BODY MRI PROTOCOLS - Geisel School of Medicine · PDF fileBODY MRI PROTOCOLS Updated...

1

BODY MRI PROTOCOLS

Updated

04/03/2017

Abdomen Pelvis Limited Abdomen and Pelvis MRCP Anal Fistula Prostate Cancer Staging

Basic (limited) Abdomen Pancreas Routine Female Pelvis Dynamic (multiparametric) Prostate

Basic (limited) Pelvis Adrenal Female Pelvis Mullerian Appendicitis Pregnant

Dynamic Liver Renal Mass Cervical CA Staging Defecography

Eovist Liver Urogram Endometrial Cancer Rectal Cancer

Liver for Hemotomocrosis Enterography Urethral

MRA/MRV Other Renal MRA Aorta (CAP) MRA MRV Pelvis DVT Fetal

Mesenteric MRA Chest - general

2

Limited Abdomen and Pelvis (Cancer surveillance, non-specific clinical history)

Axial In/Out Phase Pelvis

Axial T2 FS Pelvis

Axial 3D VIBE FS Pre Pelvis

Axial In/Out Phase Abdomen

Axial T2 Abdomen

Coronal T2 Abdomen/Pelvis

Axial 3D VIBE FS Pre Abdomen

Axial 3D VIBE FS Post Abdomen (arterial)

Axial 3D VIBE FS Post Abdomen (venous)

Axial 3D VIBE FS Post Pelvis

Coronal 3D VIBE FS Abdomen/Pelvis

Sequence TR TE FOV

SLICE GAP MATRIX PHASE

DIR NEX

SCAN DIR

OTHER FREQ PHASE PHASE FREQ

AX IN/OUT PHASE PEL 170 1.2 and 2.4

380 80% 5 1 256 256 A/P 1 S->I

AX T2 FS PELVIS 1600 95 380 80% 5 1 192 320 A/P 1 S->I AX VIBE PELVIS 4.3 1.89 380 80% 3 0.6 320 190 A/P 1 S->I

AX IN/OUT PHASE ABD 170 1.2 and 2.4

380 80% 5 1 256 256 A/P 1 S->I

AX T2 ABD 1600 95 380 80% 5 1 194 320 A/P 1 S->I COR T2 ABD/PELVIS 1400 91 440 100% 5 1 320 320 R/L 1 P->A AX VIBE PRE ABD 4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I AX VIBE POST ABD(ARTERIAL/VENOUS)

4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I

AX VIBE POST PELVIS 4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I COR VIBE POST ABD/PEL 4.3 1.89 440 100% 3 0.6 194 320 R/L 1 P->A

3

Basic Abdomen (Abscess, non-specific clinical history, non-organ evaluation)

Coronal T2

Ax T2 RESP TRIGGERED or T2 Breath held

Ax T2 FS

Ax In/Out Phase

Ax 3D VIBE FS Pre

Cor 3D VIBE FS Pre

Axial 3D VIBE FS Post Arterial

Cor 3D VIBE FS Post Delayed

Sequence TR TE FOV


DIR NEX

SCAN DIR


COR T2 1400 91 440 100% 5 1 320 320 R/L 1 P->A AX T2 RESP TRIG/BH 380 80% A/P S->I

AX T2 FS 1600 95 380 80% 5 1 194 320 A/P 1 S->I

AX IN/OUT PHASE 170 1.2 and 2.4

380 80% 5 1 256 256 A/P 1 S->I

AX VIBE PRE 4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I

COR VIBE PRE 4.0 1.74 400 100% 3 0.6 256 320 R/L 1 P->A

AX VIBE POST (arterial) 4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I COR VIBE POST 4.0 1.74 400 100% 3 0.6 256 320 R/L 1 P->A

4

Basic Pelvis (Abscess, non-specific clinical history)

Ax T2 FS

Ax In/Out Phase

Ax 3D VIBE FS Pre

Axial 3D VIBE FS Post

Cor 3D VIBE FS Post

Sequence TR TE FOV


DIR NEX

SCAN DIR


AX T2 FS 1600 95 380 80% 5 1 194 320 A/P 1 S->I

AX IN/OUT PHASE 170 1.2 and 2.4

380 80% 5 1 256 256 A/P 1 S->I

AX VIBE PRE 4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I

COR VIBE PRE 4.0 1.74 400 100% 3 0.6 256 320 R/L 1 P->A

AX VIBE POST 4.3 1.89 380 80% 3 0.6 194 320 A/P 1 S->I

COR VIBE POST 4.0 1.74 400 100% 3 0.6 256 320 R/L 1 P->A

5

Dynamic Liver (HCC, Cholangiocarcinoma, lesion characterization)

