body mri protocols - geiselmed.dartmouth.edu liver renal mass cervical ca staging defecography ......

1

BODY MRI PROTOCOLS

Updated

03/02/2018

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

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

Basic (limited) Pelvis Adrenal Female Pelvis Mullerian Appendicitis Pregnant

Dynamic Liver Renal Mass Cervical CA Staging Defecography

Eovist Liver Urogram Endometrial Cancer Rectal Cancer

Liver for Hemotomocrosis Enterography Urethral

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

Mesenteric MRA Chest - general

2

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

Axial In/Out Phase Pelvis

Axial T2 FS Pelvis

Axial 3D VIBE FS Pre Pelvis

Axial In/Out Phase Abdomen

Axial T2 Abdomen

Coronal T2 Abdomen/Pelvis

Axial 3D VIBE FS Pre Abdomen

Axial 3D VIBE FS Post Abdomen (arterial)

Axial 3D VIBE FS Post Abdomen (venous)

Axial 3D VIBE FS Post Pelvis

Coronal 3D VIBE FS Abdomen/Pelvis

Sequence TR TE FOV

SLICE GAP MATRIX PHASE

DIR NEX

SCAN DIR

OTHER FREQ PHASE PHASE FREQ

AX IN/OUT PHASE PEL 170 1.2 and 2.4

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

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

AX IN/OUT PHASE ABD 170 1.2 and 2.4

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

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

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

3

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

Coronal T2

Axial T2 RESP TRIGGERED or T2 Breath held

Axial T2 FS

Axial In/Out Phase

Axial 3D VIBE FS Pre

Coronal 3D VIBE FS Pre

Axial 3D VIBE FS Post Arterial

Coronal 3D VIBE FS Post Delayed

Sequence TR TE FOV


DIR NEX

SCAN DIR


COR T2 1400 91 440 100% 5 1 320 320 R/L 1 P->A AX T2 RESP TRIG/BH 380 80% A/P S->I AX T2 FS 1600 95 380 80% 5 1 194 320 A/P 1 S->I

AX IN/OUT PHASE 170 1.2 and 2.4

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

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

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

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

4

Basic Pelvis (Abscess, non-specific clinical history)

Axial T2 FS

Axial In/Out Phase

Axial 3D VIBE FS Pre

Axial 3D VIBE FS Post

Coronal 3D VIBE FS Post

Sequence TR TE FOV


DIR NEX

SCAN DIR


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

AX IN/OUT PHASE 170 1.2 and 2.4

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

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

5

Dynamic Liver (HCC, Cholangiocarcinoma, lesion characterization)

COR T2

AXIAL T2 BH

AXIAL T2 FS BH

AXIAL IN/OUT PHASE

AXIAL 3D VIBE FS PRE

AXIAL 3D VIBE FS POST

(30 SEC/1 MIN/3 MIN)

*with subtractions

CORONAL 3D VIBE FS POST

(5 MIN)

AXIAL DIFFUSION (b value 50 and 750)

Need ADC maps

Sequence TR TE FOV Slice

Thickness (mm)

Gap (mm)

Matrix Phase Direction

NEX Scan

Direction OTHER

Frequency Phase %

Phase Frequency

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

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

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

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

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

AXIAL VIBE FS PRE

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

AXIAL VIBE FS POST

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

COR VIBE FS POST

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

AXIAL DIFFUSION

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

50/400/750

6

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

CORONAL T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AXIAL 3D VIBE FS


(2 phase arterial/1 MIN/3 MIN)

CORONAL 3D VIBE FS POST (4 MIN)

AXIAL 3D VIBE FS POST (5 MIN)

AXIAL 3D VIBE FS POST (20 MIN)

CORONAL 3D VIBE FS POST (20 MIN)

*with subtractions

Sequence TR TE FOV: Slice

Thickness (mm)

Gap (mm)

