richland msk mri protocols
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RICHLAND 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
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 IMAGESTIP: IF FATSAT IS POOR DO STIR INSTEAD OF
FSE T2 FAT SATUSC ATHLETES ON 3 T IF POSSIBLE
MR SHOULDER
TIP: IF METALLIC ARTIFACT FROM HARDWARE SUCH AS IM RODS OR SCREWS FOR FRACTURE REPAIR. TURN OFF THE FAT SAT ON THE T1 AND T2 SEQUENCES AND ADD ONE AXIAL STIR SEQUENCE.
TIP: ALL PEDS SPORTS RELATED INJURY CASES(THROWERS/OVERHEAD ATHLETES) ADD CORONAL 3D MEDIC (BLACK BONE) SEQUENCE TO EVALUATE PHYSIS
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
3 T MR SHOULDER ROUTINE
SEQ FOV NEX SLICE TR TE PHASEDIRECTION
ETL BANDWITH
FREQUENCY/PHASE
AX Tru Fisp 14
COR T2 FSE FAT SAT
14 3 4mm/1mm
2825 55 R to L
12 25 320/288
SAG T1 14 3 4mm/1mm
500 10 A to P
3 31.25 320/288
SAG T2 FSE FAT SAT
14 3 3mm/1mm
2825 58 A to P
12 25 320/288
AX T2 FSE FAT SAT
14 3 4mm/0.2mm
3000 50 A to P
12 25 320/256
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 FISP
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 12 A TO
P
3 T MR SHOULDER ARTHROGRAM
SEQ FOV NEX SLICE TR TE PHASEDIRECTION
ETL BANDWITH
FREQUENCY/PHASE
AX PD FSE FAT SAT
14 3 3mm/1mm
3250 55 A to P
10 31.25 320/256
AX T1 FSE FAT SAT
14 1 4mm/0.2mm
500 10 A to P
1 31.25 320/256
COR FSE T2 FAT SAT
14 3 4mm/1mm
2825 55 R to L
12 25 320/288
COR T1 FSE FAT SAT
14 2 4mm/1mm
500 10 R to L
3 31.25 320/288
SAG FSE T1 14 1 4mm/
1mm500 10 A to
P3 31.25 320/288
SAG T2 FSE FAT SAT
14 3 3mm/1mm
2825 55 A to P
12 25 320/288
AX TRU FISP 12
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
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. USE KNEE COIL ON 3 T. COMPETITIVE ATHLETES TO BE DONE 3 T IF AT ALL POSSIBLE.
ADD A CORONAL T1 NON FAT SAT IF COMPETETIVE ATHLETE ON ELBOW ARTHROGRAM
MR ELBOW
SAGITTAL SEQUENCES MUST GO THROUGH ENTIRE COMMON FLEXOR AND EXTENSOR TENDON ORIGINS. MAKE SURE THEY ARE COMPLETELY INCLUDED.
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
3 T MR ELBOW STANDARD
SEQ FOV NEX SLICE TR TE PHASEDIRECTION
ETL BANDWITH
FREQUENCY/PHASE
Cor Fse T2 fat sat
14 3 3mm/0 gap
3300 55 Sup to Inf
12 25 384/320
Cor Tru Fisp
14
Sag Fse T2 fat sat
14 2 3mm/1mm
3300 55 Sup to Inf
12 25 384/320
Ax Fse T2 fat sat
14 2 3mm/1mm
4300 55 R to L
12 25 384/320
Ax Fse T1
12 1 3mm/1mm
550 9 R to L
3 31.25 512/320
COR 3D MEDIC
14
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 ARTHROGRAMSEQ FOV MATRIX/
NEXSLICE TR TE PHASE
DIRECTION
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
Sag T1 non fat sat
14 256/192 4/1 400-800
min
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
3 T MR ELBOW ARTHROGRAM
SEQ FOV NEX SLICE TR TE PHASEDIRECTION
ETL BANDWITH
FREQUENCY/PHASE
AX T1 FSE NON FAT SAT
14 1 3/1 550 9 R TO L
3 31.25 512/320
AX T2 FSE FAT SAT
14 2 3/1 4300 55 R TO L
12 25 384/320
SAG FSE T2 FAT SAT
14 2 3/1 3300 55 Sup to inf
12 25 384/320
Cor t1 fse fat sat
12 1 3/0 gap 625 14 SUP TO INF
3 31.25 512/320
COR T2 FSE FAT SAT
12 3 3/ 0 GAP 3300 55 SUP TO INF
12 25 384/320
Cor 3d gre
12
COR T1 NO FAT SAT
12 DO IF COMPETITIVE ATHLETE
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)
TIP: SHOULD BE TRIAGED TO PARKRIDGE IF POSSIBLE
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
TIP: SHOULD BE TRIAGED TO PARKRIDGE IF AT ALL POSSIBLE
MR FINGER
1 COR FAT SAT PD
2 COR STIR
3 COR T1
4 SAT FAT SAT T2
5 AX FAT SAT T2
6 AX T1
7 AX FAT SAT PD
MR FINGER
SEQ FOV MATRIX/NEX
SLICE TR TE PHASEDIRECTION
ETL BANDWITH
FREQUENCY/PHASE
COR T1 SE
256/256 3/0.3 400-800
MINIMUM 16
SAG T2 FSE FAT SAT
256/256 3/0.3 2000-6000
90-110
16 16
AX T1 SE 256/192 3/0.3 400-800
MINIMUM 16
AX T2 FSE FAT SAT
256/256 3/0.3 >2000 50-60 8 16
COR STIR 256/192
3
3/0.3 >2000 20-40
TI 150
8 16
COR PD FSE FAT SAT
256/256 3/0.3 1500 35 8 16
AX PD FAT SAT
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 HIP POST ARTHROPLASTY
TIP: USE FLEX WRAPAROUND COIL
TIP: SAG IMAGES MUST GO THROUGH THE MUSCLE INSERTIONS ON GREATER TROCHANTER
TIP: PHASE ENCODING ALWAYS PARALLEL TO LONG AXIS OF PROSTHESIS (CRANIOCAUDAL DIRECTION
MR POST HIP ARHTROPLASTY
TIP:Optimized image quality can be achieved with spin-echo MR imaging by using a high bandwidth (at least 130 Hz per pixel), a high-spatial-resolution matrix (512 × 512), sequences with multiple refocusing pulses, and a frequency-encoding axis parallel to the long axis of the prosthesis. The degree of distortion is reduced by using this optimized technique .