COR T2

AXIAL T2 BH

AXIAL T2 FS BH

AXIAL IN/OUT PHASE

AX 3D VIBE FS PRE

AX 3D VIBE FS POST

(30 SEC/1 MIN/3 MIN)

*with subtractions

COR 3D VIBE FS POST

(5 MIN)

AXIAL DIFFUSION (b value 50 and 750)

Need ADC maps

Sequence TR TE FOV Slice

Thickness (mm)

Gap (mm)

Matrix Phase Direction

NEX Scan

Direction OTHER

Frequency Phase

% Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 5 1 256 256 A/P 1 S->I

AXIAL VIBE PRE 4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I

AXIAL VIBE POST

4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I

COR VIBE POST 4 1.7 400 100 3 0.6 240 320 R/L 1 P->A

AXIAL DIFFUSION

5800 61 380 80 5 1 160 190 A/P NA S->I B VALUE:

50/400/750

6

Eovist Liver (R/O mets, if FNH/adenoma suspected, biliary leaks)

COR T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AX 3D VIBE FS

AX 3D VIBE FS POST

(2 phase arterial/1 MIN/3 MIN)

COR 3D VIBE FS POST (4 MIN)

AX 3D VIBE FS POST (5 MIN)

AX 3D VIBE FS POST (20 MIN)

COR 3D VIBE FS POST (20 MIN)

*with subtractions

Sequence TR TE FOV: Slice

Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 5 1 256 256 A/P 1 S->I


AXIAL VIBE POST

4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I


7

Liver for Hemochromatosis

**Must be done on 1.5T Scanner**

Axial GRE 90 degree flip TE 4.0





Sequence TR TE FOV


DIR NEX

SCAN DIR



120 4.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 90


120 4.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20


120 9.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20


120 14.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20


120 21.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20

8

MRCP (Patient prep: NPO 4 hours prior. Arrive 20-30 min early for 150-300ml of PO pineapple juice)

COR T2

AXIAL T2

AXIAL IN/OUT PHASE

THICK SLAB SSFSE – 4 OBLIQ PLANES THROUGH PANC/CBD/GB 40MM THICK

COR 3D VOLUME RESPIRATORY TRIGGERED MRCP*

1. THIN COR MIP IMAGES CREATED FROM THIS 1.6/ 0.8

2. THIN AX MIP CREATED FROM THIS 1.6/0.8

*DO BREATH HOLD COR 3D ACQUISITION IF THE RESPIRATORY TRIGGER IS POOR

IF SECRETIN EXAM:

*SECRETIN: ADULT: 0.2µg/kg IV SLOWLY PUSHED OVER 1 MINUTE

PEDIATRIC: 0.2µg/kg (MAX DOSE 16 µg)

*ADMINISTERED BY ANGIO RN – IV PUSH

THICK SLAB SSFSE THROUGH PLANE OF PANCREATIC DUCT EVERY MINUTE FOR 10 MINUTES (STACKED)

THICK SLAB ANGLES

9

MRCP cont.


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 5 1 256 256 A/P 1 S->I

COR THICK SLAB

4500 735 300 100 50 25 269 384 L/R 1 P->A

SAG THK SLAB 4500 735 300 100 50 25 269 384 P/A 1 P->A

COR OBLIQ SLAB

4500 735 300 100 50 25 269 384 P/A 1 P->A

COR OBLIQ SLAB

4500 735 300 100 50 25 269 384 P/A 1 P->A

COR 3D RESP TRIGGERED

5800 698 380 100 1 0 376 384 R/L 1.7 P->A

COR 3D BREATH HOLD

2000 697 380 100 1 .5 256 320 R/L 1.4 P->A

COR THK SLAB POST SECRETIN

4500 735 300 100 50 25 269 384 P/A 1 P->A RUN X 10

10

Pancreas Patient Prep: NPO for 4 hours

If MRCP is NOT requested, give 750mL water (PO) starting 60 minutes prior to exam

COR T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AX 3D VIBE FS PRE

AX 3D VIBE FS POST

(35 SEC/70 SEC/3 MIN)

Slice thickness 3mm

COR 3D VIBE FS POST

(3 MIN)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL T2 1600 95 380 75 3 1 192 320 A/P 1 S->I

AXIAL T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 5 1 256 256 A/P 1 S->I


AXIAL VIBE POST

4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I


11

Adrenal If indication is adrenal adenoma, call rad o check after IN/OUT phase series