Matrix: Phase Direction

NEX Scan

Direction OTHER

Frequency Phase

% Phase Frequency

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

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

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

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

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

AXIAL VIBE FS PRE

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

AXIAL VIBE FS POST

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

COR VIBE FS POST

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

7

Liver for Hemochromatosis

**Must be done on 1.5T Scanner**

Axial GRE 90 degree flip TE 4.0





Sequence TR TE FOV


DIR NEX

SCAN DIR



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


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


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


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


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

8

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

COR T2

AXIAL T2

AXIAL IN/OUT PHASE

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

COR 3D VOLUME RESPIRATORY TRIGGERED MRCP*

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

2. THIN AX MIP CREATED FROM THIS 1.6/0.8

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

IF SECRETIN EXAM:

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

PEDIATRIC: 0.2µg/kg (MAX DOSE 16 µg)

*ADMINISTERED BY ANGIO RN – IV PUSH

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

THICK SLAB ANGLES

9

MRCP cont.


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

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

COR THICK SLAB

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

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

COR OBLIQ SLAB

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

COR OBLIQ SLAB

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

COR 3D RESP TRIGGERED

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

COR 3D BREATH HOLD

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

COR THK SLAB POST SECRETIN

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

10

Pancreas Patient Prep: NPO for 4 hours

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

CORONAL T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AXIAL 3D VIBE FS PRE


(35 SEC/70 SEC/3 MIN)

Slice thickness 3mm


(3 MIN)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

AXIAL T2 FS 1600 95 380 75 3 1 194 320 A/P 1 S->I

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

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

AXIAL VIBE FS PRE

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

AXIAL VIBE FS POST

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

COR VIBE FS POST

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

11

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

CORONAL T2: diaphragm to aortic bifurcation

AXIAL IN/OUT PHASE Adrenals

CORONAL IN/OUT PHASE Adrenals

AXIAL T2 FS: diaphragm to aortic bifurcation

AXIAL 3D VIBE FS PRE: diaphragm to aortic bifurcation

AXIAL 3D VIBE FS POST: diaphragm to aortic bifurcation

(35 SEC/70 SEC)


(3 MIN)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

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

COR IN/OUT PHASE 170

1.2/2.4 (3T)

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

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

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

AXIAL VIBE FS POST

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

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

12

Renal Mass FOV limited to kidneys CORONAL T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AXIAL 3D VIBE PRE

SAGITTAL 3D VIBE FS PRE of each kidney

CORONAL 3D VIBE FS PRE


(25 SEC/90 SEC)

SAGITTAL 3D VIBE FS POST of each kidney


**If patient cannot receive gadolinium**

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


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

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

AXIAL IN/OUT

PHASE 170

1.2/2.4 (3T) 2.2/4.4(1.5T)

380 75 5 1 256 256 A/P 1 S->I

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

SAG VIBE FS (each kidney)

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

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

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

SAG VIBE FS POST (each kidney)

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

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

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

50/400/750

13

Urogram Patient Prep: Arrive 1 hour prior to get IVF

Empty bladder prior to getting on table

Adult: 500mL NS bolus immediately before scan

Pediatric: weight based IVF:

4mL/kg/hr 1st 10kg

2mL/kg/hr next 10kg

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

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

*Lasix dose: 20-40mg slow IV push

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

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

CORONAL T2 Abdomen/Pelvis

CORONAL T2 FS Abdomen/Pelvis

AXIAL T1 FS Abdomen/Pelvis

AXIAL T2 Abdomen/Pelvis

AXIAL T2 FS Abdomen/Pelvis

**Inject Lasix**

CORONAL T2 Thick Slabs

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

- Need 3D reconstructions

CORONAL 3D VIBE FS PRE


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

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

- Automatic MIP images of each volume acquired

**Have Rad Check**

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

(10 MIN)

SAGITTAL 3D VIBE FS POST: of each kidney

(10 MIN)

14

Urogram cont.


