Mass Protocol
- Ventral (V) or dorsal (D) mass will image Axial and Sagittal
- Medial (M) or lateral (L) mass will image Axial and Coronal
- Do not usually need Coronal and Sagittal, pick one based on mass location.
- T2 Fat Sat can be replaced with STIR sequences if getting poor fat saturation.
Closed
Non Enhanced
Axial T1 Axial T1
Axial T2 Fat Sat Axial T1 Fat Sat Pre Gad
Sag STIR (V/D) Axial T1 Fat Sat Post Gad
Sag T1 (V/D) Axial T2 Fat Sat
Cor T1 (M/L) Sag STIR (V/D)
Cor STIR (M/L) Sag T1 (V/D)
Sag T1 Fat Sat Post Gad (V/D)
Cor STIR (M/L)
Cor T1 (M/L)
Cor T1 Fat Sat Post Gad (M/L)
Open
Non Enhanced With Gadolinium
Axial T1 Axial T1
Axial STIR Axial T1 Post Gad
Sag STIR (V/D) Axial STIR
Sag T1 (V/D) Sag STIR (V/D)
Cor T1 (M/L) Sag T1 (V/D)
Cor STIR (M/L) Sag T1 Post Gad (V/D)
Cor STIR (M/L)
Cor T1 (M/L)
Cor T1 Post Gad (M/L)
Sacrum
- General Indications- sacroilitis, trauma
- Image relative to sacrum
- T2 Fat Sat can be replaced with STIR sequences if getting poor fat saturation.
Closed
General MRI With Gadolinium
Cor STIR Cor STIR
Cor Oblique T1 Cor Oblique T1
Cor Oblique T2 Fat Sat Cor Oblique T1 Post Gad Fat Sat
Ax T2 Fat Sat Cor Oblique T2 Fat Sat
Ax T1 Ax T2 Fat Sat
Sagital T1 Ax T1
Ax T1 Post Gad Fat Sat
Sagital T1
Open
General With Gadolinium
Cor STIR (pelvis plane) Cor STIR
Cor Oblique T1 Cor Oblique T1
Cor Oblique STIR Cor Oblique STIR
Ax STIR Cor T1 Post Gad
Ax T1 Axial STIR
Sagital T1 Ax T1
Ax T1 Post Gad
Sagital T1
Shoulder MRI
- General Indications – decreased range of motion, weakness, instability, rotator cuff injury
- Indications Arthrogram- post operative shoulder, labral pathology, instability
- T2 Fat Sat can be replaced with STIR sequences if getting poor fat saturation.
- Perform Cor STIR and Sag STIR or Sag T2 Fat Sat as first two sequences.
Closed
General MRI Arthrogram MRI
Ax PD Fat Sat Ax T1 Fat Sat
Oblique Cor STIR Oblique Cor T1 Fat Sat
Oblique Cor PD Oblique Cor STIR
Oblique Sag T1 Oblique Sag T1 Fat Sat
Oblique Sag T2 Fat Sat ABER T1 Fat Sat
Oblique Sag T1
Open
Open 1 Open 2
Ax T2 Ax T2 GE
Oblique Cor STIR Oblique Cor FIR
Oblique Cor PD Oblique Cor PD
Oblique Sag T1 Oblique Sag T1
Oblique Sag STIR Oblique Sag FIR
Through AC Joint
Chest Pectoral Muscle
*Include from Sternum to outside of shoulder
Cor Oblique T1
Cor Oblique STIR
Ax T1
Ax T2
Ax FIR
Sag Oblique T1( perpindicular to plane of COR)
Elbow MRI
- General Indications- biceps tear, triceps tear, epicondylitis, pain, weakness
- Indications Arthrogram- loose body, collateral ligament injury, young throwing athletes
- T2 Fat Sat can be replaced with STIR sequences if getting poor fat saturation.
