Оглавление
Catherine Westbrook. Handbook of MRI Technique
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Handbook of MRI Technique
Contributors
Preface
Acknowledgements
About the Companion Website
1 How to Use This Book
INTRODUCTION
COMMON INDICATIONS
BASIC ANATOMY
EQUIPMENT
PATIENT POSITIONING
SLICE PRESCRIPTION
SUGGESTED PROTOCOL
PROTOCOL OPTIMIZATION
PATIENT CONSIDERATIONS
CONTRAST USAGE
SUMMARY
TERMS AND ABBREVIATIONS USED IN PART 2
CONCLUSION
2 Protocol Parameters and Trade‐offs
INTRODUCTION
SIGNAL‐TO‐NOISE RATIO (SNR)
CONTRAST‐TO‐NOISE RATIO (CNR)
A note on fat suppression techniques
SPATIAL RESOLUTION
SCAN TIME
DECISION STRATEGIES
CONCLUSION
3 Pulse Sequences
INTRODUCTION
CONVENTIONAL SPIN ECHO (CSE)
FAST SPIN ECHO OR TURBO SPIN ECHO (FSE/TSE)
INVERSION RECOVERY (IR/FSE/TSE‐IR)
REWOUND GRADIENT ECHO
BALANCED GRE
SPOILED GRE
REVERSE ECHO GRE
ECHO PLANAR IMAGING (EPI)
Magnetic resonance angiography (MRA)
CONCLUSION
4 Flow Phenomena and Artefacts
FLOW PHENOMENA. INTRODUCTION
TIME OF FLIGHT (TOF)
ENTRY SLICE PHENOMENON
INTRA‐VOXEL DEPHASING
FLOW ARTEFACT REMEDIES
ARTEFACTS. INTRODUCTION
PHASE MISMAPPING
ALIASING
CHEMICAL SHIFT
OUT‐OF‐PHASE SIGNAL CANCELLATION
TRUNCATION
MAGNETIC SUSCEPTIBILITY
MAGIC ANGLE
CONCLUSION
5 Gating and Respiratory Compensation Techniques
INTRODUCTION
CARDIAC GATING (ECG/EKG GATING)
Lead placement
The ECG or EKG
How to improve the trace
Cable safety
PERIPHERAL GATING (PE GATING)
CINÉ IMAGING
IMAGING PLANES
RESPIRATORY COMPENSATION (RC)
CONCLUSION
6 Patient Care and Safety
INTRODUCTION
PATIENT SCREENING
SAFETY ZONES
SAFETY CONCERNS DURING THE EXAMINATION
PATIENT COUNSELLING
PATIENT IMMOBILIZATION
PATIENT AFTER‐CARE
CONCLUSION
7 Contrast Agents
INTRODUCTION
GD‐BASED POSITIVE CONTRAST AGENTS
NEGATIVE CONTRAST AGENTS
PATIENT CONSIDERATIONS
CONCLUSION
8 Head and Neck
BRAIN. Common indications
Basic anatomy (Figures 8.1 and 8.2)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE or spoiled GRE T1 or FSE/TSE‐IR T1
Axial/oblique CSE/FSE/TSE T2
Coronal/oblique CSE/FSE/TSE T2 (Figure 8.6)
Additional techniques. Axial/oblique FSE/TSE‐IR T1 (Figure 8.7)
Axial/oblique FLAIR T2 (Figure 8.8)
Axial/oblique CSE/FSE/TSE or spoiled GRE T1 +/– contrast enhancement
Axial 3D spoiled GRE T1 +/– contrast enhancement
SS‐FSE/TSE T2 with radial k‐space
Axial/oblique rewound GRE T2* or 3D SWI
Axial/oblique CSE MT
Axial/oblique EPI/ DWI (Figure 8.9)
Diffusion tensor imaging (DTI) (Figure 8.10)
Axial perfusion imaging
MR‐proton spectroscopy (MRS)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
TEMPORAL LOBES. Common indications
Basic anatomy (Figure 8.13) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1
Coronal/oblique CSE/FSE/TSE T1
Coronal 3D incoherent (spoiled) GRE T1
Axial/oblique/coronal/oblique FSE/TSE‐IR T2
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
INTERNAL AUDITORY MEATUS AND POSTERIOR FOSSA. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1 +/– contrast enhancement
Coronal CSE/FSETSE T1 +/– contrast enhancement
3D spoiled GRE T1 +/– contrast enhancement
Axial 3D FSE/TSE T1/PD/T2
Additional techniques. Axial 3D balanced GRE T2*
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
PITUITARY FOSSA. Common indications
Basic anatomy (Figure 8.22)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal SE/FSE/TSE T1
Coronal SE/FSE/TSE T1 +/– fat suppression
Additional techniques. Coronal CSE/FSE/TSE T1 +/– contrast enhancement
Sagittal CSE/FSE/TSE T1 +/– contrast enhancement
Sagittal 3D spoiled GRE T1 +/– contrast enhancement
Axial FSE/TSE T2
