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Msk Mri Protocols 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 Coronalsupraspinatus Imaging muscle Plane --CoronalCoronal ImagingImagingPrescribe coronal plane offPlanePlane of axial images parallel to ShoulderShoulder Relevant Anatomy Supraspinatus 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.
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