COR T2: diaphragm to aortic bifurcation

AXIAL IN/OUT PHASE Adrenals

CORONAL IN/OUT PHASE Adrenals

AXIAL T2 FS: diaphragm to aortic bifurcation

AX 3D VIBE FS PRE: diaphragm to aortic bifurcation

AX 3D VIBE FS POST: diaphragm to aortic bifurcation

(35 SEC/70 SEC). Slice thickness 3mm

COR 3D VIBE FS POST

(3 MIN)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 4 1 256 256 A/P 1 S->I

COR IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 4 1 256 256 A/P 1 S->I

AXIAL T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I


AXIAL VIBE POST

4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I


12

Renal Mass FOV limited to kidneys

COR T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AX 3D VIBE PRE

SAG 3D VIBE FS PRE of each kidney

COR 3D VIBE FS PRE

COR 3D VIBE FS POST

(25 SEC/90 SEC)

SAG 3D VIBE FS POST of each kidney

AX 3D VIBE FS POST

**If patient cannot receive gadolinium:

AXIAL DIFFUSION X2 (b value of 50 and 750) and ADC maps

Sequence TR: TE: FOV: Slice

Thickness (mm):

Gap (mm):

Matrix: Phase

Direction: NEX

Scan Direction:

OTHER Frequency:

Phase %:

Phase: Frequency:

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 380 75 5 1 256 256 A/P 1 S->I


SAG VIBE (each kidney)

4.0 1.7 400 100 3 0.6 240 320 A/P 1 L->R

COR VIBE PRE 4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I

COR VIBE POST 4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I

SAG VIBE POST (each kidney)

4.0 1.7 400 100 3 0.6 240 320 A/P 1 L->R

AX VIBE POST 4 1.7 400 100 3 0.6 240 320 R/L 1 P->A

AXIAL DIFFUSION 5800 61 380 80 5 1 160 190 A/P NA S->I B VALUE:

50/400/750

13

Urogram Patient Prep: Arrive 1 hour prior to get IVF

Empty bladder prior to getting on table

Adult: 500mL NS bolus immediately before scan

Pediatric: weight based IVF:

4mL/kg/hr 1st 10kg

2mL/kg/hr next 10kg

1mL/kg/hr for each kg above 20kg

Adults: arrive 1 hour prior to angio for IV placement, fluids, possible catheter placement(optional)

*Lasix dose: 20-40mg slow IV push

Pediatrics: Requires Pain Free and catheter (can administer Lasix)

*Lasix dose: 1mg/kg (up to max dose 20mg) slow IV push

COR T2 Abdomen/Pelvis

COR T2 FS Abdomen/Pelvis

AXIAL T1 FS Abdomen/Pelvis

AXIAL T2 Abdomen/Pelvis

AXIAL T2 FS Abdomen/Pelvis

**Inject Lasix**

COR T2 Thick Slabs

COR T2 Thin (1mm) Respiratory Triggered Kidneys/Ureters

- Need 3D reconstructions

- If comes out poorly, try breath hold

COR 3D VIBE FS PRE

COR 3D VIBE FS POST

- Coronal oblique plane to include kidneys and bladder (2mm slice thickness)

- Arterial (~30 sec), 60 SEC (PVP), 100 SEC (nephrographic), 8 MIN (excretory)

- Automatic MIP images of each volume acquired

**Have Rad Check**

COR 3D VIBE FS POST (need to see ureters to bladder)

(10 MIN)

SAG 3D VIBE FS POST: of each kidney

14

(10 MIN)

Urogram cont.


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

COR T2 FS 1600 91 440 100 5 1 320 320 R/L 1 P->A

AXIAL T1 FS 572 20 380 75 5 1 256 192 A/P 2 S->I

AXIAL T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AXIAL T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

COR T2 THK Slabs

4500 564 420

80 50 0 218 384 S/I 1 P->A

COR T2 Thin RESP TRIG

2400 698 380 100 1.0 384 384 R/L 1.7 P->A

COR VIBE PRE 4.3 1.8 400 80 2 0.4 190 320 A/P 1 S->I

COR VIBE POST 4.3 1.8 400 80 2 0.4 190 320 A/P 1 S->I

SAG VIBE POST 4 1.7 400 100 3 0.6 240 320 R/L 1 P->A

15

Enterography Patient prep: Volumen, 3 bottles, 90 minutes prior

Glucagon – 1 mg IM after THK slabs and FIESTA

Coronal Thick Slabs T2 Coronal T2 FIESTA **HAVE IMAGES CHECKED BY RADIOLOGIST** *Have RN inject glucagon Coronal T2 BH Axial T2 BH Axial T2 FS BH Axial 3D VIBE FS PRE Coronal 3D VIBE FS PRE Coronal 3D VIBE FS Post (35 seconds and 70 seconds) Axial 3D VIBE FS Post

