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RICHLAND MSK MRI PROTOCOLS PITTS RADIOLOGY

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Pitts Radiology Richland MSK MRI Protocols

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Page 1: Richland MSK MRI Protocols

RICHLAND MSK MRI PROTOCOLS

PITTS RADIOLOGY

Page 2: Richland MSK MRI Protocols

UPPER EXTREMITY

STERNOCLAVICULAR JOINTSHOULDERPEC MAJORELBOWWRISTTHUMBHAND/SYNOVITISFINGERBRACHIAL PLEXUS

Page 3: Richland MSK MRI Protocols

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)

Page 4: Richland MSK MRI Protocols

ROUTINE SC JOINT

Page 5: Richland MSK MRI Protocols

SC JOINT AXIAL IMAGING PLANE

Page 6: Richland MSK MRI Protocols

SC JOINT-SAGITTAL IMAGING PLANE

Page 7: Richland MSK MRI Protocols

SC JOINT-CORONAL IMAGING PLANE

Page 8: Richland MSK MRI Protocols

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

Page 9: Richland MSK MRI Protocols

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

Page 10: Richland MSK MRI Protocols

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

Page 11: Richland MSK MRI Protocols

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

Page 12: Richland MSK MRI Protocols

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

Page 13: Richland MSK MRI Protocols

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

Page 14: Richland MSK MRI Protocols

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

Page 15: Richland MSK MRI Protocols

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

Page 16: Richland MSK MRI Protocols

SHOULDER POINTER AXIAL PLANE

Page 17: Richland MSK MRI Protocols

SHOULDER AXIAL IMAGING PLANE

Page 18: Richland MSK MRI Protocols

SHOULDER CORONAL PLANE

Page 19: Richland MSK MRI Protocols

SHOULDER SAGITTAL PLANE

Page 20: Richland MSK MRI Protocols

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)

Page 21: Richland MSK MRI Protocols

MR PEC MAJOR

Page 22: Richland MSK MRI Protocols

PEC MAJOR AXIAL PLANE

Page 23: Richland MSK MRI Protocols

PEC MAJOR CORONAL PLANE

Page 24: Richland MSK MRI Protocols

PEC MAJOR SAGITTAL PLANE

Page 25: Richland MSK MRI Protocols

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

Page 26: Richland MSK MRI Protocols

MR ELBOW

SAGITTAL SEQUENCES MUST GO THROUGH ENTIRE COMMON FLEXOR AND EXTENSOR TENDON ORIGINS. MAKE SURE THEY ARE COMPLETELY INCLUDED.

Page 27: Richland MSK MRI Protocols

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

Page 28: Richland MSK MRI Protocols

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

Page 29: Richland MSK MRI Protocols

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

Page 30: Richland MSK MRI Protocols

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)

Page 31: Richland MSK MRI Protocols

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

Page 32: Richland MSK MRI Protocols

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

Page 33: Richland MSK MRI Protocols

ELBOW AXIAL PLANE

Page 34: Richland MSK MRI Protocols

ELBOW CORONAL PLANE

Page 35: Richland MSK MRI Protocols

ELBOW SAGITTAL PLANE

Page 36: Richland MSK MRI Protocols

MR WRIST

TIP: DO STIR IF POOR FAT SAT

TIP: FOV 6-8

TIP: FILM WITH PALM FACING UP

Page 37: Richland MSK MRI Protocols

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

Page 38: Richland MSK MRI Protocols

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

Page 39: Richland MSK MRI Protocols

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

Page 40: Richland MSK MRI Protocols

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

Page 41: Richland MSK MRI Protocols

MR WRIST AXIAL PLANE

Page 42: Richland MSK MRI Protocols

MR WRIST CORONAL PLANE

Page 43: Richland MSK MRI Protocols

MR WRIST SAGITTAL PLANE

Page 44: Richland MSK MRI Protocols

MR THUMB

TIP: CORRECT IMAGING PLANES CRUCIAL (SEE SETUP SECTION)

TIP: SHOULD BE TRIAGED TO PARKRIDGE IF POSSIBLE

Page 45: Richland MSK MRI Protocols

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

Page 46: Richland MSK MRI Protocols

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

Page 47: Richland MSK MRI Protocols

MR THUMB AXIAL PLANE

Page 48: Richland MSK MRI Protocols

MR THUMB CORONAL PLANE

Page 49: Richland MSK MRI Protocols

MR THUMB SAGITTAL PLANE

Page 50: Richland MSK MRI Protocols

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.

