Advanced Medical Imaging Consultants, PC

Advanced Medical Imaging Consultants, PC

MRI MSK Protocols

Updated April, 2020

1

MRI Protocols

Shoulder Protocols 3 Bony Pelvis Protocols 33

Shoulder Pictures 5 Bony Pelvis Pictures 37

Humerus Protocols 8 Hip Protocols 33

Elbow Protocols 9 Hip Pictures 42

Elbow Pictures 11 Femur Protocols 46

Forearm Protocols 14 Knee Protocols 48

Wrist Protocols 15 Knee Pictures 50

Wrist Pictures 17 Tibia/Fibula Protocols 53

Hand Protocols 22 Tibia/Fibula Pictures 54

Hand Pictures 23 Ankle/Hindfoot Protocols 56

Thumb/Finger Protocols 28 Ankle/Hindfoot Pictures 58

Thumb/Finger Pictures 30 Foot Protocols 63

Foot Pictures 65

Table of ContentsUpper Extremity Lower Extremity

General Notes on Musculoskeletal MRI Protocols

Throughout this book, CORONAL = LONG AXIS, AXIAL = SHORT AXIS

Whenever intravenous gadolinium is given, a pre-contrast fat suppressed T1-weighted sequence must be included. This sequence should have identical parameters to a post-contrast series in the same plane.

2

MRI Protocols

Upper Extremity

Sequence

ParametersSeries Description FOV (cm)

Slice

ThicknessTR (ms) TE (ms) Avgs Resolution

3-plane Locator R

or L ShiftSCOUT 25 8 15 5 1 256x128

Axial 3D GRE AX_3D_GRE 10-12 4/0.4

Axial PD FS AX_PD_FS 10-12 4/0.4 >2000 20-30 2 256x256

Coronal T2 FS COR_T2_FS 16-18 4/0.4 >3000 40-50 2 256x256

Coronal T1 COR_T1 16-18 4/0.4 400-800 Min 1 256x256

Sagittal T2 FS SAG_T2_FS 16-18 4/0.4 >3000 40-50 2 256x256

Sagittal T1 SAG_T1 16-18 4/0.4 400-800 Min 2 256x256

Sequence


Slice


3-Plane Locator R

or L ShiftSCOUT 25 8 15 5 1 256x128

Axial T1 FS AX_T1_FS 10-12 4/0.4 400-800 Min 1 256x256

Axial 3D GRE AX_3D_GRE 10-12 4/0.4

Coronal T1 FS COR_T1_FS 16-18 4/0.5 400-800 Min 1 256x256



Sagittal T2 FS SAG_T2_FS 16-18 4/0.5 >2000 70-80 2 256x256

Sequence Parameters

Arthrogram Labrum Pathology/Tear

Infection/Osteomyelitis/Mass

Routine

Arthrogram

Per Scanner

Per Scanner

Protocol Indications

Routine Shoulder Rotator Cuff Pathology/Evaluation

Shoulder

Overview

Photos - Shoulder AxialPhotos - Shoulder

Coronal ObliquePhotos - Shoulder Sagittal

3 7/2018

MRI Protocols

Upper Extremity

Sequence


Slice


3-Plane Scout - R

of L ShiftSCOUT 25 8 15 5 1 256x192

Axial STIR AX_STIR 10-12 4/0.4 4000-6000 60-90 2-3 256x192

Axial T1 AX_T1 10-12 4/0.4 400-800 Min 1 256x256



Axial T1 FS Pre GD AX_T1_FS_PRE 10-12 4/0.4 400-800 Min 1 256x256

Axial T1 FS Post

GDAX_T1_FS_POST 10-12 4/0.5 400-800 Min 1 256x256

Coronal or

Sagittal T1 FS Post

GD

COR_T1_FS_POST or

SAG_T1_FS_POST16-18 4/0.5 400-800 Min 1 256x256

Comments: Choose Coronal or Sagittal T1 FS Post GD depending on location of mass.

Infection, Osteomyelitis, Mass,

4 7/2018

MRI Protocols

Upper Extremity

Shoulder - AxialFOV = 12-16 cm

Localizer: Coronal Oblique

Orient all imaging planes with respect to the glenoid articular surface. Scan superiorly through the AC joint and inferiorly to include a portion of

humeral diaphysis.

Figure 1. On the coronal localizer, the axial plane is perpendicular to the glenoid articular surface.

Figure 2. In this example, the patinet's shoulder is hunched. The axial plane must be angled to compensate for the glenoid position.

Shoulder - Axial, Final Image

5 7/2018

MRI Protocols

Upper Extremity

Shoulder - Coronal ObliqueFOV = 12-16 cm

Localizer: Axial

Orient all imaging planes with respect to the glenoid articular surface. Scan posteriorly to include all bones and anteriorly to include coracoid

process.

Figure 3. On the axial localizer, the coronaloblique plane is perpendicular to the glenoid.

Shoulder - Coronal Oblique, Final Image

6 7/2018

MRI Protocols

Upper Extremity

FOV = 12-16 cm

Axial and Coronal

Orient all imaging planes with respect to the glenoid articular surface. Scan laterally to include the bones. Scan medially to include 2-3 cm

medical to the glenoid articular surface.

Shoulder - Sagittal

Figure 4. On the coronal oblique localizer, the sagittal plane is parallel to the glenoid surface.

Figure 5. On the axial localizer, the sagittal plane is patallel to the glenoid surface.

Shoulder - Sagittal, Final Image

7 7/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series

DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution

Axial T1 AX_T1 24 7 500 12 2 256X204

Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204

Coronal T1 COR_T1 32 5 500 12 1 256x192

Coronal STIR COR_STIR 32 5 5000 65 1 256x204

Sagittal T1 SAG_T1 32 5 500 12 1 256x192

Sagittal STIR SAG_STIR 32 5 5000 65 1 256x204

Sequence

Parameters

Series


Axial T1 AX_T1 24 7 500 12 2 256X204

Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204


Coronal T1 COR_T1 32 5 500 12 1 256x192


Axial T1 FS Pre

GadAX_T1_FS_PRE 24 7 600 15 1 256x192

Axial T1 FS

Post GadAX_T1_FS_POST 24 7 600 15 1 256x192

Coronal or

Sagittal T1 FS

Post GD

COR_T1_FS_

POST or

SAG_T1_FS_

POST

32 7 600 15 1 256x192


Humerus (Long Bone)Overview

If there is a specific mass or lump being evaluated, choose the Soft Tissue mass Protocol. The major difference is that this

protocol scans a larger area. This requires thicker slices and larger FOV, factors which may hinder soft tissue mass assessment.

In general, minimize the FOV on the axial images to improve resolution. Orient the scan planes with respect to the humerus. Axial

images should slice the humerus like a straight-cut loaf of bread.

If there is a specific region of interest or site of pain, bracket it with two vitamin capsules/markers. Do not press the markers into

the skin as this can distort MR signal.

For axial images, slice thickness/slice gap can be increased from 4mm/1mm up to 6mm/2mm to improve exam time.

