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MEDICAL DEVICES/FOREIGN BODIES
EMERGENCY MRI PROTCOLSSTROKE RULE OUT First check CT Head, if negative Brain MRI C- Brain MRA C- Neck MRA C- DISSECTION RULE OUT Brain MRI C- Brain MRA C- Neck MRA C- with Fat Sat T1 NEURORADIOLOGY MRI PROTOCOLSBrain Routine Appropriate FOV and spacing per patient head size Axial T1 FLAIR (T1 for patients under 3) Axial T2 Axial FLAIR Axial DWI Sagittal T1 Axial Gradient Echo (include for hemorrhage or trauma) optional sequences Sagittal FLAIR (include for MS) Coronal T1 (include for AVM) Coronal T2 high res (include for epilepsy) Coronal FLAIR (include for epilepsy) Coronal 3D T1 IR (optional for epilepsy, do for pediatric patients) Axial FIESTA IAC (Ax T2 hi res IAC if no FIESTA) (optional for vertigo/dizziness) Use Propeller for patients who cannot hold still if you have it Brain with and without Gadolinium Appropriate FOV and spacing per patient head size Axial T1 (not T1 FLAIR) Axial T2 Axial FLAIR Axial DWI 3 planes post T1 Optional sequences from Brain Routine as needed Coronal with 3D recons per Seizure Protocol MRA COW (Circle of Willis) Routine 3D TOF 3 or 4 slab depending on patient size and anatomy MIP anterior separate from posterior with side to side rotations and SI rotations Magnify MIPS so that they fit most of the FOV Axial T2 brain Axial DWI brain MRA Neck Routine 2D Time of Flight aortic arch to sella 3D Time of Flight carotid bifurcations Axial T1 fat sat sella to C6 (include for rule out dissection) MIP Carotid and Vertebral arteries together from each side with rotational views *If Gadolinium requested, add dynamic study (with fluoro-triggering if available, timing run if not MRV head Routine 2D Time of Flight Coronal acquisition, MIP Rotations and SI *If done as part of a noncontrast study, do non contrast *If done in conjunction with a contrast brain MRI, do post contrast Dynamic Gadolinium (Optional with timing run for sites that have it) Cervical Spine Routine 3 Plane Scout Sagittal T1 FLAIR 3x1 frequency AP 22 FOV (May decrease FOV for smaller people) Sagittal T2 3x1 frequency AP 24 FOV Sagittal STIR optional if marrow abnormalities (fractures, infxn, neoplasm) Axial T1 4x1 C2-T1 18 FOV Axial T2 4x1 C2-T1 18 FOV Axial GE 4x1 C2-T1 18 FOV Thoracic Spine Routine Scout to count from C2 Sagittal T1 FLAIR or T1 (whichever looks better on your system) 3x1 Frequency AP T1- bottom of L1 include conus Sagittal T2 3x1 Frequency AP T1- bottom of L1 include conus Sagittal STIR optional if marrow abnormalities ((fractures, infxn, neoplasm) Axial T1 5x5 T1-L1 18 FOV Axial T2 5x5 T1-L1 18 FOV Lumbar Spine Routine Sagittal T1 4x1 Frequency AP 28 FOV Sagittal T2 4x1 Frequency AP 28 FOV Sagittal STIR optional if marrow abnormalities Axial T1 4x1 S1-L1 18 FOV Axial T2 4x1 S1-L1 18 FOV Axials can be done multioblique or in blocks depending on patient but must cover discs levels at least pedicle to pedicle. Watch out for cross talk (dark bands) if doing multiobliques Total Spine Routine Scout entire spine and split into 2 halves so that the sagittals overlap by 1-2 vert bodies Upper Half Sagittal T1 3x1 Frequency AP Upper Half Sagittal T2 3x1 Frequency AP Lower Half Sagittal T1 3x1 Frequency AP Lower Half Sagittal T2 3x1 Frequency AP Axial T1 and T2 entire spine 5x5 18 FOV Sagittal STIR (optional, should be used for trauma or metastatic disease) Cervical, Thoracic, or Lumbar Spine with and without Gadolinium Pre Sagittal T1 Pre Sagittal T2 Post Sagittal T1 without fat sat Sagittal Proton Density should be done if Hx MS (C or T Spine) Axial T1 post and Axial T2, thickness and spacing per appropriate spine level Optional Axial Gradient Echo for C-spine Pituitary with and without Gad Sagittal T1 Brain pre Coronal T1 Pituitary 3 x .3 16 FOV Coronal T2 Pituitary 3 x .3 16 FOV Coronal T1 Post 3 x .3 16 FOV Sagittal T1 Post 3 x .3 16 FOV Post Axial T1 Brain Axial T2 Brain Axial DWI If Pituitary and Brain requested, add Axial T2 FLAIR Brain *If noncontrast Pituitary - Cut Post Coronal T1 Pituitary and Post Sagittal T1 Brain. Do Sagittal T1 Pituitary Pre. Run all other sequences Neuro Orbit (or Cavernous Sinus) (ie: for non-ENT cases) Coronal T1 Pre 4x1 16 FOV from behind sella through globe Coronal STIR to match thickness and spacing Coronal T1 Post gadolinium with Fat Suppression to match thickness and spacing Axial T1 Post gadolinium Fat Sat 3 x 0.3 orbits and sella 18 FOV Axial T1 post brain Axial T2 brain Axial DWI *If noncontrast orbit - Cut coronal