MRI PROTOCOLS COMPLETE-2015

1 MSK MRI PROTOCOLSMSK MRI PROTOCOLSC ontentsContents Upper ExtremityUpper ExtremityPagePage ShoulderShoulder ElbowElbow WristWrist FingerFinger ThumbThumb Lower ExtremityLower Extremity Hip Hip PelvisPelvis ThighThigh KneeKnee Lower Extremity/ShinLower Extremity/Shin AnkleAnkle FootFoot Special CasesSpecial Cases Soft Tissue MassSoft Tissue Mass Metal ProtocolMetal ProtocolMSK CHESTMSK CHESTMR MSK Chest Indications:MR MSK Chest Indications: PectoralisPectoralisMajorMajor Indications:Indications: PecPecteartear Sternum / SC jointsSternum / SC joints Indications:Indications: Tumor, infection, arthritis, trauma Tumor, infection, arthritis, trauma Chest wallChest wall Indications: Indications: Trauma, tumorTrauma, tumorPectoralisPectoralisMajorMajor Use large FOVUse large FOV MedialMedial--lateral: cover to midline chestlateral: cover to midline chest SuperiorSuperior--inferior: cover down to midinferior: cover down to mid--humeral humeral : : : : : : 702020--4040>1500>15004 x 192256 x 192223636--4848 CorCorOblOblFSTIRFSTIR161688----8080--10 0100>2000>20004 x 256256 x 256223030--3636 AxialAxialT2 FSET2 FSE161688----4040--6060>2000>20004/14/12 56 x 192256 x 192223030--3636 SagSagObliqueObliqueT2 FSET2 FSEFat SatFat : : : : : : 702020--4040>1500>15004 x 192256 x 192223030--3636 AxialAxialFSTIRFSTIR1616------minmin4004 00--8008004 x 256256 x SliceTRTETI Flip ETL : : : : : : 702020--4040>1500>15004 x 192256 x 192222020--3030 SagSagFSTIRFSTIR1616------minmin400400-- 8008004 x 256256 x 256222020--3030 SagSagT1T1161688----4040--6060>2000>2000 4/14/1256 x 192256 x 192222020--2424 CorCorobliqueobliqueT2 FSET2.

2 702020--4040>1500>15004 x 192256 x 192222424 AxialAxialFSTIRFSTIR1616------minmin4004 00--8008004 x 256256 x SliceTRTETI Flip ETL BWNex Coronal: oblique Coronal: oblique along sternum along sternum Planned from sagittal imagesPlanned from sagittal : : : : : : 702020--4040>1500>15004 x 192256 x 192222020--2424 SagSagFSTIRFSTIR1616------minmin400400-- 8008004 x 256256 x 256222020--2424 SagSagT1T1161688----4040--6060>2000>2000 4/14/1256 x 192256 x 192221414--2020 CorCorT2 FSET2 : : : : : : 702020--4040>1500>15004 x 192256 x 192221414--2020 AxialAxialFSTIRFSTIR1616------minmin4004 00--8008004 x 256256 x SliceTRTETI Flip ETL BWNex Smaller FOV for SC jointsSmaller FOV for SC joints Otherwise protocol Otherwise protocol is similar to Sternumis similar to SternumMSK MSK --Chest WallChest WallUPPER EXTREMITYUPPER EXTREMITYMR Shoulder Indications:MR Shoulder Indications: Routine ShoulderRoutine Shoulder Indications:Indications: Rotator Cuff Pathology/EvaluationRotator Cuff Pathology/Evaluation MR ArthrogramMR Arthrogram Indications:Indications: Labrum Pathology/Tear Labrum Pathology/Tear Post Gadolinium Shoulder (Indirect MR Post Gadolinium Shoulder (Indirect MR Arthrogram)Arthrogram) Indications: Indications.

