MRI Technologist References
MRI Technologist References
See the complete reference spreadsheet with formatting here (requires the ability to access Google Sheets):
https://docs.google.com/spreadsheets/d/1M7XnLjHeIveAvoMeDZ5DG93zLgyB-N4ynP8oLxNbYf8/
Liver MRI with contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | liver lesion characterization; metastatic disease workup; screening for HCC in chronic liver diseases | |||||
Contrast | type | rate | volume | saline flush | ||
gadolinium | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 TSE/FSE | Y | Resp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE. | |||
Ax | T1 GRE IN/OPP | n/a | ||||
Ax | DWI | n/a | B value 800 | |||
Ax | T1 VIBE/LAVA pre-Gd | Y | pre-contrast | |||
Ax | T1 VIBE/LAVA post-Gd | Y | care bolus arterial phase: breath hold and start scan immediately after Gd reaches heart | |||
Ax | T1 VIBE/LAVA post-Gd | Y | portal phase: begin 10 sec after arterial phase complete (70 sec) | |||
Ax | T1 VIBE/LAVA post-Gd | Y | equilibrium phase: start 3-5 min after contrast injection. | |||
Cor | T1 VIBE/LAVA post-Gd | Y | wait 15-20 sec to recover breath, then run | |||
Comments: | care bolus: coronal fast gradient refocused sequence to trigger arterial phase at the moment contrast reaches the heart. Patient must hold breath at this moment and arterial phase run immediately. | |||||
Liver MRI without contrast (4/28/21) | ||||||
Indications: | liver lesion characterization; metastatic disease workup; screening for HCC in chronic liver diseases | |||||
Comments: | contrast strongly preferred - if non-contrast study ordered, indication should be reviewed by radiologist | |||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 TSE/FSE | Y | Resp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE. | |||
Ax | T1 GRE IN/OPP | n/a | ||||
Ax | DWI | n/a | B value 800 | |||
Ax | T1 VIBE/LAVA | Y | ||||
Cor | T1 VIBE/LAVA | Y | ||||
Comments: | ||||||
Liver MRI with Eovist (4/28/21) | ||||||
Indications: | suspect FNH (focal nodular hyperplasia); metastatic workup; cirrhosis screening; biliary reconstruction, bile leak | |||||
Comments: | Eovist will be specifically requested. If unsure call radiologist. | |||||
Contrast | type | rate | volume | saline flush | ||
Eovist | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax | T2 HASTE/SSFSE | N | ||||
Ax | T1 GRE IN/OPP | n/a | ||||
Ax | T1 VIBE/LAVA pre-Gd | Y | pre-contrast | |||
Ax | T1 VIBE/LAVA post-Gd | Y | care bolus arterial phase: breath hold and start scan immediately after Gd reaches heart | |||
Ax | T1 VIBE/LAVA post-Gd | Y | portal phase: begin 10 sec after arterial phase complete | |||
Ax | DWI | n/a | B value 800 | |||
Ax | T1 VIBE/LAVA post-Gd | Y | equilibrium phase: start 5 min after portal phase complete. | |||
Ax | T2 TSE/FSE | Y | resp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE. | |||
Ax | T1 VIBE/LAVA post-Gd | Y | total 20 min. delay after contrast injection | |||
Cor | T1 VIBE/LAVA post-Gd | Y | ||||
Comments: | care bolus |
MRCP (4/28/21) | ||||
---|---|---|---|---|
Indications: | post-cholecystectomy pain | |||
Comments: | to be performed as an add-on to liver or pancreas MRI protocols. Not to be performed as a stand alone protocol. | |||
Acquisition | sequence | fat sat | comments | |
Cor | T2 TSE/FSE 3D | (SPACE on Siemens). 1 mm slices. | ||
MIP of above | ||||
Cor OBL | T2 HASTE/SSFSE | Y | 40 mm slab rotated 20-30 degrees clockwise to include gallbladder and CBD | |
Cor OBL | T2 HASTE/SSFSE | Y | 40 mm slab rotated 20-30 degrees counterclockwise to include CBD and pancreatic duct | |
Cor | T2 HASTE/SSFSE | Y | thin acquisition (3 mm): cover as much of GB, CBD, pancreatic duct as possible | |
Comments: | thin section acquisition is critical --- repeat if motion artifact |
Adrenal MRI without contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | adrenal lesion characterization; clinical suspicion of functioning adenoma | |||||
Comments: | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor | T2 HASTE/SSFSE | N | ||||
Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 FSE/BLADE | Y | ||||
Ax | DWI | B value 800 | ||||
Ax | T1 GRE IN/OPP | n/a | key sequence, repeat BH instructions and repeat sequence as needed | |||
Ax | T1 VIBE/LAVA | Y | ||||
Comments: | ||||||
Adrenal MRI with IV contrast (4/28/21) | ||||||
Indications: | study typically performed without contrast | |||||
Comments: | if study ordered with contrast, contact radiologist | |||||
Contrast | type | rate | volume | saline flush | ||
gadolinium | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor | HASTE/SSFSE | N | ||||
Ax | HASTE/SSFSE | N | ||||
Ax | T2 FSE/BLADE | Y | ||||
Ax | DWI | B value 800 | ||||
Ax | T1 GRE IN/OPP | n/a | key sequence, repeat BH instructions and repeat sequence as needed | |||
Ax | T1 VIBE/LAVA pre-Gd | Y | ||||
Ax | T1 VIBE/LAVA post-Gd | Y | arterial/portal/equilibrium phases, same as liver except FOV | |||
Comments: |
Pancreas MRI without contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | pancreatic mass; evaluate for source of biliary or pancreatic ductal obstruction | |||||
Comments: | pancreas MRI should be with contrast - contact radiologist if ordered without contrast | |||||
Acquisition | sequence | fat sat | comments | |||
Cor | HASTE/SSFSE | N | ||||
Ax | HASTE/SSFSE | N | ||||
Ax | T2 FSE or BLADE | Y | AX HASTE/SSFSE FS if unable to respiratory trigger. | |||
Ax | DWI | n/a | B value 800 | |||
Ax | VIBE/LAVA | Y | ||||
Cor | VIBE/LAVA | Y | ||||
Comments: | ||||||
Pancreas MRI with IV contrast (4/28/21) | ||||||
Indications: | pancreatic mass; evaluate for source of biliary or pancreatic ductal obstruction | |||||
Comments: | ||||||
Contrast | type | rate | volume | saline flush | ||
gadolinium | ||||||
Comments: | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 TSE/FSE | Y | Resp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE. | |||
Ax | T1 GRE IN/OPP | n/a | ||||
Ax | DWI | n/a | B value 800 | |||
Ax | T1 VIBE/LAVA pre-Gd | Y | pre-contrast | |||
Ax | T1 VIBE/LAVA post-Gd | Y | care bolus arterial phase: breath hold and start scan immediately after Gd reaches heart | |||
Ax | T1 VIBE/LAVA post-Gd | Y | portal phase: begin 10 sec after arterial phase complete (70 sec) | |||
Ax | T1 VIBE/LAVA post-Gd | Y | equilibrium phase: start 3-5 min after injection. | |||
Cor | T1 VIBE/LAVA post-Gd | Y | wait 15-20 sec to recover breath, then run | |||
