PITTS RADIOLOGY

RICHLAND MSK MRI PROTOCOLS

 UPPER EXTREMITY

STERNOCLAVICULAR JOINT
SHOULDER
PEC MAJOR
ELBOW
WRIST
THUMB
HAND/SYNOVITIS
FINGER
BRACHIAL PLEXUS
 MR STERNOCLAVICULAR JOINT

TIP: MAY NEED TO FLIP PHASE/FREQUENCY

ENCODING GRADIENTS

TIP: PRONE POSITION MAY REDUCE MOTION

ARTIFACT

COIL: 5 INCH FLEX (USE TMJ HOLDER IF

PATIENT SUPINE)
ROUTINE SC JOINT
SC JOINT AXIAL IMAGING PLANE
SC JOINT-SAGITTAL IMAGING PLANE
SC JOINT-CORONAL IMAGING PLANE
 MR SHOULDER

TIP: ON OBLIQUE CORONAL PHASE ENCODING

SHOULD BE RIGHT TO LEFT NOT SUPERIOR-
INFERIOR
TIP: PLACE ARM AT SIDE WITH THUMB TOWARD
CEILING
TIP: AXIAL SEQUENCE EXTENDS THROUGH
BICIPITAL GROOVE OF HUMERUS
TIP: BEWARE OF FLIPPED SHOULDER IMAGES
TIP: IF FATSAT IS POOR DO STIR INSTEAD OF FSE T2
FAT SAT
USC ATHLETES ON 3 T IF POSSIBLE
 MR SHOULDER

TIP: IF METALLIC ARTIFACT FROM HARDWARE

SUCH AS IM RODS OR SCREWS FOR FRACTURE
REPAIR. TURN OFF THE FAT SAT ON THE T1
AND T2 SEQUENCES AND ADD ONE AXIAL STIR
SEQUENCE.

TIP: ALL PEDS SPORTS RELATED INJURY

CASES(THROWERS/OVERHEAD ATHLETES)
ADD CORONAL 3D MEDIC (BLACK BONE)
SEQUENCE TO EVALUATE PHYSIS
 MR SHOULDER ROUTINE

1 AXIAL PROTON FSE FAT SAT

2 CORONAL OBLIQUE T2 FSE FAT SAT

3 SAG OBLIQUE T1

4 SAG OBLIQUE T2 FSE FAT SAT

5 AXIAL T2 FSE FAT SAT

6 CORONAL PD NO FAT SAT

 MR SHOULDER ROUTINE
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX PD FSE 256/256 A TO P
FAT SAT 12 4/0.5 1500 35 8 16
3

COR T2 256/256 ~4000 R TO L

FSE FAT 14 3/0.5 50-70 8 16
SAT
3

SAG T1 256/192 minimum A TO P

16 4/0.5 600 16
1

SAG T2 ~4000
FSE FAT 16 256/256 3/0.5 50-70 A TO P 8 16
SAT
2

AX T2 FSE ~4000
FAT SAT 16 256/256 4/0.5 50-70 A TO P 8 16
2

COR PD 2000
NO FAT 14 256/256 3/0.5 35 R TO L 8 16
SAT
 3 T MR SHOULDER ROUTINE
NEX PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
DIRECT
ION

AX Tru
Fisp 14

COR T2 320/288
FSE FAT 14 3 4mm/ 2825 55 R to L 12 25
SAT
1mm
SAG T1 320/288
14 3 4mm/ 500 10 A to P 3 31.25
1mm
SAG T2 320/288
FSE FAT 14 3 3mm/ 2825 58 A to P 12 25
SAT
1mm
AX T2 FSE 4mm/0.2 320/256
FAT SAT 14 3 mm
3000 50 A to P 12 25
 MR ARTHROGRAM SHOULDER

1 AXIAL PD FSE FAT SAT

2 AXIAL T1 SE FAT SAT

(ANGLED IN PLANE WITH GLENOID FOR
LABRUM)
3 CORONAL OBLIQUE FSE T2 FAT SAT

4 CORONAL OBLIQUE T1 SE FAT SAT

5 SAG OBLIQUE T1 SE (NON FAT SAT)!!!

6 SAG OBLIQUE FSE T2 FAT SAT

7 AX FISP
 MR SHOULDER ARTHROGRAM
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX PD 256/256 A TO P
FSE FAT 12 4/0.5 1500 35 8 16
SAT
3

AX T1 SE 256/192 minimum A TO P
FAT SAT 14 3/0.5 600 16
2

COR FSE 256/256 ~4000 R TO L

T2 FAT 14 3/0.5 50-70 8 16
SAT
3

COR T1 SE 256/192 minimum R TO L

FAT SAT 14 3/0.5 600 16
2

SAG T1 SE 256/192 minimum A TO P

14 3/0.5 600 15
2

SAG FSE 256/192 ~4000 A TO P

T2 FAT 14 4/0.4 50-70 8 16
SAT
2

AX TRU A TO
FISP 12
 3 T MR SHOULDER ARTHROGRAM
SEQ FOV NEX SLICE TR TE PHASE ETL
BANDWITH FREQUENC
Y/PHASE
DIRECT
ION

AX PD FSE
FAT SAT 14 3 3mm/ 3250 55 A to P 10 31.25 320/2
1mm 56
AX T1 FSE
FAT SAT 14 1 4mm/0.2
mm
500 10 A to P 1 31.25 320/256

