ALBERT EINSTEIN MEDICAL
CENTER
Philadelphia, Pennsylvania
Department of Radiology
Policies and Procedures
Manual
Musculoskeletal and Body MRI
June 2003
Prepared and Approved by:
Cheryl L. Kirby, MD date
Section Chief, Body
MRI
Sumathi Wable, MD date
Section Chief, Musculoskeletal Radiology
Matthew Schultz, RT date
Supervisor, MRI
Table of Contents
Body MRI
Renals
Renal Mass/
Lesion (added February 2003)
Adrenals
Aorta
Liver
Pelvis
MRCP
Prostate
Renal
Arteries
Pancreas
Lower
Extremity Angio
Musculoskeletal MRI
Shoulder
Shoulder MR
Arthrogram
Hips
Knee
Wrist
Ankle
Elbow
Forefoot/Toes
Extremity Soft Tissue/Osteomyelitis
Lower Extremity Run- Off
Renals
Family: Abdomen Patient:
Grp: Renals/Adrenals Radiologist:
Survey
T1 AX SE
568/10
T2 SPIR AX
TSE 1666/70
T1 Inph/RT TFE
15/4.6/25°
T1 Outph/RT TFE
15/2.3/25°
BH 3D COR LOHI T1 TFE 3.8/1.2/40° (Dynamic GAD) (CE – Angio)
T1 SPIR AX
SE 500/10
Options:
T1
Inph/COR (adjust
slice thickness based
T1
Outph/COR on
size of adrenal lesion)
FE
EPI COR FEEP1
867/17/60°
T1
BH FL CO
TFL 16/6.8/25°
BH 3D
AX T1 FFE
6.9/17.7/40°
Inph BH
TFE 15/4.6/25°
Outph BH
TFE 15/2.3/25°
T2W/RC SE
2000/20/100
T2/TSE/RT TSE
1800/110
2DTOF (superior saturation) for IVC
Coil: Phased-array
synergy body coil
Positioning: Head first. Supine
Coverage: Entire kidneys
*
Filming: Film source images for
renal
parenchymal evaluation
Subtract post-gad images
from pre-gad images
Renal Mass / Lesion (revised April 2003)
Family: Abdomen Patient:
Grp:
Renals/Adrenals Radiologist:
Syn Body Coil
1. T1 SPIR
AX SE 568/10
2. T2 SPIR
AX 1666/70
3. T1 Inph & outph breathhold
4. COR
3D TFE (Kidney/Adr
#34) 1 pre; 4 post - 20 sec, 1 min, 2
min, 5 min delays
5. T1 SPIR
AX SE 500/10
Options:
SSh T2
TSF COR
BH 3D AX
T1 FFE 6.9/17.7/40°
T2 / TSE / RT
TSE 1800/110
Adrenals
Family: Abdomen Patient:
Grp: Renals/Adrenals Radiologist:
Survey
T1 AX SE
568/10
T2 SPIR AX
TSE 1666/70
T1 Inph/RT TFE
15/4.6/25°
T1 Outph/RT TFE
15/2.3/25°
Options:
BH 3D COR T1
FFE 6.0/1.5/40° (Dynamic GAD)
T1 SPIR
AX SE 500/10
T1
Inph/COR (adjust
slice thickness based
T1
Outph/COR on
size of adrenal lesion)
FE
EPI COR FEEP1
867/17/60°
T1
BH FL CO
TFL 16/6.8/25°
BH 3D
AX T1 FFE
6.9/17.7/40°
Inph BH
TFE 15/4.6/25°
Outph BH
TFE 15/2.3/25°
T2W/RC SE
2000/20/100
T2/TSE/RT TSE
1800/110
2DTOF (superior saturation) for IVC
Coil: Body coil
Coverage: Adrenal and renals
Aorta
Family: Thorax & Abdomen Patient:
Grp:
Aorta Radiologist:
Always try to inject Right arm for thoracic
aorta
Survey / QBC
#9 AX
BH BB TSE
750/60
#10 Sag
BH BB - angle to plane of aortic arch
Bolus track and angio + 2nd
run
Options:
2D timing T1 FFE with 3D
Lo Hi with Gad
T1W/SE SE
750/25
T2W/TSE SE
2250/120
T2W/TSE/HR SE
2250/90 (512 Matrix)
T1W/SE/EPI COR
A. fib COR
TFE 9.7/2.5/20°
(For severe A. fib – no cardiac
gating)
2D CT
Cine FFE 923/12/60°
(Ax Arch/Ao Root/Diaph) (Plug in HR)
Coil: Body
coil
Note: All
T1 weighted images are gated
Coverage: Transverse images of the thorax should start
2 cm above the aortic arch and cover down to diaphragm.