Positioning


Routine

Mass/Infection/Abscess

Routine

Infection, Mass, Abscess

Sequence Parameters

8 07/2018

MRI Protocols

Upper Extremity

Sequence

ParametersSeries Description FOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution

3-Plane Scout Small

FOVSCOUT_SM 20 8 15 5 1 256X128

Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256X256

Coronal T1 COR_T1 16 3/0.3 400-800 Min 1 256x256

Coronal T2 FS COR_T2_FS 16 3/0.3 >3000 70-80 2 256x256

Coronal 3D GRE COR_3D_GRE 12 1.5 20 12 2 256x192

Sagittal Stir SAG_STIR 12 3/0.3 4500 65 1 256x204

Sequence


3-Plane Scout Small

FOVSCOUT_SM 20 8 15 5 1 256x128

Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 10-121 3/0.3 >3000 70-80 2 256x256

Coronal T1 FS COR_T1_FS 16 3/0.3 400-800 Min 1 256x256

Sagittal T1 FS SAG_T1_FS 16 3/0.3 400-800 Min 1 256x256

Coronal PD FS COR_PD_FS 16 3/0.3 2000-2500 20-30 2 256x256

Elbow

Medial/Lateral Collateral Ligament Evaluation

Pre and Post Gadolinium Bicepts or Triceps Tear Infection, osteomyelitis, mass, bone lesion

Common Flexor/Common Extensor Tendon Pathology


Routine Elbow Medial/Lateral Collateral Ligament tears

Pictures of Elbow - Axial Pictures of Elbow - Coronal Pictures of Elbow - Sagittal

Arthrogram

Overview

Elbow anatomy is complex. A typical person has 15-20° of valgus angulation at the elbow. Therefore, the best imaging planes for the humerus

will not be the same best imaging planes for the proximal radius and ulna. The imaging strategy in this section is designed to optimize

visualization of critical structures nad should work well in most situations.

Patient Position #1 - "Superman": Provides the best signal because the elbow is closer to the isocenter of the magnet. Requires cooperative

patient without significant shoulder pain or injury. Patient is prone, arm above the head. The elbow is in full extension with the thumb up

(forearm supination). Neutral position/mild pronation (i.e. hand flat) is usually adequate, too. Pad the hand for comfort and to reduce motion. In

general, you should select the best available knee coil when scanning the elbow in the "superman" position.

Patient Position #2 - Supine: This positioning should be reserved for patients who cannot do the Superman position (e.g. shoulder pain or injury).

It has the disadvantages of reduced signal- to-noise and limited coil selection (further reducing signal-to-noise). Keep elbows as far from the edge

of the bore as possible. If the elbow is very close to the bore, fat saturation will not work. (You may need to substiture STIR for T2/PD fat sat).

Patient is supine, arm at the side. Eblow in full extension with the thumb up (forearm supination). Pad the hand for comfort and to reduce

motion. Larger coil devices such as an HR knee coil often won't fit next to the patient. Choose the best coil that will fit, often a flex coil.

Sequence ParametersRoutine Pain, Injury

Positioning

MR Elbow Arthrogram Intra-articular Body Evaluation

9 7/2018

MRI Protocols

Upper Extremity

Sequence


3-Plane Scout Small

FOVSCOUT_SM 20 8 15 5 1 256x128

Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256 Zip 512

Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256X256

Cor STIR COR_STIR 16 3/0.3 4000-6000 60-90 2-3 256x192


Axial T1 FS Pre GD AX_T1_FS_PRE 10-12 3/0.3 400-800 Min 1 256x256

Axial T1 FS Post GD AX_T1_FS_POST 10-12 3/0.3 400-800 Min 1 256x256

Coronal or Sagittal

T1 FS Post GD

COR_T1_FS_POST or

SAG_T1_FS_POST16 3/0.3 400-800 Min 1 256x256


Infection/Osteomyelitis/Mass

10 7/2018

MRI Protocols

Upper Extremity

Elbow - Axial FOV = 12 - 14 cm

Localizer: Axial and coronal

Figure 6. Include 6cm proximal to the joint line and all of the radial

Figure 7. On the sagittal localizer, the axial plan connects the center of the trochlea with the tip of

Figure 8. The axial plan bisects the epicondyles of the humerus.

Elbow - FinalImage.

11 7/2018

MRI Protocols

Upper Extremity

Elbow - CoronalFOV = 12 - 14 cm

Localizer: Axial and sagittal

Figure 9. On an axial localizer, the coronal plane bisects the epicondyles of the humerus.

Figure 10. On a sagittal localizer, the coronal plane is perpendicular to the line connecting the center of the trochlea and the tip of the olecranon (i.e., perpendicular to the axial plane).

Elbow - Final Image

12 7/2018

MRI Protocols

Upper Extremity

Elbow - SagittalFOV = 12 - 14 cm

Localizer: Axial and coronal

Figure 11. On the axial localizer, the sagittal plane is perpendicular to the coronal plane through

Figure 12. On the coronal localizer, the sagittal plane is perpendicular to the axial plane through the epicondyles of the humerus. Include all of the bones.

Elbow - Final Image.

13 7/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series


Axial T1 AX_T1 24 7 500 12 2 256X204

Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204

Coronal T1 COR_T1 32 5 500 12 1 256x192


Sagittal T1 SAG_T1 32 5 500 12 1 256x192


Sequence

Parameters

Series


Axial T1 AX_T1 24 7 500 12 2 256X204

Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204


Coronal T1 COR_T1 32 5 500 12 1 256x192


Axial T1 FS Pre

GadAX_T1_FS_PRE 24 7 600 15 1 256x192

Axial T1 FS

Post GadAX_T1_FS_POST 24 7 600 15 1 256x192

Coronal or

Sagittal T1 FS

Post GD

COR_T1_FS_

POST or

SAG_T1_FS_

POST

32 7 600 15 1 256x192


Forearm (Long Bone)Overview

If there is a specific mass or lump being evaluated, choose the Soft Tissue mass Protocol. The major difference is that this

protocol scans a larger area. This requires thicker slices and larger FOV, factors which may hinder soft tissue mass assessment.

In general, minimize the FOV on the axial images to improve resolution. Orient the scan planes with respect to the radius. Axial

images should slice the forearm bones like a straight-cut loaf of bread.

If there is a specific region of interest or site of pain, bracket it with two vitamin capsules/markers. Do not press the markers into

the skin as this can distort MR signal.

For axial images, slice thickness/slice gap can be increased from 4mm/1mm up to 6mm/2mm to improve exam time.


