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)

1 MRI-1-2


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

 

 

MRI-8-2line

 


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

MRI-9-2

MRI-9-3MRI-9-4MRI-9-5


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

 

 

MRI-10-1MRI-10-2

 


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

 

 

 

MRI-11-1

 

 


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

 

 

MRI-12-1

 

MRI-12-2

 

 

 

 

 

 

 

 

 

 

 

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

 

 

MRI-13-1

MRI-13-2

MRI-13-3

 

 

 

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

 

 

MRI-14-1

 

 

 

 


 

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

 

 

 

MRI-15-1

 

MRI-15-2

 

 

 


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

 

 

 

 

MRI-16-1MRI-16-2

 

 

 

 


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

 

 

 

MRI-17-1MRI-17-2

 

 

 

 

 


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