body mri protocols - geiselmed.dartmouth.edu liver renal mass cervical ca staging defecography ......
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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
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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
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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
SLICE GAP MATRIX PHASE
DIR NEX
SCAN DIR
OTHER FREQ PHASE PHASE FREQ
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
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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
SLICE GAP MATRIX PHASE
DIR NEX
SCAN DIR
OTHER FREQ PHASE PHASE FREQ
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
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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
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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
AXIAL 3D VIBE FS POST
(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
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Liver for Hemochromatosis
**Must be done on 1.5T Scanner**
Axial GRE 90 degree flip TE 4.0
Axial GRE 20 degree flip TE 4.0
Axial GRE 20 degree flip TE 9.0
Axial GRE 20 degree flip TE 14.0
Axial GRE 20 degree flip TE 21.0
Sequence TR TE FOV
SLICE GAP MATRIX PHASE
DIR NEX
SCAN DIR
OTHER FREQ PHASE PHASE FREQ
Axial GRE 90 degree flip TE 4.0
120 4.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 90
Axial GRE 20 degree flip TE 4.0
120 4.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20
Axial GRE 20 degree flip TE 9.0
120 9.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20
Axial GRE 20 degree flip TE 14.0
120 14.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20
Axial GRE 20 degree flip TE 21.0
120 21.0 380 80% 10 2 192 256 A/P 1 S->I Flip Angle: 20
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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
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MRCP cont.
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 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
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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
AXIAL 3D VIBE FS POST
(35 SEC/70 SEC/3 MIN)
Slice thickness 3mm
CORONAL 3D VIBE FS POST
(3 MIN)
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 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
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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)
CORONAL 3D VIBE FS POST
(3 MIN)
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 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
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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
CORONAL 3D VIBE FS POST
(25 SEC/90 SEC)
SAGITTAL 3D VIBE FS POST of each kidney
AXIAL 3D VIBE FS POST
**If patient cannot receive gadolinium**
AXIAL DIFFUSION X2 (b value of 50 and 750) and 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
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 3D VIBE FS POST
- 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.
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
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
SLICE GAP MATRIX PHASE
DIR NEX
SCAN DIR
OTHER FREQ PHASE PHASE FREQ
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)
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
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
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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
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 1 320 194 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
Sequence TR TE FOV: Slice
Thickness (mm)
Gap (mm)
Matrix: Phase Direction
NEX Scan
Direction OTHER
Frequency Phase % Phase Frequency
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
Sequence TR TE FOV Slice
Thickness
(mm)
Gap (mm)
Matrix Phase Direction
NEX Scan
Direction OTHER
Frequency Phase % Phase Frequency
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)
Sequence TR TE FOV 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
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
Thickness (mm)
Gap (mm)
Matrix: Phase Direction
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
Sequence TR TE FOV: Slice
Thickness (mm)
Gap (mm)
Matrix: Phase Direction
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)
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
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
Sequence TR TE FOV: Slice
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/