Routine

Infection/Mass/Osteomyelitis/Abscess

Routine

Infection, Mass, Osteomyelitis, Abscess

Positioning

Sequence Parameters

14 07/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series


3-Plane Scout

Small FOVSCOUT_SM 20 8 15 5ms 1 256x128

Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 8-10 3/0.5 >2000 70-80 2 256x256



Coronal GRE 3D COR_3D_GRE 12-14

Sagittal STIR SAG_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192

Sequence

Parameters

Series


3-Plane Scout

Small FOVSCOUT_SM 20 8 15 5 1 256x128

Axial T1 FS AX_T1_FS 8-10 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 8-10 3/0.3 >2000 70-80 2 256x256




Coronal 3D T1

FS-SPGR or

similar

COR_3D_T1_FS 12-14

Arthrogram

Routine, Pain, TFCC, Ligament

Per Scanner

Per Scanner


MR Wrist Arthrogram TFCC/LT/SL Ligament Tears

Infection/Mass/Osteomyelitis/Bone Lesion

Sequence Parameters

Routine Wrist TFCC, Lunotriquetral, Scapholunate Tear

Flexor Tendon/Carpal Tunnel/Extensor Tendon Pathology

Nonunion, AVN, Pseudoarthrosis

Wrist Overview

Tailor the FOV to the region of interest: wrist, metacarpal region (hand), or whole hand. Use a smaller FOV when targeting a specific

area of interest (e.g. soft tissue mass). Place the hand flat un the neurtal position, fingers and thumbs straight. Do not tuck the

thumb under unless required to do so when using a wrist coil. The imaging planes for HAND and WHOLE HAND (see overview page)

are both oriented to the metacarpals as described below. Choose the metacarpal closest to the site of pain or mass. If there is no

specific area, pick the 3rd metacarpal.

Wrist/Hand Overview Wrist - Axial (Short Axis) Wrist - Coronal (Long Axis) Wrist - Sagittal

Wrist: 3 cm proximal to the radiocarpal joint line and 5-7 cm distal. FOV (all planes) = 8-10 cm

Hand: Radiocarpal joint proximal and MCP joints distal. FOV (all planes) = 8-10 cm

Whole Hand: CMC joints proximal to the tips of the fingers dital. FOC (long axis) = 14-18 cm. FOV (short axis) = 8-12 cm

15 07/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256




Coronal T1 FS

Pre GdCOR_T1_FS_PRE 12-14 3/0.3 400-800 Min 1 256x256

Coronal T1 FS

Post GdCOR_T1_FS_POST 12-14 3/0.3 400-800 Min 1 256x256

Axial T1 FS

Post GdAX_T1_FS_POST 8-10 3/0.3 400-800 Min 1 256x256

Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 8-10 3/0.3 >2000 70-80 2 256x256


Coronal STIR COR_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192


Coronal T1 FS

Pre GdCOR_T1_FS_PRE 12-14 3/0.3 400-800 Min 1 256x256

Coronal T1 FS

Post GdCOR_T1_FS_POST 12-14 3/0.3 400-800 Min 1 256x256

Nonunion, Pseudoarthrosis, AVN

Infection, Osteomyelitis, Bone Lesion, Mass

16 07/2018

MRI Protocols

Upper Extremity

Wrist and Hand - Overview

Figure 13. Tailor the FOV appropriately.

17 07/2018

MRI Protocols

Upper Extremity

INCORRECT

Wrist and Hand - OverviewCORRECT

Figure 14. CORRECT - The hand and wrist should be laid flat in the neutral position (no ulnar deviation). This hand and wrist are properly positioned. The second digit and radius line up.

Figure 15. INCORRECT -This hand and wrist are not properly positioned. There is ulnar deviation. Notice how the second digit and radius do not line up.

18 07/2018

MRI Protocols

Upper Extremity

FOV = 8-10 cm

Localizer: Coronal and Sagittal

Wrist - Axial (Short Axis)

Figure 16. On a coronal localizer, azial images slice the distal radiusperpendicular to the cortex like a straight-cut loaf of bread (not a sloped-cut loaf of bread).

Figure 17. Axial images slice the distal radius perpendicular to the cortexlike a straight-cut load of bread (not a sloped-cut loaf of bread).

Wrist - axial. Final image.

19 07/2018

MRI Protocols

Upper Extremity

FOV = 8-10 cm

Localizer: Axial and Sagittal

First Choice: FOV = 8 cm (3 cm proximal to radiocarpal joine line and 5 cm distal)

Second Choice: FOV = 10 cm (4 cm proximal to radiocarpal joint line and 6 cm distal)

Wrist - Coronal (Long Axis)

Figure 18. On the axial localizer, the coronal plane bisects the distal radius and the ulna.

Figure 19. On a sagittal localizer, the coronal plane is parallel to the distal radius and capitate (or the 2nd metacarpal) if the wrist is in the proper neutral position.

Wrist - Coronal (Long axis). Final Image.

20 07/2018

MRI Protocols

Upper Extremity

FOV = 8-10 cm

Localizer: Coronal and Axial

Wrist - Sagittal

Figure 21. On a coronal locator, the sagittal plane should be exactly perpendicular to the axial (short axis) plane ("reference line"). Notice how the sagittal plane traverses teh 2nd metacarpal ANC is perpendicular to the axial plane reference line. This is possible only when the wrist is properly positions (i.e., in the neutral position).

Figure 20. On anaxial localizer, the sagittal plane should be exactly perpendicular to the coronal (long axis) plane ("reference line").

Wrist - Sagittal. Final Image.

21 07/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256x256


Coronal STIR COR_STIR 16 3/0.3 4000-6000 60-90 2-3 256x192


Sagittal PD FS SAG_PD_FS 12-16 3/0.3 2000-2500 20-30 2 256x256

Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256x256

Sagittal STIR SAG_STIR 10 3/0.3 4500 65 2 256x192



Axial T1 FS Pre

GdAX_T1_FS_PRE 10-12 3/0.3 400-800 Min 1 256x256

Axial T1 FS

Post GdAX_T1_FS_POST 10-12 3/0.3 400-800 Min 1 256x256

Coronal or

Sagittal T1 FS

Post Gd

COR_T1_FS_

POST or

SAG_T1_FS_

POST

16 3/0.5 400-800 Min 1 256x256

HandOverview

FOV = See Wrist and Hand Overview page

Hand - Axial Hand - Coronal Hand - Sagittal


Routine/Pain/Injury

Infection/Sepsis/Osteomyelitis/Mass

Infection, Sepsis, Osteomyelitis, Mass

Note: Choose coronal or sagittal post pontrast based on which will better depict the mass.

Sequence ParametersRoutine, Pain, Injury

22 07/2018

MRI Protocols

Upper Extremity

Hand - Axial (short axis)

FOV = See Wrist and Hand Overview PageLocalizer: Sagittal and Coronal

Figure 22. On a sagittal localizer, azial images slice the metacarpals perpendicularto the cortex like a straight-cut loaf of bread (not a sloped-cut loaf of bread).

Figure 23. This is incorrect because the metacarpals are sliced as a sloped-cut loaf of bread.

Figure 24. On a coronal (long axis) localizer, the axial plane is perpendicular to a line drawn through the 3rd metacarpal.

Hand - Axial (Short Axis) Final Image.

