BRAIN
MRA BRAINMRV BRAINPEDIATRIC BRAINORBITIAMSDWI IAMSPNSSELLAEPILAPSYTMJ'STRIGEMINALFACENECK sialographyC SPINEMRA NECKB PLEXUSMRA SUB CLAVIANSCHESTSTRENUMT SPINECARDIACKIDNEYSMRA RENALADRENALLIVERMRCPPANCREASSECRITEN MRCPSMALL BOWELmrv abdomenBREASTIMPLANT BREASTRECTAL CA BLADDERURETHRAPROSTATEPENIS TESTISGYNE PELVISPLACENTAVEGINAL FISTULAFISTULAProctogramHIPSARTHROGRAM HIPPSOSL SPINESI JOINTSL PLEXUSKUBMR UROGRAPHYTHIGHKNEETIB AND FIBANKLEFOOTMRA LEGSSHOULDERARTHROGRAM SHOULDERHUMORUSELBOWFOREARMWRISTHANDMRA ARMMRA HANDMRA WHOLE BODYmiscellaneous

 

 

 

 

 

 

 

 

Indications for cervical spine MRI scan

> Persistent neck pain or radiculopathy, with 6-week course of conservative care and inadequate
> response to treatment.
> Cancer or tumours of the spine (cancer of the spine, spinal cord, or meninges)
> Evaluation or monitoring of congenital malformations of the spinal cord
> Multiple sclerosis or other demyelinating diseases or myelopathies
> Possible spinal cord injury and post-traumatic neurologic deficit
> Post-operative evaluation, with new neurologic findings
> Congenital or acquired spinal abnormalities in children
> Fracture evaluation for suspected or known fracture.
> Severe intractable arm pain for more than 6 weeks
> Infectious or inflammatory processes
> Evaluation or monitoring of myelopathy
> Monitoring of previous spinal surgery
> Evaluation or monitoring of syrinx
> Spinal injury or trauma
> Spinal cord tumour
> Spinal TB

Contraindications





Any electrically, magnetically or mechanically activated implant (e.g. cardiac pacemaker, insulin pump biostimulator, neurostimulator, cochlear implant, and hearing aids)
Intracranial aneurysm clips (unless made of titanium)
Pregnancy (risk vs benefit ratio to be assessed)
Ferromagnetic surgical clips or staples
Metallic foreign body in the eye
Metal shrapnel or bullet

Patient preparation







>

A satisfactory written consent form must be taken from the patient before entering the scanner room
Ask the patient to remove all metal objects including keys, coins, wallet, cards with magnetic strips, jewellery, hearing aid and hairpins
If possible provide a chaperone for claustrophobic patients (e.g. relative or staff )

Contrast injection risk and benefits must be explained to the patient before the scan
Gadolinium should only be given to the patient if GFR is > 30

Offer earplugs or headphones, possibly with music for extra comfort
Explain the procedure to the patient
Instruct the patient to keep still
Note the weight of the patient

Positioning for cervical spine MRI




Head first supine
Position the head in the head and neck coil and immobilise with cushions
Give cushions under the legs for extra comfort
Centre the laser beam localiser over the mid neck (2.5cm below the chin in chin-down position)

cervical spine mri positioning image

Suggested protocols, parameters and planning

localiser

A three plane localiser must be taken in the beginning to localise and plan the sequences. Localisers are normally less than 25sec. T1 weighted low resolution scans.

cervical spine mri localizer image

T2 tse sagittal

Plan the sagittal slices on the coronal plane; angle the position block parallel to spinal cord.  Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted patient (parallel to the line along the centre of the vertebral body through the length of the spinous process). Check the position block in the sagittal plane; FOV must be big enough to cover the whole cervical spine from pons down to T4 (normally 280mm). Slices must be sufficient to cover the spine from the lateral border of RT transverse process to the lateral border of LT transverse process. A saturation band must be placed over the neck (in front of the oesophagus) in the sagittal plane. This is to avoid swallowing artefacts over the spinal area. Phase direction should be head to foot to avoid motion artefacts from the neck.

