pittsrad msk mri

MSK MRI PROTOCOLS

PITTS RADIOLOGY

UPPER EXTREMITY

STERNOCLAVICULAR JOINTSHOULDERPEC MAJORELBOWWRISTTHUMBHAND/SYNOVITISFINGERBRACHIAL PLEXUS

MR STERNOCLAVICULAR JOINT

TIP: MAY NEED TO FLIP PHASE/FREQUENCY ENCODING GRADIENTS

TIP: PRONE POSITION MAY REDUCE MOTION ARTIFACT

COIL: 5 INCH FLEX (USE TMJ HOLDER IF PATIENT SUPINE)

ROUTINE SC JOINT

SC JOINT AXIAL IMAGING PLANE

SC JOINT-SAGITTAL IMAGING PLANE

SC JOINT-CORONAL IMAGING PLANE

MR SHOULDER ROUTINE

TIP: ON OBLIQUE CORONAL PHASE ENCODING SHOULD BE RIGHT TO LEFT NOT SUPERIOR-INFERIOR

TIP: PLACE ARM AT SIDE WITH THUMB TOWARD CEILING

TIP: AXIAL SEQUENCE EXTENDS THROUGH BICIPITAL GROOVE OF HUMERUS

TIP: BEWARE OF FLIPPED SHOULDER IMAGES

TIP: IF FATSAT IS POOR DO STIR INSTEAD OF FSE T2 FAT SAT

MR SHOULDER ROUTINE

1 AXIAL PROTON FSE FAT SAT

2 CORONAL OBLIQUE T2 FSE FAT SAT

3 SAG OBLIQUE T1

4 SAG OBLIQUE T2 FSE FAT SAT

5 AXIAL T2 FSE FAT SAT

6 CORONAL PD NO FAT SAT

MR SHOULDER ROUTINE

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX PD FSE FAT SAT

12 256/256

3

4/0.5 1500 35 A TO P 8 16

COR T2 FSE FAT SAT

14 256/256

3

3/0.5 ~4000 50-70 R TO L 8 16

SAG T1 16 256/192

1

4/0.5 600 minimum A TO P 16

SAG T2 FSE FAT SAT

16 256/256

2

3/0.5 ~4000 50-70 A TO P 8 16

AX T2 FSE FAT SAT

16 256/256

2

4/0.5 ~4000 50-70 A TO P 8 16

COR PD NO FAT SAT

14 256/256

3/0.5 2000 35 R TO L 8 16

MR ARTHROGRAM SHOULDER

1 AXIAL PD FSE FAT SAT

2 AXIAL T1 SE FAT SAT (ANGLED IN PLANE WITH GLENOID FOR

LABRUM)3 CORONAL OBLIQUE FSE T2 FAT SAT

4 CORONAL OBLIQUE T1 SE FAT SAT

5 SAG OBLIQUE T1 SE (NON FAT SAT)!!!

6 SAG OBLIQUE FSE T2 FAT SAT

7 AX GRE (merge on ge, fisp on siemens)

MR SHOULDER ARTHROGRAM

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX PD FSE FAT SAT

12 256/256

3

4/0.5 1500 35 A TO P 8 16

AX T1 SE FAT SAT 14 256/192

2

3/0.5 600 minimum A TO P 16

COR FSE T2 FAT SAT

14 256/256

3

3/0.5 ~4000 50-70 R TO L 8 16

COR T1 SE FAT SAT

14 256/192

2

3/0.5 600 minimum R TO L 16

SAG T1 SE 14 256/192

2

3/0.5 600 minimum A TO P 15

SAG FSE T2 FAT SAT

14 256/192

2

4/0.4 ~4000 50-70 A TO P 8 16

AX TRU FISP or merge

12 A TO P

SHOULDER POINTER AXIAL PLANE

SHOULDER AXIAL IMAGING PLANE

SHOULDER CORONAL PLANE

SHOULDER SAGITTAL PLANE

MR PECTORLIS MAJOR

TIP: MAY NEED TO FLIP PHASE/FREQUENCY ENCODING GRADIENTS

TIP: PRONE POSITION MAY REDUCE MOTION ARTIFACT

TIP: AXIAL IMAGES HAVE TO GO THROUGH ENTIRE PEC INSERTION(IF ? CALL RAD TO APPROVE IMAGES)