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
ORBITS. Common indications
Basic anatomy (Figures 8.26 and 8.27) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1
Axial/oblique CSE/FSE/TSE T1 or T2
Coronal CSE/FSE/TSE T2 +/– fat suppression or STIR (Figure 8.31)
Additional techniques. 3D or 2D Coronal/axial CSE/FSE/TSE T1/T2 + fat suppression +/– contrast enhancement (Figure 8.32)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
PARANASAL SINUSES. Common indications
Basic anatomy (Figure 8.33) Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal CSE/FSE/TSE T1
Axial CSE/FSE/TSE T1
Coronal/axial CSE/FSE/TSE T2 +/– fat suppression or STIR
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
PHARYNX. Common indications
Basic anatomy (Figure 8.36)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal CSE/FSE/TSE T1
Axial or coronal CSE/FSE/TSE T2 or STIR (Figure 8.40)
Sagittal CSE/FSE/TSE T2
Additional techniques
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
LARYNX. Common indications
Basic anatomy (see Figure 8.36) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1 and T2
Axial CSE/FSE/TSE T1
Coronal CSE/FSE/TSE T1
Axial/coronal CSE/FSE/TSE /T2 or STIR (Figures 8.43 and 8.44)
Additional techniques. Fast spoiled GRE or GE‐EPI T1
DWI
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
THYROID AND PARATHYROID GLANDS. Common indications
Basic anatomy (Figures 8.45 and 8.46) Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial/coronal CSE/FSE/TSE T1 +/– contrast enhancement (Figure 8.48)
Axial/ coronal CSE/FSE/TSE T2 +/– fat suppression
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
SALIVARY GLANDS. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal/sagittal CSE/FSE/TSE T1
Axial CSE/FSE /TSE T1
Axial CSE/FSE/TSE /T2 +/– fat suppression or STIR (Figure 8.49)
Additional techniques. SS‐FSE/TSE T2 or balanced GRE T2* or reverse‐echo GRE T2
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
TEMPOROMANDIBULAR JOINTS. Common indications
Basic anatomy (Figure 8.50) Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1 (mouth closed)
Sagittal/oblique CSE/FSE/TSE T1 (mouth closed and open)
Coronal/oblique CSE/FSE/TSE T1 (mouth closed and open)
Additional techniques. Sagittal/oblique FSE/SS‐FSETSE or SE‐EPI during mouth opening and closing
3D spoiled GRE or FSE/TSE T1
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
VASCULAR IMAGING. Common indications
Equipment
Patient positioning
Suggested protocol. Vascular imaging in the brain (Figures 8.52 and 8.53)
Vascular imaging in the neck
Contrast‐enhanced MRA of the carotids (Figure 8.54)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
HEAD AND NECK IMAGING – KEY POINTS
9 Spine
CERVICAL SPINE. Common indications
Basic anatomy (Figures 9.1 and 9.2)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1
Sagittal CSE/FSE/TSE T2 or rewound GRE T2* (Figure 9.5)
2D or 3D axial/oblique CSE/FSE/TSE T2 or rewound GRE T2* (Figure 9.6)
Additional techniques. Sagittal/axial oblique CSE/FSE/TSE T1 with contrast enhancement
Sagittal CSE/FSE/TSE T2 or STIR
3D balanced GRE (Figure 9.7)
Sagittal DWI
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
THORACIC SPINE. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1
Sagittal CSE/FSE/TSE T2 or rewound GRE T2* (Figure 9.9)
2D or 3D axial/oblique CSE/FSE/TSE T2 or rewound GRE T2* (Figure 9.10)
Additional techniques. Sagittal/axial/oblique CSE/FSE/TSE or spoiled GRE T1 +/– contrast enhancement
Sagittal STIR
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