COR FSE
T2 FAT 14 3 4mm/ 2825 55 R to L 12 25 320/288
SAT
1mm
COR T1 320/288
FSE FAT 14 2 4mm/ 500 10 R to L 3 31.25
SAT
1mm
SAG FSE 320/288
T1 14 1 4mm/ 500 10 A to P 3 31.25
1mm
SAG T2 320/288
FSE FAT 14 3 3mm/ 2825 55 A to P 12 25
SAT
1mm
AX TRU
FISP 12
SHOULDER POINTER AXIAL PLANE
SHOULDER AXIAL IMAGING PLANE
SHOULDER CORONAL PLANE
SHOULDER SAGITTAL PLANE
 MR PECTORLIS MAJOR

TIP: MAY NEED TO FLIP PHASE/FREQUENCY

ENCODING GRADIENTS

TIP: PRONE POSITION MAY REDUCE MOTION

ARTIFACT

TIP: AXIAL IMAGES HAVE TO GO THROUGH

ENTIRE PEC INSERTION(IF ? CALL RAD TO
APPROVE IMAGES)
MR PEC MAJOR
PEC MAJOR AXIAL PLANE
PEC MAJOR CORONAL PLANE
PEC MAJOR SAGITTAL PLANE
 MR ELBOW

TIP: AXIAL IMAGES GO THROUGH RADIAL

TUBEROSITY TO COVER BICEPS INSERTION

OBLIQUE SLICES TO GET TRUE IMAGING

PLANES (SEE SETUP EXAMPLES)!!!

TIP: USE SMALL FLEXI WRAP COIL ON 1.5. USE KNEE

COIL ON 3 T. COMPETITIVE ATHLETES TO BE DONE 3
T IF AT ALL POSSIBLE.
ADD A CORONAL T1 NON FAT SAT IF COMPETETIVE
ATHLETE ON ELBOW ARTHROGRAM
 MR ELBOW

SAGITTAL SEQUENCES MUST GO

THROUGH ENTIRE COMMON FLEXOR AND
EXTENSOR TENDON ORIGINS. MAKE SURE
THEY ARE COMPLETELY INCLUDED.
 MR ELBOW STANDARD

1 AXIAL T2 FSE FAT SAT

2 AXIAL T1 SE (NON FAT SAT)!!!

3 SAGITTAL STIR

4 SAGITTAL T1 SE (NON FAT SAT)!!!

5 CORONAL FSE T2 FAT SAT

6 CORONAL GRE 2D MEDIC

 MR ELBOW STANDARD
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX T2 FSE 256/192 ~4000 R TO L

FAT SAT 12 3/0.3 50-70 8 16
2

AX T1 SE 256/192 minimum R TO L
12 3/0.3 5-800 16
1

SAG STIR 256/192 2-4000 SUP TO

14 3/0.3 50 INF
8 16
2

COR FSE 256/192 ~4000 SUP TO

T2 FAT 12 3/0.3 50-70 INF
8 16
SAT
2

COR GRE SUP TO

2D medic 12 INF
 3 T MR ELBOW STANDARD
NEX PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
DIRECT
ION

Cor Fse 14 3 3mm/ 3300 55 Sup to 12 25 384/320

T2 fat sat
0 gap Inf
Cor Tru 14
Fisp

Sag Fse 14 2 3mm/ 3300 55 Sup to 12 25 384/320

T2 fat sat
1mm Inf
Ax Fse T2 14 2 3mm/ 4300 55 R to L 12 25 384/320
fat sat
1mm
Ax Fse T1 12 1 3mm/ 550 9 R to L 3 31.25 512/320

1mm
COR 3D 14
MEDIC
 MR ELBOW ARTHROGRAM

1 AXIAL T1 FSE (NON FAT SAT)!!!

2 AXIAL T2 FSE FAT SAT

3 SAG T1 SE (NON FAT SAT)!!!

4 SAG STIR

5 CORONAL T1 SE FAT SAT

6 CORONAL T2 FSE FAT SAT

7 CORONAL 3D MEDIC

8 CORONAL T1 NON FAT SAT (DO IF COMPETITIVE

 MR ELBOW ARTHROGRAM
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX FSE 256/256 ~4000

T2 FAT
14 4/1 50-60 8 16
3
SAT

AX TI SE 256/192 MINIMUM
NON FAT 14 4/1 400- 16
SAT 2
800
Sag T1 non 256/192 min
fat sat 14 4/1 400-
800
COR T1 256/192 MINIMUM
SE FAT
12 4/1 400- 16
SAT 2 800
COR T2 256/256 ~4000
FSE FAT 12 4/1 50-60 8 16
SAT 3

SAG 14 256/192 3/0.3 2- 50 8 16

STIR 2 4000
COR 3D 12
MEDIC
 3 T MR ELBOW ARTHROGRAM
PHASE BANDWITH FREQUENC
SEQ FOV NEX SLICE TR TE ETL Y/PHASE
DIRECT
ION