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

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

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

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

COR T2 THK Slabs

4500 564 420

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

COR T2 Thin RESP TRIG

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

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

COR VIBE FS POST

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

SAG VIBE FS POST

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

15

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

Glucagon – 1 mg IM after THK slabs and CISS

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

Sequence TR TE FOV


DIR NEX

SCAN DIR


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

Coronal T2 CISS 186 1.15 430 100 5.5 0 169 224 R->L 1 P->A Coronal T2 1600 91 440 100 5 1 320 320 R/L 1 P->A AX T2 1600 95 380 75 5 1 194 320 A/P 1 S->I

AX T2 FS 1600 95 380 75 5 1 194 320 A/P 1 S->I AX VIBE FS PRE 4.3 1.8 380 80 3 0.6 190 320 A/P 1 S->I COR VIBE FS PRE 4 1.7 440 100 3 0.6 240 320 R/L 1 P->A COR VIBE FS POST (35 and 70 sec)

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

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

16

RENAL MRA CORONAL T2

– to determine anatomy and location of kidneys AXIAL T2 FS BH AXIAL T2 CISS TRIGGER BH (gated multiphase) CORONAL T2 CISS TRIGGER BH AXIAL 3D VIBE FS PRE CORONAL Angio3D PRE CORONAL Angio3D post (2 phases)

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

AXIAL 3D VIBE FS POST CORONAL 3D VIBE FS 5 MIN Post 3D PC (IF GAD NOT GIVEN)


Thickness

(mm)

Gap

(mm)

Matrix: Phase

Direction NEX

Scan

Direction OTHER

Frequency Phase % Phase Frequency

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

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

AX T2 CISS TRIGGER

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

COR T2 CISS TRIGGER BH

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

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

COR Angio3D

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

COR VIBE FS 5 MIN

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

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

17

MESENTERIC MRA

CORONAL T2 AXIAL T2 FS BH AXIAL 3D VIBE FS PRE SAGITTAL Angio3D PRE CARE BOLUS SAGITTAL Angio3D post (2 phases)

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

AXIAL 3D VIBE FS POST CORONAL 3D VIBE FS 5 MIN Post

Sequence TR TE

FOV: Slice

Thickness

(mm)

Gap

(mm)

Matrix: Phase

Direction NEX

Scan

Direction OTHER


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

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

AX VIBE

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

COR Angio3D

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

COR VIBE 5 MIN

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

18

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

AXIAL DIR (PERIPHERAL GATED) AXIAL T2 CISS (PERIPHERAL GATED) SAGITTAL OBL CINE GRE (PERIPHERAL GATED) AXIAL VIBE PRE Sagittal Oblique Angio3D PRE CARE BOLUS Sagittal Oblique (Candy Cane) Angio3D post

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

AXIAL 3D VIBE FS POST Angle for SAG OBL

Sequence TR TE

FOV: Slice

Thickness

(mm)

Gap

(mm)

Matrix: Phase

Direction NEX

Scan

Direction OTHER

Frequency Phase

% Phase Frequency

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

AX T2 CISS 3.58 1.57 380 81.3 5 0 320 208 A/P 1 L->R

AX VIBE FS

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

SAG OBL

Angio3D

pre/post

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

19

Anal Fistula Should be performed on 3T

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

*Use to establish oblique planes –

Axial and coronal to long axis of anal canal

MD to check planes if unsure

Small FOV (26cm):

Axial Oblique T1 (4mm/0.8)

Axial Oblique T2 FS (4mm/0.8)

Axial Oblique T2 (4mm/0.8)

Coronal Oblique T2 FS (4mm/0.8)

Coronal Oblique T2 (4mm/0.8)

Axial Oblique VIBE FS Pre

Axial Oblique VIBE FS Post

Coronal Oblique VIBE FS Post


Thickness (mm)

Gap (mm)


NEX Scan

Direction OTHER


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

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

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

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

COR OBL T2 FS 3000 86

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

COR OBL T2 3000 86

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

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

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

COR VIBE FS POST

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

20

MRV Pelvis DVT

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

Sequence TR TE

FOV: Slice

Thickness

(mm)

Gap

(mm)

Matrix: Phase

Direction NEX

Scan

Direction OTHER

Frequency Phase

% Phase Frequency

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

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

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

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

21

Routine Female Pelvis Adenomyosis, fibroids, adnexa

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

Coronal T2 Abdomen/Pelvis

Axial T1 whole pelvis

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

Axial T2

Axial T2 FS

Sagittal T2 (uterine evaluation)