Biceps Tear
- If proximal then do a shoulder
- If distal do elbow
- If distal with Popeye Sign then do elbow and humerus
Closed
General MRI
Ax T1
Ax T2 Fat Sat
Cor T1
Cor STIR
Sag T2 Fat Sat
Arthrogram MRI
Ax T1 Fat Sat
Ax T2 Fat Sat
Ax T1
Cor T1 Fat Sat
Sag T1 Fat Sat
Ax t1 fs
Ax t2 fs
Cor t1 fs
Sag t1 fs
Ax t1
Cor STIR
Open
Open 1 Open 2
Ax T1 Ax T1
Axial STIR Ax FIR
Sag STIR Sag FIR
Cor T1 Cor T1
Cor STIR Cor FIR
Image from epicondyle through radial tuberosity
Wrist MRI
- General Indications- occult fracture, carpal tunnel, tendon pathology, pain
- Indications Arthrogram- TFC tear, ligament tear, wide scapholunate interval, loose body.
- Indications Gadolinium- avascular necrosis, mass, non-union
- T2 Fat Sat can be replaced with STIR sequences if getting poor fat saturation.
Closed
General MRI Arthrogram MRI
Cor T1 Cor T1 Fat Sat
Cor STIR Cor STIR
Ax T2 Fat Sat Ax T1 Fat Sat
Ax T1 Ax T2 Fat Sat
Sag T2 Fat Sat Sag T1 Fat Sat
Cor T1
Post Gadolinium MRI
Cor T1
Cor T1 Gad Fat Sat
Cor STIR
Ax T1 Fat Sat
Ax T1
Ax T1 Gad Fat Sat
Sag T2 Fat Sat
Arthrogram MRI
Cor T1 Cor T1 Fat Sat
Open
Open 1 Open 2
Cor T1 Cor T1
Cor STIR Cor FIR
Ax STIR Ax FIR
Ax T1 Ax T1
Sag STIR Sag FIR
Thumb
- General Indications- Gamekeepers thumb (UCL), tendon injury, occult fracture.
- All images are relative to the 1st MCP joint
- Small FOV and only thumb
Closed
General MRI
Cor T1
Cor STIR
Ax T1
Ax T2 Fat Sat
Sag STIR
Open
Open 1 Open 2
Cor T1 Cor T1
Cor STIR Cor STIR
Ax T1 Ax T1
Ax STIR Ax FIR
Sag STIR Sag FIR
Finger
- General Indication- tendon tear, sprain, occult fracture, pulley injury
- Small FOV and small parts coil
Closed
General MRI
Sag T1
Sag T2 Fat Sat
Ax T1
Ax T2 Fat Sat
Cor STIR
Open
Open 1 Open 2
Sag T1 Sag T1
Sag STIR Sag FIR
Ax T1 Ax T1
Ax T2 Ax T2
Cor STIR Cor FIR
Female Pelvis
Pelvis
AX T1
AX T2
AX T1 FS
AX T1 FS Post Gad
Cor T1
Cor STIR
Cor T1 FS Post Gad
Sag T1 Pelvic contents
Pelvis/Hip
- General Indications- trauma, AVN, transient osteoporosis, mets, arthritis, pain, tendonitis, bursitis
- Indications Arthrogram- labral tear, paralabral cyst, loose body
- Hip MR then image only requested side
- T2 Fat Sat can be replaced with STIR sequences if getting poor fat saturation.
