Overview

Indications

Scheduling

Patient Prep

Series Details

Filming

Billing

ICD9 Codes

Sample Report

Examples

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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:

 


Patient Preparation:

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

 

Series 2: Sagittal T2

 

 

 

 

Series 3: Axial T1

This sequence is to evaluate for fatty masses, hemorrogic collection/cysts, adenopahthy and muscles.

 

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.

 

 

Series 5: Coronal T2 (Coronal to Uterus)

This sequence evaluates abnormalities of the uterus.  It is acquired coronal to the uterine 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