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MRI protocol complete may 2016 musculoskeletal

The document provides MRI protocols for various musculoskeletal regions including the chest, shoulder, elbow, wrist, and thumb. For the shoulder, it lists protocols for routine exams, MR arthrograms, and post-gadolinium exams. The elbow section outlines similar routine, arthrogram, and post-gadolinium protocols. For the wrist, it again lists routine, arthrogram, and dynamic post-gadolinium protocols and emphasizes the importance of pre- and post-gadolinium coronal images through the carpal bones. Imaging planes and relevant anatomy are also described for each region.

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MSK MRI PROTOCOLS
Contents ► 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
MSK CHEST
MR MSK Chest Indications: ►Pectoralis Major § Indications: ►Pec tear ►Sternum / SC joints § Indications: ►Tumor, infection, arthritis, trauma ►Chest wall § Indications: ►Trauma, tumor
Pectoralis Major ►Use large FOV § Medial-lateral: cover to midline chest § Superior-inferior: cover down to mid-humeral shaft FOV
Pectoralis Major Axial T1 30-36 256 x 256 1 4/0.5 400-800 min - - - 16 Axial FSTIR 30-36 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Axial T2 FSE 30-36 256 x 256 2 4/0.5 >2000 80-100 - - 8 16 Cor Obl FSTIR 36-48 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Sag Oblique T2 FSE Fat Sat 30-36 256 x 192 2 4/1 >2000 40-60 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sternum Axial T1 20-24 256 x 256 1 4/0.5 400-800 min - - - 16 Axial FSTIR 24 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Sag T1 20-30 256 x 256 2 4/0.5 400-800 min - - - 16 Sag FSTIR 20-30 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Cor oblique T2 FSE 20-24 256 x 192 2 4/1 >2000 40-60 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
►Coronal: oblique along sternum Planned from sagittal images
Sternoclavicular joints Axial T1 14-20 256 x 256 1 4/0.5 400-800 min - - - 16 Axial FSTIR 14-20 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Sag T1 20-24 256 x 256 2 4/0.5 400-800 min - - - 16 Sag FSTIR 20-24 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Cor T2 FSE 14-20 256 x 192 2 4/1 >2000 40-60 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
►Smaller FOV for SC joints § Otherwise protocol is similar to Sternum
MSK - Chest Wall
UPPER EXTREMITY
MR Shoulder Indications: ► Routine Shoulder § Indications: ►Rotator Cuff Pathology/Evaluation ► MR Arthrogram § Indications: ►Labrum Pathology/Tear ► Post Gadolinium Shoulder (Indirect MR Arthrogram) § Indications: ►Labral Pathology/Instability without ability to do a direct arthrogram
Shoulder-Routine Axial PD FSE FatSat 12-14 512 x 256 2 4/0.5 2000-300 0 20-40 - - 8 16 Cor Oblique FSTIR 16-18 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Cor Oblique T1 SE Non FatSat 16-18 256 x 256 1 4/0.5 400-800 minimum - - 16 Sag Oblique T2 FSE Non Fat Sat 14-16 256 x 192 1 4/1 >2000 90-110 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
MR Arthrogram Shoulder Axial T1 SE FatSat 12-14 256 x 192 2 3/0.5 400-800 minimum 16 Cor Oblique T1 SE FatSat 14-16 256 x 192 2 3/0.5 400-800 minimum 16 Cor Oblique PD FSE FatSat 14-16 256 x 192 2 3/0.5 >1500 30-50 8 16 Sag Oblique T1 SE Non FatSat 14 256 x 192 1 4/1 400-800 minimum 16 ABER T1 SE Fat Sat 14 256 x 192 2 3/0.5 400-800 minimum 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Shoulder-Post Gadolinium (Indirect MR Arthrogram) **Inject standard dose of IV contrast and wait 20 minutes before scanning** Axial T1 SE FatSat 12-14 256 x 192 2 3/0.5 400-800 minimum 16 Axial PD FSE FatSat 12-14 256 x 192 2 3/0.5 2000-400 0 30-50 8 Cor Oblique T1 SE FatSat 14-16 256 x 192 2 3/0.5 400-800 minimum 16 Sagittal PD FSE FatSat 14-16 256 x 192 2 4/1 2000-400 0 30-50 8 Cor Oblique FSTIR 16-18 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Shoulder – Axial Imaging Plane The Axial imaging plane is slightly oblique (30 degrees): please prescribe off the sagittal plane and angle approximately 30 degrees to horizontal line as shown here (dashed line): Bony Glenoid coracoid AC Joint Cover from top of AC joint through proximal humeral diaphysis.
Shoulder-Coronal Imaging Plane Coronal Imaging Plane Prescribe coronal plane off of axial images parallel to supraspinatus muscle Relevant Anatomy
Shoulder-Sagittal Imaging Plane Humeral Head Bony Glenoid Labrum Cartilaginous Labrum Ant. and Post. 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
MR Elbow Indications: ► Routine Elbow § Indications: ► Biceps/Triceps tear ► Medial/Lateral collateral ligament tear ► Common Flexor/Common extensor tendon pathology ► MR Arthrogram Elbow § Indications: ► Intra articular body evaluation ► Medial/Lateral Collateral Ligament Evaluation ► Osteochondral defect (OCD) ► Post Gadolinium Elbow (Indirect MR arthrogram) § Indications: ► IA body ► OCD
Elbow-Routine* Axial T1 12-14 256 x 256 1 4/1 400-800 minimum 16 Axial FSTIR 14-16 256 x 192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Coronal T1 14-16 256 x 256 1 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 14-16 256 x 256 2 3/0.5 > 1500 20-40 8 16 Sag PD FSE FatSat 12-14 256 x 256 2 3/0.5 1500-300 0 20-40 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex *for Biceps pathology perform FABS sequence; follow this link.
MR Arthrogram Elbow Axial T1 Non FatSat 12-14 256 x 256 1 4/1 400-800 minimum 16 Axial PD FSE FatSat 12-14 256 x 256 2 4/1 >1500 30-50 8 16 Coronal T1 FatSat 12-14 256 x 256 2 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 12-14 256 x 256 2 3/0.5 >1500 30-50 8 16 Sag T1 SE FatSat 12-14 256 x 256 2 3/0.5 400-800 minimum 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Elbow-Axial Imaging Plane Relevant Anatomy Axial Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan from humeral metaphysis through radial tuberosity. © © * * Radial Tuberosity (bump on medial radius) Lateral and Medial Humeral Condyles Ulna Radius Radial tuberosity
Elbow-Coronal Imaging Plane Relevant Anatomy Coronal Imaging Plane *Prescribe plane parallel to medial and lateral epicondyles. * * Lateral Epicondyle Medial Epicondyle Olecranon process of Ulna
Elbow-Sagittal Imaging Plane Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan through entire elbow. © © * * Lateral Humeral Condyle Medial Humeral Condyle Olecranon process of Ulna Relevant Anatomy
FABS Sequence ►For Biceps pathology § Acquire T1 and T2 FS
Wrist Indications: ► Routine Wrist § Indications: ► TFCC, Lunotriquetral, Scapholunate tear ► Flexor Tendon/Carpal Tunnel/ Extensor Tendon Pathology ► Evaluation for Occult fracture ► MR Wrist Arthrogram § Indications: ► TFCC/LT/SL ligament tears ► Dynamic Enhanced Wrist (Post Gad Images) § Indications: ► Evaluation of Scaphoid Nonunion/Avascular Necrosis Exam: § IMPORTANT: **Perform routine wrist PLUS Pre/Post Gadolinium images through carpal bones in coronal plane**
Wrist-Routine Coronal T1 8-12 256 x 256 1 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 8-12 256 x 256 2 3/0.5 >1500 30-50 8 16 Coronal 2D or 3D GRE FatSat 10-12 256 x 192 2 1/0 60 minimum 20-40 16 Axial PD FSE Fat Sat 8-12 256 x 256 2 3/1 2000-300 0 30-50 8 16 Sag FSTIR 12-14 256 x 192 2 3/1 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
MR Arthrogram Wrist (direct or indirect) Coronal T1 SE FatSat 8-10 256 x 256 2 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 8-12 256 x 256 2 3/0.5 >1500 30-50 8 16 Coronal 2D or 3D GRE FatSat 10-12 256 x 192 2 1/0 60 minimum 45-60 16 Axial PD FSE FatSat 8-12 256 x 256 2 3/1 >1500 30-50 8 16 Axial T1 Non- FatSat 8-12 256 x 192 1 3/1 400-800 minimum 16 Sag PD FSE FatSat 10-12 3/1 >1500 30-50 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Wrist-Axial Imaging Plane Distal ulna cap Dist radius trapm trapz ham Relevant Anatomy Axial Imaging Plane Prescribe plane parallel to distal radius. Scan from proximal metacarpals through distal radial/ulnar metaphysis. ***IMAGE WRIST IN PRONATED POSITION! SUPINATED PRONATED
Wrist-Coronal Imaging Plane Relevant Anatomy Coronal Imaging Plane *Prescribe plane along line drawn from ulnar styloid through radial styloid. Scan through entire wrist. * * Ulnar Styloid Radial Styloid Remember to pronate the wrist!
