Ressonancia Magnetica (MRI parameters and positioning-2003

Ressonancia Magnetica (MRI parameters and positioning-2003

(Parte 1 de 9)

MRI Parameters and Positioning

Torsten B. Moeller, M.D.

Am Caritas-Krankenhaus Dillingen/Saar Germany

Emil Reif, M.D.

Am Caritas-Krankenhaus Dillingen/Saar Germany

With Contributions by A. Beck N. Bigga Ch. Buntru M. Forschner B. Hasselberg M. Hellinger S. Köhl

S. Mattil M. Paarmann P. Saar-Schneider B. Schild K.-H. Trümmler M. Wolff

199 Illustrations

Thieme Stuttgart · New York

Library of Congress Cataloging-in- Publication Data is available from the publisher.

Typesetting by primustype R. Hurler GmbH, D-73274 Notzingen, Typeset on Textline Printed in Germany by Druckhaus Götz, Ludwigsburg ISBN 3-13-130581-9 (GTV) ISBN 1-58890-149-1 (TNY) 1 2 3 4 5

Important Note: Medicine is an everchanging science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect of any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

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This book is a completely revised and enlarged new edition based on the 1 German edition published and copyrighted 2001 by Georg Thieme Verlag, Stuttgart, Germany Title of the German Edition: MRT-Einstelltechnik

Translated by Dietrich Herrmann, M.D. Hameln, Germany

V Preface

Although magnetic resonance imaging, or MRI, has been with us for quite some time and is in widespread and routine use, good “recipe books” on the performance of specific actual studies are hard to find. Since all imaging modalities, and particularly MRI, are carried out by a range of operators under varying clinical circumstances, standardizing the work flow becomes ever more important, because it is only through standardization that the quality of diagnostic imaging will improve. This pared-down book attempts to close the gaps in MRI protocols for routine applications. By leaving out all extraneous information, we have put together a power-packed “how-to-doit” book.

We have compiled protocols for most major studies, not only paying particular attention to the “classic” indications in neurology and orthopedics but also including the more recent developments such as MR angiography and MR cholangiography.

Consistent text layout is vital to clear presentation and ease of reference.

The text has been structured along the same lines as the protocols themselves: starting with the preparations required for the study and the materials needed, it goes on to cover any specific points about the positioning and/ or choice of coils, and then delineates the steps for each study, including not only examples of the various sequences but also available modifications. Wherever possible, we have added useful hints that may facilitate the study and point out potential complications and how to avoid them.

Experience tells us that almost every radiologist and technician has his or her own way of doing a study and prefers certain sequences and/or protocols, much as famous chefs each produce their own versions of particular dishes. Nevertheless, standardized protocols are still important and sometimes even seasoned veterans thumb through them just to check on how others have solved certain problems. We have also left plenty of space for personal notes.

This book would lose half its worth if it were based on just our own ideas about work flow. We are deeply indebted to the senior application specialists from Siemens and Philips as well as members of the sequence development units of those two companies for their commitment and innumerable valuable suggestions. Some of the work flows and choices of sequences therefore reflect the enormous expertise accumulated by these two global players in the MRI market. We are particularly grateful to Marion Hellinger, Birgit Hasselberg, Monika Forschner, and Karl-Heinz Trümmler from Siemens, and to Michael Wolff from Philips.

This resource incorporates the suggestions and expertise of many technicians in the German radiology community, and we would like to thank An- drea Beck, Silke Köhl, Pia Saar-Schneider, Sabine Mattil, Brigitte Schild, Michael Paarmann, and Dr. Christoph Buntru for their close and unwavering support.

Dillingen, Fall 2002

Torsten B. Möller Emil Reif


VII Contents

Brain and Skull2
Ruling Out Bleeding5
Soft Tissues of the Neck17
Chest MRI with Gd-DTPA24

Magnetic Resonance Imaging: Head, Neck, Chest Neurocranium After Surgery Inner Ear (e.g., Acoustic Epilepsy (Temporal Lobe MRI of the Chest Wall and


Contrast MRI of the Sternum . 28

Upper Abdomen/Liver34

Magnetic Resonance Imaging: Abdomen, Pelvis

magnetic Contrast Agent37
Biliary Tree39
Small Intestine (Hydro-MRI)40
MRI of the Small Intestine4

Liver MRI with Superpara- MRI of the Liver with

Dynamic Contrast Series51

Biliary Tree and Pancreatic

MR Urography5
Adrenal Gland57
Dynamic Series61
Uterus, Vagina, Bladder64
(Sizing the Birth Canal)70

Secretin-Enhanced MR Pelvic Outlet Measurements

Temporomandibular Joint76

Magnetic Resonance Imaging: Bones, Joints

Upper Arm84

Indirect Arthrography of the


Indirect Arthrography of the


Indirect Arthrography of the

Enhanced MRI of the Knee118
Indirect Arthrography119
Lower Leg121
Imaging of the Cartilage128
MRI of the Achilles Tendon130
Enhanced MRI of the Ankle132

Technical Study Modification: Indirect Arthrography of the Enhanced MRI of the Forefoot 137

Cervical Spine140

Magnetic Resonance Imaging: Spine

Spondylodiskitis, Abscess144
Trauma, Suspected Fracture147
Thoracic Spine149

Suspected Tumor, Suspected Suspected Disseminated Encephalomyelitis or Syringo-

Spondylodiskitis, Abscess153
Trauma, Suspected Fracture154
Lumbar Spine156
After Lumbar Disk Surgery160
Spondylodiskitis, Abscess161
Trauma, Suspected Fracture162
Sacroiliac Joints164

Suspected Tumor or Suspected Tumor or

Cervical Vessels170
Thoracic Aorta173
Arteries of the Upper Arm176
Arteries of the Forearm179
Arteries of the Hand182
Abdominal Aorta184
Renal Arteries187

Magnetic Resonance Angiography

Lower Extremity190
Double-Bolus Technique190
Lower Leg190
Iliofemoral Region192
Table Travel194

Arteries of the Pelvis and Contents

Magnetic Resonance Imaging: Head, Neck, Chest

Brain and Skull

Patient preparation — Have the patient go to the toilet before the study

— Explain the procedure to the patient

— Offer the patient ear plugs or ear protectors

(Parte 1 de 9)