MR PEC MAJOR

PEC MAJOR AXIAL PLANE

PEC MAJOR CORONAL PLANE

PEC MAJOR SAGITTAL PLANE

MR ELBOW STANDARD

TIP: AXIAL IMAGES GO THROUGH RADIAL TUBEROSITY TO COVER BICEPS INSERTION

OBLIQUE SLICES TO GET TRUE IMAGING PLANES (SEE SETUP EXAMPLES)!!!

TIP: USE SMALL FLEXI WRAP COIL ON 1.5. ADD A CORONAL T1 NON FAT SAT IF

COMPETETIVE ATHLETE ON ELBOW ARTHROGRAM

MR ELBOW STANDARD

1 AXIAL T2 FSE FAT SAT

2 AXIAL T1 SE (NON FAT SAT)!!!

3 SAGITTAL STIR

4 SAGITTAL T1 SE (NON FAT SAT)!!!

5 CORONAL FSE T2 FAT SAT

6 CORONAL GRE 2D MEDIC

MR ELBOW STANDARD

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX T2 FSE FAT SAT

12 256/192

2

3/0.3 ~4000 50-70 R TO L 8 16

AX T1 SE 12 256/192

1

3/0.3 5-800 minimum R TO L 16

SAG STIR 14 256/192

2

3/0.3 2-4000 50 SUP TO INF

8 16

COR FSE T2 FAT SAT

12 256/192

2

3/0.3 ~4000 50-70 SUP TO INF

8 16

COR GRE 2D medic 12 SUP TO

INF

MR ELBOW ARTHROGRAM

1 AXIAL T1 FSE (NON FAT SAT)!!!

2 AXIAL T2 FSE FAT SAT

3 SAG T1 SE (NON FAT SAT)!!!

4 SAG STIR

5 CORONAL T1 SE FAT SAT

6 CORONAL T2 FSE FAT SAT

7 CORONAL 3D MEDIC

8 CORONAL T1 NON FAT SAT (DO IF COMPETITIVE ATHLETE)

MR ELBOW ARTHROGRAM

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX FSE T2 FAT SAT

14 256/256

3

4/1 ~4000 50-60 8 16

AX TI SE NON FAT SAT

14 256/192

2

4/1 400-800

MINIMUM 16

COR T1 SE FAT SAT

12 256/192

2

4/1 400-800

MINIMUM 16

COR T2 FSE FAT SAT

12 256/256

3

4/1 ~4000 50-60 8 16

SAG STIR

14 256/192

2

3/0.3 2-4000

50 8 16

COR 3D MEDIC

12

Cor t1 non fat sat

12 256/192

2

4/1 400-800

min 16

ELBOW AXIAL PLANE

ELBOW CORONAL PLANE

ELBOW SAGITTAL PLANE

MR WRIST

TIP: DO STIR IF POOR FAT SAT

TIP: FOV 6-8

TIP: FILM WITH PALM FACING UP

MR WRIST STANDARD

1 CORONAL T1 SE (NON FAT SAT)!!!

2 CORONAL STIR

3 AXIAL T1 SE (NON FAT SAT)!!!

4 AXIAL T2 FSE FAT SAT

5 CORONAL HIGH RES 3D GRADIENT

6 SAGITTAL T2 FSE FAT SAT

MR WRIST STANDARD

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

CORONAL STIR 6-8 256/256

3

3/0.3 >2000

TI 150

20-40 8 16

AX T1 SE 6-8 256/192

2

3/0.3 5-800 MINIMUM 1 16

AX T2 FSE FAT SAT

6-8 256/192

2

3/0.3 ~4000 50-60 8 16

COR HIGH RES 3D GRE

8

SAG T2 FSE FAT SAT

10 256/192

2