Wrist-Coronal Imaging Plane Ulnar Styloid Radial Styloid Relevant Anatomy: See on the left, another example for the correct plane for coronal images with the plane prescribed off the axials and through both the ulnar and radial styloid Ulnar Styloid Radial Styloid
Wrist-Sagittal Imaging Plane Ulnar Styloid Radial Styloid Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan through entire wrist. © © * * Ulnar Styloid Radial Styloid
Hint: if the ulnar styloid is poking out to the side, the wrist is in pronated position
Thumb Indications: ►Routine Thumb § Indications: ►Gamekeeper’s thumb (Ulnar Collateral Ligament tear) ►Flexor/Extensor Tendon Tear ►R/O Occult Fracture
Thumb Coronal PD FSE 10 256 x 256 2 3/0.3 >1500 30-50 4 Coronal T2 FSE Fat Sat 10 256 x 192 2 3/0.3 2000-600 0 50-70 8 16 Sag FSE STIR 10-14 256 x 192 2 3/0.3 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Axial T1 SE 10 256 x 192 1 3/0.3 400-800 minimal Axial T2 FSE Fat Sat 10 256 x 192 2 3/0.3 2000-600 0 50-70 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Thumb-Axial Imaging Plane Relevant Anatomy Axial Imaging Plane Prescribe plane perpendicular to midshaft of proximal 1st phalanx. Scan from CMC joint through thumb.
Thumb-Coronal Imaging Plane Relevant Anatomy Coronal Imaging Plane *Prescribe plane along line bisecting sesamoid bones or if sesamoids are not well seen along line bisecting the 1st metatarsal head (red lines through the yellow square shown below). Scan through entire thumb. Sesamoids Thumb *
Thumb-Sagittal Imaging Plane Sesamoids Thumb Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal imaging plane (©). Scan through entire thumb. © *
Finger Indications: ► Routine Finger § Indications: ►Pulley rupture/Flexor or Extensor Tendon Injury ► Post Gadolinium Finger § 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.
Finger-Routine Sag T1 SE 10 256 x 192 1 3/0.3 400-800 minimum 16 Sag T2 FSE FatSat 10 256 x 192 2 3/0.3 2000-600 0 50-70 8 16 Axial T1 SE 10 256 x 192 2 3/0.3 400-800 minimum 16 Axial PD FSE FatSat 10 256 x256 2 3/0.3 2000-600 0 30-50 4 16 Coronal STIR 10-14 256 x256 2 3/0.3 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Finger-Axial Imaging Plane Distal Phalanx Mid Phalanx Metacarpal Proximal Phalanx Relevant Anatomy Axial Imaging Plane Prescribe best fit line. Scan from proximal metacarpal through entire finger.
Finger-Coronal Imaging Plane Relevant Anatomy Coronal Imaging Plane *Prescribe plane parallel to anterior metacarpal head. Scan through entire finger. Include 2 adjacent fingers. * Thumb Extensor Tendon
Finger-Sagittal Imaging Plane Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan through entire finger. Include 2 adjacent fingers. * © Thumb Extensor Tendon
LOWER EXTREMITY
Bony pelvis ► Indication: AVN, Mets, transient osteoporosis, bursitis, arthritis, tendonitis, hip pain over age 50 ► PA Torso Coil is 1st choice Coronal FSE-STIR 36-40 256x192 2-3 4/1 >2000 20-40 150 8 16 Axial T2 FSE FatSat 36-40 256 x 256 2 5/1.5 3000 30-40 8 16 Coronal T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Sag T2 FSE FatSat (Hip to Hip) 12-16 256 x 256 1-2 5/1 >2000 40-50 8 16 Coronal in/ out of phase T1 GRE Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
ER Hip (Hip fracture screening) Coronal FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Coronal T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Axial T2 FSE FatSat 36-40 256 x 256 2 4/1 >2000 80-110 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Coronal (PELVIS) T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Coronal (PELVIS) FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Axial (PELVIS) T2 FSE FatSat 36-40 256 x 256 2 4/1 >2000 40-50 8 16 Ax oblique (HIP) T1 FatSat 14-20 384 x 256 2 4/0.5 400-800 Minimum 16 Coronal (HIP) T1 FatSat 14-20 384 x 256 2 4/0.5 400-800 Minimum 16 Sag (HIP) T1 FatSat 14-16 384 x 256 2 4/0.5 400-800 Minimum 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Direct arthrogram hip ► 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
Coronal (PELVIS) T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Coronal (PELVIS) FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Axial (PELVIS) T2 FSE FatSat 36-40 256 x 256 2 4/1 >2000 40-50 8 16 Ax oblique (HIP) PD FSE FatSat 14-20 384 x 256 2 4/1 >2000 30-40 8 16 Coronal (HIP) PD FSE FatSat 14-20 384 x 256 2 4/1 >2000 40-50 8 16 Sag (HIP) PD FSE FatSat 14-16 384 x 256 2 4/1 >2000 40-50 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Noncontrast hip ► Indication: Unilateral hip pain ► PA Torso coil is 1st choice ► Prescribe ax obliques along femoral neck from coronal localizer
Metal Protocol – general recommendations ►Use FSE instead of conventional SE ►Maximize BW (bandwidth) ►Lower TE for T2 and STIR ►Remove fat suppression ►Avoid GRE ►Use STIR instead of T2w fat sat
MARS (Metal Artifact Reduction Sequences) – Hip Exam Coronal FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 64 Coronal T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 64 Axial T2 FSE 36-40 256 x 256 2 4/1 >2000 50-70 8 64 Axial (HIP) PD FSE 14-20 384 x 256 2 4/1 >2000 30-40 8 max Coronal (HIP) PD FSE Non FatSat 14-20 384 x 256 2 4/1 >2000 40-50 8 max Sag (HIP) PD FSE Non FatSat 14-16 384 x 256 2 4/1 >2000 40-50 8 max Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Hip-Axial Imaging Plane Lesser Trochanter Greater Trochanter Ilium Acetabular Roof Relevant Anatomy Axial Imaging Plane Prescribe plane parallel line bisecting lesser trochanters and/or acetabular roofs. Scan from iliac crests through lesser trochanter.