AX T1 14 1 3/1 550 9 R TO 3 31.25 512/320

FSE NON
FAT SAT L
AX T2 14 2 3/1 4300 55 R TO 12 25 384/320
FSE FAT
SAT L
SAG FSE 14 2 3/1 3300 55 Sup to 12 25 384/320
T2 FAT
SAT inf
Cor t1 fse 12 1 3/0 gap 625 14 SUP TO 3 31.25 512/320
fat sat INF

COR T2 3/ 0 GAP SUP TO 384/320

FSE FAT
12 3 3300 55 INF
12 25
SAT

Cor 12
3d gre
COR T1 DO IF
12 COMPETITIVE
ELBOW AXIAL PLANE
ELBOW CORONAL PLANE
ELBOW SAGITTAL PLANE
 MR WRIST

TIP: DO STIR IF POOR FAT SAT

TIP: FOV 6-8

TIP: FILM WITH PALM FACING UP

 MR WRIST STANDARD

1 CORONAL T1 SE (NON FAT SAT)!!!

2 CORONAL STIR

3 AXIAL T1 SE (NON FAT SAT)!!!

4 AXIAL T2 FSE FAT SAT

5 CORONAL HIGH RES 3D GRADIENT

6 SAGITTAL T2 FSE FAT SAT

 MR WRIST STANDARD
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

CORONAL 256/256 >2000

STIR 6-8 3/0.3 20-40 8 16
3 TI 150

AX T1 SE 256/192 MINIMUM
6-8 3/0.3 5-800 1 16
2

AX T2 FSE 256/192 ~4000

FAT SAT 6-8 3/0.3 50-60 8 16
2

COR HIGH
RES 3D 8
GRE

SAG T2 256/192 ~4000

FSE FAT 10 3/0.3 50-60 8 16
SAT
2
 MR ARTHROGRAM WRIST

1 CORONAL T1 SE (NON FAT SAT)!!!

2 CORONAL STIR

3 CORONAL T1 SE FAT SAT

4 CORONAL HIGH RES 3D GRADIENT

5 AXIAL T2 FSE FAT SAT

6 AXIAL T1 SE FAT SAT

7 SAG T2 FSE FAT SAT

 MR WRIST ARTHROGRM
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

CORONAL 256/256 >2000

STIR 6-8 3/0.3 20-40 8 16
TI 150
3

COR T1 SE 256/192
FAT SAT 6-8 3/0.3 400- 10-20 16
2 800
COR HIGH 256/192 MINIMUM
RES GRE 8 1/0 60 16
FLIP >40
1

AX T2 FSE ~4000
FAT SAT 8 256/2 3/0.3 50-60 8 16
56
AX T1 SE 256/192 MINIMUM
FAT SAT 8 3/0.3 400- 16
2 800
SAG T2 256/192 ~4000
FSE FAT 12 3/0.3 50-60 8 16
SAT 3
MR WRIST AXIAL PLANE
MR WRIST CORONAL PLANE
MR WRIST SAGITTAL PLANE
 MR THUMB

TIP: CORRECT IMAGING PLANES CRUCIAL (SEE

SETUP SECTION)

TIP: SHOULD BE TRIAGED TO PARKRIDGE IF

POSSIBLE
 ROUTINE THUMB MR

1 CORONAL T1 SE (NON FAT SAT)

2 CORONAL PROTON DENSITY FSE FAT SAT

3 CORONAL T2 FSE FAT SAT

4 AXIAL T1 SE (NON FAT SAT)

5 AXIAL T2 FSE FAT SAT

6 SAG STIR
 MR THUMB
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

COR T1 SE 256/256 MINIMUM

6-8 3/0.3 400- 16
800
COR T2 256/256
FSE FAT 6-8 3/0.3 2000- 90- 16 16
SAT
6000 110
AX T1 SE 256/192 MINIMUM
6-8 3/0.3 400- 16
800
AX T2 FSE 256/256 >2000
FAT SAT 6-8 3/0.3 50-60 8 16

SAG STIR 256/192 >2000 20-40

6-8 3/0.3 8 16
3 TI 150

COR PD 256/256
FSE FAT 6-8 3/0.3 1500 35 8 16
SAT
MR THUMB AXIAL PLANE
MR THUMB CORONAL PLANE
MR THUMB SAGITTAL PLANE
 MR HAND

TIP: FOR SYNOVITIS SCREENING ADD POST AXIAL AND

CORONAL T1 FAT SAT POST GAD

TIP: FOR SYNOVITIS SCREENING FOV MUST ALLOW

VISUALIZATION OF RADIOCARPAL JOINT AND PIP JOINTS

TIP: THIS PROTOCOL SHOULD BE USED RARELY EXCEPT

FOR SYNOVITIS. MOST HAND MR’S ORDERED SHOULD BE
WRIST, THUMB, OR FINGER IF PROTOCOLED CORRECTLY.
CHECK WITH MD BEFORE DOING 4 SEQUENCE HAND.
 MR HAND/SYNOVITIS

