. Các nhà cung cấp hệ thống tạo ảnh cộng hưởng từ khác nhau, thực hiện một số cải tiến dựa trên SSFP và đưa ra những tên gọi khác nhau, đôi khi khá phức tạp (xem hình 12).
Ngoài ra, có 2 chuỗi xung T2W GRE mà độ tương phản dựa vào tỷ lệ T2/T1 đó là chuỗi xung FIESTA (fast imaging employing steady-state precession) và trueFISH (true fast imaging with steady-state precession). Dịch máu có tỷ lệ T2/T1 cao do vậy sẽ tăng tín hiệu trên các chuỗi xung này. Một ưu điểm khác của các chuỗi xung SSFP là tín hiệu của nó không quá phụ thuộc vào dòng chảy của máu, cộng với việc có khả năng thực hiện cắt nhanh, lớp cắt mỏng nên SSFP được ứng dụng rộng rãi trong tạo ảnh cộng hưởng từ mạch tim và các mạch máu lớn, đặc biệt là chụp động học (dynamic) hoặc chụp cine.
Multi-Echo
Multi-Echo là giải pháp kỹ thuật ứng dụng cho cả các chuỗi xung SE và GRE, nhằm tạo ra nhiều tín hiệu echo hơn trong mỗi chu kỳ tạo ảnh. Đối với SE, multi-echo được thực hiện bằng cách sử dụng lặp đi lặp lại nhiều lần chuỗi xung đảo ngược RF -1800. Đối với GRE, multiecho được thực hiện bằng cách liên tục đảo chiều Gradient mã hóa tần số. Có 2 lý do cần thiết phải thực hiện kỹ thuật multi-echo: Tăng tốc độ tạo tín hiệu do vậy rút ngắn thời gian cắt lớp, cho phép thực hiện các kỹ thuật tạo ảnh siêu nhanh (ultrafast imaging). Điều này rất quan trọng trong cộng hưởng từ mạch máu hoặc những người không hợp tác được. Nhiều tín hiệu echo được tạo ra liên tiếp sẽ cho phép làm tăng độ tương phản của hình ảnh lên nhiều lần (T1, T2, T2* hoặc PD). Chú ý không nhầm lẫn kỹ thuật mulit-echo với kỹ thuật multislice đã đề cập trong phần trước.
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