MSKMSK MRIMRI PROTOCOLSPROTOCOLS ContentsContents
► Upper Extremity Page ► Shoulder ► Elbow ► Wrist ► Finger ► Thumb ► Lower Extremity ► Hip ► Pelvis ► Thigh ► Knee ► Lower Extremity/Shin ► Ankle ► Foot ► Special Cases ► Soft Tissue Mass ► Metal Protocol MSKMSK CHESTCHEST MRMR MSKMSK ChestChest Indications:Indications:
►►PectoralisPectoralis MajorMajor Indications:Indications: ►PecPec teartear ►►SternumSternum // SCSC jointsjoints Indications:Indications: ►Tumor,Tumor, infection,infection, arthritis,arthritis, traumatrauma ►►ChestChest wallwall Indications:Indications: ►Trauma,Trauma, tumortumor PectoralisPectoralis MajorMajor ►►UseUse largelarge FOVFOV MedialMedial--lateral:lateral: covercover toto midlinemidline chestchest SuperiorSuperior--inferior:inferior: covercover downdown toto midmid--humeralhumeral shaftshaft
FOV PectoralisPectoralis MajorMajor Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Axial 30-36 256 x 256 4/0.5 400-800 min - - - 16 T1 1
Axial 30-36 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70
Axial 30-36 256 x 256 4/0.5 >2000 80-100 - - 8 16 T2 FSE 2
Cor Obl 36-48 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70
Sag 30-36 256 x 192 4/1 >2000 40-60 - - 8 16 Oblique 2 T2 FSE Fat Sat SternumSternum Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Axial 20-24 256 x 256 4/0.5 400-800 min - - - 16 T1 1
Axial 24 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70
Sag 20-30 256 x 256 4/0.5 400-800 min - - - 16 T1 2
Sag 20-30 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70
Cor 20-24 256 x 192 4/1 >2000 40-60 - - 8 16 oblique 2 T2 FSE ►►Coronal:Coronal: obliqueoblique alongalong sternumsternum PlannedPlanned fromfrom sagittalsagittal imagesimages SternoclavicularSternoclavicular jointsjoints
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Axial 14-20 256 x 256 4/0.5 400-800 min - - - 16 T1 1
Axial 14-20 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70
Sag 20-24 256 x 256 4/0.5 400-800 min - - - 16 T1 2
Sag 20-24 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70
Cor 14-20 256 x 192 4/1 >2000 40-60 - - 8 16 T2 FSE 2 ►►SmallerSmaller FOVFOV forfor SCSC jointsjoints OtherwiseOtherwise protocolprotocol isis similarsimilar toto SternumSternum MSKMSK -- ChestChest WallWall UPPERUPPER EXTREMITYEXTREMITY MRMR ShoulderShoulder Indications:Indications:
► RoutineRoutine ShoulderShoulder Indications:Indications: ► Rotator Cuff Pathology/Evaluation ► MRMR ArthrogramArthrogram Indications:Indications: ► Labrum Pathology/Tear ► PostPost GadoliniumGadolinium ShoulderShoulder (Indirect(Indirect MRMR Arthrogram)Arthrogram) Indications:Indications: ► Labral Pathology/Instability without ability to do a direct arthrogram ShoulderShoulder--RoutineRoutine Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Axial 12-14 512 x 256 4/0.5 2000- 20-40 - - 8 16 PD FSE 2 3000 FatSat
Cor 16-18 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 Oblique 2 1.5T: 150 FSTIR 0.7T 100 0.3T: 70
Cor 16-18 256 x 256 4/0.5 400-800 minimum - - 16 Oblique 1 T1 SE Non FatSat Sag 14-16 256 x 192 4/1 >2000 90-110 - - 8 16 Oblique 1 T2 FSE Non Fat Sat MRMR ArthrogramArthrogram ShoulderShoulder Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Axial 12-14 256 x 192 3/0.5 400-800 minimum 16 T1 SE 2 FatSat
Cor 14-16 256 x 192 3/0.5 400-800 minimum 16 Oblique 2 T1 SE FatSat Cor 14-16 256 x 192 3/0.5 >1500 30-50 8 16 Oblique 2 PD FSE FatSat Sag 14 256 x 192 4/1 400-800 minimum 16 Oblique 1 T1 SE Non FatSat ABER 14 256 x 192 3/0.5 400-800 minimum 16 T1 SE 2 Fat Sat ShoulderShoulder--PostPost GadoliniumGadolinium (Indirect(Indirect MRMR Arthrogram)Arthrogram) **Inject standard dose of IV contrast and wait 20 minutes before scanning** Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Axial 12-14 256 x 192 3/0.5 400-800 minimum 16 T1 SE 2 FatSat
Axial 12-14 256 x 192 3/0.5 2000- 30-50 8 PD FSE 2 4000 FatSat
Cor 14-16 256 x 192 3/0.5 400-800 minimum 16 Oblique 2 T1 SE FatSat Sagittal 14-16 256 x 192 4/1 2000- 30-50 8 PD FSE 2 4000 FatSat
Cor 16-18 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16 Oblique 2 1.5T: 150 FSTIR 0.7T 100 0.3T: 70 ShoulderShoulder--AxialAxial ImagingImaging PlanePlane
Relevant Anatomy Axial Imaging Plane Prescribe plane parallel to humeral shaft. Cover from top of AC joint through proximal humeral diaphysis.