Comments: | care bolus: coronal fast gradient refocused sequence to trigger arterial phase at the moment contrast reaches the heart. Patient must hold breath at this moment and arterial phase run immediately. |
Kidney MRI without contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | - renal mass | |||||
Comments: | - if ordered without contrast, contact radiologist | |||||
Acquisition | sequence | fat sat | comments | |||
Cor | T2 HASTE/SSFSE | N | ||||
Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 FSE or BLADE | Y | AX HASTE/SSFSE FS if unable to respiratory trigger. | |||
Ax | DWI | n/a | B value 800 | |||
Ax | T1 VIBE/LAVA | Y | ||||
Cor | T1 VIBE/LAVA | Y | ||||
Comments: | ||||||
Kidney MRI with IV contrast (4/28/21) | ||||||
Indications: | - renal mass, cancer follow-up | |||||
Comments: | - always send subtractions | |||||
Contrast | type | rate | volume | saline flush | ||
gadolinium | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 TSE/FSE | Y | Resp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE. | |||
Ax | T1 GRE IN/OPP | n/a | ||||
Ax | DWI | n/a | B value 800 | |||
Ax | T1 VIBE/LAVA pre-Gd | Y | pre-contrast | |||
Ax | T1 VIBE/LAVA post-Gd | Y | care bolus arterial phase: breath hold and start scan immediately after Gd reaches heart | |||
Ax | T1 VIBE/LAVA post-Gd | Y | neprographic phase: begin 10 sec after arterial phase complete (70 sec) | |||
Ax | T1 VIBE/LAVA post-Gd | Y | equilibrium phase: start 3-5 min after injection. | |||
Cor | T1 VIBE/LAVA post-Gd | Y | wait 15-20 sec to recover breath, then run | |||
MR Urogram | ||||||
Indications: | hematuria, mass in collecting system | |||||
Comments: | FOV from top of kidneys through bladder, patient to be well hydrated, 250 cc IV fluid bolus during initial scanning, 5mg Lasix IV after COR VIBE precon | |||||
Contrast | type | rate | volume | saline flush | ||
Multihance | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor | T2 HASTE/SSFSE | N | ||||
Ax | T2 HASTE/SSFSE | N | ||||
Ax | T2 FSE or BLADE | Y | can do AX HASTE/SSFSE FS if unable to respiratory trigger. | |||
Ax | DWI | N/A | ||||
Ax | T1 VIBE/LAVA pre-Gd | Y | if utilizing Dixon technique , send water only, In/Out phase | |||
Cor | T1 VIBE/LAVA pre-Gd | Y | ||||
Ax | In/Out phase GRE | N/A | only if not utilizing Dixon | |||
Cor | MRCP thick slab | through kidneys | ||||
Cor | T1 VIBE/LAVA dynamic | Y | fluoro triggered corticomedullary phase, followed by nephrographic and urographic phases per timing protocol | |||
Ax | T1 VIBE/LAVA post-Gd | Y | ||||
Comments: |
Pelvis | ||||||
---|---|---|---|---|---|---|
Indications: | Surveillance, follow up cancer | |||||
Comments: | To be performed with a routine abdomen MRI when a provider orders an MRI of the abdomen and pelvis, typically for follow up of malignancy when patient is unable to have a CT scan or as part of a research protocol. Perform a routine abdomen/liver protocol as well as the following Pelvis protocol. | |||||
Contrast | type | rate | volume | saline flush | ||
Comments: | Yes | |||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax | Haste/SSFSE | N | ||||
Ax | T2 BLADE or FSE | Y | ||||
Sag | T2FSE | N | ||||
Ax | T1 GRE In/Out Phase | N | ||||
Ax | DWI | B value 800 | ||||
Ax | T1 3D GRE pre-Gd (VIBE/LAVA) | Y | ||||
Ax | T1 3D GRE post-Gd (VIBE/LAVA) | Y | ||||
Comments: |
"Routine" female pelvis MRI with IV contrast (12/24/21) | ||||||
---|---|---|---|---|---|---|
Indications: | uterine fibroids, uterine malignancy | |||||
Comments: | Orient Cor/Ax planes to endometrial cavity for all uterine pathology, otherwise use routine coronal and axial planes. | |||||
Contrast | type | rate | volume | saline flush | ||
Comments: | gadolinium | |||||
Acquisition | sequence | fat sat | comments | |||
Cor/Sag/Ax | T2 BLADE or FSE | N | ||||
Ax | T2 BLADE or FSE | Y | ||||
Ax | DWI | B value 800 | ||||
Ax | T1 FSE pre-Gd | N | ||||
Ax | T1 FSE pre-Gd | Y | ||||
Ax/Cor/Sag | T1 FSE post-Gd | Y | ||||
Comments: | ||||||
"Routine" female pelvis MRI without contrast (4/28/21) | ||||||
Indications: | same as above; contra-indication to IV contrast | |||||
Comments: | study should be performed with IV contrast if possible. Orient Cor/Ax planes to endometrial cavity for all uterine pathology, otherwise use routine coronal and axial planes. | |||||
Acquisition | sequence | fat sat | comments | |||
Cor/Sag | T2 BLADE/FSE | N | ||||
Ax | T2 BLADE/FSE | Y | ||||
Ax | DWI | B value 800 | ||||
Ax/Cor | T1 FSE | Y | ||||
Ax | T1 FSE | N | ||||
Comments: | ||||||
Female pelvis for urethral diverticulum (4/28/21) | ||||||
Indications: | suspected urethral divertiulum; peri-urethral mass | |||||
Comments: | Gadolinium | |||||
Acquisition | sequence | fat sat | comments | |||
Ax/Cor/Sag | T2 BLADE | N | orient Cor/Ax planes to the urethra | |||
Ax | T2 BLADE | Y | orient plane to urethra (i.e. short axis urethra) | |||
Ax | T1 GRE In/Out | N | ||||
Ax | T1 FSE | N | orient plane to urethra (i.e. short axis urethra) | |||
Ax/Cor | T1 FSE | Y | orient Cor/Ax planes to the urethra | |||
Ax/Cor | T1 FSE | Y | Post contrast with planes as above. | |||
Comments: | ||||||
Female pelvis for pelvic floor dysfunction (MR Defogram) (4/28/21) | ||||||
Indications: | pelvic floor dysfunction | |||||
Comments: | 100 ml ultrasound gel in rectum. 50ml ultrasound gel in vagina. | |||||
Acquisition | sequence | fat sat | comments | |||
Ax | T2 BLADE | N | from superior border of pubic symphysis through anal canal. Small FOV (20-22) | |||
Ax/Cor/Sag | SSFSE | N | entire pelvis (large FOV about 32). | |||
Sag | Fiesta | N | Midline at anorectal junction. Dynamic defecation phase. Cine clip. | |||
Comments: |
Prostate MRI with contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | prostate cancer staging; radiation therapy planning | |||||
Comments: | should be performed on 3T unit | |||||
Contrast | type | rate | volume | saline flush | ||
Comments: | Gadolinium | |||||
Acquisition | sequence | fat sat | comments | |||
Ax/Cor/Sag | T2 TSE | no | 180 FOV | |||
Ax | T1 TSE | no | 380 FOV, through entire pelvis (for lymph node evaluation) | |||
Ax | DWI/ADC | n/a | B-value 50 and 1500 (only send B1500 to PACS and Dynacad) | |||
Ax | T1 VIBE pre-Gd | yes | ||||
Ax | T1 VIBE post-Gd | yes | multiphase post-Gd dynamic | |||
Comments: | ||||||
Prostate MRI without IV contast (4/28/21) | ||||||
