MRI Thoracic Spine
Indications for MRI Thoracic Spine
- Localised upper back pain and radiculopathy with 6-week course of conservative care and inadequate response to treatment.
- Infectious or inflammatory processes (eg.Spinal Cord Abscess or Spinal Osteomyelitis)
- Myelopathies, Multiple Sclerosis and other demyelinating diseases
- Evaluation or monitoring of congenital malformations of the spinal cord
- Evaluation or monitoring of inflammation of the CNS or meninges
- Evaluation or monitoring of tumour of the CNS or meninges
- Evaluation or monitoring of demyelinating disease
- Nontraumatic vascular injuries of the spine
- Monitoring of previous spinal surgery
- Evaluation or monitoring of trauma
- Spinal Cord Tumour
- Spine 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 for MRI Thoracic Spine
- 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 down the weight of the patient
Positioning for MRI Thoracic Spine
- Head first supine
- Position the patient in the spine and neck coils
- Give cushions under the legs for extra comfort
- Centre the laser beam localiser over the mid sternum (T4-T5 level)
Recommended MRI Thoracic Spine Protocols and Planning
MRI Thoracic Spine localiser
A three-plane localizer must be taken at the beginning to localize and plan the sequences. Localizers are typically less than 25 seconds and consist of T1-weighted low-resolution scans.
T2 tse sagittal
Plan the sagittal slices on the coronal plane and angle the positioning block parallel to the spinal cord. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane, parallel to the line along the center of the vertebral body and the spinous process. Check the positioning block in the sagittal plane; the field of view (FOV) must be large enough to cover the entire thoracic and cervical spine from C1 down to T12 (normally 470 mm). The slices should be sufficient to cover the spine from the lateral border of the right (RT) transverse process up to the lateral border of the left (LT) transverse process. Place a saturation band over the chest in the sagittal plane, as shown in the diagram. This is done to avoid breathing artifacts over the spinal area. The phase direction should be head to feet to minimize further motion artifacts from the chest.
Parameters
TR 3000-4000 | TE 100-120 | SLICE 4MM | FLIP 130-150 | PHASE H>F | MATRIX 512X512 | FOV 480-490 | GAP 10% | NEX(AVRAGE) 2 |
T1 tse sagittal
Plan the sagittal slices on the coronal plane and angle the positioning block parallel to the spinal cord. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane, parallel to the line along the center of the vertebral body and the spinous process. Check the positioning block in the sagittal plane; the field of view (FOV) must be large enough to cover the entire thoracic and cervical spine from C1 down to T12 (normally 470 mm). The slices should be sufficient to cover the spine from the lateral border of the right (RT) transverse process up to the lateral border of the left (LT) transverse process. Place a saturation band over the chest in the sagittal plane, as shown in the diagram. This is done to avoid breathing artifacts over the spinal area. The phase direction should be head to feet to minimize further motion artifacts from the chest.
Parameters
TR 400-600 | TE 15-25 | SLICE 4 MM | FLIP 90 | PHASE H>F | MATRIX 512X512 | FOV 480-490 | GAP 10% | NEX(AVRAGE) 2 |
T2 TSE STIR sagittal
Plan the sagittal slices on the coronal plane and angle the positioning block parallel to the spinal cord. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane, parallel to the line along the center of the vertebral body and the spinous process. Check the positioning block in the sagittal plane; the field of view (FOV) must be large enough to cover the entire thoracic and cervical spine from C1 down to T12 (normally 470 mm). The slices should be sufficient to cover the spine from the lateral border of the right (RT) transverse process up to the lateral border of the left (LT) transverse process. Place a saturation band over the chest in the sagittal plane, as shown in the diagram. This is done to avoid breathing artifacts over the spinal area. The phase direction should be head to feet to minimize further motion artifacts from the chest.
Parameters
TR 4000-5000 | TE 110 | FLIP 130 | NEX 2 | SLICE 4MM | MATRIX 512X384 | FOV 480-490 | PHASE H>F | GAP 10% | TI 130 |
T2 TSE Axial block 4mm
Plan the axial slices on the sagittal plane and angle the positioning block perpendicular to the spinal cord. An appropriate angle must be given in the coronal plane (parallel to the intervertebral disc space). Ensure that the slices are sufficient to cover the entire thoracic spine from T1 to T12. Place a saturation band over the chest in the sagittal plane, as depicted in the diagram. This is to prevent breathing artifacts over the spinal area.
Note: If the pathology is localized to a specific part of the thoracic spine, perform axial imaging over the affected area (e.g., bulging disc, cord compressions, or spinal cord tumors)
Parameters
TR 3000-4000 | TE 100-120 | SLICE 4 MM | FLIP 130-150 | PHASE A>P | MATRIX 256X256 | FOV 200-250 | GAP 10% | NEX(AVRAGE) 2 |
T1 TSE Axial block 4mm
Plan the axial slices on the sagittal plane and angle the positioning block perpendicular to the spinal cord. An appropriate angle must be given in the coronal plane (parallel to the intervertebral disc space). Ensure that the slices are sufficient to cover the entire thoracic spine from T1 to T12. Place a saturation band over the chest in the sagittal plane, as depicted in the diagram. This is to prevent breathing artifacts over the spinal area.
Parameters
TR 400-600 | TE 15-25 | SLICE 4 MM | FLIP 90 | PHASE A>P | MATRIX 256X256 | FOV 200-250 | GAP 10% | NEX(AVRAGE) 2 |
Indications for contrast enhancement spine scans
- Evaluation or monitoring of tumour of the CNS or meninges
- Monitoring of previous spinal surgery
- MS, hemipeligia/paresthesia and Infection
- Suspected spine lesions (e.g. bone Mets)
- Spinal Cord Tumour
- Syringomyelia