Clavicle
AC Joint Humeral (Not shown on MR) Head
Bony Glenoid ShoulderShoulder--CoronalCoronal ImagingImaging PlanePlane
Relevant Anatomy Coronal Imaging Plane Prescribe coronal plane off of axial images parallel to supraspinatus muscle
S up ra sp in at us ShoulderShoulder--SagittalSagittal ImagingImaging PlanePlane
Relevant Anatomy Sagittal Imaging Plane Prescribe sagittal plane off axial images with line parallel to bony glenoid. Image from mid-scapula through deltoid muscle.
Deltoid Muscle Cartilaginous Labrum Ant. and Post. Humeral Head
Bony Glenoid Labrum MRMR ElbowElbow Indications:Indications:
► RoutineRoutine ElbowElbow Indications: ► Biceps/Triceps tear ► Medial/Lateral collateral ligament tear ► Common Flexor/Common extensor tendon pathology ► MRMR ArthrogramArthrogram ElbowElbow Indications: ► Intra articular body evaluation ► Medial/Lateral Collateral Ligament Evaluation ► Osteochondral defect (OCD) ► PostPost GadoliniumGadolinium ElbowElbow (Indirect(Indirect MRMR arthrogram)arthrogram) Indications: ► IA body ► OCD ElbowElbow--Routine*Routine*
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Axial 12-14 256 x 256 4/1 400-800 minimum 16 T1 1
Axial 14-16 256 x 192 4/1 >2000 20-40 3.0T: 180 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70 Coronal 14-16 256 x 256 3/0.5 400-800 minimum 16 T1 1
Coronal 14-16 256 x 256 3/0.5 > 1500 20-40 8 16 PD FSE 2 FatSat
Sag 12-14 256 x 256 3/0.5 1500- 20-40 8 16 PD FSE 2 3000 FatSat
*for Biceps pathology perform FABS sequence; follow this link. MRMR ArthrogramArthrogram ElbowElbow Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Axial 12-14 256 x 256 4/1 400-800 minimum 16 T1 1 Non FatSat Axial 12-14 256 x 256 4/1 >1500 30-50 8 16 PD FSE 2 FatSat
Coronal 12-14 256 x 256 3/0.5 400-800 minimum 16 T1 2 FatSat Coronal 12-14 256 x 256 3/0.5 >1500 30-50 8 16 PD FSE 2 FatSat
Sag 12-14 256 x 256 3/0.5 400-800 minimum 16 T1 SE 2 FatSat ElbowElbow--AxialAxial ImagingImaging PlanePlane
Axial Imaging Plane Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©). Scan from humeral metaphysis through radial tuberosity.
Lateral and Medial Humeral Condyles *
Radial Tuberosity (bump on medial radius) © ©
Radius Ulna
Radial tuberosity * ElbowElbow--CoronalCoronal ImagingImaging PlanePlane
Coronal Imaging Plane Relevant Anatomy *Prescribe plane parallel to medial and lateral epicondyles.
Lateral Epicondyle
*
H u me ru s
* Medial Olecranon process Epicondyle of Ulna ElbowElbow--SagittalSagittal ImagingImaging PlanePlane
Sagittal Imaging Plane Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©). Scan through entire elbow.
