mrimaster

MRI Prostate (Oblique Imaging)

Indications for prostate mri scan

Contraindications

Patient preparation for prostate mri scan

Positioning for prostate mri scan

MRI prostate positioning

Recommended Prostate MRI Protocols and Planning

Prostate mri scan localiser

A three-plane HASTE localizer must be taken initially to localize and plan the sequences. These are fast, single-shot localizers with under 25s acquisition time, which are excellent for localizing abdominal and pelvic structures.

MRI prostate protocol and planning localiser image
Prostate imaging quality can often be affected by peristalsis around the pelvic area. To mitigate the artifacts caused by peristalsis, it is strongly advised to administer IV buscopan to the patient before proceeding further. The recommended dosage for IV buscopan is 20mg. However, as buscopan is a prescription drug, it is essential to consult your radiologist to determine the correct dosage for each individual case. For specific information on dosage and contraindications, please refer to the chart below containing the manufacturer's instructions.

T2 tse sagittal 3mm SFOV prostate

Plan the sagittal slices on the axial plane, angle the positioning block parallel to the interpubic fibrocartilage and the anal canal. Check the positioning block in the other two planes, ensuring an appropriate angle is given in the coronal plane (parallel to the interpubic fibrocartilage). The 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 prostate and seminal vesicles (typically 180mm-200mm). Additionally, to minimize artifacts arising from arterial pulsation, peristalsis, and breathing, consider incorporating saturation bands on the top and front of the sagittal block.

Parameters

TR

4000-5000

TE

100-120

SLICE

3 MM

FLIP

130-160

PHASE

A>P

MATRIX

320X320

FOV

180-200

GAP

10%

NEX(AVRAGE)

4

T2 tse axial oblique 3mm SFOV prostate

Plan the axial oblique slices on the sagittal plane; angle the positioning block perpendicular to the prostatic urethra (i.e., parallel to the base of the urinary bladder). Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular to the prostatic urethra). Slices must be sufficient to cover the whole prostate and seminal vesicles. Additionally, to minimize artefacts arising from arterial pulsation, peristalsis, and breathing, consider incorporating saturation bands on top and in front of the axial block.

MRI prostate protocol and planning of axial oblique scans

Parameters

TR

4000-5000

TE

100-120

SLICE

3 MM

FLIP

130-160

PHASE

R>L

MATRIX

320X288

FOV

180-200

GAP

10%

NEX(AVRAGE)

4

T2 tse coronal oblique 3mm SFOV

Plan the coronal oblique slices on the sagittal plane, angle the positioning block parallel to the prostatic urethra (i.e., perpendicular to the base of the urinary bladder). Check the positioning block in the other two planes, ensuring an appropriate angle is given in the axial plane (parallel to the right and left hip joints). The slices must be sufficient to cover the entire prostate and seminal vesicles.  Additionally, to minimize artefacts stemming from arterial pulsation and breathing, consider incorporating saturation bands on the top and front of the coronal block.

MRI prostate protocol and planning of coronal oblique scans

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

ZOOMIT\DWI epi3scan trace axial 3 mm SFOV

Plan the axial DWI oblique slices on the sagittal plane; angle the positioning block perpendicular to the prostatic urethra (i.e., parallel to the base of the urinary bladder). Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular to the prostatic urethra). Slices must be sufficient to cover the whole prostate and seminal vesicles. Additionally, to minimize artefacts arising from arterial pulsation, peristalsis, and breathing, consider incorporating saturation bands on top and in front of the axial block.

MRI prostate protocol and planning of axial oblique ZOOMIT DWI scans

Parameters ZOOIT

TR

5000-6000

TE

74

FLIP

130

NEX

10

SLICE

3 MM

MATRIX

204X192

FOV

200X110

PHASE

R>L

GAP

10%

B VALUE

0
500
1000

Parameters EPI DWI

TR

5000-6000

TE

110

FLIP

130

NEX

10

SLICE

3 MM

MATRIX

192X192

FOV

200-250

PHASE

R>L

GAP

10%

B VALUE

0
500
1000

Zoomit DWI

Zoomit DWI is an advanced MRI imaging technique that leverages Siemens’ TimTX TrueShape platform and the application called Syngo ZOOMit. TimTX TrueShape introduces a new transmit platform with two independent transmitters, enabling flexible switching of RF waveforms and gradient shapes. This dynamic parallel transmission (pTX) capability opens up new possibilities for imaging applications.

Syngo ZOOMit, the first application based on TimTX TrueShape, utilizes the concept of “zooming” in MR imaging. Similar to optical zoom in a camera, ZOOMit allows for exciting a smaller field-of-view (FOV) than the object in the phase-encoding direction, thereby avoiding aliasing artifacts. By reducing the FOV, fewer phase-encoding lines are required, leading to faster scan times, improved spatial resolution in the region of interest, and reduced motion and flow artifacts.