Sequence TR TE FOV


DIR NEX

SCAN DIR


Coronal T2 Thick Slabs 4500 586 440 80 50 0 218 384 R->L 1 P->A

Coronal T2 FIESTA 186 1.15 430 100 5.5 0 169 224 R->L 1 P->A

16

RENAL MRA COR T2 – to determine anatomy and location of kidneys AX T2 FS BH AX T2 FIESTA TRIGGER BH (gated multiphase) COR T2 FIESTA TRIGGER BH AX 3D VIBE FS PRE COR Angio3D PRE COR Angio3D post (2 phases)

- 3D acquisition arterial phase x 2 - Reformat into thin AX and COR - 3D reformats of arterial phase

AX 3D VIBE FS POST COR 3D VIBE FS 5 MIN Post 3D PC (IF GAD NOT GIVEN)

Coronal T2 1600 91 440 100 5 1 320 320 R/L 1 P->A AX T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AX T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

AX VIBE PRE 4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I

COR VIBE PRE 4 1.7 440 100 3 0.6 240 320 R/L 1 P->A

COR VIBE POST (35 and 70 sec)

4 1.7 440 100 3 0.6 240 320 R/L 1 P->A

AX VIBE Post 4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I

Sequence TR TE

FOV: Slice Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency Phase % Phase

Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

17

MESENTERIC MRA COR T2 AX T2 FS BH AX 3D VIBE FS PRE SAG Angio3D PRE CARE BOLUS SAG Angio3D post (2 phases)

- 3D acquisition arterial phase x 2 - Reformat into thin axial and sagittal - 3D reformats of arterial phase

AX 3D VIBE FS POST COR 3D VIBE FS 5 MIN Post

AX T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I

AX T2 FIESTA TRIGGER BH

3.58 1.57 380 81.3 5 0 208 320 A/P 1 L->R

COR T2 FIESTA TRIGGER BH

3.52 1.54 400 100 5 1 256 320 R/L 1 P->A

AX VIBE PRE/POST 4.3 1.89 380 81.3 3 1 190 320 A/P 1 S->I

COR Angio3D pre/post

2.98 1.06 380 100 1.10 0 213 320 R/L 1 P->A

COR VIBE 5 MIN Post

4 1.74 400 100 3 1 240 320 R/L 1 P->A

3D PC 38.3 5.6 320 90 .90 1 192 256 R/L 1 S->I

Sequence TR TE

FOV: Slice

Thickness

(mm)

Gap

(mm)

Matrix: Phase

Direction NEX

Scan

Direction OTHER

Frequency Phase % Phase Frequency

COR T2 1600 91 440 100 5 1 320 320 R/L 1 P->A

AX T2 FS 1600 95 380 75 5 1 320 194 A/P 1 S->I

18

AORTA (CAP) MRA If patient cannot get gadolinium – must be done on 3T

AX DIR (PERIPHERAL GATED) AX T2 FIESTA (PERIPHERAL GATED) SAG OBL CINE GRE (PERIPHERAL GATED) AX VIBE PRE Sagittal Oblique Angio3D PRE CARE BOLUS Sagittal Oblique (Candy Cane) Angio3D post

- 3D acquisition arterial phase x 2 - Reformat into thin axial and sagittal - 3D reformats of arterial phase

AX 3D VIBE FS POST Angle for SAG OBL

AX VIBE

PRE/POST 4.3 1.89 380 81.3 3 1 320 190 A/P 1 S->I

COR Angio3D

pre/post 2.98 1.06 380 100 1.10 0 320 213 R/L 1 P->A

COR VIBE 5 MIN

Post 4 1.74 400 100 3 1 320 240 R/L 1 P->A

Sequence TR TE FOV: Slice Gap Matrix: Phase NEX Scan OTHER

19

Anal Fistula Should be performed on 3T

Sagittal T2 (Full FOV, 2.5mm/gap 0mm)

*Use to establish oblique planes –

Axial and coronal to long axis of anal canal

MD to check planes if unsure

Small FOV (26cm):

Axial Oblique T1 (4mm/0.8)

Axial Oblique T2 FS (4mm/0.8)

Axial Oblique T2 (4mm/0.8)

Coronal Oblique T2 FS (4mm/0.8)

Coronal Oblique T2 (4mm/0.8)

Axial Oblique VIBE FS Pre

Axial Oblique VIBE FS Post

Coronal Oblique VIBE FS Post

Frequency Phase

%

Thickness

(mm)