Lateral Humeral Condyle * ©
H u Medial Humeral Condyle me ru s
* ©
Olecranon process of Ulna FABSFABS SequenceSequence ►►ForFor BicepsBiceps pathologypathology AcquireAcquire T1T1 andand T2T2 FSFS WristWrist Indications:Indications:
► RoutineRoutine WristWrist Indications: ► TFCC, Lunotriquetral, Scapholunate tear ► Flexor Tendon/Carpal Tunnel/ Extensor Tendon Pathology ► Evaluation for Occult fracture ► MRMR WristWrist ArthrogramArthrogram Indications: ► TFCC/LT/SL ligament tears ► DynamicDynamic EnhancedEnhanced WristWrist (Post(Post GadGad Images)Images) Indications: ► Evaluation of Scaphoid Nonunion/Avascular Necrosis Exam: IMPORTANT: **Perform routine wrist PLUS Pre/Post Gadolinium images through carpal bones in coronal plane** WristWrist--RoutineRoutine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 8-12 256 x 256 3/0.5 400-800 minimum 16 T1 1
Coronal 8-12 256 x 256 3/0.5 >1500 30-50 8 16 PD FSE 2 FatSat
Coronal 10-12 256 x 192 1/0 60 minimum 20-40 16 2D or 3D 2 GRE FatSat Axial 8-12 256 x 256 3/1 2000- 30-50 8 16 PD FSE 2 3000 Fat Sat
Sag 12-14 256 x 192 3/1 >1500 20-40 3.0T: 180 8 16 FSTIR 2 1.5T: 150 0.7T 100 0.3T: 70 MRMR ArthrogramArthrogram WristWrist (direct(direct oror indirect)indirect) Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Coronal 8-10 256 x 256 3/0.5 400-800 minimum 16 T1 SE 2 FatSat
Coronal 8-12 256 x 256 3/0.5 >1500 30-50 8 16 PD FSE 2 FatSat
Coronal 10-12 256 x 192 1/0 60 minimum 45-60 16 2D or 3D 2 GRE FatSat Axial 8-12 256 x 256 3/1 >1500 30-50 8 16 PD FSE 2 FatSat
Axial 8-12 256 x 192 3/1 400-800 minimum 16 T1 1 Non- FatSat Sag 10-12 3/1 >1500 30-50 8 16 PD FSE FatSat WristWrist--AxialAxial ImagingImaging PlanePlane ***IMAGE WRIST IN PRONATED POSITION!
SUPINATED PRONATED
Axial Imaging Plane Relevant Anatomy Prescribe plane parallel to distal radius. Scan from proximal metacarpals through distal radial/ulnar metaphysis.
trapz ham trapm cap q i r s t ca ph lun
Dist Distal radius ulna WristWrist--CoronalCoronal ImagingImaging PlanePlane
Remember to pronate the wrist!
Relevant Anatomy Coronal Imaging Plane *Prescribe plane parallel to line drawn from ulnar styloid through radial styloid. Scan through entire wrist.
Radial Ulnar Styloid Styloid
** WristWrist--SagittalSagittal ImagingImaging PlanePlane
Sagittal Imaging Plane Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©). Scan through entire wrist.
Radial Ulnar Styloid © Styloid
* *
© Hint: if the ulnar styloid is poking out to the side, the wrist is in pronated position ThumbThumb Indications:Indications:
►►RoutineRoutine ThumbThumb Indications:Indications: ►GamekeeperGamekeeper’’ss thumbthumb ((UlnarUlnar CollateralCollateral LigamentLigament tear)tear) ►Flexor/ExtensorFlexor/Extensor TendonTendon TearTear ►R/OR/O OccultOccult FractureFracture ThumbThumb Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 10 256 x 256 3/0.3 >1500 30-50 4 PD FSE 2
Coronal 10 256 x 192 3/0.3 2000- 50-70 8 16 T2 FSE 2 6000 Fat Sat
Sag FSE 10-14 256 x 192 3/0.3 >1500 20-40 3.0T: 180 8 16 STIR 2 1.5T: 150 0.7T 100 0.3T: 70 Axial 10 256 x 192 3/0.3 400-800 minimal T1 SE 1
Axial 10 256 x 192 3/0.3 2000- 50-70 8 16 T2 FSE 2 6000 Fat Sat ThumbThumb--AxialAxial ImagingImaging PlanePlane
Axial Imaging Plane Prescribe plane perpendicular to midshaft of Relevant Anatomy proximal 1st phalanx. Scan from CMC joint through thumb.
IP int anx Jo hal al P xim Pro
P MC int Jo al arp tac Me
C CM nt Joi ThumbThumb--CoronalCoronal ImagingImaging PlanePlane Coronal Imaging Plane *Prescribe plane with line bisecting sesamoid bones. Scan through entire thumb.
Relevant Anatomy
*
Sesamoids
Thumb ThumbThumb--SagittalSagittal ImagingImaging PlanePlane
Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal imaging plane (©). Scan through entire thumb.
