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Indications for soft tissue neck MRI scan

> Abnormalities noted on other imaging or endoscopic studies
> Staging of known malignancy of head and neck
> Congenital anomalies (e.g., branchial cleft cyst)
> Treatment planning for radiation therapy
> Evaluation for response to treatment  
> Pre-operative evaluation of tumours
> Presence of a foreign body
> Upper airway obstruction
> Obstructive thyroid disease
> Head/neck abscess
> Retropharyngeal abscess
> Tracheal stenosis
> Vocal cord paralysis
> Lymphadenopathy
> Nasopharynx tumours
> Parotid tumor
> Orbital tumours
> Trauma

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
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

If possible provide a chaperone for claustrophobic patients (e.g. relative or staff )
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




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 (1 inch below the chin in chin down position)

Positioning for mri neck

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.

NECK LOCALIZER

T2 stir coronal 4mm 280FOV

Plan the coronal slices on the sagittal plane; angle the position block parallel to the cervical spine. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted neck (parallel to the strenoclavicular joints). Slices must be sufficient to cover the soft tissue neck from the nose tip up to the line of the spinous process of cervical spine. FOV must be big enough to cover the whole neck from the frontal sinus down to the clavicle.  Phase direction in the coronal scans must be right to left, this is to avid the artefacts form the chest and heart motion. It is very important to instruct the patient to avoid swallowing during the sequence acquisition (in our imaging department we give 30s after each scan for the patient to swallow saliva). This will avoid the motion artefacts in the neck during image acquisition. Using Saturation bands under the coronal block can reduce the arterial pulsation artefacts.

RI NECK CORONAL PLANNING AND PROTOCOLS

Parameters

TR

4000-5000

TE

110

FLIP

130

NXA

2

SLICE

4 MM

MATRIX

320X320

FOV

280-300

PHASE

R>L

GAP

10%

TI

130

T1 tse coronal 4mm 280FOV

Plan the coronal slices on the sagittal plane; angle the position block parallel to the cervical spine. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted neck (parallel to the strenoclavicular joints). Slices must be sufficient to cover the soft tissue neck from the nose tip up to the line of the spinous process of cervical spine. FOV must be big enough to cover the whole neck from the frontal sinus down to the clavicle.  Phase direction in the coronal scans must be right to left, this is to avid the artefacts form the chest and heart motion. It is very important to instruct the patient to avoid swallowing during the sequence acquisition (in our imaging department we give 30s after each scan for the patient to swallow saliva). This will avoid the motion artefacts in the neck during image acquisition. Using Saturation bands under the coronal block can reduce the arterial pulsation artefacts.

RI NECK CORONAL PLANNING

Parameters

TR

400-600

TE

15-25

SLICE

4 MM

FLIP

130

PHASE

R>L

MATRIX

384X320

FOV

280-300

GAP

10%

NXA(AVRAGE)

2

T1 tse axial 4mm 270 FOV

Plan the axial slices on the sagittal plane: angle the position block perpendicular to the cervical spine. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane on a tilted neck (perpendicular to the cervical spine). Slices must be sufficient to cover the soft tissue neck from frontal sinus down to the line of the clavicle.  Phase direction in the axial scans must be anterior to posterior with 100% over sample. This will reduce the arterial pulsation and swallowing artefacts. It is important to instruct the patient to avoid swallowing during the sequence acquisition (in our imaging department we give 30s after each scan for the patient to swallow saliva). This will avoid the motion artefacts in the neck during image acquisition. Using saturation bands under the axial block can reduce the arterial pulsation artefacts.

MRI NECK AXIAL PLANNING AND PROTOCOLS

Parameters

TR

400-600

TE

15-25

SLICE

4 MM

FLIP

130

PHASE

A>P

MATRIX

320X320

FOV

270-290

GAP

10%

NXA(AVRAGE)

2

T2 STIR axial 4mm 270 FOV

Plan the axial slices on the sagittal plane: angle the position block perpendicular to the cervical spine. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane on a tilted neck (perpendicular to the cervical spine). Slices must be sufficient to cover the soft tissue neck from frontal sinus down to the line of the clavicle.  Phase direction in the axial scans must be anterior to posterior with 100% over sample. This will reduce the arterial pulsation and swallowing artefacts. It is important to instruct the patient to avoid swallowing during the sequence acquisition (in our imaging department we give 30s after each scan for the patient to swallow saliva). This will avoid the motion artefacts in the neck during image acquisition. Using saturation bands under the axial block can reduce the arterial pulsation artefacts.

MRI NECK AXIAL PLANNING

Parameters

TR

4000-5000

TE

110

FLIP

130

NXA

2

SLICE

4 MM

MATRIX

320X320

FOV

270-290

PHASE

A>P

GAP

10%

TI

130

DWI epi2scan trace axial 5mm(with 7 average(NXA))

Plan the axial slices on the sagittal plane; angle the position block perpendicular to the cervical spine. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane on a tilted neck (perpendicular to the cervical spine). Slices must be sufficient to cover the soft tissue neck from frontal sinus down to the line of the clavicle.  Phase direction in the axial scans must be anterior to posterior with the smallest possible phase FOV (i.e. the upper border touching the nose and lower border touching the spinous process). This is to reduce air-skin interface artefacts in the neck area. It’ isvery important to instruct the patient to avoid swallowing during the sequence acquisition (in our imaging department we give 30s after each scan for the patient to swallow saliva). This will avoid the motion artefacts in the neck during image acquisition.

MRI NECK AXIAL PLANNING

Parameters

TR

5000-6000

TE

110

FLIP

130

NXA

7

SLICE

5 MM

MATRIX

192X192

FOV

210-230

PHASE

R>L

GAP

10%

B VALUE

0
800

T2 tse sagittal 4mm 280 -300 FOV

Plan the sagittal slices on the coronal plane: angle the position block parallel to the cervical spine. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted neck (parallel to the midline of the brain). Slices must be sufficient to cover the soft tissue neck from RT pinna to the LT pinna. FOV must be big enough to cover the whole neck from the frontal sinus down to clavicle. Phase direction in the sagittal scans must be anterior to posterior with 100% over sample. Giving 100% oversample will reduce the arterial pulsation and swallowing artefacts. It’s very important to instruct the patient to avoid swallowing during the sequence acquisition (in our imaging department we give 30s after each scan for the patient to swallow saliva). This will avoid the motion artefacts in the neck during image acquisition. Using Saturation bands under the sagittal block can reduce the arterial pulsation artefacts.

MRI NECK SAGITTAL PLANNING AND PROTOCOLS

Parameters

TR

4000-5000

TE

110

FLIP

130

NXA

2

SLICE

4 MM

MATRIX

320X320

FOV

290-300

PHASE

A>P

GAP

10%

NO.SLICE

25

 

Use T1 TSE Fat saturated axial and coronal 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