Closed
General MRI Hip Arthrogram MRI
Cor T1 Cor T1 Fat Sat
Cor STIR Sag T1 Fat Sat
Ax T1 Sag T1
Ax T2 Fat Sat Ax Oblique T1 Fat Sat
Sag T2 Fat Sat Ax T2 Fat Sat (entire pelvis)
Open
Open 1 Open 2
Cor T1 Cor T1
Cor STIR Cor FIR
Ax T1 Ax T1
Ax STIR Ax FIR
Sag T2 Sag T2
Pubic Bone
- General Indications- athletic pubalgia, sports hernia
Closed
General MRI
Cor STIR
Cor T1
Ax T2 Fat Sat
Ax Oblique T2 Fat Sat
Ax Oblique PD
Sag T2 Fat Sat
Abdomen
- Indications- evaluate mass, lymphadenopathy, hypertension
- Image diaphragm to iliac crest
Closed
General MRI with Gado
Ax T2 SSFSE Fat Sat
Ax T2 Breath Hold
Ax T1 In Phase Breath Hold
Ax T1 Out Phase Breath Hold
Ax T1 FS Post Gad
Cor T1 In Phase Breath Hold
Cor T2 Breath Hold
Cor T2 Fat Sat Breath Hold
Cor T1 Post Gad
Open
General MRI with Gado
Ax T2 FSE
Ax T1
Ax T1 Post Gado
Ax STIR
Cor T1
Cor T1 Post Gado
Cor T2 FSE
Cor STIR
Sports Hernia
Open
WO Gad
Cor STIR
Cor T1 SE
AX T2 FSE Fat Sat
AX OBL PD FSE NON Fat Sat
AX OBL T2 FSE
Sag T2 FSE Fat Sat
SAG PD FSE
Complex Partial Seizures
- Cor Oblique FLAIR through temporal lobes high resolution (2mm, skip 0)
- Cor Oblique T2 FSE through temporal lobes high resolution (3mm, skip 0)
- Axial STIR (full brain)
- Axial T2 (full brain)
- Axial T1 (full brain)
- Axial T1 W Gad (full brain)
- Axial Diffusion
- Sagittal T1
- Coronal T1
* For above sequences, the scan plane shold be perpendicular to the hippocampi, and smaller FOV
Brain Routine
- Indications- TIA, CVA, Mental status changes, memory loss, vertigo, weakness, etc
- If trauma or hypertension add Axial GE
Closed
General MRI with Gad General MRI w/o Gad
Sag T1 Sag T1
Axial FLAIR Axial FLAIR
Axial T2 Axial T2
Axial T1 Axial T1
Axial T1 Post Gad Axial Diffusion
Coronal T1 Post Gad Axial ADC
Axial Diffusion Cor T2
Axial ADC
Open
Open with Gad Open w/o Gad
Sag T1 Sag T1
Axial FLAIR Axial FLAIR
Axial T2 Axial T2
Axial T1 Axial T1
Axial T1 Post Gad Axial Diffusion
Cor T1 Post Gad Cor T2
Axial Diffusion
MS Brain
- Indication MS
- If visual changes or optic neuritis add ***, cover chiasm through orbits
Closed/Open
With Gad W/O Gad
Sag T1 Sag T1
Sag FLAIR Sag FLAIR
Ax T2 Ax T2
Ax PD Ax PD
Ax FLAIR Ax FLAIR
Ax T1 Ax Diffusion
Ax T1 Post Gad
Cor T1 Post Gad
Ax Diffusion
***Cor T2 Fat Sat Orbits Closed Magnet
***Cor STIR Orbits Open Magnet
Orbit
- Indications- MS Orbits, optic neuritis, visual changes, if don’t need brain
- All images are 3 mm and only through orbits except, *** which are routine 5 mm and are whole brain
- Coronals are Chiasm through orbit only
Closed
With Gad W/O Gad
Axl T1 Ax T1
Ax T1 Post Gad Fat Sat Ax T2 Fat Sat
Ax T2 Fat Sat Cor T2 Fat Sat
Cor T1 Ax T2
Cor T1 Post Gad Fat Sat ***Ax Diffusion
Cor T2 Fat Sat ***Ax FLAIR
***Ax FLAIR
***Ax Diffusion
Open With Gad
Ax T1
Ax T1 Post Gad
Ax STIR
Cor T1
Cor T1 Post Gad
Cor STIR
***Ax FLAIR
***Ax Diffusion
Parotid or 7th Cranial Nerve
- Indications- parotid mass, facial pain, facial weakness
- Axial image temporal bone through hyoid
- Coronal image back of cords to nose
- Scan 4 mm
Closed Open
Ax T1 Ax T1
Ax T1 Post Gad Fat Sat Ax T1 Post Gad
Axial T2 Fat Sat Ax STIR
Cor T1 Cor T1
Cor T1 Post Gad Fat Sat Cor T1 Post Gad
Cor STIR Cor STIR
Pituitary
- Note thin sections are small field of view through the pituitary to include from orbits through brainstem on Coronals and ventricle to ventricle on the Sagitals.