1 CORONAL T1 SE

2 CORONAL STIR

3 AXIAL STIR

4 AXIAL T1 SE

5 AXIAL T1 SE FAT SAT POST

(DONE ONLY FOR SYNOVITIS SCREENING)

6 CORONAL T1 SE FAT SAT POST

(DONE ONLY FOR SYNOVITIS SCREENING)
 MR FINGER

TIP: CORRECT IMAGING PLANES CRUCIAL ( SEE

SETUP IMAGES)

TIP: BE SURE TO CHECK WITH RADIOLOGIST

BEFORE COMPLETING STUDY IF INDICATION IS
LESION/MASS/INFECTION AND NO CONTRAST
WAS GIVEN

TIP: SHOULD BE TRIAGED TO PARKRIDGE IF

AT ALL POSSIBLE
 MR FINGER
1 COR FAT SAT PD

2 COR STIR

3 COR T1

4 SAT FAT SAT T2

5 AX FAT SAT T2

6 AX T1

7 AX FAT SAT PD
 MR FINGER
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

COR T1 SE 256/256 MINIMUM

3/0.3 400- 16
800
SAG T2 256/256
FSE FAT 3/0.3 2000- 90- 16 16
SAT
6000 110
AX T1 SE 256/192 MINIMUM
3/0.3 400- 16
800
AX T2 FSE 256/256 >2000
FAT SAT 3/0.3 50-60 8 16

COR STIR 256/192 >2000 20-40

3/0.3 8 16
3 TI 150

COR PD 256/256
FSE FAT 3/0.3 1500 35 8 16
SAT

AX PD FAT
SAT
MR FINGER AXIAL PLANE
MR FINGER CORONAL PLANE
MR FINGER SAGITTAL PLANE
 MR BRACHIAL PLEXUS

TIP: COVER HUMERUS TO HUMERUS ON CORONAL

SCANS. SAGGITAL SCAN AFFECTED SIDE START MID
C-SPINE THROUGH ENTIRE SHOULDER.COVER C2-T2
ON AXIAL SCANS

TIP: CHECK WITH MD IF NO CONTRAST GIVEN AND

INDICATION LESION/MASS/NEURITIS

TIP: TORSO PA COIL

CONTRAST IMAGES ARE POST T1 FAT SAT ALL 3 PLANES

 MR BRACHIAL PLEXUS

1 CORONAL T1 SE (NON FAT SAT)

2 CORONAL STIR

3 AXIAL T1 SE (NON FAT SAT)

4 AXIAL T2 FSE FAT SAT

(IF POOR FAT SAT SWITCH TO STIR)

5 (SIDE(S) IN ?) SAGITTAL T2 FSE FAT SAT

(IF POOR FAT SAT SWITCH TO STIR)

6 (SIDE(S) IN ?) SAGITTAL T1 SE (NON FAT SAT)

 MR BRACHIAL PLEXUS
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

COR T1 SE 256/192 MINIMUM

20 5/1 400- 16
1
800
COR STIR 256/192
20 5/1 2000- 40 8 16
2
4000
AX T1 SE 256/192 MINIMUM
20 5/1 400- 16
1
800
AX T2 FSE 256/192 3-4000
FAT SAT 20 5/1 70 8 16
2

SAG T2 256/192 3-4000

FSE FAT 20 5/1 70 8 16
SAT 2

SAG T1 SE 256/192 MINIMUM

20 5/1 400- 16
1
800
 LOWER EXTREMITY

OSSEOUS PELVIS
HIP
ATHLETIC PUBALGIA/SPORTS HERNIA
THIGH
KNEE
ANKLE
MIDFOOT
FOREFOOT
WHOLE FOOT
STRESS (TIBIA OR FEMUR)
 MR OSSEOUS PELVIS

INDICATIONS: OCCULT FRACTURE, MUSCLE

STRAINS/TEARS, HIP PAIN, R/O METS, SACROILITIS,
R/O AVN, R/O OSTEOMYELITIS

TIP: FOR R/O METS, R/O OSTEOMYELITIS, AND

SACROILITIS ADD PRE FAT SAT AXIAL T1 AND
POST T1 FAT SAT CORONAL AND AXIAL
SEQUENCES

TIP: ON AXIAL SEQUENCES SCAN FROM ILIAC

CRESTS TO JUST BELOW LESSER TROCHANTERS
 MR OSSEOUS PELVIS

1 AXIAL T1 SE (NON FAT SAT)

2 AXIAL FSE T2 FAT SAT

3 CORONAL T1 SE (NON FAT SAT)

4 CORONAL STIR

5 SAGITTAL FSE T2 FAT SAT (BOTH HIPS)

6,7,8 PRE FAT SAT T1 AXIAL AND POST AXIAL AND

CORONAL FAT SAT T1
(TO BE DONE ONLY FOR METS, OSTEO, SACROILITIS)
 MR OSSEOUS PELVIS
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