LUMBAR SPINE. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1 (Figure 9.13)
Sagittal CSE/FSE/TSE T2 or rewound GRE T2*
2D or 3D axial/oblique CSE/FSE/TSE T2 or rewound GRE T2* (Figure 9.14)
Additional techniques. Axial/oblique or sagittal CSE/FSE/TSE T1 +/– contrast enhancement +/– fat suppression
Coronal CSE/FSE/TSE T1
Sagittal STIR (Figure 9.15)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
WHOLE SPINE IMAGING. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T1 and T2 (Figure 9.16)
Axial/oblique CSE/FSE/TSE T1 or T2
Additional techniques. Sagittal CSE/FSE/TSE T2 or STIR
Sagittal/oblique SE/FSE/TSE T1
MR myelography/neurography (Figure 9.17)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
SPINE IMAGING – KEY POINTS
10 Chest
LUNGS AND MEDIASTINUM. Common indications
Basic anatomy (Figure 10.1)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1 or spoiled GRE T1 (Figure 10.3)
Axial FSE/TSE PD/T2 or SS‐FSE/TSE T2/GRE T2*
Additional techniques. Perfusion studies
Ventilation study
Coronal fast spoiled GRE T1 or SS‐FSE/TSE T2
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
HEART AND GREAT VESSELS. Common indications
Basic anatomy (Figures 10.7 and 10.8)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Black‐blood imaging (Figure 10.16)
Sagittal/oblique CSE/FSE/TSE T1
Bright‐blood imaging (Figure 10.16)
Multi‐oblique spoiled GRE T1 or rewound GRE T2* multiphase (ciné)
Additional techniques. Spatial modulation of magnetization (SPAMM)
Contrast‐enhanced cardiac and vascular studies (Figures 10.17 and 10.18)
Cardiac perfusion studies
Diffusion tensor imaging (DTI)
Myocardial mapping
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
THYMUS. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1
Axial CSE/FSE/TSE T1 with contrast enhancement and fat suppression
Additional techniques. Axial FSE/TSE T2
Chemical shift imaging (in‐phase/out‐of‐phase GRE)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
BREAST. Common indications. For breast lesions
For breast implants
Basic anatomy (Figure 10.19)
Equipment
Patient positioning
Slice prescription
Suggested protocol (breast lesion imaging) Sagittal/axial CSE/FSE/TSE or spoiled GRE T1 (Figure 10.21)
Sagittal/axial CSE/FSE/TSE T2 +/– fat suppression or STIR (Figure 10.22)
Sagittal/axial 3D fast spoiled GRE T1 with fat suppression (pre‐contrast enhancement) (Figure 10.23)
Axial/sagittal 3D fast spoiled GRE T1 with fat suppression (dynamic post‐contrast enhancement) (Figure 10.24)
Sagittal fast spoiled GRE T1 (post‐processing) (Figure 10.25)
Suggested protocol (breast implants) Sagittal/axial FSE/TSE T1 and T2
Sagittal/axial FSE/TSE‐IR or STIR with fat/silicone/saline suppression (Figure 10.27)
Additional techniques. Axial CSE/FSE/TSE T1/T2 or STIR (Figure 10.28)
SS‐FSE/TSE or SE‐EPI or GRE‐EPI
DWI
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
AXILLA. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1
Axial CSE/FSE/TSE PD/T2 + fat suppression or STIR
Additional techniques. Sagittal CSE/FSE/TSE T1 and T2
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
BRACHIAL PLEXUS. Common indications
Basic anatomy (Figure 10.29)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal/oblique CSE/FSE/TSE T1 (Figure 10.30)
Coronal/oblique 3D FSE/TSE T2 or STIR (Figure 10.31)
Axial 3D spoiled GRE T1
Axial CSE/FSE/TSE PD/T2 + fat suppression
Sagittal/oblique CSE/FSE/TSE T1
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
CHEST IMAGING – KEY POINTS
11 Abdomen
LIVER AND BILIARY SYSTEM. Common indications
