mri protocol

MSK MRI PROTOCOLSMSK MRI PROTOCOLS

ContentsContents►► Upper ExtremityUpper Extremity PagePage►► ShoulderShoulder►► ElbowElbow►► WristWrist►► FingerFinger►► ThumbThumb►► Lower ExtremityLower Extremity►► Hip Hip ►► PelvisPelvis►► ThighThigh►► KneeKnee►► Lower Extremity/ShinLower Extremity/Shin►► AnkleAnkle►► FootFoot►► Special CasesSpecial Cases►► Soft Tissue MassSoft Tissue Mass►► Metal ProtocolMetal Protocol

UPPER EXTREMITYUPPER EXTREMITY

MR Shoulder Indications:MR Shoulder Indications:

►► Routine ShoulderRoutine ShoulderIndications:Indications:►►Rotator Cuff Pathology/EvaluationRotator Cuff Pathology/Evaluation

►► MR ArthrogramMR ArthrogramIndications:Indications:►►Labrum Pathology/Tear Labrum Pathology/Tear

►► Post Gadolinium ShoulderPost Gadolinium ShoulderIndications: Labral Pathology/Instability without ability Indications: Labral Pathology/Instability without ability to do a direct arthrogramto do a direct arthrogramContraindications: PostContraindications: Post--opop

ShoulderShoulder--RoutineRoutine

AxialAxialProton Proton FSEFSEFatSatFatSat

1010 512 x 256512 x 25622

4/0.54/0.5 30003000 2020 -- -- 88 1616

CorCorObliqueObliqueSTIRSTIR

1616--1818 256 x 192256 x 19233

4/0.54/0.5 >1500>1500 4040 120120 9090 88 1616

CorCorObliqueObliqueT1 SET1 SENonNonFatSatFatSat

1616--1818 256 x 256256 x 25611

3/0.53/0.5 400400--800800 400400--800800 -- -- 1616

SagSagObliqueObliqueT2 FSET2 FSENonNonFat SatFat Sat

1616 256x 256256x 25622

3/0.53/0.5 >2000>2000 110110 -- -- 88 1616

Seq. FOV Matrix/ Slice TR TE TI Flip ETL BWNex

MR Arthrogram ShoulderMR Arthrogram Shoulder

AxialAxialT1 SET1 SEFatSatFatSat

1414 256 x 192256 x 192 3/0.53/0.5 400400--800800 minimumminimum 1616

CorCorObliqueObliqueT1 SE T1 SE FatSatFatSat


CorCorObliqueObliqueT2 FSET2 FSEFatSatFatSat

1414 256 x 256256 x 256 3/0.53/0.5 >1500>1500 7070--8080 88 1616

SagSagObliqueObliqueT1 SET1 SENon Non FatSatFatSat


ABERABERT1 SET1 SEFat SatFat Sat



ShoulderShoulder--Post GadoliniumPost Gadolinium

Axial T1Axial T1FatSatFatSat

1414 256x192256x192 4/.54/.5 400400--800800 minimumminimum 1616

AxialAxialT2 FSET2 FSEFatSatFatSat

1414 256x 256256x 256 4/1mm4/1mm 20002000--60006000

6060--7070 88

CorCorObliqueObliqueT1 T1 FatSatFatSat


SagSagObliqueObliqueT1 T1 FatSatFatSat


CorCorObliqueObliqueT2 FSET2 FSEFatSatFatSat

1212 256x256256x256 4/14/1 20002000--60006000

6060--7070 88 1616


ShoulderShoulder--Axial Imaging PlaneAxial Imaging Plane

Relevant Anatomy

HumeralHead

Bony Glenoid

Clavicle

Axial Imaging PlanePrescribe plane parallel to humeral shaft. Cover

from AC joint through proximal humeral diaphysis.

AC Joint(Not shown on MR)

ShoulderShoulder--Coronal Imaging PlaneCoronal Imaging Plane

Coronal Imaging PlanePrescribe coronal plane off of axial images parallel to

supraspinatus muscle

Relevant Anatomy

Supraspinatus

ShoulderShoulder--Sagittal Imaging PlaneSagittal Imaging Plane

Humeral Head

Bony GlenoidLabrum

CartilaginousLabrumAnt. and Post.

Relevant Anatomy Sagittal Imaging PlanePrescribe sagittal plane off axial images with

line parallel to bony glenoid. Image from bony glenoid through deltoid muscle.

Deltoid Muscle

MR Elbow Indications:MR Elbow Indications:

►► Routine ElbowRoutine ElbowIndications:Indications:►►Biceps/Triceps tearBiceps/Triceps tear►►Medial/Lateral Collateral Ligament TearsMedial/Lateral Collateral Ligament Tears►►Common Flexor/Common Extensor Tendon PathologyCommon Flexor/Common Extensor Tendon Pathology

►► MR Arthrogram ElbowMR Arthrogram ElbowIndications:Indications:►► Intra articular Body evaluationIntra articular Body evaluation►►Sometimes Medial/Lateral Collateral Ligament EvaluationSometimes Medial/Lateral Collateral Ligament Evaluation

►► Post Gadolinium ElbowPost Gadolinium ElbowIndications:Indications:►► IA bodyIA body