(mm) Phase Frequency

Direction Direction

AX DIR 750 27 380 81.3 8 2 256 256 A/P 1 S->I

AX T2

FIESTA 3.58 1.57 380 81.3 5 0 320 208 A/P 1 L->R

AX VIBE

PRE/POST 4.3 1.89 380 81.3 3 1 320 190 A/P 1 S->I

SAG OBL

Angio3D

pre/post

2.98 1.06 380 100 1.10 0 320 213 R/L 1 P->A

Sequence TR TE FOV: Slice Gap Matrix: Phase NEX Scan OTHER

20

MRV Pelvis DVT

2D TOF – reformat into 3D image AXIAL VIBE Pre 3D MRV Pre (dry run) 3D MRV Post: Scan in 3 phases (2min/3min/4min) Reformat each phase into axial and sagittal 3D Coronal MIP of each phase AXIAL VIBE Post

Frequency Phase

% Thickness

(mm) (mm)

Phase Frequenc: Direction Direction

SAG T2 2570 92 300 100 2.5 0 384 384 S/I 3 L->R

AXIAL OBL T1 527 20 260 100 4 0.8 240 320 R/L 2 S->I

AXIAL OBL T2 FS 3000 86 260 100 4 0.8 272 320 R/L 2 S->I

AXIAL OBL T2 3000 86 260 100 4 0.8 272 320 R/L 2 S->I

COR OBL T2 FS 3000 86

260 100 4 0.8 272 320 R/L 2 P->A

COR OBL T2 3000 86

260 100 4 0.8 272 320 R/L 2 P->A

AX VIBE PRE 7.4 3.8 260 80 3 0.6 190 320 A/P 4 S->I

AX VIBE POST 7.4 3.8 260 80 3 0.6 190 320 A/P 4 S->I

COR VIBE POST 7.2 3.8 260 100 3 0.6 240 320 R/L 4 P->A

21

Routine Female Pelvis Adenomyosis, fibroids, adnexa

Planes in relation to the uterus for uterine pathology, otherwise in relation to pelvis

Coronal T2 Abdomen/Pelvis

Axial T1 whole pelvis

Small FOV: Ax T1 FS (superior and inferior sat bands)

Axial T2

Axial T2 FS

Sagittal T2 (uterine evaluation)

Sag T2 FS

*OPTIONAL WITH CONTRAST

Axial VIBE FS Pre

Axial VIBE FS Post

Sequence TR TE

FOV: Slice

Thickness

(mm)

Gap

(mm)

Matrix: Phase

Direction NEX

Scan

Direction OTHER

Frequency Phase

% Phase Frequency

2D TOF 458 3.7 350 50 3.5 -27 320 320 A->P 1 S->I

AX VIBE Pre 6.19 2.39 340 100 3 1 320 240 R->L 4 S->I

3D MRV Post 3.08 1.11 320 320 1 1 320 262 R->L 1 P->A

AX VIBE Post 6.19 2.39 340 100 3 1 320 240 R->L 4 S->I

AXIALS

CORONALS

22

Coronal VIBE FS Post

Sagittal VIBE FS Post

Female Pelvis Mullerian Planes in relation to the uterus

Axial T2 FS Full FOV

Axial T1 Full FOV

Coronal T2 Full FOV to include kidneys (7mm slice)

Small FOV in relation to the uterus:

Sagittal T2 (4mm slice)

Axial T2 (4mm slice)

Coronal T2 (4mm slice)


Thickness (mm)

Gap (mm)

Matrix Phase Direction

NEX Scan

Direction OTHER

Frequency Phase % Phase Frequency

COR T2 1400 91 440 100 5 1 320 320 R->L 1 s->I

AX T1 455 20 300 100 5 1 320 256 R->L 1 S->I

AX T1 FS 582 21 200 100 5 1 320 240 R->L 2 S->I

AX T2 5370 91 200 100 5 1 320 272 R->L 2 S->I

AX T2 FS 3000 91 200 100 5 1 320 272 R->L 2 S->I

SAG T2 5160 91 220 100 5 1 320 272 A->P 3 R->L

SAG T2 FS 3000 91 220 100 5 1 320 272 A->P 3 R->L

AX VIBE Pre 6.47 2.65 240 100 3 1 320 240 A->P 4 S->I

AX VIBE Post 6.47 2.65 240 100 3 1 320 240 A->P 4 S->I

COR VIBE Post 4.42 1.46 240 109.4 2 1 320 245 R->L 2 A->P

Sag VIBE Post 4.42 1.46 240 100 2 1 320 245 A->P 2 R->L

AXIALS

CORONALS

23

Cervical Cancer Staging Planes for small FOV axial images in relation to the cervix