256/192
AX T1 30-45 4/1 4-800 MIN 16
SE
AX FSE T2 256/256
FAT SAT 30-45 4/1 3-4000 50-60 8 16

CORONAL 256/192
STIR 30-45 4/1 >2000 20-40 8 16
3
TI 150
SAG FSE 256/256
T2 FAT 20 4/1 3-4000 50-60 8 16
SAT BOTH
HIPS

COR SE T1 256/192
30-45 4/1 4-800 MIN 16

*IF 256/192
NEEDED 30 3/.5
POST T1
VIBE FAT
SAT
MR OSSEOUS PELVIS AXIAL PLANE
MR OSSEOUS PELVIS CORONAL PLANE
MR OSSEOUS PELVIS SAG PLANE
 MR HIP NONARTHROGRAM

1 AXIAL T1 SE (NON FAT SAT) LARGE FOV

2 AXIAL FSE T2 FAT SAT LARGE FOV
3 CORONAL T1 SE (NON FAT SAT)
4 CORONAL STIR
5 SAGITTAL FSE T2 FAT SAT (SYMPTOMATIC
HIP)
6 CORONAL FAT SAT PD (SYMPTOMATIC HIP)
 MR HIP NONARTHROGRAM

USE SAME PARAMETERS AS LISTED IN MR

OSSEOUS PELVIS FOR LARGE FOV SEQUENCES
AND SAME PARAMETERS AS LISTED IN MR
ARTHROGRAM FOR SMALL FOV SEQUENCES

IF FAT SAT POOR ON AXIAL T2 SWITCH TO STIR

 MR HIP ARTHROGRAM

TIP: PERFORM CORONAL STIR TO INCLUDE BOTH

HIPS AS ON OSSEOUS PELVIS. PERFORM ALL
OTHER SEQUENCES ON ONLY SIDE IN QUESTION.

TIP: PROPER SETUP CRUCIAL FOR ACCURATE

LABRAL EVALUATION. PLEASE SEE SETUP
IMAGES TO FOLLOW (SHOULD DO SEPARATE LOCALIZER TO SET UP THE
AXIAL OBLIQUE T1 AND GRE SEQUENCES)

TIP: IF NOT PRESSED FOR TIME ADDING SAG

GRADIENT OPTIONAL.
 MR HIP ARTHROGRAM

1 AXIAL FSE T2 FAT SAT

2 AXIAL OBLIQUE T1 SE (NON FAT SAT)

(IN PLANE WITH FEMORAL NECK)
3 SAGITTAL T1 SE FAT SAT

4 CORONAL T1 SE FAT SAT

5 CORONAL STIR

6 SAGITTAL FSE T2 FAT SAT

7 AXIAL OBLIQUE HIGH RES GRADIENT

(TRUFISP SIEMENS, MERGE GE)
 MR HIP ARTHROGRAM
SEQ FOV MATRIX/ SLICE TR TE PHASE ETL
BANDWITH FREQUENC
Y/PHASE
NEX DIRECT
ION

AX OBL T1 256/192
SE 20 4/1 4-800 MIN 16

AX FSE 256/256
T2 FAT
18 4/1 ~4000 50-70 8 16
SAT

SAG T1 SE 256/192
FAT SAT 20 4/1 4-800 MIN 16

COR T1 SE 256/192
FAT SAT 20 4/1 4-800 MIN 16

CORONAL 256/192
STIR 40 4/1 >2000 20-40 8 16
3
TI 150
SAG FSE 256/192
T2 FAT 20 4/1 ~4000 50-70 8 16
SAT

AX SMALL AS
OBLIQUE POSSIBLE
TRUFISP
3D
MR HIP ARTHROGRAM AXIAL PLANE (* SEE AXIAL
OBLIQUE TO FOLLOW*
MR HIP ARTHROGRAM CORONAL PLANE
MR HIP ARTHROGRAM SAGITTAL PLANE
 MR HIP ARTHROGRAM AXIAL OBLIQUE PLANE
(SHOULD DO SEPARATE COR LOCALIZER TO SET THIS UP CORRECTLY) THIS IS HOW THE IMAGE SHOULD
LOOK WHEN SE T UP CORRECTLY!
 MR HIP ARTHROGRAM AXIAL OBLIQUE PLANE
(SHOULD DO SEPARATE COR LOCALIZER TO SET THIS UP CORRECTLY)
MR HIP ARTHROGRAM AXIAL OBLIQUE PLANE
This is how the lines go down the femoral neck
 MR HIP ARTHROGRAM AXIAL OBLIQUE PLANE
This is NOT !!! how the lines go down the femoral neck. THIS IS INCORRECT SET UP BELOW FOR
EXAMPLE
 MR HIP POST ARTHROPLASTY

TIP: USE FLEX WRAPAROUND COIL

TIP: SAG IMAGES MUST GO THROUGH THE

MUSCLE INSERTIONS ON GREATER
TROCHANTER

TIP: PHASE ENCODING ALWAYS PARALLEL TO

LONG AXIS OF PROSTHESIS (CRANIOCAUDAL
DIRECTION
 MR POST HIP ARHTROPLASTY

TIP:Optimized image quality can be achieved with

spin-echo MR imaging by using a high bandwidth (at
least 130 Hz per pixel), a high-spatial-resolution
matrix (512 × 512), sequences with multiple
refocusing pulses, and a frequency-encoding axis
parallel to the long axis of the prosthesis. The degree
of distortion is reduced by using this optimized
technique .
 MR HIP POST ARTHOPLASTY
SEQ FOV MATRIX/ SLICE TR TE PHASE ETL
BANDWITH FREQUENC
Y/PHASE
NEX DIRECT
ION
AX T1 FSE 140X80 512X256 HIGHER
MM
3/1 669 18 9 THE
BETTER AT
LEAST 130
HZ PER
PIXEL