ElbowElbow--RoutineRoutine

AxialAxialPD FSEPD FSENon Non FatSatFatSat

1010 512 x 256 512 x 256 22

4/0.54/0.5 30003000 4040 88 1616


1010 256 x 256256 x 25622

4/0.54/0.5 >2000>2000 7070--8080 88 1616

CoronalCoronalT1 SET1 SENon Non FatSatFatSat

1616--1818 256 x 256256 x 25611

3/0.53/0.5 400400--800800 minimalminimal 1616

CoronalCoronalSTIRSTIR

1616--1818 256 x 192256 x 19233

3/0.53/0.5 > 1500> 1500 4040 120120 9090 88 1616

SagSagT2 FSET2 FSEFatSatFatSat

1616 256 x 256256 x 25622

3/0.53/0.5 >1500>1500 7070--8080 88 1616


MR Arthrogram ElbowMR Arthrogram Elbow

AxialAxialT1 SET1 SENon Non FatSatFatSat

1212--1414 256 x 256256 x 256 4/14/1 400400--800800 minimumminimum 1616

AxialAxialT2T2FSEFSEFatSatFatSat

1212--1414 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616

CoronalCoronalT1 SET1 SEFatSatFatSat


CoronalCoronalT2T2FSE FSE FatSatFatSat

1212--1414 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616

SagSagT2 SET2 SEFatSatFatSat

1212--1414 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616




ElbowElbow--Axial Imaging PlaneAxial Imaging Plane

Relevant AnatomyAxial Imaging Plane

*Prescribe plane perpendicular to coronalplane (©). Scan from humeral metaphysis

through radial tuberosity.

©©

*

*

Radial Tuberosity(bump on medial radius)

Lateral and MedialHumeral Condyles

UlnaRadius

Expected location radial tuberosity(Not shown)

ElbowElbow--Coronal Imaging PlaneCoronal Imaging Plane

Relevant AnatomyCoronal Imaging Plane

*Prescribe plane parallel to anterior humerus at condyles. Scan through entire elbow.

*

*

Lateral Humeral Condyle

Medial Humeral Condyle

Olecranon processof Ulna

Humerus

ElbowElbow--Sagittal Imaging PlaneSagittal Imaging Plane

Sagittal Imaging Plane*Prescribe plane perpendicular to coronal plane (©). Scan

through entire elbow.

©

©

*

*Lateral Humeral Condyle

Medial Humeral Condyle

Olecranon processof Ulna

Humerus

Relevant Anatomy

Wrist Indications:Wrist Indications:

►► Routine WristRoutine WristIndications:Indications:►► TFCC, TFCC, LunotriquentralLunotriquentral, , ScapholunateScapholunate teartear►► Flexor Tendon/Carpal Tunnel/ Extensor Tendon PathologyFlexor Tendon/Carpal Tunnel/ Extensor Tendon Pathology►► Evaluation for Occult fractureEvaluation for Occult fracture

►► MR Wrist ArthrogramMR Wrist ArthrogramIndications:Indications:►► Some TFCC/LT/SL ligament tearsSome TFCC/LT/SL ligament tears

►► Dynamic Enhanced Wrist (Post Gad Images)Dynamic Enhanced Wrist (Post Gad Images)Indications:Indications:►► Evaluation of Evaluation of ScaphoidScaphoid Nonunion/Avascular Necrosis Exam: Nonunion/Avascular Necrosis Exam:

IMPORTANT: **Perform routine wrist PLUS FMPSPGR IMPORTANT: **Perform routine wrist PLUS FMPSPGR FatSatFatSatPre/Post Gadolinium images through carpal bones in Pre/Post Gadolinium images through carpal bones in coronalcoronalplane**plane**

WristWrist--RoutineRoutine

CoronalCoronalT1 SE T1 SE Non Non FatSatFatSat

1212--1414 512 x 256512 x 25611

3/0.53/0.5 400400--800800 minimumminimum 1616

CoronalCoronalT2 FSET2 FSEFatSatFatSat

1212--1414 256 x 256256 x 25622

3/0.53/0.5 >1500>1500 7070--8080 88 1616

CoronalCoronalGradientGradient

1212--1414 256 x 192256 x 19222

1/01/0 6060 minimumminimum 3030--4040 88 1616

AxialAxialPD FSEPD FSENon Fat Non Fat SatSat

88--1010 256 x 256256 x 25622

3/0.53/0.5 30003000 4040 88 1616

SagSagSTIRSTIR

1212 256 x 192256 x 19233

3/0.53/0.5 >1500>1500 4040 120120 9090 88 1616


MR Arthrogram Wrist (dir or MR Arthrogram Wrist (dir or indind))


88--1010 256 x 256256 x 256 3/0.53/0.5 400400--800800 1010--2020 1616


88--1010 256 x 256256 x 256 3/0.33/0.3 >1500>1500 7070--8080 88 1616

CoronalCoronal3D 3D GradientGradient

88--1010 256 x 192256 x 192 1/01/0 6060 minimumminimum 3030--4040 88 1616


88--1010 256 x 256256 x 256 3/0.53/0.5 >1500>1500 7070--8080 88 1616

AxialAxialT1 SET1 SENonNon--FatSatFatSat

1212 3/0.53/0.5 400400--800800 1010--2020 1616


1212 3/0.53/0.5 >1500>1500 7070--8080 88 1616


WristWrist--Axial Imaging PlaneAxial Imaging Plane

Distalulna

lun

scaph

cap

triq

Distradius

trapmtrapz ham


Prescribe plane parallel to distal radius. Scanfrom proximal metacarpals through distal

radial/ulnar metaphysis.

