Peroneal Tendon MRI : Protocol and Planning
Indications for peroneal tendon MRI
- peroneal tendon inflammation
- peroneal tendon rupture
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 peroneal tendon MRI
- 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
- 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 the weight of the patient
Positioning for peroneal tendon MRI
- Position the patient in supine position with feet pointing towards the magnet (feet first supine)
- Position the ankle in the foot and ankle coil (use knee coil if ankle coil is not available) and lock it properly (Ankle should be at 90° position)
- Securely tighten the foot using cushions to prevent movement
- Give a pillow under the head for extra comfort
- Centre the laser beam localiser over ankle joint
Recommended Peroneal Tendon MRI Protocols and Planning
localiser
A three-plane localizer must be taken at the beginning to localize and plan the sequences. Localizers are usually less than 25 seconds and consist of T1-weighted, low-resolution scans.
T1 tse sagittal 3mm
Plan the sagittal slices on the axial plane and angle the planning block perpendicular to the line between the medial and lateral malleoli. Check the planning block in the other two planes. An appropriate angle must be given in the coronal plane, parallel to the tibia. The slices must be sufficient to cover the ankle joint from the outer border of the medial malleolus to the outer border of the lateral malleolus. Using saturation bands above the axial block can reduce arterial pulsation artefacts.
Parameters
TR 400-600 | TE 15-25 | SLICE 3 MM | FLIP 150 | PHASE A>P | MATRIX 320X320 | FOV 150-170 | GAP 10% | NEX(AVRAGE) 2 |
T2 stir sagittal 3mm
Plan the sagittal slices on the axial plane and angle the planning block perpendicular to the line between the medial and lateral malleoli. Check the planning block in the other two planes. An appropriate angle must be given in the coronal plane, parallel to the tibia. The slices must be sufficient to cover the ankle joint from the outer border of the medial malleolus to the outer border of the lateral malleolus. Using saturation bands above the axial block can reduce arterial pulsation artefacts.
Parameters
TR 4000-6000 | TE 110 | FLIP 150 | NEX 2 | SLICE 3 MM | MATRIX 256X256 | FOV 150-170 | PHASE A>P | GAP 10% | TI 150 |
PD fat saturated coronal oblique 2mm SFOV
Plan the coronal slices on the sagittal plane, angle the planning block perpendicular to the peroneal tendon. Check the planning block in the other two planes. An appropriate angle must be established in the axial plane (perpendicular to the calcaneus). Ensure that the slices are sufficient to cover the peroneal tendon from the tarsometatarsal joint to the lateral malleolus.
Parameters
TR 3000-5000 | TE 15-20 | SLICE 2 MM | FATSAT ON | PHASE R>L | MATRIX 288X256 | FOV 120-140 | GAP 10% | NEX(AVRAGE) 2 |
PD fat saturated axial oblique 2mm SFOV
Plan the axial slices on the sagittal plane, aligning the planning block parallel to the peroneal tendon. Verify the planning block in the other two planes. Establish an appropriate angle in the coronal plane, keeping it parallel to the tibiotalar joint space. Ensure that the slices adequately cover the peroneal tendon.
Parameters
TR 3000-5000 | TE 15-20 | SLICE 2 MM | FATSAT ON | PHASE A>P | MATRIX 288X256 | FOV 130-150 | GAP 10% | NEX(AVRAGE) 2 |