MSK MRI PROTOCOLS

Contents
► Upper Extremity Page
► Shoulder
► Elbow
► Wrist
► Finger
► Thumb
► Lower Extremity
► Hip
► Pelvis
► Thigh
► Knee
► Lower Extremity/Shin
► Ankle
► Foot
► Special Cases
► Soft Tissue Mass
► Metal Protocol
MSK CHEST
 MR MSK Chest Indications:
► Pectoralis Major
§ Indications:
►Pec tear
► Sternum / SC joints
§ Indications:
►Tumor, infection, arthritis, trauma
► Chest wall
§ Indications:
►Trauma, tumor
 Pectoralis Major
► Use large FOV
§ Medial-lateral: cover to midline chest
§ Superior-inferior: cover down to mid-humeral
shaft

FOV
 Pectoralis Major
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 30-36 256 x 256 4/0.5 400-800 min - - - 16
T1 1

Axial 30-36 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70

Axial 30-36 256 x 256 4/0.5 >2000 80-100 - - 8 16

T2 FSE 2

Cor Obl 36-48 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16
FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70

Sag 30-36 256 x 192 4/1 >2000 40-60 - - 8 16

Oblique 2
T2 FSE
Fat Sat
 Sternum
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 20-24 256 x 256 4/0.5 400-800 min - - - 16
T1 1

Axial 24 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70

Sag 20-30 256 x 256 4/0.5 400-800 min - - - 16

T1 2

Sag 20-30 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70

Cor 20-24 256 x 192 4/1 >2000 40-60 - - 8 16

oblique 2
T2 FSE
► Coronal: oblique
along sternum
Planned from sagittal images
 Sternoclavicular joints
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 14-20 256 x 256 4/0.5 400-800 min - - - 16
T1 1

Axial 14-20 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70

Sag 20-24 256 x 256 4/0.5 400-800 min - - - 16

T1 2

Sag 20-24 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70

Cor 14-20 256 x 192 4/1 >2000 40-60 - - 8 16

T2 FSE 2
► Smaller FOV for SC joints
§ Otherwise protocol
is similar to Sternum
MSK - Chest Wall
UPPER EXTREMITY
 MR Shoulder Indications:
► Routine Shoulder
§ Indications:
► Rotator Cuff Pathology/Evaluation
► MR Arthrogram
§ Indications:
► Labrum Pathology/Tear
► Post Gadolinium Shoulder (Indirect MR
Arthrogram)
§ Indications:
► Labral Pathology/Instability without ability to do a direct
arthrogram
 Shoulder-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 12-14 512 x 256 4/0.5 2000-300 20-40 - - 8 16
PD FSE 2 0
FatSat

Cor 16-18 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

Oblique 2 1.5T: 150
FSTIR 0.7T 100
0.3T: 70

Cor 16-18 256 x 256 4/0.5 400-800 minimum - - 16

Oblique 1
T1 SE
Non
FatSat
Sag 14-16 256 x 192 4/1 >2000 90-110 - - 8 16
Oblique 1
T2 FSE
Non
Fat Sat
 MR Arthrogram Shoulder
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 12-14 256 x 192 3/0.5 400-800 minimum 16
T1 SE 2
FatSat

Cor 14-16 256 x 192 3/0.5 400-800 minimum 16

Oblique 2
T1 SE
FatSat
Cor 14-16 256 x 192 3/0.5 >1500 30-50 8 16
Oblique 2
PD FSE
FatSat
Sag 14 256 x 192 4/1 400-800 minimum 16
Oblique 1
T1 SE
Non FatSat
ABER 14 256 x 192 3/0.5 400-800 minimum 16
T1 SE 2
Fat Sat
 Shoulder-Post Gadolinium
(Indirect MR Arthrogram)
**Inject standard dose of IV contrast and wait 20 minutes before scanning**
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial T1 12-14 256 x 192 3/0.5 400-800 minimum 16
SE 2
FatSat

Axial 12-14 256 x 192 3/0.5 2000-400 30-50 8

PD FSE 2 0
FatSat

Cor 14-16 256 x 192 3/0.5 400-800 minimum 16

Oblique 2
T1 SE
FatSat
Sagittal 14-16 256 x 192 4/1 2000-400 30-50 8
PD FSE 2 0
FatSat