3/0.3 ~4000 50-60 8 16

MR ARTHROGRAM WRIST

1 CORONAL T1 SE (NON FAT SAT)!!!

2 CORONAL STIR

3 CORONAL T1 SE FAT SAT

4 CORONAL HIGH RES 3D GRADIENT

5 AXIAL T2 FSE FAT SAT

6 AXIAL T1 SE FAT SAT

7 SAG T2 FSE FAT SAT

MR WRIST ARTHROGRM

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

CORONAL STIR 6-8 256/256

3

3/0.3 >2000

TI 150

20-40 8 16

COR T1 SE FAT SAT

6-8 256/192

2

3/0.3 400-800

10-20 16

COR HIGH RES GRE

8 256/192

1

1/0 60 MINIMUM

FLIP >40

16

AX T2 FSE FAT SAT

8 256/256

3/0.3 ~4000 50-60 8 16

AX T1 SE FAT SAT 8 256/192

2

3/0.3 400-800

MINIMUM 16

SAG T2 FSE FAT SAT

12 256/192

3

3/0.3 ~4000 50-60 8 16

MR WRIST AXIAL PLANE

MR WRIST CORONAL PLANE

MR WRIST SAGITTAL PLANE

MR THUMB

TIP: CORRECT IMAGING PLANES CRUCIAL (SEE SETUP SECTION)

ROUTINE THUMB MR

1 CORONAL T1 SE (NON FAT SAT)

2 CORONAL PROTON DENSITY FSE FAT SAT

3 CORONAL T2 FSE FAT SAT

4 AXIAL T1 SE (NON FAT SAT)

5 AXIAL T2 FSE FAT SAT

6 SAG STIR

MR THUMB

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

COR T1 SE 6-8 256/256 3/0.3 400-

800

MINIMUM 16

COR T2 FSE FAT SAT

6-8 256/256 3/0.3 2000-6000

90-110

16 16

AX T1 SE 6-8 256/192 3/0.3 400-800

MINIMUM 16

AX T2 FSE FAT SAT

6-8 256/256 3/0.3 >2000 50-60 8 16

SAG STIR 6-8 256/192

3

3/0.3 >2000 20-40

TI 150

8 16

COR PD FSE FAT SAT

6-8 256/256 3/0.3 1500 35 8 16

MR THUMB AXIAL PLANE

MR THUMB CORONAL PLANE

MR THUMB SAGITTAL PLANE

MR HAND

TIP: FOR SYNOVITIS SCREENING ADD POST AXIAL AND CORONAL T1 FAT SAT POST GAD

TIP: FOR SYNOVITIS SCREENING FOV MUST ALLOW VISUALIZATION OF RADIOCARPAL JOINT AND PIP JOINTS

TIP: THIS PROTOCOL SHOULD BE USED RARELY EXCEPT FOR SYNOVITIS. MOST HAND MR’S ORDERED SHOULD BE WRIST, THUMB, OR FINGER IF PROTOCOLED CORRECTLY. CHECK WITH MD BEFORE DOING 4 SEQUENCE HAND.

MR HAND/SYNOVITIS

1 CORONAL T1 SE

2 CORONAL STIR

3 AXIAL STIR

4 AXIAL T1 SE

5 AXIAL T1 SE FAT SAT POST(DONE ONLY FOR SYNOVITIS SCREENING)

6 CORONAL T1 SE FAT SAT POST(DONE ONLY FOR SYNOVITIS SCREENING)

MR FINGER

TIP: CORRECT IMAGING PLANES CRUCIAL ( SEE SETUP IMAGES)

TIP: BE SURE TO CHECK WITH RADIOLOGIST BEFORE COMPLETING STUDY IF INDICATION IS LESION/MASS/INFECTION AND NO CONTRAST WAS GIVEN