Hip-Coronal Imaging Plane Greater Trochanter Femoral Neck Superior Pubic Ramus Relevant Anatomy Coronal Imaging Plane *Prescribe plane parallel femoral heads. Scan from ischium through pubic symphyses. Ischium * Femoral Head
Hip-Sagittal Imaging Plane Greater Trochanter Femoral Neck Superior Pubic Ramus Femoral Head Ischium Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane. Scan from acetabulum through greater trochanter. *
Axial Oblique Imaging Plane (For Femoracetabular Impingement Patients Only) Axial Oblique Plane Prescribe plane parallel to femoral neck. Scan through entire femoral neck. Relevant Anatomy Femoral Neck Femoral Head
Coronal STIR 28-36 (Both hips) 256x192 2-3 4/1 >2000 20-40 150 8 16 Coronal T1 SE 28 (Both hips) 256x256 1-2 4/1 400-800 minimum 16 Axial T2 FSE Fat Sat 28 (Both hips) 256x256 2-3 5/1 >2000 50-60 8 16 Axial Obl PD FSE Nonfatsat 20 256x192 1-2 4/.5 3000 (max) 25-30 4 16 Axial Obl T2 FSE Fat Sat 20 256x192 2-3 4/.5 >2000 50-60 8 16 Sag T2 FSE Fat Sat 20-22 256x192 2-3 4/.5 >2000 50-60 8 16 Sag PD FSE Nonfatsat (optional) 20-22 256x256 2-3 4/.5 >2000 20-30 8 16 Seq. FOV Matrix/NEX Slice TR TE TI ETL BW TJUH Athletic Pubalgia MR Protocol ► 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
Axial Oblique Imaging Plane (Adductor unfolding plane) Relevant Anatomy Axial Oblique Imaging Plane *Prescribe plane to line paralleling anterior Iliac crest*. Be sure to scan across pubic symphysis at midline * * Hip joint
Axial Oblique Imaging Plane (Adductor unfolding plane)
Bony Pelvis (Special Cases) *Follow Hip Planes* ► Post Gadolinium Pelvis § Indications: ►Osteomylitis § 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/Out of Phase Pelvis § Indications: ►Possible Bony Metastases § IMPORTANT: ►Perform In/Out of Phase images in Coronal Plane
Bony Pelvis Osteo – pre/post option Coronal T1 Non FatSat 30-45 256 x 192 4/1 400-800 minimal 16 Coronal STIR 30-45 256 x 192 4/1 >2000 20-40 8 16 Axial T1 Non FatSat 30-45 256 x 192 4/1 400-800 minimal 16 Axial T2 FSE FatSat 30-45 256 x 256 4/1 2000-600 0 60-70 8 16 Sag T2 FSE FatSat 20 256 x 256 4/1 2000-600 0 50? (60-70) 8 16 Axial/Cor FMPSPGR FatSat Pre/Post 12 256 x 192 3/.5 50 5 30-40 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Sacrum – Sacroiliac joints Coronal STIR 30-45 256 x 192 4/1 >2000 20-40 8 16 Axial T2 FSE FatSat 30-45 256 x 256 4/1 >1500 70-80 8 16 Cor Oblique T1 SE Non FatSat 18-22 256 x 256 3/.5 400-800 minimal Cor Oblique T2 FSE FatSat 18-22 256 x 256 3/.5 >1500 70-80 8 16 Sag T2 FSE FatSat 18-22 256 x 256 3/.5 >1500 70-80 8 16 Axial T1 SE Non FatSat 18-22 256 x 256 3/.5 400-800 minimal Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Indications: Possible Sacroileitis (Septic/Rheumatoid or Rheumatoid Variant Arthritis)
Sacrum – Sacroiliac joints ► Prescribing the coronal oblique plane: parallel the sacrum on a sagittal localizer
Routine Thigh (Follow Hip Imaging Planes) ►Routine Thigh § Indications: ►Polymyositis/Diabetic Myonecrosis
Thigh-Routine Coronal T1 SE Non FatSat 40 256 x 192 4/1 400-800 minimal 16 Coronal T2 FSE FatSat 40 256 x 256 4/1 >1500 70-80 8 16 Sag STIR 26 256 x 192 4/1 >2000 20-40 150 8 16 Axial SE T1 Non FatSat 26 256 x 192 4/1 400-800 minimal 16 Axial T2 FSE FatSat 26 256 x 256 4/1 >1500 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Knee Indications ► Routine Knee § Indications: ►Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL ► Direct Arthrogram § Indications: ►Meniscal Re-tear ►Intra articular Body ► Post Gadolinium Knee § Indications ►Meniscal Re-tear § IMPORTANT: Image 20 minutes post gadolinium
Knee-Routine Sag PD FSE NonFatSat 14-16 512 x 256 2 4/0.5 3000 15-20 8 16 Sag T2 FSE FatSat 14-16 256 x 256 2 4/0.5 2000 70-80 8 16 Cor T1 SE Non FatSat 16-18 256 x 192 1 3/0.5 400-800 Minimal 16 Coronal T2 FSE Fat Sat 16-18 256 x 256 2 3/0.5 >2000 70-80 8 16 Axial T2 FSE FatSat 14-16 256 x 256 2 3/0.5 >2000 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
MR Arthrogram Knee (dir or ind) Sag T1 Se FatSat 14-16 256 x 192 4/1 400-800 Minimal 16 Sag PD FSE NonFatSat 14-16 512 x 256 2 4/0.5 3000 15-20 8 16 Coronal T2 FSE FatSat 16-18 256 x 256 2 4/1 >1500 70-80 8 16 Coronal T1 SE FatSat 16-18 256 x 192 1 4/1 400-800 Minimal 16 Axial T2 FSE FatSat 14-16 256 x 256 4/1 >1500 70-80 8 16 Axial T1 SE FatSat 14-16 256 x 192 4/1 400-800 Minimal 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Knee-Axial Imaging Plane P A T Tibia Femur Patellar Tendon Insertion Relevant Anatomy Axial Imaging Plane Image from distal quad tendon through patellar tendon insertion Distal Quadriceps tendon
Knee-Coronal Imaging Relevant Anatomy Med Fem Condyle Lat Fem Condyle Patella Coronal Imaging Plane Prescribe plane with line parallel to femoral condyles. Image entire knee.
