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MRI Uterine Fibroids

Indications for MRI Uterine Fibroids scans

Contraindications

Patient preparation for MRI Uterine Fibroids scans

Positioning for MRI Uterine Fibroids scans

MRI GYNAECOLOGY PELVIS positioning image

Recommended MRI Uterine Fibroids Protocols and Planning

MRI Uterine Fibroids scans localiser

A three-plane localiser must be taken at the beginning to localise and plan the sequences. Localisers are normally less than 25 seconds and are T2-weighted low-resolution scans.

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 align the positioning block parallel to the linea alba and median sacral crest. Verify the positioning block in the other two planes. In the coronal plane, ensure an appropriate angle that parallels the lumbosacral spine. Ensure that the slices cover the entire pelvis, ranging from the right acetabulum to the left acetabulum. The field of view (FOV) should be sufficiently large to encompass the fibroids, 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.

Uterine fibroids MRI protocol and planning of sagittal scans

Parameters

TR

4000-6000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

H>F

MATRIX

320X320

FOV

270-300

GAP

10%

NEX(AVRAGE)

3

T2 tse axial 6 mm large FOV

Plan the large field of view (FOV) axial slices on the coronal plane, positioning the block parallel to the line along the right and left iliac crest. Verify the positioning block in the other two planes as well. Establish an appropriate angle in the sagittal plane, perpendicular to the lumbar spine. The slices should adequately cover the entire lower abdomen and pelvis, extending from the middle of the kidneys down to the symphysis pubis. The FOV should be large enough to encompass the entire pelvis, typically ranging from 350mm to 400mm. To reduce artifacts caused by arterial pulsation and breathing, consider adding saturation bands on top of the axial block. Large FOV scans are usually performed to assess the local spread, para-aortic, and pre-sacral nodes.

Uterine fibroids MRI protocol and planning of axial abdomen and pelvis scans

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

T2 stir coronal 5 mm big FOV

Plan the large field of view (FOV) coronal slices on the sagittal plane and position the block parallel to the lumbar spine. Verify the positioning block in the other two planes as well. Establish an appropriate angle in the axial plane, which runs parallel to the right and left hip joint. The slices should adequately cover the entire abdomen and pelvis, extending from the anterior abdominal wall to the sacrum. The FOV must be large enough to encompass the abdomen and pelvis, typically ranging from 380mm to 400mm. Large FOV scans are usually performed to evaluate the local spread of the pathology and assess the para-aortic and pre-sacral nodes.

Parameters

TR

4000-5000

TE

110

FLIP

130

NEX

2

SLICE

5MM

MATRIX

384X320

FOV

380-400

PHASE

R>L

GAP

10%

TI

130

T2 tse axial 3mm SFOV pelvis

Plan the axial slices on the sagittal plane and position the block horizontally across the pelvis. Verify the positioning block in the other two planes. Determine an appropriate angle in the coronal plane that is parallel to the right and left hip. Ensure that the slices adequately cover the entire fibroids (consider using a slice thickness of 4 if the fibroid is large). Adding saturation bands on top and in front of the axial block can help minimize artifacts caused by arterial pulsation and breathing.

In modern scanners, the anterior-posterior phase direction can lead to noticeable motion artifacts. This is because of the enhanced signal-to-noise ratio (SNR), which results in increased signal intensity in abdominal fat. As the abdominal fat moves during the acquisition, it can cause ghosting effects on the axial images. To address this issue, axial scans are typically performed using a right-to-left phase direction.

Parameters

TR

5000-6000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

R>L

MATRIX

320X320

FOV

200-230

GAP

10%

NEX(AVRAGE)

4

T2 tse coronal 3mm SFOV pelvis

Plan the coronal slices on the sagittal plane and position the block vertically across the pelvis. Verify the positioning block in the other two planes. Provide an appropriate angle in the axial plane that is parallel to the right and left hip. Ensure that the slices adequately cover the entire fibroids (consider using a slice thickness of 4 if the fibroid is large). Adding saturation bands on top and in front of the coronal block will help reduce artifacts caused by arterial pulsation and breathing.

Uterine fibroids MRI protocol and planning of coronal scans

Parameters

TR

5000-6000

TE

100-120

SLICE

3 MM

FLIP

130-150

PHASE

R>L

MATRIX

320X320

FOV

200-230

GAP

10%

NEX(AVRAGE)

4

T1 tse fat sat axial 3mm SFOV PELVIS

Plan the axial slices on the sagittal plane and position the block horizontally across the pelvis. Verify the positioning block in the other two planes. Determine an appropriate angle in the coronal plane that is parallel to the right and left hip. Ensure that the slices adequately cover the entire fibroids (consider using a slice thickness of 4 if the fibroid is large). Adding saturation bands on top and in front of the axial block can help minimize artifacts caused by arterial pulsation and breathing.

In modern scanners, the anterior-posterior phase direction can lead to noticeable motion artifacts. This is because of the enhanced signal-to-noise ratio (SNR), which results in increased signal intensity in abdominal fat. As the abdominal fat moves during the acquisition, it can cause ghosting effects on the axial images. To address this issue, axial scans are typically performed using a right-to-left phase direction.

Parameters

TR

400-650

TE

15-25

SLICE

3 MM

FLIP

130

PHASE

R>L

MATRIX

256X256

FOV

200-230

GAP

10%

NEX(AVRAGE)

4

DWI epi 3 scan trace axial 3mm SFOV PELVIS

Plan the axial slices on the sagittal plane and position the block horizontally across the pelvis. Verify the positioning block in the other two planes. Establish an appropriate angle in the coronal plane that is parallel to the right and left hip. Ensure that the slices adequately cover the entire fibroids (consider using a slice thickness of 4 if the fibroid is large). Adding saturation bands on top and both sides of the block can help minimize artifacts caused by fat signal, arterial pulsation, and breathing.

Uterine fibroids MRI protocol and planning of axial epi DWI scans

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.

Indications for contrast enhanced uterine fibroids scans

T1 VIBE DIXON 3D sagittal dynamic 1 pre 8 post

Plan the sagittal slices on the axial plane and align the positioning block parallel to the linea alba and median sacral crest. Verify the positioning block in the other two planes. In the coronal plane, ensure an appropriate angle that parallels the lumbosacral spine. Ensure that the slices cover the entire pelvis, ranging from the right acetabulum to the left acetabulum. The field of view (FOV) should be sufficiently large to encompass the fibroids, 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 slice and phase oversampling to prevent any wrap-around artifacts.

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

6-7

TE

2.39   4.77

FLIP

10

NEX

1

SLICE

3 MM

MATRIX

224X224

FOV

220-260

PHASE

R>L

DYNAMIC

9 SCANS

IPAT

ON