MRI Technologist References

All

See the complete reference spreadsheet with formatting here (requires the ability to access Google Sheets):

https://docs.google.com/spreadsheets/d/1M7XnLjHeIveAvoMeDZ5DG93zLgyB-N4ynP8oLxNbYf8/

Liver

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

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

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

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.

Kidneys

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:

General Pelvis

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:

Female Pelvis

"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:	Please add subtraction axial images to any/every body MR with contrast



"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:	Please add subtraction axial images to any/every body MR with contrast



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

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 (fat-sat)	yes	wide FOV (aortic bifurcation to inferior rami)
Ax	T1 VIBE post-Gd	yes	multiphase post-Gd dynamic
Ax	T1 VIBE POST-Gd (fat-sat)	yes	final POST-gad wide FOV (aortic bifurcation to inferior rami)
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

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. Please add subtraction axial images to any/every body MR with contrast.



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

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. Please add subtraction axial images to any/every body MR with contrast.

Pregnant Appendicitis

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
Ax	ADC/DWI	n/a	to better detect blood products and appendicitis complications
Comment: FOV typically from dome of liver to pubic symphysis.

MRA Chest

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:

MRA Abdomen

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:

MRI Brain

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

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:

MRA MRV Head

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:

MRI Pituitary

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:

MRI Orbits

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:

MRI Cranial Nerves

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:

MRI TMJ

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"

MRI Neck

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:

MRA Neck

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

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:

MRI C-Spine

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.

MRI T-Spine

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

MRI L-Spine

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

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

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

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

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

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

Pelvis

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

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

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

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

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 Mass

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 Infection

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 Pain

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

MRI Technologist References

MRI Technologist References

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