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.       

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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. 

MRI Renal Angio Protocol

Normal MRA-RENAL ANGIO Protocol

• Coronal 2D steady-state precession sequence was performed for localization of the origin of the renal arteries
• Pre-contrast Coronal-3D GRE (Mask)-Coronal breath-hold fat-saturated spoiled gradient-recalled echo sequences (fast low-angle shot)
• Post-contrast Coronal 3D GRE + 3D RECONS

Optional

• Coronal 2D FIESTA FS / BALANCED FFE / TrueFISP
• Axial T2 SSFSE / SS TSE / HASTE
• Axial 2D FIESTA FS /BALANCED FFE / TrueFISP
• Axial GRE IN/OUT PHASE

TECHNICAL NOTES

• Contrast administration dose-0.2 mmol/kg for 1.5 T and at a dose of 0.1 mmol/kg for 3 T
• The sequence was immediately started when bolus tracking showed contrast agent in the abdominal aorta. 
• The injection rate was kept constant to keep the bolus as compact as possible.

3D MRCP Pancreas Technique

SOURCE: http://imageradiology.blogspot.com/2012/06/3d-mrcp-pancreas.html

The 3D TSE sequence can produce high-spatial-resolution MRCP images . Thin sections without a slice gap allow better assessment of small stones, side branches of the main pancreatic duct, and intrahepatic bile ducts. Three-dimensional TSE MRCP may be performed as a series of breath-holds or during free breathing. We acquire 1–2 mm, contiguous slices during free breathing and use the navigator-echo technique to reduce motion effects. The main disadvantage of this technique is the relatively long acquisition time. In addition, navigator-based triggering requires uniform and regular breathing cycles for optimal image quality. If the patient has rapid or irregular breathing, the image quality may be impaired. An alternative method of producing 3D MRCP images is to use a TSE sequence with a 90° flip-back pulse. This sequence is called FRFSE (fast recovery fast spin-echo), DRIVE, or RESTORE. The unique feature of this sequence is that after a long echo-train, the residual transverse magnetization is refocused into a final spin-echo and then flipped along the z-axis by a –90° fast recovery pulse . This accelerates relaxation of the longitudinal magnetization, leading to a reduction in TR without a loss of SNR. It is possible to perform breath-hold 3D MRCP with this sequence. However, the number of slices that may be obtained is substantially less than with respiratory-triggered versions of 3D MRCP.

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Three-dimensional volumetric MRCP images are of superior quality and give better delineation of pancreaticobiliary anatomy than conventional 2D images and have the added advantage of multiplanar and postprocessing capabilities.

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Dynamic Coronal MRCP
Secretin-Enhanced MRCP Protocol

MR Cholangiopancreatography (MRCP) PROTOCOLS

MRCP reference line for 3D biliary imaging

Secretin-Enhanced MRCP Protocol

--> Secretin is a naturally occurring 27-amino acid polypeptide released by ductal mucosa in response to acid in the lumen. Secretin increases bicarbonate and pancreatic fluid secretion by the exocrine cells. Secretin relaxes the sphincter of Oddi and opens pancreatic duct orifices.
Secretin is injected intravenously at the time of the MRCP. Images are then taken every 30 seconds for 10 minutes. Maximum output of pancreatic fluid is optimal between 6 to 8 minutes. A dynamic image and video is created from a 3-D rendering by the radiologist. This image sequence examines the pancreas response to stimulation. The excess pancreatic fluid/bicarbonate will resonate a sharper image of the pancreas. Static MRCP’s turn into dynamic images with pancreatic stimulation.
Secretin enhanced MRCP (S-MRCP) relies on dynamic responses of the main pancreatic duct to secrete fluid after Secretin stimulation, which causes the improvement of visual clarity in sharpening pancreatic imaging Secretin is a polypeptide hormone secreted by duodenal mucosa in response to luminal acid . It induces pancreatic secretion of water and bicarbonate. In the first 5–7 minutes, the tone of the sphincter of Oddi is increased. These effects result in temporary distention of the pancreatic ducts. Synthetic human secretin  is given IV over 1 minute to avoid potential abdominal pain that may occur with a bolus injection. An adult dose of 16 μg (0.2 μg/kg body weight in children) is used. At the commencement of injection, a baseline scan is obtained, followed by coronal SSFSE images (2-second scanning time) every 30 seconds for 10 minutes. In healthy subjects, the maximal effect of IV secretin is between 7–10 minutes 