MR FINGER

MR FINGER AXIAL PLANE

MR FINGER CORONAL PLANE

MR FINGER SAGITTAL PLANE

MR BRACHIAL PLEXUS

TIP: COVER HUMERUS TO HUMERUS ON CORONAL SCANS. SAGGITAL SCAN AFFECTED SIDE START MID C-SPINE THROUGH ENTIRE SHOULDER.COVER C2-T2 ON AXIAL SCANS

TIP: CHECK WITH MD IF NO CONTRAST GIVEN AND INDICATION LESION/MASS/NEURITIS

TIP: TORSO PA COIL

CONTRAST IMAGES ARE POST T1 FAT SAT ALL 3 PLANES

MR BRACHIAL PLEXUS

1 CORONAL T1 SE (NON FAT SAT)

2 CORONAL STIR

3 AXIAL T1 SE (NON FAT SAT)

4 AXIAL T2 FSE FAT SAT(IF POOR FAT SAT SWITCH TO STIR)

5 (SIDE(S) IN ?) SAGITTAL T2 FSE FAT SAT(IF POOR FAT SAT SWITCH TO STIR)

6 (SIDE(S) IN ?) SAGITTAL T1 SE (NON FAT SAT)

MR BRACHIAL PLEXUS

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

COR T1 SE 20 256/192

1

5/1 400-800

MINIMUM 16

COR STIR 20 256/192

2

5/1 2000-4000

40 8 16

AX T1 SE 20 256/192

1

5/1 400-800

MINIMUM 16

AX T2 FSE FAT SAT

20 256/192

2

5/1 3-4000 70 8 16

SAG T2 FSE FAT SAT

20 256/192

2

5/1 3-4000 70 8 16

SAG T1 SE 20 256/192

1

5/1 400-800

MINIMUM 16

LOWER EXTREMITY

OSSEOUS PELVISHIPATHLETIC PUBALGIA/SPORTS HERNIATHIGHKNEE ANKLEMIDFOOTFOREFOOTWHOLE FOOTSTRESS (TIBIA OR FEMUR)

MR OSSEOUS PELVIS

INDICATIONS: OCCULT FRACTURE, MUSCLE STRAINS/TEARS, HIP PAIN, R/O METS, SACROILITIS, R/O AVN, R/O OSTEOMYELITIS

TIP: FOR R/O METS, R/O OSTEOMYELITIS, AND SACROILITIS ADD PRE FAT SAT AXIAL T1 AND POST T1 FAT SAT CORONAL AND AXIAL SEQUENCES

TIP: ON AXIAL SEQUENCES SCAN FROM ILIAC CRESTS TO JUST BELOW LESSER TROCHANTERS

MR OSSEOUS PELVIS

1 AXIAL T1 SE (NON FAT SAT)

2 AXIAL FSE T2 FAT SAT

3 CORONAL T1 SE (NON FAT SAT)

4 CORONAL STIR

5 SAGITTAL FSE T2 FAT SAT (BOTH HIPS)

6,7,8 PRE FAT SAT T1 AXIAL AND POST AXIAL AND CORONAL FAT SAT T1

(TO BE DONE ONLY FOR METS, OSTEO, SACROILITIS)

MR OSSEOUS PELVIS

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX T1 SE

30-45 256/192 4/1 4-800 MIN 16

AX FSE T2 FAT SAT

30-45 256/256 4/1 3-4000 50-60 8 16

CORONAL STIR 30-45 256/192

3

4/1 >2000 20-40TI 150

8 16

SAG FSE T2 FAT SAT BOTH HIPS

20 256/256 4/1 3-4000 50-60 8 16

COR SE T1 30-45 256/192 4/1 4-800 MIN 16*IF NEEDED POST T1 VIBE FAT SAT

30 256/192 3/.5

MR OSSEOUS PELVIS AXIAL PLANE

MR OSSEOUS PELVIS CORONAL PLANE

MR OSSEOUS PELVIS SAG PLANE

MR HIP NONARTHROGRAM

1 AXIAL T1 SE (NON FAT SAT) LARGE FOV

2 AXIAL FSE T2 FAT SAT LARGE FOV3 CORONAL T1 SE (NON FAT SAT)4 CORONAL STIR5 SAGITTAL FSE T2 FAT SAT

(SYMPTOMATIC HIP)6 CORONAL FAT SAT PD (SYMPTOMATIC

HIP)

