MRI PROTOCOL – WOMEN AND CHILDREN HOSPITAL KUALA LUMPUR

PAEDIATRIC MRI CONTROL

WOMEN AND CHILDREN HOSPITAL KUALA LUMPUR

BRAIN EXAMINATION
1. PEADS GENERAL (GDD, HYDROCEPHALLUS)
 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Coronal
 T2 Flair Axial
 GRE/Haemo Axial
 DWI/ADC (b value 0, 500, 100)
 3D MPRAGE ISO
 T1 IR Axial (more than 6 months)

2. TUMOR / PHAKOMA / TUBEROUS SCLEROSIS / SEGA

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Coronal
 T2 Flair Axial
 GRE/Haemo Axial
 DWI/ADC (b value 0, 500, 100)
POST GAD
 3D MPRAGE ISO GAD
 T1 Axial GAD

3. ACUTE ENCEPHALOPHATY
(INFECTION, PARA INFECTION, PARANEOPLASTIC AND METABOLIC DISEASE, BLEED)
 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Coronal
 T2 Flair Axial
 GRE/Haemo Axial
 DWI/ADC (b value 0, 500, 100)
 TOF MRA COW
 PC MRV Brain
KIV POST GAD
 3D MPRAGE ISO GAD
 T1 Axial GAD
 T2 Flair Axial GAD

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 MRI PROTOCOL – WOMEN AND CHILDREN HOSPITAL KUALA LUMPUR

4. DEMYELINATING DISEASE (MS, ADEM, NMO)

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Sagittal
 T2 Flair Axial
 DWI/ADC (b value 0, 500, 100)
POST GAD
 3D MPRAGE ISO GAD
 T1 Axial GAD

5. BRAIN AND SPINE DROP METS / LEPTOMENINGEAL – TUMOR

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Coronal
 T2 Flair Axial
 GRE/Haemo Axial
 DWI/ADC (b value 0, 500, 100)
POST GAD
BRAIN
 3D MPRAGE ISO GAD
 T1 Axial GAD
WHOLE SPINE
 T1 DIXON Sagittal GAD
 T1 Vibe FS Axial GAD

NOTE: For Sagittal and Axial one stack in small children and two stack in older children, FOV is 400
mm; do not exceed the suggested FOV, to maintain a spatial resolution.

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6. SEIZURES
 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Coronal
 T2 Flair Axial
 GRE Axial
 T1 IR Coronal
 DWI/ADC (b value 0, 500, 100)
 3D MPRAGE ISO
 T2 3D Space Flair
 T2 3D Space
TEMPORAL LOBE CUT (KIV AFTER REVIEW BY RADIOLOGIST)
 T2 Coronal Temporal Lobes
 T2 Flair Coronal Temporal Lobes
 T1 IR Coronal Temporal Lobes
 T1 Axial Temporal Lobes (parallel to Temporal Lobes)
 T2 Axial Temporal Lobes (parallel to Temporal Lobes)
KIV POST GAD (SEIZURE WITH TEMPORAL LOBE MASS OR FOCAL LESION)
Contrast needed will be decided by the radiologist:
BRAIN
 3D MPRAGE ISO GAD
 T1 Axial GAD

PLANNING FOR TEMPORAL LOBES CUT

NOTE: For coronal planning, slice must perpendicular to temporal lobes long axis on sagittal images,
and on axial images make sure the slice planned symmetrically for both side of temporal
lobe.

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7. TRIVENTRICULAR HYDROCEPHALUS
 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Axial
 CISS 3D sag midbrain
 T2 3D Space
 3D MPRAGE ISO
 CSF Flow Study (more than 2 years old)

8. ARTERIAL VENOUS MALFORMATION (AVM)

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Axial
 T2 Coronal Flair
 GRE/Haemo Axial
 DWI Axial
 TOF MRA Brain
POST GAD
 CE MRA Brain GAD
 3D MPRAGE ISO GAD

9. HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Axial
 T2 Flair Coronal
 GRE/Haemo Axial
 DWI Axial
 3D MPRAGE ISO