© Sesamoids
* Thumb FingerFinger Indications:Indications:
► RoutineRoutine FingerFinger Indications:Indications: ► Pulley rupture/Flexor or Extensor Tendon Injury ► PostPost GadoliniumGadolinium FingerFinger Indications:Indications: ► Mass ► **Perform routine finger plus Axial and either Coronal or Sagittal (whichever plane mass best seen) pre/post gadolinium FatSat fast GRE or T1 SE images. See “mass” protocol and adjust FOV and other parameters as needed. FingerFinger--RoutineRoutine Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sag 10 256 x 192 3/0.3 400-800 minimum 16 T1 SE 1
Sag 10 256 x 192 3/0.3 2000- 50-70 8 16 T2 FSE 2 6000 FatSat
Axial 10 256 x 192 3/0.3 400-800 minimum 16 T1 SE 2
Axial 10 256 x256 3/0.3 2000- 30-50 4 16 PD FSE 2 6000 FatSat
Coronal 10-14 256 x256 3/0.3 >1500 20-40 3.0T: 180 8 16 STIR 2 1.5T: 150 0.7T 100 0.3T: 70 FingerFinger--AxialAxial ImagingImaging PlanePlane
Relevant Anatomy
Distal Phalanx
Mid Phalanx Axial Imaging Plane Prescribe best fit line. Scan from Proximal proximal metacarpal through entire Phalanx finger.
Metacarpal FingerFinger--CoronalCoronal ImagingImaging PlanePlane
Relevant Anatomy Coronal Imaging Plane *Prescribe plane parallel to anterior metacarpal head. Scan through entire Extensor Tendon finger. Include 2 adjacent fingers.
*
Thumb FingerFinger--SagittalSagittal ImagingImaging PlanePlane
Sagittal Imaging Plane Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©). Scan through entire Extensor Tendon finger. Include 2 adjacent fingers.
©
Thumb
* LOWERLOWER EXTREMITYEXTREMITY BonyBony pelvispelvis ► Indication:Indication: AVN,AVN, Mets,Mets, transienttransient osteoporosis,osteoporosis, bursitis,bursitis, arthriarthritis,tis, tendonitis,tendonitis, hiphip painpain overover ageage 5050 ► PAPA TorsoTorso CoilCoil isis 11st choicechoice
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Coronal 36-40 256x192 4/1 >2000 20-40 150 8 16 FSE-STIR 2-3
Axial 36-40 256 x 256 5/1.5 3000 30-40 8 16 T2 FSE 2 FatSat
Coronal 36-40 256 x 256 4/1 400-800 Minimum 16 T1 SE 1 Non FatSat
Sag 12-16 256 x 256 5/1 >2000 40-50 8 16 T2 FSE 1-2 FatSat (Hip to Hip)
Coronal in/out of phase T1 GRE ERER HipHip (Hip(Hip fracturefracture screening)screening)
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16 FSE-STIR 2 1.5T: 150 0.7T 100 0.3T: 70 Coronal 36-40 256 x 256 4/1 400-800 Minimum 16 T1 SE 1 Non FatSat
Axial 36-40 256 x 256 4/1 >2000 80-110 8 16 T2 FSE 2 FatSat DirectDirect arthrogramarthrogram hiphip ► Indication: hip labrum tear, FAI or dysplasia, hip pain under age 50 ► PA Torso coil is 1st choice ► Prescribe obliques along femoral neck from coronal localizer
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal (PELVIS) 36-40 256 x 256 4/1 400-800 Minimum 16 T1 SE 1 Non FatSat Coronal (PELVIS) 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16 FSE-STIR 2 1.5T: 150 0.7T 100 0.3T: 70 Axial (PELVIS) 36-40 256 x 256 4/1 >2000 40-50 8 16 T2 FSE 2 FatSat
Ax oblique (HIP) 14-20 384 x 256 4/0.5 400-800 Minimum 16 T1 FatSat 2
Coronal (HIP) 14-20 384 x 256 4/0.5 400-800 Minimum 16 T1 FatSat 2
Sag (HIP) 14-16 384 x 256 4/0.5 400-800 Minimum 16 T1 FatSat 2 NoncontrastNoncontrast hiphip
► Indication: Unilateral hip pain ► PA Torso coil is 1st choice ► Prescribe ax obliques along femoral neck from coronal localizer
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal (PELVIS) 36-40 256 x 256 4/1 400-800 Minimum 16 T1 SE 1 Non FatSat Coronal (PELVIS) 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16 FSE-STIR 2 1.5T: 150 0.7T 100 0.3T: 70 Axial (PELVIS) 36-40 256 x 256 4/1 >2000 40-50 8 16 T2 FSE 2 FatSat
Ax oblique (HIP) 14-20 384 x 256 4/1 >2000 30-40 8 16 PD FSE 2 FatSat Coronal (HIP) 14-20 384 x 256 4/1 >2000 40-50 8 16 PD FSE 2 FatSat Sag (HIP) 14-16 384 x 256 4/1 >2000 40-50 8 16 PD FSE 2 FatSat MARSMARS (Metal(Metal ArtifactArtifact ReductionReduction Sequences)Sequences) –– HipHip ExamExam Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Coronal 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 64 FSE-STIR 2 1.5T: 150 0.7T 100 0.3T: 70 Coronal 36-40 256 x 256 4/1 400-800 Minimum 64 T1 SE 1 Non FatSat Axial 36-40 256 x 256 4/1 >2000 50-70 8 64 T2 FSE 2
Axial (HIP) 14-20 384 x 256 4/1 >2000 30-40 8 16 PD FSE 2
Coronal (HIP) 14-20 384 x 256 4/1 >2000 40-50 8 16 PD FSE 2 FatSat
Sag (HIP) 14-16 384 x 256 4/1 >2000 40-50 8 16 PD FSE 2 FatSat HipHip--AxialAxial ImagingImaging PlanePlane
Axial Imaging Plane Relevant Anatomy Prescribe plane parallel line bisecting lesser trochanters and/or acetabular roofs. Scan from iliac crests through lesser trochanter.
