Revised April 3 2017



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Revised April 3 2017


Neuroradiology MR Protocols
Brain protocols

N 1: Brain MRI without contrast

N 2: Pre- and post-contrast brain MRI

N 3 is deleted

N 4: Brain MRI without or pre-/post-contrast (seizure protocol)

N 5: Pre- and post-contrast brain MRI (multiple sclerosis protocol)

N 6: Pre- and post-contrast brain MRI (internal auditory canal protocol)

N 7: Pre- and post-contrast brain MRI (pituitary protocol)

N 8: Pre- and post-contrast orbital MRI

N 9: Pre- and post-contrast brain MRI (cavernous sinus protocol)

N10: Pre- and post-contrast brain MRI (cranial nerve protocol)


Neurovascular protocols


N11: Pre- and post-contrast neck MR angiography

N12: Brain MR angiography without contrast

N13: Brain MR venogram without contrast

Combined protocols

Stroke protocol: N2 + N12 + N11





Head and neck protocols


ENT 1: Pre- and post-contrast neck MRI

ENT 2: Temporomandibular joint MRI





Peripheral nerve protocols


PN 1: Pre- and post-contrast brachial plexus MRI

PN 2: Pre- and post-contrast sacral plexus MRI

N 1: Brain MRI without contrast



Indications: general screening; headaches, stroke, bleeds, memory loss.
Sequences:


Comments:

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

  • Substitute sagittal T1 SE for FLAIR in patients 10 years of age or younger.

N 2: Pre- and post-contrast brain MRI



Indications: tumor, infection.
Sequences:

  • Sagittal FLAIR

  • Axial T1 SE

  • Axial GRE or SWI

  • Axial T2 FSE

  • Axial FLAIR

  • Coronal T2 FSE

  • Axial diffusion with ADC

  • Post-Gd axial & coronal T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE with coronal reformats (3 mm thick).


Comments:

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

  • 3D VIBE: Perform with 0.8-1.0 mm thick isotropic voxels. Radiologists can request additional sagittal reformats as needed.

  • If post-Gd axial 3D VIBE performed, then omit the post-Gd axial and coronal T1 SE with fat saturation.

  • Substitute sagittal T1 SE for FLAIR in patients 10 years of age or younger.

N 4: Brain MRI without or pre-/post-contrast (seizure protocol)



Indications: seizure disorder, first time seizures.
Sequences:

  • Sagittal FLAIR

  • Axial T1 SE

  • Axial T2 FSE

  • Axial FLAIR

  • Axial GRE or SWI

  • Coronal thin-slice T2 FSE (hippocampi)

  • Axial diffusion with ADC

  • Opt: Post-Gd axial & coronal T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE with coronal reformats (3 mm thick).


Comments:

  • Give IV contrast for new onset seizure workups only.

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

  • Substitute sagittal T1 SE for FLAIR in patients 10 years of age or younger.



N 5: Pre- and post-contrast brain MRI (multiple sclerosis protocol)



Indications: assess for multiple sclerosis or ADEM.
Sequences:

  • Sagittal FLAIR

  • Axial T2 FSE

  • Axial FLAIR

  • Axial T1 SE

  • Axial GRE or SWI

  • Coronal T2 FSE

  • Axial diffusion with ADC

  • Post-Gd axial & coronal T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE with coronal reformats (3 mm thick).


Comments:

  • Sagittal FLAIR improves detection of corpus callosum lesions.

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

  • 5 minute delay before post-Gd T1 weighted sequences; should acquire axial T2 FSE sequence during this time.



N 6: Pre- and post-contrast brain MRI (internal auditory canal protocol)



Indications: vertigo, cerebellopontine angle masses, Ramsay Hunt syndrome.
Sequences:

  • Sagittal T1 SE

  • Axial FLAIR

  • Axial diffusion with ADC

  • Axial GRE or SWI

  • Coronal localizer tru-FISP (IAC only)

  • Axial 3-D CISS (IAC)

  • Thin-slice axial T1 SE with fat saturation (IAC)

  • Post-Gd thin-slice axial T1 SE with fat saturation (IAC)

  • Post-Gd thin-slice coronal T1 SE with fat saturation (IAC)

  • Whole head post-Gd axial T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE (3 mm thick).



Comments:

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.



N 7: Pre- and post-contrast brain MRI (pituitary protocol)



Indications: pituitary masses
Sequences:

  • Sagittal FLAIR

  • Axial FLAIR

  • Axial GRE or SWI

  • Axial diffusion and ADC

  • Thin-slice sagittal T1 SE (pituitary fossa)

  • Thin-slice coronal T1 SE (pituitary fossa)

  • Thin-slice coronal T2 FSE (pituitary)

  • Coronal dynamic thin-slice T1 SE (pre- and post-Gd)

  • Delayed post-Gd thin-slice coronal T1 SE (pituitary)

  • Delayed post-Gd thin-slice sagittal T1 SE (pituitary)

  • Whole head post-Gd axial T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE (3 mm thick).


Comments:

  • For macroadenomas (ie., visible mass >1cm in size), coronal dynamic thin-slice T1 SE can be omitted.

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.



N 8: Pre- and post-contrast orbital MRI



Indications: orbital masses, optic neuritis, diplopia.
Sequences:

  • Sagittal T1 SE

  • Axial T2 FSE

  • Axial FLAIR

  • Axial GRE or SWI

  • Axial diffusion and ADC

  • Coronal STIR (orbits)

  • Thin-slice axial T1 SE (orbits)

  • Post-Gd thin-slice axial T1 SE with fat saturation (orbits)

  • Post-Gd thin-slice coronal T1 SE with fat saturation (orbits)

  • Whole head post-Gd axial T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE (3 mm thick).