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Dynamic Coronal MRCP
3D MRCP Pancreas Technique

MR Cholangiopancreatography (MRCP) PROTOCOLS

MRCP reference line for 3D biliary imaging

LIVER MRI PROTOCOL

LIVER MRI PROTOCOL


3-plane localizer
Coronal SSFSE (single-shot fast spin-echo)
 Axial SSFSE
Axial dual in-phase and out-of phase
Axial 3D Dynamic Gd (FAME)
Post-Gd Coronal T1

Liver donor Special Sequence:

Fast 2D TOF-

 It produces excellent vascular motion suppression with respiratory compensation (ROPE) which is especially useful in patients who cannot breathe hold

POST CONTRAST T1 2D or 3D 

arterial phase : 20 - 25 seconds

portal venous phase : 60 - 70 seconds

equilibrium phase : 3 - 5 minutes

hepatobiliary delayed phase : 10 - 30 minutes with and without fat sat

later delayed phase : 1 hour + / - 3 hours in some institutions

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To detect and characterize focal liver lesions

MRI Imaging Characteristics of Liver Mass Lesions

MRI Protocol for RENAL MASS

MRI  examinations are performed with dedicated body (array) coils  

Plain sequeces

• T1-weighted gradient-echo (GRE, in- and opposed-phase) AXIAL
• T2-weighted turbo spin echo (TSE) AXIAL & CORONAL
• 3D Spoiled Gradient echo-CORONAL-2mm(For renal arteries)
• Ultra fast GE axial

Post contrast Sequences

• DYNAMIC GADOLINIUM 3D Spoiled Gradient echo-CORONAL
• Ultra fast GE AXIAL-late arterial (20-s delay), nephrographic (80-s delay) and excretory phases (180-s delay).
• Normal Delayed- Ultra fast Gradient AXIAL/CORONAL-7 to 10 min
• Urogram Delayed- 3D Spoiled gradient echo AXIAL/CORONAL-7 to 10 min / thick-slab single-shot T2-weighted TSE

Follow up RENAL MASS
Plain MRI

• Ultra Fast SE non fat sat AXIAL & CORONAL
• Ultra Fast GE AXIAL

POST CONTRAST

• DYNAMIC GADOLINIUM 3D Spoiled Gradient echo-CORONAL
• Ultra fast GE AXIAL-late arterial (20-s delay), nephrographic (80-s delay) and excretory phases (180-s delay).

OPTIONAL 

The use of furosemide for forced diuresis and a further distension of the collecting system and for a consecutive reduction in the T2* effects of the concentrated contrast material is optional 

Concerning diffusion-weighted imaging (DWI), different authors have shown the value of apparent diffusion coefficients (ADCs) for characterising renal masses. 

NOTE:If the mass is near the hilum / collecting system give LASIX prior to the CONTRAST injuction.Dose: 1mg (1cc from standard 10cc vial)

               

The use of furosemide for forced diuresis and a further distension of the collecting system and for a consecutive reduction in the T2* effects of the concentrated contrast material is optional 

Concerning diffusion-weighted imaging (DWI), different authors have shown the value of apparent diffusion coefficients (ADCs) for characterising renal masses. 

In these studies, renal tumours had significantly lower ADCs compared with benign cysts, and solid enhancing tumours had significantly lower ADCs compared with non-enhancing necrotic or cystic regions]. They concluded that ADC measurements may aid in differentiating subgroups of renal masses, particularly benign cystic lesions from cystic renal cell cancers .