Cor 16-18 256 x 192 4/0.5 >1500 20-40 3.0T: 180 - 8 16

Oblique 2 1.5T: 150
FSTIR 0.7T 100
0.3T: 70
 Shoulder – Axial Imaging Plane
coracoid
AC Joint

The Axial imaging plane is

slightly oblique (30 degrees):
please prescribe off the
sagittal plane and angle
approximately 30 degrees
to horizontal line as shown
here (dashed line):

Bony
Glenoid
Cover
from top of AC joint through
proximal humeral diaphysis.
Shoulder-Coronal Imaging Plane
Relevant Anatomy Coronal Imaging Plane
Prescribe coronal plane off of axial images parallel to
supraspinatus muscle
 Shoulder-Sagittal Imaging Plane
Relevant Anatomy Sagittal Imaging Plane
Prescribe sagittal plane off axial images with
line parallel to bony glenoid. Image from mid-scapula
through deltoid muscle.

Deltoid
Muscle Cartilaginous
Labrum
Ant. and Post.
Humeral
Head

Bony Glenoid
Labrum
 MR Elbow Indications:
► Routine Elbow
§ Indications:
► Biceps/Triceps tear
► Medial/Lateral collateral
ligament tear
► Common Flexor/Common extensor tendon pathology
► MR Arthrogram Elbow
§ Indications:
► Intraarticular body evaluation
► Medial/Lateral Collateral Ligament Evaluation
► Osteochondral defect (OCD)
► Post Gadolinium Elbow (Indirect MR arthrogram)
§ Indications:
► IA body
► OCD
 Elbow-Routine*
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 12-14 256 x 256 4/1 400-800 minimum 16
T1 1

Axial 14-16 256 x 192 4/1 >2000 20-40 3.0T: 180 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70
Coronal 14-16 256 x 256 3/0.5 400-800 minimum 16
T1 1

Coronal 14-16 256 x 256 3/0.5 > 1500 20-40 8 16

PD FSE 2
FatSat

Sag 12-14 256 x 256 3/0.5 1500-300 20-40 8 16

PD FSE 2 0
FatSat

*for Biceps pathology perform FABS sequence; follow this link.

 MR Arthrogram Elbow
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 12-14 256 x 256 4/1 400-800 minimum 16
T1 1
Non
FatSat
Axial 12-14 256 x 256 4/1 >1500 30-50 8 16
PD FSE 2
FatSat

Coronal 12-14 256 x 256 3/0.5 400-800 minimum 16

T1 2
FatSat
Coronal 12-14 256 x 256 3/0.5 >1500 30-50 8 16
PD FSE 2
FatSat

Sag 12-14 256 x 256 3/0.5 400-800 minimum 16

T1 SE 2
FatSat
 Elbow-Axial Imaging Plane
Axial Imaging Plane
Relevant Anatomy *Prescribe plane perpendicular to coronal
plane (©). Scan from humeral metaphysis
through radial tuberosity.

Lateral and Medial

Humeral Condyles *

Radial Tuberosity
(bump on medial radius) ©
©

Radius Ulna
Radial tuberosity *
 Elbow-Coronal Imaging Plane

Coronal Imaging Plane

Relevant Anatomy *Prescribe plane parallel to medial and lateral
epicondyles.

Lateral Epicondyle

*
Medial
Olecranon process Epicondyle
of Ulna
 Elbow-Sagittal Imaging Plane

Sagittal Imaging Plane

Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©). Scan
through entire elbow.

Lateral Humeral Condyle *

Medial Humeral Condyle

Olecranon process
of Ulna
 FABS Sequence
► For Biceps pathology
§ Acquire T1 and T2 FS
 Wrist Indications:
► Routine Wrist
§ Indications:
► TFCC, Lunotriquetral, Scapholunate tear
► Flexor Tendon/Carpal Tunnel/ Extensor Tendon Pathology
► Evaluation for Occult fracture

► MR Wrist Arthrogram
§ Indications:
► TFCC/LT/SL ligament tears
► Dynamic Enhanced Wrist (Post Gad Images)
§ Indications:
► Evaluation of Scaphoid Nonunion/Avascular Necrosis Exam:
§ IMPORTANT: **Perform routine wrist PLUS Pre/Post Gadolinium
images through carpal bones in coronal plane**
 Wrist-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 8-12 256 x 256 3/0.5 400-800 minimum 16
T1 1