Knee-Sagittal Imaging Plane Med Fem Condyle Lat Fem Condyle Patella Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan from the medial to the lateral femoral condyle. © © * *
Lower Extremity/Shin ►Indication: § Shin Splints ►IMPORTANT: § Acquire coronal and axial (STIR) sequences covering both shins, but sagittal and axial (t2 FatSat only of side in question § Place a marker on pain / tenderness
Lower Extremity/Shin Area Coronal T1 SE Non FatSat 35-40 256 x 256 4/1 400-800 minimal 16 Coronal STIR 35-40 256 x 192 4/1 >2000 20-40 150 8 16 Axial STIR 35-40 256 x 192 4/1 >2000 20-40 150 8 16 Axial T2 FSE FatSat (through marker region) 14-16 256 x 256 4/1 >1500 70-80 8 16 Sag T2 FSE FatSat 256 x 256 4/1 >1500 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Ankle Indications ►Routine Ankle § Ligament Sprain/Tendon pathology/Tarsal Tunnel/Sinus Tarsi/Occult fracture, PTT, Plantar fasciitis ►Ankle Arthrogram § Indications: ►Intra-articular Body ►Post Gadolinium Ankle
Ankle-Routine Sag T1 SE Non FatSat 16-18 256 x 256 1 3/1 400-800 Minimal 16 Sag STIR 16-18 256 x 192 3 3/1 >1500 40 120 90 8 16 Axial PD FSE Non FatSat 14-16 384 x 256 2 4/1 3000 40 8 16 Axial T2 FSE FatSat 14-16 256 x 256 2 4/1 >2000 70-80 8 16 Coronal T2 FSE FatSat 14 256 x 256 3 3/1 >2000 40-55 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
MR Arthrogram Ankle (dir or ind) Sag T1 SE FatSat 16 256 x 192 4/1 400-800 minimal 16 Sag STIR 18 256 x 192 4/1 >2000 20-40 150 8 16 Axial T1 SE FatSat 14 256 x 256 4/1 800 min 16 Axial PD FSE Non FatSat 14-16 513 x 256 2 4/1 3000 40 8 16 Coronal T1 SE FatSat 14 256 x 192 4/1 400-800 minimal 16 Coronal T2 FSE FatSat 14 256 x 256 4/1 >1500 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Ankle-Post Contrast Axial FMPSPGR FatSat Pre/Post 14 256 x XX 200 ? 4 ? 16 Sag T1 SE Non FatSat 16 256 x 192 4/1 400-800 minimal 16 Axial T1 SE FatSat 12 256 x 256 4/1 ?800 Minimal 16 Axial PD FSE FatSat 14 256 x 256 4/1 >2000 40-50 4 16 Cor T1 SE FatSat 14 256 x 256 4/1 400-800 minimal 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Ankle-Axial Imaging Plane Tibia Talus Calcaneus Relevant Anatomy Axial Imaging Plane Prescribe plane parallel to axis of calcaneus. Scan ankle from distal tibia through subcutaneous soft tissues (include plantar fascia). Black band is plantar fascia
Ankle-Coronal Imaging Plane Coronal Imaging Plane Prescribe plane perpendicular to axial imaging plane. Scan ankle from calcaneus through metatarsal bases. Calcaneus Talus Cuboid Relevant Anatomy
Ankle-Sagittal Imaging Plane Talus Sagittal Imaging Plane Prescribe plane with line parallel to talus. Cover ankle from medial through lateral malleolus. Relevant Anatomy
Midfoot
Forefoot
Foot-Indications ► Routine Foot § Indications ►Plantar Plate Injury, R/O fracture, Lisfranc injury, tarsal/ metatarsal fracture ► Post Gadolinium Foot § Indications: ►Morton’s Neuroma ►Osteomyelitis § IMPORTANT: Perform routine foot plus coronal FMPSPGR fat saturated pre and post gad images and axial POST gad FMPSPGR fat saturated images.
Foot-Routine Coronal (short axis) T1 Non FatSat 10 256 x 256 1 3/0.5 400-800 minimal 16 Coronal (short axis) T2 FSE FatSat 10 256 x 256 2 3/0.5 >2000 70-80 8 16 Sag STIR 12-14 256 x 192 3 3/0.5 >1500 40 120 90 8 16 Sag T1 Non FatSat 12-14 256 x 256 1 3/0.5 400-800 minimal 16 Axial (long axis) PD FSE Non FatSat 12-14 256 x 256 2 3/0.5 >2000 30 8 16 Axial (long axis) T2 FSE FatSat 12-14 256 x 256 2 3/0.5 >2000 90 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Foot-Mass/Osteomyelitis Coronal T1 SE Non FatSat 10-12 256 x 256 1 3/0.5 400-800 minimal 16 Coronal T2 FSE FatSat 10-12 256 x 192 2 3/0.5 >2000 70-80 8 16 Sag STIR 12-14 256 x 192 2 3/0.5 >1500 40 120 90 8 16 Sag T1 Non FatSat 12-14 256 x 256 1 3/0.5 400-800 minimal 16 Coronal FMPSPGR FatSat Pre/Post 10-12 256 x 192 2 3/.5 60 5 30-40 8 16 Axial FMPSPGR FatSat Post 10-12 256 x 192 2 3/.5 60 5 30-40 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Foot-Axial Imaging Plane Relevant Anatomy Axial Imaging Plane Prescribe plane parallel to 2rd or 3rd metatarsal. Scan foot from navicular through phalanges. N A V Phalanges
Foot-Coronal Imaging Plane Relevant Anatomy Metatarsals 1 2 3 4 5 Coronal Plane *Prescribe plane parallel to 1st and 5th metatarsal Shafts. Scan through entire foot. *
Foot-Sagittal Imaging Plane * * Metatarsals 1 2 3 4 5 Sagittal Plane *Prescribe plane perpendicular to coronal Plane (©). Scan through entire foot. Relevant Anatomy © © *
Soft Tissue Mass Protocol General Recommendations ►Place Vitamin E capsule LIGHTLY on skin (do not depress skin with capsule) § If post-operative: place markers at each end of surgical scar ►FOV determined by mass size / location ►Try to include adjacent joint for reference ►Axial always; Sag or Cor depending on location of mass (speak with radiologist)
Soft Tissue Mass Axial T1 SE Non FatSat 256 x 192 5/1 400-800 minimum 16 Axial T2 FSE FatSat 256 x 192 5/1 >2000 40-60 8 16 Sag or Cor T1 SE Non FatSat 256 x 192 5/1 400-800 minimum 16 Sag or Cor STIR 256 x 192 5/1 >2000 30-40 150 8 16 Axial T1 GRE or SE FatSat Pre/Post Gd 256 x 192 5/1 60 400-800 5 minimum 30-40 - 8 16 Sag or Cor T1 GRE or SE FatSat Pre/Post Gd 256 x 192 5/1 60 400-800 5 minimum 30-40 - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
MR Neurography Pelvis Coronal (PELVIS) T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Coronal (PELVIS) FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 8 16 Axial (PELVIS) T2 FSE FatSat 24 (hip to hip) 256 x 256 2 3.5/1 >2000 70-80 >8 16 Coronal T2 vista (or equivalent) 30-34 232x345 1 2/1 2800 288 90 150 Axial T1 3D FFE 24 276 x276 1 3/1.5 28 2.3 30 1 Axial M FFE 24 240x160 1 3/0 3570 4 45 4 Sagittal PD SPAIR 24-28 282x282 1 3.5/1 Max 45 90 >8 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
Marrow Survey
ER / Inpatient Protocols ►Hip / pelvis fracture ►Joint: survey exam ►Non-contrast “R/O osteomyelitis” ►Chest wall / Abdominal wall ►Spine survey

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MRI protocol complete may 2016 musculoskeletal

  • 1.
  • 2.
    Contents ► Upper ExtremityPage ► Shoulder ► Elbow ► Wrist ► Finger ► Thumb ► Lower Extremity ► Hip ► Pelvis ► Thigh ► Knee ► Lower Extremity/Shin ► Ankle ► Foot ► Special Cases ► Soft Tissue Mass ► Metal Protocol
  • 3.
  • 4.
    MR MSK ChestIndications: ►Pectoralis Major § Indications: ►Pec tear ►Sternum / SC joints § Indications: ►Tumor, infection, arthritis, trauma ►Chest wall § Indications: ►Trauma, tumor
  • 5.
    Pectoralis Major ►Use largeFOV § Medial-lateral: cover to midline chest § Superior-inferior: cover down to mid-humeral shaft FOV
  • 6.