WristWrist--Coronal Imaging PlaneCoronal Imaging Plane

Relevant Anatomy Coronal Imaging Plane*Prescribe plane parallel to line drawn from

ulnar styloid through radial styloid. Scanthrough entire wrist.

* *

UlnarStyloid

RadialStyloid

WristWrist--Sagittal Imaging PlaneSagittal Imaging Plane

UlnarStyloid

RadialStyloid

Relevant AnatomySagittal Imaging Plane

*Prescribe plane perpendicular to coronal plane (©).Scan through entire wrist.

©

©

**

UlnarStyloid

RadialStyloid

Thumb Indications:Thumb Indications:

►►Routine ThumbRoutine ThumbIndications: Indications: ►►GamekeeperGamekeeper’’s thumb (s thumb (UlnarUlnar Collateral Ligament tear)Collateral Ligament tear)►►Flexor/Extensor Tendon TearFlexor/Extensor Tendon Tear►►R/O Occult FractureR/O Occult Fracture

ThumbThumb


1010 256 x 192256 x 192 3/0.33/0.3 400400--800800 minimalminimal 1616

CoronalCoronalT2 FSET2 FSENon Non FatSatFatSat

1010 256 x 256256 x 256 3/0.33/0.3 20002000--60006000

9090--110110 1616 1616

SagSagSTIRSTIR

1010 256 x 192256 x 192 3/0.33/0.3 150150 1616 1616


1010 256 x 192256 x 192 3/0.33/0.3 400400--800800 minimalminimal 1616


1010 256 x 256256 x 256 3/0.33/0.3 20002000--60006000

6060--7070 1616 1616


ThumbThumb--Axial Imaging PlaneAxial Imaging Plane


Prescribe plane perpendicular to midshaft ofproximal 1st phalanx. Scan from CMC joint

through thumb.

CMC

Joint

MCP

Joint

IPJoint

Metacarpal

Proximal Phalanx

ThumbThumb--Coronal Imaging PlaneCoronal Imaging Plane

Relevant Anatomy Coronal Imaging Plane*Prescribe plane with line bisecting

sesamoid bones. Scan through entire thumb.

Sesamoids

Thumb

*

ThumbThumb--Sagittal Imaging PlaneSagittal Imaging Plane

Sesamoids

Thumb

Relevant Anatomy Sagittal Imaging Plane*Prescribe plane perpendicular to coronal

imaging plane (©). Scan through entire thumb.

©

*

Finger Indications:Finger Indications:

►►Routine FingerRoutine FingerIndications:Indications:►►Pulley rupture/Flexor or Extensor Tendon InjuryPulley rupture/Flexor or Extensor Tendon Injury

►►Post Gadolinium FingerPost Gadolinium FingerIndications:Indications:►►MassMass►►**Perform routine finger plus Axial and either **Perform routine finger plus Axial and either

Coronal or Sagittal (whichever plane mass best seen) Coronal or Sagittal (whichever plane mass best seen) pre/post gadolinium FMPSPGR imagespre/post gadolinium FMPSPGR images

FingerFinger--RoutineRoutine

SagSagT1 SET1 SENon Non FatSatFatSat

256 x 192256 x 192 3/0.33/0.3 400400--800800 minimumminimum 1616


256 x256256 x256 3/0.33/0.3 20002000--60006000

6060--7070 1616 1616




256 x256256 x256 3/0.33/0.3 20002000--60006000

6060--7070 1616 1616


256 x256256 x256 3/0.33/0.3 >2000>2000 2020--4040 1616 1616


FingerFinger--MassMass



Axial Axial T2 FSET2 FSEFatSatFatSat

256 x 256256 x 256 3/0.33/0.3 20002000--60006000

6060--7070 1616 1616

Sag/Sag/CorCorT2 FSET2 FSEFatSatFatSat

256 x 256256 x 256 3/0.33/0.3 20002000--60006000

6060--7070 1616 1616

AxialAxialFMPSPGRFMPSPGRFatSatFatSatPre/PostPre/Post

256 x ??256 x ?? 200 ?200 ? 4 ?4 ? 1616

Sag/Sag/CorCorFMPSPGRFMPSPGRFatSatFatSatPre/PostPre/Post

256 x ??256 x ?? 200 ?200 ? 4 ?4 ? 1616


FingerFinger--Axial Imaging PlaneAxial Imaging Plane

DistalPhalanx

MidPhalanx

Metacarpal

Proximal Phalanx

Relevant Anatomy

Axial Imaging PlanePrescribe best fit line. Scan from

proximal metacarpal through entirefinger.

FingerFinger--Coronal Imaging PlaneCoronal Imaging Plane

Relevant Anatomy Coronal Imaging Plane*Prescribe plane parallel to anterior

metacarpal head. Scan through entirefinger.