Transverse images of the abdomen should cover
from the diaphragm to the bifurcation.
Sagittal oblique images should be in the plane of
the aortic arch.
6/26/03
Liver
Family:
Abdomen Patient:
Grp:
Liver/Spleen Radiologist:
Survey:
T1 AX FB (free breathing)
T2/PD
AX Pros TR
1800
T2 160
TE TSE
1666/160
T1 Outph/BH 223/2.3
T1 Inph/BH Axial 224/4.6
3D Dyn T1 3.6/1.08 25° (Dynamic GAD, pre, 15 sec, 1 min, 5 min, (10 min if hemangioma)
Options:
T1 AX SE
572/10 (resp trigger)
T1 AX Mover TSE 550/10 (no resp trigger)
3D Dyn 7.0/3.4 15° (Smoother 3D but SI backround)
T1 BH pre TFE
1616.9
T1 BH FLASH TFE 16/6.9 FLIP 25 (3 run)
BH 3D COR LOHI T1 TFE 3.8/1.2/40° (Dynamic GAD x 3) (CE – Angio)
3DBHLIN T1FFE 3.8/1.2
FLIP 40 (3 Dynamics)
T2 FFE FFE 600/14 (Fe Deposition)
STIR AX TIR 1666/100 (Resp. Trig. small lesions)
T2 SPIR Ax TSE
1666/70 (?
border lesion)
T2 SPIR COR
TSE 1666/70
T1 SPIR Ax SE 50/10 (with GAD if border lesion)
T1 SPIR Ax RT TSE
MRCP 3D/RT COR TSE 1800/600
MRCP RADIAL TSE 8000/1200 (Thick slab – mult BH)
MRCP BH TSE 8000/2000 (Thick slab)
MRCP BH MS TSE 8000/260 (MS = multislice)
T2 SSh COR TSE 23247/100 (Fast T2 = cover liver in 1 BH)
T2/SPIR/512 TSE 1800/80 (hi
resolution)
3D/TFE/RT TFE 15/4.6 FLIP 25° (Heavily T1 - ? delayed images
with GAD for hemangioma)
T1W/TFE/BH$1 TFE 7.0/3.0 FLIP 15° (Inph BH for perph lesion)
T1W/FEP1 FEEP/252/5.0/80° (FatSat Bkrd inph BH)
2D/QF/Porta T1 FFE 6.9/4.1/15° (Phase contrast sug 6 slice)
Pelvis
Family:
Musclskel Patient:
Grp:
Pelvis Radiologist:
Glucagon 1 mg IM or SQ
1. Survey
2. T1
AX Gyn SE
575/13
3. T2
FS Ax Gyn TSE
2200/70 (FatSat)
Options:
4. T2 Sag
Gyn TSE 4531/90 (3 mm for uterus)
5.
T2 FS
CR Gyn TSE
2200/70
6.
T1 FS
Ax Sag, Cor Gyn SE 525/14
7. T1W TFE
(#39 underlumbar spine TR shortest
TE 4-6)
3D
COR LIN T1 FFE
3.8/1.2/40°
(recommended)
3D
COR LOHI TFE 3.8/1.2/40°
T2 Sag or Cor 8 mm
TSE 3000/100
T1 Sag or Cor SE
575/12
STIR Cor or Sag
TIR 1400/12
T1 COR
SE 500/14
T2
SSh
COR TSE 23247/100 (Quick Abd
to check for kidneys)
Positioning: Supine,
head first
Arms crossed over abd and chest, not next to pelvis
Sample
Protocols:
Benign
conditions: 1® 2® 3® 4® 5 ® 6T1 FS AX
(Cor or Sag
to uterus – may need to oblique images)
(For uterine
duplication, add scout abd cor
to include kidneys)
Cervical
CA and Endometrial CA: 1 or 7 ® 2® 3® 4® 5® In phase Sag Dyn pre & post Gd x3 (Liver Dyn sequence) ® 6 or 7
Ovarian CA: 1® 2® 3® T2 Sag 8 mm® 5® 6 Axial Pre-Gad ® In phase Sag Dyn
pre & post Gd x3 (Liver Dyn
sequence) ® 6 or 7
Bony Pelvis: 1® 2® 3® STIR COR ® T1 COR (will need to
increase slice thickness for full coverage from iliac crest to peroneum)
MRCP
Family:
Abdomen Patient:
Grp:
Liver/Spleen Radiologist:
Survey:
MRCP RADIAL
TSE 8000/1200
MRCP BH
MS AXIAL TSE
8000/2000 (MS = multislice)
T1 Axial SE
572/10 (Resp
Trigger)
STIR Ax TIR
1666/100
SSH T2 CORONAL
Options:
MRCP 3D/RT
COR TSE 1800/600
MRCP BH TSE 8000/2000 (Thick
slab)
T2 SPIR Ax TSE 1666/70
T2/SPIR/512 TSE 1800/80 (hi
resolution)
T2 SSH
COR TSE 23247/100
Notes:
1) Film MIPs from MRCP 3D/RT. Source images will be saved and checked by
radiologist on monitor and filmed upon request of the radiologist.