Coronal 8-12 256 x 256 3/0.5 >1500 30-50 8 16

PD FSE 2
FatSat

Coronal 10-12 256 x 192 1/0 60 minimum 20-40 16

2D or 3D 2
GRE
FatSat
Axial 8-12 256 x 256 3/1 2000-300 30-50 8 16
PD FSE 2 0
Fat Sat

Sag 12-14 256 x 192 3/1 >1500 20-40 3.0T: 180 8 16

FSTIR 2 1.5T: 150
0.7T 100
0.3T: 70
 MR Arthrogram Wrist (direct or indirect)
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 8-10 256 x 256 3/0.5 400-800 minimum 16
T1 SE 2
FatSat

Coronal 8-12 256 x 256 3/0.5 >1500 30-50 8 16

PD FSE 2
FatSat

Coronal 10-12 256 x 192 1/0 60 minimum 45-60 16

2D or 3D 2
GRE
FatSat
Axial 8-12 256 x 256 3/1 >1500 30-50 8 16
PD FSE 2
FatSat

Axial 8-12 256 x 192 3/1 400-800 minimum 16

T1 1
Non-
FatSat
Sag 10-12 3/1 >1500 30-50 8 16
PD FSE
FatSat
 Wrist-Axial Imaging Plane
***IMAGE WRIST IN PRONATED POSITION!
SUPINATED PRONATED

Axial Imaging Plane

Relevant Anatomy Prescribe plane parallel to distal radius. Scan
from proximal metacarpals through distal
radial/ulnar metaphysis.

trapz ham
trapm
cap

Dist Distal
radius ulna
 Wrist-Coronal Imaging Plane
Remember to
pronate the wrist!

Relevant Anatomy Coronal Imaging Plane

*Prescribe plane along line drawn from
ulnar styloid through radial styloid. Scan
through entire wrist.

Radial
Ulnar Styloid
Styloid

* *
 Wrist-Coronal Imaging Plane

Radial Relevant Anatomy:

Ulnar Styloid See on the left, another
Styloid
example for the correct
plane for coronal images with
the plane prescribed off the
axials and through both the
ulnar and radial styloid
 Wrist-Sagittal Imaging Plane

Sagittal Imaging Plane

Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©).
Scan through entire wrist.

Radial
Ulnar Styloid ©
Styloid

* *

©
Hint: if the ulnar styloid is poking
out to the side, the wrist is
in pronated position
 Thumb Indications:

► Routine Thumb
§ Indications:
►Gamekeeper’s thumb (Ulnar Collateral Ligament
tear)
►Flexor/Extensor Tendon Tear
►R/O Occult Fracture
 Thumb
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 10 256 x 256 3/0.3 >1500 30-50 4
PD FSE 2

Coronal 10 256 x 192 3/0.3 2000-600 50-70 8 16

T2 FSE 2 0
Fat Sat

Sag FSE 10-14 256 x 192 3/0.3 >1500 20-40 3.0T: 180 8 16
STIR 2 1.5T: 150
0.7T 100
0.3T: 70
Axial 10 256 x 192 3/0.3 400-800 minimal
T1 SE 1

Axial 10 256 x 192 3/0.3 2000-600 50-70 8 16

T2 FSE 2 0
Fat Sat
Thumb-Axial Imaging Plane
Axial Imaging Plane
Prescribe plane perpendicular to midshaft of
Relevant Anatomy proximal 1st phalanx. Scan from CMC joint
through thumb.
Thumb-Coronal Imaging Plane
Coronal Imaging Plane
*Prescribe plane along line bisecting
sesamoid bones or if sesamoids are not well seen along line
bisecting the 1st metatarsal head
(red lines through the yellow square shown below).
Scan through entire thumb.
Relevant Anatomy

Sesamoids

Thumb
Thumb-Sagittal Imaging Plane

Relevant Anatomy Sagittal Imaging Plane

*Prescribe plane perpendicular to coronal
imaging plane (©). Scan through entire thumb.