Renal MRI Protocol

RENAL MRI TECHNIQUE:



In MRI of the kidneys, fast imaging techniques are essential because of respiratory motion of the kidneys . When possible the scan should be performed within one breath-hold. The patient should get clear instructions on breath-hold technique. If the patient has difficulty with breath-holding, a short period of hyperventilation before breath-holding may be helpful. The scan should be performed during expiration because the kidney position is more constant in expiration than in inspiration. If the sequence is too long to perform in one breath-hold, respiratory triggering can be used. Another technique of respiratory motion control is respiratory gating by use of a navigator pulse. In this technique the movement of the diaphragm is monitored by a very fast 1D MRI sequence. If breath-holding is not possible, signal averaging can be used, but the quality of the images will be limited. The use of a phased array body coil is preferable because of the improved signal-to-noise ratio. To prevent aliasing in coronal imaging, the patient’s arms should be raised above the head, or the arms may be supported by cushions, anterior to the coronal plane through the kidneys.


Sample Renal MR Protocol


PLAIN
1.Coronal T2-weighted half Fourier single-shot turbo spin echo sequence (HASTE) 
2.Axial T2-weighted turbo spin echo sequence with fat suppression 
3.Axial T1-weighted gradient echo sequence, in-phase and opposed-phase


Pre and Post Gadolinium axial 
Optional


1. GRE T1-Opposed phase axial-DYNAMIC IMAGING
2. 3D MRA coronal
3.Coronal 3D fast gradient echo with fat suppression

1. Coronal T2-weighted half Fourier single-shot turbo spin echo sequence (HASTE) (TR infinite, TE 120 ms, flip angle 90°, breath-hold), serving as a localizer, but also supplying valuable T2-weighted information. The limitation of this sequence is a relatively low signal-to-noise ratio.
   
   
2. Axial T2-weighted turbo spin echo sequence with fat suppression (TR 2,000 ms, TE 100 ms, flip angle 90°, respiratory triggering). This sequence provides for more detailed T2-weighted information. The T2-weighted sequence is especially helpful in characterizing cysts and intraparenchymal abscesses and in evaluating hydronephrosis. Furthermore, the T2-weighted sequence is helpful in detecting solid lesions.
   
   
3. Axial T1-weighted gradient echo sequence, in-phase and opposed-phase (TR 180 ms, TE 2.3 ms/4.6 ms, flip angle 90°, breath-hold), preferably as a dual-echo sequence. Many solid renal lesions are hypointense compared to the renal parenchyma on T1-weighted images, but lesions with hemorrhage, lesions with macroscopic fat, melanin-containing lesions and cysts with high protein content may show hyperintense signal . Opposed-phase T1-weighted gradient echo sequences can be used to prove the presence of small amounts of fat.
   
   
4. Axial T1-weighted gradient echo sequence for dynamic imaging (TR 130 ms, TE 1.0 ms, flip angle 90°), using 30 ml intravenous gadolinium contrast, immediately followed by three breath-hold periods with four scan series per breath-hold. In this way pre-contrast and post-contrast images in arterial and nephrographic phase are obtained. Gadolinium-enhanced images are used for lesion detection and characterization.
   
   
5. Coronal 3D fast gradient echo with fat suppression, obtained immediately after the dynamic series for delayed contrast-enhanced images (TR 3 ms, TE 2 ms, flip angle 15°). This sequence can be used for renal venous anatomy, for the analysis of (tumor) thrombus and for evaluation of extent of the tumor in the perinephric fat.