Ilium Acetabular Roof
Greater Trochanter
Lesser Trochanter HipHip--CoronalCoronal ImagingImaging PlanePlane
Coronal Imaging Plane Relevant Anatomy *Prescribe plane parallel femoral heads. Scan from ischium through pubic symphyses.
Superior Pubic Ramus Femoral Neck
*
Femoral Head
Ischium
Greater Trochanter HipHip--SagittalSagittal ImagingImaging PlanePlane
Sagittal Imaging Plane Relevant Anatomy *Prescribe plane perpendicular to coronal plane. Scan from acetabulum through greater trochanter.
Superior Pubic Ramus Femoral * Neck
Femoral Head
Ischium
Greater Trochanter AxialAxial ObliqueOblique ImagingImaging PlanePlane (For Femoracetabular Impingement Patients Only)
Axial Oblique Plane Relevant Anatomy Prescribe plane parallel to femoral neck. Scan through entire femoral neck.
Femoral Femoral Head Neck TJUHTJUH AthleticAthletic PubalgiaPubalgia MRMR ProtocolProtocol
► Indication: Athletic Pubalgia, Sports Hernia, Sportsman’s Hernia, Adductor tear/strain, Rectus Abdominis Injury ► PA Torso coil is 1st choice ► Prescribe obliques along anterior iliac crest from sagittal localizer
Seq. FOV Matrix/NEX Slice TR TE TI ETL BW
Coronal 28-36 256x192 4/1 >2000 20-40 150 8 16 STIR (Both hips) 2-3 Coronal 28 256x256 4/1 400-800 minimum 16 T1 SE (Both hips) 1-2 Axial T2 FSE 28 256x256 5/1 >2000 50-60 8 16 Fat Sat (Both hips) 2-3 Axial Obl PD FSE 20 256x192 4/.5 3000 25-30 4 16 (max) Nonfatsat 1-2 Axial Obl T2 FSE 20 256x192 4/.5 >2000 50-60 8 16 Fat Sat 2-3 Sag T2 FSE 20-22 256x192 4/.5 >2000 50-60 8 16 Fat Sat 2-3 Sag PD FSE 20-22 256x256 4/.5 >2000 20-30 8 16 Nonfatsat 2-3 (optional) AxialAxial ObliqueOblique ImagingImaging PlanePlane (Adductor(Adductor unfoldingunfolding plane)plane)
Axial Oblique Imaging Plane *Prescribe plane to line paralleling anterior Relevant Anatomy Iliac crest*. Be sure to scan across pubic symphysis at midline
t s * re c c ia Il
Hip joint * AxialAxial ObliqueOblique ImagingImaging PlanePlane (Adductor(Adductor unfoldingunfolding plane)plane) BonyBony PelvisPelvis (Special(Special Cases)Cases) *Follow*Follow HipHip Planes*Planes*
► PostPost GadoliniumGadolinium PelvisPelvis Indications:Indications: ► Osteomylitis IMPORTANT:IMPORTANT: ► Same as Routine Hip Protocol but perform axial and coronal images on both sides. ► In addition, perform FMPSPGR fat saturated images pre/post in both axial and coronal planes. ► In/OutIn/Out ofof PhasePhase PelvisPelvis Indications:Indications: ► Possible Bony Metastases IMPORTANT:IMPORTANT: ► Perform In/Out of Phase images in Coronal Plane BonyBony PelvisPelvis OsteoOsteo –– pre/postpre/post optionoption
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Coronal 30-45 256 x 192 4/1 400-800 minimal 16 T1 Non FatSat Coronal 30-45 256 x 192 4/1 >2000 20-40 8 16 STIR
Axial 30-45 256 x 192 4/1 400-800 minimal 16 T1 Non FatSat Axial 30-45 256 x 256 4/1 2000- 60-70 8 16 T2 FSE 6000 FatSat
Sag 20 256 x 256 4/1 2000- 50? 8 16 T2 FSE 6000 (60-70) FatSat
Axial/Cor 12 256 x 192 3/.5 50 5 30-40 8 16 FMPSPGR FatSat Pre/Post SacrumSacrum –– SacroiliacSacroiliac jointsjoints Indications: Possible Sacroileitis (Septic/Rheumatoid or Rheumatoid Variant Arthritis) Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 30-45 256 x 192 4/1 >2000 20-40 8 16 STIR