Basic anatomy (Figure 11.1)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE or spoiled GRE T1 – in and out of phase (Figures 11.3 and 11.4)
Axial CSE/FSE/TSE T2 or SS‐FSE/TSE T2 or rewound or balanced GRE T2* (Figures 11.5 and 11.6)
Axial SE/FSE/TSE or breath‐hold spoiled GRE T1 + contrast enhancement
Additional techniques. SS‐FSE/TSE T2 or balanced GRE or reverse‐echo GRE T2* (Figure 11.8)
SS‐FSE/TSE or GRE‐EPI/SE‐EPI/DWI or multi‐parametric imaging + contrast enhancement
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
KIDNEYS AND ADRENAL GLANDS. Common indications
Basic anatomy (Figure 11.9)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial spoiled GRE T1 in and out of phase +/– contrast enhancement +/– fat suppression (Figures 11.11and11.12)
Axial breath‐hold balanced GRE T2*
Additional techniques. MR urography (MRU)
Static‐fluid MRU – coronal breath‐hold SS‐FSE/TSE T2 or balanced GRE or reverse‐echo GRE T2*
Static‐fluid MRU – coronal/oblique respiratory triggered 3D FSE/TSE T2
Excretory MRU‐coronal breath‐hold 3D fast spoiled GRE T1 +/– contrast enhancement
DWI
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
PANCREAS. Common indications
Basic anatomy (Figure 11.16) Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE or breath‐hold fast spoiled GRE T1 +/– fat suppression/in‐ and out‐of‐phase imaging
Axial FSE/TSE or SS‐FSE/TSE T2 or balanced GRE T2* (Figures 11.19 and 11.20)
Axial breath‐hold fast spoiled GRE T1
SS‐FSE/TSE T2 or balanced GRE or reverse‐echo GRE T2* (Figure 11.21)
Additional techniques
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
BOWEL. Common indications
Equipment
Patient positioning
Patient preparation (may vary from site to site)
Slice prescription
Suggested protocol – MR Enterography (MRE) Coronal breath‐hold SS‐FSE/TSE T2 +/– fat suppression (Figure 11.22)
Coronal breath‐hold balanced‐GRE T2*
Axial breath‐hold balanced GRE T2*
Coronal breath‐hold balanced GRE T2*
Coronal breath‐hold 3D fast spoiled GRE T1
Axial breath‐hold 3D fast spoiled GRE T1
Coronal breath‐hold 3D fast spoiled GRE + contrast enhancement (Figures 11.23 and 11.24)
Axial breath‐hold 3D spoiled GRE T1
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
VASCULAR IMAGING. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. TOF‐MRA
Contrast‐enhanced MRA (CE‐MRA) (Figure 11.25)
Non‐contrast‐enhanced MRA
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
ABDOMINAL IMAGING – KEY POINTS
12 Pelvis
PROSTATE. Common indications
Basic anatomy (Figure 12.1)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal or sagittal/oblique CSE/FSE/TSE T2 (Figure 12.3)
Axial CSE/FSE/TSE T2 (Figure 12.4)
Coronal CSE/FSE /TSE T2 (Figure 12.5)
Axial CSE/FSE/TSE T1 +/– contrast enhancement (Figure 12.6)
DWI (Figure 12.7)
Additional techniques. Axial 3D fast spoiled GRE T1 +/– contrast enhancement (Figure 12.8)
Axial T1 (Pelvic survey)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
RECTUM AND TESTES. Common indications
Basic anatomy (Figure 12.1) Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal CSE/FSE/TSE T2
Axial CSE/FSE/TSE T1 and T2
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
UTERUS AND CERVIX. Common indications
Basic anatomy (Figure 12.10) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal CSE/FSE/TSE T2 (Figures 12.11 and 12.12)
Axial CSE/FSE/TSE T2
Axial CSE/FSE/TSE/spoiled GRE T1 (+/‐ fat suppression)
Coronal CSE/FSE/TSE T2
Additional techniques. SS‐FSE/TSE or GRE‐EPI/SE‐EPI or DWI
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