*

Thumb

Extensor Tendon

FingerFinger--Sagittal Imaging PlaneSagittal Imaging Plane


*Prescribe plane perpendicular to coronal plane (©). Scan through entire

finger.

*

©

Thumb

Extensor Tendon

LOWER EXTREMITYLOWER EXTREMITY

Bony pelvisBony pelvis►► Indication: hip fracture, AVN, Mets, transient osteoporosis, Indication: hip fracture, AVN, Mets, transient osteoporosis,

bursitis, arthritis, tendonitis, hip pain over age 50bursitis, arthritis, tendonitis, hip pain over age 50►► If If metsmets/marrow, add in/out of phase coronal of full pelvis/marrow, add in/out of phase coronal of full pelvis►► PA Torso Coil is 1PA Torso Coil is 1stst choicechoice►► Sagittal may be skipped in ED hip fracture, elderly, multiSagittal may be skipped in ED hip fracture, elderly, multi--

traumatrauma

CoronalCoronalFSEFSE--STIRSTIR

3636--4040 256x192256x19222--33

4/14/1 >2000>2000 2020--4040 150150 88 1616


3636--4040 256 x 256256 x 25622

5/1.55/1.5 30003000 3030--4040 88 1616


3636--4040 256 x 256256 x 25611

4/14/1 400400--800800 MinimumMinimum 1616

SagSagT2 FSET2 FSEFatSatFatSat(Hip to Hip)(Hip to Hip)

1212--1616 256 x 256256 x 25611--22

5/15/1 >2000>2000 4040--5050 88 1616


Coronal (PELVIS) Coronal (PELVIS) T1 SET1 SENon Non FatSatFatSat

3636--4040 256 x 256256 x 25611

4/14/1 400400--800800 MinimumMinimum 1616

Coronal (PELVIS)Coronal (PELVIS)FSEFSE--STIRSTIR

3636--4040 256x192256x19222--33

4/14/1 >2000>2000 2020--4040 150150 88 1616

Axial (PELVIS)Axial (PELVIS)T2 FSET2 FSEFatSatFatSat

3636--4040 256 x 256256 x 25611--22

5/1.55/1.5 >2000>2000 4040--5050 88 1616

Ax oblique (HIP)Ax oblique (HIP)T1 T1 FatSatFatSat

1414--1616 384 x 256384 x 2561.51.5

4/.54/.5 400400--800800 MinimumMinimum 1616

Coronal (HIP)Coronal (HIP)T1 T1 FatSatFatSat

1414--1616 384 x 256384 x 2561.51.5

4/.54/.5 400400--800800 MinimumMinimum 1616

Sag (HIP)Sag (HIP)T1 T1 FatSatFatSat

1616 384 x 256384 x 2561.51.5

4/.54/.5 400400--800800 MinimumMinimum 1616


Direct arthrogram hipDirect arthrogram hip►► Indication: hip labrum tear, FAI or dysplasia, hip pain under Indication: hip labrum tear, FAI or dysplasia, hip pain under

age 50age 50►► PA Torso coil is 1PA Torso coil is 1stst choicechoice►► Prescribe Prescribe obliquesobliques along femoral neck from coronal localizeralong femoral neck from coronal localizer


3636--4040 256 x 256256 x 25611

4/14/1 400400--800800 MinimumMinimum 1616


3636--4040 256x192256x19222--33

4/14/1 >2000>2000 2020--4040 150150 88 1616


3636--4040 256 x 256256 x 25611--22

5/1.55/1.5 >2000>2000 4040--5050 88 1616

Ax oblique (HIP)Ax oblique (HIP)T1 T1 FatSatFatSat

1414--1616 384 x 256384 x 2561.51.5

4/.54/.5 400400--800800 MinimumMinimum 1616

Coronal (HIP)Coronal (HIP)T1 T1 FatSatFatSat

1414--1616 384 x 256384 x 2561.51.5

4/.54/.5 400400--800800 MinimumMinimum 1616

Sag (HIP)Sag (HIP)T1 T1 FatSatFatSat

1616 384 x 256384 x 2561.51.5

4/.54/.5 400400--800800 MinimumMinimum 1616


Indirect arthrogram hipIndirect arthrogram hip►► Indication: hip labrum tear, FAI or dysplasia, hip pain under Indication: hip labrum tear, FAI or dysplasia, hip pain under

age 50 when direct MR arthrography not availableage 50 when direct MR arthrography not available►► PA Torso coil is 1PA Torso coil is 1stst choicechoice►► Prescribe Prescribe obliquesobliques along femoral neck from coronal localizeralong femoral neck from coronal localizer