23 07/2018

MRI Protocols

Upper Extremity


Hand - Coronal (Long Axis)

FOV = See Wrist and Hand Overview Page

Figure 25. On the axial (short axis)localizer, draw a "best fit" line through the 2nd through 5th metacarpals.

Figure 26. In this example, the coronal plane is incorrectly set as parallel to the table.

24 07/2018

MRI Protocols

Upper Extremity

Hand - Coronal (Long Axis)

FOV = See Wrist and Hand Overview PageLocalizer: Axial and Sagittal

Figure 27. On a sagittal localizer, draw a line along the 3rd metacarpal shaft (or the metacarpal closest to the region of interest). The example on the right is incorrect because the plane is parallel to the table, not the metacarpal.

Hand - Coronal (Long Axis) Final Image.

25 07/2018

MRI Protocols

Upper Extremity

Hand - Sagittal

FOV = See Wrist and Hand Overview Page

Scan to include at least one metacarpal on either side of the region of interest. If there is no specific area, scan to include

all bones.

Localizer: Axial and Coronal

Figure 28. On a coronal (long axis) localizer, the sagittal plane is along the 3rd metacarpal (or the metacarpalclosest to the region of interest).

Figure 29. On the axial localizer, draw a line perpendicular to the "best fit" line through the 2nd - 5th metacarpals (permendicular to

26 07/2018

MRI Protocols

Upper Extremity

Hand - Sagittal

FOV = See Wrist and Hand Overview PageLocalizer: Axial and Coronal

Scan to include at least one metacarpal on either side of the region of interest. If there is no specific area, scan to include

all bones.

Figure 30. In this example, the scan plane is incorrctly set with respect to the table.

Hand - SagittalFinal Image

27 07/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 8-10 3/0.3 >3000 70-80 2 256x256


Coronal PD FS COR_PD_FS 8-10 3/0.3 2000-2500 20-30 2 256x256


Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 8-10 3/0.3 >3000 70-80 2 256x256


Coronal STIR COR_STIR 8-10 3/0.3 4000-6000 60-90 2-3 256x192

Sagittal T1 SAG_T1


Thumb and FingerOverview

Thumb and Finger Axial Thumb and Finger Coronal Thumb and Finger Sagittal

Mass/Infection/osteomyelitis/Arthritis


Routine Thumb Ulnar collateral ligament injury/stenor lesion/sprain/fracture/pain

Routine Finger Injury/Tendon Injury

PositioningPlace the hand flat, fingers and thumb straight. Do not tuck the thumb under. Thumb: include the tip of the thumb distally and the

base of the first metacarpal proximally. Finger: Center on the region of interest with FOV as small as possible. Scan from the fingertip

through the MCP joint.

Sequence Parameters

Routine Finger

Routine Thumb

28 07/2018

MRI Protocols

Upper Extremity

Sequence

Parameters

Series


3-Plane Scout


Axial T1 AX_T1 8 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 8-10 3/0.3 .3000 70-80 2 256x256



Axial T1 FS Pre

GdAX_T1_FS_PRE 8 3/0.3 400-800 Min 1 256x256

Axial T1 FS

Post GdAX_T1_FS_POST 8 3/0.3 400-800 Min 1 256x256

Coronal or

Sagittal T1 FS

Post Gd

COR_T1_FS_

POST or

SAG_T1_FS_

POST

8 3/0.3 400-800 Min 1 256x256


Infection, Mass, Osteonyelitis

29 07/2018

MRI Protocols

Upper Extremity

Thumb/Finger - Axial (Short Axis)FOV = 8-10 cm

See Thumb and Finger Positioning


Figure 31. On a sagittal localizer, draw a reference line through the MCP joint. The axial (short axis) plane is perpendicular to this reference

Figure 32. On a coronal (long axis) localizer, draw a refernce line through the MCP joint. The axial (short axis) plane is perpenducilar to this reference

Thumb/Finger - Axial (Short Axis) Final Image

30 07/2018

MRI Protocols

Upper Extremity

Thumb/Finger - Coronal (Long Axis)FOV = 8-10 cm



Figure 33. On an axial localizer, the coronal (long axis) plane is parallel to the dorsal cortex of the finger or of the thumb at the level of the sesamoids. For the thumb, this line is usually parallel to a line connecting the thumb sesamoids.

Figure 34. This patient has "hitchhiker" thumb where the distal phalanx hyperextends. By default, the coronal plane is straight through the MCP joint since it is usually of greater interest. Therefore, the IP joint will not always be in plane.

Thumb/Finger -Coronal (Long Axis) Final Image.

31 07/2018

MRI Protocols

Upper Extremity

FOV = 8-10 cm

Localizer: Coronal and axial


Thumb/Finger - Sagittal

Figure 35. On an axial (short axis) localizer, the sagittal plane is perpendicular to the coronal (long axis) plane as described above.

Figure 36. On a coronal (long axis)localizer, the sagittal plane is straight through the MCP joint. The sagittal plane is perpendicular to the axial (short axis) plane ("Reference Line").

Thumb/Finger - Sagittal Final Image

32 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice


3-Plane Scout SCOUT 45 10 15 5 1 256x128

Axial T1 Whole

PelvisAX_T1 36-40 5/1 400-800 Min 1 256x256

Coronal T2 FS

PelvisCOR_T2_FS 36-40 5/1 >3000 70-90 2 256x256

Sagittal T1 FS

OBL Affected

Hip

SAG_T1_FS_

OBL14-16 4/0.4 400-800 Min 1 256x256

Coronal T1 FS

OBL Affected

Hip

COR_T1_FS_

OBL14-16 4/1.4 400-800 Min 1 256x256

Axial OBL T1 FS

Affected HipAX_OBL_T1_FS 14-16 4/0.4 400-800 Min 1 256x256

Sagittal PD FS

Affected HipSAG_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256

COR PD FS

Affected HipCOR_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice



Axial T1 Whole

PelvisAX_T1 36-40 5/1 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 36-40 5/1 >2000 70-80 2 256x256

Coronal T1

Whole PelvisCOR_T1 36-40 5/1 400-800 Min 1 256x256

Coronal STIR COR_STIR 33-40 5/1 4000-6000 60-90 2-3 256x192

Sagittal T2 FS SAG_T2_FS 30-40 5/1 >2000 70-80 2 256x256

MARS

SI Joints

TJUH Athletic PubalgiaAthletic Pubalgia, sports hernia, sportsman's hernia, adductor

tear/strain, rectus abdominus injury

Metal Artifact Reduction Sequence) DePuy Recelled Hip

Bony Pelvis (Pain/Trauma/Fracture/AVN)

Hip Arthrogram

Sequence Parameters

Non-Contrast HipPain, labral tear, FAI or dysplasis when direct MR arthrography not

possible

Post Gadolinium Hip Infection, mass, osteomyelitis

Post Gadolinium Pelvis Infection, mass, osteomyelitis


Bony Pelvis Pain, Fracture, AVN

Direct or Indirect Arthrogram Hip Hip labrum tear, FAI or dysplasia

Bony Pelvis

Hip Sagittal

Bony Pelvis Sagittal Hip Axial Hip Axial Oblique Hip Coronal

Bony Pelvis Axial Bony Pelvis Axial Oblique Bony Pelvis Coronal Bony Pelvis Coronal Oblique