AX T1 Abdomen/Pelvis

Axial T2 FS Full FOV Pelvis

SAG T2 small FOV pelvis

Axial Obl. (SAX) T2 small FOV Cervix


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

Ax T2 FS 3450 96 300 100 5 1 320 310 A->P 2 S->I

Ax T1 455 20 300 100 5 1 320 256 R=>L 1 S->I

Cor T2 1400 91 440 100 5 1 320 320 R->L 1 A->P

Sag T2 4960 91

220 100 4 1 320 256 A->P 3 R->L

Ax T2 4960 91 200 100 4 1 320 272 R->L 2 S->I

Cor T2 4960 91 200 100 4 1 320 272 R->L 2 A->P

24

SAX to the cervix

Endometrial Cancer

Planes for small FOV axial/coronal images in relation to the uterus

Large FOV:

Ax T1 upper abdomen and pelvis

Ax T2 FS Pelvis full FOV

Small FOV:

Sag T2 Small FOV

Axial OBL (SAX of the uterus) T2

Axial OBL (SAX) VIBE PRE

Sag VIBE FS PRE

Sag VIBE FS POST (1 MIN/3 MIN/5 MIN)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

AX T1 4.3 1.89 380 81 3 190 320 A/P 1 S->I

AX T2 FS 3400 96 300 100 5 1 310 320 A/P 2 S->I

SAG T2 4900 86 240 100 5 1 256 320 A/P 3 L->R

SAX T2 4900 91 200 100 5 1 272 320 R/L 2 S->I

25

Axial OBL (SAX) VIBE FS POST (4 MIN)

SAX to the uterus

Female Pelvis - Urethral

COR T2 (wide FOV to include kidneys)

Small FOV (18cm-24cm) centered at urethra:

AXIAL T2 FS

SAG T2 FS

COR T2 FS

If indicated (requested by the MD for infection, inflammation, or malignancy):

AX VIBE FS PRE

AX VIBE FS POST

SAG VIBE FSPOST

COR VIBE FS POST


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

AX T1 4.30 1.89 380 81 3 190 320 A/P 1 S->I 64 slabs

AX T2 FS 3450 96 300 100 5 1 310 320 A/P 2 S->I

SAG T2 500 96 220 100 5 1 256 320 A/P 3 L->R

AX OBL (SAX) T2 4900 96 200 100 5 1 272 320 R/L 2 S->I AX OBL (SAX) VIBE PRE

4.3 2.08 240 100 3 0.6 240 320 R/L 1 S->I 72 slabs

SAG VIBE PRE 4.51 2.19 240 81 3 0.6 190 320 A/P 1 L->R 61 slabs SAG VIBE POST 4.51 2.19 240 81 3 0.6 190 320 A/P 1 L->R 61 slabs

AX OBL (SAX) VIBE PRE

4.3 2.08 240 100 3 0.6 240 320 R/L 1 S->I 72 slabs

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Prostate Cancer Staging 3T when possible For staging or XRT planning

Set angles straight to the pelvis and cover prostate and seminal vesicles

Axial T1 whole pelvis

Small FOV:

Axial T1

Axial T2 (3mm slice)

Sagittal T2 (3mm slice)

Coronal T2 (3mm slice)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1800 95 440 100 5 1 320 320 R/L 1 P->A

AXIAL T2 FS 3000 91 200 100 3 1 272 320 R/L 3 S->I

SAG T2 FS 3000 86 220 100 3 1 224 320 A/P 4 L->R

COR T2 FS 3000 86 220 100 3 1 224 320 R/L 4 P->A

AXIAL VIBE PRE 4.8 2.19 240 100 3

240 320 A/P 4 S->I 88 slabs

AXIAL VIBE POST

4.8 2.19 240 100 3 240 320 A/P 4 S->I 88 slabs

SAG VIBE POST 3.19 1.46 240 100 2 245 320 A/P 2 L->R 160 slabs

COR VIBE POST 3.19 1.46 240 100 2 245 320 R/L 2 P->A 176 slabs

27

Axial 3D T2

Dynamic Prostate (Multiparametric) Elevated PSA, negative biopsy

Must be done on 3T/phased array body coil

Cover entire prostate and seminal vesicles


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

Ax T1 455 20 300 100 5 1 320 256 R->L 1 S->I

Ax T1 626 13 200 100 5 1 256 100 R->L 1 S->I

Ax T2 3000 91 200 100 3 0 320 256 R->L 3 S->I

Sag T2 3000 91 200 100 3 0 320 256 H->F 3 R->L

Cor T2 3000 91 220 100 3 0 320 256 R->L 3 P->A

Ax 3D T2 1700 98 320 100 2 0 320 291 R->L 1.4 S->I

28

Axial T1 FSE TR/TE 650/10 small FOV(20cm) 3mm/1mm MATRIX 320

Axial T2 small FOV(20cm) 3mm/1mm MATRIX 320

Sagittal T2 small FOV FSE 3mm/1mm

Coronal T2 5000/93 Echo train 13 small FOV(20cm) 3mm/1mm MATRIX 320

DWI axial TR/TE 6000/78 flip angle 90, nex 6, b-values 0 and 1000, matrix 128x92 FOV 35cm x35cm 3mm/1mm to cover entire prostate and seminal vesicles.