Indications: | prostate cancer staging; radiation therapy planning | |||||
Comments: | should be performed on 3T unit | |||||
should be perfromed with contrast - if ordered non-contrast, contact abdominal radiology to confirm | ||||||
Acquisition | sequence | fat sat | comments | |||
Ax/Cor/Sag | T2 TSE | no | 180 FOV | |||
Ax | T1 TSE | no | 380 FOV, through entire pelvis (for lymph node evaluation) | |||
Ax | DWI/ADC | n/a | B-value 50 and 1500 (only send B1500 to PACS and Dynacad) | |||
Ax | T1 VIBE non con | yes | ||||
Comments: | ||||||
Pelvic MRI post-prostatectomy (4/28/21) | ||||||
Indications: | prostate cancer staging, post-prostatectomy | |||||
Comments: | should be performed on 3T unit | |||||
Acquisition | sequence | fat sat | comments | |||
Ax/Cor/Sag | T2 TSE | no | 180 FOV | |||
Ax | T1 TSE | no | 380 FOV, whole pelvis | |||
Ax | DWI/ADC | n/a | B-value 50 and 1500 (only send B1500 to PACS and Dynacad) | |||
Ax | T1 VIBE pre-Gd | yes | ||||
Ax/Cor | T1 VIBE post-Gd | yes | multiphase post-Gd dynamic | |||
Comments: | orient all Ax/Cor imaging to body |
Pelvic fistula MRI with IV contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | perianal fistula or abscess | |||||
Comments: | scan physician office notes into PACS at start of exam; mark painful masses or skin openings | |||||
should be performed on 3T unit | ||||||
Contrast | type | rate | volume | saline flush | ||
Comments: | Gadolinium | |||||
Acquisition | sequence | fat sat | comments | |||
Ax/Cor/Sag | T2 FSE or BLADE | no | orient Cor/Ax with internal anal sphincter | |||
Ax | T2 FSE or BLADE | yes | orient Cor/Ax with internal anal sphincter | |||
Ax | DWI | B-value 800 | ||||
Ax | T1 TSE | yes | orient Cor/Ax with internal anal sphincter | |||
Ax/Cor | T1 TSE | yes | post-Gd | |||
Comments: | call radiologist after 1st few sequences to check coverage and scan angulation | |||||
Pelvic fistula MRI without contrast (4/28/21) | ||||||
Indications: | as above; study should be performed with contrast, unless contraindication | |||||
Comments: | scan physician office notes into PACS at start of exam; mark painful masses or skin openings | |||||
should be performed on 3T unit | ||||||
Acquisition | sequence | fat sat | comments | |||
Ax/Cor/Sag | T2 FSE or BLADE | no | orient Cor/Ax with internal anal sphincter | |||
Ax | T2 FSE or BLADE | yes | orient Cor/Ax with internal anal sphincter | |||
Ax | T1 TSE | yes | orient Cor/Ax with internal anal sphincter | |||
AX | DWI | B-value 800 | ||||
Comments: | call radiologist after 1st few sequences to check coverage and scan angulation |
Rectal mass protocol, without IV contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | known rectal malignancy | |||||
Comments: | scan physician office notes into PACS at start of exam | |||||
should be performed on 3T unit | ||||||
Contrast | type | rate | volume | saline flush | ||
Comments: | None | |||||
Acquisition | sequence | fat sat | comments | |||
Sag | T2 FRFSE | no | Large 380 FOV, 5 mm slice thickness | |||
Ax | T2 FRFSE | no | Large 380 FOV, whole pelvis, 5 mm slice thickness | |||
Oblique Ax/Cor | T2 FRFSE | no | Small ~180 FOV, angled to rectal mass, 3 mm slice thickness | |||
Ax | DWI | Entire pelvis, 5 mm slice thickness, B value 800 | ||||
Comments: | call radiologist after 1st few sequences to check coverage and scan angulation | |||||
Rectal mass protocol, with contrast (4/28/21) | ||||||
Indications: | as above; study should be performed without contrast, unless unique circumstance | |||||
Comments: | scan physician office notes into PACS at start of exam | |||||
should be performed on 3T unit | ||||||
Acquisition | sequence | fat sat | comments | |||
Sag | T2 FRFSE | no | Large 380 FOV, 5 mm slice thickness | |||
Ax | T2 FRFSE | no | Large 380 FOV, whole pelvis, 5 mm slice thickness | |||
Oblique Ax/Cor | T2 FRFSE | no | Small ~180 FOV, angled to rectal mass, 3 mm slice thickness | |||
Oblique Ax | T1 TSE | yes | Small ~180 FOV, angled to rectal mass, 3 mm slice thickness | |||
Oblique Ax/Cor | T1 TSE | yes | Small ~180 FOV, angled to rectal mass, 3 mm slice thickness | |||
Ax | DWI | Entire pelvis, 5 mm slice thickness,B value 800 | ||||
Comments: | call radiologist after 1st few sequences to check coverage and scan angulation |
Pregnant appendicitis MRI (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications: | abdominal MRI in pregnancy, typically for appendicitis | |||||
Contrast | type | rate | volume | saline flush | ||
None | ||||||
Acquisition | sequence | fat sat | comments | |||
Cor/Ax/Sag | T2 HASTE/SSFSE | N | ||||
Ax | T2 TSE/FSE | Y | Resp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE. | |||
Ax | T1 GRE IN/OPP | n/a | ||||
Ax | Trufisp | N | ||||
Ax | STIR | Y | Optional if no other good T2 Fat sat sequence | |||
Comment: FOV typically from dome of liver to pubic symphysis. |
Aortic MRA with contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Aortic aneurysm ,dissection | |||||
Comments: | Contrast enhanced MRA is always the preferred method of imaging. EKG gating should be utilized when possible. | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Multihance | 2-3 ml/sec | 0.1-0.2 mmol/kg | 20 ml | |||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Cor | Double IR or HASTE/SSFSE | No | ||||
Ax | Double IR or HASTE/SSFSE | No | ||||
Ax | T1 FSE | No | ||||
3D CE-MRA Care Bolus/Bolus Triggered | Yes | |||||
Ax | T1 GRE (Vibe/Lava) | Yes | ||||
Aortic MRA without IV contrast (4/28/21) | ||||||
Indications and preparation | ||||||
Indications: | Aortic Aneurysm, dissection ,etc. | |||||
Comments: | Contrast enhanced MRA is always the preferred method of imaging. EKG gating should be utilized when possible. | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Non | ||||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Cor | Double IR or HASTE/SSFSE | No | ||||
Ax | Double IR or HASTE/SSFSE | No | ||||
Ax | T1 FSE | No | ||||
Cor | White Blood (Fiesta/Trufisp/BFFE) | No | ||||
Ax | White Blood (Fiesta/Trufisp/BFFE) | No | ||||
Comments: |
Abdominal MRA with contrast (4/28/21) | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Aneurysm, dissection, renal artery stenosis | |||||
Comments: | Contrast enhanced MRA is always the preferred method of imaging. | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Multihance | 2-3 ml/sec | 0.1-0.2 mmol/kg | 20ml | |||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Cor | SSFSE | No | ||||
