MRI Whole Spine Automatic Composing
Indications
- Infectious or inflammatory processes (eg.Spinal Cord Abscess or Spinal Osteomyelitis)
- 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
- Nontraumatic vascular injuries of the spine
- Monitoring of previous spinal surgery
- Evaluation or monitoring of trauma
- Ankylosing spondylitis
- spinal metastasis
- 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
- 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
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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
- Head first supine
- Position the patient in the spine and head and neck coils
- Connect the head and neck coil over the head. (The head and neck coil is used for axial C-spine imaging.)
- Give cushions under the legs for extra comfort
- Centre the laser beam localiser over the mid abdomen (3-4 inches above the iliac crest)
Recommended MRI Whole Spine Automatic Composing 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.
T2 TSE sagittal 4mm whole spine automatic composing
When using the auto-composing protocol, both the cervicothoracic and thoracolumbar blocks will appear on the whole spine auto-compose localizer. The planning should begin with the cervicothoracic block and once it is fully completed, move on to the thoracolumbar block. It is important to ensure sufficient overlap between the blocks. Once both blocks are planned, with proper positioning and alignment, the user can initiate the scan. After both scans are completed, the system will automatically compose the blocks and generate whole spine sagittal images.
For the cervicothoracic planning block, it should be planned on the coronal plane, and the positioning block should be angled parallel to the cervicothoracic spine. It is necessary to check the positioning block in the axial and sagittal planes. In the axial plane, the angle should be parallel to 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 down to T11, typically ranging from 350-400 mm. The slices should adequately cover the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To avoid breathing artifacts over the spinal area, a saturation band should be placed over the chest in the sagittal plane, as depicted in the diagram. The phase direction should be head to feet to minimize motion artifacts from the chest.
Similarly, for the thoracolumbar planning block, it should be planned on the coronal plane, with the positioning block angled parallel to the thoracolumbar spine. The positioning block should be checked 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 down to the coccyx, typically ranging from 350-400 mm. The slices should sufficiently cover 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 placed over the abdomen in the sagittal plane, as shown in the diagram. The phase direction should be head to feet to minimize motion artifacts from the chest.
Parameters
TR 3000-5000 | TE 100-120 | SLICE 4MM | FLIP 130-150 | PHASE H>F | MATRIX 512X512 | FOV 350-400 | GAP 10% | NEX(AVRAGE) 2 |
T1 tse sagittal 4mm whole spine automatic composing
The cervicothoracic planning block should be planned on the coronal plane, and the positioning block should be angled parallel to the cervicothoracic spine. It is necessary to check the positioning block in the axial and sagittal planes. In the axial plane, the angle should be parallel to 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 down to T11, typically ranging from 350-400 mm. The slices should adequately cover the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To avoid breathing artifacts over the spinal area, a saturation band should be placed over the chest in the sagittal plane, as depicted in the diagram. The phase direction should be head to feet to minimize motion artifacts from the chest.
Similarly, for the thoracolumbar planning block, it should be planned on the coronal plane, with the positioning block angled parallel to the thoracolumbar spine. The positioning block should be checked 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 down to the coccyx, typically ranging from 350-400 mm. The slices should sufficiently cover 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 placed over the abdomen in the sagittal plane, as shown in the diagram. The phase direction should be head to feet to minimize motion artifacts from the chest.
Parameters
TR 400-600 | TE 15-25 | SLICE 4 MM | FLIP 90 | PHASE H>F | MATRIX 512X512 | FOV 350-400 | GAP 10% | NEX(AVRAGE) 2 |
T2 TSE STIR sagittal 4mm whole spine automatic composing
The cervicothoracic planning block should be planned on the coronal plane, and the positioning block should be angled parallel to the cervicothoracic spine. It is necessary to check the positioning block in the axial and sagittal planes. In the axial plane, the angle should be parallel to 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 down to T11, typically ranging from 350-400 mm. The slices should adequately cover the spine from the lateral border of the right transverse process to the lateral border of the left transverse process. To avoid breathing artifacts over the spinal area, a saturation band should be placed over the chest in the sagittal plane, as depicted in the diagram. The phase direction should be head to feet to minimize motion artifacts from the chest.
Similarly, for the thoracolumbar planning block, it should be planned on the coronal plane, with the positioning block angled parallel to the thoracolumbar spine. The positioning block should be checked 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 down to the coccyx, typically ranging from 350-400 mm. The slices should sufficiently cover 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 placed over the abdomen in the sagittal plane, as shown in the diagram. The phase direction should be head to feet to minimize motion artifacts from the chest.
Parameters
TR 4000-5000 | TE 110 | FLIP 130 | NEX 2 | SLICE 4MM | MATRIX 512X384 | FOV 350-400 | PHASE H>F | GAP 10% | TI 150 |
T2-TSE axial block 4mm lumbar spine
Whole spine scans are commonly performed for various purposes, such as metastatic spine screening, 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.
Parameters
TR 3000-4000 | TE 100-120 | SLICE 4MM | FLIP 130-150 | PHASE A>P | MATRIX 320X256 | FOV 180-200 | GAP 10% | NEX(AVRAGE) 2 |
T1 TSE axial axial block 4mm lumbar spine
Plan the axial block on the sagittal plane, positioning the block perpendicular to the lumbar spine. Ensure to check the positioning block in the other two planes for proper alignment. Determine the appropriate angle in the coronal plane, aligning it horizontally across the intervertebral disc space. Adjust the number of slices as needed to adequately cover the pathology of interest. To minimize peristalsis and breathing artifacts over the spinal area, place a saturation band over the abdomen (specifically in front of the aorta) on the sagittal plane.
Parameters
TR 400-600 | TE 15-25 | SLICE 4MM | FLIP 90 | PHASE A>P | MATRIX 320X304 | FOV 180-200 | GAP 10% | NEX(AVRAGE) 2 |
T2 TSE Axial block 4mm 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 3000-4000 | TE 100-120 | SLICE 4MM | FLIP 130-150 | PHASE A>P | MATRIX 320X256 | FOV 160-200 | GAP 10% | NEX(AVRAGE) 2 |
T1 TSE Axial block 4mm 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 4MM | FLIP 90 | PHASE A>P | MATRIX 320X256 | FOV 160-200 | GAP 10% | NEX(AVRAGE) 2 |
T2 TSE Axial block 4mm 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 3000-4000 | TE 100-120 | SLICE 4MM | FLIP 130-150 | PHASE A>P | MATRIX 320X256 | FOV 160-200 | GAP 10% | NEX(AVRAGE) 2 |
T1 TSE Axial block 4mm 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 400-600 | TE 15-25 | SLICE 4MM | FLIP 90 | PHASE A>P | MATRIX 320X256 | FOV 160-200 | 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
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
- LOCALIZER_3 PLANE1
