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 : : : : : : 702020--4040>1500>15004 x 192256 x 192222424 AxialAxialFSTIRFSTIR1616------minmin4004 00--8008004 x 256256 x SliceTRTETI Flip ETL BWNex Coronal: oblique Coronal.

2 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: 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.

3 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)** 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.

4 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. 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.

5 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; 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 ( ).

6 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. **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: **Perform routine wrist PLUS Pre/Post Gadolinium IMPORTANT.

7 **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.

8 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.

9 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.

10 See fast GRE or T1 SE images. See massmass protocol and protocol and adjust FOV and other parameters as FOV and other parameters as : : : : : : 702020--4040>1500>15003 x256256 x256221010--1414 CoronalCoronalSTIRSTIR1616443030--505020 002000--600060003 x256256 x256221010 AxialAxialPD FSEPD FSEFatSatFatSat1616minimumminimum400400- -8008003 x 192256 x 192221010 AxialAxialT1 SET1 SE1616885050--707020002000--600060003 x 192256 x 192221010 SagSagT2 FSET2 FSEFatSatFatSat1616minimumminimum400400- -8008003 x 192256 x 192111010 SagSagT1 SET1 Flip ETLBWNexFingerFinger--Axial Imaging PlaneAxial Imaging PlaneDistalPhalanxMidPhalanxMetacarpalPr oximal PhalanxRelevant AnatomyAxial Imaging PlanePrescribe best fit line. Scan from proximal metacarpal through Imaging PlaneCoronal Imaging PlaneRelevant AnatomyCoronal Imaging Plane*Prescribe plane parallel to anteriormetacarpal head. Scan through entirefinger. Include 2 adjacent fingers.*ThumbExtensor TendonFingerFinger--Sagittal Imaging PlaneSagittal Imaging PlaneRelevant AnatomySagittal Imaging Plane*Prescribe plane perpendicular to coronal plane ( ).