33 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice



Coronal T1


Coronal STIR

Whole PelvisCOR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192

Axial T2 FS

Whole PelvisAX_T2_FS 36-40 5/1 >2000 70-80 2 256x256

Axial T1 Whole

PelvisAX_T1 36-40 6/1 400-800 Min 1 256x256

Axial T1 FS

PreGd Whole

Pelvis

AX_T1_FS_PRE 36-40 4/0.4 400-800 Min 1 256x256

Axial T1 FS

PostGd Whole

Pelvis

AX_T1_FS_POST 36-40 4/0.4 400-800 Min 1 256x256

Coronal T1 FS

PostGd Whole

Pelvis

COR_T1_FS_

POST36-40 4/0.4 400-500 Min 1 256x256

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice



Axial T2 FS

Whole PelvisAX_T2_FS 36-40 5/1 >2000 70-80 2 256x256

Coronal T1


Coronal STIR

Whole PelvisCOR_STIR 33-40 5/1 4000-6000 60-90 2-3 256x192

Sagittal PD FS

Affected HipSAG_PD_FS 16-20 4/0.4 2000-2500 20-30 2 256x256

Coronal

Oblique PD FS

Affected Hip

COR_OBL_PD_

FS16-20 4/0.4 2000-2500 20-30 2 256x256

Axial Oblique

PD FSAX_OBL_PD_FS 20 4/0.4 2000-2500 20-30 2 256x256

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice



Axial T1 Whole

PelvisAX_T1 40 6 500 15 1 512x256

Coronal T1

Whole PelvisCOR_T1 40 6 500 15 1 512x256

Coronal STIR

Whole PelvisCOR_STIR 40 6 5000 70 2 256x192

Coronal T2

Affected HipCOR_T2 24 3 4500 75 2 256x256

Sagittal T2

Affected HipSAG_T2 24 3 4500 75 2 256x256

Hip

Pelvis: Bone Lesion, Soft Tissue mass, Infection, Osteomyelitis

Optional: * If history includes labral tear, evaluate for labral tear or prior labral surgery, add an Axial Oblique PD FS

MARS

34 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice



COR T1 - Angle

to SI jointsCOR_T1 24 4/1 400-800 Min 1 256x256

COR STIR -

Angle to SI

joints

COR_STIR 24 4/1 4000-6000 60-90 2-3 256x192

AX T1 - Angle

to SI jointsAX_T1 24 4/1 400-800 Min 1 256x256

AX T2 FS -

Angle to SI

Joints

AX_T2_FS 24 4/1 >2000 70-80 2 256x256

SAG T2 (no FS) -

Angle to SI

joint

SAT_T2 24 4/1 >3000 70-80 2 256x256

Ax T1 FS PreAX_T1_FS_

PRE24 4/1 400-800 Min 1 256x256

Ax T1 FS PostAX_T1_FS_

POST24 4/1 400-800 Min 1 256x256

Cor T1 FS PostCOR_T1_FS_

POST24 4/1 400-800 Min 1 256x256

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice


3-Plane

LocatorSCOUT 50 8 15 5 1 256x128

Coronal STIR

Large FOVCOR_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192

Coronal T1

Large FOVCOR_T1 36-40 4/1 400-800 Min 1 256x256

Axial T2 FS

Large FOVAX_T2_FS 36-40 4/1 >2000 70-80 2 256x256

Sagittal T2 FS SAG_T2_FS 36-40 4/1 >2000 70-80 2 256x256

Axial Oblique

PDAX_OBL_PD 20 4/1 >2000 30-40 2 256x256

Axial Oblique

T2 FS

AX_OBL_T2_

FS20 4/1 >2000 70-80 2 256x256

SI Joints

Sports HerniaComments:

Center on symphysis pubis and have patient empty bladder prior to scanning.

Axial: Scan from superior acetabulum thru symphysis pubis.

Coronal: Use an angle parallel with symphysis pubis and scan from back of ischial tuberosities thru pubis.

Sagittal: Angle perpendicular to coronal plane and scan from left thru right ischial tuberosities.

Axial Obl: Angle parallel to anterior ilio-pubic cortex and scan from back of acetabulum thru soft tissue anteriorly.

Optional: * if ordered with gad

35 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series

DescriptionFOV (cm)

Slice



Axial STIR

Whole PelvisCoronal T1


Axial T1 AX_T1 36-40 6/1 400-800 Min 1 256x256

Sagittal T2 FS SAG_T2_FS 36-40 4/1 >2000 70-80 2 256-256

Axial T1 FS

PreGd

AX_T1_FS_

PRE36-40 4/0.4 400-800 Min 1 256x256

Axial T1 FSAX_T1_FS_

POST36-40 4/0.4 400-800 Min 1 256x256

Coronal T1 FS

PostGd

COR_T1_FS_

POST36-40 4/0.4 400-500 Min 1 256x256

Comments:

Ok to expand FOV as necessary to include entire pelvis if needed

HIP: Bone Lesion, Soft Tissue mass, Infection, Osteomyelitis

36 07/2018

MRI Protocols

Lower Extremity

Bony Pelvis - AxialFOV = 30-40 cm

Localizer: Coronal

Figure 37. The scan plane is parallel to a line along the top of the femoral heads. Scan from the iliac crests through the ischial tuberosities.

Bony Pelvis - Axial. Final Image.

37 07/2018

MRI Protocols

Lower Extremity

Bony Pelvis - CoronalFOV = 30-40 cm

Localizer: Axial

Figure 38. The scan plane is parallel to a line connecting the femoral heads. Scan to include all bones.

Bony Pelvis -Coronal. Final Image.

38 07/2018

MRI Protocols

Lower Extremity

Bony Pelvis - SagittalFOV = 20-26 cm

Localizer: Coronal

Figure 39. The scan plane is perpendicular to a line along the top of the femoral heads. Scan from the iliac crests through the ischial tuberosities.

Bony Pelvis -Sagittal. Final Image.

39 07/2018

MRI Protocols

Lower Extremity

Localizer: Sagittal

Bony Pelvis - Athletic Pubalgia/"Sports Hernia" - Axial ObliqueFOV = 20 cm

Figure 40. The scan plane is along the anterior iliac crest near the lateral margin of the femoral head.

Athletic Pubalggia/"Sports Hernia" -Axial Oblique. Final Image.

Figure 41.

40 07/2018

MRI Protocols

Lower Extremity

Sacrum or Sacroilian Joints - Coronal ObliqueFOV = 18-24 cm

Figure 42.

Figure 43.

Sacrum/Sacroilian Joints -Coronal Oblique. Final Image.