©
Sesamoids

Thumb
 Finger Indications:
► Routine Finger
§ Indications:
► Pulley rupture/Flexor or Extensor Tendon Injury
► Post Gadolinium Finger
§ Indications:
► Mass
► **Perform routine finger plus Axial and either Coronal or
Sagittal (whichever plane mass best seen) pre/post gadolinium
FatSat fast GRE or T1 SE images. See “mass” protocol and
adjust FOV and other parameters as needed.
 Finger-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex

Sag 10 256 x 192 3/0.3 400-800 minimum 16

T1 SE 1

Sag 10 256 x 192 3/0.3 2000-600 50-70 8 16

T2 FSE 2 0
FatSat

Axial 10 256 x 192 3/0.3 400-800 minimum 16

T1 SE 2

Axial 10 256 x256 3/0.3 2000-600 30-50 4 16

PD FSE 2 0
FatSat

Coronal 10-14 256 x256 3/0.3 >1500 20-40 3.0T: 180 8 16

STIR 2 1.5T: 150
0.7T 100
0.3T: 70
 Finger-Axial Imaging Plane
Relevant
Anatomy
Distal
Phalanx

Mid
Phalanx

Axial Imaging Plane

Prescribe best fit line. Scan from
Proximal proximal metacarpal through entire
Phalanx finger.

Metacarpal
 Finger-Coronal Imaging Plane

Relevant Anatomy Coronal Imaging Plane

*Prescribe plane parallel to anterior
metacarpal head. Scan through entire
Extensor Tendon finger. Include 2 adjacent fingers.

Thumb
 Finger-Sagittal Imaging Plane

Sagittal Imaging Plane

Relevant Anatomy *Prescribe plane perpendicular to
coronal plane (©). Scan through entire
Extensor Tendon finger. Include 2 adjacent fingers.

Thumb

*
LOWER EXTREMITY
 Bony pelvis
► Indication: AVN, Mets, transient osteoporosis, bursitis, arthritis,
tendonitis, hip pain over age 50
► PA Torso Coil is 1st choice
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 36-40 256x192 4/1 >2000 20-40 150 8 16
FSE-STIR 2-3

Axial 36-40 256 x 256 5/1.5 3000 30-40 8 16

T2 FSE 2
FatSat

Coronal 36-40 256 x 256 4/1 400-800 Minimum 16

T1 SE 1
Non FatSat

Sag 12-16 256 x 256 5/1 >2000 40-50 8 16

T2 FSE 1-2
FatSat
(Hip to Hip)

Coronal in/
out of phase
T1 GRE
 ER Hip
(Hip fracture screening)
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex

Coronal 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16

FSE-STIR 2 1.5T: 150
0.7T 100
0.3T: 70
Coronal 36-40 256 x 256 4/1 400-800 Minimum 16
T1 SE 1
Non FatSat

Axial 36-40 256 x 256 4/1 >2000 80-110 8 16

T2 FSE 2
FatSat
 Direct arthrogram hip
► Indication: hip labrum tear, FAI or dysplasia, hip pain under age 50
► PA Torso coil is 1st choice
► Prescribe obliques along femoral neck from coronal localizer

Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW

Nex

Coronal (PELVIS) 36-40 256 x 256 4/1 400-800 Minimum 16

T1 SE
1
Non FatSat

Coronal (PELVIS) 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16

FSE-STIR 2 1.5T: 150
0.7T 100
0.3T: 70
Axial (PELVIS) 36-40 256 x 256 4/1 >2000 40-50 8 16
T2 FSE 2
FatSat

Ax oblique (HIP) 14-20 384 x 256 4/0.5 400-800 Minimum 16

T1 FatSat 2

Coronal (HIP) 14-20 384 x 256 4/0.5 400-800 Minimum 16

T1 FatSat 2

Sag (HIP) 14-16 384 x 256 4/0.5 400-800 Minimum 16

T1 FatSat 2
 Noncontrast hip
► Indication: Unilateral hip pain
► PA Torso coil is 1st choice
► Prescribe ax obliques along femoral neck from coronal localizer

Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW

Nex
Coronal (PELVIS) 36-40 256 x 256 4/1 400-800 Minimum 16
T1 SE
1
Non FatSat

Coronal (PELVIS) 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16

FSE-STIR 2 1.5T: 150
0.7T 100
0.3T: 70
Axial (PELVIS) 36-40 256 x 256 4/1 >2000 40-50 8 16
T2 FSE 2
FatSat

Ax oblique (HIP) 14-20 384 x 256 4/1 >2000 30-40 8 16

PD FSE 2
FatSat
Coronal (HIP) 14-20 384 x 256 4/1 >2000 40-50 8 16
PD FSE 2
FatSat
Sag (HIP) 14-16 384 x 256 4/1 >2000 40-50 8 16
PD FSE 2
FatSat
 Metal Protocol – general
recommendations