Axial 30-45 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat
Cor Oblique 18-22 256 x 256 3/.5 400-800 minimal T1 SE Non FatSat
Cor Oblique 18-22 256 x 256 3/.5 >1500 70-80 8 16 T2 FSE FatSat
Sag 18-22 256 x 256 3/.5 >1500 70-80 8 16 T2 FSE FatSat
Axial 18-22 256 x 256 3/.5 400-800 minimal T1 SE Non FatSat SacrumSacrum –– SacroiliacSacroiliac jointsjoints ► PrescribingPrescribing thethe coronalcoronal obliqueoblique plane:plane: parallelparallel thethe sacrumsacrum onon aa sagittalsagittal localizerlocalizer RoutineRoutine ThighThigh (Follow(Follow HipHip ImagingImaging Planes)Planes)
►►RoutineRoutine ThighThigh Indications:Indications: ►PolymyositisPolymyositis/Diabetic/Diabetic MyonecrosisMyonecrosis ThighThigh--RoutineRoutine Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 40 256 x 192 4/1 400-800 minimal 16 T1 SE Non FatSat Coronal 40 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat
Sag 26 256 x 192 4/1 >2000 20-40 150 8 16 STIR
Axial SE 26 256 x 192 4/1 400-800 minimal 16 T1 Non FatSat Axial 26 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat KneeKnee IndicationsIndications
► RoutineRoutine KneeKnee Indications:Indications: ► Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL ► DirectDirect ArthrogramArthrogram Indications:Indications: ► Meniscal Re-tear ► Intra articular Body ► PostPost GadoliniumGadolinium KneeKnee IndicationsIndications ► Meniscal Re-tear IMPORTANT:IMPORTANT: ImageImage 2020 minutesminutes postpost gadoliniumgadolinium KneeKnee--RoutineRoutine Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sag 14-16 512 x 256 4/0.5 3000 15-20 8 16 PD FSE 2 NonFatSat
Sag 14-16 256 x 256 4/0.5 2000 70-80 8 16 T2 FSE 2 FatSat
Cor 16-18 256 x 192 3/0.5 400-800 Minimal 16 T1 SE 1 Non FatSat Coronal 16-18 256 x 256 3/0.5 >2000 70-80 8 16 T2 FSE 2 Fat Sat
Axial 14-16 256 x 256 3/0.5 >2000 70-80 8 16 T2 FSE 2 FatSat MRMR ArthrogramArthrogram KneeKnee (dir(dir oror indind)) Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sag 14-16 256 x 192 4/1 400-800 Minimal 16 T1 Se FatSat
Sag 14-16 512 x 256 4/0.5 3000 15-20 8 16 PD FSE 2 NonFatSat
Coronal 16-18 256 x 256 4/1 >1500 70-80 8 16 T2 FSE 2 FatSat
Coronal 16-18 256 x 192 4/1 400-800 Minimal 16 T1 SE 1 FatSat
Axial 14-16 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat Axial 14-16 256 x 192 4/1 400-800 Minimal 16 T1 SE FatSat KneeKnee--AxialAxial ImagingImaging PlanePlane
Relevant Anatomy Axial Imaging Plane Image from distal quad tendon through patellar tendon insertion
Distal Quadriceps tendon
P A T Femur
Patellar Tendon Insertion Tibia KneeKnee--CoronalCoronal ImagingImaging
Coronal Imaging Plane Relevant Anatomy Prescribe plane with line parallel to femoral condyles. Image entire knee.
Patella
Med Lat Fem Fem Condyle Condyle KneeKnee--SagittalSagittal ImagingImaging PlanePlane
Sagittal Imaging Plane Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©). Scan from the medial to the lateral femoral condyle.