3636--4040 256 x 256256 x 25611

4/14/1 400400--800800 MinimumMinimum 1616


3636--4040 256x192256x19222--33

4/14/1 >2000>2000 2020--4040 150150 88 1616


3636--4040 256 x 256256 x 25611--22

5/1.55/1.5 >2000>2000 4040--5050 88 1616

Ax oblique (HIP)Ax oblique (HIP)PD FSE PD FSE FatSatFatSat

1414--1616 256 x 256256 x 25622

4/14/1 30003000 3030--4040 44 1616

Coronal (HIP)Coronal (HIP)T2 FSET2 FSEFatSatFatSat

1414--1616 256 x 256256 x 25622

4/14/1 >2000>2000 4040--5050 88 1616

Sag (HIP)Sag (HIP)T2 FSET2 FSEFatSatFatSat

1616 256 x 256256 x 25622

4/14/1 >2000>2000 4040--5050 88 1616


Noncontrast hipNoncontrast hip►► Indication: hip labrum tear, FAI or dysplasia when direct MR arIndication: hip labrum tear, FAI or dysplasia when direct MR arthrogram is not throgram is not

possible, hip pain under age 50possible, hip pain under age 50►► PA Torso coil is 1PA Torso coil is 1stst choicechoice►► Prescribe Prescribe obliquesobliques along femoral neck from coronal localizeralong femoral neck from coronal localizer

HipHip--Axial Imaging PlaneAxial Imaging Plane

Lesser Trochanter

GreaterTrochanter

IliumAcetabular

Roof


Prescribe plane parallel line bisecting lessertrochanters and/or acetabular roofs. Scanfrom iliac crests through lesser trochanter.

HipHip--Coronal Imaging PlaneCoronal Imaging Plane

Greater Trochanter

FemoralNeck

Superior Pubic Ramus

Relevant AnatomyCoronal Imaging Plane

*Prescribe plane parallel femoral heads. Scan from ischium through pubic

symphyses.

Ischium

*

FemoralHead

HipHip--Sagittal Imaging PlaneSagittal Imaging Plane

Greater Trochanter

FemoralNeck

Superior Pubic Ramus

Femoral Head

Ischium


*Prescribe plane perpendicular to coronal plane. Scan from acetabulum through greater

trochanter.

*

Axial Oblique Imaging PlaneAxial Oblique Imaging Plane(For (For FemoracetabularFemoracetabular Impingement Patients Only)Impingement Patients Only)

Axial Oblique PlanePrescribe plane parallel to femoralneck. Scan through entire femoral

neck.

Relevant Anatomy

FemoralNeck

FemoralHead


2828--3636(Both hips)(Both hips)

256x192256x19222--33

4/14/1 >2000>2000 2020--4040 150150 88 1616

CoronalCoronalT1 SET1 SE

2828(Both hips)(Both hips)

256x256256x25611--22

4/14/1 400400--800800 minimumminimum 1616

Axial T2 FSEAxial T2 FSEFat SatFat Sat

2828(Both hips)(Both hips)

256x256256x25622--33

5/15/1 >2000>2000 5050--6060 88 1616

Axial Axial OblObl PD FSEPD FSENonfatsatNonfatsat

2020 256x192256x19211--22

4/.54/.5 3000 3000 (max)(max)

2525--3030 44 1616

Axial Axial OblObl T2 FSE T2 FSE Fat SatFat Sat

2020 256x192256x19222--33

4/.54/.5 >2000>2000 5050--6060 88 1616

Sag T2 FSESag T2 FSEFat SatFat Sat

2020--2222 256x192256x19222--33

4/.54/.5 >2000>2000 5050--6060 88 1616

PD FSE (optional)PD FSE (optional)NonfatsatNonfatsat

2020--2222 256x256256x25622--33

4/.54/.5 >2000>2000 2020--3030 88 1616

Seq. FOV Matrix/NEX Slice TR TE TI ETL BW

TJUH Athletic Pubalgia MR ProtocolTJUH Athletic Pubalgia MR Protocol►► Indication: Athletic Pubalgia, Sports Hernia, SportsmanIndication: Athletic Pubalgia, Sports Hernia, Sportsman’’s Hernia, Adductor s Hernia, Adductor

tear/strain, Rectus Abdominis Injurytear/strain, Rectus Abdominis Injury►► PA Torso coil is 1PA Torso coil is 1stst choicechoice►► Prescribe Prescribe obliquesobliques along anterior iliac crest from sagittal localizeralong anterior iliac crest from sagittal localizer

Axial Oblique Imaging PlaneAxial Oblique Imaging Plane(Adductor unfolding plane)(Adductor unfolding plane)

Relevant Anatomy

Axial Oblique Imaging Plane*Prescribe plane to line paralleling anteriorIliac crest*. Be sure to scan across pubic

symphysis at midline

*

*

Iliac c

rest

Hip joint

Axial Oblique Imaging PlaneAxial Oblique Imaging Plane(Adductor unfolding plane)(Adductor unfolding plane)

Bony PelvisBony Pelvis(Special Cases)(Special Cases)

*Follow Hip Planes**Follow Hip Planes*

►► Post Gadolinium PelvisPost Gadolinium PelvisIndications:Indications:►►OsteomylitisOsteomylitis

IMPORTANT:IMPORTANT:►►Same as Routine Hip Protocol but perform axial and coronal Same as Routine Hip Protocol but perform axial and coronal

images on both sides. images on both sides. ►► In addition, perform FMPSPGR fat saturated images pre/post in In addition, perform FMPSPGR fat saturated images pre/post in

both axial and coronal planes.both axial and coronal planes.

