Abdomen Pelvis MRI Protocol

• Axial Haste(SS TSE) Abdomen & Pelvis
• Coronal Haste(SS TSE) Abdomen & Pelvis
• Coronal GRE in/out phase T1 
• Axial DWI Abdomen only
• T2 fat sat Abdomen Abdomen & Pelvis
• True FISP Axial Abdomen & Pelvis
• STIR coronal Abdomen & Pelvis
• Pre contrast LAVA/VIBE 

Timing run:

• Post contrast Dynamic Abdomen LAVA/VIBE 
• Post contrast Delay Abdomen & Pelvis

Technical notes for "Abdomen Pelvis MRI Protocol"

• The acquisition of MR images with steady-state free precession sequences (true fast imaging with steady-state precession [FISP], balanced fast field echo, or fast imaging employing steady-state acquisition) is optional . With these pulse sequences, images may be acquired in the coronal or axial plane. The sequences also provide excellent morphologic contrast while being fast and reliable.
• A coronal short inversion time inversion-recovery (STIR) sequence covering the entire abdomen and pelvis should be used with free breathing for Acute abdomen. The use of such a sequence requires as much as 3 minutes of imaging time and leads to a good overview, with enhanced depiction of free fluid within the abdominal cavity
• T1-weighted sequences used after the administration of gadolinium-based contrast agents enable improved depiction of the bowel wall, for example, inflammatory bowel wall thickening or perfusion defects, as well as the assessment of abscesses
• The exact value of diffusion-weighted imaging in acute abdominal or pelvic diseases has not yet been established. Only the combination of diffusion-weighted images and ADC maps will enable the assessment of diffusion. Some investigators have suggested that diffusion-weighted imaging might also be used as an alternative to contrast agent–enhanced sequences and might be a promising technique for the depiction of inflammatory changes.       

-->

Urinary Bladder MRI Protocol

• T2 TSE Sag 4mm
• T2 TSE Ax 4mm
• T1 in Ax Coverage, bifurcation to pubic symphysis.
• HASTE Cor Thru kidneys. Use body coil if necessary.
• Fast multiplanar spoiled gradient-echo images with fat suppression Axial plain and contraast enhanced Dynamic 2mm thickness

Technical notes for "Urinary Bladder MRI Protocol"

Sagittal and coronal gadolinium-enhanced images were added if the tumor was located in the base or the dome of the bladder. 
On T2-weighted images, the normal bladder wall was identified as a hypointense line outlining the bladder lumen 
MRI with dynamic contrast administration has been shown to be superior to CT, particularly in detecting superficial and multiple tumors and in detecting extravesical tumor extension and surrounding organ invasion
 Ideally, the urinary bladder should be moderately distended during imaging. The low distension may cause misevaluation of the bladder wall thickening, and overdistension may obscure small tumors. 

-->

Thoracic Aorta MRI protocol

• Coronal SSFSE  / SS TSE / HASTE
• Axial T1 Double IR 
• Sagittal Oblique "Candy Cane"T1 Double IR 
• Sagittal 3D CE MRA + RECONS 

Cardiac Gating
OPTIONAL:

•  AX FIESTA 
•  LAO (CANDY CANE) FIESTA 

(Do a second post gad run immediately after first, allowing for a quick 5 sec breathhold)

The thoracic aorta is generally examined using ECG-gated T1-weighted spin echo sequence, ECG-gate cine gradient echo sequences (Higgins, 1992) and contrast enhanced MR angiography (Prince et al., 1996). Occasionally T2-weighted SE is used in areas of aortic wall thickening to identify active inflammation.
The T1-weighted sequences produce a static black blood image where the movement of spins return a signal void, as flowing blood passes through the slice of interest in between a 90 degree and 180 degree RF pulse (Jara & Barish, 1999).  The T1-weighted sequences allow the identification of dissecting flap which appears as a thin, linear structure of intermediate signal between the true and false lumens (Nienaber & Knap, 2002).  T1-weighted sequences also allow the depiction of aortic wall thickening as in the case of intramural haematoma. Depending on the age of the haematoma, the area of thickening may be isointense or hyperintense relative to skeletal muscle (Krinsky et al., 1997).
--> Anatomic and physiologic information is obtained using ECG-gated cine gradient echo imaging.  The sequences results in dynamic bright blood images where flowing blood returns a bright signal due to flow related enhancement by the application of a single radiofrequency pulse followed by rapid gradient refocusing with flow compensation.  The magnitude of the signal depends on the flow of blood and thus enables the practitioner to differentiate between true and false lumen in aortic dissection (Flamm et al., 1996) and characterization of intramural haematoma (Murray et al., 1997).  In addition 3D contrast-enhanced MRA is a rapid and accurate image sequence that assess the dimension of the dissection, the involvement of the arch vessels and side branches without ECG or respiratory gating.  Unfortunately, CEMRA is insensitive to intramural haematoma, and so this sequence compliments black blood imaging protocol

Perianal fistula MRI Protocol

NORMAL MRI ANO-RECTAL FISTULA MRI PROTOCOL

-->

T2 FSE 3 Planes-Axial-Coronal 5mm with intervel .5mm

T2 FSE Fat Sat Axial-Coronal-Sagital 5mm with intervel .5mm

T1 FSE Fat Sat Axial 5mm with intervel .5mm

POST CONTRAST 

• T1 FSE Fat Sat Axial 5mm with intervel .5mm

OPTIONAL SEQUENCES

• STIR Axial/Coronal
• 3D Dynamic Post contrast
• T2-weighted SE with saline instillation (MR fistulography)

TECHNICAL NOTES:

•  Mucin-containing fistulas were recognized as tubular structures with a hyperintense signal surrounded by a hypointense rim on T2-weighted two-dimensional turbo SE images. Non–mucin-containing fistulas were recognized as tubular structures with a hypointense signal on T2-weighted images. Fluid-filled cavities were hyperintense on T2-weighted images and surrounded by a border of hypointense signal.
• Dynamic gadolinium-enhanced imaging has been described as superior to STIR for detecting active sepsis, with the main advantage of being faster but with the additional cost of gadolinium use. MR fistulography with instillation of saline can facilitate the detection of fistula tracks, but the technique is cumbersome and depends on the existence of an external opening
• MR imaging with an endoanal coil can also generate images with a high spatial resolution because of the very high signal-to-noise ratio near the coil. The main drawback of the endoanal MR imaging technique is that it fails to show many secondary extensions that lie beyond the range of the and this problem can be overcome by combining the endoanal coil with a phased-array coil. 
•  Spasmolytics such as 20 mg of hyoscine butylbromide (Buscopan; Boehringer Ingelheim, Ingelheim, Germany) or 1 mg of glucagon administered intramuscularly may help to reduce motion-induced artifacts. (Hyoscine butylbromide is not licensed for use in the United States.)