mrimaster

MRI Spinal Cord : Protocol and Planning

Indications for MRI Spinal Cord

Contraindications

Patient preparation for MRI Spinal Cord

Positioning for MRI Spinal Cord

MRI positioning for spinal cord scan

Recommended MRI Spinal Cord Protocols and Planning

localiser cervicothoracic spine

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

T2 tse sagittal large FOV localiser for spine counting

This scan is for the localisation of the spinal cord and to check the vertebral body level of any spinal cord pathologies. This sequence can be performed under one minute with a limited number of slices and parallel imaging techniques. The alternative to this method is to perform the scans with a marker such as a cod liver oil tablet placed at the level of T4. The marker must be included in the upper and lower spinal cord high resolution small field of view (FOV) sagittal scans.

Plan the sagittal slices on the coronal plane, angle the position 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 on a tilted patient, this should be parallel to the imaginary line running through the centre of the vertebral body and spinous process. Check the position block in the sagittal plane where the FOV must be big enough to cover the whole cervical and thoracic spine from C1 down to T12. An FOV of 480mm should normally be sufficient. The slices should be enough to cover the spine from the lateral border of the right transverse process to the lateral border of left transverse process. A saturation band must be placed over the chest in the sagittal plane to avoid breathing artefacts over the spinal area. The phase direction should be head to foot to avoid further motion artefacts from the chest.

Parameters

TR

3000-4000

TE

100-120

SLICE

4MM

IPAT

ON

PHASE

H>F

MATRIX

512X384

FOV

480-490

GAP

10%

NEX(AVRAGE)

1

T2 tse sagittal 2mm 270-280 FOV or Isotropic 3D T2 SPACE .9mm

Utilising thin slices and small field of views is mandatory for spinal cord imaging to enable the detection of small multiple sclerosis (MS) lesions. The modern practise is to replace the tse scans with an isotropic 3D sequence with a slice thickness of 0.9mm.

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, this should be parallel to the imaginary line running through the centre of the vertebral body and the spinous process. Check the position block in the sagittal plane where the FOV must be big enough to cover the upper spinal cord from the pons down to T5. Normally an FOV of 270- 280mm should be sufficient. The slices should be enough to cover the spinal cord side to side. A saturation band must be placed over the neck in front of the oesophagus in the sagittal plane to avoid swallowing artefacts. The phase direction should be head to foot to avoid motion artefacts from the neck.

Parameters

TR

3000-4000

TE

110

SLICE

2MM

FLIP

130-150

PHASE

H>F

MATRIX

320X320

FOV

270-280

GAP

10%

NEX(AVRAGE)

4

 

T1 tse sagittal 2mm 270-280 FOV or Isotropic 3D T1 .9mm

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, this should be parallel to the imaginary line running through the centre of the vertebral body and the spinous process. Check the position block in the sagittal plane where the FOV must be big enough to cover the upper spinal cord from the pons down to T5. Normally an FOV of 270- 280mm should be sufficient. The slices should be enough to cover the spinal cord side to side. A saturation band must be placed over the neck in front of the oesophagus in the sagittal plane to avoid swallowing artefacts. The phase direction should be head to foot to avoid motion artefacts from the neck.

Parameters

TR

400-600

TE

15-25

SLICE

2MM

FLIP

150

PHASE

H>F

MATRIX

320X320

FOV

270-280

GAP

10%

NEX(AVRAGE)

4

 

T2 TSE Axial block 3mm 150- 160 FOV

Axial scans are only performed over spinal cord pathologies e.g. MS lesions or a syrinx. If no pathologies are identified, acquire a small axial block over the cervical cord area. Plan the axial slices on the sagittal plane, angle the position block perpendicular to the spinal cord. An appropriate angle must be given in the coronal plane on a tilted or scoliotic spine, angling parallel to the intervertebral disc spaces. Slices must be sufficient to cover the area of pathology or cervical cord. In the sagittal plane a saturation band must be placed over the neck in front of the oesophagus to avoid swallowing artefacts.