Patella
Med Lat Fem Fem * Condyle Condyle
© ©
* LowerLower Extremity/ShinExtremity/Shin
►►Indication:Indication: ShinShin SplintsSplints ►►IMPORTANT:IMPORTANT: AcquireAcquire coronalcoronal andand axialaxial (STIR)(STIR) sequencessequences coveringcovering bothboth shins,shins, butbut sagittalsagittal andand axialaxial (t2(t2 FatSatFatSat onlyonly ofof sideside inin questionquestion PlacePlace aa markermarker onon painpain // tendernesstenderness LowerLower Extremity/ShinExtremity/Shin AreaArea Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 35-40 256 x 256 4/1 400-800 minimal 16 T1 SE Non FatSat Coronal 35-40 256 x 192 4/1 >2000 20-40 150 8 16 STIR
Axial 35-40 256 x 192 4/1 >2000 20-40 150 8 16 STIR
Axial 14-16 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat (through marker region) Sag 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat AnkleAnkle IndicationsIndications
►►RoutineRoutine AnkleAnkle LigamentLigament Sprain/TendonSprain/Tendon pathology/Tarsalpathology/Tarsal Tunnel/SinusTunnel/Sinus Tarsi/OccultTarsi/Occult fracture,fracture, PTT,PTT, PlantarPlantar fasciitisfasciitis ►►AnkleAnkle ArthrogramArthrogram Indications:Indications: ►IntraIntra--articulararticular BodyBody ►►PostPost GadoliniumGadolinium AnkleAnkle AnkleAnkle--RoutineRoutine Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sag 16-18 256 x 256 3/1 400-800 Minimal 16 T1 SE 1 Non FatSat Sag 16-18 256 x 192 3/1 >1500 40 120 90 8 16 STIR 3
Axial 14-16 384 x 256 4/1 3000 40 8 16 PD FSE 2 Non FatSat Axial 14-16 256 x 256 4/1 >2000 70-80 8 16 T2 FSE 2 FatSat
Coronal 14 256 x 256 3/1 >2000 40-55 8 16 T2 FSE 3 FatSat MRMR ArthrogramArthrogram AnkleAnkle (dir(dir oror indind)) Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sag 16 256 x 192 4/1 400-800 minimal 16 T1 SE FatSat
Sag 18 256 x 192 4/1 >2000 20-40 150 8 16 STIR
Axial 14 256 x 256 4/1 800 min 16 T1 SE FatSat
Axial 14-16 513 x 256 4/1 3000 40 8 16 PD FSE 2 Non FatSat Coronal 14 256 x 192 4/1 400-800 minimal 16 T1 SE FatSat
Coronal 14 256 x 256 4/1 >1500 70-80 8 16 T2 FSE FatSat AnkleAnkle--PostPost ContrastContrast Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Axial 14 256 x XX 200 ? 4 ? 16 FMPSPGR FatSat Pre/Post Sag 16 256 x 192 4/1 400-800 minimal 16 T1 SE Non FatSat
Axial 12 256 x 256 4/1 ?800 Minimal 16 T1 SE FatSat
Axial 14 256 x 256 4/1 >2000 40-50 4 16 PD FSE FatSat
Cor 14 256 x 256 4/1 400-800 minimal 16 T1 SE FatSat AnkleAnkle--AxialAxial ImagingImaging PlanePlane
Axial Imaging Plane Relevant Anatomy Prescribe plane parallel to axis of calcaneus. Scan ankle from distal tibia through subcutaneous soft tissues (include plantar fascia).
Tibia
Talus
Calcaneus
Black band is plantar fascia AnkleAnkle--CoronalCoronal ImagingImaging PlanePlane
Coronal Imaging Plane Prescribe plane perpendicular Relevant Anatomy to axial imaging plane. Scan ankle from calcaneus through metatarsal bases.
Talus
M E T A Calcaneus T A Cuboid R S A L S AnkleAnkle--SagittalSagittal ImagingImaging PlanePlane
Sagittal Imaging Plane Relevant Anatomy Prescribe plane with line parallel to talus. Cover ankle from medial through lateral malleolus.
d Me l Ma s Talu
Lat l Ma
h Ac MidfootMidfoot ForefootForefoot FootFoot--IndicationsIndications
► RoutineRoutine FootFoot IndicationsIndications ► Plantar Plate Injury, R/O fracture, Lisfranc injury, tarsal/metatarsal fracture ► PostPost GadoliniumGadolinium FootFoot Indications:Indications: ► Morton’s Neuroma ► Osteomyelitis IMPORTANT:IMPORTANT: PerformPerform routineroutine footfoot plusplus coronalcoronal FMPSPGRFMPSPGR fatfat saturatedsaturated prepre andand postpost gadgad imagesimages andand axialaxial POSTPOST gadgad FMPSPGRFMPSPGR fatfat saturatedsaturated images.images. FootFoot--RoutineRoutine Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Coronal 10 256 x 256 3/0.5 400-800 minimal 16 (short axis) 1 T1 Non FatSat Coronal 10 256 x 256 3/0.5 >2000 70-80 8 16 (short axis) 2 T2 FSE FatSat Sag 12-14 256 x 192 3/0.5 >1500 40 120 90 8 16 STIR 3
Sag 12-14 256 x 256 3/0.5 400-800 minimal 16 T1 1 Non FatSat Axial 12-14 256 x 256 3/0.5 >2000 30 8 16 (long axis) 2 PD FSE Non FatSat Axial 12-14 256 x 256 3/0.5 >2000 90 8 16 (long axis) 2 T2 FSE FatSat FootFoot--Mass/OsteomyelitisMass/Osteomyelitis Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Coronal 10-12 256 x 256 3/0.5 400-800 minimal 16 T1 SE 1 Non FatSat Coronal 10-12 256 x 192 3/0.5 >2000 70-80 8 16 T2 FSE 2 FatSat Sag 12-14 256 x 192 3/0.5 >1500 40 120 90 8 16 STIR 2
Sag 12-14 256 x 256 3/0.5 400-800 minimal 16 T1 1 Non FatSat Coronal 10-12 256 x 192 3/.5 60 5 30-40 8 16 FMPSPGR 2 FatSat Pre/Post Axial 10-12 256 x 192 3/.5 60 5 30-40 8 16 FMPSPGR 2 FatSat Post FootFoot--AxialAxial ImagingImaging PlanePlane
Relevant Anatomy Axial Imaging Plane Prescribe plane parallel to 2rd or 3rd metatarsal. Scan foot from navicular through phalanges.
