MRI Uterus Protocol

SEQUENCES REQUIRED

• Large Field-of-View Coronal SSFSE
• Sagittal T2
• Axial T1
• Axial T2 (Axial to Uterus)
• Coronal T2 (Coronal to Uterus)

POST CONTRAST

• Fat Sat T1 Axial
• Fat Sat T1 Coronal
• Fat Sat T1 Sagital

OPTIONAL SEQUENCES

• Axial T1 Fat Sat entire pelvis-if endometriosis suspected
• Post contrast DYNAMIC UTERUS if UAE(uterine artery embolism)

TECHNICAL NOTES:
Imaging technique and patient preparation are important to obtain optimal results. Patients are usually instructed to fast for 4–6 hours before the MRI examination to limit artifact due to small-bowel peristalsis. An anti-peristaltic agent (hyoscine butyl bromide or glucagons) may be administered to the patient before imaging as an alternative to fasting. Ideally, the patient is asked to empty the bladder before going on the MR scanner. A full bladder may degrade T2-weighted images because of ghosting and motion artifacts. Patients are imaged in the supine position using a pelvic surface array multichannel coil.

The basic MRI protocol  includes axial T1-weighted spin-echo images with a large field of view to evaluate the entire pelvis and upper abdomen for lymphadenopathy and bone marrow changes; high-resolution T2-weighted fast spin-echo (FSE) images in the axial and sagittal planes for the evaluation of the primary tumor; and dynamic contrast-enhanced T1-weighted images (small field of view) in the sagittal and axial oblique planes to evaluate the extent of myometrial and cervical involvement.

Sagittal T2(Normal pelvis Sagital)

• Anterior saturation band over subcutaneous fat helps to eliminate respiratory motion artifact
• Include entire uterus and lower lumbar spine and sacrum
• If there is pelvic pain than it may be useful to also acquire proton density (TE = 17) images at the same time to evaluate any intervertebral disc disease.

Axial T1(Normal pelvis Axial)

Useful to evaluate the uterine contour, lymph nodes, and bone marrow,fatty masses, hemorrogic collection/cysts, adenopahthy and muscles.

• Cover entire pelvis
• Place anterior saturation band
• If endometriosis is suspected, repeat with fat saturation.

Axial T2 (Axial to Uterus)

This sequence shows the zonal anatomy ofthe uterus, evaluates any endometrial abnormalities and shows the relationship of any fibroids to the endometrium and identifies submucusal fibroids which may cause irregular bleeding. If adnexal mass suspected use pelvis axial instead of uterine axials.

Coronal T2 (Coronal to Uterus)

This sequence evaluates abnormalities of the uterus.  It is acquired coronal to the uterine fundus. Do not use fat saturation, bright fat helps to identify the outer contour of the fundus. Remember for the entire pelvis MRI my preference goes to T2 Fat Sat.

Contrast enhancement is used to document the extent of endometrial carcinoma invasion or to detect the presence of necrosis in uterine leiomyomas. Dynamic contrast injection can be used in women who are considering uterine artery embolization (UAE) in order to evaluate the uterine arteries and the potential collateral gonadal arterial supply. ¹ In the evaluation of congenital uterine anomalies, sagittal T2W images should be acquired first to determine the long-axis orientation of the uterus. Subsequently, images should then be obtained parallel to the long axis of the uterus in order to show the outer uterine contour