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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.      Why is pelvic MRI requested?________________

2.      Do you have infertility?______________________

3.      Do you have pelvic pain?____________________  Location Right___ Left___

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 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

 

 

Example

Case 1