MR HIP POST ARTHOPLASTYSEQ FOV MATRIX/
NEXSLICE TR TE PHASE
DIRECTION
ETL BANDWITH
FREQUENCY/PHASE
AX T1 FSE
140X80MM
512X256 3/1 669 18 9 HIGHER THE BETTER AT LEAST 130 HZ PER PIXEL
AX STIR 180X100MM
512X256 4/1 5550 34 WITH TI 150
SAG T1 SE
180X100MM
512X256 6/1 707 23
COR T1 FSE
220X100MM
512X256 4/1 4-800 MIN 9
CORONAL FSE T2
220X100MM
512X256 4/1 3910 75 9
SAG FSE T2
180X100MM
512X256 6/1 ~4000 75 9
SAGITTAL EXAMPLE IMAGE.
Pfirrmann C W A et al. Radiology 2005;235:969-976
©2005 by Radiological Society of North America
CORONAL EXAMPLE IMAGE
Pfirrmann C W A et al. Radiology 2005;235:969-976
©2005 by Radiological Society of North America
AXIAL EXAMPLE IMAGES
Pfirrmann C W A et al. Radiology 2005;235:969-976
©2005 by Radiological Society of North America
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: ON 3T IF PATIENT NOT AN ATHLETE OF ANY KIND SKIP FISP SEQUENCES AND ADD CORONAL T1 IN PLACE OF FISP SEQUENCES.
TIP: SWAP PHASE AND FREQUENCY ON SAG AND AXIAL SCANS.
TIP: IF POOR FAT SAT ON FSE T2 DO STIR.
TIP: .* USC ATHLETES TO BE DONE ON 3 T IF POSSIBLE*
TIP: DO FAT SAT T2 ACL SEQUENCE ON ALL ATHLETE KNEES AND ANY CASE THAT ORDER STATES CONCERN FOR ACL TEAR
MRI KNEE
TIP: SAGITTAL SEQUENCES MUST GO THROUGH ENTIRE FIBULAR HEAD. WE MUST SEE THE INSERTION OF THE LATERAL LIGAMENTOUS STRUCTURES AND BICEPS TENDON ON THE FIBULAR HEAD.
TIP: PEDIATRIC CASES ADD CORONAL 2D OR 3D GRADIENT SEQUENCE IF SPORTS/STRESS INJURY THE INDICATION
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 14 256/192 3/0.5 2000 25
COR SE T1
16 256/192 4/0.4 4-800 MIN
COR FSE PD
14 256/192 3/0.5 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
3 T MR KNEE
1 AXIAL FSE T2 FAT SAT
2 CORONAL FSE T2 FAT SAT
3 SAGITTAL FSE T2 FAT SAT
4 SAGITTAL FSE PD (NON FAT SAT!!!)
5 SAGITTAL HIGH RES GRE(TRUFISP SIEMENS)
6 CORONAL HIGH RES GRE(TRUFISP SIEMENS)
7 CORONAL PD (NON FAT SAT) *ADD T2 FAT SAT ACL SEQUNECE IF NEEDED*
3 T MR KNEESEQ FOV NEX SLICE TR TE PHASE
DIRECTION
ETL BANDWITH
FREQUENCY/PHASE
AX FSE T2 FAT SAT
15 2 4MM/1MM
3959 55 R TO L 12 31 384/320
SAG FSE T2 FAT SAT
15 2 3MM/1MM
4050 55 SUP TO INF
12 25 384/320
COR FSE T2 FAT SAT
15 2 4MM/1MM
3925 55 R TO L 12 31 384/320
SAG FSE PD
15 2 2MM/0.2MM
3950 10 SUP TO INF
6 50 320/50
SAG TRUFISP 15
COR TRUFISP 15
COR PD *(ADD T2 FS ACL SEQUENCE IF NEEDED)*
15 2 3mm/0.5mm
3950 10 R TO L
12 50 320/50
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
ALL PEDS SPORTS RELATED INJURY CASES ADD CORONAL 3D MEDIC (BLACK BONE) SEQUENCE TO EVALUATE PHYSIS
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.
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.
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