MR HIP NONARTHROGRAM

USE SAME PARAMETERS AS LISTED IN MR OSSEOUS PELVIS FOR LARGE FOV SEQUENCES AND SAME PARAMETERS AS LISTED IN MR ARTHROGRAM FOR SMALL FOV SEQUENCES

IF FAT SAT POOR ON AXIAL T2 SWITCH TO STIR

MR HIP ARTHROGRAM

TIP: PERFORM CORONAL STIR TO INCLUDE BOTH HIPS AS ON OSSEOUS PELVIS. PERFORM ALL OTHER SEQUENCES ON ONLY SIDE IN QUESTION.

TIP: PROPER SETUP CRUCIAL FOR ACCURATE LABRAL EVALUATION. PLEASE SEE SETUP IMAGES TO FOLLOW (SHOULD DO SEPARATE LOCALIZER TO SET UP THE AXIAL OBLIQUE T1 AND GRE SEQUENCES)

TIP: IF NOT PRESSED FOR TIME ADDING SAG GRADIENT OPTIONAL.

MR HIP ARTHROGRAM

1 AXIAL FSE T2 FAT SAT

2 AXIAL OBLIQUE T1 SE (NON FAT SAT)

(IN PLANE WITH FEMORAL NECK)

3 SAGITTAL T1 SE FAT SAT

4 CORONAL T1 SE FAT SAT

5 CORONAL STIR

6 SAGITTAL FSE T2 FAT SAT

7 AXIAL OBLIQUE HIGH RES GRADIENT(TRUFISP SIEMENS, MERGE GE)

MR HIP ARTHROGRAMSEQ FOV MATRIX/

NEXSLICE TR TE PHASE

DIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX OBL T1 SE 20 256/192 4/1 4-800 MIN 16

AX FSE T2 FAT SAT

18 256/256 4/1 ~4000 50-70 8 16

SAG T1 SE FAT SAT

20 256/192 4/1 4-800 MIN 16

COR T1 SE FAT SAT

20 256/192 4/1 4-800 MIN 16

CORONAL STIR 40 256/192

3

4/1 >2000 20-40 TI 150

8 16

SAG FSE T2 FAT SAT

20 256/192 4/1 ~4000 50-70 8 16

AX OBLIQUE TRUFISP 3D

SMALL AS POSSIBLE

MR HIP ARTHROGRAM AXIAL PLANE (* SEE AXIAL OBLIQUE TO FOLLOW*

MR HIP ARTHROGRAM CORONAL PLANE

MR HIP ARTHROGRAM SAGITTAL PLANE

MR HIP ARTHROGRAM AXIAL OBLIQUE PLANE(SHOULD DO SEPARATE COR LOCALIZER TO SET THIS UP CORRECTLY) THIS IS HOW THE

IMAGE SHOULD LOOK WHEN SE T UP CORRECTLY!

MR HIP ARTHROGRAM AXIAL OBLIQUE PLANE(SHOULD DO SEPARATE COR LOCALIZER TO SET THIS UP CORRECTLY)

MR HIP ARTHROGRAM AXIAL OBLIQUE PLANEThis is how the lines go down the femoral neck

MR HIP ARTHROGRAM AXIAL OBLIQUE PLANEThis is NOT !!! how the lines go down the femoral neck. THIS IS INCORRECT

SET UP BELOW FOR EXAMPLE

MR THIGH

TIP: OBTAIN BOTH SIDES FOR COMPARISON

TIP: USE BODY OR TORSO COIL

TIP: THIS PROTOCOL USED MORE FOR SYSTEMIC PROCESSES SUCH AS POLY OR DERMATOMYOSITIS TO EVAL MUSCLE SIGNAL. IF MASS IS THE INDICATION USE MASS PROTOCOL

TIP: FOLLOW OSSEOUS PELVIS IMAGING PLANES BUT SCAN FROM ACETABULI TO KNEES IN AXIAL AND CORONAL PLANES.