► Use FSE instead of conventional SE

► Maximize BW (bandwidth)
► Lower TE for T2 and STIR
► Remove fat suppression
► Avoid GRE
► Use STIR instead of T2w fat sat
 MARS (Metal Artifact Reduction
Sequences) – Hip Exam
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 64
FSE-STIR 2 1.5T: 150
0.7T 100
0.3T: 70
Coronal 36-40 256 x 256 4/1 400-800 Minimum 64
T1 SE 1
Non FatSat

Axial 36-40 256 x 256 4/1 >2000 50-70 8 64

T2 FSE 2

Axial (HIP) 14-20 384 x 256 4/1 >2000 30-40 8 max

PD FSE 2

Coronal (HIP) 14-20 384 x 256 4/1 >2000 40-50 8 max

PD FSE 2
Non FatSat

Sag (HIP) 14-16 384 x 256 4/1 >2000 40-50 8 max

PD FSE 2
Non FatSat
 Hip-Axial Imaging Plane
Axial Imaging Plane
Relevant Anatomy Prescribe plane parallel line bisecting lesser
trochanters and/or acetabular roofs. Scan
from iliac crests through lesser trochanter.

Ilium
Acetabular
Roof

Greater
Trochanter

Lesser Trochanter
 Hip-Coronal Imaging Plane

Coronal Imaging Plane

Relevant Anatomy *Prescribe plane parallel femoral heads.
Scan from ischium through pubic
symphyses.

Superior Pubic Ramus

Femoral
Neck

Femoral
Head

Ischium

Greater Trochanter
 Hip-Sagittal Imaging Plane

Sagittal Imaging Plane

Relevant Anatomy
*Prescribe plane perpendicular to coronal plane.
Scan from acetabulum through greater
trochanter.

Superior Pubic Ramus

Femoral *
Neck

Femoral Head

Ischium

Greater Trochanter
 Axial Oblique Imaging Plane
(For Femoracetabular Impingement Patients Only)

Axial Oblique Plane

Relevant Anatomy Prescribe plane parallel to femoral
neck. Scan through entire femoral
neck.

Femoral
Femoral Head
Neck
 TJUH Athletic Pubalgia MR Protocol
► Indication: Athletic Pubalgia, Sports Hernia, Sportsman’s Hernia, Adductor tear/
strain, Rectus Abdominis Injury
► PA Torso coil is 1st choice
► Prescribe obliques along anterior iliac crest from sagittal localizer

Seq. FOV Matrix/NEX Slice TR TE TI ETL BW

Coronal 28-36 256x192 4/1 >2000 20-40 150 8 16
STIR (Both hips) 2-3

Coronal 28 256x256 4/1 400-800 minimum 16

T1 SE (Both hips) 1-2

Axial T2 FSE 28 256x256 5/1 >2000 50-60 8 16

Fat Sat (Both hips) 2-3

Axial Obl PD FSE 20 256x192 4/.5 3000 25-30 4 16

1-2 (max)
Nonfatsat
Axial Obl T2 FSE 20 256x192 4/.5 >2000 50-60 8 16
Fat Sat 2-3

Sag T2 FSE 20-22 256x192 4/.5 >2000 50-60 8 16

Fat Sat 2-3

Sag PD FSE 20-22 256x256 4/.5 >2000 20-30 8 16

Nonfatsat 2-3
(optional)
 Axial Oblique Imaging Plane
(Adductor unfolding plane)
Axial Oblique Imaging Plane
*Prescribe plane to line paralleling anterior
Relevant Anatomy Iliac crest*. Be sure to scan across pubic
symphysis at midline

Hip joint
*
Axial Oblique Imaging Plane
(Adductor unfolding plane)
 Bony Pelvis
(Special Cases)
*Follow Hip Planes*
► Post Gadolinium Pelvis
§ Indications:
► Osteomylitis
§ IMPORTANT:
► Same as Routine Hip Protocol but perform axial and coronal
images on both sides.
► In addition, perform FMPSPGR fat saturated images pre/post in
both axial and coronal planes.
► In/Out of Phase Pelvis
§ Indications:
► Possible Bony Metastases
§ IMPORTANT:
► Perform In/Out of Phase images in Coronal Plane
 Bony Pelvis Osteo – pre/post option
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 30-45 256 x 192 4/1 400-800 minimal 16
T1
Non
FatSat
Coronal 30-45 256 x 192 4/1 >2000 20-40 8 16
STIR