AX STIR 180X100 512X256 5550 34 WITH

MM
4/1 TI 150
SAG T1 SE 512X256
6/1 707 23
180X100
MM

COR T1 220X100 512X256

FSE MM
4/1 4-800 MIN 9
CORONAL 512X256
FSE T2 4/1 3910 75 9
220X100
MM

SAG FSE 180X100 512X256

T2 MM
6/1 ~4000 75 9
 SAGITTAL EXAMPLE IMAGE.

Pfirrmann C W A et al. Radiology 2005;235:969-976

©2005 by Radiological Society of North America

 CORONAL EXAMPLE IMAGE

Pfirrmann C W A et al. Radiology 2005;235:969-976

©2005 by Radiological Society of North America

 AXIAL EXAMPLE IMAGES

Pfirrmann C W A et al. Radiology 2005;235:969-976

©2005 by Radiological Society of North America

 MR THIGH

TIP: OBTAIN BOTH SIDES FOR COMPARISON

TIP: USE BODY OR TORSO COIL

TIP: THIS PROTOCOL USED MORE FOR SYSTEMIC

PROCESSES SUCH AS POLY OR DERMATOMYOSITIS TO
EVAL MUSCLE SIGNAL. IF MASS IS THE INDICATION USE
MASS PROTOCOL

TIP: FOLLOW OSSEOUS PELVIS IMAGING PLANES BUT

SCAN FROM ACETABULI TO KNEES IN AXIAL AND
CORONAL PLANES.
 MR THIGH

1 AXIAL SE T1 (NON FAT SAT)

2 AXIAL STIR

3 CORONAL SE T1 (NON FAT SAT)

4 CORONAL STIR
MR THIGH
 MR ATHLETIC PUBALGIA/SPORTS HERNIA

TIP:CENTER ON PUBIC SYMPHYSIS.

TIP: USE PHASE ARRAY COIL (SAME COIL USED

FOR GYN PATHOLOGY)

TIP: HAVE PATIENT EMPTY BLADDER PRIOR TO

SCAN
MR ATHLETIC PUBALGIA/SPORTS HERNIA
MR ATHLETIC PUBALGIA/SPORTS HERNIA AXIAL
PLANE
MR ATHLETIC PUBALGIA/SPORTS HERNIA CORONAL
PLANE
MR ATHLETIC PUBALGIA/SPORTS HERNIA SAG PLANE
 MR KNEE

TIP: ON 3T IF PATIENT NOT AN ATHLETE OF ANY KIND SKIP

FISP SEQUENCES AND ADD CORONAL T1 IN PLACE OF FISP
SEQUENCES.

TIP: SWAP PHASE AND FREQUENCY ON SAG AND AXIAL

SCANS.

TIP: IF POOR FAT SAT ON FSE T2 DO STIR.

TIP: .* USC ATHLETES TO BE DONE ON 3 T IF

POSSIBLE*
 TIP: DO FAT SAT T2 ACL SEQUENCE ON ALL ATHLETE KNEES AND ANY
CASE THAT ORDER STATES CONCERN FOR ACL TEAR
 MRI KNEE

TIP: SAGITTAL SEQUENCES MUST GO

THROUGH ENTIRE FIBULAR HEAD. WE
MUST SEE THE INSERTION OF THE
LATERAL LIGAMENTOUS STRUCTURES
AND BICEPS TENDON ON THE FIBULAR
HEAD.

TIP: PEDIATRIC CASES ADD CORONAL 2D OR 3D

GRADIENT SEQUENCE IF SPORTS/STRESS
INJURY THE INDICATION
 MR KNEE STANDARD
1 AXIAL PD FAT SAT

2 CORONAL FSE PD FAT SAT

3 SAG PD

4 SAG FSE T2 FAT SAT

5 COR T1 SE

6 COR FSE PD
(ADD FAT SAT T2 ACL SEQUENCE IF ATHLETE
AND/OR IF ACL TEAR CONCERN ON ORDER)
 MR KNEE STANDARD
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX PD FAT 16 256/192 4/0.4 2000 25

SAT
2

COR FSE 16 256/192 4/0.4 2000 40-50 4

PD FAT
SAT

SAG PD 14 256/192 3/0.5 2000 25

COR SE T1 16 256/192 4/0.4 4-800 MIN

COR FSE 14 256/192 3/0.5 2000 20 4

PD

SAG T2 14-16 256/192 4/0.4 4000 70 8

FSE FAT
SAT 2

CORONAL
OBLIQUE
 3 T MR KNEE

1 AXIAL FSE T2 FAT SAT

2 CORONAL FSE T2 FAT SAT

3 SAGITTAL FSE T2 FAT SAT

4 SAGITTAL FSE PD (NON FAT SAT!!!)

5 SAGITTAL HIGH RES GRE

(TRUFISP SIEMENS)