MR THIGH

1 AXIAL SE T1 (NON FAT SAT)

2 AXIAL STIR

3 CORONAL SE T1 (NON FAT SAT)

4 CORONAL STIR

MR THIGH

MR ATHLETIC PUBALGIA/SPORTS HERNIA

TIP:CENTER ON PUBIC SYMPHYSIS.

TIP: USE PHASE ARRAY COIL (SAME COIL USED FOR GYN PATHOLOGY)

TIP: HAVE PATIENT EMPTY BLADDER PRIOR TO SCAN

MR ATHLETIC PUBALGIA/SPORTS HERNIA

MR ATHLETIC PUBALGIA/SPORTS HERNIA AXIAL PLANE

MR ATHLETIC PUBALGIA/SPORTS HERNIA CORONAL PLANE

MR ATHLETIC PUBALGIA/SPORTS HERNIA SAG PLANE

MR KNEE

TIP: SWAP PHASE AND FREQUENCY ON SAG AND AXIAL SCANS.

TIP: IF POOR FAT SAT ON FSE T2 DO STIR.

TIP: DO FAT SAT T2 ACL SEQUENCE ON ALL ATHLETE KNEES AND ANY CASE THAT ORDER STATES CONCERN FOR ACL TEAR

MR KNEE STANDARD1 AXIAL PD FAT SAT

2 CORONAL FSE PD FAT SAT

3 SAG PD

4 SAG FSE T2 FAT SAT

5 COR T1 SE

6 COR FSE PD (ADD FAT SAT T2 ACL SEQUENCE IF ATHLETE AND/OR IF ACL TEAR CONCERN ON ORDER)

MR KNEE STANDARD

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX PD FAT SAT

16 256/192

2

4/0.4 2000 25

COR FSE PD FAT SAT

16 256/192 4/0.4 2000 40-50 4

SAG PD 14-16 256/192 4/0.4 2000 25

COR SE T1

16 256/192 4/0.4 4-800 MIN

COR FSE PD

16 256/192 4/0.4 2000 20 4

SAG T2 FSE FAT SAT

14-16 256/192

2

4/0.4 4000 70 8

CORONAL OBLIQUE T2 FAT SAT ACL FAT SAT T2 IF NEEDED

MR KNEE ARTHROGRAM

1 AXIAL FSE T2 FAT SAT

2 CORONAL SE T1 (NON FAT SAT!!!)

3 CORONAL STIR

4 SAG FSE T2 FAT SAT

5 SAG SE T1 FAT SAT

6 SAG GRE T2*

MR KNEE HARDWARE(MEANS METAL SURGICAL HARDWARE. (NOT ACL REPAIR)IF ?

CHECK WITH RADIOLOGIST

1 AXIAL FSE T2 FAT SAT

2 SAGITTAL FSE PD (NON FAT SAT)

3 CORONAL STIR

4 SAG STIR

5 CORONAL FSE PD (NON FAT SAT)

6 CORONAL GRE T2 *

MR KNEE AXIAL PLANE

MR KNEE CORONAL PLANE

MR KNEE SAG PLANE

MR ANKLE/MIDFOOT

TIP: IF POOR FAT SAT ON T2 FSE SWITCH TO STIR.

TIP: IF OSTEOMYELITIS IS THE QUESTION DO STANDARD ANKLE AND CHECK WITH RADIOLOGIST TO SEE IF CONTRAST NEEDED. IF CANNOT CONTACT RAD OR IN DOUBT DO FAT SAT T1 POST IN ALL 3 PLANES.

