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YOUR HEALTH. IN FOCUS .
MRI & CT Indication 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
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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
Yes
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)
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.
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
MRI & CTIndication Guidelines
2
> recommended over other study>> strongly recommended over other study
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.
BRAIN
MRI & CTIndication Guidelines
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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.
> recommended over other study>> strongly recommended over other study
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.
BRAIN
MRI & CTIndication Guidelines
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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
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.
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
MRI & CTIndication Guidelines
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= 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
MRI & CTIndication Guidelines
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> recommended over other study>> strongly recommended over other study
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.
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
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
CTA LowerExtremities
T-Spine
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YOUR HEALTH. IN FOCUS .