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10. STROKE
 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Axial
 T2 Flair Coronal
 GRE/Haemo Axial
 DWI Axial
 3D TOF MRA Brain
 3D TOF MRA Carotids
 3D MPRAGE ISO
(KIV additional sequence; will be decided by radiologist)
 T2 STIR Axial neck (base of skull to arch of aorta)
 T1 Vibe DIXON Axial neck (base of skull to arch of aorta)

11. ENCEPHALOCELE OCCIPITAL / MIDLINE SCALP DERMOID, SCALP LESION / SINUS PERICRANI
 T2 Axial
 T1 Axial
 T1 Sagittal
 3D Space Flair
 3D Space T2
 3D MPRAGE ISO
 PC MRV Brain
 TOF MRA Brain

12. CRANIAL NERVE

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Flair Coronal
 T2 Flair Axial
 T2 Flair Axial thin cut (cover mid-3rd ventricle to upper cervical)
 CISS 3D (cover base of skull)
POST GAD
 3D MPRAGE Brain GAD
 T1 Axial GAD
 T1 Axial thin cut 3mm (cover mid-3rd ventricle to upper cervical) GAD

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13. ORBITS VASCULAR LESION / TUMOR / INFECTION

 T2 Axial Brain
 DWI Brain
 T2 FS Coronal 3mm
 T1 Coronal 3mm
 T2 DIXON Axial 3mm
 T1 DIXON Axial 3mm
 T2 Oblique Right and Left Sagittal (unilateral)
POST GAD
 T1 MPRAGE Brain GAD
 T1 Axial Brain GAD
 T1 DIXON Axial Orbits 3mm GAD
 T1 DIXON Coronal Orbits 3mm GAD
 T1 DIXON Right and Left Sagittal Orbits 3mm (unilateral) GAD

14. PITUITARY MACROADENOMA

 T2 Axial Brain
 T1 Axial Brain
 T2 Sagittal Brain
 T1 Sagittal pituitary 3mm
 T2 Coronal pituitary 3mm
 T1 Coronal pituitary 3mm
POST GAD
 3D MPRAGE ISO Brain GAD
 T1 Coronal pituitary 3mm GAD
 T1 Sagittal pituitary 3mm GAD

15. PITUITARY MICROADINOMA (DELAYED / PRECOCIUS PUBERTY)

 T2 Axial Brain
 T1 Axial Brain
 T2 Sagittal Brain
 T1 Sagittal pituitary 3mm
 T2 Coronal pituitary 3mm
 T1 Coronal pituitary 3mm
POST GAD
 T1 Coronal Vibe Dynamic GAD
 3D MPRAGE ISO Brain GAD
 T1 Coronal pituitary 3mm GAD
 T1 Sagittal pituitary 3mm GAD

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16. IAC TUMOR / INFECTION

 T2 Axial Brain
 T2 Flair Axial Brain
 DWI Axial Brain
 T1 Coronal 3mm inner ear
 T2 Coronal 3mm inner ear
 T1 Axial 3mm inner ear
 T2 Axial 3mm inner ear
 T2 Axial CISS 3D
POST GAD
 T1 Coronal 3mm inner ear GAD
 T1 Axial 2mm inner ear GAD
 3D MPRAGE Brain GAD
 T1 Axial Brain GAD

17. IAC COCHLEAR IMPLANT CANDIDATE

 T1 Axial Brain
 T2 Axial Brain
 T1 Sagittal Brain
 T2 Flair Coronal Brain
 T2 Flair Axial Brain
 T1 IR Axial Brain
 3D MPRAGE ISO
 3D Space Flair
 3D Space T2 Weighted
 DWI/ADC (b value 0, 500, 100) Brain

18. CSF LEAK

 T1 Axial
 T2 Axial
 T1 Sagittal
 T2 Space cor
 T2 Flair Axial
 DWI/ADC (b value 0, 500, 100)
 3D MPRAGE ISO
 CISS 3D Coronal (cover until pit fossa)

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WHOLE SPINE EXAMINATION

NOTE: One stack in small children and two stacks in older children. It is recommended keeping [...]
FOV to avoid any artefact especially in axial slices. Selection and use of appropriate phase
[...] encoding direction and rest slab will minimize the artefact.

