MRI Brain Protocol and Planning.pptx MRI Brain Protocol and Planning.pptx

MRI Brain Protocol and Planning.pptxMRI Brain Protocol and Planning.pptx

1. MRI Brain Protocol and Planning By Mr. Dinesh Sekar M.Sc. Radiology Assistant Professor /Clinical Supervisor Department Of Radiology

2. COMMON INDICATIONS FOR MRI OF THE BRAIN Transient ischaemic attack (TIA), cerebrovascular attack (CVA) Infection, inflammation, meningitis, encephalitis, HIV, AIDS, TB Cognitive decline, neurodegenerative disorders, dementia Demyelinating disease, multiple sclerosis Loss of consciousness, seizures, epilepsy Brain tumour, metastases, abscess Cerebellar lesion, brainstem lesion Congenital abnormalities Post-operative follow-up Vascular pathologies Headaches Haemorrhage

3. CONTRAINDICATIONS Any electrically, magnetically or mechanically activated implant (e.g. cardiac pacemaker, insulin pump biostimulator, neurostimulator, cochlear implant, and hearing aids) Intracranial aneurysm clips (unless made of titanium) Pregnancy (risk vs benefit ratio to be assessed) Ferromagnetic surgical clips or staples Metallic foreign body in the eye Metal shrapnel or bullet

4. PATIENT PREPARATION FOR MRI BRAIN A satisfactory written consent form must be taken from the patient before entering the scanner room Ask the patient to remove all metal objects including keys, coins, wallet, cards with magnetic strips, jewellery, hearing aid and hairpins Contrast injection risk and benefits must be explained to the patient before the scan Gadolinium should only be given to the patient if GFR is > 30 Offer earplugs or headphones, possibly with music for extra comfort Explain the procedure to the patient Instruct the patient to keep still Note the Hight and weight of the patient

5. POSITIONING FOR MRI BRAIN Head first supine Position the head in the head coil and immobilize with cushions Give cushions under the legs for extra comfort Centre the laser beam localiser over the glabella

6. Recommended MRI Brain Protocols and Planning BRAIN LOCALISER A three-plane localizer must be taken at the beginning to localize and plan the sequences. Localizers are usually less than 25 seconds and are T1-weighted low-resolution scans.

7. T2 TSE AXIAL Plan the axial slices on the sagittal plane and position the block parallel to the genu and splenium of the corpus callosum. Verify the planning block in the other two planes and ensure that an appropriate angle is maintained in the coronal plane, making it perpendicular to the line of the midline of the brain and the 4th ventricle. Ensure that the number of slices is sufficient to cover the entire brain from the vertex to the line of the foramen magnum.

8. Protocol Parameters of T2 TR 4000-5500 TE 100-120 SLICE 3MM FLIP 130-150 PHASE R>L MATRIX 320X320 FOV 210-230 GAP 10% NEX(AVRAGE) 2

9. T2 FLAIR AXIAL Plan the axial slices on the sagittal plane and position the block parallel to the genu and splenium of the corpus callosum. Verify the planning block in the other two planes and ensure that an appropriate angle is maintained in the coronal plane, making it perpendicular to the line of the midline of the brain and the 4th ventricle. Ensure that the number of slices is sufficient to cover the entire brain from the vertex to the line of the foramen magnum.

10. Protocol Parameters of FLAIR TR 7000-9000 TE 110 FLIP 130 NEX 2 SLICE 3MM MATRIX 320X320 FOV 210-230 PHASE R>L GAP 10% TI 2500

11. RESOLVE DWI AXIAL Plan the axial slices on the sagittal plane and position the block parallel to the genu and splenium of the corpus callosum. Verify the planning block in the other two planes and ensure that an appropriate angle is maintained in the coronal plane, making it perpendicular to the line of the midline of the brain and the 4th ventricle. Ensure that the number of slices is sufficient to cover the entire brain from the vertex to the line of the foramen magnum.

