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MRI Pediatric Whole Spine : Protocol and Planning

Indications

Contraindications

Patient preparation

Patient preparation for under 3 and neonates

Positioning

MRI whole spine positioning photo

Recommended MRI Pediatric Whole Spine Protocols and Planning

localiser whole spine automatic composing

The auto-composing localizer system comprises two distinct localizers, one for the thoracolumbar spine and another for the cervicothoracic spine. After completing the localizer for the thoracolumbar spine, the table will automatically reposition itself and perform a cervical thoracic localizer. Once both localizers are finished, the system will merge them together to generate a coronal and sagittal localizer for the entire spine.

MRI pediatric whole spine localiser image

T2 TSE sagittal 2.5 mm whole spine automatic composing

When utilizing the auto-composing protocol, the whole spine auto-compose localizer will display both the cervicothoracic and thoracolumbar blocks. The planning process should commence with the cervicothoracic block, ensuring its complete configuration before moving on to the thoracolumbar block. It is essential to have adequate overlap between the blocks. Once both blocks are planned and appropriately positioned, the user can initiate the scan. Subsequently, the system will automatically combine the blocks and generate sagittal images of the entire spine.

For the cervicothoracic planning block, it should be planned on the coronal plane, with the positioning block aligned parallel to the cervicothoracic spine. Verification of the positioning block is necessary in the axial and sagittal planes. In the axial plane, the angle should parallel the line connecting the center of the vertebral body and the spinous process. In the sagittal plane, the field of view (FOV) should cover the cervicothoracic spine from 1 inch above C1 to T11, typically ranging from 200-250 mm. The slices should adequately encompass the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To minimize breathing artifacts over the spinal area, a saturation band should be positioned over the chest in the sagittal plane, as illustrated in the diagram. The phase direction should be from head to feet to minimize motion artifacts originating from the chest.

Likewise, for the thoracolumbar planning block, it should be planned on the coronal plane, with the positioning block angled parallel to the thoracolumbar spine. Verification of the positioning block is necessary in the axial and sagittal planes, ensuring an appropriate angle parallel to the line connecting the center of the vertebral body and the spinous process in the axial plane. The sagittal plane FOV should cover the thoracolumbar spine from T7 to the coccyx, typically ranging from 200-250 mm. The slices should adequately encompass the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To prevent breathing artifacts, a saturation band should be positioned over the abdomen in the sagittal plane, as depicted in the diagram. The phase direction should be from head to feet to minimize motion artifacts originating from the chest.

MRI pediatric whole spine sagittal scan planning and protocol image

Parameters

TR

3000-5000

TE

100-120

SLICE

2.5MM

FLIP

130-150

PHASE

H>F

MATRIX

304X304

FOV

200-250

GAP

10%

NEX(AVRAGE)

2

When conducting spine imaging in children, it is crucial to conduct scans with a small field of view (FOV) and thinner slices (e.g., 250mm FOV with 2 to 3mm slice thickness). Another important aspect to consider is the duration of each sequence. The sagittal acquisition time should range from 1 to 2 minutes. Please modify the scanner parameters to achieve faster scans, although this may not be feasible on older generation scanners.

T1 tse sagittal 2.5mm whole spine automatic composing

For the cervicothoracic planning block, it should be planned on the coronal plane, with the positioning block aligned parallel to the cervicothoracic spine. Verification of the positioning block is necessary in the axial and sagittal planes. In the axial plane, the angle should parallel the line connecting the center of the vertebral body and the spinous process. In the sagittal plane, the field of view (FOV) should cover the cervicothoracic spine from 1 inch above C1 to T11, typically ranging from 200-250 mm. The slices should adequately encompass the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To minimize breathing artifacts over the spinal area, a saturation band should be positioned over the chest in the sagittal plane, as illustrated in the diagram. The phase direction should be from head to feet to minimize motion artifacts originating from the chest.

