Neuro - MRI
Table of Contents
Page
No.
Scanning Parameters follow
each section:
Routine
Brain 3
Routine
Brain with Contrast 4
Epilepsy
Seizure Work-Up 5-6
History
of Trauma 7
Brain
Stem 8
Posterior
Fossa with Contrast 9
Sella
Turcica 11
Internal
Auditory Canals (7th and 8th Cranial Nerves) 12
Cranial
Nerves III, IV, V, VI 13
Orbits 14
Pediatric
Brain (Under 2 years of age) 15
Pediatric
Brain (Over 2 years of age) 16
Pediatric
Brain (with Contrast) 17
Spine
Survey 18
Routine
Cervical Spine 19
Cervical
Spine 20
Cervical
Spine without Contrast 21
Thoracic
Spine 22
Thoracic
Spine with Contrast 23
Routine
Lumbar Spine 24
Lumbar
Spine with Contrast 25
Brachial
Plexus 26
Neck 27
Larynx 28
Acute
Ischemic Brain 29
Uncooperative
Patient 30
Routine Brain
A. Clinical
Indications
1. Migraine headaches
1. Collagen vascular disease
2. Central atrophy
3. Dementia
4. Huntington's chorea (add turbo T2C)
6. MS (add Turbo T3 Sag)
B. Patient
Positioning
1. Head coil
2. Supine
3. Center at glabella
C. Scanning
Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 T2-/PD Ax
4. $4 Flair Cor
5. #5 T1 Sag
6. #12 DW/SSH - for CVA, Acute infarct, TIA,
stroke
7. #6 Turbo T2 Sag – for MS
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
Routine Brain with Contrast
A. Clinical Indications
1. Meningitis
2. Leptomeningeal
carcinomatosis
3. Sarcoid
4. Brain
tumor
5. Metastatic
disease
6. New
onset seizure without history of trauma
7. Abscess
8. HIV
positive (toxoplasmosis, encephalopathy)
B. Patient Positioning
1. Head
coil
2. Supine
3. Center
at glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 PD/T2 Ax
4. #4 Flair Cor
5. Inject
6. #2 T1 Ax
7. #6 T1 Cor
8. #5 T1 Sag
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. Coronal
images should be filmed in scanning order
Epilepsy Seizure Work-Up
A. Clinical Indications
1. Complex
partial seizures
2. Mesial
temporal sclerosis
3. Onset
seizures
B. Patient Positioning
1. Head
coil
2. Supine
3. Center
at glabella
C. Scanning Sequences
1. All
ages
a. T1 and T2 thin Cor
2. Under Age 35
a. #1
Survey
b. #2
T1 Ax
c. #3 PD/T2 Ax
d. #4 Flair Cor
e. #5 T1 Sag
f. #10
T1 FFE Cor
g. #8 T2 Cor 2 mm
3. Over Age 35
a. #1
Survey
b. #2
T1 Ax
c. #3 PD/T2 Ax
d. #4 Flair Cor
e. #5 T1 Sag
f. #10
T1 FFE Cor
g. #8 T2 Cor 2 mm
h. Inject
i. #2 T1 Ax
j. #6 T1 Cor
k. #5 T1 Sag
D. Scanning
Parameters
see attached sheets
F. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. Include
thin T2 coronal images
6. T1
coronals
7. All
thin cut scans mag to size of head
History of Trauma
A. Clinical Indications
1. Subdural
hematoma
2. History
of subdural concussion
B. Patient Positioning
1. Head
coil
2. Supine
3. Center
at glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 PD/T2 Ax
4. #4 Flair Cor
5. #5 T1 Sag
6. Fast
Scan prn (see Fast Scan protocol)
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. T1
coronal images
Brain Stem
A. Clinical Indications
1. Attention
brain stem
2. Infarct
B. Patient Positioning
1. Head coil
2. Supine
3. Center at
glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 PD/T2 Ax
4. #4 Flair Cor
5. #5 T1 Sag
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. T2
sagittal scan
Posterior Fossa with Contrast
A. Clinical Indications
1. Brain
stem tumor
2. Foramen
magnum tumor
B. Patient Positioning
1. Head coil
2. Supine
3. Center at
glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 PD/T2 Ax
4. #4 Flair Cor
5. #17 T2 Cor 6 mm
6. Inject
7. #2 T1 Ax
8. #6 T1 Cor
9. #5 T1 Sag
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. T1
sagittal scans
A. Clinical Indications
1.