Currently 1- to 1.5-T systems are generally used for abdominal imaging, but the advent of 3-T MRI systems brings a twofold increase in the signal-to-noise ratio (SNR). The increase in SNR can be spent on higher resolution or on even faster imaging. When combined with parallel imaging techniques such as sensitivity encoding (SENSE), the speed of any sequence can be increased by up to a factor of four or higher. However, although 3-T MRI is promising, only a limited amount of research has been published on 3-T MR imaging for renal lesions, and its value has still to be established 

MRI ABDOMAN ARTIFACT REDUCTION BY FAT SATURATION

Fat Suppression 
Fat signal causes high signal respiration induced ghosts on T1 weighted images and T2 weighted Turbo Spin Echo images. Basic fat suppression methods are used in different combinations by different equipment so take time to learn how your scanner suppresses fat signal. These notes only give a basic outline.

Selective Spectral Saturation
• aka Chemsat, FATSAT, CHESS spectral non spatial selective saturation


• A fat selective excitation pulse is applied to the whole volume, followed by a spoiler gradient , Only water spins contribute signal to the following imaging sequence.
• Usually applied before each excitation pulse (TR x slice)
• Takes 10 - 20 msec per routine
• Fat saturation effect lasts about 100 msec
• Increases SAR
• Sensitive to magnetic field distortions
• Only modifies appearance of Fat other contrasts remain unaltered
• Suitable for use after Gadolinium contrast agents
• More difficult (and slower) to achieve at lower field strengths.

Binomial Excitation
• aka Water Excitation, Jump Back excitation, 1331 excitation
• Relies on the fat and water spins moving out of phase. A series of broadband low flip pulses are timed to decrease the flip angle of Fat, but increase the flip angle of water spins.
• Fat Suppression by selective excitation of water (WE)
• Less susceptible to magnetic field inhomogeneity than spectral saturation
• Lower SAR loading than FATSAT or STIR
• Fastest fat suppression routine

STIR
• Short TI (tau) Inversion Recovery
• Fat suppression is based on T1 behaviour and selection of TI
• Reverse T1 contrast plus T2 contrast
• Uniform fat suppression independent of magnetic field inhomogeneity
• Can be implemented at any field strength with equal success
• Works well with many acquisition regimes
• Don't use STIR post Gd contrast
• Higher SAR than FATSAT or Water Excitation

SPIR
• aka Spectral Inversion Recovery
• Spectrally selective form of STIR
• A spectrally selective pulse is applied (non spatial) with a flip selected between 90 and 180 degrees. After a suitable delay time (TD depending on flip angle) the fat spins have reached Mz=0 and the imaging sequence is run.
• Compatible with Gadolinium contrast
• Less susceptible to magnetic field inhomogoneities
• Must be applied at for each excitation routine (TR x slice)

MRI Imaging Characteristics of Liver Mass Lesions

Imaging Characteristics of Liver Mass Lesions

Early enhancement & Washout  Hepatocellular Carcinoma Hepatic Adenoma Cholangiocarcinoma Hypervascular metastases (unusual)	Bright on T2 Haemangioma Hepatocellular Carcinoma Cholangiocarcinoma Metastases Simple Cysts (very bright esp on Te > 120)
Contains Fat or blood  Hepato-cellular Carcinoma Adenoma (most drop signal on OOP image)	Pseudo-capsule (compressed liver) Hepato-cellular Carcinoma Adenoma
Decreased Signal on OOP image Adenoma Fatty infiltration (cirrhosis, post chemotherapy)	Uniform enhancement Fibro-nodular Hyperplasia Adenoma
Persistent rim enhancement metastases Late enhancement & delayed washout Haemangioma very rarely hypervascular metastases

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To detect and characterize focal liver lesions 

MRI Imaging Characteristics of Liver Mass Lesions

MR Cholangiopancreatography (MRCP) PROTOCOLS

MRCP PROTOCOL

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• Coronal SSFSE
• Axial T2 SE with respiratory triggering
• Axial T1 SPGR- spoiled gradient echo, in-phase with fat saturation of pancreas
• Coronal oblique SSFSE-RAO & LAO thin slice MRCP
• Coronal oblique SSFSE-RAO & LAOThick slab MRCP

MR Cholangiopancreatography (MRCP)