    Pectoralis Major Axial T1 30-36 256x 256 1 4/0.5 400-800 min - - - 16 Axial FSTIR 30-36 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Axial T2 FSE 30-36 256 x 256 2 4/0.5 >2000 80-100 - - 8 16 Cor Obl FSTIR 36-48 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Sag Oblique T2 FSE Fat Sat 30-36 256 x 192 2 4/1 >2000 40-60 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 7.
    Sternum Axial T1 20-24 256 x256 1 4/0.5 400-800 min - - - 16 Axial FSTIR 24 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Sag T1 20-30 256 x 256 2 4/0.5 400-800 min - - - 16 Sag FSTIR 20-30 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Cor oblique T2 FSE 20-24 256 x 192 2 4/1 >2000 40-60 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 8.
  • 9.
    Sternoclavicular joints Axial T1 14-20 256x 256 1 4/0.5 400-800 min - - - 16 Axial FSTIR 14-20 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Sag T1 20-24 256 x 256 2 4/0.5 400-800 min - - - 16 Sag FSTIR 20-24 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Cor T2 FSE 14-20 256 x 192 2 4/1 >2000 40-60 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 10.
    ►Smaller FOV forSC joints § Otherwise protocol is similar to Sternum
  • 11.
  • 12.
  • 13.
    MR Shoulder Indications: ►Routine Shoulder § Indications: ►Rotator Cuff Pathology/Evaluation ► MR Arthrogram § Indications: ►Labrum Pathology/Tear ► Post Gadolinium Shoulder (Indirect MR Arthrogram) § Indications: ►Labral Pathology/Instability without ability to do a direct arthrogram
  • 14.
    Shoulder-Routine Axial PD FSE FatSat 12-14 512x 256 2 4/0.5 2000-300 0 20-40 - - 8 16 Cor Oblique FSTIR 16-18 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Cor Oblique T1 SE Non FatSat 16-18 256 x 256 1 4/0.5 400-800 minimum - - 16 Sag Oblique T2 FSE Non Fat Sat 14-16 256 x 192 1 4/1 >2000 90-110 - - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 15.
    MR Arthrogram Shoulder Axial T1SE FatSat 12-14 256 x 192 2 3/0.5 400-800 minimum 16 Cor Oblique T1 SE FatSat 14-16 256 x 192 2 3/0.5 400-800 minimum 16 Cor Oblique PD FSE FatSat 14-16 256 x 192 2 3/0.5 >1500 30-50 8 16 Sag Oblique T1 SE Non FatSat 14 256 x 192 1 4/1 400-800 minimum 16 ABER T1 SE Fat Sat 14 256 x 192 2 3/0.5 400-800 minimum 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 16.
    Shoulder-Post Gadolinium (Indirect MRArthrogram) **Inject standard dose of IV contrast and wait 20 minutes before scanning** Axial T1 SE FatSat 12-14 256 x 192 2 3/0.5 400-800 minimum 16 Axial PD FSE FatSat 12-14 256 x 192 2 3/0.5 2000-400 0 30-50 8 Cor Oblique T1 SE FatSat 14-16 256 x 192 2 3/0.5 400-800 minimum 16 Sagittal PD FSE FatSat 14-16 256 x 192 2 4/1 2000-400 0 30-50 8 Cor Oblique FSTIR 16-18 256 x 192 2 4/0.5 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 17.
    Shoulder – AxialImaging Plane The Axial imaging plane is slightly oblique (30 degrees): please prescribe off the sagittal plane and angle approximately 30 degrees to horizontal line as shown here (dashed line): Bony Glenoid coracoid AC Joint Cover from top of AC joint through proximal humeral diaphysis.
  • 18.
    Shoulder-Coronal Imaging Plane CoronalImaging Plane Prescribe coronal plane off of axial images parallel to supraspinatus muscle Relevant Anatomy
  • 19.
    Shoulder-Sagittal Imaging Plane Humeral Head BonyGlenoid Labrum Cartilaginous Labrum Ant. and Post. 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
  • 20.
    MR Elbow Indications: ►Routine Elbow § Indications: ► Biceps/Triceps tear ► Medial/Lateral collateral ligament tear ► Common Flexor/Common extensor tendon pathology ► MR Arthrogram Elbow § Indications: ► Intra articular body evaluation ► Medial/Lateral Collateral Ligament Evaluation ► Osteochondral defect (OCD) ► Post Gadolinium Elbow (Indirect MR arthrogram) § Indications: ► IA body ► OCD
  • 21.
    Elbow-Routine* Axial T1 12-14 256 x256 1 4/1 400-800 minimum 16 Axial FSTIR 14-16 256 x 192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Coronal T1 14-16 256 x 256 1 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 14-16 256 x 256 2 3/0.5 > 1500 20-40 8 16 Sag PD FSE FatSat 12-14 256 x 256 2 3/0.5 1500-300 0 20-40 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex *for Biceps pathology perform FABS sequence; follow this link.
  • 22.
    MR Arthrogram Elbow Axial T1 Non FatSat 12-14256 x 256 1 4/1 400-800 minimum 16 Axial PD FSE FatSat 12-14 256 x 256 2 4/1 >1500 30-50 8 16 Coronal T1 FatSat 12-14 256 x 256 2 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 12-14 256 x 256 2 3/0.5 >1500 30-50 8 16 Sag T1 SE FatSat 12-14 256 x 256 2 3/0.5 400-800 minimum 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 23.
    Elbow-Axial Imaging Plane RelevantAnatomy Axial Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan from humeral metaphysis through radial tuberosity. © © * * Radial Tuberosity (bump on medial radius) Lateral and Medial Humeral Condyles Ulna Radius Radial tuberosity
  • 24.
    Elbow-Coronal Imaging Plane RelevantAnatomy Coronal Imaging Plane *Prescribe plane parallel to medial and lateral epicondyles. * * Lateral Epicondyle Medial Epicondyle Olecranon process of Ulna
  • 25.
    Elbow-Sagittal Imaging Plane SagittalImaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan through entire elbow. © © * * Lateral Humeral Condyle Medial Humeral Condyle Olecranon process of Ulna Relevant Anatomy
  • 26.
    FABS Sequence ►For Bicepspathology § Acquire T1 and T2 FS
  • 27.
    Wrist Indications: ► RoutineWrist § Indications: ► TFCC, Lunotriquetral, Scapholunate tear ► Flexor Tendon/Carpal Tunnel/ Extensor Tendon Pathology ► Evaluation for Occult fracture ► MR Wrist Arthrogram § Indications: ► TFCC/LT/SL ligament tears ► Dynamic Enhanced Wrist (Post Gad Images) § Indications: ► Evaluation of Scaphoid Nonunion/Avascular Necrosis Exam: § IMPORTANT: **Perform routine wrist PLUS Pre/Post Gadolinium images through carpal bones in coronal plane**
  • 28.
    Wrist-Routine Coronal T1 8-12 256 x256 1 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 8-12 256 x 256 2 3/0.5 >1500 30-50 8 16 Coronal 2D or 3D GRE FatSat 10-12 256 x 192 2 1/0 60 minimum 20-40 16 Axial PD FSE Fat Sat 8-12 256 x 256 2 3/1 2000-300 0 30-50 8 16 Sag FSTIR 12-14 256 x 192 2 3/1 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 29.
