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MRI Gynaecology Pelvis (Endometrial CA Protocol)

Indications for MRI female pelvis endometrial scans

Contraindications for endometrial MRI scans

Patient preparation for endometrial MRI scans

Positioning for endometrial MRI scans

MRI GYNAECOLOGY PELVIS positioning image

Recommended Endometrial Cancer(CA) MRI Protocols and Planning

Endometrial MRI scans 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.

mri gyne pelvis localizer

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 3mm SFOV

Plan the sagittal slices on the axial plane and angle the positioning block parallel to the line along the linea alba and median sacral crest. Verify the positioning block in the other two planes. In the coronal plane, an appropriate angle must be given, which should be parallel to the lumbosacral spine. Make sure 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 270mm to 300mm. To minimize artifacts caused by arterial pulsation, peristalsis, and breathing, consider adding saturation bands on top and in front of the sagittal block. Ensure an adequate level of  phase oversampling to prevent any 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.

MRI gynaecology pelvis (endometrial protocol) Sagittal t2 scan planning

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 6 mm largeFOV

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.

MRI gynecology pelvis large FOV axial planning and protocol

Parameters

TR

5000-6000

TE

100-120

SLICE

6 MM

FLIP

130-150

PHASE

R>L

MATRIX

384X384

FOV

350-400

GAP

10%

NEX(AVRAGE)

2

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.

MRI gynecology pelvis large FOV axial planning and protocol

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

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.

MRI gynecology pelvis large FOV coronal planning and protocol

Parameters

TR

4000-6000

TE

110

FLIP

160

NEX

2

SLICE

5MM

MATRIX

384X320

FOV

380-400

PHASE

R>L

GAP

10%

TI

150

T2 tse axial oblique 3mm SFOV of uterus

Plan the axial oblique slices on the sagittal plane, ensuring that the position block is angled perpendicular to the endometrium. Verify the positioning block in the other two planes. Provide an appropriate angle in theaxial plane (straight across the uterus). The slices must be sufficient to cover the entire uterus and ovaries. 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.

gyne pelvis mri planning of axial small FOV t2

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)

5

T2 tse coronal oblique 3mm SFOV of uterus

Plan the coronal oblique slices on the sagittal plane, ensuring that the position block is angled parallel to the endometrium. Check the positioning block in the other two planes. Ensure an appropriate angle is set in the axial plane (across the uterus). The slices must be sufficient to 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 any 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 right-to-left phase direction.

gyne pelvis mri planning of coronal small FOV t2

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)

5

T1 tse fat sat axial oblique 3mm SFOV of uterus

Plan the axial oblique slices on the sagittal plane; angle the position block perpendicular to the endometrium (this angulation can be vary according to the pathology check the normal variation section for the differences in planning). Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular to the endometrium). Slices must be sufficient to cover the whole uterus and ovaries. Adding saturation bands on top and front of the axial block will reduce artifacts from arterial pulsation and breathing.

gyne pelvis mri planning of axial small FOV t2

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 epi3scan trace axial 3mm SFOV

Plan the coronal oblique slices on the sagittal plane; angle the position block parallel to the endometrium (this angulation can be vary according to the pathology check the normal variation section for the differences in planning). Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (straight across the uterus). Slices must be sufficient to cover the whole uterus and ovaries. Adding saturation bands on top and both sides of the block can help minimize artifacts caused by fat signal, arterial pulsation, and breathing.

MRI gynaecology pelvis (endometrial protocol) axial DWI scan planning

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

Most common indications for contrast enhanced 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 endometrium. Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular to the uterus). Slices must be sufficient to cover the entire pelvis from the right acetabulum to the left acetabulum. The field of view (FOV) must be large enough to encompass the entire pelvis (usually 270mm-300mm). 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.

MRI gynaecology pelvis (endometrial protocol) sagital scan planning
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