B. Patient Positioning
1. Head coil
2. Supine
3. Center at
glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 PD/T2 Ax
4. #4 Flair Cor
5. #5 T1 Sag (get as low
as possible)
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. T1
sagittal scan
Sella Turcica
A. Clinical Indications
1. Pituitary
micro/macroadenoma
2. Pituitary
tumor
3. Suprasellar
mass or hypothalamic lesion
4. History
of amenorrhea
5. Increased
prolactin levels
B. Patient Positioning
1. Start
intravenous line with long extension tubing as patient will not come out of the
scanner for the injection
2. Head coil
3. Supine
4. Center at
glabella
C. Scanning Sequences
1. #1 Survey
2. #2 PD/T2 Ax
3. #3 T1 Sag 3 mm
4. #4 T1 Cor 3 mm
5. Inject
6. #4 T1 Cor 3mm
7. #3 T1 Sag 3 mm
8. #5 T1 Ax 5 mm
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. Thin
sagittal and coronal images should be filmed at the same window levels with a mag factor of 2 centering at the sella turcica
Internal Auditory Canals - 7th
and 8th Cranial Nerves
7th - Facial Nerve 8th -
Cranial Nerve
A. Clinical Indications
1. Tinnitus
2. Acoustic
neuroma
3. Hearing
loss
4. Vertigo
5. Atypical
Bell's palsy
6. Bell's
palsy
B. Patient Positioning
1. Head coil
2. Supine
3. Center at
glabella
C. Scanning Sequences
1. #1 Survey
2. #2 PD/T2 Ax
3. #3 T1 Ax (thin)
4. Inject
5. #3 T1 Ax (thin)
6. #4 T1 Cor (thin)
7. #5 T1 Ax 5 mm
8. T1
Para sag
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. Thin
transverse and coronal scans should be similarly magnified to include the
entire posterior fossa and petrous bones.
Note: Use wide window levels so the petrous bones
are well visualized.
Cranial Nerves III, IV, V, VI
3rd - Occular motor 4th - Troclear 5th - Trigeminal 6th
- Abducens
A. Clinical Indications
1. Cranial
nerve palsies
B. Patient Positioning
1. Head coil
2. Supine
3. Center at
glabella
C. Scanning Sequences
1. Pituitary
Group
a. #1
Survey
b. #2
T2/PD Ax
c. #7 T1 Ax (thin)
d. Inject
e. #7 T1 Ax (thin)
f. #4
T1 Cor – 1
g. #5 T1 Ax 5 mm
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. Thin
T1 transverse and coronal should be similarly magnified to include cranial
nerves with wide windows.
6. T1
parasagittal images should be magnified x2 to best
visualize the facial nerve with wide windows
Orbits
A. Clinical Indications
1. Optic
neuropathy
2. Optic
tumor
3. Orbital
tumor
4. Proptosis
B. Patient Positioning
1. Head coil
2. Supine
3. Center at
glabella
C. Scanning Sequences
1. #1 Survey
2. #2 PD/T2 Ax 5 mm
3. #3 T1 Ax 3mm
4. Inject
5. #4 T1 Ax FS 3mm
6. #5 T1 Cor FS 3mm
7. #6 T1 Sag FS 3mm
8. #7 T1 Ax 5mm
D. Scanning
Parameters
see attached sheets
E. Filming
1. Transverse
scans: from foramen magnum to vertex
(bottom to top)
2. All
three sagittal localizers
3. Midline
localizer with lines representing study
4. Combine
last pd and T2 images on one page
5. Thin
transverse and coronals should be similarly magnified with windows wide enough
to see the entire orbital space and chiasm
Pediatric Brain (Under 2 years
of age)
A. Clinical Indications
1. Neurological
Work-up
B. Patient Positioning
1. All
patients to be sedated
2. Pulse
oxidation monitors should be hooked up to a toe and should face the scanning
console
3. Cardiac
monitoring can be done according to nursing or attending physician
4. Head
coil
5. Supine
with head in the middle of the coil
6. Center
at the glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Sag
3. #3 Dual TSE Ax
4. #4 Flair Cor
5. #5 T1 Ax
D. Scanning
Parameters
see attached sheets
E. Filming
1. Use
the same mag factor for all images and include
localizers on all sequences
Pediatric Brain (Over 2 years
of age)
A. Clinical Indications
1. Neurological
work-up
B. Patient Positioning
1. All
children 2-8 years of age should be sedated.
Older children may possibly need sedation depending on history and ability
to cooperate.