• An imaging technique that aims to replicate the information provided by endoscopic cholangiopancreatography (ERCP) and other cholangiographic techniques by developing very high contrast between fluid (in the ductal anatomy) and background tissues.
• Best results with extremely T2 weighted long ETL TSE sequences with fat suppression, acquired in a single breath hold.
• Slices < 4 mm can be processed in a MIP programme to allow some variation of projection
• Thick slices can provide very fast sequences with a single view and high in-plane resolution

MRCP Parameters  

Thick Slice

Localiser or simple display of ductal anatomy: 

Fat saturated single shot HASTE Axial and oblique coronal planes 

TR 2800 TE 1100 ETL 128 Slice thickness 70 mm FOV 300 mm Matrix 256 x 240 Resolution 1.27 x 1.2 mm Acquisition time 7 seconds ( uses 2 TR to establish steady state) 

Thin Slice 

For detailed depiction of gallstones or ductal obstruction 

Fat suppressed single shot HASTE Coronal 

TR 11.9 (infinite) Te 95 ETL 128 13 slices 4 m thick FOV 270 mm (7/8) matrix 256 x 240 resolution 1.13 x 1.05 mm Acquisition time 20 seconds

ANOTHER PROTOCOL Locator SSFSE Axial T2 Axial in-phase MRCP (Thin Slice) MRCP  (Thick Slab) ·        Schedule for 30 minutes slot in AM , preferably \before 11am ·        Patient must be npo after midnight, may drink water only prior to MRI.  This is important for making sure the gallbladder is distended. Patient Preparation: ·        Oxygen, 2-4 liters/min by nasal canulae is useful if patient is short of breath ·        Valium (5-10mg po) or Xanax (1-2 mg po) if patient is claustrophobic Series 1: Locator SSFSE shows the abdominal anatomy well.  It is done preferably with a breathhold in expiration so it can be used for planning Series 2 and 3 Axial T2 and T1.  It can also be performed without breath holding.  Alternatively, a breath hold FMPSPGR or coronal T1 spin echo (with respiratory compensation)  sequences are also adequate.   With SSFSE or FMPSPGR, use a sufficiently large FOV (ie. set FOV to width of patient) to eliminate wrap-around artifact. Series 2: Axial T2             This sequence identifies hepatic, pancreatic and other lesions.  It shows the common bile duct to guide acquisition of coronal oblique MRCP sequences.  If the respiratory waveform shows the pattern is breathing at regular intervalsàuse respiratory triggering.  If the breathing pattern is not regular then use fat saturation and 3-4 NEX.  Adjust slice thickness as necessary to cover liver and pancreas in 19-20 slice so the sequence will fit on a single sheet of film. Series 3: Axial in-phase (fat saturation)             This sequence is excellent for evaluating pancreatic pathology and especially for identifying pancreatic masses. Cover the entire pancreas.  If necessary, the slice can be made thicker if more coverage is needed. It must be performed with breath holding.  If the patient can not suspend breathing long enough, consider T1 spin echo (6 mm thick slice interleaved) with fat saturation. Series 4: MRCP (Thin Slice)             The purpose of this sequence is to comprehensively image the biliary system in patients suspected of biliary obstruction, stones or post liver transplantaion. It may be acceptable to perform just on straight coronal acquisition. But a more comprehensive study includes both oblique acquisitions. ·        Prescribe this series from the axial T2 series. Select an image which shows the common bile duct (CBD). ·        Use 5 mm thick with 0 gap slices ·        15 slices takes about 30 seconds, which is reasonable breath hold. Although breath holding is not essential, it does make reformations possible Coronal View:  Set the imaging volume from posterior to the CBD as it passes through the head of the pancreas to anterior to the parta hepatis. Ideally the entire gallbladder should be included within the 15 slices, but if it extends too far anteriorly, you may have to exclude part of the gallbladder in order to image the entire CBD. RAO:  Rotate 20-30 counterclockwise and include the CBD. Do not worry about excluding part of gallbladder. LAO:  Rotate 20-30 clockwise centered on the CBD and be sure to include entire gallbladder. Axial:  Set the axial plane at 4-5 mm slice thickness is useful in patients with suspected of pancreatic divisum. Series 5:  MRCP (Thick Slib)             This alternative approach to MRCP acquires an image of the entire biliary system in just 2 seconds.  Use oblique prescription and hold shift key down to prescribe multiple slabs at different angles.