N C A U V Phalanges l sa N ar at et nd m 2 FootFoot--CoronalCoronal ImagingImaging PlanePlane
Relevant Anatomy Coronal Plane *Prescribe plane parallel to 1st and 5th metatarsal Shafts. Scan through entire foot.
Metatarsals
* 2 1 3 4 5 FootFoot--SagittalSagittal ImagingImaging PlanePlane
Relevant Anatomy Sagittal Plane *Prescribe plane perpendicular to coronal Plane (©). Scan through entire foot.
Metatarsals © * 2 * 1 3 4 5
© * SoftSoft TissueTissue MassMass ProtocolProtocol GeneralGeneral RecommendationsRecommendations
►►PlacePlace VitaminVitamin EE capsulecapsule LIGHTLYLIGHTLY onon skinskin (do(do notnot depressdepress skinskin withwith capsule)capsule) IfIf postpost--operative:operative: placeplace markersmarkers atat eacheach endend ofof surgicalsurgical scarscar ►►FOVFOV determineddetermined byby massmass sizesize // locationlocation ►►TryTry toto includeinclude adjacentadjacent jointjoint forfor referencereference ►►AxialAxial always;always; SagSag oror CorCor dependingdepending onon locationlocation ofof massmass (speak(speak withwith radiologist)radiologist) SoftSoft TissueTissue MassMass Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Axial 256 x 192 5/1 400-800 minimum 16 T1 SE Non FatSat
Axial 256 x 192 5/1 >2000 40-60 8 16 T2 FSE FatSat
Sag or Cor 256 x 192 5/1 400-800 minimum 16 T1 SE Non FatSat
Sag or Cor 256 x 192 5/1 >2000 30-40 150 8 16 STIR
Axial T1 GRE 256 x 192 5/1 60 5 30-40 8 16 or SE FatSat Pre/Post Gd 400-800 minimum -
Sag or Cor 256 x 192 5/1 60 5 30-40 8 16 T1 GRE or SE FatSat 400-800 minimum - Pre/Post Gd MetalMetal ProtocolProtocol –– generalgeneral recommendationsrecommendations
►►AssessAssess severityseverity ofof artifactartifact onon scoutscout –– discussdiscuss withwith MSKMSK radiologistradiologist ►►MaximizeMaximize BWBW (bandwidth)(bandwidth) ►►LowerLower TETE (T2(T2 andand STIR)STIR) ►►RemoveRemove fatfat suppressionsuppression (call(call MSKMSK radrad first)first) ►►AvoidAvoid GREGRE ►►UseUse STIRSTIR insteadinstead ofof T2wT2w fatfat satsat MRMR NeurographyNeurography PelvisPelvis
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal 36-40 256 x 256 4/1 400-800 Minimum 16 (PELVIS) T1 SE 1 Non FatSat Coronal 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16 (PELVIS) 2 1.5T: 150 FSE-STIR Axial (PELVIS) 24 (hip 256 x 256 3.5/1 >2000 70-80 >8 16 T2 FSE to hip) 2 FatSat
Coronal T2 vista 30-34 232x345 2/1 2800 288 90 150 (or equivalent) 1
Axial T1 3D FFE 24 276 x276 3/1.5 28 2.3 30 1 1
Axial M FFE 24 240x160 3/0 3570 4 45 4 1
Sagittal PD 24-28 282x282 3.5/1 Max 45 90 >8 SPAIR 1 MarrowMarrow SurveySurvey ERER // InpatientInpatient ProtocolsProtocols
►►HipHip // pelvispelvis fracturefracture ►►Joint:Joint: surveysurvey examexam ►►NonNon--contrastcontrast ““R/OR/O osteomyelitisosteomyelitis”” ►►ChestChest wallwall // AbdominalAbdominal wallwall ►►SpineSpine surveysurvey