2. Head
coil
3. Supine
with the head in the center of the coil
4. Center
at the glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Sag
3. #3 Dual TSE Ax
4. #4 Flair Cor
5. #5 T1 Ax
D. Scanning
Parameters
see attached sheets
E. Filming
1. Use
the same mag factor for all images and include
localizers on all sequences
Pediatric Brain (with Contrast)
A. Clinical Indications
1. Tumor
2. Metastasis
3. Meningitis
4. Abscess
5. Neurofibromatosis
6. Tuberous
sclerosis
B. Patient Positioning
1. NO
children under the age of 2 years should receive gad unless OK'd by a staff
radiologist
2. All
children needing sedation should be sedated
3. Intravenous
lines should be placed
4. Head
coil
5. Supine
with the head in the middle of the coil
6. Center
at glabella
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Sag
3. #3 Dual TSE Ax
4. #4 Flair Cor
5. #5 T1 Ax
6. Inject
7. #5 T1 Ax
8. #2 T1 Sag
9. #6 T1 Cor
D. Scanning
Parameters
see attached sheets
E. Filming
1. Use
the same mag factor for all images and include
localizers on all sequences
Spine Survey
A. Clinical Indications
1. Metastatic
disease
2. Cord
compression
B. Patient Positioning
1. Body coil
2. Supine
3. 1st scan
- sternal notch
4. 2nd scan
- just below xyphoid process
C. Scanning Sequences
1. Upper
Survey
a. #1,2,3 Survey
b. #4
T1 Sag C&T
c. #5 T2 Sag C&T
2. Lower
Survey
a. #1,2,3 Survey
b. #6
T1 Sag T&L
c. #7 T2 Sag T&L
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen 2
format
2. Type date
on first image of each sequence
Routine Cervical Spine
A. Clinical Indications
1. Radiculopathy
2. Stenosis
3. Disc
Disease
4. Post-operative
for discectomy or fusion
B. Patient Positioning
1. Neck coil
2. Supine
3. Center at
Adam's apple
C. Scanning Sequences
1. #1,2,3 Survey
2. #4 T1 Sag
3. #6 T2 Sag
4. #9 T2W/FFE/3D
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen
2 format for sagittal T1 and T2 images. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse images. Combine both scans and arrange scans by bed
position. Use mag.
factor of 2.56. Type
date on first image of the scanning sequence. Include localizer without and with lines.
Cervical Spine
A. Clinical Indications
1. Myelopathy
2. Cord
infarct
3. Multiple
sclerosis
B. Patient Positioning
1. Neck coil
2. Supine
3. Center at
Adam's apple
C. Scanning Sequences
1. #1,2,3 Survey
2. #4 T1 Sag
3. #6 T2 Sag
4. #10 T2
TSE Ax
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen
2 format for sagittal T1 and T2 images. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse images. Combine both scans and arrange scans by bed
position. Use mag.
factor of 2.56. Type
date on first image of the scanning sequence. Include localizer without and with lines.
Cervical Spine with Contrast
A. Clinical Indications
1. Tumor
2. Myelopathy
3. Sarcoid
4. Infection
5. Drop
metastatic disease
B. Patient Positioning
1. Neck coil
2. Supine
3. Center at
Adam's apple
C. Scanning Sequences
1. #1,2,3 Survey
2. #4 T1 Sag
3. #6 T2 Sag
4. #10 T2 TSE Ax
5. #14 T1 Ax
6. Inject
7. #4 T1 Sag
8. #14 T1 Ax
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen
2 format for sagittal T1 and T2 images. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse images. Combine both scans and arrange scans by bed position. Use mag. factor of
2.56. Type date on
first image of the scanning sequence.
Include localizer without and with lines.
3. Pre-
and post-contrast images should have the same window width and center factors.
Thoracic Spine
A. Clinical Indications
1. Metastatic
disease
2. Disc
herniation
3. Post
trauma
B. Patient Positioning
1. Do spine
survey first
2. Elliptical
surface coil
3. Supine
4. Center at
area of disease seen on survey
C. Scanning Sequences
1. Set-up
off Spine Survey
a. #4
T1 Sag
b. #6
T2 Sag
c. #9 T1 Ax
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen
2 format for sagittal scans. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse scans. Use mag. factor of
2.37. Include localizer with lines.
Thoracic Spine with Contrast
A. Clinical Indications
1. Post-operative
2. Infection
3. Tumor
B. Patient Positioning
1. Do spine
survey first
2. Elliptical
surface coil
3. Supine
4. Center at
area of disease seen on survey
C. Scanning Sequences
1. Set-up on
Spine Survey
a. #4
T1 Sag
b. #6
T2 Sag
c. #9 T1 Ax
d. Inject
e. #4 T1 Sag
f. #9
T1 Ax
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen
2 format for sagittal scans. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse scans. Include localizer with the lines.
