Musculskeletal MRI Prtcls Reviewed by: Lawrence Tang, MD Last Review Date: July 2017 Cntact: (866) 761-4200, Optin 1 *Nte t MR technlgists: Marking updates and changes frm previus prtcls. Please pay extra attentin. Please feel free t cntact Dr. Tang if yu have any questins. Thank yu. The current revisin includes the fllwing key changes: 1. Hand/wrist fr arthritis/inflammatry arthrpathy prtcl : add cr T1 FS pre cntrast sequence 2. Lng bne mass/cyst prtcl: add a secnd plane pst cntrast T1 FS General parameters (1.5 T magnets): Fr all T1 sequences, please keep TE belw 20 (between 10 and 15 if pssible); TR 500-600. Fr all T2 FS sequences, use equivalent f FSE/TSE. TE f mid t upper 50 s is the mst ideal. It is imprtant t have TE lng enugh fr T2 weighing but nt s lng that it is signal starved. Fr STIR, TI = ~ 135 Rutine Knee sag PD sag T2 FS cr T1 cr T2 FS Pelvis: All pelvis cr and ax sequences need t cver frm bne t bne t be adequate Rutine Pelvis cr T1 cr STIR
Sacrum d standard pelvis then add small fr sacrum and cccyx (FOV = 24 cm) sag T2 FS (if FS fails, d STIR) Sacriliiac jints cr T1 - whle pelvis cr STIR whle pelvis small FOV fr sacrum and SI jints (FOV = 22 cm) blique cr T1 blique cr T2 FS precntrast blique cr T1 FS pst cntrast blique cr T1 FS Rutine Hip cr T1 (whle pelvis) cr STIR (whle pelvis) small FOV, hip f interest nly (FOV = 18 t 24 cm) cr T2 FS small FOV, hip f interest nly n hip f interest nly *** sag T2 FS small FOV, hip f interest nly blique small FOV, hip f interest nly Pelvis/Hip Trauma Reserved fr ER/urgentcare/prmpt care patients and inpatients wh fell nt the hip, with hip pain and inability t bear weight n the hip. ***All sequences dne fr the whle pelvis cr T1 (whle pelvis) cr STIR (whle pelvis) (whle pelvis) (whle pelvis) Rutine Ankle/Hindft (nt fr stemyelitis) cr T1 cr T2 FS sag STIR (TI = 135 fr 1.5 T)
Rutine Freft (nt fr stemyelitis) shrt axis T1 shrt axis T2 FS cr T1 (cr t ft) cr T2 FS sag STIR Lng Bne pain prtcl (lwer extremity) Ax T1 bilateral Ax T2 FS bilateral If anterir r psterir If medial r lateral Sag T1 unilateral cr T1 bilateral Sag T2 FS r STIR unilateral cr T2 FS r STIR bilateral Rutine Shulder blique cr T1 blique cr T2 FS blique blique sag T2 FS Rutine Elbw cr T1 (use the interepicndylar line t determine cr plane) cr T2 FS sag T2 FS Fr distal biceps tendn rupture evaluatin, please start the exam as rutine elbw, radial tubersity has t be included in cverage. Rutine Wrist cr T1 cr T2 FS cr 3D gradient ech sag T2 FS
Sprts Hernia/Athletic Pubalgia cr T1 whle pelvis cr STIR whle pelvis Small FOV t center at symphasis pubis cr T1 FOV 28 32 cm cr STIR FOV 28 32 cm FOV 28 cm sag T2 FS FOV 20 cm blique FOV 20 cm blique FOV 20 cm Nte: blique axial plane set up after sagittal sequence plane apprximately parallel t the arcuate line and ilipectineal line (see illustratin n the next page). D nt hesitate t call MSK radilgist t check the sequences.
Hands/Wrists fr Arthritis/Inflammatry Arthrpathy (e.g. rheumatid arthritis, psriatic arthritis) Extremity cil FOV: cr 16-17 cm; ax 15 cm Cverage: the entire wrist(s), MCP jints, t PIP jints. DIP can be excluded frm the FOV t ensure ptimal cverage f the wrist(s) and MCPs. Key jints: wrist(s) and MCP jints; must have gd signals n scuts frm distal radius t PIPs. Unilateral cr T1 cr T1 FS cr T2 FS cr T1 FS pst cntrast FS pst cntrast
Bilateral Image bth sides tgether: line up palms and fingers, skin-t-skin leaving n space in between, tape tgether; Mark the drsum f the right hand with an MR cmpatible marker; Preacher psitin. cr T1 cr T1 FS cr T2 FS cr T1 FS pst cntrast FS pst cntrast MSK MR Mass vs. Cyst Prtcls Lng bne sft tissue mass vs. cyst prtcl (lwer extremity) bilateral bilateral if lesin anterir r psterir if lesin medial r lateral unilateral cr T1 bilateral sag T2 FS r STIR unilateral cr T2 FS r STIR bilateral FS pre cntrast FS pre cntrast FS pst cntrast FS pst cntrast FS pst cntrast cr T1 FS pst Lng bne sft tissue mass vs. cyst prtcl (upper extremity) if lesin anterir r psterir if lesin medial r lateral cr T1 sag T2 FS r STIR cr T2 FS r STIR FS pre cntrast FS pre cntrast FS pst cntrast FS pst cntrast FS pst cntrast cr T1 FS pst cntrast If the mass is thrugh t be a lipma, n intravenus cntrast is needed. Single plane T1 FS sequence shuld d may need radilgist t check.
