mrimaster

MRI Adrenal Gland

Indications for MRI Adrenal Glands

Adrenal glands anatomy

The adrenal glands are small, triangular-shaped endocrine glands located on top of each kidney. Consisting of two distinct regions, the outer cortex and inner medulla, they play a crucial role in hormone production and regulation. The adrenal cortex synthesizes and secretes steroid hormones such as cortisol, aldosterone, and sex hormones. These hormones are vital for metabolism, blood pressure regulation, and reproduction. On the other hand, the adrenal medulla produces and releases catecholamines, including adrenaline and noradrenaline, which are involved in the body’s fight-or-flight response. The adrenal glands are highly vascularized and receive a rich blood supply, allowing for efficient hormone production and distribution throughout the body.

Kidneys and adrenal gland anatomy

Contraindications

Patient preparation for MRI Adrenal Gland

Positioning for MRI Adrenal Gland

adrenal gland MRI positioning photo

Recommended MRI Adrenal Gland Protocols and Planning

localiser

A three-plane T2 HASTE localizer must be taken initially to localize and plan the sequences. These fast, single-shot localizers usually have an acquisition time of less than 25 seconds, which is excellent for localizing abdominal structures.

mri adrenal gland localiser image

T2 tse breath hold (HASTE) coronal 3mm

Plan the coronal slices on the axial plane; angle the positioning block parallel to the midline along the right and left kidneys. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, parallel to the long axis of the kidney. Slices must be sufficient to cover both kidneys anterior to posterior. Phase oversampling and, in the case of 3D blocks, slice oversampling, must be used to avoid wraparound artifacts. Instruct the patient to hold their breath during image acquisition. In our department, we instruct the patients to breathe in and out twice before the “breathe in and hold” instruction.

adrenal mri planning of coronal images

Parameters

TR 5000-6000

TE

150

FLIP

150

NXA

1

SLICE

3MM

MATRIX

256×256

FOV

300

PHASE

R>L

OVERSAMPLE

50%

IPAT

ON

T1 vibe DIXON breath hold coronal 3mm

Plan the coronal slices on the axial plane; angle the positioning block parallel to the midline along the right and left kidneys. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, parallel to the long axis of the kidney. Slices must be sufficient to cover both kidneys anterior to posterior. Phase oversampling and, in the case of 3D blocks, slice oversampling, must be used to avoid wraparound artifacts. Instruct the patient to hold their breath during image acquisition. In our department, we instruct the patients to breathe in and out twice before the “breathe in and hold” instruction.

mri adrenal gland protocol and planning of coronal vibe Dixon scans

Parameters

TR

6-7

TE

2.39   4.77

FLIP

10

NXA

1

SLICE

4 MM

MATRIX

320×320

FOV

320-350

PHASE

A>P

OVERSAMPLE

20%

BH

YES

T1 VIBE DIXON 3mm axial BH pre GD(In-opposed phase and water sat)

Plan the axial slices on the coronal plane; angle the positioning block perpendicular to the thoracic vertebra. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, perpendicular to the long axis of the kidney. Slices must be sufficient to cover both adrenals from the diaphragm down to the lower pole of the kidneys. Phase oversampling and, in the case of 3D blocks, slice oversampling must be used to avoid wrap-around artifacts. Using a saturation band on the top and bottom of the block will help to reduce artifacts from vascular pulsation and breathing. Instruct the patient to hold their breath during image acquisition.

When planning the axial breath-hold scans, it is crucial to utilize the breath-hold vibe coronal sequence. This is because during inhalation, the diaphragm exerts downward pressure on the liver, causing a shift in its position from the initial localizer scans. Therefore, to accurately capture the desired imaging area of the liver, it is important to account for this positional change by utilizing the breath-hold vibe coronal sequence.