Ax | SSFSE | No | ||||
3D CE-MRA Care Bolus | ||||||
Ax | 3D GRE (Vibe/Lava) | Yes | ||||
Abdominal MRA without IV contrast (4/28/21) | ||||||
Indications and preparation | ||||||
Indications: | Aneurysm, dissection, renal artery stenosis | |||||
Comments: | Contrast enhanced MRA is always the preferred method of imaging. | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Non | ||||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Cor | SSFSE | No | ||||
Ax | SSFSE | No | ||||
Cor | White Blood (Fiesta, Trufisp, BFFE) | No | ||||
Ax | White Blood (Fiesta, Trufisp, BFFE) | No | ||||
Ax | T1 GRE (VIBE, Lava) | Yes | ||||
Comments: |
. | Brain MRI without contrast | |||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Altered mental status, stroke, dementia, etc | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | ||||||
Sagittal | T1 | |||||
Axial | T2 | |||||
Axial | FLAIR | |||||
Axial | T1 | |||||
Coronal | T1 | |||||
Axial | EPI/DWI | |||||
Axial or Coronal | T2* (FLASH) | Coronal prefered on Siemens | ||||
Siemens | ||||||
Comments: History of Trauma-Please add SWI where possible. | ||||||
NPH- add axial PD TSE, sagittal T2, and CSF flow sequence (if available and requested). | ||||||
Fast protocol | ||||||
Brain MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Primary and metastatic neoplasm, Infection, etc. | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | ||||||
Sagittal | T1 | |||||
Axial | T2 | |||||
Axial | FLAIR | |||||
Axial | T1 | |||||
Axial | EPI/DWI | |||||
Axial | T2* (FLASH) | |||||
Axial | T1 POST | |||||
Coronal | T1 POST | |||||
Axial | T1 POST-MT | with magnetization transfer- for neoplasm | ||||
Siemens | ||||||
Comments: | Fast protocol | |||||
Brain MRI, MS protocol | ||||||
Indications and preparation | ||||||
Indications: | MS, demyelinating disease | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | ||||||
Sagittal | T1 | |||||
Sagittal | FLAIR | |||||
Axial | EPI/DWI | |||||
Axial | T2 | All axials are 3 ST with 0 gap | ||||
Axial | FLAIR | |||||
Axial | T1 | |||||
Axial | PD T2 TSE | |||||
Axial | T1 POST | |||||
Sagittal | FLASH Volume | 1 mm | ||||
Coronal | FLASH Volume | Siemens | ||||
Comments: | These are thinner section with no gap (interleaved, if necessary) | |||||
Brain MRI with IV contrast - Seizure | ||||||
Indications and preparation | ||||||
Indications: | Seizure | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | ||||||
Sagittal | T1 | |||||
Axial | T2 | |||||
Axial | FLAIR | |||||
Axial | T1 | |||||
Axial | EPI/DWI | |||||
Coronal | T1 | |||||
Coronal | T2* (FLASH) | |||||
Coronal Oblique | T2 TSE | high resolution angled perpendicular to hippocampus | ||||
Coronal Volume | MPRAGE | SPGR | ||||
Axial | T1 POST | |||||
Coronal | T1 POST | Siemens | ||||
Comments: | Coronal Volume is whole brain. If isotropic sagittal MPRAGE or SPGR available, use that and reconstruct | |||||
in coronal and axial planes. | ||||||
Brain MRI SPECTROSCOPY | ||||||
Indications and preparation | ||||||
Indications: | Brain tumor/Radiation necrosis | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal | Localizer | |||||
Axial | T2 | |||||
Sagittal | T2 | |||||
Coronal | T2 | |||||
BEST | SV SSE 135 | SIEMENS | ||||
Comments: DO NOT RENAME SEQUENCES,SERIES 6AND 7 BEFORE APPLYING GO TO SCROLL SELECT NEAREST APPLY | ||||||
Brain MRI PERFUSION | ||||||
Indications and preparation | ||||||
Indications: | Stroke, brain tumor evaluation, etc. | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
SIEMENS | ||||||
Comments: |
Brain MRI STEALTH with contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Brain tumor, surgical planning, radiation planning, etc. | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | ||||||
Sagittal | T1 SE GAD | |||||
Axial | MPRAGE GAD | BRAVO where possible | ||||
SIEMENS | ||||||
Comments: | ||||||
Brain MRI STEALTH without contrast | ||||||
Indications and preparation | ||||||
Indications: | Trigeminal neuralgia, surgical planning, radiation planning, etc. | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | ||||||
Axial | T2 SPC 3MM | DARK | ||||
Axial | T2 SPC 2MM | DARK | ||||
SIEMENS | ||||||
Comments: |
Intracranial MRA, noncontrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Stroke, dizziness, etc. | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal localizer | PC | |||||
Axial | TOF | |||||
STANDARD AND FAST Siemens PROTOCOLS | ||||||
Comments: | - please see Excel spreadsheet for standard and fast protocols. | |||||
Recons: | COW spin and nod, R ICA spin, L ICA spin, VB system spin | |||||
Intracranial MRA with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | AVM | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal localizer | PC | |||||
Axial | TOF | |||||
Axial | TOF post | No superior saturation band | ||||
STANDARD AND FAST Siemens PROTOCOLS | ||||||
Comments: | ||||||
Intracranial MRV without and with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Venous thrombosis | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal localizer | PC | |||||
Coronal | 2D TOF | inferior sat band | ||||
Coronal | FL 3D TOF PRE | |||||
Coronal | FL 3D TOF POST | Inject-wait 35 seconds | ||||
SIEMENS | ||||||
Comments: |
Pituitary MRI without and with contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Pituitary microadenoma, Prolactinemia, Pituitary dysfunction, etc. | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Comments: | 1/2 dose contrast | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal | T1 SE | |||||
Axial | T2 TSE | |||||
Axial | FLAIR | |||||
Axial | EPI/DWI | |||||
Coronal | T2 TSE thin | |||||
Coronal | T1 SE thin | |||||
Coronal | T1 thin bolus | NO | dynamic keyhole for initial screening (3 runs adequate) | |||
Coronal | T1 thin POST | NO | ||||
Sagittal | T1 thin POST | NO | Siemens | |||
Axial | T1 POST | Optional-as indicated | ||||
Comments: |
Orbits MRI without and with contrast | |||||||
---|---|---|---|---|---|---|---|
Indications and preparation | b | ||||||
Indications: | Proptosis, Diplopia, Orbital mass, Cavernous sinus pathology | ||||||
Comments: | |||||||
Contrast | |||||||
type | rate | volume | saline flush | ||||
Comments: | |||||||
Acquisition | |||||||
plane | sequence | fat sat | comments | ||||
Sagittal | T1 | brain | |||||
Axial | T2 | brain | |||||
Axial | FLAIR | brain | |||||
