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
Indications:liver lesion characterization; metastatic disease workup; screening for HCC in chronic liver diseases
Contrasttyperatevolumesaline flush
Multihance
Acquisitionsequencefat satcomments
Cor/AxT2 HASTE/SSFSEN
AxT2 TSE/FSEYResp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE.
AxT1 GRE IN/OPPn/a
AxDWIn/a
AxT1 VIBE/LAVA pre-GdYpre-contrast
AxT1 VIBE/LAVA post-GdYcare bolus arterial phase: breath hold and start scan immediately after Gd reaches heart
AxT1 VIBE/LAVA post-GdYportal phase: begin 10 sec after arterial phase complete (70 sec)
AxT1 VIBE/LAVA post-GdYequilibrium phase: start 3-5 min after contrast injection.
CorT1 VIBE/LAVA post-GdYwait 15-20 sec to recover breath, then run
AxT1 VIBE/LAVA post-GdYwait additional 5 min: ONLY RUN if indication includes hemangioma or cholangiocarcinoma (otherwise equilibrium is last sequence)
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
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
Acquisitionsequencefat satcomments
Cor/AxT2 HASTE/SSFSEN
AxT2 TSE/FSEYResp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE.
AxT1 GRE IN/OPPn/a
AxDWIn/a
AxT1 VIBE/LAVAY
CorT1 VIBE/LAVAY
Comments:
Liver MRI with Eovist
Indications:suspect FNH (focal nodular hyperplasia); metastatic workup; cirrhosis screening; biliary reconstruction, bile leak
Comments:Eovist will be specifically requested. If unsure call radiologist.
Contrasttyperatevolumesaline flush
Eovist
Acquisitionsequencefat satcomments
Cor/AxT2 HASTE/SSFSEN
AxT1 GRE IN/OPPn/a
AxT1 VIBE/LAVA pre-GdYpre-contrast
AxT1 VIBE/LAVA post-GdYcare bolus arterial phase: breath hold and start scan immediately after Gd reaches heart
AxT1 VIBE/LAVA post-GdYportal phase: begin 10 sec after arterial phase complete
AxDWIn/a
AxT1 VIBE/LAVA post-GdYequilibrium phase: start 5 min after portal phase complete.
AxT2 TSE/FSEYresp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE.
AxT1 VIBE/LAVA post-GdYtotal 20 min. delay after contrast injection
CorT1 VIBE/LAVA post-GdY
Comments:care bolus

MRCP
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.
Acquisitionsequencefat satcomments
CorT2 TSE/FSE 3D(SPACE on Siemens). 1 mm slices.
MIP of above
Cor OBL T2 HASTE/SSFSEY40 mm slab rotated 20-30 degrees clockwise to include gallbladder and CBD
Cor OBL T2 HASTE/SSFSEY40 mm slab rotated 20-30 degrees counterclockwise to include CBD and pancreatic duct
Cor T2 HASTE/SSFSEYthin 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
Indications:adrenal lesion characterization; clinical suspicion of functioning adenoma
Comments:
Acquisitionsequencefat satcomments
CorT2 HASTE/SSFSEN
AxT2 HASTE/SSFSEN
AxT2 FSE/BLADEY
AxDWI
AxT1 GRE IN/OPPn/akey sequence, repeat BH instructions and repeat sequence as needed
AxT1 VIBE/LAVAY
Comments:
Adrenal MRI with IV contrast
Indications:study typically performed without contrast
Comments:if study ordered with contrast, contact radiologist
Contrasttyperatevolumesaline flush
Multihance
Acquisitionsequencefat satcomments
CorHASTE/SSFSEN
AxHASTE/SSFSEN
AxT2 FSE/BLADEY
AxDWI
AxT1 GRE IN/OPPn/akey sequence, repeat BH instructions and repeat sequence as needed
AxT1 VIBE/LAVA pre-GdY
AxT1 VIBE/LAVA post-GdYarterial/portal/equilibrium phases, same as liver except FOV
Comments:

