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Protocol Name = PELVIS (rountine) 9.08.
Entry = Feet First
Position = Supine
Series number = 14
Series Notes Pulse Sequence Mode Imaging Options Plane FOV Thickness Spacing Frequency Phase TR TE Flip Angle
3-plane localizer Spin Echo 2D Seq, Fast, SS 3-PLANE 46.0 10.0 10.0 256 192 Minimum Minimum
Calibration scan Gradient Echo 2D Fast, Calib AXIAL 48.0 9.0 0.0
COR T2 FSE-XL 2D NPW, TRF, Fast CORONAL 30.0 5.0 1.0 288 224 4600.0 102.0
AXL T2 FSE-XL 2D NPW, EDR, TRF, Fast AXIAL 28.0 4.0 1.0 320 224 4775.0 102.0
SAG T2 FSE-XL 2D NPW, TRF, Fast SAGITTAL 30.0 4.0 1.0 288 224 4725.0 102.0
AXL T1 SE Spin Echo 2D RC, NPW, ZIP512 AXIAL 28.0 4.0 1.0 256 160 550.0 Min Full
AXL T1 SE F/S PRE Spin Echo 2D RC, NPW, ZIP512 AXIAL 28.0 4.0 1.0 256 160 650.0 Min Full
AXL T1 SE F/S POST Spin Echo 2D RC, NPW, ZIP512 AXIAL 28.0 4.0 1.0 256 160 650.0 Min Full
SAG T1 FSE F/S POST FSE-XL 2D FC, NPW, TRF, Fast, ZIP512 SAGITTAL 28.0 4.0 1.0 256 160 400.0 Min Full
COR T1 FSE F/S POST FSE-XL 2D FC, NPW, TRF, Fast, ZIP512 CORONAL 28.0 4.0 1.0 256 160 400.0 Min Full
COR SSFSE ABDOMEN Spin Echo 2D Fast, SS CORONAL 40 6.0 2.0 256 160 Minimum 180.0
SAG T2 BH optional FRFSE-XL 2D FC, TRF, Fast, ZIP512, FR SAGITTAL 30.0 4.0 1.0 256 160 2110.0 100.0
-OPT 4 ENDOMETRIUM--- Gradient Echo 2D Seq, Fast 3-PLANE 30.0 5.0 5.0 256 128
OBL 3D FIESTA +C note Fiesta-C 3D Fast, ZIP2 OBLIQUE 29.0 2.0 288 288 Minimum 65

The uterine protocol uses the same imaging sequences as the routine pelvis protocol. 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.

625.9 Pelvic pain
628.9 Infertility
752.3 Uterine anomaly
218.9 Uterine leiomyoma
617.0 Adenomyosis
625.8 Uterine mass

First Ask:
1. Why is pelvic MRI requested?
2. Do you have infertility?
3. Do you have pelvic pain? Location?
4. Date of most recent menses? Are you taking any hormones?
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 -- valium 10mg po or axons 1-2 mg po to be taken at time of scanning.

• 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

Billing Code
please add

ICD9 Codes
179 Malignant neoplasm fo uterus, part unspecified
180.0-180.9 Malignant neoplasm of cervix uteri
181 Malignant neoplasm of placenta
182.0-182.8 Malignant neoplasm of body of uterus
183.0-183.6 Malignant neoplasm of ovary and other uterine adnexa
218.0-218.9 Benign neoplasm, uterine leiomyoma
219.0-219.9 Other benogn neoplasm of ovary
220 Benign neoplasm of ovary
236.0 Carcinoma of uterus
617.0 Adenomyosis

Normal Dictation
Clinical statement:

The patient is on day _____ of her menstrual cycle.

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

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.

Normal Pelvic MRI

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May 26, 2010  Tags: , , ,   Posted in: body, MRI, pelvis-female