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Indications for placenta MRI scan

> For the assessment of intrauterine fetal growth restriction
> Diagnosis and management of placenta accreta
> Diagnosis and management of placenta previa
> Surgical management of abnormal placentation

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 object including keys, coins, wallet, any cards with magnetic strips, jewellery, hearing aid and hairpins
Ask the patient to undress and change into a hospital gown
An intravenous line must be placed with extension tubing extending out of the magnetic bore
Claustrophobic patients may be accompanied into the scanner room e.g. by staff member or relative with proper safety screening
Offer earplug or headphones possibly with music for extra comfort
Explain the procedure to the patient and answer questions
Note down the weight of the patient
Pregnancy scanning consent must be taken before the procedure

Positioning



 



Position the patient in supine position with head pointing towards the magnet (head first supine)
Position the patient over the spine coil and place the body coils over abdomen and pelvis (nipple down to elbow three inches below symphysis pubis)
Securely tighten the body coil using straps to prevent respiratory artefacts
Give a pillow under the head and cushions under the legs for extra comfort
Centre the laser beam localiser over mid abdomen
Register the patient in the scanner as head first supine

mri positioning for placenta scan

Suggested protocols, parameters and planning

localiser

A three plane TrueFISP localiser must be taken initially to localise and plan the sequences. These are fast single shot localisers with under 25s aqusition time which are excellent for localising abdominal structures.

mri placenta localizer image

T2 truefisp sagittal 4mm breath hold

Plan the sagittal slices on the coronal localizer; angle the position block parallel through the placenta. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (perpendicular to the placenta). Slices must be sufficient to cover the whole abdomen and pelvis from the right to left. FOV must be big enough to cover the whole abdomen and pelvis (normally 450 mm-480mm). Normally these scans are 35 seconds which is a long time for a pregnant lady to hold hear breath. If the patient is unable to hold there breath for long you can do these scans as non breath hold (these are fast single shot with low sensitivity to motion artefacts).

mri placenta  placenta accreta sagittal planning and protocols

Parameters

TR

4-5

TE

2-3

FLIP

60

NXA

1

SLICE

4 MM

MATRIX

320x320

FOV

450-480

PHASE

A>P

OVERSAMPLE

10%

IPAT

ON

T2 truefisp coronal 4mm breath hold

Plan the coronal slices on the sagittal localizer; angle the position block parallel through the placenta. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (parallel across  the placenta). Slices must be sufficient to cover the whole abdomen and pelvis from the anterior abdominal wall to the spinous process of vertebrae. FOV must be big enough to cover the whole abdomen and pelvis (normally 450 mm-480mm). Normally these scans are 35 seconds which is a long time for a pregnant lady to hold hear breath. If the patient is unable to hold there breath for long you can do these scans as non breath hold (these are fast single shot with low sensitivity to motion artefacts).

mri placenta placenta previa  coronal planning and protocols

Parameters

TR

4-5

TE

2-3

FLIP

60

NXA

1

SLICE

4 MM

MATRIX

320x320

FOV

450-480

PHASE

R>L

OVERSAMPLE

30%

IPAT

ON

T2 truefisp axial 5 mm breath hold

Plan the axial slices on the sagittal localizer; angle the position block perpendicular through the placenta. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular across  the placenta). Slices must be sufficient to cover the whole abdomen and pelvis from the diaphragm to pubic symphysis. Normally these scans are 35 seconds which is a long time for a pregnant lady to hold hear breath. If the patient is unable to hold there breath for long you can do these scans as non breath hold (these are fast single shot with low sensitivity to motion artefacts).

mri placenta placenta previa axial planning and protocols

Parameters

TR

4-5

TE

2-3

FLIP

60

NXA

1

SLICE

5 MM

MATRIX

320x320

FOV

450-480

PHASE

A>P

OVERSAMPLE

10%

IPAT

ON

T1 vibe axial 6 mm breath hold

Plan the axial slices on the sagittal localizer; angle the position block perpendicular through the placenta. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular across  the placenta). Slices must be sufficient to cover the whole abdomen and pelvis from the diaphragm to pubic symphysis. These scans are only 20 seconds long.

mri placenta placenta accreta axial t1 planning and protocols

Parameters

TR

3-4

TE

1-2

FLIP

12

NXA

1

SLICE

5 MM

MATRIX

320X320

FOV

450-480

PHASE

A>P

OVERSAMPLE

10%

IPAT

ON

TT2 truefisp axial oblique 4 mm breath hold

Plan the axial slices on the sagittal scans; angle the position block perpendicular to the birth canal. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (parallel to right and left iliac crest). Slices must be sufficient to cover the whole birth canal.

mri placenta placenta accreta axial birth canal  planning and protocols

Parameters

TR

4-5

TE

2-3

FLIP

60

NXA

1

SLICE

5 MM

MATRIX

320x320

FOV

450-480

PHASE

A>P

OVERSAMPLE

10%

IPAT

ON

 

CLICK THE SEQUENCES BELOW TO CHECK THE SCANS