19. WHOLE SPINE (PRIMARY TUMOR / INFECTION)

 T2 Coronal
 T1 DIXON Sagittal
 T2 Sagittal
 T1 Vibe DIXON Axial whole spine
 T2 Axial whole spine
POST GAD
 T1 DIXON Sagittal GAD
 T1 Vibe DIXON Axial whole spine GAD

20. SPINAL CORD GENERAL / MYELOMENINGOCELE / SPINA BIFIDA

 T1 DIXON Sagittal
 T2 Sagittal
 T1 Vibe DIXON Axial whole spine
 T2 Axial whole spine
(KIV GAD; will be decided by radiologist for post-surgery)
 T1 DIXON Sagittal GAD
 T1 Vibe DIXON Axial whole spine GAD

21. WHOLE SPINE (ADEM, MS)

 T1 Sagittal
 T2 Sagittal
 T1 Vibe Axial whole spine
 T2 Axial whole spine
POST GAD
 T1 DIXON Sagittal GAD
 T1 Vibe FS Axial whole spine GAD

22. WHOLE SPINE SCOLIOSIS

 T2 Coronal
 T2 Sagittal
 T1 DIXON Sagittal
 T1 Vibe Axial whole spine
 T2 Axial whole spine

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23. DORSAL DERMAL SINUS

BRAIN
 T2 Axial Brain
 T1 Axial Brain
WHOLE SPINE
 T1 DIXON Sagittal
 T2 Sagittal
 T1 Vibe DIXON Axial whole spine
 T2 DIXON Axial whole spine
POST GAD
 T1 DIXON Sagittal GAD
 T1 Vibe DIXON Axial whole spine GAD
 3D MPRAGE Brain GAD
 T1 Axial Brain GAD

24. CRANIOCERVICAL LESION

 T2 Axial Brain
 T2 sag small FOV (focus on CV junction)
 T1 DIXON Sagittal whole spine
 T2 Sagittal whole spine
 T1 Vibe Axial whole spine
 T2 Axial whole spine

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BASE OF SKULL AND NECK EXAMINATION

25. MIDLINE AND PARAMEDIAL FACIAL DEFECT
 T2 Axial Brain
 T1 Sagittal 3mm mid face
 T2 Coronal 3mm mid face
 T2 STIR Coronal mid face
 T1 Axial DIXON 3mm – anterior cranial fossa to hard palate
 T2 Axial DIXON 3mm – anterior cranial fossa to hard palate

26. OROFACIAL LESIONS (LYMPHATIC / VENOLYMPHATIC / CUTENEOUS LESION / BONE [...]

CUTENEOUS TUMORS / PHELEBOLITH)
 T2 Axial Brain
 GRE/Haemo Axial Brain
 T1 Sagittal 3mm mid face
 T2 Coronal 3mm mid face
 T2 STIR Coronal mid face
 T1 Axial DIXON 3mm – anterior cranial fossa to hard palate
 T2 Axial DIXON 3mm – anterior cranial fossa to hard palate
POST GAD
 3D MPRAGE Brain GAD
 T1 Axial DIXON 3mm – anterior cranial fossa to hard palate GAD
 T1 Coronal DIXON 3mm mid face GAD
 T1 Sagittal DIXON 3mm mid face GAD

27. NECK
 T2 Axial Brain
 T1 Coronal 3mm (base of skull to arch)
 T2 Sagittal 3mm (base of skull to arch)
 T2 STIR Sagittal / Coronal (base of skull to arch)
 T1 Axial DIXON 3mm (base of skull to arch)
 T2 Axial DIXON 3mm (base of skull to arch)
POST GAD
 3D MPRAGE Brain GAD
 T1 Axial DIXON 3mm (base of skull to arch) GAD
 T1 Coronal DIXON 3mm (base of skull to arch) GAD

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28. SALIVARY GLAND / PNS / NPC

 T2 Axial Brain
 T1 Coronal 3mm
 T2 Coronal 3mm
 T2 STIR Coronal 3mm
 T1 Axial DIXON 3mm
 T2 Axial DIXON 3mm
POST GAD
 3D MPRAGE Brain GAD
 T1 Axial DIXON 3mm GAD
 T1 Coronal DIXON 3mm GAD