3 Labral Pathology/Instability without ability to do a direct Labral Pathology/Instability without ability to do a direct arthrogramarthrogramShoulderShoulder--Ro utineRoutine1616----minimumminimum400400 --8008004 x 256256 x 256111616--1818 CorCorObliqueObliqueT1 SET1 SENonNonFatSatFatSat161688----9090--1101 10>2000>20004/14/1256 x 192256 x 192111414--1616 SagSagObliqueObliqueT2 FSET2 FSENonNonFat SatFat : : : : : : 702020--4040>1500>15004 x 192256 x 192221616--1818 CorCorObliqueObliqueFSTIRFSTIR161688---- 2020--404020002000--300030004 x 256512 x 256221212--1414 AxialAxialPD FSEPD SliceTRTETIFlipETLBWNexMR Arthrogram ShoulderMR Arthrogram Shoulder1616minimumminimum400400--800800 3 x 192256 x 192221414 ABERABERT1 SET1 SEFat SatFat Sat1616minimumminimum400400--8008004/14/ 1256 x 192256 x 192111414 SagSagObliqueObliqueT1 SET1 SENon Non FatSatFatSat1616883030--5050>1500>15003 x 192256 x 192221414--1616 CorCorObliqueObliquePD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 192256 x 192221414--1616 CorCorObliqueObliqueT1 SE T1 SE FatSatFatSat1616minimumminimum400400--80 08003 x 192256 x 192221212--1414 AxialAxialT1 SET1 SliceTRTETIFlipETLBWNexShoulderShoulder- -Post GadoliniumPost Gadolinium(Indirect MR Arthrogram)(Indirect MR Arthrogram)

4 **Inject standard dose of IV contrast and wait 20 minutes before**Inject standard dose of IV contrast and wait 20 minutes beforescanning**scanning** : : : : : : 702020--4040>1500>15004 x 192256 x 192221616--1818 CorCorObliqueObliqueFSTIRFSTIR883030--50 5020002000--400040004/14/1256 x 192256 x 192221414--1616 SagittalSagittalPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 192256 x 192221414--1616 CorCorObliqueObliqueT1 SE T1 SE FatSatFatSat883030--505020002000--400040 003 x 192256 x 192221212--1414 AxialAxialPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 192256 x 192221212--1414 AxialAxialT1 SET1 Flip ETL BWNexShoulderShoulder--Axial Imaging PlaneAxial Imaging PlaneRelevant AnatomyHumeralHeadBony GlenoidClavicleAxial Imaging PlanePrescribe plane parallel to humeral shaft. Cover from top of AC joint through proximal humeral diaphysis. AC Joint(Not shown on MR)ShoulderShoulder--Coronal Imaging PlaneCoronal Imaging PlaneCoronal Imaging PlanePrescribe coronal plane off of axial images parallel to supraspinatus muscleRelevant AnatomySupraspinatusShoulderShoulder--Sa gittal Imaging PlaneSagittal Imaging PlaneHumeral HeadBony GlenoidLabrumCartilaginousLabrumAnt.

5 And AnatomySagittal Imaging PlanePrescribe sagittal plane off axial images withline parallel to bony glenoid. Image from mid-scapulathrough deltoid MuscleMR Elbow Indications:MR Elbow Indications: Routine ElbowRoutine Elbow Indications:Indications: Biceps/Triceps tearBiceps/Triceps tear Medial/Lateral collateral ligament tearMedial/Lateral collateral ligament tear Common Flexor/Common extensor tendon pathologyCommon Flexor/Common extensor tendon pathology MR Arthrogram ElbowMR Arthrogram Elbow Indications:Indications: Intra articular body evaluationIntra articular body evaluation Medial/Lateral Collateral Ligament EvaluationMedial/Lateral Collateral Ligament Evaluation Osteochondral defect (OCD)Osteochondral defect (OCD) Post Gadolinium Elbow (Indirect MR arthrogram)Post Gadolinium Elbow (Indirect MR arthrogram) Indications:Indications: IA bodyIA body OCDOCDE lbowElbow--Routine*Routine*1616882020--4 04015001500--300030003 x 256256 x 256221212--1414 SagSagPD FSEPD FSEFatSatFatSat1616882020--4040> 1500> 15003 x 256256 x 256221414--1616 CoronalCoronalPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 256256 x : : : : : : 702020--4040>2000>20004/14/1256 x 192256 x 192221414--1616 AxialAxialFSTIRFSTIR1616minimumminimum40 0400--8008004/14/1256 x 256 256 x 256 Flip ETL BWNex*for Biceps pathology perform FABS sequence.