Axial 30-45 256 x 192 4/1 400-800 minimal 16

T1
Non
FatSat
Axial 30-45 256 x 256 4/1 2000-600 60-70 8 16
T2 FSE 0
FatSat

Sag 20 256 x 256 4/1 2000-600 50? 8 16

T2 FSE 0 (60-70)
FatSat

Axial/Cor 12 256 x 192 3/.5 50 5 30-40 8 16

FMPSPGR
FatSat
Pre/Post
 Sacrum – Sacroiliac joints
Indications:
Possible Sacroileitis (Septic/Rheumatoid or Rheumatoid Variant
Arthritis)
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 30-45 256 x 192 4/1 >2000 20-40 8 16
STIR

Axial 30-45 256 x 256 4/1 >1500 70-80 8 16

T2 FSE
FatSat

Cor Oblique 18-22 256 x 256 3/.5 400-800 minimal

T1 SE
Non FatSat

Cor Oblique 18-22 256 x 256 3/.5 >1500 70-80 8 16

T2 FSE
FatSat

Sag 18-22 256 x 256 3/.5 >1500 70-80 8 16

T2 FSE
FatSat

Axial 18-22 256 x 256 3/.5 400-800 minimal

T1 SE
Non FatSat
 Sacrum – Sacroiliac joints
► Prescribing the coronal oblique plane: parallel the sacrum
on a sagittal localizer
 Routine Thigh
(Follow Hip Imaging Planes)

► Routine Thigh
§ Indications:
►Polymyositis/Diabetic Myonecrosis
 Thigh-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 40 256 x 192 4/1 400-800 minimal 16
T1 SE
Non
FatSat
Coronal 40 256 x 256 4/1 >1500 70-80 8 16
T2 FSE
FatSat

Sag 26 256 x 192 4/1 >2000 20-40 150 8 16

STIR

Axial SE 26 256 x 192 4/1 400-800 minimal 16

T1
Non
FatSat
Axial 26 256 x 256 4/1 >1500 70-80 8 16
T2 FSE
FatSat
 Knee Indications

► Routine Knee
§ Indications:
► Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL
► Direct Arthrogram
§ Indications:
► Meniscal Re-tear
► Intra articular Body

► Post Gadolinium Knee

§ Indications
► Meniscal Re-tear
§ IMPORTANT: Image 20 minutes post gadolinium
 Knee-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Sag 14-16 512 x 256 4/0.5 3000 15-20 8 16
PD FSE 2
NonFatSat

Sag 14-16 256 x 256 4/0.5 2000 70-80 8 16

T2 FSE 2
FatSat

Cor 16-18 256 x 192 3/0.5 400-800 Minimal 16

T1 SE 1
Non FatSat

Coronal 16-18 256 x 256 3/0.5 >2000 70-80 8 16

T2 FSE 2
Fat Sat

Axial 14-16 256 x 256 3/0.5 >2000 70-80 8 16

T2 FSE 2
FatSat
 MR Arthrogram Knee (dir or ind)
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Sag 14-16 256 x 192 4/1 400-800 Minimal 16
T1 Se
FatSat

Sag 14-16 512 x 256 4/0.5 3000 15-20 8 16

PD FSE 2
NonFatSat

Coronal 16-18 256 x 256 4/1 >1500 70-80 8 16

T2 FSE 2
FatSat

Coronal 16-18 256 x 192 4/1 400-800 Minimal 16

T1 SE 1
FatSat

Axial 14-16 256 x 256 4/1 >1500 70-80 8 16

T2 FSE
FatSat
Axial 14-16 256 x 192 4/1 400-800 Minimal 16
T1 SE
FatSat
 Knee-Axial Imaging Plane
Relevant Anatomy Axial Imaging Plane
Image from distal quad tendon
through patellar tendon insertion

Distal Quadriceps tendon

P
A
T Femur

Patellar
Tendon
Insertion
Tibia
 Knee-Coronal Imaging
Coronal Imaging Plane
Relevant Anatomy Prescribe plane with line parallel to
femoral condyles. Image entire knee.