Axial | EPI/DWI | brain | |||||
Coronal | T2 TSE thin | front of globe to brainstem | |||||
Axial | T1 SE thin | ||||||
Axial | T1 SE thin POST | YES | |||||
Axial | T2 with FS or STIR | ||||||
Coronal | T1 SE thin POST | YES | |||||
Axial | T1 POST | NO | brain | ||||
Comments: | - ADD Axial T2 STIR or T2 with FS | ||||||
Siemens | |||||||
Orbits MRI without IV contrast | |||||||
Indications and preparation | |||||||
Indications: | |||||||
Comments: | |||||||
Acquisition | |||||||
plane | sequence | fat sat | comments | ||||
Sagittal | T1 | ||||||
Axial | T2 | ||||||
Axial | FLAIR | ||||||
Axial | EPI/DWI | ||||||
Coronal | T2 TSE thin | ||||||
Axial | T1 SE thin | Siemens | |||||
Axial | STIR or T2 with FS | ||||||
Comments: |
IAC (7 and 8 nerve) protocol MRI with contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | SNHL, hearing loss, facial nerve paralysis | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal | T1 | |||||
Axial | T2 | |||||
Axial | FLAIR | |||||
Axial | EPI/DWI | |||||
Axial | T1 SE thin | |||||
Axial | T2 CISS | center at IAC | ||||
Axial | T1 SE thin POST | NO | ||||
Coronal | T1 SE thin POST | NO | Siemens | |||
Axial | T1 POST | NO | ||||
Comments: | - for 6th nerve CISS from IAC to pituitary and for CN 9-12, center below IAC | |||||
5th nerve MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Trigeminal neuralgia | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal | T1 | |||||
Axial | T2 | |||||
Axial | FLAIR | |||||
Axial | EPI/DWI | |||||
Coronal | T2 TSE thin | |||||
Coronal | T1 SE thin | |||||
Axial | T2 CISS | center at bottom of pituitary | ||||
Axial | T1 SE thin POST | NO | Optional +/- FAT SAT | |||
Coronal | T1 SE thin POST | NO | Siemens | |||
Axial | T1 POST | NO | OPTIONS | |||
Comments: | ||||||
3rd and 4th nerve MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Third and/or Fourth nerve palsy | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Sagittal | T1 | |||||
Axial | T2 | |||||
Axial | FLAIR | |||||
Axial | EPI/DWI | |||||
Coronal | T2 TSE thin | |||||
Coronal | T1 SE thin | |||||
Axial | T2 CISS | center at pituitary | ||||
Axial | T1 thin POST | NO | ||||
Coronal | T1 thin POST | NO | ||||
Sagittal | T1 thin POST | NO | ||||
Axial | T1 POST Brain | NO | Siemens | |||
Comments: |
TMJ MRI without contrast | ||||
---|---|---|---|---|
Indications and preparation | ||||
Indications: | Pain, TMJ syndrome | |||
Comments: | ||||
Acquisition | ||||
plane | sequence | fat sat | comments | |
Localizer | ||||
Coronal Oblique | T1 SE | Closed mouth | ||
Sagittal Oblique | T2 TSE | Closed mouth | ||
Sagittal Oblique | PD TSE | Closed mouth | ||
Sagittal Oblique | PD TSE | Open mouth | ||
T* or TSE T2 | dynamic-OPTIONAL | |||
SIEMENS | ||||
Comments: | Use dynamic with history of "click" |
Neck MRI without and with contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Mass, infection/inflammation, lymph node enlargement | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
3-plane | Localizer | |||||
Coronal | SE T1 FC | |||||
Coronal | T2 STIR | |||||
Axial | SE T1 FC | |||||
Axial | TSE T2 FS | YES | ||||
Axial | SE T1 FC FS | YES | POST GAD | |||
Coronal | SE T1 FC FS | YES | POST GAD | |||
MRI Pituitary'!E19=C10INK(E17ocs.google.com/spreadsheet/ccc?key=0ArsFxxLrJ2l-dHBTcmlZbW1ISGhzWk5HLUJVUEZnOGc&usp=sharing#gid=113";"SIEMENS") | ||||||
Comments: | Add Sagittal T1 pre and Sagittal T1 post with FS for Nasopharynx evaluation | |||||
Neck MRI with IV contast | ||||||
Indications and preparation | ||||||
Indications: | ||||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Comments: |
Neck MRA without contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | stroke, carotid stenosis, dizziness | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Axial | 2D TOF | |||||
Axial | 3D TOF | through carotid bifurcations only | ||||
Siemens | ||||||
Comments: | ||||||
Neck MRA with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Stroke, dizziness, carotid stenosis, vessel occlusion, dissection | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
3-Plane | Localizer | |||||
Axial | Localizer | |||||
Sagittal | Localizer | |||||
Coronal Volume | 3D TOF VOL | Yes | ||||
Coronal Volume | Care Bolus | Siemens | ||||
Coronal Post | 3D TOF VOL | YES | ||||
Comments: | Add Axial T1 pre-contrast with FATSAT for Dissection | |||||
TRICKS/TWIST where available for AVF evalution in close consultation with Neuroradiologist. |
Brachial plexus MRI without contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Brachial plexopathy. Upper extremity pain, numbness, parathesias, infection, tumor, etc. | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
3 plane | Localizer | |||||
Axial | Localizer | |||||
Coronal | TSE T1 Bilateral | |||||
Coronal | TSE STIR Bilateral | |||||
Axial Oblique | T1 Unilateral | |||||
Sagittal | SE T1 Unilateral | |||||
Sagittal | TSE T2 Unilateral | YES | ||||
Sagittal | TSE STIR Unilateral | Siemens | ||||
Coronal | TSE T1 Unilateral | |||||
Comments: | all imaging in external rotation | |||||
Brachial plexus MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Brachial plexopathy. Upper extremity pain, numbness, parathesias, infection, tumor, etc. | |||||
Comments: | All sequences from without study with additional sequences below. | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Coronal | TSE T2 Unilateral | YES | ||||
Coronal | SE T1 FS | YES | ||||
Sagittal | SE T1 FS | YES | ||||
Coronal | TSE T1 Bilateral | YES | Siemens | |||
Comments: |
C spine MRI without contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Neck pain, disc herniation, myelopathy, upper extremity radiculopathy, etc. | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR/SAG | Localizer | |||||
Sagittal | TSE T1 | |||||
Sagittal | TSE T2 | |||||
Sagittal | STIR TSE | |||||
Axial | 2D MEDIC | MERGE for GE | ||||
Axial | 3D SPACE | CUBE for GE | ||||
SIEMENS | ||||||
Comments: | Add Stacked Axial T2 TSE/FSE for MS and neoplasm. | |||||
C spine MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Myelopathy, neuropathy, cord mass, etc. | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR/SAG | Localizer | |||||
Sagittal | TSE T1 | |||||
Sagittal | TSE T2 | |||||
Sagittal | STIR TSE | |||||
Sagittal | TSE PD | Optional: Add for myelopathy/MS | ||||
Axial | 2D MEDIC | MERGE for GE | ||||
Axial | 3D SPACE | CUBE for GE | ||||
Axial | SE T1 POST | |||||
