Appendicitis MRI Protocol

MRI Protocol without contrast

• FSE breathhold T1 Coronal/Axial (4-mm slice thickness)
• SE breathholdT2 Coronal/Axial (4-mm slice thickness)
• FSE breathhold T2 Fat Sat Coronal/Axial (4-mm slice thickness)

Post contrast

• Fat Sat T1 Coronal/Axial

Optional

• Axial 2D TOF ( periappendiceal veins)

Technical Notes:

• Using fat-saturation techniques, contrast differences were observed between the inflamed appendix and the surrounding fat. Fat-suppressed, T2-weighted, axial and coronal images also helped in the detection and evaluation of appendicitis and its complications.
• Axial 2D time-of-flight images are acquired from the renal veins to the symphysis pubis to screen for a venous clot and to differentiate the appendix from the frequently encountered periappendiceal veins. 
• MRI protocol includes oral preparation with a combination of 300 mL of silicone-coated superparamagnetic iron oxide (GastroMARK [ferumoxsil], Mallinckrodt Medical Inc.) and 300 mL of barium sulfate suspension (Readi-Cat 2, EZ-EM Canada Inc.). This solution is administered 1 hr before the examination in order to ensure filling of the cecum. It provides negative oral contrast on T1- and T2-weighted images without substantial susceptibility effect.
• The normal appendix is seen on MRI as a tubular structure less than 6 mm in diameter. The presence of air or superparamagnetic oral contrast material within the lumen of the appendix is visualized as a central hypointense area in the normal appendix.