3. Pre-
and post-contrast scans should have the same window width and center
Routine Lumbar Spine
A. Clinical Indications
1. Spinal
stenosis
2. Radiculopathy
3. Herniated
nucleus pulposus
B. Patient Positioning
1. Elliptical
coil
2. Supine
3. Center at
iliac crest
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Sag
3. #3 T2 TSE Sag
4. #6 T2/PD Ax MSMA
D. Scanning
Parameters
see attached sheets
E. Filming
1. Screen
2 format for sagittal scans. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse images. use mag. factor of 2.29.
Include localizer with corresponding lines for each scan.
Lumbar
Spine with Contrast
A. Clinical Indications
1. Post-operative
study
2. Discitis
3. Infection
4. Tumor
B. IV Line Placement
1. Patient
needs an IV line placed so injection can be done without moving the patient.
C. Patient Positioning
1. Elliptical
coil
2. Supine
3. Center
at iliac crest
D. Scanning Sequences:
1. #1 Survey
2. #2 T1 Sag
3. #3 T2 TSE Sag
4. #6 T2/PD Ax MSMA
5. #7 T1 stack
6. Inject
7. #2 T1 Sag
8. #7 T1 stack
D. Scanning
Parameters
see attached sheets
F. Filming
1. Screen
2 format for sagittal scans. Type date on first image of
each scanning sequence.
2. Screen
4 format for transverse images. Use mag. factor of
2.29. Include localizer with
corresponding lines for the scan.
3. Pre-
and post-contrast scans should have the same window width and center factors.
Brachial
Plexus
A. Clinical Indications
1. Brachial
plexopathy
2. Horner's
syndrome
B. Patient Positioning
1. Neck
coil
2. Head
first
3. Supine
4. Center
at Adam's apple
C. Scanning Sequences
1. #1,2,3 Survey
2. #15 T1 Ax Brach
3. #16 T2 Ax Brach
4. #17 T1 Cor Brach
5. #18 T1 Sag Brach
6. Inject
per radiologist
7. #15 T1 Ax Brach
8. #17 T1 Cor Brach
9. #18 T1 Sag Brach
D. Scanning
Parameters
see attached sheets
E. Filming
1. Magnify
the transverse images reducing the mag factor when
you get to the apex of the chest so you can see laterally to the axillae.
2. Scroll
sagittal images so they will be centered on the screen.
3. Combine
last T1 and turbo T2 transverse images on one page.
Neck
A. Clinical Indications
1. Nasopharyngeal
carcinoma
2. Lymphadenopathy
3. Infection
4. Soft
tissue mass
B. Patient Preparation
1. Patient
to be examined by radiologist
C. Patient Positioning
1. Neck coil
2. Head
first
3. Supine
4. Center at
Adam's apple
D. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #3 T2 TSE Ax
4. #4 T1 Sag Neck
5. #5 T1 Cor Neck
6. Inject
7. #6 T1 SPIR Ax
8. #5 T1 Cor Neck
9. #4 T1 Sag Neck
D. Scanning
Parameters
see attached sheets
F. Filming
1. Magnify
transverse images using the same mag factor for the
T1 and T2 images.
Larynx
A. Clinical Indications
1. Laryngeal
Ca
2. Vocal
cord paralysis
B. Patient Positioning
1. Neck coil
2. Head
first
3. Supine
4. Center at
Adam's apple
C. Scanning Sequences
1. #1 Survey
2. #2 T1 Ax
3. #7 T1 thin Ax
4. #8 T2 TRA thin
5. #9 T1 Cor thin
6. Inject
7. #10 T1 TRA F5/3mm
8. #11 T1 Cor F5/3mm
D. Scanning
Parameters
see attached sheets
E. Filming
1. Magnify
transverse images using the same mag factor.
Acute Ischemic Brain
A. Indications
1. CVA
2. Infarct
3. Ischemia
4. Sudden
onset weakness
B. Patient Positioning
C. Scanning Sequences
1. Diffusion
2. Perfusion
3. Fast Spin
Echo
a. T1 transverse
b. T2 transverse dual echo
4. MRA
– carotids and COW as necessary
5. Falir – fast
D. Scanning
Parameters
see attached sheets
E. Filming
Uncooperative Patient
A. Indications
1. Claustrophobia
2. Demented
patient
3. Uncontrolled
movement disorder
4. Non-sedated
(for medical reasons)
B. Patient Positioning
C. Scanning Sequences
1. Fast T1
sagittal
2. Fast T1
axial S.E.
3. Fast dual
PD and T2 fast S.E.
D. Scanning
Parameters
see attached sheets
E. Filming