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MRI Gynaecology Pelvis (CA Cervix MRI Protocol and Planning)

Indications for MRI cervix scans

Contraindications

Patient preparation for MRI cervix scans

Positioning for MRI cervix scans

MRI GYNAECOLOGY PELVIS positioning image

Recommended MRI Cervix Scans Protocols and Planning

MRI cervix 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.

Please consider acquiring a few additional axial slices covering the pelvis. These slices will be utilized for planning the targeted oblique sagittal small FOV scans.

Carcinoma of the cervix MRI localiser image

Pause for buscopan injection

Before proceeding to the next step, intravenously inject 0.5 to 1 ml of Buscopan (according to the manufacturer’s instructions and departmental policy). Wait for 1 minute before starting the next scan (Buscopan takes a few seconds to start its function).

Warning

* Buscopan injection should not be administered to patients with myasthenia gravis, megacolon, narrow angle glaucoma, tachycardia, prostatic enlargement with urinary retention, mechanical stenoses in the region of the gastrointestinal tract or paralytic ileus.*

T2 tse sagittal oblique 3mm SFOV cervix

Plan the sagittal slices on the axial plane and align the positioning block parallel to the endometrium. Verify the positioning block in the other two planes. In the coronal plane, ensure an appropriate angle that is perpendicular to the cervix. Ensure that the slices cover the entire pelvis from the right acetabulum to the left acetabulum. The field of view (FOV) should be sufficiently large to encompass the entire pelvis, typically ranging from 200mm to 220mm. To minimize artifacts caused by arterial pulsation, peristalsis, and breathing, consider adding saturation bands on top and in front of the sagittal block.

Carcinoma of the cervix MRI prptocol and planning of sagittal scans

Parameters

TR

3000-4000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

A>P

MATRIX

320X320

FOV

270-300

GAP

10%

NEX(AVRAGE)

4

T2 tse axial oblique 3mm SFOV of cervix

Plan the axial oblique slices on the sagittal plane, ensuring that the positioning block is angled perpendicular to the cervix. Verify the positioning block in the other two planes. Provide an appropriate angle in the axial plane (perpendicular to the cervix). The slices must be sufficient to cover the entire uterus. Adding saturation bands on top and in front of the axial block will help reduce artifacts caused by arterial pulsation and breathing. Ensure an adequate level of phase oversampling to prevent any wrap-around artifacts.

Carcinoma of the cervix MRI prptocol and planning of axial scans

Parameters

TR

4000-6000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

H>F

MATRIX

320X256

FOV

180-230

GAP

10%

NEX(AVRAGE)

4

T1 tse fat sat axial oblique 3mm SFOV of cervix

Plan the axial oblique slices on the sagittal plane, ensuring that the positioning block is angled perpendicular to the cervix. Verify the positioning block in the other two planes. Provide an appropriate angle in the axial plane (perpendicular to the cervix). The slices must be sufficient to cover the entire uterus. Adding saturation bands on top and in front of the axial block will help reduce artifacts caused by arterial pulsation and breathing. Ensure an adequate level of phase oversampling to prevent any wrap-around artifacts.

Carcinoma of the cervix MRI prptocol and planning of axial scans

Parameters

TR

400-600

TE

15-25

SLICE

3 MM

FLIP

130

PHASE

R>L

MATRIX

256X256

FOV

180-230

GAP

10%

NEX(AVRAGE)

3

DWI epi 3 scan trace axial oblique 3mm SFOV cervix

Plan the axial oblique slices on the sagittal plane, ensuring that the positioning block is angled perpendicular to the cervix. Verify the positioning block in the other two planes. Provide an appropriate angle in the axial plane (perpendicular to the cervix). The slices must be sufficient to cover the entire uterus. Adding saturation bands on top and in front of the axial block will help reduce artifacts caused by arterial pulsation and breathing. Ensure an adequate level of phase oversampling to prevent any wrap-around artifacts.