29. TMJ ARTHRITIS AND INFECTION

 T2 Axial Brain
 T1 Coronal 3mm (bos to mandible)
 T2 Coronal 3mm
 T2 STIR Sagittal
 T1 Oblique Sagittal 3mm
 T1 FS Sagittal
Additional view T1 Sagittal open and close mouth for TMJ subluxation locked jaw
POST GAD
 3D MPRAGE Brain GAD
 T1 Sagittal DIXON 3mm (base of skull to arch) GAD
 T1 Coronal DIXON 3mm (base of skull to arch) GAD

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BODY IMAGING
30. THORACIC WALL
 T1 DIXON Coronal
 T2 FS Coronal
 T2 STIR Sagittal
 T1 DIXON Axial
 T2 FS Axial
 T1 Vibe DIXON Axial
 T2 Axial
POST GAD
 T1 DIXON Coronal GAD
 T1 DIXON Sagittal GAD
 T1 tra DIXON GAD

31. MRCP AND LIVER

 T2 Haste Coronal
 T2 Trufi Coronal
 T1 Vibe DIXON Axial (gated / breath hold)
 T2 Haste FS Axial
 Axial DWI (b value 0, 50, 500, 1000, 1500)
 T2 Haste Coronal thick slab
 T2 Space Coronal thin slab
 T1 Vibe DIXON Axial breath hold (pre-GAD dynamic)

POST GAD (CAR BOLUS TECHNIQUE)

 T1 Vibe DIXON Axial breath hold (arterial phase)
 T1 Vibe DIXON Axial breath hold (venous phase)
 T1 Vibe DIXON Axial breath hold (3 minutes delay)
 T1 Vibe DIXON Axial breath hold (5 minutes delay)
 T1 Vibe DIXON Coronal GAD

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32. MR ENTROGRAPHY (CROHNS DISEASE, IBD, SMALL BOWEL PATHOLOGY)

ORAL CONTRAST DILUTION
 1000 ml water
 500 ml mannitol
 Braium 1 teaspoon
ORAL CONTRAST DOSE (Max: 20 ml/kg)
 10 ml/kg 1 hour before scan
 5 ml/kg 30 minutes before scan
 5 ml/kg on table
ANTIPERISTALTIC DRUG
 IV Glucagon 0.25 mg slowly, or Buscopan 0.15 mg/kg (max: 10 mg)
Scan technique and sequence (coverage from diaphragm to anus)
 T2 Haste Coronal (pre-Buscopan)
 T2 Trufi Coronal (pre-Buscopan)
Inject 1st dose Buscopan
 T2 Haste Axial
 T2 Haste Coronal
 T1 Vibe Axial
 T1 Vibe Coronal
Inject 2nd dose Buscopan and IV Contrast
 T1 Vibe Axial GAD
 T1 Vibe Coronal GAD

33. INTRAABDOMINAL / SOFT TISSUE VASCULAR MALFORMATION

 T1 Vibe Coronal
 T2 Haste FS Coronal
 T2 Haste FS Axial
 T2 STIR Sagittal
 T1 Vibe DIXON Axial
POST GAD
 T1 Axial Vibe DIXON GAD
 T1 Coronal Vibe DIXON GAD
 T1 Sagittal Vibe DIXON GAD

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34. LIVER MASS / GLYCOGEN STORAGE

 T2 Haste Coronal
 T2 Haste Axial
 T1 Vibe DIXON Axial
 T2 Coronal thick slab
 T2 Coronal thin slab
 T1 Vibe DIXON Axial breath hold (pre-GAD dynamic)
POST GAD (CARE BOLUS TECHNIQUE)
 T1 Vibe DIXON Axial breath hold (arterial phase)
 T1 Vibe DIXON Axial breath hold (venous phase)
 T1 Vibe DIXON Axial breath hold (3 minutes delay)
 T1 Vibe DIXON Axial breath hold (5 minutes delay)
 T1 Vibe DIXON Coronal GAD

35. ANORECTAL ANOMALY

 T2 Sagittal

}
 T2 Coronal
 T1 Vibe DIXON Axial cover whole pelvis
 T2 DIXON Axial

36. PERIANAL FISTULA

 T2 DIXON Sagittal 3mm

}
 T2 Coronal 3mm
 T2 STIR Coronal 3mm follow anal canal
 T2 DIXON Axial 3mm
POST GAD
 T1 FS Axial GAD
 T1 FS Coronal GAD
 T1 FS Sagittal GAD