►► In/Out of Phase PelvisIn/Out of Phase PelvisIndications:Indications:►►Possible Bony MetastasesPossible Bony Metastases

IMPORTANT:IMPORTANT:►►Perform In/Out of Phase images in Coronal PlanePerform In/Out of Phase images in Coronal Plane

Bony Pelvis Bony Pelvis OsteoOsteo –– pre/post optionpre/post option

CoronalCoronalT1T1Non Non FatSatFatSat

3030--4545 256 x 192256 x 192 4/14/1 400400--800800 minimalminimal 1616


3030--4545 256 x 192256 x 192 4/14/1 >2000>2000 2020--4040 88 1616

AxialAxialT1T1Non Non FatSatFatSat



3030--4545 256 x 256256 x 256 4/14/1 20002000--60006000

6060--7070 88 1616


2020 256 x 256256 x 256 4/14/1 20002000--60006000

50?50?(60(60--70)70)

88 1616

Axial/Axial/CorCorFMPSPGRFMPSPGRFatSatFatSatPre/PostPre/Post

1212 256 x 192256 x 192 3/.53/.5 5050 55 3030--4040 88 1616


Sacrum Sacrum –– Sacroiliac jointsSacroiliac joints


3030--4545 256 x 192256 x 192 4/14/1 >2000>2000 2020--4040 88 1616


3030--4545 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616

CorCor ObliqueObliqueT1 SET1 SENon Non FatSatFatSat

1818--2222 256 x 256256 x 256 3/.53/.5 400400--800800 minimalminimal

CorCor ObliqueObliqueT2 FSET2 FSEFatSatFatSat

1818--2222 256 x 256256 x 256 3/.53/.5 >1500>1500 7070--8080 88 1616


1818--2222 256 x 256256 x 256 3/.53/.5 >1500>1500 7070--8080 88 1616


1818--2222 256 x 256256 x 256 3/.53/.5 400400--800800 minimalminimal


Indications:Indications:Possible Sacroileitis (Septic/Rheumatoid or Rheumatoid Variant Possible Sacroileitis (Septic/Rheumatoid or Rheumatoid Variant Arthritis)Arthritis)

Sacrum Sacrum –– Sacroiliac jointsSacroiliac joints►► Prescribing the coronal oblique plane: parallel the sacrum Prescribing the coronal oblique plane: parallel the sacrum

on a sagittal localizeron a sagittal localizer

Routine ThighRoutine Thigh(Follow Hip Imaging Planes)(Follow Hip Imaging Planes)

►►Routine ThighRoutine ThighIndications:Indications:►►PolymyositisPolymyositis/Diabetic /Diabetic MyonecrosisMyonecrosis

ThighThigh--RoutineRoutine


4040 256 x 192256 x 192 4/14/1 400400--800800 minimalminimal 1616


4040 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616

SagSagSTIRSTIR

2626 256 x 192256 x 192 4/14/1 >2000>2000 2020--4040 150150 88 1616

Axial SEAxial SET1T1Non Non FatSatFatSat



2626 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616


Knee IndicationsKnee Indications

►► Routine KneeRoutine KneeIndications:Indications:►►Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCLMeniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL

►► Direct ArthrogramDirect ArthrogramIndications:Indications:►►Meniscal ReMeniscal Re--tear tear ►► Intra articular BodyIntra articular Body

►► Post Gadolinium KneePost Gadolinium KneeIndicationsIndications►►Meniscal ReMeniscal Re--teartear

IMPORTANT: Image 20 minutes post gadoliniumIMPORTANT: Image 20 minutes post gadolinium

KneeKnee--RoutineRoutine

SagSagPD FSEPD FSENonFatSatNonFatSat

1414--1616 512 x 256512 x 25622

4/0.54/0.5 30003000 1515--2020 88 1616


1414--1616 256 x 256256 x 25622

4/0.54/0.5 20002000 7070--8080 88 1616

CorCorT1 SET1 SENon Non FatSatFatSat

1616--1818 256 x 192256 x 19211

3/0.53/0.5 400400--800800 MinimalMinimal 1616

CoronalCoronalT2 FSET2 FSEFat SatFat Sat

1616--1818 256 x 256256 x 25622

3/0.53/0.5 >2000>2000 7070--8080 88 1616


1414--1616 256 x 256256 x 25622

3/0.53/0.5 >2000>2000 7070--8080 88 1616


MR Arthrogram Knee (dir or MR Arthrogram Knee (dir or indind))

SagSagT1 SeT1 SeFatSatFatSat

1414--1616 256 x 192256 x 192 4/14/1 400400--800800 MinimalMinimal 1616

SagSagPD FSEPD FSENonFatSatNonFatSat

1414--1616 512 x 256512 x 25622

4/0.54/0.5 30003000 1515--2020 88 1616


1414--1616 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616


1616--1818 256 x 256256 x 25622

4/14/1 >1500>1500 7070--8080 88 1616


1616--1818 256 x 192256 x 19211

4/14/1 400400--800800 MinimalMinimal 1616


1414--1616 256 x 192256 x 192 4/14/1 400400--800800 MinimalMinimal 1616


KneeKnee--Axial Imaging PlaneAxial Imaging Plane

PAT

Tibia

Femur

PatellarTendon Insertion

Relevant Anatomy Axial Imaging PlaneImage from distal quad tendon

through patellar tendon insertion

Distal Quadriceps tendon

KneeKnee--Coronal ImagingCoronal Imaging

Relevant Anatomy

MedFemCondyle

LatFemCondyle

Patella

Coronal Imaging PlanePrescribe plane with line parallel to

femoral condyles. Image entire knee.