PELVIC IMAGING – KEY POINTS
13 Upper Limb
SHOULDER. Common indications
Basic anatomy (Figure 13.1)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial FSE/TSE T2 or rewound GRE T2*
Coronal/oblique CSE/FSE/TSE T1
Coronal/oblique FSE/TSE T2 +/− fat suppression (Figure 13.6)
Axial/oblique CSE/FSE/TSE T1 + fat suppression
Additional techniques. Sagittal/oblique CSE/FSE/TSE T1
Sagittal/coronal/axial/oblique FSE/TSE PD/T2 +/– fat suppression (Figures 13.7 and 13.8)
3D FSE/TSE PD or T2 contrast +/– fat suppression
3D GRE rewound GRE or balanced GRE T2*
MR arthrography (Figures 13.9 and 13.10)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
HUMERUS. Common indications
Basic anatomy (Figure 13.11) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal/coronal STIR (Figure 13.12)
Coronal CSE/FSE/TSE PD/T1 +/– fat suppression (Figure 13.13)
Axial CSE/FSE/TSE PD/T1 +/– fat suppression (Figure 13.14)
Axial FSE/TSE T2 + fat suppression or STIR
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
ELBOW. Common indications
Basic anatomy
Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal CSE/FSE/TSE T1(Figure 13.19)
Coronal FSE/TSE PD/T2 +/− fat suppression or STIR (Figure 13.20)
Sagittal CSE/FSE/TSE T1
Sagittal STIR or sagittal PD +/− fat suppression (Figure 13.21)
Axial FSE T1 or PD/T2 +/− fat suppression (Figure 13.22)
Rewound GRE T2* +/– fat suppression
Additional techniques. Coronal spoiled GRE T1
Coronal 3D rewound GRE T2*
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
FOREARM. Common indications
Basic anatomy (Figure 13.23)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal STIR
Coronal CSE/FSE/TSE T1 (Figure 13.24)
Axial CSE/FSE/TSE T1
Axial FSE/TSE T2 +/– fat suppression or STIR
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
WRIST AND HAND. Common indications
Basic anatomy (Figure 13.25)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal CSE/FSE/TSE T1
Coronal FSE/TSE T2 or rewound GRE T2* +/− fat suppression
Axial FSE/TSE T2 (Figure 13.29)
Axial CSE/FSE/TSE T1 (Figure 13.30)
Additional techniques. Axial FSE/TSE PD + fat suppression
Sagittal CSE/TSE/FSE T1
Sagittal CSE/FSE/TSE PD + fat suppression
3D spoiled GRE T1 or rewound GRE T2*
Sagittal/axial/coronal CSE/FSE/TSE T1/T2 (Figures 13.31 and 13.32)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
UPPER LIMB IMAGING – KEY POINTS
14 Lower Limb
HIPS. Common indications
Basic anatomy (Figure 14.1)
Equipment
Patient positioning
Slice prescription
Suggested protocol: bilateral examination. Coronal FSE/TSE T2 +/– fat suppression or STIR (Figure 14.4)
Coronal CSE/FSE/TSE T1
Axial CSE/FSE/TSE T1
Sagittal FSE/TSE PD/T2 or rewound GRE T2* +/– fat suppression (Figure 14.5)
Suggested protocol: unilateral examination
Coronal CSE/FSE/TSE T1
Coronal rewound GRE T2* or FSE/TSE T2 +/– fat suppression
Axial FSE/TSE PD +/− fat suppression
Axial CSE/FSE/TSE or spoiled GRE T1
Additional techniques. Coronal FSE/TSE T2 +/– fat suppression (bilateral)
Coronal/oblique FSE/TSE T2 + fat suppression (unilateral)
Axial/coronal CSE/FSE/TSE or spoiled GRE T1 + contrast enhancement
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
FEMUR. Common indications
Basic anatomy (Figure14.7) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal FSE/TSE T2 + fat suppression or STIR (Figure 14.8)
Coronal CSE/FSE/TSE T1
Coronal/oblique FSE/TSE T2 + fat suppression (bilateral) or coronal STIR (bilateral)
Axial CSE/FSE/TSE T1
Axial FSE/TSE PD/T2 +/− fat suppression (Figure 14.9)
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