Patella

Med Lat
Fem Fem
Condyle Condyle
Knee-Sagittal Imaging Plane
Sagittal Imaging Plane
Relevant Anatomy *Prescribe plane perpendicular to coronal plane (©).
Scan from the medial to the lateral femoral condyle.

Patella

Med Lat
Fem Fem
Condyle *
Condyle

© ©

*
 Lower Extremity/Shin

► Indication:
§ Shin Splints
► IMPORTANT:
§ Acquire coronal and axial (STIR) sequences
covering both shins, but sagittal and axial (t2
FatSat only of side in question
§ Place a marker on pain / tenderness
 Lower Extremity/Shin Area
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex

Coronal 35-40 256 x 256 4/1 400-800 minimal 16

T1 SE
Non
FatSat
Coronal 35-40 256 x 192 4/1 >2000 20-40 150 8 16
STIR

Axial 35-40 256 x 192 4/1 >2000 20-40 150 8 16

STIR

Axial 14-16 256 x 256 4/1 >1500 70-80 8 16

T2 FSE
FatSat
(through
marker
region)
Sag 256 x 256 4/1 >1500 70-80 8 16
T2 FSE
FatSat
 Ankle Indications

► Routine Ankle
§ Ligament Sprain/Tendon pathology/Tarsal
Tunnel/Sinus Tarsi/Occult fracture, PTT, Plantar
fasciitis
► Ankle Arthrogram
§ Indications:
►Intra-articular Body
► Post Gadolinium Ankle
 Ankle-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Sag 16-18 256 x 256 3/1 400-800 Minimal 16
T1 SE 1
Non
FatSat
Sag 16-18 256 x 192 3/1 >1500 40 120 90 8 16
STIR 3

Axial 14-16 384 x 256 4/1 3000 40 8 16

PD FSE 2
Non
FatSat
Axial 14-16 256 x 256 4/1 >2000 70-80 8 16
T2 FSE 2
FatSat

Coronal 14 256 x 256 3/1 >2000 40-55 8 16

T2 FSE 3
FatSat
 MR Arthrogram Ankle (dir or ind)
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Sag 16 256 x 192 4/1 400-800 minimal 16
T1 SE
FatSat

Sag 18 256 x 192 4/1 >2000 20-40 150 8 16

STIR

Axial 14 256 x 256 4/1 800 min 16

T1 SE
FatSat

Axial 14-16 513 x 256 4/1 3000 40 8 16

PD FSE 2
Non
FatSat
Coronal 14 256 x 192 4/1 400-800 minimal 16
T1 SE
FatSat

Coronal 14 256 x 256 4/1 >1500 70-80 8 16

T2 FSE
FatSat
 Ankle-Post Contrast
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 14 256 x XX 200 ? 4? 16
FMPSPGR
FatSat
Pre/Post
Sag 16 256 x 192 4/1 400-800 minimal 16
T1 SE
Non
FatSat

Axial 12 256 x 256 4/1 ?800 Minimal 16

T1 SE
FatSat

Axial 14 256 x 256 4/1 >2000 40-50 4 16

PD FSE
FatSat

Cor 14 256 x 256 4/1 400-800 minimal 16

T1 SE
FatSat
 Ankle-Axial Imaging Plane

Axial Imaging Plane

Relevant Anatomy Prescribe plane parallel to axis of calcaneus.
Scan ankle from distal tibia through subcutaneous
soft tissues (include plantar fascia).

Tibia

Talus

Calcaneus

Black band is plantar fascia

Ankle-Coronal Imaging Plane

Coronal Imaging Plane

Prescribe plane perpendicular
Relevant Anatomy to axial imaging plane. Scan ankle
from calcaneus through metatarsal bases.

Talus

Calcaneus
Cuboid
Ankle-Sagittal Imaging Plane
Sagittal Imaging Plane
Prescribe plane with line parallel
Relevant Anatomy to talus. Cover ankle from medial through lateral
malleolus.

s
Talu
Midfoot
Forefoot
 Foot-Indications

► Routine Foot
§ Indications
► Plantar Plate Injury, R/O fracture, Lisfranc injury, tarsal/
metatarsal fracture
► Post Gadolinium Foot
§ Indications:
► Morton’sNeuroma
► Osteomyelitis