37. MRA RENAL

 T2 Trufi Coronal
 T2 Haste Coronal
 T2 Haste Axial (gated / breath hold)
 T1 Vibe DIXON Axial
POST GAD
 T1 Vibe FS Coronal CE MRA
 T1 Vibe DIXON Axial GAD

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38. RENAL MRU

 T2 Trufi Coronal
 T2 Haste Coronal
 T2 Haste Axial
 T1 Vibe DIXON Axial
 T2 Space MRU 3D
KIV
 Dynamic MRU

39. RENAL MASS

 T2 Trufi Coronal
 T2 Haste Coronal
 T2 Haste Axial
 T1 Vibe DIXON Axial
POST GAD
 T1 Axial Vibe DIXON GAD
 T1 Coronal Vibe DIXON GAD
 T1 Sagittal Vibe DIXON GAD

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MUSCULOSKELETAL MRI
40. MSK-TUMOR / AVM / INFLAMMATORY LESION / HAEMANGIOMA / ABSCESS
(UPPER LIMB, LOWER LIMB TRUNKS OR EXTREMITIES)

}
 T1 Coronal / Sagittal
 T2 DIXON Coronal / Sagittalselection based on lesion location
 T2 STIR Coronal / Sagittal

}
 T1 DIXON Axial
 T2 DIXON Axial (cut through the lesion)
 T2 Haemo Axial
POST GAD
 T1 DIXON Axial GAD
 T1 DIXON Coronal GAD
 T1 DIXON Sagittal GAD

41. HUMERUS / RAD ULNA / FEMUR / TIBIA (CONGENITAL ANOMALY)

}
 T2 Coronal
 T2 STIR Coronal
 T1 Coronal (two joint view / full length view)
 T2 FS Sagittal
 T2 Sagittal
 T1 DIXON Axial

42. ELBOW JOINT (TRAUMA, OCD, LIGAMENTOUS TEAR, DISTAL BICEP AND TENDON RUPTURES)
 PD FS Coronal
 PD FS Sagittal
 PD Axial
 T1 Coronal
 T2 DIXON Axial

43. WRIST JOINT (TFCC, SCHAPOLUNATE & ULNOLUNATE LIGAMENTOUS TEAR, CARPAL TUNNEL,
EXTENSOR TENDON, FLEXOR TENDON, OCCULT FRACTURE)
 T2 Coronal
 T2 STIR Sagittal
 T1 Coronal
 T2 DIXON Axial
 Axial DISS 3D

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44. BONY PELVIC – AVN, OSTEOMYELITIS, METS, SACROILITIS, SEPTIC ARTHRITIS, RHEUMATOID
ARTHRITIS
 T1 Coronal
 T2 STIR Sagittal
 T1 DIXON Axial
 T2 DIXON Axial
 T2 FS Sagittal (unilateral parallel to meck of tumor)
POST GAD
 T1 DIXON Axial GAD
 T1 Sagittal GAD
 T1 Coronal GAD

45. HIPS JOINT AVN

 T1 Coronal
 T2 STIR Coronal
 T1 DIXON Axial
 T2 DIXON Axial

46. HIPS SEPTIC ARTHRITIS

 T1 Coronal
 T2 STIR Coronal
 T1 DIXON Axial
 T2 DIXON Axial
POST GAD
 T1 DIXON Axial GAD
 T1 DIXON Coronal GAD

47. KNEE JOINT (TRAUMA, FALL, SPORTS INJURY)

 T2 Axial
 PD FS Sagittal
 PD FS Coronal
 T1 Sagittal
 T2 Axial oblique (perpendicular to ACL)
 DISS 3D

48. ELBOW JOINT (TRAUMA, OCD, LIGAMENTOUS TEAR, DISTAL BICEP AND TENDON RUPTURES)
 T2 DIXON Axial
 PD FS Sagittal
 PD FS Coronal
 T1 Coronal
 PD Axial

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49. ANKLE JOINT (TRAUMA, SPORTS INJURY, FALL)

 T2 DIXON Axial
 PD FS Sagittal
 PD FS Coronal
 T1 Coronal
 PD FS Axial
 DISS 3D

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