Parameters

TR

3000-4000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

A>P

MATRIX

256X256

FOV

150-160

GAP

10%

NEX(AVRAGE)

4

 

T1 TSE Axial block 3mm 150- 160 FOV

Plan the axial slices on the sagittal plane, angle the position block perpendicular to the spinal cord. An appropriate angle must be given in the coronal plane on a tilted or scoliotic spine, angling parallel to the intervertebral disc spaces. Slices must be sufficient to cover the area of pathology or cervical cord. In the sagittal plane a saturation band must be placed over the neck in front of the oesophagus to avoid swallowing artefacts.

Parameters

TR

400-600

TE

15-25

SLICE

3 MM

FLIP

90

PHASE

A>P

MATRIX

256X256

FOV

150-160

GAP

10%

NEX(AVRAGE)

4

 

Next, move the table inward towards the magnet by 250-300mm depending on the patient’s height. Modern scanners provide an auto-table move option which allows the user to plan an isocentered localiser in the lower spine without losing the upper spine localisers. If this options are not available in your scanner please re-enter the patient for the lower cord.

localiser thoraco lumbar spine

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

T2 tse sagittal 2mm 270-280 FOV or Isotropic 3D T2 SPACE .9mm

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, this should be parallel to the imaginary line running through the centre of the vertebral body and the spinous process. Check the position block in the sagittal plane where the FOV must be big enough to cover the lower spinal cord from T4 down to L3. Normally an FOV of 270- 280mm should be sufficient. The slices should be enough to cover the spinal cord side to side. In the sagittal plane a saturation band must be placed over the abdomen in front of the aorta to avoid peristalsis and breathing artefacts. Phase direction should be head to foot to avoid motion artefacts from the abdomen.

Parameters

TR

3000-4000

TE

100-120

SLICE

2 MM

FLIP

130-150

PHASE

H>F

MATRIX

320X320

FOV

270-280

GAP

10%

NEX(AVRAGE)

4

It is important to have some overlap of the spinal cord to avoid missed anatomy. For example, if the upper sagittal sequences cover the spinal cord from the pons down to T5 then the lower sagittal sequences must cover the spinal cord from T4 down to L3.

T1 tse sagittal 2mm 270-280 FOV or Isotropic 3D T1 .9mm

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, this should be parallel to the imaginary line running through the centre of the vertebral body and the spinous process. Check the position block in the sagittal plane where the FOV must be big enough to cover the lower spinal cord from T4 down to L3. Normally an FOV of 270- 280mm should be sufficient. The slices should be enough to cover the spinal cord side to side. In the sagittal plane a saturation band must be placed over the abdomen in front of the aorta to avoid peristalsis and breathing artefacts. Phase direction should be head to foot to avoid motion artefacts from the abdomen.

Parameters

TR

400-600

TE

15-25

SLICE

2 MM

FLIP

150

PHASE

H>F

MATRIX

320X320

FOV

270-280

GAP

10%

NEX(AVRAGE)

4

T2 TSE Axial block 3mm 150- 160 FOV

Axial scans are only performed over spinal cord pathologies e.g. MS lesions or a syrinx. Axial scanning can be avoided in the lower sagittal sequences if no pathologies are identified.

Plan the axial slices on the sagittal plane, angle the position block perpendicular to the spinal cord. An appropriate angle must be given in the coronal plane on a tilted or scoliotic spine, angling parallel to the intervertebral disc spaces. Slices must be sufficient to cover the area of pathology. In the sagittal plane a saturation band must be placed over the abdomen in front of the aorta to avoid peristalsis and breathing artefacts. Phase direction should be head to foot to avoid further motion artefacts from the abdomen.

Parameters

TR

3000-4000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

A>P

MATRIX

256X256

FOV

150-160

GAP

10%

NEX(AVRAGE)

4

T1 TSE Axial block 3mm 150- 160 FOV

Plan the axial slices on the sagittal plane, angle the position block perpendicular to the spinal cord. An appropriate angle must be given in the coronal plane on a tilted or scoliotic spine, angling parallel to the intervertebral disc spaces. Slices must be sufficient to cover the area of pathology. In the sagittal plane a saturation band must be placed over the abdomen in front of the aorta to avoid peristalsis and breathing artefacts. Phase direction should be head to foot to avoid further motion artefacts from the abdomen.

Parameters

TR

400-600

TE

15-25

SLICE

3 MM

FLIP

90

PHASE

A>P

MATRIX

256X256

FOV

150-160

GAP

10%

NEX(AVRAGE)

4

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.