Sagittal | TSE T1 POST | YES | SIEMENS | |||
Comments: | Add Stacked Axial T2 TSE/FSE for MS and neoplasm. |
T spine MRI without contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Pain, tumor, myelopathy, MS | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
SAG/COR | Localizer | |||||
Sagittal | Localizer | |||||
Sagittal | TSE T1 | |||||
Sagittal | TSE T2 | |||||
Sagittal | STIR TSE | |||||
Sagittal | TSE PD | Optional: Add for myelopathy | ||||
Axial | 2D MEDIC | MERGE for GE | ||||
Axial | SE T1 | Keep T2 for GE sites | ||||
SIEMENS | ||||||
Comments: | ** On axial images at least one slice per disc space /add additional slices as needed. Stacked for MS and neoplasm. | |||||
Consider axial T2 for spinal tumor and for post-operative hardware cases with susceptibility artifacts | ||||||
T spine MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | ||||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
SAG/COR | Localizer | |||||
Sagittal | Localizer | |||||
Sagittal | TSE T1 | |||||
Sagittal | TSE T2 | |||||
Sagittal | STIR TSE | |||||
Sagittal | TSE PD | Optional: Add for myelopathy | ||||
Axial | 2D MEDIC | MERGE for GE | ||||
Axial | SE T1 | |||||
Axial | SE T1 POST | |||||
Sagittal | TSE T1 POST | YES | SIEMENS | |||
Comments: | ** On axial images at least one slice per disc space /add additional slices as needed. Stacked for MS and neoplasm. | |||||
Consider axial T2 for spinal tumor and for post-operative hardware cases with susceptibility artifacts |
L spine MRI without contrast | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | Pain, spinal stenosis, radiculopathy, etc. | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
SAG/COR | Localizer | |||||
Sagittal | Localizer | |||||
Sagittal | TSE T1 | |||||
Sagittal | TSE T2 | |||||
Sagittal | STIR TSE | |||||
Axial | TSE T2 | |||||
Axial | SE T1 | Siemens | ||||
Comments: | ||||||
L spine MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Infection, tumor, post-operative assessment, etc. | |||||
Comments: | In addition to all sequences from noncontrast exam | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Axial | SE T1 POST | NO | ||||
Sagittal | TSE T1 POST | YES | Siemens | |||
Comments: | Also, fat sat axials if specific question is infection. | |||||
NO FAT SAT IF KNOWN RODS AND SCREWS OR IF METALLIC ARTIFACTS ON POST WITH FAT SAT | ||||||
Lumbosacral plexus MRI | ||||||
Indications and preparation | ||||||
Indications: | Pain, paraspinal mass, plexopathy | |||||
Comments: | Specialty request study | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Localizer | FOV400 | |||||
Localizer | FOV340 | |||||
Sagittal | TSE T1 | |||||
Coronal Oblique | T1 STIR | |||||
Coronal Oblique | TSE STIR | |||||
Axial | TSE T2 | |||||
Axial | SE T1 | Siemens | ||||
Axial | TSE T2 STIR FS | |||||
Comments: | ||||||
L spine MRI with IV contrast | ||||||
Indications and preparation | ||||||
Indications: | Infection, tumor, post-operative assessment, etc. | |||||
Comments: | In addition to all sequences from noncontrast exam | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Axial | SE T1 POST | NO | ||||
Sagittal | TSE T1 POST | YES | Siemens | |||
Comments: | ||||||
Lumbar facet MRI | ||||||
Indications and preparation | ||||||
Indications: | ||||||
Comments: | Add below sequence-T2 with FAT SAT | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
Axial | TSE T2 FS | |||||
Siemens | ||||||
Comments: |
Shoulder MRI without contrast - MSK 1 | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | - shoulder pain, internal derangement, rotator cuff tear | |||||
Comments: | - good for diagnosing rotator cuff tears; less effective for labral pathology | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
oblique COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
oblique COR | PD TSE | - | - use TE 30 +/- 5 msec | |||
oblique SAG | T1 SE | - | - use TE 30 +/- 5 msec | |||
oblique SAG | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
AXIAL | PD TSE | fat sat | - use TE 50 +/- 5 msec | |||
AXIAL | PD TSE | - | - use TE 50 +/- 5 msec | |||
Comments: | shoulder positioned in EXTERNAL rotation | |||||
Shoulder MR arthrogram - MSK 1A | ||||||
Indications and preparation | ||||||
Indications: | - shoulder dislocation/instability, evaluate antero-inferior labral pathology | |||||
Comments: | - good for both rotator cuff and labral pathology | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
- dilute intra-articular gadolinium | 12 cc | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
oblique COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
oblique COR | T1 SE | fat sat | - use TE 30 +/- 5 msec | |||
oblique SAG | T1 SE | - | - use TE 30 +/- 5 msec | |||
oblique SAG | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
AXIAL | PD TSE | fat sat | - use TE 50 +/- 5 msec | |||
AXIAL | PD TSE | - | - use TE 50 +/- 5 msec | |||
ABER | T1 SE | fat sat | - use TE 30 +/- 5 msec | |||
Comments: | - shoulder positioned in EXTERNAL rotation; | |||||
- also includes Abduction External Rotation (ABER) sequence as tolerated |
Elbow MRI without contrast - MSK 2 | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | pain, internal derangement | |||||
Comments: | good for evaluating distal biceps and triceps tears, elbow pathology; less effective for collateral ligaments | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | PD FSE | - | - use TE 50 +/- 5 msec | |||
COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
AXIAL | PD FSE | - | - use TE 50 +/- 5 msec | |||
AXIAL | T2 FSE | fat sat | *** if T2FS is bad then do STIR | |||
SAG | T1 SE | - | - use TE 30 +/- 5 msec | |||
SAG | STIR | - | ***add cor 3D GRE/Medic(GRASS/FISP) on Siemens | |||
Comments: | - elbow supinated at side (preferred) or overhead while prone | |||||
- make sure that axial sequences go distal enough to encompass the biceps tendon insertion on the radius | ||||||
Elbow MR arthrogram - MSK 2A | ||||||
Indications and preparation | ||||||
Indications: | pain, internal derangement, evaluate for collateral ligament tear | |||||
Comments: | good for evaluating distal biceps and triceps tears, elbow pathology, and collateral ligaments | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
- dilute intra-articular gadolinium | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | fat sat | - use TE 30 +/- 5 msec | |||
COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