41 07/2018

MRI Protocols

Lower Extremity

Hip - AxialLarge FOV = 34-40 cm (include both hips and pelvis)

Normal FOV for one side = 14-18 cm

Localizer: Coronal

Draw a line actoss tops of both femoral heads or estimate this line if localizer only of one hip. Scan superiorly to include

acetabulum and inferiorly to include all of the lesser trochanger. Scan medially to include pubic symphysis and laterally

to include all bones, muscles and any fluid collection. Lateral subcutaneous fat may be excluded. If the pubic symphysis

is not included on the acials, it should definitely be included on the coronals.

Figure 44. The scan plane is parallel to a line along the top of the femoral heads.

Hip - Axial. Final Image.

42 07/2018

MRI Protocols

Lower Extremity

Hip - CoronalLarge FOV = 34-40 cm (include both hips and pelvis)


Localizer: Axial

The medial margin of the scan is the first part of the opposite pubic bone (i.e., just barely include both sides of the

pubic symphysis).

The lateral margin of the scan is just lateral to the greater trochanter, to include all of the gluteal tendons and any

trochangeric fluid collection.

Anteriorly, scan to includ the pubic symphysis.

Posteriorly, scan to include the ischial tuberosities.

Hip - Coronal.Final Image.

Figure 45.

43 07/2018

MRI Protocols

Lower Extremity

Large FOV = 34-40 cm (include both hips and pelvis)


Localizer: Coronal

Draw a line across tops of both femoral heads or estimate this line if localizer only of one hip.

Scan medially to include whole hip joint.

Scan laterally just past greater trochanter. It is not necessary to go all the way to skin unless there is a mass, abscess,

fluid collection, etc.

Hip - Sagittal

Figure 46. The scan plane is perpendicular to a line along the top of the femoral heads. Scan from the iliac crests through the ischial tuberosities.

Hip - Sagittal. Final Image.

44 07/2018

MRI Protocols

Lower Extremity

Hip - Axial Oblique(Femoroacetabular impingement [FAI] and labrum sequence)

Figure 48. This sequence can be a challenge to master. Notice how the lines do not go quite "down the barrel" of the femoral neck.

Hip -Axial Oblique Final Image.

Figure 47.

45 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series



Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256

Coronal T1 COR_T1 36-40 4/1 400-800 Min 1 256x256

Coronal STIR (include both legs)

COR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192

Sagittal STIR SAG_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192

Sequence

Parameters

Series


3-Plane

LocatorSCOUT 45 10 15 5 1 256x128

Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256



Axial T1 FS Pre

GdAX_T1_FS_PRE 14-20 5/1 400-800 Min 1 256x256

Axial T1 FS

Post GdAX_T1_FS_POST 14-20 5/1 400-800 Min 1 256x256

Sag or Cor T1

FS Post Gd

SAG or

COR_T1_FS_

POST

36-40 4/1 400-800 Min 1 256x256

FemurOverview

Bracket region of interest with vitamin marker(s). Do not press markers into the skin as this can distort anatomy and local blood

flow.

Axial images should slice the long bones like a straight-cut loaf of bread.

AXIAL - Slice thickness/Gap:

6mm/2mm for diffuse pain or no specific lesion.

(less than or equal to) 4mm/(less than or equal to) 1 mm for mass/lump/lesion. (include lesion and at least 3 slices about and 3

slices below.


Choose coronal OR sagittal post gad to show mass. If mass is dorsal/ventral choose sagittal. If mass is medial/lateral choose

coronal.

Routine Femur/Thigh

Soft Tissue Mass or Bone Lesion, Infection

Routine Femur/Thigh Pain/Injury/Muscle Strain/Stress Fracture

Positioning


Hamstring/Quads/Tear/Thigh

Sequence Parameters

FEMUR - Use the KNEE scan planes.

46 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series



Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256



COR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192


Hamstring/Quads/Tear/Thigh

47 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series


3-Plane Scout

R or L ShiftSCOUT 28 8 15 5ms 1 256x128

Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256



Sagittal 3D GRE SAG_GRE 14-16 3/0.3

Coronal PD FS COR_PD_FS 14-16 3/0.3 2000-2500 20-30 2 256x256

Sagittal

Oblique ACLSAG_OBL_ACL 14 3 2500 70 1 256x256


Sequence

Parameters

Series


3-Plane Scour

R or L ShiftSCOUT 28 8 15 5 1 256x128

Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256


Sagittal T1 FS SAG_T1_FS 14-16 3/0.3 400-800 Min 1 256x256




KneeOverview

Axial and Sagittal FOV = 14-16 cm

Coronal FOV = 16-18 cm

Knee Axial Knee Coronal Knee Sagittal


Routine Knee Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL

Arthrogram Meinscal Re-Tear; Intra-articular Body

Sequence Parameters

Pre and Post Gadolinioum Knee Mass, infection, osteomyelitis

Popliteal Artery Entrapment

Pain, Routine

Arthrogram

Per Scanner

Optional: * If reported history includes: acute inury, OCD, loose body, torn cartilage add Sagittal Stir

48 04/2020

MRI Protocols

Lower Extremity

Sequence

Parameters

Series


3-Plane Scout


Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256



Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256

Axial T1 FS Pre-

GdAX_T1_FS_ PRE 14-16 3/0.3 400-800 Min 1 256x256

Axial T1 FS

Post-GdAX_T1_FS_ POST 14-16 3/0.3 400-800 Min 1 256x256

Coronal T1 FS

Post-Gd

COR_T1_FS_

POST14-16 3/0.3 400-800 Min 1 256x256

Sequence

Parameters

Series


3-Plane Scout


Axial T1

NeutralAX_T1_NEUTRAL 36 6 470 2.3

Axial T2 FS

Neutral

AX_T2_FS_

NEUTRAL6 3000 60 1

Axial T2 FS

Toes Down

AX_T2_FS_

STRESSED36 6 3000 60 1

Twist Post

Neutral

TW_POST_

NEUTRAL40 2 12-15 phases

Axial T1 FS

Post Neutral

AX_T1_FS_POST_

NEUTRAL36 6 470 2.3 1

Twist Post

Stressed

TW_POST_

STRESSED40 2 12-15 phases

Axial T1 FS

Post Stressed

AX_T1_FS_POST_

STRESSED36 6 470 2.3 1

Popliteal Artery Entrapment

Infection, Osteomyelitis, Mass, Bone Lesion

49 04/2020

MRI Protocols

Lower Extremity

Knee - CoronalLocalizer - Axial

Figure 51. Draw a line parallel to the posterior margin of femoral condyles. Include patella anteriorly through popliteal vessels posteriouly.

Figure 52. In this example, the plane section is incorrectly set as parallel to the table, not to the posterior margin of the femoral condyles.

Knee - Coronal. Final Image.

50 07/2018

MRI Protocols

Lower Extremity

Knee - SagittalLocalizer - Axial

Figure 53. The scan plane is perpendicular to the coronal plane along the posterior margin of the femoral condyles. Include all bones.

Figure 54. In this example, the plane of secion is incorrectly set relative to the table instead of to the

Knee - Sagittal. Final Image.