TIP: IMAGES SHOULD COVER ENTIRE MIDFOOT ALL SEQUENCES

TIP: IF FOREIGN BODY IS INDICATION ADD SAG GRE.

MR ANKLE/MIDFOOT

1 AXIAL SE T1 (NON FAT SAT)

2 AXIAL FSE T2 FAT SAT

3 SAG STIR

4 SAG SE T1 (NON FAT SAT)

5 CORONAL FSE T2 FAT SAT

6 COR SE T1

MR ANKLE/MIDFOOT

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX SE T1

12-14 256/192

1

4/0.4 5-800 MIN

AX FSE T2 FAT SAT

12-14 256/192

2

4/0.4 ~4000 70 8

SAG STIR

12-14 256/192 4/0.4

SAG SE T1

12-14 256/192

1

4/0.4 5-800 MIN

COR FSE T2 FAT SAT

12-14 256/192

2

4/0.4 ~4000 70 8

COR SE T1 12-14 256/192

1

4/0.4 5-800 MIN

MR ANKLE ARTHROGRAM

1 SAG SE T1 FAT SAT

2 SAG STIR

3 CORONAL T1 (NON FAT SAT)

4 CORONAL FSE T2 FAT SAT

5 AXIAL FSE T2 FAT SAT

6 AXIAL SE T1 FAT SAT

MR ANKLE ARTHROGRAM

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

AX SE T1 FAT SAT

12-14 256/192

1

4/0.4 5-800 MIN

AX FSE T2 FAT SAT

12-14 256/192

2

4/0.4 ~4000 70 8

SAG STIR

12-14 256/192 4/0.4

SAG SE T1 FAT SAT

12-14 256/192

1

4/0.4 5-800 MIN

COR FSE T2 FAT SAT

12-14 256/192

2

4/0.4 ~4000 70 8

COR SE T1 12-14 256/192

1

4/0.4 5-800 MIN

MR ANKLE AXIAL PLANE

MR ANKLE CORONAL PLANE

MR ANKLE SAG PLANE

MR FOREFOOT

TIP: CONTRAST GIVEN IF INDICATION MORTONS NEUROMA, PLANTAR PLATE INJURY, OR SOFT TISSUE MASS/PALPABLE ABNORMALITY.

TIP: THIS PROTOCOL AND ANKLE SHOULD BE USED MOST OFTEN. WHOLE FOOT LESS OFTEN. IF IN DOUBT WHICH TO USE PLEASE CHECK WITH RADIOLOGIST.

TIP: IF FOREIGN BODY IS THE INDICATION ADD SAG GRE.

MR FOREFOOT

1 SHORT AXIS SE T1 (NON FAT SAT)

2 SHORT AXIS FSE T2 FAT SAT

3 SAG STIR

4 SAG SE T1 (NON FAT SAT)

5 LONG AXIS SE T1 (NON FAT SAT)

6 LONG AXIS STIR

7(ONLY IF

INICATED)