6 CORONAL HIGH RES GRE

(TRUFISP SIEMENS)

7 CORONAL PD (NON FAT SAT) *ADD T2 FAT SAT

 3 T MR KNEE
NEX PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
DIRECT
ION
AX FSE 15 2 4MM/ 3959 55 R TO L 12 31 384/320
T2 FAT
SAT 1MM
SAG FSE 15 2 3MM/ 4050 55 SUP TO 12 25 384/320
T2 FAT INF
SAT 1MM
COR FSE 15 2 4MM/ 3925 55 R TO L 12 31 384/320
T2 FAT
SAT 1MM
SAG FSE 15 2 2MM/0.2 3950 10 SUP TO 6 50 320/50
PD MM INF

SAG
TRUFISP 15

COR
TRUFISP 15

COR PD
*(ADD T2 15 2 3mm/ 3950 10 R TO 12 50 320/5
FS ACL
SEQUENCE
0.5mm L 0
IF
NEEDED)*
 MR KNEE ARTHROGRAM

1 AXIAL FSE T2 FAT SAT

2 CORONAL SE T1 (NON FAT SAT!!!)

3 CORONAL STIR

4 SAG FSE T2 FAT SAT

5 SAG SE T1 FAT SAT

6 SAG GRE T2*

 MR KNEE HARDWARE
(MEANS METAL SURGICAL HARDWARE. (NOT ACL REPAIR)IF ? CHECK
WITH RADIOLOGIST

1 AXIAL FSE T2 FAT SAT

2 SAGITTAL FSE PD (NON FAT SAT)

3 CORONAL STIR

4 SAG STIR

5 CORONAL FSE PD (NON FAT SAT)

6 CORONAL GRE T2 *
MR KNEE AXIAL PLANE
MR KNEE CORONAL PLANE
MR KNEE SAG PLANE
 MR ANKLE/MIDFOOT

TIP: IF POOR FAT SAT ON T2 FSE SWITCH TO STIR.

TIP: IF OSTEOMYELITIS IS THE QUESTION DO STANDARD

ANKLE AND CHECK WITH RADIOLOGIST TO SEE IF
CONTRAST NEEDED. IF CANNOT CONTACT RAD OR IN
DOUBT DO FAT SAT T1 POST IN ALL 3 PLANES.

TIP: IMAGES SHOULD COVER ENTIRE MIDFOOT ALL

SEQUENCES

TIP: IF FOREIGN BODY IS INDICATION ADD SAG

GRE.
 MR ANKLE

ALL PEDS SPORTS RELATED INJURY CASES ADD

CORONAL 3D MEDIC (BLACK BONE) SEQUENCE
TO EVALUATE PHYSIS
 MR ANKLE/MIDFOOT

1 AXIAL SE T1 (NON FAT SAT)

2 AXIAL FSE T2 FAT SAT

3 SAG STIR

4 SAG SE T1 (NON FAT SAT)

5 CORONAL FSE T2 FAT SAT

6 COR SE T1
 MR ANKLE/MIDFOOT
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX SE 12-14 256/192 4/0.4 5-800 MIN

T1 1

AX FSE T2 256/192 ~4000

FAT SAT 12-14 4/0.4 70 8
2

SAG 12-14 256/192 4/0.4

STIR

SAG 12-14 256/192 4/0.4 5-800 MIN

SE T1 1

COR FSE 256/192 ~4000

T2 FAT 12-14 4/0.4 70 8
SAT
2

COR SE T1 256/192
12-14 4/0.4 5-800 MIN
1
 MR ANKLE ARTHROGRAM

1 SAG SE T1 FAT SAT

2 SAG STIR

3 CORONAL T1 (NON FAT SAT)

4 CORONAL FSE T2 FAT SAT

5 AXIAL FSE T2 FAT SAT

6 AXIAL SE T1 FAT SAT

 MR ANKLE ARTHROGRAM
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

AX SE T1 12-14 256/192 4/0.4 5-800 MIN

FAT SAT
1

AX FSE T2 256/192 ~4000

FAT SAT 12-14 4/0.4 70 8
2

SAG 12-14 256/192 4/0.4

STIR
SAG SE 12-14 256/192 4/0.4 5-800 MIN
T1 FAT
SAT 1

COR FSE 256/192 ~4000

T2 FAT 12-14 4/0.4 70 8
SAT
2

COR SE T1 256/192
12-14 4/0.4 5-800 MIN
1
MR ANKLE AXIAL PLANE
MR ANKLE CORONAL PLANE
MR ANKLE SAG PLANE
 MR FOREFOOT

TIP: CONTRAST GIVEN IF INDICATION MORTONS

NEUROMA, PLANTAR PLATE INJURY, OR SOFT
TISSUE MASS/PALPABLE ABNORMALITY.

TIP: THIS PROTOCOL AND ANKLE SHOULD BE USED

MOST OFTEN. WHOLE FOOT LESS OFTEN. IF IN
DOUBT WHICH TO USE PLEASE CHECK WITH
RADIOLOGIST.

