Musculskeletal MRI Prtcls Reviewed by: Lawrence Tang, MD Last Review Date: March 2018 Cntact: (866) 761-4200, ptin 1 *Nte t MR technlgists: Updates and new prtcls are underlined in this dcument. Please feel free t cntact Dr. Tang if yu have any questins. Thank yu. 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 fr Siemens, 60-65 fr GE, and ~ 60 fr Tshiba. It is imprtant t have TE lng enugh fr T2 weighting but nt s lng that it is signal starved. Fr STIR, TI = ~ 135
Rutine Knee sag PD 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) (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 blique cr T1 FS pre cntrast blique cr T1 FS pst cntrast 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 small FOV, hip f interest nly small FOV, hip f interest nly blique small FOV, hip f interest nly
Rutine Shulder blique cr T1 blique cr T2 FS blique blique Rutine Elbw cr T1 (use the interepicndylar line t determine cr plane) cr 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 Rutine Hand/Finger (generalized hand/finger pain) cr T1 cr T2 FS
Trauma Hip Reserved fr ER/urgent care/prmpt care patients t rule ut hip fracture ***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) bilateral bilateral cr T1 bilateral cr T2 FS r STIR bilateral r STIR unilateral Lng Bne Pain Prtcl (upper extremity) - All unilateral sequences cr T1
cr T2 FS r STIR r STIR MR Chest Pectralis Prtcl - Unilateral - Cverage: prximal half f humerus, medial half f clavicle (including clavicular head) and unilateral half f the sternum blique cr T1 (align with pectralis majr muscle) blique cr T2 FS Rutine Thumb: MCP Jint Cllateral Ligaments r Thumb Pain blique cr T1 (cr t the MCP jint) blique cr T2 FS (cr t the MCP jint) Sprts Hernia/Athletic Pubalgia cr T1 whle pelvis cr STIR whle pelvis Small FOV t center at symphysis pubis cr T1 FOV 28 32 cm cr STIR FOV 28 32 cm FOV 28 cm 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 T2 FS FS pre cntrast FS pst cntrast cr T1 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 T2 FS FS pre cntrast FS pst cntrast cr T1 FS pst cntrast Hand/Finger Infectin. - If w/ cntrast nly cr T1 cr T2 FS sag STIR - add the fllwing if w/ and w/ cntrast FS pre cntrast
FS pst cntrast 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 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 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 thught 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 cntrast 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 cntrast T1 FS Ostemyelitis bilateral ft - When ding MR f bth feet fr stemyelitis in ne setting, please mark the drsum f the RIGHT ft with tw MR cmpatible markers. - Image ne ft at a time. Ostemyelitis pst-surgical stump (belw the knee r abve the knee amputatin) ax STIR cr T1 cr STIR cr T1 FS pre cntrast cr T1 FS pst cntrast FS pst cntrast FS pst cntrast Other lng bne stemyelitis Please refer t ankle stemyelitis fr plane selectin f pre and pst cntrast sequences.\ Ostemyelitis pelvis (sacrum and cccyx) - whle pelvis ax STIR cr T1 (sacrum and cccyx) sag STIR (sacrum and cccyx) FS pre cntrast (sacrum and cccyx) FS pst cntrast (sacrum and cccyx) FS pst cntrast (whle pelvis)
Ostemyelitis pelvis (ther than sacrum and cccyx) - whle pelvis ax STIR cr T1 cr STIR FS pre cntrast FS pst cntrast FS pst cntrast (whle pelvis) MSK MR Arthrgram Prtcls Shulder Arthrgram - Add ABER T1 (n FS) if the patient is 40 y.. r yunger blique cr T1 FS blique cr T2 FS blique blique Is the patient 40 y.. r yunger? (ABER T1 n FS) Wrist Arthrgram cr T1 FS cr T2 FS cr 3D gradient ech Elbw Arthrgram cr T1 FS (use the interepicndylar line t determine cr plane) cr T2 FS Hip Arthrgram cr T1 whle pelvis cr T2 FS whle pelvis
small FOV hip f interest cr T2 FS blique (NO FS) FS Knee Arthrgram sag PD FS cr T1 cr T2 FS