Likewise, for the thoracolumbar planning block, it should be planned on the coronal plane, with the positioning block angled parallel to the thoracolumbar spine. Verification of the positioning block is necessary in the axial and sagittal planes, ensuring an appropriate angle parallel to the line connecting the center of the vertebral body and the spinous process in the axial plane. The sagittal plane FOV should cover the thoracolumbar spine from T7 to the coccyx, typically ranging from 200-250 mm. The slices should adequately encompass the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To prevent breathing artifacts, a saturation band should be positioned over the abdomen in the sagittal plane, as depicted in the diagram. The phase direction should be from head to feet to minimize motion artifacts originating from the chest.

MRI pediatric whole spine sagittal scan planning and protocol image

Parameters

TR

400-600

TE

15-25

SLICE

2.5 MM

FLIP

90

PHASE

H>F

MATRIX

304X304

FOV

350-400

GAP

10%

NEX(AVRAGE)

2

T2 STIR sagittal 2.5mm whole spine automatic composing

For the cervicothoracic planning block, it should be planned on the coronal plane, with the positioning block aligned parallel to the cervicothoracic spine. Verification of the positioning block is necessary in the axial and sagittal planes. In the axial plane, the angle should parallel the line connecting the center of the vertebral body and the spinous process. In the sagittal plane, the field of view (FOV) should cover the cervicothoracic spine from 1 inch above C1 to T11, typically ranging from 200-250 mm. The slices should adequately encompass the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To minimize breathing artifacts over the spinal area, a saturation band should be positioned over the chest in the sagittal plane, as illustrated in the diagram. The phase direction should be from head to feet to minimize motion artifacts originating from the chest.

Likewise, for the thoracolumbar planning block, it should be planned on the coronal plane, with the positioning block angled parallel to the thoracolumbar spine. Verification of the positioning block is necessary in the axial and sagittal planes, ensuring an appropriate angle parallel to the line connecting the center of the vertebral body and the spinous process in the axial plane. The sagittal plane FOV should cover the thoracolumbar spine from T7 to the coccyx, typically ranging from 200-250 mm. The slices should adequately encompass the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To prevent breathing artifacts, a saturation band should be positioned over the abdomen in the sagittal plane, as depicted in the diagram. The phase direction should be from head to feet to minimize motion artifacts originating from the chest.

MRI pediatric whole spine sagittal scan planning and protocol image

Parameters

TR

4000-5000

TE

110

FLIP

130

NEX

2

SLICE

2.5MM

MATRIX

256X256

FOV

200-250

PHASE

H>F

GAP

10%

TI

150

T2-TSE axial block 3mm SFOV lumbar spine

Whole spine scans are commonly performed for various purposes, such as trauma, tuberculosis (TB) spine evaluation, spinal cord tumors, and spine infections. In these cases, it is preferable to conduct an axial block specifically targeting the affected pathology, rather than relying on disc axials. However, if no pathology is identified, it is recommended to perform axial blocks covering both the lumbar and cervical areas.

To plan the axial block, position the block perpendicularly to the lumbar spine on the sagittal plane. The positioning block should be checked in the other two planes as well. Ensure an appropriate angle horizontally across the intervertebral disc space in the coronal plane. The number of slices should be sufficient to cover the pathology adequately. Additionally, place a saturation band over the abdomen, specifically in front of the aorta, on the sagittal plane. This helps to minimize artifacts caused by peristalsis and breathing, particularly over the spinal area.

Note: If spina bifida is suspected, the axial block should cover the lower lumbar and full sacrum.

Parameters

TR

3000-4000

TE

100-120

SLICE

3MM

FLIP

130-150

PHASE

A>P

MATRIX

256X256

FOV

140-160

GAP

10%

NEX(AVRAGE)

2

T1 TSE axial axial block 3mm SFOV lumbar spine

Plan the axial block and position it perpendicular to the lumbar spine on the sagittal plane. The positioning block should also be checked in the other two planes. Ensure an appropriate angle horizontally across the intervertebral disc space in the coronal plane. The number of slices should be sufficient to adequately cover the pathology. Additionally, place a saturation band over the abdomen, specifically in front of the aorta, on the sagittal plane. This helps minimize artifacts caused by peristalsis and breathing, particularly in the spinal area.