Need ADC maps.

Post gadolinium:

Axial post gad: rapid dynamic contrast enhanced Slice thickness 4.0/0.0, sequential 16 axial slices, 20 phase acquisition FOV 22

APPENDICITIS PREGNANT (R/O APPENDICITIS)

COR T2 SSFSE

AXIAL T2 SSFSE

SAG T2 SSFSE

COR T2 FS BH

AX T2 FS BH

COR FIESTA

AX FIESTA (OPTIONAL- DO IF ? KIDNEY STONE)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

Ax T1 650 10 300 100 5 1 320 256 R->L 1 S->I

Ax T2 3100 91 200 100 3 0 320 256 R->L 3 S->I

Sag T2 3100 91 200 100 3 0 320 256 H->F 3 R->L

Cor T2 3100 91 220 100 3 0 320 256 R->L 3 P->A

DWI 8500 99 300 100 3 0 192 144 A->P 6 S->I b values 0 and 100

Dynamic Ax Post

4.72 1.86 260 260 3 1 192 192 a->P 1 S->I

29

Defecography

Axial T2

Sagittal T2 to obtain midline

Sagittal FIESTA at Rest

Sagittal FIESTA with Kegel

Sagittal FIESTA with minimal straining

Sagittal FIESTA with moderate straining

Sagittal FIESTA with maximum straining

Sagittal FIESTA with defecation


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 SSFSE 1600 132 440 100 5 1 320 320 R/L 1 P->A

AX T2 SSFSE 1600 132 380

75

5 1 320 194 A/P 1 S->I

SAG T2 SSFSE 1600 132 440

100

5 1 320 194 A/P 1 L->R

COR T2 FS BH 1600 132 380 194 5 1 320 320 R/L 1 P->A

AX T2 FS 1600 135 380 75 5 1 320 194 A/P 1 S->I

COR FIESTA 191 1.18 400 100 5.5 0 224 169 R/L 1 P->A

AX FIESTA 191 1.18 400 100 5.5 0 224 169 A/P 1 S->I

30

Fetal Add T1s for blood, especially in the brain

Sag T2

Axial T2

Coronal T2

Coronal FIESTA

Sag FIESTA

Axial FIESTA


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

AX T2 1600 95 380 75 5 1 320 194 A->P 3 S->I

SAG T2 1400 91 360 100 5 1 320 320 A->P 2 R->L

SAG FIESTA (X6) 3.89 1.7 306 100 5 1 320 256 A->P 1 R->L

31

Set angle to the area of interest on the fetus

With the smallest FOV possible

Rectal Cancer Should be performed on 3T during the day to be monitored by a radiologist

Planes for Small FOV axial/coronal image in relation to rectum

Sagittal T2 (Full FOV for planning sequences)

Axial T1 (Aortic bifurcation through pelvis)

Axial T2 (full FOV)

Small FOV:

Coronal Oblique T2

**Check with radiologist for rectal gel and administer gel if necessary

Sagittal T2 (small FOV 3mm slice)

Coronal Oblique T2 (small FOV: 3mm slice)

Axial Oblique T2 (small FOV: 3mm slice)

Axial Oblique T2 (small FOV: 3mm slice)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

Sag T2 1500 80 220 100 5 1 256 320 A/P 1 L->R

Ax T2 1500 80 220 100 5 1 256 320 R/L 1 S->I

Cor T2 1500 80 220 100 5 1 256 320 R/L 1 P->A

Cor CISS 191 1.18 400 100 5.5 169 224 R/L 1 P->A

Sag CISS 191 1.18 400 100 5.5 169 224 A/P 1 L->R

Ax CISS 191 1.18 400 100 5.5 169 224 A/P 1 S->I

OBL AXIAL =

parallel to long

axis rectum

OBL CORONAL =

perpendicular to

long axis rectum

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(angle set to perpendicular to the long axis of the

anal canal to evaluate sphincter involvement)

Axial Oblique VIBE FS Pre (small FOV: 3mm slice)

Axial Oblique VIBE FS Post (small FOV: 3mm slice)