§ IMPORTANT: Perform routine foot plus coronal

FMPSPGR fat saturated pre and post gad images and
axial POST gad FMPSPGR fat saturated images.
 Foot-Routine
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 10 256 x 256 3/0.5 400-800 minimal 16
(short axis) 1
T1
Non FatSat
Coronal 10 256 x 256 3/0.5 >2000 70-80 8 16
(short axis) 2
T2 FSE
FatSat
Sag 12-14 256 x 192 3/0.5 >1500 40 120 90 8 16
STIR 3

Sag 12-14 256 x 256 3/0.5 400-800 minimal 16

T1 1
Non
FatSat
Axial 12-14 256 x 256 3/0.5 >2000 30 8 16
(long axis) 2
PD FSE
Non FatSat
Axial 12-14 256 x 256 3/0.5 >2000 90 8 16
(long axis) 2
T2 FSE
FatSat
 Foot-Mass/Osteomyelitis
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Coronal 10-12 256 x 256 3/0.5 400-800 minimal 16
T1 SE 1
Non
FatSat
Coronal 10-12 256 x 192 3/0.5 >2000 70-80 8 16
T2 FSE 2
FatSat
Sag 12-14 256 x 192 3/0.5 >1500 40 120 90 8 16
STIR 2

Sag 12-14 256 x 256 3/0.5 400-800 minimal 16

T1 1
Non
FatSat
Coronal 10-12 256 x 192 3/.5 60 5 30-40 8 16
FMPSPGR 2
FatSat
Pre/Post
Axial 10-12 256 x 192 3/.5 60 5 30-40 8 16
FMPSPGR 2
FatSat
Post
 Foot-Axial Imaging Plane

Relevant Anatomy Axial Imaging Plane

Prescribe plane parallel to 2rd or 3rd
metatarsal. Scan foot from navicular through
phalanges.

N
A
V
Phalanges
Foot-Coronal Imaging Plane

Relevant Anatomy Coronal Plane

*Prescribe plane parallel to 1st and 5th metatarsal
Shafts. Scan through entire foot.

Metatarsals

*
2
1 3
4
5
Foot-Sagittal Imaging Plane

Relevant Anatomy Sagittal Plane

*Prescribe plane perpendicular to coronal
Plane (©). Scan through entire foot.

Metatarsals
©
*
2 *
1 3
4
5

*
 Soft Tissue Mass Protocol
General Recommendations

► Place
Vitamin E capsule LIGHTLY on skin
(do not depress skin with capsule)
§ If post-operative: place markers at each end of
surgical scar
► FOV determined by mass size / location
► Try to include adjacent joint for reference
► Axial always; Sag or Cor depending on
location of mass (speak with radiologist)
 Soft Tissue Mass
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex
Axial 256 x 192 5/1 400-800 minimum 16
T1 SE
Non FatSat

Axial 256 x 192 5/1 >2000 40-60 8 16

T2 FSE
FatSat

Sag or Cor 256 x 192 5/1 400-800 minimum 16

T1 SE
Non FatSat

Sag or Cor 256 x 192 5/1 >2000 30-40 150 8 16

STIR

Axial T1 GRE 256 x 192 5/1 60 5 30-40 8 16

or SE FatSat
Pre/Post Gd 400-800 minimum -

Sag or Cor 256 x 192 5/1 60 5 30-40 8 16

T1 GRE or
SE FatSat 400-800 minimum -
Pre/Post Gd
 MR Neurography Pelvis
Seq. FOV Matrix/ Slice TR TE TI Flip ETL BW
Nex

Coronal 36-40 256 x 256 4/1 400-800 Minimum 16

(PELVIS) T1 SE
1
Non FatSat
Coronal 36-40 256x192 4/1 >2000 20-40 3.0T: 180 8 16
(PELVIS)
2 1.5T: 150
FSE-STIR
Axial (PELVIS) 24 (hip 256 x 256 3.5/1 >2000 70-80 >8 16
T2 FSE to hip) 2
FatSat

Coronal T2 vista 30-34 232x345 2/1 2800 288 90 150

(or equivalent)
1

Axial T1 3D FFE 24 276 x276 3/1.5 28 2.3 30 1

1
Axial M FFE 24 240x160 3/0 3570 4 45 4
1

Sagittal PD 24-28 282x282 3.5/1 Max 45 90 >8

SPAIR
1
Marrow Survey
 ER / Inpatient Protocols

► Hip / pelvis fracture

► Joint: survey exam
► Non-contrast “R/O osteomyelitis”
► Chest wall / Abdominal wall
► Spine survey