cervical spine mri protocol and t2 sagittal planning image

Parameters

TR

3000-4000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

H>F

MATRIX

256X256

FOV

280-290

GAP

10%

NXA(AVRAGE)

2

T1 tse sagittal

Plan the sagittal slices on the coronal plane; angle the position block parallel to spinal cord.  Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted patient (parallel to the line along the centre of the vertebral body through the length of the spinous process). Check the position block in the sagittal plane; FOV must be big enough to cover the whole cervical spine from pons down to T4 (normally 280mm). Slices must be sufficient to cover the spine from the lateral border of RT transverse process to the lateral border of LT transverse process. A saturation band must be placed over the neck (in front of the oesophagus) in the sagittal plane. This is to avoid swallowing artefacts over the spinal area. Phase direction should be head to foot to avoid motion artefacts from the neck.

cervical spine mri protocol and t1 sagittal planning image

Parameters

TR

400-600

TE

15-25

SLICE

3 MM

FLIP

150

PHASE

H>F

MATRIX

256X256

FOV

280-290

GAP

10%

NXA(AVRAGE)

2

T2 TSE STIR sagittal

Plan the sagittal slices on the coronal plane; angle the position block parallel to spinal cord.  Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted patient (parallel to the line along the centre of the vertebral body through the length of the spinous process). Check the position block in the sagittal plane; FOV must be big enough to cover the whole cervical spine from pons down to T4 (normally 280mm). Slices must be sufficient to cover the spine from the lateral border of RT transverse process to the lateral border of LT transverse process. A saturation band must be placed over the neck (in front of the oesophagus) in the sagittal plane. This is to avoid swallowing artefacts over the spinal area. Phase direction should be head to foot to avoid motion artefacts from the neck.

cervical spine mri protocol and stir sagittal planning image

Parameters

TR

7000-9000

TE

110

FLIP

130

NXA

2

SLICE

3 MM

MATRIX

256X256

FOV

280

PHASE

H>F

GAP

10%

TI

130

T2*(medic) Axial

Plan the axial slices on the sagittal plane; angle the position block perpendicular to the spinal cord. Additional blocks must be placed if there is a disc prolapse at any other level (eg.T2,T3). An appropriate angle must be given in the coronal plane on a tilted spine (parallel to the intervertebral disc space). Slices must be sufficient to cover the whole C spine from C2 to T1. A saturation band must be placed over the neck (in front of the oesophagus) in the sagittal plane. This is to avoid swallowing artefacts over the spinal area.

cervical spine mri protocol and t2 medic axial planning image

Parameters

TR

800-1200

TE

15-25

FLIP

30

NXA

2

SLICE

3 MM

MATRIX

256X256

FOV

180-200

PHASE

A>P

GAP

10%

oversample

100%

T1 TSE Axial

Plan the axial slices on the sagittal plane; angle the position block perpendicular to the spinal cord. Additional blocks must be placed if there is a disc prolapse at any other level (eg.T2,T3). An appropriate angle must be given in the coronal plane on a tilted spine (parallel to the intervertebral disc space). Slices must be sufficient to cover the whole C spine from C2 to T1. A saturation band must be placed over the neck (in front of the oesophagus) in the sagittal plane. This is to avoid swallowing artefacts over the spinal area.

cervical spine mri protocol and t1 axial planning image

Parameters

TR

400-500

TE

15-20

FLIP

150

NXA

2

SLICE

3 MM

MATRIX

256X256

FOV

180-200

PHASE

A>P

GAP

10%

oversample

100%

 

mrv abdomen

 

Indications for contrast enhancement cervical spine scans

> Evaluation or monitoring of tumour of the CNS or meninges
> Monitoring of previous spinal surgery
> Suspected spine lesions (e.g. bone mets)
> Spinal cord tumour
> Syringomyelia

 

Use T1 TSE fat saturated axial and sagittal after the administration of IV gadolinium DTPA injection(copy the planning outlined above). The recommended dose of gadolinium DTPA injection is 0.1 mmol/kg, i.e. 0.2 mL/kg in adults, children and infants.

CLICK THE SEQUENCES BELOW TO CHECK THE SCANS