TIP: IF FOREIGN BODY IS THE INDICATION

ADD SAG GRE.
 MR FOREFOOT

1 SHORT AXIS SE T1 (NON FAT SAT)

2 SHORT AXIS FSE T2 FAT SAT

3 SAG STIR

4 SAG SE T1 (NON FAT SAT)

5 LONG AXIS SE T1 (NON FAT SAT)

6 LONG AXIS STIR

7 POST GAD ALL 3 PLANE FAT SAT T1 SE

(ONLY IF
INICATED)
 MR FOREFOOT
MATRIX/ PHASE BANDWITH FREQUENC
SEQ FOV SLICE TR TE ETL Y/PHASE
NEX DIRECT
ION

SA SE 12 256/256 3/0.5 4-800 MIN 16

T1
1

SA FSE 12 256/192 3/0.5 ~4000 50-60 8 16

T2 FAT
2
SAT
SAG SE 12-14 256/256 3/0.5 4-800 MIN 16
T1
1

LA SE T1 12-14 256/256 3/0.5 4-800 MIN 16

1

LA 12-14 256/256 3/0.5 >2000 20-40 8 16

STIR
3 TI 150
SAG 12-14 256/256 3/0.5 >2000 20-40 8 16
STIR
3 TI 150
3 PLANE 256/192
POST FAT 12-14 4/1 4-800 MIN 16
MR FOREFOOT SHORT AXIS
MR FOREFOOT LONG AXIS
MR FOREFOOT SAG PLANE
 MR WHOLE FOOT

THIS SHOULD BE USED VERY RARELY. MOST

STUDIES SHOULD BE ANKLE OR FOREFOOT.
PLEASE READ ORDER AND QUESTION PATIENT
AS TO WHAT IS TO BE IMAGED. IF NEEDED
CALL ORDERING MD TO CONFIRM. LARGE FOV
IN FOOT LIMITS RESOLUTION AND BASICALLY
ANSWERS BIG QUESTIONS LIKE FRACTURES
AND OSTEOMYELITIS.
 MR WHOLE FOOT
(USE SAME IMAGING PLANES AS ANKLE AND SAME PARAMETERS)

1 SAG STIR

2 SAG T1 SE (NON FAT SAT)

3 LONG AXIS SE T1

4 LONG AXIS FAT SAT FSE T2

5 SHORT AXIS SE T1

6 SHORT AXIS FAT SAT FSE T2

IF OSTEO THE QUESTION ADD POST FAT SAT

 MR STRESS (TIBIA OR FEMUR)

TIP: FOR FEMUR SETUP PLANES JUST LIKE THIGH.

FOR TIBIA SEE IMAGES TO FOLLOW

TIP: CORONAL AND AXIAL IMAGES ARE

BILATERAL(AT LEAST TO START WITH AS LONG AS
QUALITY IS ADEQUATE) . SAG IS UNILATERAL SIDE
OF INTEREST.

TIP: PLEASE PAY ATTENTION TO IMAGE QUALITY IF

AXIAL BILATERAL SEQUENCE IS POOR QUALITY
SWITH TO UNILATERAL
 MR STRESS (TIBIA OR FEMUR)

1 CORONAL SE T1 (BILATERAL)

2 CORONAL STIR (BILATERAL)

3 AXIAL SE T1 (BILATERAL)

4 AXIAL STIR (BILATERAL)

5 SAGITTAL STIR (UNILATERAL LEG OF

INTEREST)
MR STRESS (TIBIA) CORONAL PLANE
MR STRESS (TIBIA) AXIAL PLANE
MR STRESS (TIBIA) SAGITTAL PLANE
 MR MASS OR INFECTION

TIP: SITE MUST BE MARKED IF POSSIBLE

TIP: DO SAG IF MASS IS ANTERIOR OR POSTERIOR. DO

CORONAL IF MASS IS MEDIAL OR LATERAL. IF IN
DOUBT AND CANNOT CONSULT RADIOLOGIST DO ALL 3
PLANES.

TIP: THIS IS NOT TO BE USED IN THE FOOT OR PELVIS.

PLEASE CONSULT SECTIONS ABOVE. IF IN DOUBT
PLEASE CHECK WITH RAD. IF THERE IS A MASS IMAGES
SHOULD ALWAYS IF POSSIBLE BE REVIEWED BY
RADIOLOGIST BEFORE PATIENT LEAVES.
 MR MASS OR INFECTION

1 AXIAL SE T1 (NON FAT SAT)!!!

2 AXIAL STIR

3 CORONAL OR SAG SE T1 (NON FAT SAT)!!!

4 CORONAL STIR

5 AXIAL POST GAD SE T1 (IF MASS NO FAT SAT, IF

INFECTION FAT SAT) IF ? CALL RADIOLOGIST

6 SAG OR CORONAL POST GAD SE T1 WITH

FAT SAT
 ADDITIONAL TIPS

TIPS: PLEASE CALL WITH ?’S AS MUCH AS

NEEDED.

TIPS: SMALL PARTS CASES ( WRISTS, FINGERS,

COMPETITIVE ATHLETES FOOT/ANKLE)
SHOULD BE TRIAGED TO APPROPRIATE
LOCATIONS AS MUCH AS POSSIBLE SO BEST
QUALITY IMAGES CAN BE OBTAINED.