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

miscellaneous

 

 

 

 

 

 

 

 

Indications for MRI brain

> Transient ischaemic attack (TIA), syncope, collapse , stroke
> Brain Tumour, Suspected brain tumour, metastases, papilloedema
> CNS infection, abscess, meningitis, AIDS,&TB
> Congenital malformation of brain or meninges
> Post-operative follow-up after brain surgery
> Dementia, neurodegenerative disorder
> Demyelinating disease of the brain
> Encephalopathy, encephalitis
> Cerebellar, or brainstem lesion
> Head trauma, epilepsy,stroke
> CVA, altered mental status
> Suspected leukodystrophies
> Ataxia, bipolar disorder
> Multiple sclerosis
> ENT problems

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 for MRI brain







>

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 MRI brain




Head first supine
Position the head in the head coil and immobilise with cushions
Give cushions under the legs for extra comfort
Centre the laser beam localiser over the glabella

brain mri positioning image

Suggested protocols, parameters and planning

localiser

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

brain mri localizer image

T2 tse axial

Plan the axial slices on the sagittal plane; angle the position block parallel to the genu and splenium of the corpus callosum. Slices must be sufficient to cover the whole brain from the vertex to the line of the foramen magnum. Check the positioning block in the other two planes. An appropriate angle must be given in coronal plane on a tilted head (perpendicular to the line of 3rd ventricle and brain stem).

brain mri protocol and t2 axial planning image

Parameters

TR

3000-4000

TE

100-120

SLICE

5MM

FLIP

130-150

PHASE

R>L

MATRIX

320X320

FOV

210-230

GAP

10%

NXA(AVRAGE)

2

T2 FLAIR axial

Plan the axial slices on the sagittal plane; angle the position block parallel to the genu and splenium of the corpus callosum. Slices must be sufficient to cover the whole brain from the vertex to the line of the foramen magnum. Check the positioning block in the other two planes. An appropriate angle must be given in coronal plane on a tilted head (perpendicular to the line of 3rd ventricle and brain stem).

brain mri protocol and flair axial planning image

Parameters

TR

7000-9000

TE

110

FLIP

130

NXA

2

SLICE

5MM

MATRIX

320X320

FOV

210-230

PHASE

R>L

GAP

10%

TI

2500

T1 SE coronal

Plan the coronal slices on the sagittal plane; angle the position block parallel to the brain stem. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane on a tilted head (perpendicular to mid line of the brain). Slices must be sufficient to cover the whole brain from the frontal sinus to the line of the occipital protubernce.

brain mri protocol and t1 coronal planning image

Parameters

TR

400-600

TE

15-25

SLICE

5MM

FLIP

90

PHASE

R>L

MATRIX

320X320

FOV

210-230

GAP

10%

NXA(AVRAGE)

2

T2 tse sagittal

Plan the sagittal slices on the axial plane; angle the position block parallel to midline of the brain.  Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane on a tilted head (parallel to the line along 3rd ventricle and brain stem). Slices must be sufficient to cover the brain from temporal lobe to temporal lobe.

brain mri protocol and t2 sagittal planning image

Parameters

TR

3000-4000

TE

100-120

SLICE

5MM

FLIP

130-150

PHASE

A>P

MATRIX

320X320

FOV

210-230

GAP

10%

NXA(AVRAGE)

2

DWI epi3scan trace axial

Plan the DWI axial slices on the sagittal plane; angle the position block parallel to the line from the glabella to the foramen magnum. This angle will reduce air-bone interface artefacts from the Para nasal sinuses. Slices must be sufficient to cover the whole brain from the vertex to the foramen magnum. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane on a tilted head (perpendicular to the line of 3rd ventricle and brain stem).

brain mri protocol and dwi axial planning image

Parameters

TR

7000-9000

TE

110

FLIP

130

NXA

4

SLICE

5MM

MATRIX

192X192

FOV

210-230

PHASE

R>L

GAP

10%

B VALUE

0
500
1000

Indications for contrast enhancement brain scans

> Tumour, Metastases, Cranial nerve lesion, Indeterminate intracranial lesion, IAC mass  
> Cavernous angioma, Amyloid angiopathy, Neurocysticercosis
> Meningitis, Encephalitis, Leptomeningeal spread
> Multiple Sclerosis, AVM, HIV, Infection Abscess
> Leukodystrophies, Delayed development
> Syringomyelia(Syrinx)

Use T1 SE 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.

 

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