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Uterus Protocol
Overview
Uterine MRI is performed on patients with suspected uterine masses, uterine
anomalies and sometimes for pelvic pain. Since uterine anomalies can be
associated with renal anomalies it is useful to start with a large field of view
coronal SSFSE locator (using the body coil) to get a quick look at the kidneys.
Then switch to a small FOW and higher resolution pelvic array or torso array
coil. The uterus is best evaluated on T2 weighted images because of the uterine
geometry and importance of showing the endometrium and relationship of any
abnormality to the endometrium; it is essential to image the uterus in 3 planes.
Start with sagittal T2 and use this as a guide for obtaining images that are axial
and coronal to the uterine fundus. An axial T1 weighted sequence is useful as a
general pelvic screening sequence for adenopathy or other masses. If
endometriosis is suspected image the pelvis with T1 fat saturation images.
Met-hemoglobin in endometriomas will be bright on this sequence. When endometrial carcinoma is present, a dynamic Gd FMPSPGR
sequence in the sagittal (or axial to uterus) plane can help to delineate the depth of tumor invasion.

 
  Large FOV Sag PD & T2 Ax T1 Ax T2 Cor T2
IMAGING PARAMETERS
Plane Coronal Sagittal Axial Oblique Oblique
Mode 2D 2D 2D 2D 2D
Pulse Seq SSFFSE FSE SE FSE FSE
Imaging Options Fast, VB, NPW FC, NBW, Fast RC, NPW, EDR NPW, VBW, Fast NPW, VBW, Fast
SCAN TIMING
# of Echoes 1 2 1 1 1
TE 90 102 Min full 130 130
TR -- 2700 500 6000 6000
Flip Angle -- ETL=8   ET:16 ET:16
Bandwidth 31.25 31.25   31.25 31.25
ADDITIONAL PARAMETERS (see attached instructions)
SAT None A A,S,I A,S,I S,I
 ACQUISITION TIMING
Freq 256 256 256 256 256
Phase 256 192 160 160 224
NEX 1 2 2 3 2
Phase FOV 1   --    
Locs Before Pause 10        
Freq DIR S/I S/I R/L R/L S/I
Auto Center Freq Water Water Peak Water Water
Auto Shim On Off On Off Off
Contrast No No No No No
SCANNING RANGE
FOV 44 22 20 22 22
Slice Thickness 8 4.0 8 5 5.0
Spacing 0 1.0 intleave 1 1
Start - End A75-P85     -- --
# Slices 20 19 20 19 19
Scan Time 40 3:36 9:00. 3:48 3:36
 
Common Indications ICD9 Codes
Pelvic pain 625.9
Infertility 628.9
Uterine anomaly 752.3
Uterine leiomyoma 218.9
Adenomyosis 617.0
Uterine mass 625.8
 
Scheduling Guidelines:
 First Ask
1. 1.      Why is pelvic MRI requested?________________
2. 2.      Do you have infertility?______________________
3. 3.      Do you have pelvic pain?____________________ Location Right___ Left___
4. 4.      Date of most recent menses__________________ Are you taking any hormones?__________
5. 5.      Any prior imaging (Ultrasound or CT)?__________
 If not Cornell please ask for fax or copies of prior reports.
6. Have you had pelvic surgery? Hysterectomy? Ovaries present or absent?
7. Have you ever had cancer? What type________? When was cancer diagnosed?_________
8. If claustrophobic à valium 10mg po or axons 1-2 mg po to be taken at time of scanning.
 Schedule on Dr. Troiano’s Day ( Tuesday) in AM preferably before 11 am.
 If it cannot be scheduled on Tuesday, notify Dr. Troiano (beeper 17443)
 Pelvic MRI requires a 30 minute slot without Gd, 1 hour if with Gd (ie. mass or cancer).
 
Patient Preparation:
 Change all clothes;
Remove bra if it any metal
as it is necessary to obtain
one image that includes
kidneys.
 If mass or cancer
suspected start intravenous
line (20 or 22 gauge iv).
If iv calibre is small (i.e.
22 gauge) then pre-warm
the gadolinium contrast to
body temperature to
reduce its viscosity.
Coil: Pelvic or torso array
Patient Positioning: Supine, feet first,
Landmark: Just below top of iliac Crest
 
 
 
Series 1: Large Field-of-View
Coronal SSFSE
 This sequence must be high enough to
include kidneys which may be abnormal in
patients with uterine anomalies
 Use body coil

 
Series 2: Sagittal T2
 Anterior saturation band over
subcutaneous fat helps to eliminate
respiratory motion artifact
 Include entire uterus and lower lumbar
spine and sacrum
 If there is pelvic pain than it may be useful
to also acquire proton density (TE = 17)
images at the same time to evaluate any
intervertebral disc disease.

 
 
 
 
Series 3: Axial T1
This sequence is to evaluate for fatty masses,
hemorrogic collection/cysts, adenopahthy and
muscles.
 Cover entire pelvis
 Place anterior saturation band
 If endometriosis is suspected, repeat with
fat saturation.
 
Series 4: Axial T2 (Axial to Uterus)
This sequence evaluates any endometrial abnormalities and shows the relationship of any
fibroids to the endometrium. It is especially useful for identifying submucusal fibroids
which may cause irregular bleeding.
 If cervical CA or adnexal mass is suspected scan as axial to pelvis instead of axial
to uterus.

 
 
Series 5: Coronal T2 (Coronal to Uterus)
This sequence evaluates abnormalities of the uterus. It is
acquired coronal to the uterine fundus.
 Do not use fat saturation, bright fat helps to
identify the outer contour of the fundus
 
 
Filming Instructions:
Each series on 1 sheet of film
 
Billing Instructions:
 
 
 
ICD9 Codes:
Malignant neoplasm fo uterus, part unspecified 179
Malignant neoplasm of cervix uteri 180.0-180.9
Malignant neoplasm of placenta 181
Malignant neoplasm of body of uterus 182.0-182.8
Malignant neoplasm of ovary and other uterine adnexa 183.0-183.6
Benign neoplasm, uterine leiomyoma 218.0-218.9
Other benogn neoplasm of ovary 219.0-219.9
Benign neoplasm of ovary 220
Carcinoma of uterus 236.0
Adenomyosis 617.0
 
 
 
Sample Normal Dictation:
 
Clinical Statement:
The patient is on day _____ of her menstrual cycle.
 
Technique: 1.5 Tesla
Large field –of-view Coronal SSFSE in bodycoil
Axial T1, Sagittal T2, Axial-to-uterus T2 and Coronal to uterus T2 using
torso coil
Findings: The uterus has a normal appearance measuring _____x______x______cm.
No uterine leiomyoma or other masses are identified.
The endometrium measures _____ in thickness; there is no evidence of
adenomyosis. Normal ovaries are identified bilaterally measuring
______x______x______ on the right and _____x_____x_____ on the left.
(No, trace ____) Free fluid is identified in the can de sac. No pelvic
masses are identified.
Although the technique is not optimal to evaluate the lumbo-sacral spine,
no abnormality of L4-5, L5-S1, or the rest of the sacrum is identified.
Normal sciatic nerves are identified in the sciatic notch bilaterally.
 
Impression:
Normal Pelvic MRI