MSK MR Ostemyelitis Prtcls The purpse f this seemingly cmplicated apprach t stemyelitis is t streamline the prtcl s we can perfrm the exams n a cnsistent basis t btain adequate diagnstic infrmatin with a reasnable amunt f scanning time. Fr all stemyelitis cases, pst-cntrast sequences are needed fr evaluatin f bne viability. If intravenus cntrast cannt be administered due t severe renal insufficiency r allergy, please refer t rutine prtcl t scan the patient. Ulcers shuld be marked befre scanning is initiated. Please acquire sequences in the rder listed in the prtcl. If there is difficulty cmpleting the last pst-cntrast sequence (e.g. pt. mtin, pt. pain, scanner shut dwn etc.), there is n need t repeat the specific sequence. Ft stemyelitis Shrt axis crss sectin f the metatarsals Cr cr t the ft Sag sag t the ft Ostemyelitis freft r mid-ft (ulcer at tip f ft distal ulcer) shrt axis T1 shrt axis T2 FS sag STIR sag pre cntrast T1 FS sag pst cntrast T1 FS shrt axis pst cntrast T1 FS ***cr (t ft) T1 pst cntrast, n FS fr anatmic crrelatin If ulcer at medial r lateral ft, chse shrt axis plane fr pre and pst cntrast T1 FS. Optinal pst cntrast sequence: cr pst cntrast T1 FS Ostemyelitis freft r mid-ft (ulcer at drsal r plantar ft) shrt axis T1 shrt axis T2 FS sag STIR shrt axis pre cntrast T1 FS shrt axis pst cntrast T1 FS sag pst cntrast T1 FS ***cr (t ft) T1 pst cntrast, n FS fr anatmic crrelatin
Ostemyelitis freft r mid-ft (ulcer at medial r lateral ft) shrt axis T1 shrt axis T2 FS cr T1 cr T2 FS (if FS fails, cr STIR) shrt axis pre cntrast T1 FS shrt axis pst cntrast T1 FS cr pst cntast T1 FS Ankle/hindft stemyelitis Setup as ankle MR ax axial t tibia/fibula cr crnal distal tibial sigmid ntch sag perpendicular t crnal plane Ostemyelitis hindft r ankle (ulcer at psterir hindft/ankle) sag STIR sag pre cntrast T1 FS sag pst cntrast T1 FS ax pst cntrast T1 FS Ostemyelitis hindft r ankle (ulcer at drsal r plantar hindft) cr T1 cr T2 FS sag STIR sag pre cntrast T1 FS sag pst cntrast T1 FS cr pst cntrast T1 FS Ostemyelitis hindft r ankle (ulcer at medial r lateral hindft/ankle) cr T1 cr T2 FS (if FS fails, STIR) cr pre cntrast T1 FS cr pst cntrast T1 FS ax pst cntast T1 FS
Ostemyelitis pst-surgical stump (belw the knee r abve the knee amputatin) cr T1 cr T2 FS (if FS fails, STIR) cr pre cntrast T1 FS cr pst cntrast T1 FS ax pst cntrast T1 FS Other lng bne stemyelitis Please refer t ankle stemyelitis fr plane selectin f pre and pst cntrast sequences. MSK MR Arthrgram Prtcls Shulder Arthrgram blique cr T1 FS blique cr T2 FS blique blique sag T2 FS Wrist Arthrgram cr T1 FS cr T2 FS cr 3D gradient ech sag T2 n FS (TE = 80 t 90) Elbw Arthrgram cr T1 FS (use the interepicndylar line t determine cr plane) cr T2 FS sag T2 n FS (TE = 80 t 90)
Hip Arthrgram cr T1 whle pelvis cr T2 FS whle pelvis small FOV hip f interest cr T2 FS blique (NO FS) FS sag T2 FS Knee Arthrgram sag PD sag T2 FS FS cr T1 cr T2 FS