Parameters

TR

6-7

TE

2.39   4.77

FLIP

10

NXA

1

SLICE

3 MM

MATRIX

320×320

FOV

320-350

PHASE

A>P

OVERSAMPLE

20%

BH

YES

T2 tse\HASTE breath hold 3mm axial

Plan the axial slices on the coronal plane; angle the positioning block perpendicular to the thoracic vertebra. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, perpendicular to the long axis of the kidney. Slices must be sufficient to cover both adrenals from the diaphragm down to the lower pole of the kidneys. Phase oversampling must be used to avoid wrap-around artifacts. Using a saturation band on the top and bottom of the block will help reduce artifacts from vascular pulsation and breathing. Instruct the patient to hold their breath during image acquisition.

Note: T2 breath-hold sequences may have artifacts from the anterior abdominal fat motion. To reduce this artifact, it is highly recommended to use a right-to-left phase direction in these scans. However, this might not be possible in older generation scanners. In such cases, it is better to use a HASTE sequence in those scanners.

Parameters

TR 5000-6000

TE

150

FLIP

150

NXA

1

SLICE

3MM

MATRIX

256×256

FOV

280-300

PHASE

R>L

OVERSAMPLE

50%

IPAT

ON

T2 tse\HASTE fat sat breath hold axial 3mm

Plan the axial slices on the coronal plane; angle the positioning block perpendicular to the thoracic vertebra. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, perpendicular to the long axis of the kidney. Slices must be sufficient to cover both adrenals from the diaphragm down to the lower pole of the kidneys. Phase oversampling must be used to avoid wrap-around artifacts. Using a saturation band on the top and bottom of the block will help reduce artifacts from vascular pulsation and breathing. Instruct the patient to hold their breath during image acquisition.

Parameters

TR 6000-7000

TE

150

fatsat

ON

NXA

1

SLICE

3MM

MATRIX

256×256

FOV

280-300

PHASE

R>L

OVERSAMPLE

50%

IPAT

ON

DWI epi 3 scan trace axial 3mm free breathing

Plan the axial slices on the coronal free-breathing localizer; angle the positioning block perpendicular to the thoracic vertebra. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, perpendicular to the long axis of the kidney. Slices must be sufficient to cover both adrenals from the diaphragm down to the lower pole of the kidneys. Phase oversampling must be used to avoid wrap-around artifacts. Using a saturation band on the top and bottom of the block will help reduce artifacts from vascular pulsation and breathing. Instruct the patient to take shallow breathing during the acquisition.

Note: Scan must be planned in a free breathing localizer

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

Now administer the IV gadolinium DTPA injection. The document below provides access to the recommended dosage of gadolinium DTPA injection as advised by the manufacturer.

T1 vibe DIXON breath hold Axial 3mm post contrast

Plan the axial slices on the coronal plane; angle the positioning block perpendicular to the thoracic vertebra. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, perpendicular to the long axis of the kidney. Slices must be sufficient to cover both adrenals from the diaphragm down to the lower pole of the kidneys. Phase oversampling and, in the case of 3D blocks, slice oversampling must be used to avoid wrap-around artifacts. Using a saturation band on the top and bottom of the block will help to reduce artifacts from vascular pulsation and breathing. Instruct the patient to hold their breath during image acquisition.

Parameters VIBE dixon

TR

6-7

TE

2.39   4.77

FLIP

10

NXA

1

SLICE

3 MM

MATRIX

288×288

FOV

320-350

PHASE

A>P

OVERSAMPLE

20%

BH

YES

T1 vibe DIXON breath hold coronal 3mm post contrast

Plan the coronal slices on the axial plane; angle the positioning block parallel to the midline along the right and left kidneys. Check the positioning block in the other two planes. An appropriate angle must be given in the sagittal plane, parallel to the long axis of the kidney. Slices must be sufficient to cover both kidneys anterior to posterior. Phase oversampling and, in the case of 3D blocks, slice oversampling, must be used to avoid wraparound artifacts. Instruct the patient to hold their breath during image acquisition. In our department, we instruct the patients to breathe in and out twice before the “breathe in and hold” instruction.

mri adrenal gland protocol and planning of coronal vibe Dixon scans

Parameters VIBE dixon

TR

6-7

TE

2.39   4.77

FLIP

10

NXA

1

SLICE

3 MM

MATRIX

288×288

FOV

320-350

PHASE

R>L

OVERSAMPLE

40%

BH

YES