post T1 orbit. Add Axial T2 orbit 3x .3. Do axial T1 orbit pre without fat suppression. Run all other sequences. Neuro Orbits and Brain double study (for non-ENT cases) Coronal T1 4x1 16 FOV from behind sella through globe Coronal STIR to match thickness and spacing Coronal T1 Post gadolinium with Fat Suppression to match thickness and spacing Axial T1 Post gadolinium Fat Sat 3 x .3 orbits and sella 18 FOV Axial T1 post brain Axial T2 brain Axial DWI Axial FLAIR Sagittal FLAIR Sagittal T1 Post Preop Brain Lab (stereotactic study) Pre contrast Axial T1 Post Contrast SPGR volume axial acquisition 256 x 192, 25 FOV including whole nose, head and ears. Reformat 3 planes 5x0 Post contrast Axial T1 Axial T2 Axial DWI Optional STRAIGHT AXIAL T2 brain lab 3 x 0 whole head 25 FOV Optional STRAIGHT AXIAL FLAIR brain lab 3 x 0 whole head 25 FOV IAC Routine Axial T1 pre posterior fossa 18 FOV 3 x .3 Axial FIESTA Axial T2 high res to match T1 if FIESTA not available Axial T1 post gadolinium with fat sat to match pre T1 coverage Coronal T1 post IAC 3 x .3 18 FOV Axial T2 Brain Axial T1 post Brain Axial FLAIR Brain Axial DWI Brain *if noncontrast IAC cut post axial T1 fat sat and add coronal thin T2 IAC if no FIESTA. Run all other sequences. CSF Flow study Sagittal T1 Brain Axial T2 Brain Axial DWI Brain Sagittal T2 High Resolution 16 FOV, 9 slices 4mm thick centered and angled so that middle slice is midline through floor of third ventricle. No flow comp. Axial T2 High Resolution 16 FOV 9 slices 4mm thick centered at optic chiasm and covering through the cerebral aqueduct. No flow comp. Midline Sagittal Phase Contrast cardiac gated CSF flow study | BODY MRI PROTOCOLSMR Abdomen: Routine - “+/- Gad” R/O APPENDICITIS Non-pregnant patients: “Appendicitis protocol, with Gad”. Pregnant patients write “Appendicitis protocol, without Gad”. Make sure to include axial + coronal diffusion and extra set of axial + coronal SSFSE T2 series to assess RLQ at a separate time point and garner the benefits of peristalsis. A Fiesta Axial and/or Coronal might be helpful to further delineate fat planes and organ margins. MR Abdomen: Kidneys -“+/- Gad” - With Gadavist for renal lesions, pyelonephritis MR ABDOMEN: r/o renal artery stenosis - Routine abdomen - add Axial PC 3D sequence through kidneys MR abdomen: Adrenal gland -“Adrenal gland protocol w/o Gad” - For straightforward cases (ex. adenomas) without contrast is fine. If patient may have a pheochromocytoma or ACC, contrast is helpful to more fully assess. One could review any prior CT imaging to get a sense if this is a simple appearing nodule or a more complicated case. MR Abdomen: Liver -With Eovist to evaluate for liver malignancy (patients with cirrhosis, hepatitis, etc), first timers with risk factors, metastasis, equivocal liver lesions, s/p TACE to evaluate NEW lesions. -“Liver protocol w/ Eovist -With Gadavist to evaluate hemangiomas, immediately s/p TACE. -“Liver protocol w/ Gad” -No contrast to evaluate Iron quantification -“Hemochromatosis protocol” MR Abdomen: Pancreas - “MR Abdomen: Pancreas w/ gad” (MRCP images may be added as per attending) - With Gadavist for pancreatic cystic lesions +/- PD involvement. -CT better for adenocarcinoma. MR abdomen: MRCP -“MRCP w/o gad” -Usually NO CONTRAST (although sometimes ordered WITH contrast; if there is suspicion of tumor contrast very helpful) to assess biliary tree, assessment of pancreatic duct, cholelithiasis, choledocholithiasis, biliary strictures, pancreatic divisum MR Pelvis: Ovarian mass/fibroid -“+/- Gad, subs, add T2 FS axial” - With Gadavist for ovarian lesions, uterine fibroids, uterine masses MR Pelvis: Routine -“+/- Gad” MR Pelvis: Fistula -“+/- Gad” - This protocol can be utilized for MRI Pelvis: Testicular Mass (remind techs to image supine as this will not compress the scrotal region making the case more challenging to read). - This protocol is also similar to what you can employ for a high-resolution PENILE TRAUMA MRI WITHOUT CONTRAST. Note, if there is priapism, consider recommending angiography +/- ultrasound. http://pubs.rsna.org/doi/full/10.1148/rg.333125158 MR pelvis: Prostate -“+/- Gad” -With Gadavist for prostate cancer, spermatic cord lesions -No contrast s/p seed implantation MR pelvis: Rectum -“+/- Gad, Focused high resolution rectal CA protocol” -With gadavist to evaluate for rectal cancer MR Enterography: -“+/- Gad” - To exclude Crohn's disease, assess disease activity in Crohn's. |
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