6 Follow this Arthrogram ElbowMR Arthrogram Elbow1616minimumminimum400400--8008003 x 256256 x 256221212--1414 SagSagT1 SET1 SEFatSatFatSat1616883030--5050>1500>1500 3 x 256256 x 256221212--1414 CoronalCoronalPD FSE PD FSE FatSatFatSat1616minimumminimum400400--80 08003 x 256256 x 256221212--1414 CoronalCoronalT1T1 FatSatFatSat1616883030--5050>1500>15004/ 14/1256 x 256256 x 256221212--1414 AxialAxialPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008004/14/1256 x 256256 x 256111212--1414 AxialAxialT1T1 Non Non Flip ETL BWNexElbowElbow--Axial Imaging PlaneAxial Imaging PlaneRelevant AnatomyAxial Imaging Plane*Prescribe plane perpendicular to coronalplane ( ). Scan from humeral metaphysisthrough radial tuberosity. **Radial Tuberosity(bump on medial radius)Lateral and MedialHumeral CondylesUlnaRadiusRadial tuberosityElbowElbow--Coronal Imaging PlaneCoronal Imaging PlaneRelevant AnatomyCoronal Imaging Plane*Prescribe plane parallel to medial and lateral epicondyles.

7 **Lateral EpicondyleMedialEpicondyleOlecranon processof UlnaHumerusElbowElbow--Sagittal Imaging PlaneSagittal Imaging PlaneSagittal Imaging Plane*Prescribe plane perpendicular to coronal plane ( ). Scan through entire elbow. **Lateral Humeral CondyleMedial Humeral CondyleOlecranon processof UlnaHumerusRelevant AnatomyFABS SequenceFABS Sequence For Biceps pathologyFor Biceps pathology Acquire T1 and T2 FSAcquire T1 and T2 FSWrist Indications:Wrist Indications: Routine WristRoutine Wrist Indications:Indications: TFCC, TFCC, LunotriquetralLunotriquetral, , ScapholunateScapholunateteartear Flexor Tendon/Carpal Tunnel/ Extensor Tendon PathologyFlexor Tendon/Carpal Tunnel/ Extensor Tendon Pathology Evaluation for Occult fractureEvaluation for Occult fracture MR Wrist ArthrogramMR Wrist Arthrogram Indications:Indications: TFCC/LT/SL ligament tearsTFCC/LT/SL ligament tears Dynamic Enhanced Wrist (Post Gad Images)Dynamic Enhanced Wrist (Post Gad Images) Indications:Indications: Evaluation of Evaluation of ScaphoidScaphoidNonunion/Avascular Necrosis Exam: Nonunion/Avascular Necrosis Exam: IMPORTANT.

8 **Perform routine wrist PLUS Pre/Post Gadolinium IMPORTANT: **Perform routine wrist PLUS Pre/Post Gadolinium images through carpal bones in images through carpal bones in coronalcoronalplane**plane** : : : : : : 702020--4040>1500>15003/13/1256 x 192256 x 192221212--1414 SagSagFSTIRFSTIR1616883030--505020002000 --300030003/13/1256 x 256256 x 2562288--1212 AxialAxialPD FSE PD FSE Fat SatFat Sat16162020--4040minimumminimum60601/01/ 0256 x 192256 x 192221010--1212 CoronalCoronal2D or 3D2D or 3 DGRE GRE FatSatFatSat1616883030--5050>1500>15003 x 256256 x 2562288--1212 CoronalCoronalPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 256256 x 2561188--1212 CoronalCoronalT1 T1 Flip ETL BWNexMR Arthrogram Wrist (direct or indirect)MR Arthrogram Wrist (direct or indirect)1616minimumminimum400400--80080 03/13/1256 x 192256 x 1921188--1212 AxialAxialT1T1 NonNon--FatSatFatSat1616883030--5050>150 0>15003/13/11010--1212 SagSagPD FSEPD FSEFatSatFatSat1616883030--5050>1500>150 03/13/1256 x 256256 x 2562288--1212 AxialAxialPD FSEPD FSEFatSatFatSat16164545--6060minimummini mum60601/01/0256 x 192256 x 192221010--1212 CoronalCoronal2D or 3D2D or 3 DGRE GRE FatSatFatSat1616883030--5050>1500>15003 x 256256 x 2562288--1212 CoronalCoronalPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 256256 x 2562288--1010 CoronalCoronalT1 SET1 SliceTRTETIFlipETLBWNexWristWrist--Axial Imaging PlaneAxial Imaging PlaneDistalulnalunscaphcaptriqDistradius trapmtrapzhamRelevant AnatomyAxial Imaging PlanePrescribe plane parallel to distal radius.