KneeKnee--Sagittal Imaging PlaneSagittal Imaging Plane

MedFemCondyle

LatFemCondyle

Patella


*Prescribe plane perpendicular to coronal plane (©).Scan from the medial to the lateral femoral condyle.

©©

*

*

Lower Extremity/ShinLower Extremity/Shin

►►Indication:Indication:Shin SplintsShin Splints

►►IMPORTANT:IMPORTANT:Acquire coronal and axial (STIR) sequences Acquire coronal and axial (STIR) sequences covering both shins, but sagittal and axial (t2 covering both shins, but sagittal and axial (t2 FatSatFatSat only of side in questiononly of side in questionPlace a marker on pain / tendernessPlace a marker on pain / tenderness

Lower Extremity/Shin AreaLower Extremity/Shin Area




3535--4040 256 x 192256 x 192 4/14/1 >2000>2000 2020--4040 150150 88 1616

AxialAxialSTIRSTIR

3535--4040 256 x 192256 x 192 4/14/1 >2000>2000 2020--4040 150150 88 1616

AxialAxialT2 FSET2 FSEFatSatFatSat(through (through marker marker region)region)

1414--1616 256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616


256 x 256256 x 256 4/14/1 >1500>1500 7070--8080 88 1616


Ankle IndicationsAnkle Indications

►►Routine AnkleRoutine AnkleLigament Sprain/Tendon pathology/Tarsal Ligament Sprain/Tendon pathology/Tarsal Tunnel/Sinus Tarsi/Occult fracture, PTT, Plantar Tunnel/Sinus Tarsi/Occult fracture, PTT, Plantar fasciitisfasciitis

►►Ankle ArthrogramAnkle ArthrogramIndications:Indications:►►IntraIntra--articular Bodyarticular Body

►►Post Gadolinium AnklePost Gadolinium Ankle

AnkleAnkle--RoutineRoutine

Sag Sag T1 SET1 SENon Non FatSatFatSat

1616--1818 256 x 256256 x 25611

3/13/1 400400--800800 MinimalMinimal 1616

SagSagSTIRSTIR

1616--1818 256 x 192256 x 19233

3/13/1 >1500>1500 4040 120120 9090 88 1616


1414--1616 384 x 256384 x 25622

4/14/1 30003000 4040 88 1616


1414--1616 256 x 256256 x 25622

4/14/1 >2000>2000 7070--8080 88 1616


1414 256 x 256256 x 25633

3/13/1 >2000>2000 4040--5555 88 1616


MR Arthrogram Ankle (dir or MR Arthrogram Ankle (dir or indind))



SagSagSTIRSTIR

1818 256 x 192256 x 192 4/14/1 >2000>2000 2020--4040 150150 88 1616

Axial Axial T1 SET1 SEFatSatFatSat

1414 256 x 256256 x 256 4/14/1 800800 minmin 1616


1414--1616 513 x 256513 x 25622

4/14/1 30003000 4040 88 1616




1414 256 x 256256 x 256 4/14/1 >1500>1500 7070--80 80 88 1616


AnkleAnkle--Post GadoliniumPost Gadolinium


1414 256 x XX256 x XX 200 ?200 ? 4 ?4 ? 1616

Sag Sag T1 SET1 SENon Non FatSatFatSat



1212 256 x 256256 x 256 4/14/1 ?800?800 MinimalMinimal 1616

AxialAxialPD FSEPD FSEFatSatFatSat

1414 256 x 256256 x 256 4/14/1 >2000>2000 4040--5050 44 1616

CorCorT1 SET1 SEFatSatFatSat



AnkleAnkle--Axial Imaging PlaneAxial Imaging Plane

Tibia

Talus

Calcaneus


Prescribe plane parallel to axis of calcaneus.Scan ankle from distal tibia through subcutaneous

soft tissues (include plantar fascia).

Black band is plantar fascia

AnkleAnkle--Coronal Imaging PlaneCoronal Imaging Plane

Coronal Imaging PlanePrescribe plane perpendicular

to axial imaging plane. Scan ankle from calcaneus through metatarsal bases.

Calcaneus

Talus

Cuboid

METATARSALS

Relevant Anatomy

AnkleAnkle--Sagittal Imaging PlaneSagittal Imaging Plane

Talus

LatMal

Med

Mal

Ach

Sagittal Imaging PlanePrescribe plane with line parallel

to talus. Cover ankle from medial through lateralmalleolus.