Parameters

TR

400-600

TE

15-25

SLICE

3MM

FLIP

90

PHASE

A>P

MATRIX

256X224

FOV

140-160

GAP

10%

NEX(AVRAGE)

2

T2 TSE Axial block 3mm SFOV cervical spine

Plan the axial block on the sagittal plane and position the positioning block perpendicular to the cervical spine. Ensure to check the planning block in the other two planes for accurate alignment. In the coronal plane, establish an appropriate angle horizontally across the intervertebral disc space. The number of slices should be adequate to cover the pathology under evaluation. To mitigate the impact of swallowing and vascular pulsation artifacts in the spinal area, place a saturation band over the neck in the sagittal plane, specifically in front of the esophagus.

Parameters

TR

4000-5000

TE

100-120

SLICE

3MM

FLIP

130-150

PHASE

A>P

MATRIX

256X256

FOV

140-160

GAP

10%

NEX(AVRAGE)

2

T1 TSE Axial block 3mm SFOV cervical spine

Plan the axial block on the sagittal plane and position the positioning block perpendicular to the cervical spine. Ensure to check the planning block in the other two planes for accurate alignment. In the coronal plane, establish an appropriate angle horizontally across the intervertebral disc space. The number of slices should be adequate to cover the pathology under evaluation. To mitigate the impact of swallowing and vascular pulsation artifacts in the spinal area, place a saturation band over the neck in the sagittal plane, specifically in front of the esophagus.

Parameters

TR

400-600

TE

15-25

SLICE

3MM

FLIP

90

PHASE

A>P

MATRIX

256X256

FOV

140-160

GAP

10%

NEX(AVRAGE)

2

T2 TSE Axial block 3mm SFOV thoracic spine

Plan the axial block using the sagittal plane as a reference and position the positioning block perpendicular to the thoracic spine. It is important to check the planning block’s alignment in the other two planes to ensure accuracy. In the coronal plane, establish the appropriate angle horizontally across the intervertebral disc space. The number of slices should be sufficient to cover the pathology being evaluated. To minimize the impact of artifacts caused by swallowing and vascular pulsations in the spinal area, place a saturation band over the chest in the sagittal plane in front of the thoracic vertebral bodies.

Parameters

TR

4000-6000

TE

100-120

SLICE

3MM

FLIP

130-150

PHASE

A>P

MATRIX

256X224

FOV

140-160

GAP

10%

NEX(AVRAGE)

2

T1 TSE Axial block 3mm SFOV thoracic spine

Plan the axial block using the sagittal plane as a reference and position the positioning block perpendicular to the thoracic spine. It is important to check the planning block’s alignment in the other two planes to ensure accuracy. In the coronal plane, establish the appropriate angle horizontally across the intervertebral disc space. The number of slices should be sufficient to cover the pathology being evaluated. To minimize the impact of artifacts caused by swallowing and vascular pulsations in the spinal area, place a saturation band over the chest in the sagittal plane in front of the thoracic vertebral bodies.

Parameters

TR

450-700

TE

15-25

SLICE

3MM

FLIP

90

PHASE

A>P

MATRIX

256X224

FOV

140-160

GAP

10%

NEX(AVRAGE)

2

Indications for contrast enhancement spine scans

Use T1 TSE Use T1 TSE Fat-saturated axial and sagittal sequences after the administration of intravenous gadolinium DTPA injection (following the planning outlined above). The document below provides access to the recommended dosage of gadolinium DTPA injection, as advised by the manufacturer.

CLICK THE SEQUENCES BELOW TO CHECK THE SCANS