Pancreas MRI Protocol

To detect and characterize focal pancreatic lesions

• Scout (multiple planes)
• T2 weighted Axial with fat suppression
• Axial DWI (b=1000)
• Axial DUAL ECHO IN/OUT PHASE GRE
• Coronal MRCP with RES[IRATORY TRIGGER
• T1 out of phase Spoiled Gradient Echo (SGE) Axial
• T1 in phase SGE Axial with fat suppression

Post Contrast (0.2ml/kg rapid injection followed by 10 ml saline flush)

• T1 In Phase FLASH Axial with fat suppression at :-
• End of saline flush
• 45 seconds post contrast
• 1.5 minutes post contrast
• Cor Fat-sat Gad 

NOTE:Pancreatic carcinoma appears with low signal on unenhanced fat suppressed T1 images, but a tumour may be mimicked by age related changes. Immediately post contrast, the normal pancreas enhances avidly leaving the pancreatic carcinoma as a low signal region. Normal pancreatic enhancement drops off rapidly.

Pancreas MRI Technical notes

Normal pancreas on unenhanced T1-weighted images has intermediate signal intensity--similar to liver--and is hypointense to surrounding fat. With T1-weighted fat-saturation, the pancreas becomes the highest-signal structure in the upper abdomen and is readily detectable. On nonenhanced T2-weighted images, the normal pancreas is iso- or hyperintense to liver. The pancreatic duct and common bile duct within the head of the pancreas exhibit very high signal on T2-weighted images. 2,24 Regarding contrast dynamics, after bolus gadolinium-based contrast injection, the pancreas enhances before the liver. As in liver imaging, dynamic image acquisition is important for improved pancreatic lesion detection, characterization, and differential diagnosis. Unenhanced fat-suppressed T1-weighted and immediate (arterial) fat-suppressed T1-weighted post-contrast images are by consensus the most useful for diagnosis of pancreatic disease. 25,26 In general, it is the aqueous content of the normal pancreas that creates high signal on T1-weighted images. Pancreatic tumors and chronic pancreatitis contain less aqueous tissue than normal pancreas, leading to their characteristically low signal intensity

Pancreatic carcinoma appears with low signal on unenhanced fat suppressed T1 images, but a tumour may be mimicked by age related changes. Immediately post contrast, the normal pancreas enhances avidly leaving the pancreatic carcinoma as a low signal region. Normal pancreatic enhancement drops off rapidly.

LIVER MRI PROTOCOL-Detect&characterize focal liver lesions

Liver 

To detect and characterize focal liver lesions

• Scout (multiple planes)
• T2 weighted Axial with fat suppression
• T1 out of phase Spoiled Gradient Echo (SGE) Axial
• If the lesion is bright on T1 do a fat saturated T1 Axial
• T1 in phase SGE Axial

Post Contrast (0.2ml/kg rapid injection followed by 10 ml saline flush)

• T1 In Phase FLASH Axial at :-
• End of saline flush,
• 45 seconds post contrast
• 3 minutes post contrast
• 10 minutes post contrast (optional)
• MRCP axial, RAO for Hepatic ducts, LAO for pancreatic duct

Notes

• The pre-contrast images locate lesions and provide T1 and T2 weighted information.
• Out of Phase (OOP) FLASH images display fatty infiltration and adrenal adenomas.
• The post contrast images help classify the nature of the lesion.
• The immediate post contrast image is very time critical, and is the most valuable.
• The rapid injection requires good venous access. Have the 20 G Jelco in situ before the patient is placed in the bore ( before they enter the room if possible).