POST GAD ALL 3 PLANE FAT SAT T1 SE

MR FOREFOOT

SEQ FOV MATRIX/NEX

SLICE TR TE PHASEDIRECTION

ETL BANDWITH

FREQUENCY/PHASE

SA SE T1

12 256/256

1

3/0.5 4-800 MIN 16

SA FSE T2 FAT SAT

12 256/192

2

3/0.5 ~4000 50-60 8 16

SAG SE T1

12-14 256/256

1

3/0.5 4-800 MIN 16

LA SE T1

12-14 256/256

1

3/0.5 4-800 MIN 16

LA STIR

12-14 256/256

3

3/0.5 >2000 20-40TI 150

8 16

SAG STIR

12-14 256/256

3

3/0.5 >2000 20-40TI 150

8 16

3 PLANE POST FAT SAT T1

12-14 256/192

2

4/1 4-800 MIN 16

MR FOREFOOT SHORT AXIS

MR FOREFOOT LONG AXIS

MR FOREFOOT SAG PLANE

MR WHOLE FOOT

THIS SHOULD BE USED VERY RARELY. MOST STUDIES SHOULD BE ANKLE OR FOREFOOT. PLEASE READ ORDER AND QUESTION PATIENT AS TO WHAT IS TO BE IMAGED. IF NEEDED CALL ORDERING MD TO CONFIRM. LARGE FOV IN FOOT LIMITS RESOLUTION AND BASICALLY ANSWERS BIG QUESTIONS LIKE FRACTURES AND OSTEOMYELITIS.

MR WHOLE FOOT(USE SAME IMAGING PLANES AS ANKLE AND SAME PARAMETERS)

1 SAG STIR

2 SAG T1 SE (NON FAT SAT)

3 LONG AXIS SE T1

4 LONG AXIS FAT SAT FSE T2

5 SHORT AXIS SE T1

6 SHORT AXIS FAT SAT FSE T2

IF OSTEO THE QUESTION ADD POST FAT SAT T1 ALL 3 PLNES

MR STRESS (TIBIA OR FEMUR)

TIP: FOR FEMUR SETUP PLANES JUST LIKE THIGH. FOR TIBIA SEE IMAGES TO FOLLOW

TIP: CORONAL AND AXIAL IMAGES ARE BILATERAL(AT LEAST TO START WITH AS LONG AS QUALITY IS ADEQUATE) . SAG IS UNILATERAL SIDE OF INTEREST.

TIP: PLEASE PAY ATTENTION TO IMAGE QUALITY IF AXIAL BILATERAL SEQUENCE IS POOR QUALITY SWITH TO UNILATERAL

MR STRESS (TIBIA OR FEMUR)

1 CORONAL SE T1 (BILATERAL)

2 CORONAL STIR (BILATERAL)

3 AXIAL SE T1 (BILATERAL)

4 AXIAL STIR (BILATERAL)

5 SAGITTAL STIR (UNILATERAL LEG OF INTEREST)

MR STRESS (TIBIA) CORONAL PLANE

MR STRESS (TIBIA) AXIAL PLANE

MR STRESS (TIBIA) SAGITTAL PLANE

MR MASS OR INFECTION

TIP: SITE MUST BE MARKED IF POSSIBLE

TIP: DO SAG IF MASS IS ANTERIOR OR POSTERIOR. DO CORONAL IF MASS IS MEDIAL OR LATERAL. IF IN DOUBT AND CANNOT CONSULT RADIOLOGIST DO ALL 3 PLANES.

TIP: THIS IS NOT TO BE USED IN THE FOOT OR PELVIS. PLEASE CONSULT SECTIONS ABOVE. IF IN DOUBT PLEASE CHECK WITH RAD. IF THERE IS A MASS IMAGES SHOULD ALWAYS IF POSSIBLE BE REVIEWED BY RADIOLOGIST BEFORE PATIENT LEAVES.

MR MASS OR INFECTION

1 AXIAL SE T1 (NON FAT SAT)!!!

2 AXIAL STIR

3 CORONAL OR SAG SE T1 (NON FAT SAT)!!!

4 CORONAL STIR

5 AXIAL POST GAD SE T1 (IF MASS NO FAT SAT, IF INFECTION FAT SAT) IF ? CALL RADIOLOGIST

6 SAG OR CORONAL POST GAD SE T1 WITH FAT SAT

ADDITIONAL TIPS

TIPS: PLEASE CALL WITH ?’S AS MUCH AS NEEDED UNTIL THINGS ARE IRONED OUT.

TIPS: SMALL PARTS CASES ( WRISTS, FINGERS, COMPETITIVE ATHLETES FOOT/ANKLE) SHOULD BE TRIAGED TO APPROPRIATE LOCATIONS AS MUCH AS POSSIBLE SO BEST QUALITY IMAGES CAN BE OBTAINED.