Zoomit DWI offers several advantages over conventional DWI techniques. It employs multiple parallel radiofrequency pulse sequences simultaneously, capturing high signal specifically from the area of interest. This approach reduces folding artifacts, provides better anatomical detail, decreases distortion and blurring, and improves overall image quality. Additionally, it allows for faster screening, increased spatial resolution, and minimized susceptibility artifacts and geometric distortions.

With ZOOMit, radiologists and radiographers can selectively image the volume of interest, achieve faster and higher-resolution imaging, enhance diagnostic confidence by detecting and evaluating smaller lesions in challenging areas, and broaden the scope of clinical MR imaging.

Zoomit DWI images

T2 stir coronal 5 mm Large FOV

Plan the big FOV coronal slices on the sagittal plane; angle the position block parallel to the lumbar spine. Check the positioning block in the other two planes. An appropriate angle must be given in the axial plane (parallel to the line from right to left hip joint). Slices must be sufficient to cover the para aortic area from mid abdomen to the sacrum. FOV must be big enough to cover the abdoman and pelvis (normally 380mm-400mm). Big FOV scans are normally taken to check the Para-aortic and pre-sacral nodes.

Parameters

TR

4000-5000

TE

110

FLIP

130

NEX

2

SLICE

5MM

MATRIX

384X384

FOV

380-400

PHASE

R>L

GAP

10%

TI

150

T1 tse axial 6 mm Large FOV

Plan the large FOV coronal slices on the sagittal plane, angle the positioning block vertically across the abdomen and pelvis. Verify the positioning block in the other two planes. Ensure an appropriate angle is given in the axial plane (parallel to the line from the right to the left hip joint). The slices must sufficiently cover the abdomen and pelvis from the anterior abdominal wall to the sacrum. The FOV should be big enough to encompass the abdomen and pelvis (normally ranging from 380mm to 400mm). Large FOV scans are commonly performed to assess the local spread of diseases and to evaluate the para-aortic and pre-sacral nodes.

3T MRI prostate protocol and planning of axial large FOV scans

Parameters

TR

400-600

TE

15-25

SLICE

6 MM

FLIP

160

PHASE

R>L

MATRIX

512X384

FOV

350-400

GAP

10%

NEX(AVRAGE)

2

FOR Post Contrast IMAGING

Ensure that the pressure injector is connected to the IV line to administer injections between the dynamic scans. For post-contrast imaging, it is strongly recommended to employ a time-resolved dynamic T1 GRE sequence (TWIST). Aim for approximately 25-30 measurements and administer the contrast agent after the 4th acquisition. You can find the recommended dosage of gadolinium DTPA injection in the document below, as provided by the manufacturer.

Most common indications for contrast enhanced pelvis scans

T1 TWIST DIXON\T1 VIBE 3D fat sat axial dynamic 4 pre 22 post

Plan the axial TWIST 3D block on the sagittal plane; angle the positioning block perpendicular to the prostatic urethra (i.e., parallel to the base of the urinary bladder). Check the positioning block in the other two planes. An appropriate angle must be given in the coronal plane (perpendicular to the prostatic urethra). Slices must be sufficient to cover the whole prostate and seminal vesicles. Additionally, to minimize artefacts arising from arterial pulsation, peristalsis, and breathing, consider incorporating saturation bands on top and in front of the axial block. Ensure an adequate amount of slices and phase oversampling are utilized to prevent wrap-around artifacts.

A dynamic VIBE DIXON dynamic sequence consists of 26 3mm 3D scans. Contrast injection must be administered after the fourth dynamic sequence.

Parameters TWIST DIXON

TR

4-5

TE

1.25   2.49

FLIP

14

NEX

1

SLICE

3MM

MATRIX

204X192

FOV

180-200

PHASE

R>L

DYNAMIC

26 SCAN

IPAT

ON

Parameters FLASH 3D

TR

4-5

TE

2

FLIP

12

NEX

1

SLICE

3MM

MATRIX

256X192

FOV

180-200

PHASE

A>P

DYNAMIC

11 SCAN

IPAT

ON

Optional Scans

T1 tse fat sat axial 3mm SFOV

Plan the axial slices on the sagittal plane and angle the position block perpendicular to the urethra (i.e., parallel to the base of the urinary bladder). An appropriate angle must be given in the coronal plane, parallel to the line between the right and left hip joints. Slices should sufficiently cover the pelvis from the middle of the urinary bladder down to the penile shaft. Adding saturation bands on the top and front of the axial block will reduce artifacts from arterial pulsation and breathing. T1 fat sat post-contrast scans are only used in post-prostatectomy patients.

Parameters

TR

400-600

TE

15-25

SLICE

3 MM

FLIP

130

PHASE

R>L

MATRIX

256X256

FOV

180-230

GAP

10%

NEX(AVRAGE)

5