Magnetic resonance imaging has traditionally used the T1 and T2 relaxa
tion times and proton density (PD) of tissue water (hydrogen protons)
to manipulate contrast. Magnetization transfer (MT) is a new form of t
issue contrast based on the physical concept that tissues contain two
or more separate populations of hydrogen protons: a highly mobile (fre
e) hydrogen (water) pool, H-f and an immobile (restricted) hydrogen po
ol, H-r, the latter being those protons bound to large macromolecular
proteins and lipids, such as those found in such cellular membranes as
myelin. Direct observation of the PI, magnetization pool is normally
not possible because of its extremely short T2 time (<200 mu s). But S
aturation of the restricted pool will have a detectable effect on the
mobile (free) proton pool. Saturation of the restricted pool decreases
the signal of the free pool by transferring the restricted pool's sat
uration. Exchange of magnetization between the free and restricted hyd
rogen protons is a substantial mechanism for spin-lattice (T1) relaxat
ion in tissues and the physical basis of MT. Through an appropriately
designed pulse sequence, magnetization transfer contrast (MTC) can be
produced. MT contrast is different from T1, T2, and PD, and it likely
reflects the structural integrity of the tissue being imaged. A variet
y of clinically important uses of MT have emerged. In this clinical re
view of the neuroradiological applications of MT, we briefly review th
e physics of MT, the appearance of normal brain with MT, and the use o
f MT as a method of contrast enhancement/background suppression and in
tissue characterization, such as evaluation of multiple sclerosis and
other white-matter lesions and tumors. The role of MT in small-vessel
visualization on three-dimensional time-of-flight magnetic resonance
angiography and in head and neck disease and newer applications of MT
are also elaborated.