12. RESOLVE DWI : RESOLVE is an advanced technique used to obtain high-quality and high-resolution DWI (diffusion-weighted imaging) images, particularly in body regions affected by susceptibility artifacts. It offers sharp imaging with minimal distortions and provides excellent spatial resolution. RESOLVE is especially valuable for evaluating smaller lesions in a wide range of DWI and DTI (diffusion tensor imaging) examinations. By combining RESOLVE with Simultaneous Multi-Slice (SMS) acceleration, acquisition time can be significantly reduced, improving both speed and imaging capabilities. RESOLVE finds application in various clinical fields, including neurology, oncology, and pediatric imaging. Its outstanding balance between imaging speed and quality makes it superior to other diffusion-weighted imaging sequences. Benefits of RESOLVE include high-quality DWI and DTI, reduced susceptibility and blurring artifacts, insensitivity to motion-induced phase errors, lower specific absorption rate (SAR) compared to TSE-based methods, and compatibility with iPAT for faster scans and further reduced distortions.

13. Protocol Parameters of RESOLVE DWI TR 7000-9000 TE 70 115 FLIP 180 NXA 1    2 SLICE 3MM MATRIX 192X192 FOV 210-230 PHASE R>L GAP 10% B VALUE 1000

14. T1 SE CORONAL Plan the coronal slices on the sagittal plane and angle the planning block perpendicular to the line along the genu and splenium of the corpus callosum. Verify the planning block in the other two planes. Ensure that an appropriate angle is maintained in the axial plane, perpendicular to the midline of the brain. The number of slices should be sufficient to cover the entire brain from the frontal sinus to the line of the occipital protuberance.

15. TR 500-700 TE 15-25 SLICE 3MM FLIP 90 PHASE R>L MATRIX 304X304 FOV 210-230 GAP 10% NEX(AVRAGE) 2 Protocol Parameters of T1

16. T2 TSE SAGITTAL Plan the sagittal slices on the axial plane and position the block parallel to the midline of the brain. Verify the planning block in the other two planes. Angle the planning block appropriately in the coronal plane, ensuring it is parallel to the line along the midline of the brain and the 4th ventricle. Make sure that the number of slices is sufficient to cover the entire brain from one temporal lobe to the other.

17. Protocol Parameters of T2 Sagittal TR 4500-6000 TE 100-120 SLICE 3MM FLIP 130-150 PHASE A>P MATRIX 320X304 FOV 210-230 GAP 10% NEX(AVRAGE) 2

18. INDICATIONS FOR CONTRAST-ENHANCED BRAIN SCAN Tumour, Metastases, Cranial nerve lesion, Indeterminate intracranial lesion, IAC mass Cavernous angioma, Amyloid angiopathy, Neurocysticercosis Meningitis, Encephalitis, Leptomeningeal spread Multiple Sclerosis, AVM, HIV, Infection Abscess Leukodystrophies, Delayed development Syringomyelia(Syrinx)

19. OPTIONAL EPI DWI PLANNING FOR THE OLD GENERATION SCANNERS DWI EPI 3 SCAN TRACE AXIAL To minimize air-bone interface artifacts, plan the DWI axial slices on the sagittal plane with the planning block angled parallel to the line connecting the glabella and the foramen magnum. It is important to note that older generation scanners can create such artifacts. For epi DWI scans, a different angle is used compared to other axial scans, aligning it with the glabella and foramen magnum. Make sure to verify the planning block in the other two planes and determine an appropriate angle in the coronal plane that is perpendicular to the line of the 3rd ventricle and brainstem. Additionally, ensure that the slices adequately cover the entire brain from the vertex to the foramen magnum.

20. Protocol Parameters of epi DWI TR 7000-9000 TE 110 FLIP 130 NXA 4 SLICE 4MM MATRIX 192X192 FOV 210-230 PHASE R>L GAP 10% B VALUE 500 1000

21. Reference Medical Imaging Methods: Recent Trends (Ashutosh Kumar Shukla/1st Edition) MRI Master