- Axial FLAIR
- Axial Diff
- Axial T2
- Sag T1 (thin sections)
- Sag T1 with gado (thin sections) early
- Sag T1 with gado (thin sections) delay 5 min
- Cor T1 (thin sections)
- Cor T1 with gado (thin sections) early
- Cor T1 with gado (thin sections) delay 5 min
Brain Seizure
- Indications- Mesial Temporal Sclerosis, Chronic Epilepsy
- Oblique Coronal images sequences should be thin section perpendicular to the long axis of the hippocampus
MRI with Gad MRI w/o Gad
Sag T1 Sag T1
Ax T2 Ax T2
Ax FLAIR Ax FLAIR
Ax DWI/ADC Ax DWI/ADC
Cor T2 oblique Cor T2 oblique
Cor FLAIR oblique Cor FLAIR oblique
Cor T1 w Gad
Ax T1 w Gad
Routine Brachial Plexus MRI Protocol
• Sag T2 cover mid cord to tip of transverse process, used to localize oblique Coronals.
• The oblique coronal is performed parallel to the long axis of the lower vertebral body at the C4-C7 level (the yellow line in image A).
• Use the Axial T1 large field of view to adjust coronal to ensure symmetric view of brachial plexus (the yellow line in image C).
• Oblique Coronal coverage is from posterior line of vertebral bodies through the sternum.
• Axial images are obtained perpendicular to long axis of cervical spine, the green lines in figure A and cover from C4 to T4.
• Oblique Sagittal is angled perpendicular to the brachial plexus, the blue line in figure B.
• Field of view for Oblique Sagittal is from spinal cord through the glenoid.
• Direct Coronal slice thickness is 3 mm with an intersection gap of 0-0.5 mm
• Oblique Sagittal and Oblique Coronal slice thickness is 4 mm with an intersection gap of 1-2 mm
• Axial images are 4-mm thickness with a 1- to 1.5 mm intersection gap
Precontrast Brachial Plexus MRI Protocol
• Sag T2
• Coronal STIR (Direct coronal) (large FOV)
• Axial T1 SE (large FOV)
• Axial T1 SE
• Axial STIR
• Coronal (Oblique) T1 SE
• Coronal (Oblique) T2 FSE
• Sagittal (Oblique) T1 SE
• Sagittal (Oblique) STIR
Post contrast Brachial Plexus MRI Protocol
• post-Gd axial T1 with fat saturation
• post-Gd coronal (Oblique) T1 with fat saturation
• post-Gd sagittal (Oblique) T1 with fat saturation
MR TMJ
- Ax T1
- Scout
- PD Sagittal oblique closed mouth
- STIR Sagittal oblique closed mouth
- T1 Coronal oblique closed mouth
- PD Sagittal oblique open mouth
- Use 30ml syringe as static bite block
MR Soft Tissue Neck
- Ax T1
- Ax T2 FS
- Ax T1 Post Gad FS
- Cor T1
- Cor T1 Post Gad FS
- Cor STIR
- Sag STIR
Cervical Spine
- Indication- neck pain, radiculopathy, trauma, numbness
- If patient has had surgery in last 3 years ask to give gadolinium
- If see mass, fluid collection, or think recurrent disk go back and do Stacked Ax T1 Post Gad Fat Sat through area (this does not mean whole spine, means thin slice at area of interest only)
- Axial are parallel to the disks
Closed
General MRI With Gadolinium
Sag T1 Sag T1
Sag T2 Sag T1 Post Gad Fat Sat
Sag STIR Sag T2
Ax T2 Sag STIR/FIR
Ax T1 Ax T2
Ax T2me2d Ax T1 Post Gad Fat Sat
Ax T1
Ax T2me2d
Open
General MRI With Gadolinium