    MR Arthrogram Wrist(direct or indirect) Coronal T1 SE FatSat 8-10 256 x 256 2 3/0.5 400-800 minimum 16 Coronal PD FSE FatSat 8-12 256 x 256 2 3/0.5 >1500 30-50 8 16 Coronal 2D or 3D GRE FatSat 10-12 256 x 192 2 1/0 60 minimum 45-60 16 Axial PD FSE FatSat 8-12 256 x 256 2 3/1 >1500 30-50 8 16 Axial T1 Non- FatSat 8-12 256 x 192 1 3/1 400-800 minimum 16 Sag PD FSE FatSat 10-12 3/1 >1500 30-50 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 30.
    Wrist-Axial Imaging Plane Distal ulna cap Dist radius trapm trapzham Relevant Anatomy Axial Imaging Plane Prescribe plane parallel to distal radius. Scan from proximal metacarpals through distal radial/ulnar metaphysis. ***IMAGE WRIST IN PRONATED POSITION! SUPINATED PRONATED
  • 31.
    Wrist-Coronal Imaging Plane RelevantAnatomy Coronal Imaging Plane *Prescribe plane along line drawn from ulnar styloid through radial styloid. Scan through entire wrist. * * Ulnar Styloid Radial Styloid Remember to pronate the wrist!
  • 32.
    Wrist-Coronal Imaging Plane Ulnar Styloid Radial Styloid RelevantAnatomy: See on the left, another example for the correct plane for coronal images with the plane prescribed off the axials and through both the ulnar and radial styloid Ulnar Styloid Radial Styloid
  • 33.
    Wrist-Sagittal Imaging Plane Ulnar Styloid Radial Styloid RelevantAnatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan through entire wrist. © © * * Ulnar Styloid Radial Styloid
  • 34.
    Hint: if theulnar styloid is poking out to the side, the wrist is in pronated position
  • 35.
    Thumb Indications: ►Routine Thumb §Indications: ►Gamekeeper’s thumb (Ulnar Collateral Ligament tear) ►Flexor/Extensor Tendon Tear ►R/O Occult Fracture
  • 36.
    Thumb Coronal PD FSE 10 256x 256 2 3/0.3 >1500 30-50 4 Coronal T2 FSE Fat Sat 10 256 x 192 2 3/0.3 2000-600 0 50-70 8 16 Sag FSE STIR 10-14 256 x 192 2 3/0.3 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Axial T1 SE 10 256 x 192 1 3/0.3 400-800 minimal Axial T2 FSE Fat Sat 10 256 x 192 2 3/0.3 2000-600 0 50-70 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 37.
    Thumb-Axial Imaging Plane RelevantAnatomy Axial Imaging Plane Prescribe plane perpendicular to midshaft of proximal 1st phalanx. Scan from CMC joint through thumb.
  • 38.
    Thumb-Coronal Imaging Plane RelevantAnatomy Coronal Imaging Plane *Prescribe plane along line bisecting sesamoid bones or if sesamoids are not well seen along line bisecting the 1st metatarsal head (red lines through the yellow square shown below). Scan through entire thumb. Sesamoids Thumb *
  • 39.
    Thumb-Sagittal Imaging Plane Sesamoids Thumb RelevantAnatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal imaging plane (©). Scan through entire thumb. © *
  • 40.
    Finger Indications: ► RoutineFinger § Indications: ►Pulley rupture/Flexor or Extensor Tendon Injury ► Post Gadolinium Finger § 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.
  • 41.
    Finger-Routine Sag T1 SE 10 256x 192 1 3/0.3 400-800 minimum 16 Sag T2 FSE FatSat 10 256 x 192 2 3/0.3 2000-600 0 50-70 8 16 Axial T1 SE 10 256 x 192 2 3/0.3 400-800 minimum 16 Axial PD FSE FatSat 10 256 x256 2 3/0.3 2000-600 0 30-50 4 16 Coronal STIR 10-14 256 x256 2 3/0.3 >1500 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 42.
    Finger-Axial Imaging Plane Distal Phalanx Mid Phalanx Metacarpal Proximal Phalanx Relevant Anatomy AxialImaging Plane Prescribe best fit line. Scan from proximal metacarpal through entire finger.
  • 43.
    Finger-Coronal Imaging Plane RelevantAnatomy Coronal Imaging Plane *Prescribe plane parallel to anterior metacarpal head. Scan through entire finger. Include 2 adjacent fingers. * Thumb Extensor Tendon
  • 44.
    Finger-Sagittal Imaging Plane RelevantAnatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan through entire finger. Include 2 adjacent fingers. * © Thumb Extensor Tendon
  • 45.
  • 46.
    Bony pelvis ► Indication:AVN, Mets, transient osteoporosis, bursitis, arthritis, tendonitis, hip pain over age 50 ► PA Torso Coil is 1st choice Coronal FSE-STIR 36-40 256x192 2-3 4/1 >2000 20-40 150 8 16 Axial T2 FSE FatSat 36-40 256 x 256 2 5/1.5 3000 30-40 8 16 Coronal T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Sag T2 FSE FatSat (Hip to Hip) 12-16 256 x 256 1-2 5/1 >2000 40-50 8 16 Coronal in/ out of phase T1 GRE Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 47.
    ER Hip (Hip fracturescreening) Coronal FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Coronal T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Axial T2 FSE FatSat 36-40 256 x 256 2 4/1 >2000 80-110 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 48.
    Coronal (PELVIS) T1 SE NonFatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Coronal (PELVIS) FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Axial (PELVIS) T2 FSE FatSat 36-40 256 x 256 2 4/1 >2000 40-50 8 16 Ax oblique (HIP) T1 FatSat 14-20 384 x 256 2 4/0.5 400-800 Minimum 16 Coronal (HIP) T1 FatSat 14-20 384 x 256 2 4/0.5 400-800 Minimum 16 Sag (HIP) T1 FatSat 14-16 384 x 256 2 4/0.5 400-800 Minimum 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Direct arthrogram hip ► 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
  • 49.
    Coronal (PELVIS) T1 SE NonFatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Coronal (PELVIS) FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 16 Axial (PELVIS) T2 FSE FatSat 36-40 256 x 256 2 4/1 >2000 40-50 8 16 Ax oblique (HIP) PD FSE FatSat 14-20 384 x 256 2 4/1 >2000 30-40 8 16 Coronal (HIP) PD FSE FatSat 14-20 384 x 256 2 4/1 >2000 40-50 8 16 Sag (HIP) PD FSE FatSat 14-16 384 x 256 2 4/1 >2000 40-50 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Noncontrast hip ► Indication: Unilateral hip pain ► PA Torso coil is 1st choice ► Prescribe ax obliques along femoral neck from coronal localizer
  • 50.
    Metal Protocol –general recommendations ►Use FSE instead of conventional SE ►Maximize BW (bandwidth) ►Lower TE for T2 and STIR ►Remove fat suppression ►Avoid GRE ►Use STIR instead of T2w fat sat
  • 51.
    MARS (Metal ArtifactReduction Sequences) – Hip Exam Coronal FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 0.7T 100 0.3T: 70 8 64 Coronal T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 64 Axial T2 FSE 36-40 256 x 256 2 4/1 >2000 50-70 8 64 Axial (HIP) PD FSE 14-20 384 x 256 2 4/1 >2000 30-40 8 max Coronal (HIP) PD FSE Non FatSat 14-20 384 x 256 2 4/1 >2000 40-50 8 max Sag (HIP) PD FSE Non FatSat 14-16 384 x 256 2 4/1 >2000 40-50 8 max Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 52.
