HEAD MRI with CONTRAST                                                                     

MRI and MRA Protocols    Head Cross-Sectional Anatomy (axial)    http://konez.com                                                                                                                                             

1- Sagittal T1 Spin echo (SE)

Useful for detailed assessment of the midline structures including corpus callosum, sella and suprasellar structures, clivus, craniocervical junction, as well as the bone marrow. 
 Normal Hyperintense signal abnormality in the posterior aspect of the corpus callosum (lipoma). Also, there is an optic tract glioma Hyperintense signal anterior to the pons representing prepontin acute hemorrhage  Sagittal T1 sequence showing empty sella

2- Axial DW: 

Particularly useful to determine if there is acute or subacute infarct. Its sensitivity is quite high, while the specificity is limited and requires clinical correlation. 
 Normal Acute small thalamic infarct (right).  Acute temporoparietoccipital infact (left) Menengioma(m) in the anterior left middle cranial fossa - also demonstrates hyperintensity Epidural abscess adjacent to the right mastoid (secondary to mastoiditis) demonstrating hyperientensity  

3- Axial EP

Predominantly useful to determine if the hyperintensity on DF scan is due to infact or artifactual ("T2 shine-through phenomenon". 
 Normal Hypointense area in the left parietal area is due to acute infact Acute infarct in the right parietal area

4- Axial T2 spin echo (SE)

Axial T2 SE is considered a gold standard to assess the brain anatomy, as well as paranasal sinuses and temporal bone aeration. 
 Normal Periventricular leukomalacia: clearly demonstrated using axial T2 images.  

5- Axial Flair

Flair is a good supplement to T2 to assess the white matter conditions and generally more sensitive than T2. Flair is also quite sensitive to determine if there is subarachnoid hemorrhage. 
 Normal  Intracranial tuberculosis is clearly more conspicuous on flair (1st: T2, 2nd: flair).  Acute subarachnoid hemorrhage

6- Coronal Flair

Coronal Flair is a good supplement to axial flair, to confirm the signal abnormalities seen on axial scans, as well as for further assessment of the temporal lobes.
 Normal Subtle subarachnoid hemorrhage on CT and on Flair coronal scan as a hyperintense sulci.

7- Axial pre-contrast T1 spin echo (SE)

Main purpose of this sequence is to establish a baseline for the post contrast scan. Also, T1 spin echo can be useful to assess intracranial hemorrhage as well as fat containing lesions. 

8- Axial post-contrast T1 spin echo (SE)

Axial post-contrast scanning is a gold standard to rule out enhancing intracranial lesions and also to assess the enhancement pattern of a known lesion. 
Normal Epidural abscess secondary due mastoiditis (left side) demonstrating intense contrast enhancement (same patient - see DW scan above). Also see sinusitis.  Precontrast scan is normal. However, post contrast scan demonstrates intense diffuse menengial enhancement (Intracranial hypotension). Glioblastoma Multiforme (GBM)
Left temporal area menengioma is not noticeable on pre-contrast T1 (first image) while it is easily noticeable on post-contrast scan (second image). Post-contrast scan is important to assess the extent of the tumor

9- Coronal post-contrast T1 spin echo (SE)

Good supplement to axial post-contrast scan.
Normal Small falx menengioma is clearly seen.  Perineural spread of skin cancer to 5th nerve (T). Normal Meckel's Cave (cavum trigeminale) seen on the contralateral side.