2) Axial T1 and STIR images should extend
from liver dome through pancreas.
Prostate
Family:
Pelvis Patient:
Grp:
Prostate Radiologist:
Survey (Body Coil)
T1 AX
Pelvis SE 572/10 (Image
from top of kidneys to inferior pubic rami)
Call MD to check body coil sequences prior to
bringing patient out of scanner.
Endorectal coil placement by MD.
Glucagon 1 mg IM or
SQ
T1 Ax 4mm SE 494/16
PD Ax 4mm TSE 2000/12
T2 Ax 4mm TSE 4000/100
STIR Ax 4mm TIR 1400/14
T2 Sag 4mm TSE 4000/100
T2 Cor 4mm TSE 4000/100
Options:
FFE Ax
TFE 15/1.7 (Body Coil – distinguish
vessel from lymph node)
Preparation: Fleets enema at least 2 hours prior to
exam time.
Light breakfast.
Patient should void
immediately prior to exam.
Coverage: Body coil: top of kidneys through
pelvis
Endorectal
coil: seminal vesicles and prostate
Renal Arteries
Family:
Abdomen Patient:
Grp:
Renals/Adrenals Radiologist:
IP/OP axial through adrenals
and kidneys
Coronal SSh T2 TSE abdomen
3D/Dyn pre-coronal T1
FFE
Bolus trak
abdomen angio
3D/Dyn coronal T1 FFE (x 4
pre, art, ven, delay)
Note: Include area anterior to abdominal aorta so as not to cut off prox renal arteries
Coil: Body
coil
Filming: Film MIPs. MD will check
source images on workstation and will decide whether to film source images.
* Note: All source images should be
transferred to workstation and archived.
Pancreas
Family:
Abdomen Patient:
Grp:
Pancreas Radiologist:
Survey:
T1 AX FB
T1 AX SPIR
T1 IN & OUT PH
T2/PD AX
SSH T2
CORONAL
AX 3D
TFE thru the entire pancreas 3-4
mm sections (FOV include both kidneys)
1 pre, immediate, 1 min, 3
min, 5 min
or
AX In phase dyn (liver dyn) (FOV include both
kidneys)
1 pre, immediate, 1 min, 3
min, 5 min
Options:
MRCP
Lower Extremity Angio
Family:
See individual study Patient:
Grp:
Radiologist:
Survey
T1 Ax
Arterial Study:
Ao bif
® knee (Body
Coil)
2D Timing
T1 FFE 15/2.6
(Abdomen ® Renals/Adrenals)
3D
BH LOHI (Thorax ® Aorta)
Calf (Neck Coil)
Several stations until ankle.
Survey
M2D1$1
T1 FFE 32/6.9/60° (Lower extremity ® Angio)
Foot (Head Coil)
Survey
ART
3D TRA T1
FFE 28/6.9/25° (Lower extremity ® Angio)
Option: Thigh & knee 3D
COR LIN
Venous (Foot ® Thigh)
Survey
T1 Ax
Ven M2D1$1
T1 FFE 26, 6.9, 60°
Note: Use Vit E or other
skin marker to insure
overlap of slices with coil
position change.