    Hip-Axial Imaging Plane LesserTrochanter Greater Trochanter Ilium Acetabular Roof Relevant Anatomy Axial Imaging Plane Prescribe plane parallel line bisecting lesser trochanters and/or acetabular roofs. Scan from iliac crests through lesser trochanter.
  • 53.
    Hip-Coronal Imaging Plane GreaterTrochanter Femoral Neck Superior Pubic Ramus Relevant Anatomy Coronal Imaging Plane *Prescribe plane parallel femoral heads. Scan from ischium through pubic symphyses. Ischium * Femoral Head
  • 54.
    Hip-Sagittal Imaging Plane GreaterTrochanter Femoral Neck Superior Pubic Ramus Femoral Head Ischium Relevant Anatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane. Scan from acetabulum through greater trochanter. *
  • 55.
    Axial Oblique ImagingPlane (For Femoracetabular Impingement Patients Only) Axial Oblique Plane Prescribe plane parallel to femoral neck. Scan through entire femoral neck. Relevant Anatomy Femoral Neck Femoral Head
  • 56.
    Coronal STIR 28-36 (Both hips) 256x192 2-3 4/1 >200020-40 150 8 16 Coronal T1 SE 28 (Both hips) 256x256 1-2 4/1 400-800 minimum 16 Axial T2 FSE Fat Sat 28 (Both hips) 256x256 2-3 5/1 >2000 50-60 8 16 Axial Obl PD FSE Nonfatsat 20 256x192 1-2 4/.5 3000 (max) 25-30 4 16 Axial Obl T2 FSE Fat Sat 20 256x192 2-3 4/.5 >2000 50-60 8 16 Sag T2 FSE Fat Sat 20-22 256x192 2-3 4/.5 >2000 50-60 8 16 Sag PD FSE Nonfatsat (optional) 20-22 256x256 2-3 4/.5 >2000 20-30 8 16 Seq. FOV Matrix/NEX Slice TR TE TI ETL BW TJUH Athletic Pubalgia MR Protocol ► 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
  • 57.
    Axial Oblique ImagingPlane (Adductor unfolding plane) Relevant Anatomy Axial Oblique Imaging Plane *Prescribe plane to line paralleling anterior Iliac crest*. Be sure to scan across pubic symphysis at midline * * Hip joint
  • 58.
    Axial Oblique ImagingPlane (Adductor unfolding plane)
  • 59.
    Bony Pelvis (Special Cases) *FollowHip Planes* ► Post Gadolinium Pelvis § Indications: ►Osteomylitis § 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/Out of Phase Pelvis § Indications: ►Possible Bony Metastases § IMPORTANT: ►Perform In/Out of Phase images in Coronal Plane
  • 60.
    Bony Pelvis Osteo– pre/post option Coronal T1 Non FatSat 30-45 256 x 192 4/1 400-800 minimal 16 Coronal STIR 30-45 256 x 192 4/1 >2000 20-40 8 16 Axial T1 Non FatSat 30-45 256 x 192 4/1 400-800 minimal 16 Axial T2 FSE FatSat 30-45 256 x 256 4/1 2000-600 0 60-70 8 16 Sag T2 FSE FatSat 20 256 x 256 4/1 2000-600 0 50? (60-70) 8 16 Axial/Cor FMPSPGR FatSat Pre/Post 12 256 x 192 3/.5 50 5 30-40 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 61.
    Sacrum – Sacroiliacjoints Coronal STIR 30-45 256 x 192 4/1 >2000 20-40 8 16 Axial T2 FSE FatSat 30-45 256 x 256 4/1 >1500 70-80 8 16 Cor Oblique T1 SE Non FatSat 18-22 256 x 256 3/.5 400-800 minimal Cor Oblique T2 FSE FatSat 18-22 256 x 256 3/.5 >1500 70-80 8 16 Sag T2 FSE FatSat 18-22 256 x 256 3/.5 >1500 70-80 8 16 Axial T1 SE Non FatSat 18-22 256 x 256 3/.5 400-800 minimal Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex Indications: Possible Sacroileitis (Septic/Rheumatoid or Rheumatoid Variant Arthritis)
  • 62.
    Sacrum – Sacroiliacjoints ► Prescribing the coronal oblique plane: parallel the sacrum on a sagittal localizer
  • 63.
    Routine Thigh (Follow HipImaging Planes) ►Routine Thigh § Indications: ►Polymyositis/Diabetic Myonecrosis
  • 64.
    Thigh-Routine Coronal T1 SE Non FatSat 40 256x 192 4/1 400-800 minimal 16 Coronal T2 FSE FatSat 40 256 x 256 4/1 >1500 70-80 8 16 Sag STIR 26 256 x 192 4/1 >2000 20-40 150 8 16 Axial SE T1 Non FatSat 26 256 x 192 4/1 400-800 minimal 16 Axial T2 FSE FatSat 26 256 x 256 4/1 >1500 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 65.
    Knee Indications ► RoutineKnee § Indications: ►Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL ► Direct Arthrogram § Indications: ►Meniscal Re-tear ►Intra articular Body ► Post Gadolinium Knee § Indications ►Meniscal Re-tear § IMPORTANT: Image 20 minutes post gadolinium
  • 66.
    Knee-Routine Sag PD FSE NonFatSat 14-16 512x 256 2 4/0.5 3000 15-20 8 16 Sag T2 FSE FatSat 14-16 256 x 256 2 4/0.5 2000 70-80 8 16 Cor T1 SE Non FatSat 16-18 256 x 192 1 3/0.5 400-800 Minimal 16 Coronal T2 FSE Fat Sat 16-18 256 x 256 2 3/0.5 >2000 70-80 8 16 Axial T2 FSE FatSat 14-16 256 x 256 2 3/0.5 >2000 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 67.
    MR Arthrogram Knee(dir or ind) Sag T1 Se FatSat 14-16 256 x 192 4/1 400-800 Minimal 16 Sag PD FSE NonFatSat 14-16 512 x 256 2 4/0.5 3000 15-20 8 16 Coronal T2 FSE FatSat 16-18 256 x 256 2 4/1 >1500 70-80 8 16 Coronal T1 SE FatSat 16-18 256 x 192 1 4/1 400-800 Minimal 16 Axial T2 FSE FatSat 14-16 256 x 256 4/1 >1500 70-80 8 16 Axial T1 SE FatSat 14-16 256 x 192 4/1 400-800 Minimal 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 68.
    Knee-Axial Imaging Plane P A T Tibia Femur Patellar Tendon Insertion RelevantAnatomy Axial Imaging Plane Image from distal quad tendon through patellar tendon insertion Distal Quadriceps tendon
  • 69.
    Knee-Coronal Imaging Relevant Anatomy Med Fem Condyle Lat Fem Condyle Patella CoronalImaging Plane Prescribe plane with line parallel to femoral condyles. Image entire knee.
  • 70.
    Knee-Sagittal Imaging Plane Med Fem Condyle Lat Fem Condyle Patella RelevantAnatomy Sagittal Imaging Plane *Prescribe plane perpendicular to coronal plane (©). Scan from the medial to the lateral femoral condyle. © © * *
  • 71.
    Lower Extremity/Shin ►Indication: § ShinSplints ►IMPORTANT: § Acquire coronal and axial (STIR) sequences covering both shins, but sagittal and axial (t2 FatSat only of side in question § Place a marker on pain / tenderness
  • 72.
    Lower Extremity/Shin Area Coronal T1SE Non FatSat 35-40 256 x 256 4/1 400-800 minimal 16 Coronal STIR 35-40 256 x 192 4/1 >2000 20-40 150 8 16 Axial STIR 35-40 256 x 192 4/1 >2000 20-40 150 8 16 Axial T2 FSE FatSat (through marker region) 14-16 256 x 256 4/1 >1500 70-80 8 16 Sag T2 FSE FatSat 256 x 256 4/1 >1500 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 73.