AXIAL | PD FSE | - | - use TE 50 +/- 5 msec | |||
AXIAL | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
SAG | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
SAG | T1 SE | - | - use TE 30 +/- 5 msec | |||
Comments: | - elbow supinated at side (preferred) or overhead while prone | |||||
- make sure that axial sequences go distal enough to encompass the biceps tendon insertion on the radius |
Wrist MRI without contrast - MSK 3 | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | pain, occult scaphoid fracture | |||||
Comments: | good for osseous and tendon pathology; less sensitive for triangular fibrocartilage tears and ligamentous injury | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | PD FSE | - use TE 30 +/- 5 msec | ||||
COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
AXIAL | PD FSE | |||||
AXIAL | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
COR | 3-D GRE | ***GE, water exc MEDIC, instead of DESS | ||||
SAG | T1 SE | |||||
SAG | T2 FSE | fat sat | ||||
COR | 3D CUBE | - as possible | ||||
Comments: | - wrist neutral at side or overhead while prone | |||||
Wrist MR arthrogram - MSK 3A | ||||||
Indications and preparation | ||||||
Indications: | pain, internal derangement, TFCC tear | |||||
Comments: | good for osseous pathology, tendon pathology, triangular fibrocartilage tears, and intrinsic carpal ligaments | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
- dilute intra-articular gadolinium | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | fat sat | ||||
COR | PD FSE | fat sat | - use TE 30 +/- 5 msec | |||
AXIAL | T1 SE | fat sat | ****switch to PD no FS | |||
AXIAL | STIR | ***T2 FS if bad then STIR | ||||
COR | 3-D GRE | ***GE, water exc MEDIC, instead of DESS | ||||
SAG | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
SAG | T1 SE | |||||
COR | 3D CUBE | - as possible | ||||
Comments: | - wrist neutral at side or overhead while prone |
Hand MRI without contrast - MSK 4 | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | pain, internal derangement | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | PD FSE | - | - use TE 50 +/- 5 msec | |||
COR | STIR | - | ||||
AXIAL | PD FSE | - | - use TE 50 +/- 5 msec | |||
AXIAL | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |||
SAG | T1 SE | - | - use TE 30 +/- 5 msec | |||
SAG | STIR | - | ||||
Comments: | - hand prone at side or overhead | |||||
- use field-of-view less than or equal to 10 (or as small a field-of-view as possible), centered on pathology | ||||||
- orient sagittal and coronal planes relative to fingernails | ||||||
Hand MRI with IV contrast (arthritis protocol) - MSK 4R | ||||||
Indications and preparation | ||||||
Indications: | characterize and follow-up inflammatory arthritides in the hands and wrists | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
0.1-0.4 mmol/kg Gadolinium | (up to 20mL) | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | - | - before gad | |||
COR | 2-D FLASH | fat sat | - before gad | |||
COR | STIR | - | - before gad | |||
AXIAL | STIR | - | - before gad | |||
COR | T1 SE | fat sat | - post gad | |||
AXIAL | T1 SE | fat sat | - post gad | |||
Comments: | - hand prone at side or overhead | |||||
- use as small a field-of-view as possible | ||||||
- orient sagittal and coronal planes relative to fingernails |
Finger MRI without contrast - MSK 4F | ||||
---|---|---|---|---|
Indications and preparation | ||||
Indications: | pain, internal derangement | |||
Acquisition | ||||
plane | sequence | fat sat | comments | |
COR | T1 SE | - use TE 30 +/- 5 msec | ||
COR | STIR | |||
AXIAL | PD FSE | - use TE 50 +/- 5 msec | ||
AXIAL | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |
SAG | T1 SE | - use TE 30 +/- 5 msec | ||
SAG | STIR | |||
3D CUBE | *** add 3D CUBE sequence call radiologist for plane | |||
Comments: | - hand prone at side or overhead | |||
- use as small a field-of-view as possible | ||||
- orient sagittal and coronal planes relative to fingernails | ||||
- coronal and axial sequences should encompass adjacent fingers for comparison | ||||
- sagittal sequences can be done through the symptomatic finger(s) only | ||||
Thumb MRI without contast - MSK 4T | ||||
Indications and preparation | ||||
Indications: | assess for ulnar collateral ligament injury/Stener lesion or radial collateral ligament injury | |||
Acquisition | ||||
plane | sequence | fat sat | comments | |
oblique COR | PD FSE | - use TE 50 +/- 5 msec | ||
oblique COR | STIR | |||
oblique COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |
AXIAL | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |
SAG | T1 SE | - use TE 30 +/- 5 msec | ||
SAG | STIR | |||
Comments: | - orientation should be parallel and perpendicular with the fingernail on the symptomatic finger |
MSK pelvis MRI without contrast - MSK 5T | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | assess for pelvic, hip or sacral fracture | |||||
Comments: | limited survey to assess for occult fractures; best reserved for ER add-ons | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | include entire pelvis | ||||
COR | STIR | include entire pelvis | ||||
AXIAL | T1 SE | include entire pelvis | ||||
AXIAL | STIR | include entire pelvis | ||||
MSK pelvis MRI with IV contrast - MSK 5M | ||||||
Indications and preparation | ||||||
Indications: | history of cancer, pelvic pain, evaluate for metastatic disease | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
0.1-0.4 mmol/kg Gadolinium | (up to 20 mL) | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | - | include entire pelvis | |||
COR | STIR | - | include entire pelvis | |||
AXIAL | T1 SE | - | include entire pelvis | |||
AXIAL | T1 SE | fat sat | include entire pelvis | |||
AXIAL | STIR | - | include entire pelvis | |||
SAG | STIR | - | include entire pelvis | |||
AXIAL | T1 SE | fat sat | - post gad, entire pelvis | |||
SAG | T1 SE | fat sat | - post gad, entire pelvis | |||
COR | T1 SE | fat sat | - post gad, entire pelvis | |||
Hernia MRI - MSK 5S | ||||||
Indications and preparation | ||||||
Indications: | Sports hernia, athletic pubalgia, osteitis pubis, inguinal hernia pain | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
none | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | - | large field of view pelvis | |||
COR | STIR | - | large field of view pelvis | |||
AXIAL | T1 SE | - | large field of view pelvis | |||