Relevant Anatomy

FootFoot--IndicationsIndications

►► Routine FootRoutine FootIndicationsIndications►►Plantar Plate Injury, R/O fracture, Plantar Plate Injury, R/O fracture, LisfrancLisfranc injury, injury,

tarsal/metatarsal fracturetarsal/metatarsal fracture

►► Post Gadolinium FootPost Gadolinium FootIndications:Indications:►►MortonMorton’’s s NeuromaNeuroma►►OsteomylitisOsteomylitis

IMPORTANT: Perform routine foot plus coronal IMPORTANT: Perform routine foot plus coronal FMPSPGR fat saturated pre and post gad images and FMPSPGR fat saturated pre and post gad images and axial POST gad FMPSPGR fat saturated images.axial POST gad FMPSPGR fat saturated images.

FootFoot--RoutineRoutine

Coronal Coronal (short axis)(short axis)T1T1Non Non FatSatFatSat

1010 256 x 256256 x 25611

3/0.53/0.5 400400--800800 minimalminimal 1616

Coronal Coronal (short axis)(short axis)T2 FSET2 FSEFatSatFatSat

1010 256 x 256256 x 25622

3/0.53/0.5 >2000>2000 7070--8080 88 1616

SagSagSTIRSTIR

1212--1414 256 x 192256 x 19233

3/0.53/0.5 >1500>1500 4040 120120 9090 88 1616

SagSagT1T1Non Non FatSatFatSat

1212--1414 256 x 256256 x 25611

3/0.53/0.5 400400--800800 minimalminimal 1616

AxialAxial(long axis)(long axis)PD FSEPD FSENon Non FatSatFatSat

1212--1414 256 x 256256 x 25622

3/0.53/0.5 >2000>2000 3030 88 1616

AxialAxial(long axis)(long axis)T2 FSET2 FSEFatSatFatSat

1212--1414 256 x 256256 x 25622

3/0.53/0.5 >2000>2000 9090 88 1616


FootFoot--Mass/OsteomyelitisMass/Osteomyelitis


1010--12 12 256 x 256256 x 25611

3/0.53/0.5 400400--800800 minimalminimal 1616


1010--1212 256 x 192256 x 19222

3/0.53/0.5 >2000>2000 7070--8080 88 1616

SagSagSTIRSTIR

1212--1414 256 x 192256 x 19222

3/0.53/0.5 >1500>1500 4040 120120 9090 88 1616

SagSagT1T1Non Non FatSatFatSat

1212--1414 256 x 256256 x 25611

3/0.53/0.5 400400--800800 minimalminimal 1616

CoronalCoronalFMPSPGRFMPSPGRFatSatFatSatPre/PostPre/Post

1010--1212 256 x 192256 x 19222

3/.53/.5 6060 55 3030--4040 88 1616

AxialAxialFMPSPGRFMPSPGRFatSatFatSatPostPost

1010--1212 256 x 192256 x 19222

3/.53/.5 6060 55 3030--4040 88 1616


FootFoot--Axial Imaging PlaneAxial Imaging Plane

Relevant Anatomy Axial Imaging PlanePrescribe plane parallel to 2rd or 3rd

metatarsal. Scan foot from navicular throughphalanges.

2nd meta

tarsal

NAV

Phalanges

CUN

FootFoot--Coronal Imaging PlaneCoronal Imaging Plane

Relevant Anatomy

Metatarsals

12

3

4

5

Coronal Plane*Prescribe plane parallel to 1st and 5th metatarsal

Shafts. Scan through entire foot.

*

FootFoot--Sagittal Imaging PlaneSagittal Imaging Plane

**

Metatarsals

12

3

4

5

Sagittal Plane*Prescribe plane perpendicular to coronal

Plane (©). Scan through entire foot.

Relevant Anatomy

©

©

*

Soft Tissue Mass ProtocolSoft Tissue Mass Protocol

►►Place Vitamin E tablet on skinPlace Vitamin E tablet on skin►►Perform routine imaging of the body part Perform routine imaging of the body part

imaged PLUS Pre and Post FMPSPGR fat imaged PLUS Pre and Post FMPSPGR fat saturated images in the axial plane and also saturated images in the axial plane and also in the sagittal OR coronal plane (whichever in the sagittal OR coronal plane (whichever plane mass best seen).plane mass best seen).

Soft Tissue MassSoft Tissue Mass


256 x 192256 x 192 5/15/1 400400--800800 minimalminimal 1616


256 x 256256 x 256 5/15/1 >1500>1500 7070--8080 88 1616

Sag/Sag/CorCorSTIRSTIR

256 x 192256 x 192 5/15/1 >2000>2000 3030--4040 150150 88 1616


256 x xx256 x xx 6060 55 3030--4040 88 1616

Sag/Sag/CorCorFMPSPGRFMPSPGRFatSatFatSatPre/PostPre/Post

256 x xx256 x xx 6060 55 3030--4040 88 1616


Metal Protocol Metal Protocol –– general general recommendationsrecommendations

►►Assess severity of artifact on scout Assess severity of artifact on scout –– discuss discuss with MSK radiologistwith MSK radiologist

►►Maximize BW (bandwidth)Maximize BW (bandwidth)►►Lower TE (T2 and STIR)Lower TE (T2 and STIR)►►Remove fat suppression (call MSK Remove fat suppression (call MSK radrad first)first)►►Avoid GREAvoid GRE►►Use STIR instead of T2w fat satUse STIR instead of T2w fat sat

mri protocol

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