mri/ct guidelines reference booklet · pdf fileevaluation for renal stone useful for...

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MRI & CTIndICaTIon GuIdelInes

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The information provided in this guide is not intended to be a substitute for a licensed radiologist’s recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patient’s clinical history and diagnosis provided by the referring physician.

MRI & CTIndication Guidelines

1

ABDOMEN& PElviS

Clinical Problem Preferred Contrast Comments(Abdomen & Pelvis) study

non-focal Pain

Appendicitis,diverticulitis

Painful Hematuria, r/o kidney stone

Painless HematuriaRenal mass

liver mass

bile duct stoneor obstruction

Aortic Aneurysm

CT Abdomen

CT Abdomenand Pelvis

CT Abdomenand Pelvis

CT Abdomenwith and w/oIV contrast; consider MR with and w/o contrast if CT indeterminate

MR

MR

CT

Oral and IV contrast

Oral and IV contrast

No

Yes

No

Yes

IV needed for solid organ disease

IV contrast helpful if patient is thin

Evaluation for renal stone

Useful for indeterminate renal cysts/lesions on Ultrasound

Eovist contrast is best

Request MR Cholangiopancreatography(MRCP)


Clinical Problem Preferred Contrast Comments(Abdomen & Pelvis) study

Cancer Patient

AdrenalGland

Pelvis-Female

Pelvis-male

CT Abdomenand Pelvis with contrast;

CT Abdomenwithout,contrast ifneeded afternon-contrastCT per radiologist

Ultrasound,then MR>CT

CT or MR

Oral and IVContrast

Non-contrastmay be sufficient. no oral contrast

CT: oral andsometimes IV contrast

CT: oral andsometimes IV contrast

Contrast only if non-contrast CT is inconclusive

ABDOMEN& PElviS


2

> recommended over other study>> strongly recommended over other study


BRAIN


3

Clinical Problem Preferred Contrast Comments(bRAin) study

CvA

Acute bleed

subarachnoidbleed

brain Tumor,metastases

seizure

Cns infection,Abcess, meningitis

Aids

Headache

dementia

neurodegenerativedisorder

Carotid stenosis

CT (0-24hrs)MR

CT>>MR

CT

MR>>CT

MR

MR

MR

MR

MR>CT

MR

CTA

NoNo

No

No

Yes

Yes

Yes

Yes

No

No

No

Yes

If less than 6 hours, also consider CTA or MRA of neck and brain. If less than 24 hours, referral to ER/Acute care facility for imaging is usually preferred

CT better for tumorcalcification

Contrast for adults first time seizure, especially if over 40

Contrast for meningeal/dural disease, mass, meningioma

MR gives superior evaluation of white matter changes, patterns of atrophy

Parkinson’s disease, etc.



BRAIN


4

Clinical Problem Preferred Contrast Comments(sPine) study

subduralHematoma

ms

Posterior Fossa,brainstem lesion

Acoustic neuroma,sensorineuralHearing loss

PituitaryTumor

PulsatileTinnitus

Aneurysm

venous sinusThrombosis

CT= MR

MR

MR

MR

MR

MR>CT

MRA or

CTA

CTA=MR/MRV

NoNo

Yes

Yes

Yes

Yes

Yes

Possibly

Yes

No

MR detects smaller non-surgical acute SDH and Sub-acute to chronic SDH

Contrast helpful if non-contrast is abnormal

MR far superior in this region

CT not sensitive for small IAC lesions but may be needed for otic capsule disease

MR far superior in this region

MRA neck and/or brainsometimes helpful

MRA for screeningespecially at high fieldCTA for greater detail

Usually can avoidconventional Venography

CHEST


5


Clinical Problem Preferred Contrast Comments(CHesT) study

Pulmonaryembolus

nodule, mass,Infiltrate

inerstitual lungdisease

Coronary Arterydisease

Coronary Calcium screening

Aortic Aneurysmdisease

CTA

CT

HighResolution CT

CT of Heart

CT

Yes

Yes or No

No

Yes

No

Yes

Evaluation of acute chestpain and SOB

Peripheral nodules remote from hilum can be imaged without contrast. Contrast helpful for hilar disease

1 or 2 mm slices at5 or 10 mm increments

Detailed visualization ofcoronary arteries

Screening for people with low to moderate risk of CAD

NECKSKull, BASE& ORBIT


6

= comparable studies> Recommended over other study>> strongly recommended over other study

Clinical Problem Preferred Contrast Comments(Neck, Skull, BaSe & OrBit) study

sinusitis

neck mass

ConductiveHearing loss-sesorineural Hearing loss-

skull base

squamous CA

vocal Cord Paralysis

orbit-Proptosis

optic nerves

Cavernous sinus

Cranial nerves

Facial Trauma

salivary Gland

CT

CT>MR

CT

MR

MR = CT

CT>MR

CT>>MR

CT or MR

MR>>CT

MR

MR

CT

CT

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

CT defines ostial obstructionBone changes

Adenopathy better on CT; Tongue and perineural skull base disease better on MR

Mastoid, middle ear, ossicles

IAC, brainstem/CPA,Labyrinth

CT sometimes necessary to better show bony detail

Skull base to thoracic inlet

Skull base to carina

No contrast for Graves’ disease

MR - optic neuritis,high field works bestCT - Meningioma, calcification

MR brain/sella

SPiNE


7



Clinical Problem Preferred Contrast Comments(sPine) study

Herniated disc, Cervical or Thoracic, lumbar

stenosis

discitis/ osteomyelitis

metastasis: bone

epidural or intraspinal

Compression Fracture, bone metastasis

Cord disease

Cord Tumor

MR>>CT

MR>>CT

MR

MR

MR

MR

Focal CT

MR

MR

If previoussurgery, contrast

No

Yes

No

Yes

No

No

Yes

Yes

Contrast essential to distinguish scar from disc after surgery

Helical CT with Reconstructions can be adequate especially if MR contraindication

Non-contrast forbone metastasisContrast for epiduralor intrathecal tumor

MRI allows evaluation of bone marrow,Focal CT for operativeplanning

Demyelination, syrinx

CTA LowerExtremities


8

CT

Fields of Expertise

CTA Brain Head, Orbits

Temporal BonesMastoids/lACS

Sinus Facial Bones

C-Spine

Shoulder

T-Spine T-Spine

Stone ProtocolRenal Protocol

(Mass)

Cardiac Scoring

CTA UpperExtremities

Knee

Ankle

Foot

CTA AbdominalPelvis

Elbow

Wrist

Hand

Chest(High Resolution)CTA Chest – PE

Soft Tissue Neck

Hips

9

MRI

Fields of Expertise

Elbow

MRA Lower Extremities

Brain, MRA BrainPituitary/Sella,

Orbits

MRA Carotids C-Spine

T-Spine

L-Spine

MRA Chest

MRA Abdomen

Brachial Plexus

Hips

IAC’s

Shoulder MRArthrogram

MRA UpperExtremities

KneeMR Arthrogram

Ankle

Foot

Pelvis

Wrist

Hand

Soft Tissue Neck


T-Spine

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