AXIAL | STIR | - | large field of view pelvis | |||
SAG | PD FSE | - | small field of view -- see below | |||
SAG | T2 FSE | - | small field of view -- see below | |||
SAG | T2 FSE | fat sat | small field of view -- see below | |||
- for sports hernia do parasymphyseal pubis | ||||||
- for inguinal hernia do small field of view for symptomatic side |
Hip MRI without contrast - MSK 5 | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | pain, internal derangement, avascular necrosis | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | STIR | - | - entire pelvis | |||
COR | T1 SE | - | - entire pelvis | |||
COR | PD | - | - affected hip | |||
COR | T2 FSE | fat sat | - affected hip | |||
AXIAL | PD | - | - affected hip, oblique axial orientation | |||
AXIAL | T2 FSE | fat sat | - affected hip, oblique axial orientation | |||
SAG | T2 FSE | fat sat | - affected hip | |||
Comments: | ||||||
Hip MRI arthrogram - MSK 5A | ||||||
Indications and preparation | ||||||
Indications: | hip pain, labral pathology | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | STIR | - | - entire pelvis | |||
COR | T1 SE | - | - entire pelvis | |||
COR | T1 SE | fat sat | - affected hip | |||
COR | T2 FSE | fat sat | - affected hip | |||
AXIAL | T1 SE | - | - affected hip, oblique axial orientation | |||
AXIAL | T2 FSE | fat sat | - affected hip, oblique axial orientation | |||
SAG | T2 FSE | fat sat | - affected hip | |||
Comments: |
Knee MRI without contrast - MSK 6 | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | pain, internal derangement, ACL tear, meniscus tear | |||||
Comments: | ||||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
SAG | PD FSE | fat sat | - use TE 50 +/- 5 msec | |||
SAG | PD FSE | - | - use TE 30 +/- 5 msec | |||
AXIAL | PD FSE | fat sat | - use TE 50 +/- 5 msec | |||
COR | PD FSE | - | - use TE 30 +/- 5 msec | |||
COR | PD FSE | fat sat | - use TE 50 +/- 5 msec | |||
Comments: | ||||||
Knee MR arthrogram - MSK 6A | ||||||
Indications and preparation | ||||||
Indications: | evaluate for meniscal retears, postoperative knee | |||||
Comments: | ||||||
Contrast | ||||||
type | rate | volume | saline flush | |||
- dilute intra-articular gadolinium | 50 mL | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
SAG | T1 SE | fat sat | ||||
SAG | PD FSE | fat sat | - use TE 50 +/- 5 msec | |||
COR | T1 SE | - | ||||
COR | T1 SE | fat sat | ||||
COR | PD FSE | fat sat | - use TE 50 +/- 5 msec | |||
AXIAL | PD FSE | fat sat | ||||
Comments: |
Ankle MRI without contrast | ||||
---|---|---|---|---|
Indications and preparation | ||||
Indications: | pain, internal derangement | |||
Comments: | ||||
Acquisition | ||||
plane | sequence | fat sat | comments | |
SAG | T1 SE | - | ||
SAG | T2FSE | - | -- if T2 fat sat is bad then STIR too | |
AXIAL | PD FSE | - | ||
AXIAL | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |
COR | T2 FSE | fat sat | - use TE 40 +/- 5 msec | |
OBLIQUE AXIAL | PD FSE | - | ** NOT FAT SAT ** | |
Comments: | - place fiducial marker over symptomatic site |
Foot MRI without contrast - MSK 8 | ||||
---|---|---|---|---|
Indications and preparation | ||||
Indications: | pain, internal derangement (anything other than osteomyelitis or Morton neuroma) | |||
Comments: | ||||
Acquisition | ||||
plane | sequence | fat sat | comments | |
SAG | T1 SE | |||
SAG | STIR | |||
AXIAL (long axis) | T1 SE | |||
AXIAL (long axis) | T2 FSE | fat sat | ||
COR (short axis) | T1 SE | |||
COR (short axis) | STIR | |||
Comments: | - place fiducial over symptomatic site | |||
- long axis sequences are performed parallel to the metatarsal shafts. | ||||
- short axis sequences are performed perpendicular to the metatarsal shafts. |
Extremity MRI with and without contrast (TUMOR/MASS) | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | osseous or soft tissue lesion, palpable or seen on other studies | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
0.1-0.4 mmol/kg Gadolinium | up to 20 mL | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | - | ||||
COR | STIR | - | ||||
AXIAL | T1 SE | - | ||||
SHORT AXIS | T1 SE | fat sat | *** almost always axial, except in foot (when it would be coronal) *** | |||
AXIAL | STIR | - | ||||
SAG | STIR | - | ||||
SAG | T1 SE | - | ||||
AXIAL | T1 SE | fat sat | - post gad | |||
SAG | T1 SE | fat sat | - post gad | |||
COR | T1 SE | fat sat | - post gad | |||
Comments: | - Call MSK radiologist to confirm protocol and check for extra sequences | |||||
- place fiducial over mass, if palpable | ||||||
- COR and SAG, incl. entire long bone of concern. May include contralateral leg/thigh on coronal for comparison | ||||||
- AX images, restrict slices to the actual lesion or site of concern | ||||||
- for studies attempting to diagnose a bone lesion, check PACS to see if there is a diagnostic quality plain film of the lesion in quesion. If not, consult with interpreting radiologist about sending the patient to obtain plain films |
Extremity MRI with and without contrast (INFECTION) | ||||||
---|---|---|---|---|---|---|
Indications and preparation | ||||||
Indications: | assess for osteomyelitis or abscess | |||||
Contrast | ||||||
type | rate | volume | saline flush | |||
0.1-0.4 mmol/kg Gadolinium | up to 20 mL | |||||
Acquisition | ||||||
plane | sequence | fat sat | comments | |||
COR | T1 SE | |||||
COR | STIR | |||||
AXIAL | T1 SE | |||||
AXIAL | STIR | |||||
SAG | STIR | |||||
SAG | T1 SE | |||||
AXIAL | T1 SE | fat sat | - post gad | |||
SAG | T1 SE | fat sat | - post gad | |||
COR | T1 SE | fat sat | - post gad | |||
Comments: | - place fiducial over redness and/or ulcers | |||||
*** infection protocol DOES NOT REQUIRE PRE-GAD T1 FAT SAT sequence | ||||||
Extremity MRI without contrast (Long Bone Evaluation) | ||||
---|---|---|---|---|
Indications and preparation | ||||
Indications: | non-specific pain (use extremity infection or mass protocols instead if indicated) | |||
Acquisition | ||||
plane | sequence | fat sat | comments | |
COR | T1 SE | |||
COR | STIR | |||
AXIAL | T1 SE | |||
AXIAL | STIR | |||
SAG | STIR | |||
SAG | T1 SE | |||
Comments: | - place fiducial over region of pain | |||
- COR and SAG, include entire long bone of concern. May include contralateral leg/thigh on coronal for comparison | ||||
- AX images, restrict slices to the actual site of concern | ||||
- typically done for humerus, femur, leg, or forearm |