Coils: Thigh = Body Coil
Calf
= Neck
Coil
Foot = Head
Coil
SHOULDER (Revised February 2003)
Family: Musculoskeletal
AEMC Patient:
Group: Shoulder Radiologist:
COR LOCALIZER
AXIAL LOCALIZER
COR
Oblique T1
COR Oblique
T2 TSE SPIR
SAG T1
TSE SPIR
AX PD TSE SPIR (3 mm slices)
Options AXIAL STIR
SAG STIR
COR STIR
AXIAL T1 SE
SPIR
SAG T1
SE SPIR
COR T1
SE SPIR
Shoulder MR Arthrogram
Family: Musculoskeletal AEMC Patient:
Group: Shoulder Radiologist:
Pre Gad: COR T1
COR T2
SPIR
AX T2
SPIR
Post Gad: AX T1
SPIR
COR T1
SPIR
SAG T1
SPIR
For labral pathology 2 mm cuts through the glenohumeral joint
HIPS
Family: Musculoskeletal
AEMC Patient:
Group: Hips Radiologist:
LOCALIZER
TRANS
COR T1
COR T2
TSE SPIR
AXIAL T1 SE
AXIAL PD
T2 TSE
SAG T2 TSE
SPIR (unilateral)
Options: COR STIR (for Fx instead of T2 TSE SPIR)
AXIAL
T1 SE SPIR
COR T1
SE SPIR
SAG T1
SE SPIR
KNEE
Family: Musculoskeletal AEMC Patient:
Group: Knee Radiologist:
LOCALIZER SAG or LOCALIZER TRANS
COR T1
COR STIR
SAG PD SE
SAG T2
TSE SPIR
TSE PD thin sec (2 mm) only thru ACL angled parallel to ACL
AX TSE PD MT
AX T2 TSE
SPIR
Options: SAG
TSE PD SPIR
SAG T1
SE SPIR
AX T1
SE SPIR
COR T1
SE SPIR
WRIST
Family: Musculoskeletal AEMC Patient:
Group: WRIST Radiologist:
COR
T1 SE
COR T2 *
AXIAL PD
TSE
AXIAL T2
TSE SPIR
SAG T1
STIR
Options: AXIAL
STIR
COR STIR
AXIAL T1
SE
COR T1
SE SPIR
SAG T1
SE SPIR
AXIAL T1
SE SPIR
SAG T2 TSE with or without SPIR
SAG PD TSE with or without SPIR
COR 3D FFE VOL
ANKLE (Revised February 2003)
Family: Musculoskeletal AEMC Patient:
Group: ANKLE Radiologist:
LOCALIZER COR
SAG T1
SAG STIR All
AX
PD SE 3
mm
AX T2
TSE SPIR slices
Oblique COR PD
SPIR
Options: COR
SAG
STIR
COR T1 SE
AXIAL T1 SE
SAG T1
SE SPIR
COR T1
SE SPIR
AXIAL T1
SE SPIR
AXIAL T2
PD TSE
COR T2
PD TSE
ELBOW
Family: Musculoskeletal AEMC Patient:
Group: Elbow Radiologist:
LOCALIZER
TRANS
COR T1
COR T2
SAG PD TSE
AX 2D FFE (T2 weighted)
AX T2 *
Options: COR STIR
COR TSE SPIR
SAG T2 TSE
SAG
PD TSE
SAG T1 SE
COR T1
SE SPIR
SAG T1
SE SPIR
AXIAL T1
SE SPIR
Forefoot /
Toes
Family: Musculoskeletal
AEMC Patient:
Radiologist:
Pt position: prone, toes go
in first in the knee coil
FOV: 10 to 12 cm
Localizer – multi
Sag T1, STIR
Axial T1
Coro T2 / PD TSE
SPIR
Options:
Sag T2
SPIR, T2 SE
Axial T1
SE SPIR
Coro T1
SE SPIR
Sag T1
SE SPIR
EXTREMITY SOFT
TISSUE / OSTEOMYELITIS
Family: Musculoskeletal
AEMC Patient:
Group: Extremity Soft Tissue / Osteomyelitis Radiologist:
LOCALIZER COR, AXIAL, SAG
AXIAL T1
AXIAL TI
SPIR
AXIAL T2 /
PD TSE
COR STIR
SAG
T2 TSE SPIR
Post
Gd T1 SPIR
AX , SAG and COR
Options
AXIAL
STIR
COR T2
/ PD TSE,
T1
SAG T1,
T2 / PD TSE
AX, SAG, COR T1 w/TFE (TR - shortest
TE - 4.6)
Lower
Extremity Run-Off
Angiogram - AEMC Patient:
Radiologist:
Ax H BB TSE 750/60 (from kidneys to pelvis)
Coronal SSh TSE T2
abdomen/pelvis
Runoff survey
2D timing
3D - Isovoxel runoff
Options:
2D TOF ankle/foot
3D TOF calf (COW sequence)
Coro ssh
T2 TSE – abd/pel