Coronal Oblique VIBE FS Post (small FOV: 3mm slice)

Sagittal Oblique VIBE FS Post (small FOV: 3mm slice)

Rectal Cancer Continued


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

SAG T2 1400 92 320 100 5 0 320 320 A->P 3 R->L

AX T1 584 20 320 100 5 0 384 269 A->P 2 S->I

AX T2 6100 88 320 100 5 0 448 336 A->P 3 S->I

COR OBL T2

3000 78 320 100 3 0.3 256 205 R->L 4 A->P

SAG T2 3000 92 320 100 5 0 320 320 A=>P 3 R->L

COR OBL T2 3000 78 320 100 3 .3 320 320 R[>L 4 A->P

MR technologist: if you are uncertain

about the oblique axial and coronals, or

if the tumor involves the rectum as it

curves, call MD to help select the best

imaging planes.

33

General Chest (Basic)

Use for mediastinal mass/lymphadenopathy/thymus, etc.

All sequences should be done with breath hold:

COR T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AX 3D VIBE FS (4mm slices)

AX 3D VIBE FS POST

(0SEC/30 SEC/60 SEC/120 SEC)

Inject and scan at the same time for 0 Sec

- Reformat into axial and coronal

- Subtractions axial and coronal

AX OBL T2 3000 78 220 100 3 .3 256 205 R->L 4 S->I

AX OBL T2 (ANUS) 3000 78 220 100 3 .3 256 205 R->L 3 S->I

AX OBL VIBE PRE 6.47 2.65 240 100 3 1 320 240 A->P 4 S->I

AX OBL VIBE POST 6.47 2.65 240 100 3 1 320 240 A->P 4 S->I

COR OBL VIBE POST 6.2 2.64 240 100 3 1 320 240 R->L 4 A->P

SAG OBL VIBE POST 6.2 2.64 240 100 3 1 320 240 A->P 4 R->L

34

Image sources:

http://www3.gehealthcare.com/en/products/categories/magnetic_resonance_imaging/1-5t/optima_mr450w_1-

5t_with_gem_suite#tabs/tab474A2BF180D84862A2F3061065A44677

http://femonum.telecom-paristech.fr/projects.html

https://en.wikipedia.org/wiki/Female_reproductive_system

https://schwannomacasestudy.wordpress.com/

http://radiologykey.com/mri-of-the-abdomen-and-pelvis/

https://mrimaster.com/PLAN%20PROSTATE%20sag%20t2.html


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 1820 91 360 100 5 1 320 320 R/L 1 P->A

AXIAL T2 1600 97 360 100 7 1 259 320 A/P 1 S->I

AXIAL T2 FS 1600 97 360 100 7 1 259 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

2.2/4.4(1.5T) 360 100 7 1 256 256 A/P 1 S->I

AXIAL VIBE PRE 4.3 1.92 360 100 4 0.6 234 320 A/P 1 S->I 64 slabs

AXIAL VIBE POST

4.3 1.92 360 100 4 0.6 234 320 A/P 1 S->I 64 slabs

http://www3.gehealthcare.com/en/products/categories/magnetic_resonance_imaging/1-5t/optima_mr450w_1-5t_with_gem_suite#tabs/tab474A2BF180D84862A2F3061065A44677

http://www3.gehealthcare.com/en/products/categories/magnetic_resonance_imaging/1-5t/optima_mr450w_1-5t_with_gem_suite#tabs/tab474A2BF180D84862A2F3061065A44677

http://femonum.telecom-paristech.fr/projects.html

https://en.wikipedia.org/wiki/Female_reproductive_system

https://schwannomacasestudy.wordpress.com/

http://radiologykey.com/mri-of-the-abdomen-and-pelvis/

https://mrimaster.com/PLAN%20PROSTATE%20sag%20t2.html

35

http://clinical.netforum.healthcare.philips.com/us_en/Operate/ExamCards/MRI/15T-Hi-res-MRA-of-aorta-using-navigator-

for-MotionTrak-Japan

http://radiologykey.com/the-kidneys-and-upper-urinary-tract/

http://clinical.netforum.healthcare.philips.com/us_en/Operate/ExamCards/MRI/15T-Hi-res-MRA-of-aorta-using-navigator-for-MotionTrak-Japan

http://clinical.netforum.healthcare.philips.com/us_en/Operate/ExamCards/MRI/15T-Hi-res-MRA-of-aorta-using-navigator-for-MotionTrak-Japan

http://radiologykey.com/the-kidneys-and-upper-urinary-tract/

BODY MRI PROTOCOLS - Geisel School of Medicine · PDF fileBODY MRI PROTOCOLS Updated...

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