Pancreas MRI without contrast
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
Acquisitionsequencefat satcomments
CorHASTE/SSFSEN
AxHASTE/SSFSEN
AxT2 FSE or BLADEYAX HASTE/SSFSE FS if unable to respiratory trigger.
AxDWIn/a
AxVIBE/LAVAY
AxT1 FSE FSY
CorVIBE/LAVAY
Comments:
Pancreas MRI with IV contrast
Indications:pancreatic mass; evaluate for source of biliary or pancreatic ductal obstruction
Comments:
Contrasttyperatevolumesaline flush
Multihance
Comments:
Acquisitionsequencefat satcomments
Cor/AxT2 HASTE/SSFSEN
AxT2 TSE/FSEYResp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE.
AxT1 GRE IN/OPPn/a
AxDWIn/a
AxT1 VIBE/LAVA pre-GdYpre-contrast
AxT1 VIBE/LAVA post-GdYcare bolus arterial phase: breath hold and start scan immediately after Gd reaches heart
AxT1 VIBE/LAVA post-GdYportal phase: begin 10 sec after arterial phase complete (70 sec)
AxT1 VIBE/LAVA post-GdYequilibrium phase: start 3-5 min after injection.
CorT1 VIBE/LAVA post-GdYwait 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
Indications:- renal mass
Comments:- if ordered without contrast, contact radiologist
Acquisitionsequencefat satcomments
CorT2 HASTE/SSFSEN
AxT2 HASTE/SSFSEN
AxT2 FSE or BLADEYAX HASTE/SSFSE FS if unable to respiratory trigger.
AxDWIn/a
Ax T1 VIBE/LAVAY
AxT1 FSEY
Cor T1 VIBE/LAVAY
Comments:
Kidney MRI with IV contrast
Indications:- renal mass, cancer follow-up
Comments:- always send subtractions
Contrasttyperatevolumesaline flush
Multihance
Acquisitionsequencefat satcomments
Cor/AxT2 HASTE/SSFSEN
AxT2 TSE/FSEYResp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE.
AxT1 GRE IN/OPPn/a
AxDWIn/a
AxT1 VIBE/LAVA pre-GdYpre-contrast
AxT1 VIBE/LAVA post-GdYcare bolus arterial phase: breath hold and start scan immediately after Gd reaches heart
AxT1 VIBE/LAVA post-GdYneprographic phase: begin 10 sec after arterial phase complete (70 sec)
AxT1 VIBE/LAVA post-GdYequilibrium phase: start 3-5 min after injection.
CorT1 VIBE/LAVA post-GdYwait 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
Contrasttyperatevolumesaline flush
Multihance
Acquisitionsequencefat satcomments
CorT2 HASTE/SSFSEN
AxT2 HASTE/SSFSEN
AxT2 FSE or BLADEYcan do AX HASTE/SSFSE FS if unable to respiratory trigger.
AxDWIN/A
AxT1 VIBE/LAVA pre-GdYif utilizing Dixon technique , send water only, In/Out phase
CorT1 VIBE/LAVA pre-GdY
AxIn/Out phase GREN/Aonly if not utilizing Dixon
CorMRCP thick slabthrough kidneys
CorT1 VIBE/LAVA dynamicYfluoro triggered corticomedullary phase, followed by nephrographic and urographic phases per timing protocol
AxT1 VIBE/LAVA post-GdY
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.
Contrasttyperatevolumesaline flush
Comments:Yes
Acquisitionsequencefat satcomments
Cor/AxHaste/SSFSEN
AxT2 BLADE or FSEY
Sag T2FSEN
AxT1 GRE In/Out PhaseN
AxDWI
AxT1 3D GRE pre-Gd (VIBE/LAVA)Y
AxT1 3D GRE post-Gd (VIBE/LAVA)Y
Comments:

"Routine" female pelvis MRI with IV contrast
Indications:uterine fibroids, uterine malignancy
Comments:Orient Cor/Ax planes to endometrial cavity for all uterine pathology, otherwise use routine coronal and axial planes.
Contrasttyperatevolumesaline flush
Comments:Multihance
Acquisitionsequencefat satcomments
Cor/SagT2 BLADE or FSEN
AxT2 BLADE or FSEY
AxT1 GRE In/Out PhaseN
AxDWI
AxT1 FSE pre-GdN
AxT1 FSE pre-GdY
Ax/Cor/SagT1 FSE post-GdY
Comments:
"Routine" female pelvis MRI without contrast
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.
Acquisitionsequencefat satcomments
Cor/SagT2 BLADE/FSEN
AxT2 BLADE/FSEY
AxT1 GRE In/OutN
AxDWI
Ax/CorT1 FSEY
AxT1 FSEN
Comments:
Female pelvis for urethral diverticulum
Indications:suspected urethral divertiulum; peri-urethral mass
Comments:Multihance
Acquisitionsequencefat satcomments
Ax/Cor/SagT2 BLADENorient Cor/Ax planes to the urethra
AxT2 BLADEYorient plane to urethra (i.e. short axis urethra)
AxT1 GRE In/OutN
AxT1 FSENorient plane to urethra (i.e. short axis urethra)
Ax/CorT1 FSEYorient Cor/Ax planes to the urethra
Ax/CorT1 FSEYPost contrast with planes as above.
Comments:
Female pelvis for pelvic floor dysfunction (MR Defogram)
Indications:pelvic floor dysfunction
Comments:100 ml ultrasound gel in rectum. 50ml ultrasound gel in vagina.
Acquisitionsequencefat satcomments
AxT2 BLADENfrom superior border of pubic symphysis through anal canal. Small FOV (20-22)
Ax/Cor/SagSSFSENentire pelvis (large FOV about 32).
SagFiestaNMidline at anorectal junction. Dynamic defecation phase. Cine clip.
Comments:

Prostate MRI with contrast
Indications:prostate cancer staging; radiation therapy planning
Comments:should be performed on 3T unit
Contrasttyperatevolumesaline flush
Comments:
Acquisitionsequencefat satcomments
Ax/Cor/SagT2 TSEno180 FOV
AxT1 TSE no380 FOV, through entire pelvis (for lymph node evaluation)
AxDWI/ADCn/aB-value 1500
AxT1 VIBE pre-Gdyes
AxT1 VIBE post-Gdyes or nomultiphase post-Gd dynamic
Comments:
Prostate MRI without IV contast
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
Acquisitionsequencefat satcomments
Ax/Cor/SagT2 TSEno180 FOV
AxT1 TSEno380 FOV, through entire pelvis (for lymph node evaluation)
AxDWI/ADCn/aB-value 1500
AxT1 VIBE non conyes
Comments:
Pelvic MRI post-prostatectomy
Indications:prostate cancer staging, post-prostatectomy
Comments:should be performed on 3T unit
Acquisitionsequencefat satcomments
Ax/Cor/SagT2 TSEno180 FOV
AxT1 TSEno380 FOV, whole pelvis
AxDWI/ADCn/aB-value 1500
AxT1 VIBE pre-Gdyes
Ax/CorT1 VIBE post-Gdyesmultiphase post-Gd dynamic
Comments: orient all Ax/Cor imaging to body

Pelvic fistula MRI with IV contrast
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
Contrasttyperatevolumesaline flush
Comments:
Acquisitionsequencefat satcomments
Ax/Cor/SagT2 BLADEnoorient Cor/Ax with internal anal sphincter
AxT2 BLADEyesorient Cor/Ax with internal anal sphincter
AxDWIB-value 800
AxT1 TSEyesorient Cor/Ax with internal anal sphincter
Ax/CorT1 TSEyespost-Gd
Comments:call radiologist after 1st few sequences to check coverage and scan angulation
Pelvic fistula MRI without contrast
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
Acquisitionsequencefat satcomments
Ax/Cor/SagT2 BLADEnoorient Cor/Ax with internal anal sphincter
AxT2 BLADEyesorient Cor/Ax with internal anal sphincter
AxT1 TSEyesorient Cor/Ax with internal anal sphincter
AXDWIB-value 800
Comments:call radiologist after 1st few sequences to check coverage and scan angulation

Rectal mass protocol, without IV contrast
Indications:known rectal malignancy
Comments:scan physician office notes into PACS at start of exam
should be performed on 3T unit
Contrasttyperatevolumesaline flush
Comments:None
Acquisitionsequencefat satcomments
SagT2 FRFSEnoLarge 380 FOV, 5 mm slice thickness
AxT2 FRFSEnoLarge 380 FOV, whole pelvis, 5 mm slice thickness
Oblique Ax/CorT2 FRFSEnoSmall ~180 FOV, angled to rectal mass, 3 mm slice thickness
AxDWIEntire pelvis, 5 mm slice thickness
Comments:call radiologist after 1st few sequences to check coverage and scan angulation
Rectal mass protocol, with contrast
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
Acquisitionsequencefat satcomments
SagT2 FRFSEnoLarge 380 FOV, 5 mm slice thickness
AxT2 FRFSEnoLarge 380 FOV, whole pelvis, 5 mm slice thickness
Oblique Ax/CorT2 FRFSEnoSmall ~180 FOV, angled to rectal mass, 3 mm slice thickness
Oblique AxT1 TSEyesSmall ~180 FOV, angled to rectal mass, 3 mm slice thickness
Oblique Ax/CorT1 TSEyesSmall ~180 FOV, angled to rectal mass, 3 mm slice thickness
AxDWIEntire pelvis, 5 mm slice thickness
Comments:call radiologist after 1st few sequences to check coverage and scan angulation

