MR1: BRAIN contrast
DWI & ADC map
T1 AX
FSE (TSE) T2 AX
FLAIR AX
GAD T1 AX
GAD T1 SAG
GAD T1 COR
MR2: BRAIN noncontrast
DWI & ADC map
T1 SAG
FSE (TSE) T2 AX
FLAIR AX
MR3: BRAIN MS (multiple sclerosis)
DWI & ADC map
T1AX
FSE (TSE) T2 AX
FLAIR SAG
FLAIR AX
GAD T1 AX
GAD T1 COR
MR4: BRAIN trauma bleed
Do: MR2: BRAIN noncontrast
add: T2* AX
GE: MPGR AX
Siemens: FLASH 2D AX
Philips: FFE AX
Toshiba: FE AX
MR5: BRAIN nontrauma bleed
Do: MR1: BRAIN contrast
add: T2* AX
GE: MPGR AX
Siemens: FLASH 2D AX
Philips: FFE AX
Toshiba: FE AX
MR6: BRAIN seizure new onset adult (and children 10 years and older)
Do: MR1: BRAIN contrast
add: T2* COR
GE: MPGR COR
Siemens: FLASH 2D COR
Philips: FFE COR
Toshiba: FE COR
MR7: BRAIN seizure chronic adult (and children 10 years and older)
DWI & ADC map
T1SAG whole brain (include all of temporal lobes)
FSE (TSE) T2 AX whole brain
FLAIR COR whole brain
T2* COR thin slice whole brain (slice 5, skip 0.5)
GE: MPGR COR
Siemens: FLASH 2D COR
Philips: FFE COR
Toshiba: FE COR
Ultrafast gradient echo COR whole brain (nose to back of skull, slice 1.5, skip 0)
GE: 3D FGRE or 3D Fast SPGR COR
Siemens: 3D MP RAGE COR
Philips: 3D TFE
Toshiba: QUICK 3D
note: all coronals FOV = 22 X 16
precise head positioning and centering are critically important in all COR
If FLAIR or T2 shows a mass, then skip the Ultrasfast gradient echo COR whole brain, and instead do GAD T1 AX and GAD T1 COR
MR8: BRAIN pediatric routine (age 0 - 10 years)
Note: for age greater than 10 years, use adult brain protocol
Schedule with anesthesiology service unless referring physician or parent is confident that sedation is not necessary.
Some sleeping infants can be scanned without medication: use your judgement
T1 SAG
T1 AX
FSE (TSE) T2 AX
FLAIR AX
Send to PACS and have a neuroradiologist (Nam, Kash, Patel, or Pulnik) look at images and have them decide whether to give GAD
They may be at another facility. See the Bryan Radiology schedule. Radiologists have access to other facilities' PACS at all locations unless they are at Brenham/Bellville.
If no neuroradiologist is available, it is your (the technologist's) option to ask a non-neuroradiologist at your facility if he wants to look at the pre-contrast images. If no radiologist is willing and/or available to view the pre-contrast images, then give GAD:
GAD T1 COR
GAD T1 SAG
GAD T1 AX
The radiologist who makes a decision not to give contrast must interpret and dictate the case.
MR9: BRAIN pediatric seizures (age 0 -10 years)
Note: for age greater than 10 years, use adult brain protocol
All sequences are whole brain
T1 SAG
TSE T2 AX (age <1 year: TR = 3000, TE = 120) (age >1 year: TR = 2500, TE = 80)
T1 AX
FLAIR COR
Ultrafast gradient echo COR (see abbreviations page) slice 1.5, skip 0
GAD T1 AX
GAD T1 COR
MR10: SELLA
T1 SAG whole brain
FLAIR AX whole brain
T1 COR sella
FSE (TSE) T2 COR sella (only if you see obvious sellar and suprasellar mass)
GAD dynamic T1 COR sella (only if you do NOT see obvious sellar and suprasellar mass)
GAD T1 COR sella (FATSAT if patient has had sella surgery before)
GAD T1 SAG sella (FASTSAT if patine has had sella surgery before)
If you see obvious large brain lesion on FLAIR, then do GAD T1 AX whole brain
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