Sagittal T2 FS

*OPTIONAL WITH CONTRAST

Axial VIBE FS Pre

Axial VIBE FS Post

Coronal VIBE FS Post

Sagittal VIBE FS Post


Thickness

(mm)

Gap (mm)

Matrix Phase Direction

NEX Scan

Direction OTHER


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

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

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

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

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

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

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

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

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

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

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

AXIALS

CORONALS

22

Female Pelvis Mullerian Planes in relation to the uterus

Axial T2 FS Full FOV

Axial T1 Full FOV

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

Small FOV in relation to the uterus:

Sagittal T2 (4mm slice)

Axial T2 (4mm slice)

Coronal T2 (4mm slice)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

AX T2 FS 3450 96 300 100 5 1 320 310 A->P 2 S->I Whole Pelvis AX T1 455 20 300 100 5 1 320 256 R=>L 1 S->I

COR T2 1400 91 440 100 5 1 320 320 R->L 1 A->P Full FOV

SAG T2 4960 91

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

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

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

AXIALS

CORONALS

23

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

Axial T1 Abdomen/Pelvis

Axial T2 FS Full FOV Pelvis

SAG T2 small FOV pelvis

Axial Oblique (SAX) T2 small FOV Cervix

SAX to the cervix


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

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

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

24

Endometrial Cancer

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

Large FOV:

Ax T1 upper abdomen and pelvis

Ax T2 FS Pelvis full FOV

Small FOV:

Sag T2 Small FOV

Axial OBL (SAX of the uterus) T2

Axial OBL (SAX) VIBE PRE

Sag VIBE FS PRE

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

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

SAX to the uterus


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

AX T2 FS 3450 96 300 100 5 1 310 320 A/P 2 S->I Full Pelvis SAG T2 500 96 220 100 5 1 256 320 A/P 3 L->R AX OBL (SAX) T2 4900 96 200 100 5 1 272 320 R/L 2 S->I AX OBL (SAX) VIBE FS PRE

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

SAG VIBE FS PRE 4.51 2.19 240 81 3 0.6 190 320 A/P 1 L->R 61 slabs SAG VIBE FS POST 4.51 2.19 240 81 3 0.6 190 320 A/P 1 L->R 61 slabs AX OBL (SAX) VIBE FS PRE

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

25

Female Pelvis - Urethral COR T2 (wide FOV to include kidneys)

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

AXIAL T2 FS

SAG T2 FS

COR T2 FS

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

AX VIBE FS PRE

AX VIBE FS POST

SAG VIBE FSPOST

COR VIBE FS POST


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

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

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

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

AXIAL VIBE FS POST

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

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

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

26

Prostate Cancer Staging For staging or XRT planning

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

Axial T1 whole pelvis

Small FOV:

Axial T1

Axial T2 (3mm slice)

Sagittal T2 (3mm slice)

Coronal T2 (3mm slice)

Axial 3D T2


Thickness (mm)

Gap (mm)


NEX Scan

Direction OTHER

Frequency Phase

% Phase Frequency

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

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

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

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

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

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

27

Dynamic Prostate (Multiparametric) Elevated PSA, negative biopsy

Must be done on 3T/phased array body coil

Cover entire prostate and seminal vessicles

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

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

Sagittal T2 small FOV FSE 3mm/1mm

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

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

Need ADC maps.

Post gadolinium:

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


Thickness (mm)

Gap (mm)


NEX Scan

Direction OTHER

Frequency Phase

% Phase Frequency

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

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

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

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

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

Dynamic Ax Post

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

28

APPENDICITIS PREGNANT (R/O APPENDICITIS)

CORONAL T2 SSFSE

AXIAL T2 SSFSE

SAGITTAL T2 SSFSE

CORONAL T2 FS BH

AXIAL T2 FS BH

CORONAL CISS

AXIAL CISS (Optional if questioning a kidney stone)