Pregnant appendicitis MRI
Indications:abdominal MRI in pregnancy, typically for appendicitis
Contrasttyperatevolumesaline flush
None
Acquisitionsequencefat satcomments
Cor/Ax/SagT2 HASTE/SSFSEN
AxT2 TSE/FSEYResp. triggered, BLADE/PROPELLER. If cannot acquire good result run FS AX HASTE/SSFSE.
AxT1 GRE IN/OPPn/a
AxTrufispN
AxSTIRYOptional if no other good T2 Fat sat sequence
Comment: FOV typically from dome of liver to pubic symphysis.

Aortic MRA with contrast
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
typeratevolumesaline flush
Multihance2-3 ml/sec0.1-0.2 mmol/kg20 ml
Comments:
Acquisition
planesequencefat satcomments
CorDouble IR or HASTE/SSFSENo
AxDouble IR or HASTE/SSFSENo
AxT1 FSENo
3D CE-MRA Care Bolus/Bolus TriggeredYes
AxT1 GRE (Vibe/Lava)Yes
Aortic MRA without IV contrast
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
typeratevolumesaline flush
Non
Comments:
Acquisition
planesequencefat satcomments
CorDouble IR or HASTE/SSFSENo
AxDouble IR or HASTE/SSFSENo
AxT1 FSENo
CorWhite Blood (Fiesta/Trufisp/BFFE)No
AxWhite Blood (Fiesta/Trufisp/BFFE)No
Comments:

Abdominal MRA with contrast
Indications and preparation
Indications:Aneurysm, dissection, renal artery stenosis
Comments:Contrast enhanced MRA is always the preferred method of imaging.
Contrast
typeratevolumesaline flush
Multihance2-3 ml/sec0.1-0.2 mmol/kg20ml
Comments:
Acquisition
planesequencefat satcomments
CorSSFSENo
AxSSFSENo
3D CE-MRA Care Bolus
Ax3D GRE (Vibe/Lava)Yes
Abdominal MRA without IV contrast
Indications and preparation
Indications:Aneurysm, dissection, renal artery stenosis
Comments:Contrast enhanced MRA is always the preferred method of imaging.
Contrast
typeratevolumesaline flush
Non
Comments:
Acquisition
planesequencefat satcomments
CorSSFSENo
AxSSFSENo
CorWhite Blood (Fiesta, Trufisp, BFFE)No
AxWhite Blood (Fiesta, Trufisp, BFFE)No
AxT1 GRE (VIBE, Lava)Yes
Comments:

.
Brain MRI without contrast
Indications and preparation
Indications:Altered mental status, stroke, dementia, etc
Comments:
Acquisition
planesequencefat satcomments
Localizer
Sagittal T1
AxialT2
AxialFLAIR
AxialT1
CoronalT1
AxialEPI/DWI
Axial or CoronalT2* (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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Localizer
Sagittal T1
AxialT2
AxialFLAIR
AxialT1
AxialEPI/DWI
AxialT2* (FLASH)
AxialT1 POST
CoronalT1 POST
AxialT1 POST-MTwith magnetization transfer- for neoplasm
Siemens
Comments:Fast protocol
Brain MRI, MS protocol
Indications and preparation
Indications:MS, demyelinating disease
Comments:
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Localizer
SagittalT1
SagittalFLAIR
AxialEPI/DWI
AxialT2All axials are 3 ST with 0 gap
AxialFLAIR
AxialT1
AxialPD T2 TSE
AxialT1 POST
SagittalFLASH Volume1 mm
CoronalFLASH VolumeSiemens
Comments:These are thinner section with no gap (interleaved, if necessary)
Brain MRI with IV contrast - Seizure
Indications and preparation
Indications:Seizure
Comments:
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Localizer
Sagittal T1
AxialT2
AxialFLAIR
AxialT1
AxialEPI/DWI
CoronalT1
CoronalT2* (FLASH)
Coronal ObliqueT2 TSEhigh resolution angled perpendicular to hippocampus
Coronal VolumeMPRAGESPGR
AxialT1 POST
CoronalT1 POSTSiemens
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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Sagittal Localizer
AxialT2
Sagittal T2
CoronalT2
BESTSV SSE 135SIEMENS
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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
SIEMENS
Comments:

Brain MRI STEALTH with contrast
Indications and preparation
Indications:Brain tumor, surgical planning, radiation planning, etc.
Comments:
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Localizer
Sagittal T1 SE GAD
AxialMPRAGE GADBRAVO where possible
SIEMENS
Comments:
Brain MRI STEALTH without contrast
Indications and preparation
Indications:Trigeminal neuralgia, surgical planning, radiation planning, etc.
Comments:
Acquisition
planesequencefat satcomments
Localizer
Axial T2 SPC 3MMDARK
Axial T2 SPC 2MMDARK
SIEMENS
Comments:

Intracranial MRA, noncontrast
Indications and preparation
Indications:Stroke, dizziness, etc.
Comments:
Acquisition
planesequencefat satcomments
Sagittal localizerPC
AxialTOF
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
typeratevolumesaline flush
Comments:
Acquisition
planesequencefat satcomments
Sagittal localizerPC
AxialTOF
AxialTOF postNo superior saturation band
STANDARD AND FAST Siemens PROTOCOLS
Comments:
Intracranial MRV without and with IV contrast
Indications and preparation
Indications:Venous thrombosis
Comments:
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Sagittal localizerPC
Coronal2D TOFinferior sat band
CoronalFL 3D TOF PRE
CoronalFL 3D TOF POSTInject-wait 35 seconds
SIEMENS
Comments:

Pituitary MRI without and with contrast
Indications and preparation
Indications:Pituitary microadenoma, Prolactinemia, Pituitary dysfunction, etc.
Comments:
Contrast
typeratevolumesaline flush
Comments:1/2 dose contrast
Acquisition
planesequencefat satcomments
Sagittal T1 SE
AxialT2 TSE
AxialFLAIR
AxialEPI/DWI
CoronalT2 TSE thin
CoronalT1 SE thin
CoronalT1 thin bolus NOdynamic keyhole for initial screening (3 runs adequate)
CoronalT1 thin POST NO
Sagittal T1 thin POSTNOSiemens
AxialT1 POSTOptional-as indicated
Comments:

Orbits MRI without and with contrast
Indications and preparationb
Indications:Proptosis, Diplopia, Orbital mass, Cavernous sinus pathology
Comments:
Contrast
typeratevolumesaline flush
Comments:
Acquisition
planesequencefat satcomments
Sagittal T1brain
AxialT2brain
AxialFLAIRbrain
AxialEPI/DWIbrain
CoronalT2 TSE thinfront of globe to brainstem
AxialT1 SE thin
AxialT1 SE thin POSTYES
AxialT2 with FS or STIR
CoronalT1 SE thin POST YES
AxialT1 POSTNObrain
Comments: - ADD Axial T2 STIR or T2 with FS
Siemens
Orbits MRI without IV contrast
Indications and preparation
Indications:
Comments:
Acquisition
planesequencefat satcomments
Sagittal T1
AxialT2
AxialFLAIR
AxialEPI/DWI
CoronalT2 TSE thin
AxialT1 SE thinSiemens
AxialSTIR 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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Sagittal T1
AxialT2
AxialFLAIR
AxialEPI/DWI
AxialT1 SE thin
AxialT2 CISScenter at IAC
AxialT1 SE thin POSTNO
CoronalT1 SE thin POST NOSiemens
AxialT1 POSTNO
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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Sagittal T1
AxialT2
AxialFLAIR
AxialEPI/DWI
CoronalT2 TSE thin
CoronalT1 SE thin
AxialT2 CISScenter at bottom of pituitary
AxialT1 SE thin POSTNOOptional +/- FAT SAT
CoronalT1 SE thin POST NOSiemens
AxialT1 POSTNOOPTIONS
Comments:
3rd and 4th nerve MRI with IV contrast
Indications and preparation
Indications:Third and/or Fourth nerve palsy
Comments:
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Sagittal T1
AxialT2
AxialFLAIR
AxialEPI/DWI
CoronalT2 TSE thin
CoronalT1 SE thin
AxialT2 CISScenter at pituitary
AxialT1 thin POSTNO
CoronalT1 thin POST NO
Sagittal T1 thin POSTNO
AxialT1 POST BrainNOSiemens
Comments:

TMJ MRI without contrast
Indications and preparation
Indications:Pain, TMJ syndrome
Comments:
Acquisition
planesequencefat satcomments
Localizer
Coronal ObliqueT1 SEClosed mouth
Sagittal ObliqueT2 TSEClosed mouth
Sagittal ObliquePD TSEClosed mouth
Sagittal ObliquePD TSEOpen mouth
T* or TSE T2dynamic-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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
3-planeLocalizer
CoronalSE T1 FC
CoronalT2 STIR
AxialSE T1 FC
AxialTSE T2 FSYES
AxialSE T1 FC FSYESPOST GAD
CoronalSE T1 FC FSYESPOST 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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Comments:

Neck MRA without contrast
Indications and preparation
Indications:stroke, carotid stenosis, dizziness
Comments:
Acquisition
planesequencefat satcomments
Axial2D TOF
Axial3D TOFthrough carotid bifurcations only
Siemens
Comments:
Neck MRA with IV contrast
Indications and preparation
Indications:Stroke, dizziness, carotid stenosis, vessel occlusion, dissection
Comments:
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
3-PlaneLocalizer
AxialLocalizer
SagittalLocalizer
Coronal Volume3D TOF VOLYes
Coronal VolumeCare BolusSiemens
Coronal Post3D TOF VOLYES
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
planesequencefat satcomments
3 planeLocalizer
AxialLocalizer
CoronalTSE T1 Bilateral
CoronalTSE STIR Bilateral
Axial ObliqueT1 Unilateral
SagittalSE T1 Unilateral
SagittalTSE T2 UnilateralYES
SagittalTSE STIR UnilateralSiemens
CoronalTSE 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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
CoronalTSE T2 UnilateralYES
CoronalSE T1 FSYES
SagittalSE T1 FSYES
CoronalTSE T1 BilateralYESSiemens
Comments:

C spine MRI without contrast
Indications and preparation
Indications:Neck pain, disc herniation, myelopathy, upper extremity radiculopathy, etc.
Comments:
Acquisition
planesequencefat satcomments
COR/SAGLocalizer
SagittalTSE T1
SagittalTSE T2
SagittalSTIR TSE
Axial2D MEDICMERGE for GE
Axial3D SPACECUBE 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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
COR/SAGLocalizer
SagittalTSE T1
SagittalTSE T2
SagittalSTIR TSE
SagittalTSE PDOptional: Add for myelopathy/MS
Axial2D MEDICMERGE for GE
Axial3D SPACECUBE for GE
Axial SE T1 POST
SagittalTSE T1 POSTYESSIEMENS
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
planesequencefat satcomments
SAG/CORLocalizer
SagittalLocalizer
SagittalTSE T1
SagittalTSE T2
SagittalSTIR TSE
SagittalTSE PDOptional: Add for myelopathy
Axial2D MEDICMERGE for GE
AxialSE T1Keep 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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
SAG/CORLocalizer
SagittalLocalizer
SagittalTSE T1
SagittalTSE T2
SagittalSTIR TSE
SagittalTSE PDOptional: Add for myelopathy
Axial2D MEDICMERGE for GE
AxialSE T1
Axial SE T1 POST
SagittalTSE T1 POSTYESSIEMENS
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
planesequencefat satcomments
SAG/CORLocalizer
SagittalLocalizer
SagittalTSE T1
SagittalTSE T2
SagittalSTIR TSE
AxialTSE T2
AxialSE T1Siemens
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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Axial SE T1 POSTNO
SagittalTSE T1 POSTYESSiemens
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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
LocalizerFOV400
LocalizerFOV340
SagittalTSE T1
Coronal ObliqueT1 STIR
Coronal ObliqueTSE STIR
AxialTSE T2
AxialSE T1Siemens
AxialTSE 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
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
Axial SE T1 POSTNO
SagittalTSE T1 POSTYESSiemens
Comments:
Lumbar facet MRI
Indications and preparation
Indications:
Comments:Add below sequence-T2 with FAT SAT
Contrast
typeratevolumesaline flush
Acquisition
planesequencefat satcomments
AxialTSE 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
planesequencefat satcomments
oblique CORT2 FSEfat sat- use TE 40 +/- 5 msec
oblique CORPD TSE-- use TE 30 +/- 5 msec
oblique SAGT1 SE- - use TE 30 +/- 5 msec
oblique SAGT2 FSEfat sat- use TE 40 +/- 5 msec
AXIALPD TSEfat sat- use TE 50 +/- 5 msec
AXIALPD 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
typeratevolumesaline flush
- dilute intra-articular gadolinium12 cc
Acquisition
planesequencefat satcomments
oblique CORT2 FSEfat sat- use TE 40 +/- 5 msec
oblique CORT1 SEfat sat- use TE 30 +/- 5 msec
oblique SAGT1 SE- - use TE 30 +/- 5 msec
oblique SAGT2 FSEfat sat- use TE 40 +/- 5 msec
AXIALPD TSEfat sat- use TE 50 +/- 5 msec
AXIALPD TSE-- use TE 50 +/- 5 msec
ABERT1 SEfat 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
planesequencefat satcomments
CORPD FSE-- use TE 50 +/- 5 msec
CORT2 FSEfat sat- use TE 40 +/- 5 msec
AXIALPD FSE-- use TE 50 +/- 5 msec
AXIALT2 FSEfat sat*** if T2FS is bad then do STIR
SAGT1 SE-- use TE 30 +/- 5 msec
SAGSTIR-***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
typeratevolumesaline flush
- dilute intra-articular gadolinium
Acquisition
planesequencefat satcomments
CORT1 SEfat sat- use TE 30 +/- 5 msec
CORT2 FSEfat sat- use TE 40 +/- 5 msec
AXIALPD FSE-- use TE 50 +/- 5 msec
AXIALT2 FSEfat sat- use TE 40 +/- 5 msec
SAGT2 FSEfat sat- use TE 40 +/- 5 msec
SAGT1 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
planesequencefat satcomments
CORPD FSE- use TE 30 +/- 5 msec
CORT2 FSEfat sat- use TE 40 +/- 5 msec
AXIALPD FSE
AXIALT2 FSEfat sat- use TE 40 +/- 5 msec
COR3-D GRE***GE, water exc MEDIC, instead of DESS
SAGT1 SE
SAGT2 FSEfat sat
COR3D 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
typeratevolumesaline flush
- dilute intra-articular gadolinium
Acquisition
planesequencefat satcomments
CORT1 SEfat sat
CORPD FSEfat sat- use TE 30 +/- 5 msec
AXIALT1 SEfat sat****switch to PD no FS
AXIALSTIR***T2 FS if bad then STIR
COR3-D GRE***GE, water exc MEDIC, instead of DESS
SAGT2 FSEfat sat- use TE 40 +/- 5 msec
SAGT1 SE
COR3D 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
planesequencefat satcomments
CORPD FSE-- use TE 50 +/- 5 msec
CORSTIR-
AXIALPD FSE-- use TE 50 +/- 5 msec
AXIALT2 FSEfat sat- use TE 40 +/- 5 msec
SAGT1 SE-- use TE 30 +/- 5 msec
SAGSTIR-
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
typeratevolumesaline flush
0.1-0.4 mmol/kg Gadolinium(up to 20mL)
Acquisition
planesequencefat satcomments
CORT1 SE-- before gad
COR2-D FLASHfat sat- before gad
CORSTIR-- before gad
AXIALSTIR-- before gad
CORT1 SEfat sat- post gad
AXIALT1 SEfat 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
planesequencefat satcomments
CORT1 SE- use TE 30 +/- 5 msec
CORSTIR
AXIALPD FSE- use TE 50 +/- 5 msec
AXIALT2 FSEfat sat- use TE 40 +/- 5 msec
SAGT1 SE- use TE 30 +/- 5 msec
SAGSTIR
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
planesequencefat satcomments
oblique CORPD FSE- use TE 50 +/- 5 msec
oblique CORSTIR
oblique CORT2 FSEfat sat- use TE 40 +/- 5 msec
AXIALT2 FSEfat sat- use TE 40 +/- 5 msec
SAGT1 SE- use TE 30 +/- 5 msec
SAGSTIR
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
planesequencefat satcomments
CORT1 SEinclude entire pelvis
CORSTIRinclude entire pelvis
AXIALT1 SEinclude entire pelvis
AXIALSTIRinclude 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
typeratevolumesaline flush
0.1-0.4 mmol/kg Gadolinium(up to 20 mL)
Acquisition
planesequencefat satcomments
CORT1 SE-include entire pelvis
CORSTIR-include entire pelvis
AXIALT1 SE-include entire pelvis
AXIALT1 SEfat satinclude entire pelvis
AXIALSTIR-include entire pelvis
SAGSTIR-include entire pelvis
AXIALT1 SEfat sat- post gad, entire pelvis
SAGT1 SEfat sat- post gad, entire pelvis
CORT1 SEfat sat- post gad, entire pelvis
Hernia MRI - MSK 5S
Indications and preparation
Indications:Sports hernia, athletic pubalgia, osteitis pubis, inguinal hernia pain
Contrast
typeratevolumesaline flush
none
Acquisition
planesequencefat satcomments
CORT1 SE-large field of view pelvis
CORSTIR-large field of view pelvis
AXIALT1 SE-large field of view pelvis
AXIALSTIR-large field of view pelvis
SAGPD FSE-small field of view -- see below
SAGT2 FSE-small field of view -- see below
SAGT2 FSEfat satsmall 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
planesequencefat satcomments
CORSTIR-- entire pelvis
CORT1 SE-- entire pelvis
CORPD-- affected hip
CORT2 FSEfat sat- affected hip
AXIALPD-- affected hip, oblique axial orientation
AXIALT2 FSEfat sat- affected hip, oblique axial orientation
SAGT2 FSEfat sat- affected hip
Comments:
Hip MRI arthrogram - MSK 5A
Indications and preparation
Indications:hip pain, labral pathology
Comments:
Contrast
typeratevolumesaline flush
Comments:
Acquisition
planesequencefat satcomments
CORSTIR-- entire pelvis
CORT1 SE-- entire pelvis
CORT1 SEfat sat- affected hip
CORT2 FSEfat sat- affected hip
AXIALT1 SE-- affected hip, oblique axial orientation
AXIALT2 FSEfat sat- affected hip, oblique axial orientation
SAGT2 FSEfat sat- affected hip
Comments:

Knee MRI without contrast - MSK 6
Indications and preparation
Indications:pain, internal derangement, ACL tear, meniscus tear
Comments:
Acquisition
planesequencefat satcomments
SAGPD FSEfat sat- use TE 50 +/- 5 msec
SAGPD FSE-- use TE 30 +/- 5 msec
AXIALPD FSEfat sat- use TE 50 +/- 5 msec
CORPD FSE-- use TE 30 +/- 5 msec
CORPD FSEfat sat- use TE 50 +/- 5 msec
Comments:
Knee MR arthrogram - MSK 6A
Indications and preparation
Indications:evaluate for meniscal retears, postoperative knee
Comments:
Contrast
typeratevolumesaline flush
- dilute intra-articular gadolinium50 mL
Acquisition
planesequencefat satcomments
SAGT1 SEfat sat
SAGPD FSEfat sat- use TE 50 +/- 5 msec
CORT1 SE-
CORT1 SEfat sat
CORPD FSEfat sat- use TE 50 +/- 5 msec
AXIALPD FSEfat sat
Comments:

Ankle MRI without contrast
Indications and preparation
Indications:pain, internal derangement
Comments:
Acquisition
planesequencefat satcomments
SAGT1 SE-
SAGT2FSE--- if T2 fat sat is bad then STIR too
AXIALPD FSE-
AXIALT2 FSEfat sat- use TE 40 +/- 5 msec
CORT2 FSEfat sat- use TE 40 +/- 5 msec
OBLIQUE AXIALPD 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
planesequencefat satcomments
SAGT1 SE
SAGSTIR
AXIAL (long axis)T1 SE
AXIAL (long axis)T2 FSEfat 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
typeratevolumesaline flush
0.1-0.4 mmol/kg Gadoliniumup to 20 mL
Acquisition
planesequencefat satcomments
CORT1 SE-
CORSTIR-
AXIALT1 SE-
SHORT AXIST1 SEfat sat*** almost always axial, except in foot (when it would be coronal) ***
AXIALSTIR-
SAGSTIR-
SAGT1 SE-
AXIALT1 SEfat sat- post gad
SAGT1 SEfat sat- post gad
CORT1 SEfat 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
typeratevolumesaline flush
0.1-0.4 mmol/kg Gadoliniumup to 20 mL
Acquisition
planesequencefat satcomments
CORT1 SE
CORSTIR
AXIALT1 SE
AXIALSTIR
SAGSTIR
SAGT1 SE
AXIALT1 SEfat sat- post gad
SAGT1 SEfat sat- post gad
CORT1 SEfat 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
planesequencefat satcomments
CORT1 SE
CORSTIR
AXIALT1 SE
AXIALSTIR
SAGSTIR
SAGT1 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