51 07/2018

MRI Protocols

Lower Extremity


Knee - Axial

Figure 55. Scan parallel to the femoralcondyles. Cover 2 cm superior to the patella through the attachment of the patellar tendon on the tibia.

Figure 56. Scan parallel to the femoral condyles.

Knee - Axial. Final Image.

52 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series



Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256



COR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192


Sequence

Parameters

Series


3-Plane

LocatorSCOUT 45 10 15 5 1 256x128

Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256



Axial T1 FS Pre

GdAX_T1_FS_PRE 14-20 5/1 400-800 Min 1 256x256

Axial T1 FS

Post Gd

AX_T1_FS_

POST14-20 5/1 400-800 Min 1 256x256

Sag or Cor T1

FS Post Gd

SAG or

COR_T1_FS_

POST

36-40 4/1 400-800 Min 1 256x256

Tibia/FibulaOverview

Bracket region of interest with vitamin marker(s). Do not press markers into the skin as this can distort anatomy and local blood

flow.

Axial images should slice the long bones like a straight-cut loaf of bread.

AXIAL - Slice thickness/Gap:

6mm/2mm for diffuse pain or no specific lesion.

(less than or equal to) 4mm/(less than or equal to) 1 mm for mass/lump/lesion. (include lesion and at least 3 slices about and 3

slices below.

Tibia/Fibula Axial Tibia/Fibula Coronal Tibia/Fibula Sagittal



Soft Tissue Mass or Bone Lesion, InfectionChoose coronal OR sagittal post gad to show mass. If mass is dorsal/ventral choose sagittal. If mass is medial/lateral choose

coronal.

Routine Tibia/Fibular

Sequence Parameters

Routine Tibia/Fibular Pain/Injury/Muscle Strain/Stress Fracture

PositioningTIBIA/FIBULA - For distal pain, use ANKLE/HINDFOOT scan planes (see sample images). For proximal pain, use KNEE scan

planes.

53 07/2018

MRI Protocols

Lower Extremity

Tibia/Fibula - Axial

Tibia/Fibula - Coronal

Figure 48.

Figure 49.

54 4/6/2020

MRI Protocols

Lower Extremity

Tibia/Fibula - Sagittal

Figure 50.

55 4/6/2020

MRI Protocols

Lower Extremity

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8 15ms Min 1 256x128

Sagittal T1 SAG_T1 16 4/0.4 400-800 Min 1 256x256

Sagittal STIR SAG_STIR 16 4/0.4 4000-6000 60-90 2-3 256x256


Coronal T1 COR_T1 14-16 4/0.4 400-800 Min 1

Axial T2 FS AX_T2_FS 14-16 4/0.4 >3000 70-80 2 256x256

Axial Oblique

PD FSAX_OBL_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256

Sagittal 3D T2

GRESAG_3D_ GRE 16-18 1

Coronal 3D T2

GRECOR_3D_ GRE 14-16 1


Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8 15 5 1 256x128

Sagittal T1 SAG_T1 18 4/0.4 400-800 Min 1 256x256

Sagittal STIR SAG_STIR 18 4/0.4 4000-6000 60-90 2-3 256x192


Axial T2 FS AX_T2_FS 14-16 4/0.4 >3000 70-80 2 256x256

Axial T1 AX_T1 14-16 4/0.4 400-800 Min 1 256x256

Axial Oblique

PD FSAX_OBL_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256

Per Scanner

Per Scanner

Optional: *If OCD/AVN/TALAR DOME, add Coronal T2 FS

2. SAGITTAL Sequences: Perpendicular to Axial sequences. Superior SatBand for STIR and T1. Use Axial LOC and find the distal-most

tendon and angle perpendicular to long axis of tendon. Center in the mid-Achilles tendon and use the slices given.

3. CORONAL Sequences: Perpendicular to sagittal sequences.

Routine Ankle

Supine with foot relaxed (approximately 90 degrees) and toes pointing up. Center coil at the malleoli.

Have foot relaxed and use sponges to reduce motion artifact.

Coverage includes proximal tendons.

For Achilles Tendon:

Larger coverage of lower calf. Supine with plantar flexion. Lift the other leg out of the way to prevent wrap.

Sequence Parameters

Optional: *If says coalition, add Coronal 3D GRE and Sagittal 3D GRE

Achilles Tendon1. AXIAL Seuqences: Use sagittal LOC and angle perpendicular to the Achilles tendon. Cover entire calcaneous up as proximal as the slices

go. Parallel Sat Bands for T2 and Superior Sat band for STIR.

Achilles Tendon

Positioning

Protocol IndicationsRoutine Ankle Pain/Sprain/Plantar fasciitis/tendon injury except for Achilles

Coalition

OCD/AVN/Talar Dome

Arthrogram

Pre and Post Gadolinium Osteomyelitis/mass/infection

Ankle/HindfootOverview

Coronal FOV = 10-14 cm, Axial and Sagittal FOV = 12-16 cm

Ankle/Hindfoot: Axial refers to the short axis of the tibia and fibula. Coronal refers to the long axis of the tibia and fibula.

If the Achilles tendon is torn, exten the scan superiorly to include the whole tear on Axial and Sagittal sequences.

Ankle/Hindfoot Axial Ankle/Hindfoot Axial Oblique Ankle/Hindfoot Coronal Ankle/Hindfoot Sagittal

56 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series


3-Plane Scout

Sm. FOVSCOUT_SM 20 8 15 5 1 256x128

Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256

Coronal T1 FS COR_T1_FS 14 3/0.3 400-800 Min 1 256x256

Sagittal T1 FS SAG_T1_FS 16 3/0.3 400-800 Min 1 256x256

Sagittal PD FS SAG_PD_FS 16 3/0.3 2000-2500 20-30 2 256x256

Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256

If clinical concern is a toe ulcer, center on forefoot and include midfoot. If clinical concern is a heel ulcer, perform a hindfoot

****DO IN THIS ORDER IF POSSIBLE. IF LOTS OF MOTION, THIS ORDER WILL MAXIMIZE OUR ABILITY TO ANSWER CLINICAL QUESTIONS****

WITH AND

WITHOUT

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8mm 15 5 1 256x128



Cor T1 COR_T1 14-16 3/0.3 400-800 Min 1 256x256

Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256

Axial T1 FS

PreGdAX_T1_FS_ PRE 14-16 3/0.3 400-800 Min 1 256x256

Axial T1 FS

PostGd

AX_T1_FS_

POST14-16 3/0.3 400-800 Min 1 256x256

Cor or Sag T1

FS Post Gd

COR or

SAG_T1_FS_

POST

14 3/0.3 400-800 Min 1 256x256

WITHOUT

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8mm 15 5 1 256x128



Cor T1 COR_T1 14-16 3/0.3 400-800 Min 1 256x256


Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256

Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256

Soft Tissue Mass, Infection, OsteomyelitisComments:

Ankle Arthrogram

57 07/2018

MRI Protocols

Lower Extremity

Ankle/Hindfoot - AxialLocalizer - Satittal

Figure 57. Scan parallel to the long axis of the calcaneus. This is often the same plane as the

Figure 58. This graphic shows the ankle in varying degrees of flexion. If the ankle cannot be placed in the neutral position, adjust the scan plane along the long axias of the calcaneus as shown.