9 Scanfrom proximal metacarpals through distalradial/ulnar metaphysis.**IMAGE WRIST IN PRONATED POSITION!SUPINATEDPRONATEDW ristWrist--Coronal Imaging PlaneCoronal Imaging PlaneRelevant AnatomyCoronal Imaging Plane*Prescribe plane parallel to line drawn from ulnar styloid through radial styloid. Scanthrough entire wrist.**UlnarStyloidRadialStyloidRemembe r to pronate the wrist!WristWrist--Sagittal Imaging PlaneSagittal Imaging PlaneUlnarStyloidRadialStyloidRelevant AnatomySagittal Imaging Plane*Prescribe plane perpendicular to coronal plane ( ).Scan through entire wrist. **UlnarStyloidRadialStyloidHint: if the ulnar styloid is poking out to the side, the wrist is in pronated positionThumb Indications:Thumb Indications: Routine ThumbRoutine Thumb Indications: Indications: GamekeeperGamekeeper s thumb (s thumb (UlnarUlnarCollateral Ligament tear)Collateral Ligament tear) Flexor/Extensor Tendon TearFlexor/Extensor Tendon Tear R/O Occult FractureR/O Occult FractureThumbThumb1616885050--7070200020 00--600060003 x 192256 x 192221010 AxialAxialT2 FSE T2 FSE Fat SatFat Satminimalminimal400400--8008003 x 192256 x 192111010 AxialAxialT1 SET1.

10 702020--4040>1500>15003 x 192256 x 192221010--1414 Sag FSESag FSESTIRSTIR1616885050--707020002000--600 060003 x 192256 x 192221010 CoronalCoronalT2 FSE T2 FSE Fat SatFat Sat443030--5050>1500>15003 x 256256 x 256221010 CoronalCoronalPD FSEPD SliceTRTETI Flip ETL BWNexThumbThumb--Axial Imaging PlaneAxial Imaging PlaneRelevant AnatomyAxial Imaging PlanePrescribe plane perpendicular to midshaft ofproximal 1stphalanx. Scan from CMC joint through PhalanxThumbThumb--Coronal Imaging PlaneCoronal Imaging PlaneRelevant AnatomyCoronal Imaging Plane*Prescribe plane with line bisecting sesamoid bones. Scan through entire *ThumbThumb--Sagittal Imaging PlaneSagittal Imaging PlaneSesamoidsThumbRelevant AnatomySagittal Imaging Plane*Prescribe plane perpendicular to coronal imaging plane ( ). Scan through entire thumb. *Finger Indications:Finger Indications: Routine FingerRoutine Finger Indications:Indications: Pulley rupture/Flexor or Extensor Tendon InjuryPulley rupture/Flexor or Extensor Tendon Injury Post Gadolinium FingerPost Gadolinium Finger Indications:Indications: MassMass **Perform routine finger plus Axial and either Coronal or **Perform routine finger plus Axial and either Coronal or Sagittal (whichever plane mass best seen) pre/post gadolinium Sagittal (whichever plane mass best seen) pre/post gadolinium FatSatFatSatfast GRE or T1 SE images.