    Ankle Indications ►Routine Ankle §Ligament Sprain/Tendon pathology/Tarsal Tunnel/Sinus Tarsi/Occult fracture, PTT, Plantar fasciitis ►Ankle Arthrogram § Indications: ►Intra-articular Body ►Post Gadolinium Ankle
  • 74.
    Ankle-Routine Sag T1 SE Non FatSat 16-18 256x 256 1 3/1 400-800 Minimal 16 Sag STIR 16-18 256 x 192 3 3/1 >1500 40 120 90 8 16 Axial PD FSE Non FatSat 14-16 384 x 256 2 4/1 3000 40 8 16 Axial T2 FSE FatSat 14-16 256 x 256 2 4/1 >2000 70-80 8 16 Coronal T2 FSE FatSat 14 256 x 256 3 3/1 >2000 40-55 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 75.
    MR Arthrogram Ankle(dir or ind) Sag T1 SE FatSat 16 256 x 192 4/1 400-800 minimal 16 Sag STIR 18 256 x 192 4/1 >2000 20-40 150 8 16 Axial T1 SE FatSat 14 256 x 256 4/1 800 min 16 Axial PD FSE Non FatSat 14-16 513 x 256 2 4/1 3000 40 8 16 Coronal T1 SE FatSat 14 256 x 192 4/1 400-800 minimal 16 Coronal T2 FSE FatSat 14 256 x 256 4/1 >1500 70-80 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 76.
    Ankle-Post Contrast Axial FMPSPGR FatSat Pre/Post 14 256x XX 200 ? 4 ? 16 Sag T1 SE Non FatSat 16 256 x 192 4/1 400-800 minimal 16 Axial T1 SE FatSat 12 256 x 256 4/1 ?800 Minimal 16 Axial PD FSE FatSat 14 256 x 256 4/1 >2000 40-50 4 16 Cor T1 SE FatSat 14 256 x 256 4/1 400-800 minimal 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 77.
    Ankle-Axial Imaging Plane Tibia Talus Calcaneus RelevantAnatomy Axial Imaging Plane Prescribe plane parallel to axis of calcaneus. Scan ankle from distal tibia through subcutaneous soft tissues (include plantar fascia). Black band is plantar fascia
  • 78.
    Ankle-Coronal Imaging Plane CoronalImaging Plane Prescribe plane perpendicular to axial imaging plane. Scan ankle from calcaneus through metatarsal bases. Calcaneus Talus Cuboid Relevant Anatomy
  • 79.
    Ankle-Sagittal Imaging Plane Talus SagittalImaging Plane Prescribe plane with line parallel to talus. Cover ankle from medial through lateral malleolus. Relevant Anatomy
  • 80.
  • 81.
  • 82.
    Foot-Indications ► Routine Foot §Indications ►Plantar Plate Injury, R/O fracture, Lisfranc injury, tarsal/ metatarsal fracture ► Post Gadolinium Foot § Indications: ►Morton’s Neuroma ►Osteomyelitis § IMPORTANT: Perform routine foot plus coronal FMPSPGR fat saturated pre and post gad images and axial POST gad FMPSPGR fat saturated images.
  • 83.
    Foot-Routine Coronal (short axis) T1 Non FatSat 10256 x 256 1 3/0.5 400-800 minimal 16 Coronal (short axis) T2 FSE FatSat 10 256 x 256 2 3/0.5 >2000 70-80 8 16 Sag STIR 12-14 256 x 192 3 3/0.5 >1500 40 120 90 8 16 Sag T1 Non FatSat 12-14 256 x 256 1 3/0.5 400-800 minimal 16 Axial (long axis) PD FSE Non FatSat 12-14 256 x 256 2 3/0.5 >2000 30 8 16 Axial (long axis) T2 FSE FatSat 12-14 256 x 256 2 3/0.5 >2000 90 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 84.
    Foot-Mass/Osteomyelitis Coronal T1 SE Non FatSat 10-12 256x 256 1 3/0.5 400-800 minimal 16 Coronal T2 FSE FatSat 10-12 256 x 192 2 3/0.5 >2000 70-80 8 16 Sag STIR 12-14 256 x 192 2 3/0.5 >1500 40 120 90 8 16 Sag T1 Non FatSat 12-14 256 x 256 1 3/0.5 400-800 minimal 16 Coronal FMPSPGR FatSat Pre/Post 10-12 256 x 192 2 3/.5 60 5 30-40 8 16 Axial FMPSPGR FatSat Post 10-12 256 x 192 2 3/.5 60 5 30-40 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 85.
    Foot-Axial Imaging Plane RelevantAnatomy Axial Imaging Plane Prescribe plane parallel to 2rd or 3rd metatarsal. Scan foot from navicular through phalanges. N A V Phalanges
  • 86.
    Foot-Coronal Imaging Plane RelevantAnatomy Metatarsals 1 2 3 4 5 Coronal Plane *Prescribe plane parallel to 1st and 5th metatarsal Shafts. Scan through entire foot. *
  • 87.
    Foot-Sagittal Imaging Plane * * Metatarsals 1 2 3 4 5 SagittalPlane *Prescribe plane perpendicular to coronal Plane (©). Scan through entire foot. Relevant Anatomy © © *
  • 88.
    Soft Tissue MassProtocol General Recommendations ►Place Vitamin E capsule LIGHTLY on skin (do not depress skin with capsule) § If post-operative: place markers at each end of surgical scar ►FOV determined by mass size / location ►Try to include adjacent joint for reference ►Axial always; Sag or Cor depending on location of mass (speak with radiologist)
  • 89.
    Soft Tissue Mass Axial T1SE Non FatSat 256 x 192 5/1 400-800 minimum 16 Axial T2 FSE FatSat 256 x 192 5/1 >2000 40-60 8 16 Sag or Cor T1 SE Non FatSat 256 x 192 5/1 400-800 minimum 16 Sag or Cor STIR 256 x 192 5/1 >2000 30-40 150 8 16 Axial T1 GRE or SE FatSat Pre/Post Gd 256 x 192 5/1 60 400-800 5 minimum 30-40 - 8 16 Sag or Cor T1 GRE or SE FatSat Pre/Post Gd 256 x 192 5/1 60 400-800 5 minimum 30-40 - 8 16 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 90.
    MR Neurography Pelvis Coronal (PELVIS)T1 SE Non FatSat 36-40 256 x 256 1 4/1 400-800 Minimum 16 Coronal (PELVIS) FSE-STIR 36-40 256x192 2 4/1 >2000 20-40 3.0T: 180 1.5T: 150 8 16 Axial (PELVIS) T2 FSE FatSat 24 (hip to hip) 256 x 256 2 3.5/1 >2000 70-80 >8 16 Coronal T2 vista (or equivalent) 30-34 232x345 1 2/1 2800 288 90 150 Axial T1 3D FFE 24 276 x276 1 3/1.5 28 2.3 30 1 Axial M FFE 24 240x160 1 3/0 3570 4 45 4 Sagittal PD SPAIR 24-28 282x282 1 3.5/1 Max 45 90 >8 Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW Nex
  • 91.
  • 92.
    ER / InpatientProtocols ►Hip / pelvis fracture ►Joint: survey exam ►Non-contrast “R/O osteomyelitis” ►Chest wall / Abdominal wall ►Spine survey