Comments:

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

N 9: Pre- and post-contrast brain MRI (cavernous sinus protocol)



Indications: cavernous sinus thrombosis, carotid-cavernous fistulas.
Sequences:

  • Sagittal FLAIR

  • Axial T2 FSE

  • Axial FLAIR

  • Axial GRE or SWI

  • Axial T1 SE

  • Axial diffusion and ADC

  • Post-Gd coronal thin-slice T1 SE with fat sat (cavernous sinuses)

  • Whole head post-Gd axial T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE (3 mm thick).


Comments:

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

  • Substitute sagittal T1 SE for FLAIR in patients 10 years of age or younger.



N10: Pre- and post-contrast brain MRI (cranial nerve protocol)



Indications: cranial nerve 5 impingement symptoms, skull base lesions.
Sequences:

  • Sagittal T1 SE

  • Axial T2 FSE

  • Axial FLAIR

  • Axial GRE or SWI

  • Axial diffusion and ADC

  • Axial 3-D CISS (pons and midbrain): coronal and sagittal reconstructions.

  • Thin-slice axial T1 SE with fat saturation (skull base)

  • Post-Gd thin-slice axial T1 SE with fat saturation (skull base)

  • Post-Gd thin-slice coronal T1 SE with fat saturation (skull base)

  • Whole head post-Gd axial T1 SE with fat saturation OR:

  • Post-Gd axial 3D VIBE (3 mm thick).


Comments:

  • Send b1000 DWI (#2) and ADC to PACS. Keep b0 and b500 DWI images in hard drive for 2 weeks, then can discard.

  • CISS parameters: flip angle 65 degrees, slice thickness 1 mm, 384 x 256 matrix, FOV 18-20 cm, NEX 2.



N11: Pre- and post-contrast neck MR angiography



Indications: carotid stenosis, part of stroke workup, carotid dissection
Sequences:

  • Axial tru-FISP

  • Sagittal tru-FISP

  • Dynamic coronal MRA (pre-, arterial, venous phases)

  • Rotating 3-D MIP reformats

  • Opt: axial pre-Gd thin-slice T1 SE with fat saturation (dissection).


Comments:


N12: Brain MR angiography without contrast



Indications: part of stroke workup, intracranial aneurysms
Sequences:

  • Axial 3-D time-of-flight

  • Rotating 3-D MIP reformats of right ICA, left ICA, posterior circulation separately, as well as of vessels as a whole (flip and rotate)


Comments:


N13: Brain MR venogram without contrast



Indications: evaluate for sinus thrombosis.
Sequences:

  • Coronal 2-D time-of-flight with inferior saturation band

  • Rotating 3-D MIP reformats of venous structures


Comments:

  • Suggested 2D TOF parameters: TR/TE = 32-40/8-12; flip angle 50-70 degrees, slice thickness 1.5-3.0 mm, 144 x 256 matrix, NEX 1-2.



ENT 1: Pre- and post-contrast neck MRI



Indications: neck masses, tumor staging
Sequences: place fiducial over any palpable masses

  • Sagittal T1 FSE

  • Sagittal STIR

  • Axial T1 FSE

  • Axial STIR

  • Coronal T1 FSE

  • Coronal STIR

  • Post-Gd axial T1 FSE with fat saturation

  • Post-Gd coronal T1 FSE with fat saturation

  • Post-Gd sagittal T1 FSE with fat saturation


Comments:

  • Axial sequences: use 5 mm slice thickness with 1 mm (20%) skip.



ENT 2: Temporomandibular joint MRI



Indications: TMJ pain
Sequences:

  • Axial T1 SE

  • Coronal PD FSE (closed mouth)

  • Sagittal PD FSE (closed mouth)

  • Sagittal T2 FSE with fat saturation (closed mouth)

  • Coronal PD FSE (open mouth)

  • Sagittal PD FSE (open mouth)


Comments:

  • Place fiducials over the symptomatic side.

  • Perform coronal and sagittal sequences through both sides to assess symmetry (until a dedicated TMJ coil is acquired).

  • Sagittal T2 FSE with fat saturation: adjust TE to 40 msec (+/-5 msec).



PN 1: Non-contrast vs pre-/post-contrast brachial plexus MRI



Indications: brachial plexopathy from tumor invasion or radiation, traumatic nerve injuries.
Sequences:

  • Coronal T2 FSE (large FOV)

  • Axial T1 SE (large FOV)

  • Axial T1 SE

  • Axial STIR

  • Coronal T1 SE

  • Coronal STIR

  • Sagittal T1 SE

  • Sagittal STIR

  • Opt: post-Gd axial T1 SE with fat saturation

  • Opt: post-Gd coronal T1 SE with fat saturation

  • Opt: post-Gd sagittal T1 SE with fat saturation


Comments:

  • Initial 2 sequences will help to assess for asymmetry between the brachial plexus regions.

  • Other sequences are high-resolution images through the affected side only.



PN 2: Non-contrast vs pre-/post-contrast sacral plexus MRI



Indications: sciatic nerve impingement.
Sequences:

  • Axial T1 SE

  • Axial STIR

  • Opt: post-Gd oblique coronal T1 SE with fat saturation

  • Opt: post-Gd axial T1 SE with fat saturation


Comments:


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