Magnetic Resonance Imaging of the Female Pelvis: Representative Protocols

TABLE J-1

Pelvic Mass Magnetic Resonance Imaging Protocol

Sequences

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Sag T2 Fast Spin Echo (FSE)
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  Free breathing
- •
  May need to try phase S/I and A/P to see which gives best quality
- •
  Consider anterior or superior suppression pulses
•
Axial T2 FSE Fat Saturation (FS)
- •
  Free breathing
- •
  Phase L/R
•
Axial T2 FSE
- •
  Free breathing
- •
  Phase L/R
•
Coronal T2 FSE
- •
  Free breathing
- •
  Phase L/R
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Axial T1 In and Opposed Phase
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  End expiration is preferred. Inspiration is acceptable.
•
Axial Isotropic T1 FS pre (3D Vibe)
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  Free breathing
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  PHASE L/R (not A/P)
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Inject Contrast
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Axial Isotropic T1 FS post (start 1 minute following initiation of the injection)
- •
  Free breathing
•
Axial Vibe (only if necessary to cover the anatomy)
- •
  End inspiration is acceptable
- •
  FS

If the pelvic pathology is too large to perform the isotropic T1 FS images in a reasonable amount of time, use Vibe pre- and post-contrast images similar to a Liver Mass Protocol and acquire breath hold axial, sagittal, and coronal pre- and post-contrast images.

TABLE J-2

Uterine Anomaly Magnetic Resonance Imaging Protocol

Sequences

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LOCALIZER free breathing
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  Run in ISO mode to see where the uterus is centered in the coil.
•
LOCALIZER free breathing
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  Run in ISO mode.
- •
  Center the uterus in the center of the field view.
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  When this is finished, remove the previous series from the sequence list and remove its images from the thumbnails. If you prescribe off this localizer using the REF mode, the uterus will remain in the center of the magnet.
•
HASTE LOCALIZER (T2)
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  Run in the following planes centered on the uterus. Make sure you are in reference mode and prescribe off the second localizer above.
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  Straight Axial
- •
  Straight Sagittal
- •
  Straight Coronal
•
“Coronal of Uterus” T2 Fast Spin Echo (FSE)
- •
  Use the above HASTE localizers to create a plane that parallels the endometrium to make a true coronal of the uterus.
- •
  Free breathing
- •
  Phase L/R
•
“Sagittal of Uterus” T2 FSE
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  Use of the above HASTE localizers to create a parasagittal plane that parallels the endometrium.
- •
  Free breathing
- •
  May need to try phase S/I and A/P to see which gives best quality.
- •
  Consider anterior or superior suppression pulses.
•
“Axial of Uterus” T2 FSE
- •
  Use the above HASTE localizers to create a plane that is perpendicular to the plane of the endometrium.
- •
  Free breathing
- •
  Phase L/R
•
3D T2 SPACE SAG
- •
  Free breathing
•
Axial T1 In and Opposed Phase
- •
  End expiration is preferred. End inspiration is acceptable.
•
Axial Isotropic T1 Fat Saturation (FS) pre (3D Vibe)
- •
  Free breathing
- •
  PHASE L/R not A/P
•
Axial Isotropic T1 FS post (only if giving contrast) (3D Vibe)
- •
  Free Breathing
- •
  PHASE L/R not A/P
•
CORONAL HASTE (T2) to include kidneys

TABLE J-3

Magnetic Resonance Imaging Protocol for the Pregnant Patient With Right Lower Quadrant Pain

•
Patient Position
- •
  Head first
- •
  Supine
•
Coils
- •
  Place sufficient matrix coils to cover the abdomen and pelvis (or chest, abdomen, and pelvis if necessary).
- •
  Make supercoils if the patient is large and there are enough (4) matrix coils.
•
“Zero” the scanner at the center of the top coil.
•
Assess the patient’s ability to breath hold.

Sequences

•
Axial T2 HASTE (2 station Set-and-Go)
- •
  Multiple short and expiration breath holds.
- •
  Send the composed images to PACS.
•
Coronal T2 HASTE
- •
  Navigator triggered or short end expiration breath holds.
•
Sagittal T2 HASTE
- •
  Navigator triggered or short end expiration breath holds.
•
Axial T2 HASTE Fat Saturation (FS) (2 Station Set-and-Go)
- •
  Multiple short end expiration breath holds.
- •
  Send the composed images to PACS.
•
T1 In and Out of Phase (cover Uterus and Adnexa)
- •
  End expiration is preferred. End inspiration is acceptable.

Notes:

IMPORTANT! These HASTE Sequences Are Different!

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5 mm thick with 10% slice spacing
•
Matrix of 256 x 256 is acceptable, but 320-256 is preferable if signal is OK.
•
HASTE in these cases is run without parallel imaging. If you want to turn on parallel imaging, then phase oversample (with no time penalty) to avoid artifact.
•
Image the cecum in all planes. (Since the appendix is attached to the cecum, if you image the cecum, you will also include the appendix.)
•
Do not let the images “bounce.” The appendix measures 5mm. Each pixel is 2mm. Even 2 mm of bouncing can make the appendix “disappear.” Use breath holds if possible and only use navigator as the last resort. You can Navigator off the bottom of the liver, spleen, or even the top of a moderate sized uterus!

HASTE Coverage

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Axial: gallbladder to pubis in the axial plane
•
Coronal: front to back to include from the gallbladder superiorly to the pubis inferiorly
•
Sagittal: midline to right skin surface

Axial Dual Echo VIBE Through the Uterus and Pelvis Is a Breath Hold Image.

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The purpose of this image is to look for hemorrhage in the uterus (placenta, fibroids) or fat in the adnexa (dermoid cysts).
•
Use iPAT 2
•
Choose from the appropriate breath hold protocol
•
If these images are blurry, use free breathing T1 protocol. Copy the slices from the Axial T2 HASTE.

Abbreviations:

HASTE: Single shot T2 weighted sequence VIBE: Volume interpolated gradient echo T1 weighted sequence iPAT: Parallel imaging FS: Fat supression

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