Sag T1 Sag T1
Sag T2 Sag T1 Post Gad
Sag STIR Ax PBSG
Ax BASG Ax BASG
Ax PBSG Ax T1
Ax T1 Post Gad
Sag T2
Sag STIR/FIR
Thoracic MRI
- Indication- back pain, radiculopathy, trauma
- If patient has had surgery last 3 years ask to give gadolinium
- If see mass, fluid collection, or think recurrent disk go back and do Stacked Ax T1 Post Gad Fat Sat through area (this does not mean whole spine, means thin slice at area of interest only)
- Axial are parallel to disk levels
Closed
General MRI With Gad
Sag T1 Sag T1
Sag T2 Sag T1 Post Gad Fat Sat
Sag STIR Sag T2
Ax T1 Sag STIR
Ax T2 Ax T2
Ax T1
Ax T1 Post Gad Fat Sat
Open With Gad
Sag T1 Sag T1
Sag T2 Sag T1 Post Gad Fat Sat
Sag FIR Sag T2
Ax T1 Sag FIR
Ax T2 Ax T1
Ax T1 Post Gad Fat Sat
Ax T2
Lumbar MRI
- Indication- back pain, radiculopathy, bladder/bowel incontinence, cauda equina
- If patient has had surgery last 3 years ask to give gadolinium
- If see mass, fluid collection, or think recurrent disk go back and do Stacked Ax T1 Post Gad Fat Sat through area (this does not mean whole spine, means thin slice at area of interest only)
- Axials are parallel to disk level
- Cover T12 to sacrum on Sagittal. Do not need to see T11.
Closed
General MRI With Gad
Sag T1 Sag T1
Sag T2 Sag T1 Post Gad Fat Sat
Sag STIR Sag T2
Ax T1 Sag STIR
Ax T2 Ax T2
Ax T1
Ax T1 Post Gad Fat Sat
Open With Gad
Sag T1 Sag T1
Sag T2 Sag T1 Post Gad Fat Sat
Sag FIR Sag T2
Ax T1 Sag FIR
Ax T2 Ax T1
Ax T1 Post Gad Fat Sat
Ax T2
ANKLE MRI
- Axials image parallel to calcaneus, Coronals cover calcaneal tuberosity through base of metatarsals.
Closed
General MRI with Gad
Axial PD Axial PD
Axial T2 Fat Sat Axial T2 Fat Sat
Sag T1 Axial T1 Fat Sat Post Gad
Sag IR Sag T1
Cor T1 Sag IR
Cor IR Sag T1 Fat Sat Post Gad
Cor T1
Cor IR
Open
General MRI with Gad
Axial PD Axial T1
Axial FIR Axial FIR
Sag T1 Axial T1 Post Gad
Sag FIR Sag T1
Cor T1 Sag FIR
Cor FIR Sag T1 Post Gad
Cor T1
Cor FIR
KNEE MRI
Closed
General MRI with Gad
Sag PD Sag T1
Sag STIR Sag STIR
Cor T1 Cor T1 Post Gad Fat Sat
Cor STIR Cor STIR
Axial PD Cor T1
Axial T2 Fat Sat
Axial T1 Post Gad Fat Sat
Open
General MRI with Gad
Sag PD Sag T1
Sag FIR Sag T1 Post Gad
Sag T2 Sag FIR
Cor T1 Cor T1
Axial T2 FSE Axial T2 FSE
Cor FIR Axial T1 Post Gad
FOOT MRI
- When order foot only cover the forefoot. Cover from distal navicular through toes.
- Do not do large FOV and cover foot and ankle on same exam, the imaging planes are different.
Closed
General MRI with Gad
Axial T1 long axis Axial T1 long axis
Axial T2 Fat Sat long axis Axial T1 Fat Sat Post Gad long axis
Sag T1 Axial T2 Fat Sat long axis
Sag STIR Sag T1
Cor T1 short axis Sag STIR
Cor STIR short axis Cor T1 short axis
Cor T1 Fat Sat Post Gad short axis
Cor STIR short
Open
General MRI with Gad
Axial T1 long axis Axial T1 long axis
Axial FIR long axis Axial T1 Post Gad long axis
Sag T1 Axial FIR Sat long axis
Sag FIR Sag T1
Cor T1 short axis Sag FIR
Cor FIR short axis Cor T1 short axis
Cor T1 Post Gad short axis
Cor FIR short axis