Ankle/Hindfoot - Axial.

58 07/2018

MRI Protocols

Lower Extremity

Ankle/Hindfoot - CoronalLocalizer - Axial

Figure 59. Use an image with both medial and lateral malleoli visible. The scan plane should split each of the three bones approximately in half. Cover the base of the metatarsals to the posterior

Figure 60.

59 07/2018

MRI Protocols

Lower Extremity

Ankle/Hindfoot - CoronalLocalizer - Axial

Figure 61. In this example, the plane of section is incorrectly set as parallel to the table, not with respect

to the axis of the talus.

Ankle/Hindfoot -Coronal. Final Image.

60 07/2018

MRI Protocols

Lower Extremity

Ankle/Hindfoot - SagittalLocalizer - Axial

Figure 62. The scan plane is perpendicular to the coronals. Scan medial to lateral to include all bones.

Figure 63. In this example, the plane section is incorrectly set as perpendicular to the table, not to the axis of the talus.

Ankle/Hindfoot - Sagittal. Final Image.

61 07/2018

MRI Protocols

Lower Extremity

Ankle/Hindfoot - Axial Oblique (Tendon Sequence)Localizer - Sagittal

Figire 64. Ankle/Hindfoot - Axial Oblique (Tendon Sequence)

Figure 65. In this example, the plane of sectionis incorrectly set at the wrong 45 degree angle to axial plane.

Ankle/Hindfoot - Axial Oblique (Tendon Sequence) Final Image.

62 07/2018

MRI Protocols

Lower Extremity

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8 mm 15 5 1 256x128

Axial T1 AX_T1 12-14 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 12-14 3/0.3 >3000 70-80 2 256x256




Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8mm 15 5 1 256x128

Axial T1 AX_T1 12-14 3/0.3 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 12-14 3/0.3 >3000 70-80 2 256x256




Axial T1 FS

PreGdAX_T1_FS_PRE 12 3/0.3 400-800 Min 1 256x256

Axial T1 FS

Post Gd

AX_T1_FS_

POST12 3/0.3 400-800 Min 1 256x256

Osteomyelitis/Infection/Mass

FootOverview

Midfoot/Forefoot Axial is through the short axis of the metatarsals (i.e., slicing metatarsals like a loaf of bread). Coronal is

through the long axis of the metatarsals (i.e., a cut of the entire metatarsal shaft is visible on one image).

Foot - Axial Short Axis Foot - Coronal Long Axis Foot - Sagittal

Protocol IndicationsRoutine Foot Pain/Stress Fracture/Fracture/Lisfranc Injury

Pre and Post Gadolinium Foot Morton's Neuroma

Plantar Plate

Positioning

Hindfoot - Use the ankle protocol and positioning for the hindfoot. Sample indications: plantar fasciitis, calcaneus fracture,

tarsal coalition, peroneal tendon evaluation.

Midfoot - Cover from the MTP joints through the Chopart joint (talonavicular and calcaneocuboid joints). Sample indication:

metatarsal stress fracture.

Forefoot - Cover tips of the toes through the metatarsals. Sample indications: Morton's Neuroma, Toe Ulcer, Plantar Plate

Injury.

Sequence ParametersRoutine Foot

Morton's NeuromaComments: Always centered on the forefoot

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MRI Protocols

Lower Extremity

WITHOUT AND

WITH

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8mm 15 5 1 256x128

Axial T1 AX_T1 12-14 3/0.5 400-800 Min 1 256x256

Axial T1 FS

PreGdAX_T1_FS_PRE 12-14 3/0.5 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 12-14 3/0.5 >2000 70-80 2 256x256




Axial T1 FS

PostGd

AX_T1_FS_

POST12-14 3/0.5 400-800 Min 1 256x256

Cor or Sag T1

FS Post Gd

COR or

SAG_T1_FS_

POST

10 3/0.5 400-800 Min 1 256x256

WITHOUT

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8mm 15 5 1 256x128

Axial T1 AX_T1 12-14 3/0.5 400-800 Min 1 256x256

Axial T2 FS AX_T2_FS 12-14 3/0.5 >2000 70-80 2 256x256



Coronal T1 COT_T1 12 3/0.3 400-800 Min 1 256x256


Comments:

Sequence

Parameters

Series


3-Plane Scout

R or LSCOUT 26 8mm 15 5 1 256x128

Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256

Axial PD FS AX_PD_FS 8-10 3/0.3 2000-2500 20-30 2 256x256

Sagittal PD SAG_PD 8-10 3/0.3 2000-2500 20-30 1 256x256


Coronal T1 COR_T1 10 3/0.3 2000-2500 20-30 1 256x256


Plantar Plate

Most exams will be centered at the 1st MTP joint. If other toe indicated center on the appropriate MTP joint. All imaging planes

angled to MTP joint. Sagittal images to cover the affected MTP joint.

Soft Tissue Mass, Infection, Osteomyelitis

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MRI Protocols

Lower Extremity

Foot - Axial (Short Axis)Localizer - Sagittal and Coronal

Figure 66. Short axis axial images are perpendicular to the metatarsal shaft. The plane slices the metatarsals like a straight-cut loaf of bread, not like a sloped-cut loaf of bread.

Figure 68.

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MRI Protocols

Lower Extremity

Foot - Axial (Short Axis)Localizer - Sagittal and Coronal

Figure 69. In this example, the plane of section is incorrectly set relative to the table and not to the axis of the metatarsals. The "slices of bread" are sloped.

Foot - Axial (Short Axis). Final Image.

Figure 70.

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MRI Protocols

Lower Extremity

Foot - Coronal (Long Axis)Localizers - Axial and Sagittal

Figure 71. Choose an axial localizer image at the midpoint of the metatarsal shafts. Draw a line that roughly connects the 2nd through 5th

Figure 72. In this example, the plane of section is incorrectly set as parallel to the table, not with respect to the axis of the metatarsals.

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MRI Protocols

Lower Extremity

Foot - Coronal (Long Axis)Localizers - Axial and Sagittal

Foot - Coronal (long axis) Final image.

Figure 73.

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MRI Protocols

Lower Extremity

Foot - SagittalLocalizers - Axial and Sagittal

Figure 74. Choose an axial localizer image at the midpoint of the metatarsal shafts. Draw a line that roughly connects the 2nd through 5th metatarsals. The scan plane is perpendicular to this line.

Figure 75. In this example, the plane of section is incorrectly set as perpendicular to the table, not with respect to the metatarsals.

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MRI Protocols

Lower Extremity

Localizers - Axial and Sagittal

Foot - Sagittal

Foot - Sagittal. Final Image.

Figure 76.

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Documents

Advanced Medical Imaging Consultants, PC