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

COR T2 SSFSE 1600 132 440 100 3 0.3 320 320 R/L 1 P->A

AX T2 SSFSE 1600 132 380

75

3 0.3 320 194 A/P 1 S->I

SAG T2 SSFSE 1600 132 440

100

6 1 320 194 A/P 1 L->R

COR T2 FS BH 1600 132 380 194 3 0.3 320 320 R/L 1 P->A

AX T2 FS 1600 135 380 75 3 0.3 320 194 A/P 1 S->I

COR CISS 191 1.18 400 100 8 2 224 169 R/L 1 P->A

AX CISS 191 1.18 400 100 8 2 224 169 A/P 1 S->I

29

Defecography

Axial T2

Sagittal T2 to obtain midline

Sagittal CISS at Rest

Sagittal CISS with Kegel

Sagittal CISS with minimal straining

Sagittal CISS with moderate straining

Sagittal CISS with maximum straining

Sagittal CISS with defecation


Thickness (mm)

Gap (mm)

Matrix: Phase Directio

n NEX

Scan Directio

n OTHER Frequenc

y Phase %

Phase

Frequency

AX T2 160

0 95 380 75 5 1 320 194 A->P 3 S->I

SAG T2 140

0 91 360 100 5 1 320 320 A->P 2 R->L

SAG CISS (X6) 3.89 1.7 306 100 5 1 320 256 A->P 1 R->L 1 slice at midline

30

Fetal Add T1s for blood, especially in the brain

Sagittal T2

Axial T2

Coronal T2

Coronal CISS

Sagittal CISS

Axial CISS

Set angle to the area of interest on the fetus

With the smallest FOV possible


Thickness (mm)

Gap (mm)

Matrix: Phase Directio

n NEX

Scan Directio

n OTHER Frequenc

y Phase %

Phase

Frequency

Sag T2 150

0 80 220 100 5 1 256 320 A/P 1 L->R

Ax T2 150

0 80 220 100 5 1 256 320 R/L 1 S->I

Cor T2 150

0 80 220 100 5 1 256 320 R/L 1 P->A

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

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

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

31

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

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

Sagittal T2 (Full FOV for planning sequences)

Axial T1 (Aortic bifurcation through pelvis)

Axial T2 (full FOV)

Small FOV:

Coronal Oblique T2

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

Sagittal T2 (small FOV 3mm slice)

Coronal Oblique T2 (small FOV: 3mm slice)

Axial Oblique T2 (small FOV: 3mm slice)

Coronal Oblique T2 (small FOV: 3mm slice)

(angle set to parallel to the long axis of the

anal canal to evaluate sphincter involvement)

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

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

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

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

OBL AXIAL =

parallel to long

axis rectum

OBL CORONAL =

perpendicular to

long axis rectum

MR technologist: if you are uncertain

about the oblique axial and coronals, or

if the tumor involves the rectum as it

curves, call MD to help select the best

imaging planes.

32

Rectal Cancer Continued


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

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

COR OBL T2

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

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

COR OBL T2 3000 78

320 100 3 .3 320 320 R[>L 4 A->P

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

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

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

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

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

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

33

General Chest (Basic)

Use for mediastinal mass/lymphadenopathy/thymus, etc.

All sequences should be done with breath hold:

COR T2

AXIAL T2

AXIAL T2 FS

AXIAL IN/OUT PHASE

AX 3D VIBE FS (4mm slices)

AX 3D VIBE FS POST

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

Inject and scan at the same time for 0 Sec

- Reformat into axial and coronal

- Subtractions axial and coronal


Thickness (mm)

Gap (mm)

Matrix: Phase

Direction NEX

Scan Direction

OTHER Frequency

Phase %

Phase Frequency

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

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

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

AXIAL IN/OUT PHASE

170 1.2/2.4 (3T)

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

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

AXIAL VIBE FS POST

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

34

Image sources:

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

5t_with_gem_suite#tabs/tab474A2BF180D84862A2F3061065A44677

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

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

https://schwannomacasestudy.wordpress.com/

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

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

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

for-MotionTrak-Japan

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

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

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

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

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

https://schwannomacasestudy.wordpress.com/

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

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

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

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

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

body mri protocols - geiselmed.dartmouth.edu liver renal mass cervical ca staging defecography ......

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