Carcinoma of the cervix MRI prptocol and planning of axial scans

Parameters

TR

6000-7000

TE

90

IPAT

ON

NEX

3      5      8

SLICE

3 MM

MATRIX

192X192

FOV

200-250

PHASE

R>L

GAP

10%

B VALUE

0
500
1000

T2 tse coronal oblique 3mm SFOV of uterus

Plan the coronal oblique slices on the sagittal plane, ensuring that the positioning block is angled parallel to the cervix. Check the positioning block in the other two planes. Set an appropriate angle in the axial plane (straight across the uterus). The slices should sufficiently cover the entire uterus and ovaries. Adding saturation bands on the top and front of the coronal block will help reduce artifacts caused by arterial pulsation and breathing. Ensure an adequate level of phase oversampling to prevent wrap-around artifacts.

Due to the increased signal-to-noise ratio (SNR) in new generation scanners, motion artifacts can be significant when acquiring images in the anterior-posterior phase direction. This is primarily attributed to the movement of abdominal fat, which exhibits higher signal intensity and can cause ghosting effects over the sagittal images. Therefore, to mitigate this issue, scans are typically performed using a head-to-feet phase direction.

Carcinoma of the cervix MRI prptocol and planning of coronal scans

Parameters

TR

3000-4000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

R>L

MATRIX

320X256

FOV

180-230

GAP

10%

NEX(AVRAGE)

4

T2 stir coronal 5 mm LARGE FOV

Plan the large field of view (FOV) coronal slices on the sagittal plane and position the block parallel to the lumbar spine. The positioning block should also be checked in the other two planes. An appropriate angle needs to be established in the axial plane, which runs parallel to the right and left hip joint. The slices must be sufficient to cover the entire abdomen and pelvis, ranging from the anterior abdominal wall to the sacrum. The FOV must be large enough to cover the abdomen and pelvis (typically 380mm-400mm). Large FOV scans are usually performed to evaluate the local spread of the pathology and assess the para-aortic and pre-sacral nodes.

Carcinoma of the cervix MRI prptocol and planning of coronal large fov scans

Parameters

TR

4000-6000

TE

110

FLIP

130

NEX

2

SLICE

5MM

MATRIX

384X320

FOV

380-400

PHASE

R>L

GAP

10%

TI

130

T1 tse axial 6 mm Large FOV

Plan the large field of view (FOV) axial slices on the coronal plane, position the block parallel to the line along the right and left iliac crest. The positioning block should also be checked in the other two planes. An appropriate angle needs to be established in the sagittal plane, which is perpendicular to the lumbar spine. The slices must be sufficient to cover the entire lower abdomen and pelvis, ranging from the middle of the kidneys down to the symphysis pubis. The FOV should be large enough to cover the entire pelvis, typically ranging from 350mm to 400mm. Adding saturation bands on top of the axial block can help reduce artifacts caused by arterial pulsation and breathing. Large FOV scans are usually performed to evaluate the para-aortic and pre-sacral nodes.

Carcinoma of the cervix MRI prptocol and planning of axial large fov scans

Parameters

TR

400-600

TE

15-25

SLICE

6 MM

FLIP

130

PHASE

R>L

MATRIX

384X384

FOV

350-400

GAP

10%

NEX(AVRAGE)

2

Cervical carcinoma staging scans typically do not require post-contrast scans. However, some radiologists may prefer to administer contrast to aid in identifying smaller lesions. If the radiologist specifically requests contrast, please proceed with the optional scan.

Optional Scans

T1 VIBE DIXON 3D sagittal dynamic 1 pre 8 post

Plan the sagittal 3D block on the axial plane, angling the positioning block parallel to the cervix. Check the positioning block in the other two planes. An appropriate angle must be determined in the coronal plane (perpendicular to the cervix). The slices should sufficiently cover the entire uterus from right to left. The field of view (FOV) should be large enough to encompass the entire pelvis (typically 200mm-220mm). Adding saturation bands on the top and front of the sagittal block will reduce artifacts caused by arterial pulsation and breathing. Ensure an adequate level of slice and phase oversampling to prevent any wrap-around artifacts.

Carcinoma of the cervix MRI prptocol and planning of sagittal dynamic scans

A dynamic VIBE 3D DIXON sequence comprises nine 3mm 3D scans, with a 10-second delay between the first and second scan for contrast injection. It is essential to administer the contrast injection following the initial run of the dynamic sequence.

Parameters

TR

4-5

TE

2-3

FLIP

10

NEX

1

SLICE

2 MM

MATRIX

256X256

FOV

200-250

PHASE

R>L

DYNAMIC

9 SCANS

IPAT

ON