Page 51: Richland MSK MRI Protocols

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)

Page 52: Richland MSK MRI Protocols

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

Page 53: Richland MSK MRI Protocols

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

Page 54: Richland MSK MRI Protocols

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

Page 55: Richland MSK MRI Protocols

MR FINGER AXIAL PLANE

Page 56: Richland MSK MRI Protocols

MR FINGER CORONAL PLANE

Page 57: Richland MSK MRI Protocols

MR FINGER SAGITTAL PLANE

Page 58: Richland MSK MRI Protocols

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

Page 59: Richland MSK MRI Protocols

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)

Page 60: Richland MSK MRI Protocols

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

Page 61: Richland MSK MRI Protocols

LOWER EXTREMITY

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

Page 62: Richland MSK MRI Protocols

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

Page 63: Richland MSK MRI Protocols

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)

Page 64: Richland MSK MRI Protocols

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

Page 65: Richland MSK MRI Protocols

MR OSSEOUS PELVIS AXIAL PLANE

Page 66: Richland MSK MRI Protocols

MR OSSEOUS PELVIS CORONAL PLANE

Page 67: Richland MSK MRI Protocols

MR OSSEOUS PELVIS SAG PLANE

Page 68: Richland MSK MRI Protocols

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)

Page 69: Richland MSK MRI Protocols

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

Page 70: Richland MSK MRI Protocols

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.

Page 71: Richland MSK MRI Protocols

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)

Page 72: Richland MSK MRI Protocols

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

Page 73: Richland MSK MRI Protocols

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

Page 74: Richland MSK MRI Protocols

MR HIP ARTHROGRAM CORONAL PLANE

Page 75: Richland MSK MRI Protocols

MR HIP ARTHROGRAM SAGITTAL PLANE

Page 76: Richland MSK MRI Protocols

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!

Page 77: Richland MSK MRI Protocols

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

Page 78: Richland MSK MRI Protocols

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

Page 79: Richland MSK MRI Protocols

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

BELOW FOR EXAMPLE

Page 80: Richland MSK MRI Protocols

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

Page 81: Richland MSK MRI Protocols

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 .

Page 82: Richland MSK MRI Protocols

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

Page 83: Richland MSK MRI Protocols

SAGITTAL EXAMPLE IMAGE.

Pfirrmann C W A et al. Radiology 2005;235:969-976

©2005 by Radiological Society of North America

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CORONAL EXAMPLE IMAGE

Pfirrmann C W A et al. Radiology 2005;235:969-976

©2005 by Radiological Society of North America

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AXIAL EXAMPLE IMAGES

Pfirrmann C W A et al. Radiology 2005;235:969-976

©2005 by Radiological Society of North America

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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.

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MR THIGH

1 AXIAL SE T1 (NON FAT SAT)

2 AXIAL STIR

3 CORONAL SE T1 (NON FAT SAT)

4 CORONAL STIR

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MR THIGH

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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

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MR ATHLETIC PUBALGIA/SPORTS HERNIA

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MR ATHLETIC PUBALGIA/SPORTS HERNIA AXIAL PLANE

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MR ATHLETIC PUBALGIA/SPORTS HERNIA CORONAL PLANE

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MR ATHLETIC PUBALGIA/SPORTS HERNIA SAG PLANE

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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

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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

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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)

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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

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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*

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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

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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*

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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 *

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MR KNEE AXIAL PLANE

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MR KNEE CORONAL PLANE

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MR KNEE SAG PLANE

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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.

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MR ANKLE

ALL PEDS SPORTS RELATED INJURY CASES ADD CORONAL 3D MEDIC (BLACK BONE) SEQUENCE TO EVALUATE PHYSIS

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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

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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

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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

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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

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MR ANKLE AXIAL PLANE

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MR ANKLE CORONAL PLANE

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MR ANKLE SAG PLANE

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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.

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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

Page 116: Richland MSK MRI Protocols

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

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MR FOREFOOT SHORT AXIS

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MR FOREFOOT LONG AXIS

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MR FOREFOOT SAG PLANE

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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.

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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

Page 122: Richland MSK MRI Protocols

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

Page 123: Richland MSK MRI Protocols

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)

Page 124: Richland MSK MRI Protocols

MR STRESS (TIBIA) CORONAL PLANE

Page 125: Richland MSK MRI Protocols

MR STRESS (TIBIA) AXIAL PLANE

Page 126: Richland MSK MRI Protocols

MR STRESS (TIBIA) SAGITTAL PLANE

Page 127: Richland MSK MRI Protocols

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.

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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

Page 129: Richland MSK MRI Protocols

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.