KNEE. Common indications
Basic anatomy (Figure 14.10) Equipment
Patient positioning
Slice prescription
Suggested protocol. Sagittal rewound GRE T2* or sagittal/oblique FSE/TSE PD +/– fat suppression (Figure 14.13)
Coronal FSE/TSE PD/T2 +/− fat suppression or STIR (Figure 14.14)
Coronal CSE or spoiled GRE T1
Axial FSE/TSE PD/T2 +/− fat suppression
Additional techniques. Axial/sagittal CSE/FSE/TSE T1 +/– fat suppression
3D FSE/TSE T2/PD + fat suppression
Sagittal/axial 3D rewound GRE T2* +/– fat suppression or balanced GRE T2* or T2 quantification (Figure 14.15)
Dynamic imaging
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
TIBIA AND FIBULA. Common indications
Basic anatomy (Figure 14.17) Equipment
Patient positioning
Slice prescription
Suggested protocol. Coronal CSE/FSE/TSE T1 or spoiled GRE T1
Coronal/sagittal STIR or coronal FSE/TSE T2 + fat suppression (Figure 14.18)
Axial CSE/FSE/TSE T1
Axial FSE/TSE T2 +/− fat suppression or STIR (Figure 14.19)
Sagittal CSE/FSE/TSE T2 + fat suppression or STIR unilateral
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
ANKLE. Common indications
Basic anatomy (Figure 14.20)
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1
Axial FSE/TSE PD/T2 +/− fat suppression
Sagittal CSE/FSE/TSE T1/PD or spiled GRE T1 (Figure 14.23)
Sagittal FSE/TSE T2 or rewound GRE T2* +/– fat suppression or STIR (Figure 14.24)
Coronal CSE T1 or FSE/TSE PD/T2 +/− fat suppression (Figure 14.25)
Additional techniques. 3D spoiled GRE T1/PD
Fast rewound GRE/SS‐FSE/TSE /GRE‐EPI/SE‐EPI
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
FOOT. Common indications
Equipment
Patient positioning
Slice prescription
Suggested protocol. Axial CSE/FSE/TSE T1
Axial FSE/TSE PD/T2 +/– fat suppression
Coronal CSE T1/PD/T2 + fat suppression
Sagittal CSE/FSE/TSE T1/PD (Figure 14.28)
Sagittal FSE/TSE PD/T2 or STIR or rewound GRE T2* + fat suppression (Figure 14.29)
Additional techniques. Sagittal 3D rewound GRE T2*
3D FSE/TSE
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
VASCULAR IMAGING. Common indications
Basic anatomy (Figures 14.30and14.31)
Equipment
Patient positioning
Slice prescription
Suggested protocol. 2D/3D TOF‐MRA
Contrast‐enhanced MRA
3D non‐contrast‐enhanced MRA
Protocol optimization. Technical issues
Artefacts
Patient considerations
Contrast agents
LOWER LIMB IMAGING – KEY POINTS
15 Paediatric Imaging
INTRODUCTION
CREATING THE RIGHT ENVIRONMENT
SEDATION AND ANAESTHESIA
Staff considerations
Facilities
Equipment
Monitoring
Patient preparation
Sedation/anaesthesia strategies
Advantages of anaesthesia over sedation
Disadvantages of anaesthesia over sedation
Neonates and babies under 3 months
Example feed and swaddle technique
Babies and children 6 months to 5 years
Children over 5 years
Adults
Recovery
Emergencies
Departmental policies
THE MRI EXAMINATION
Brain
MRA
Spine
Musculoskeletal
Body and cardiac
Brain imaging
Axial/coronal FSE/TSE T2 (Figures 15.1 and 15.2)
FLAIR (Figure 15.3)
2D/3D FSE/TSE or spoiled GRE T1 +/– IR T1 (Figure 15.4)
Susceptibility weighted imaging or GRE/SE‐EPI (Figures 15.5 to 15.7)
DWI
Epilepsy (Figure 15.8)
Pituitary disease (Figure 15.9)
Tumours (Figure 15.10)
Hydrocephalus
Vascular imaging (Figures 15.11 and 15.12)
Spine imaging (Figures 15.13–15.20)
Scoliosis
Musculoskeletal imaging (Figures 15.21–15.24)
Body imaging (Figures 15.25–15.29)
Cardiac imaging (Figures 15.30–15.32)
Foetal MRI (Figure 15.33)
CONCLUSION
PAEDIATRIC IMAGING – KEY POINTS
Index
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