Practical Manual For MRI Radiographers .

PRACTICAL MANUAL FOR
MRI RADIOGRAPHER
BASIC MRI STUDIES- BRAIN AND SPINE REGION
WRITTEN BY- SHAIKH MEHZIYAR ABBAS
(RADIOGRAPHER)
MRI
TECHNIQUE
BOOK

Preface
This book is a practical manual for MRI technique.
All types of basic Brain and Spine MRI technique are
explained using an easiest way. Main purpose of this
book is to provide a helping hand to the MRI
Radiographers and students who are practicing MRI.
The steps explained in this book is applied on GE
1.5T-Signa with HDxT software.

PRACTICAL MANUAL FOR MRI RADIOGRAPHER
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Topics
Body
Part
MRI Studies
A. Head
1. MRI BRAIN (PLAIN+CONTRAST)
2. MRI ORBIT (PLAIN+CONTRAST)
3. MRI PITUITARY (PLAIN+CONTRAST)
4. MRI ORAL CAVITY/NECK/ORAL CAVITY+NECK/BASE
OF SKULL/PNS/PAROTID/TEMPORAL BONE
(PLAIN+CONTRAST)
5. MRI EPILEPSY PROTOCOL OR TEMPORAL LOBE
EPLEPSY(TLE)
6. MRI VERTIGO PROTOCOL
7. MRI BRAIN ANGIOGRAPHY & NECK VESSELS
B. Spine
1. MRI CERVICAL SPINE (PLAIN+ CONTRAST)
2. MRI CERVICO-DORSAL SPINE (PLAIN+CONTRAST)
3. MRI CRANIO-VERTEBRAL JUNCTION
(PLAIN+CONTRAST)
4. MRI DORSAL SPINE (PLAIN+ CONTRAST)
5. MRI DORSO-LUMBAR SPINE
(PLAIN+ CONTRAST)
6. MRI LUMBAR/LUMBO-SACRAL SPINE
(PLAIN+CONTRAST)
7. MRI SACRUM & COCCYX (PLAIN+ CONTRAST)
8. MRI WHOLE SPINE SCREENING (PLAIN+CONTRAST)

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Important Notes
1. The MRI planning explained in this book is applicable for all
machines.
2. History of patient, anatomy and pathology for MRI study are
given less, only as an example.
3. The coil selection given in this book is according to GE
machine, please do select the coil option properly as per
available in your MRI machine.
4. Common steps included in MRI scanning are as follows: -
Step 1- Data entry of the patient
Step 2- Selection of the protocol
Step 3- Start the scan to get the localizer of the scanning part
and follow the given options respectively for every planning
sequences.
VIEW EDIT
|
PLANNING
(OF THE
SEQUENCE)
|
RESET SNR
|
SAVE SERIES
|
DOWNLOAD
(Only for first localizer)

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|
AUTO SCAN
(Always active, except breath hold sequences)
5. The calibration for the part of interest should be done properly
to acquire the MRI images. For example, if you are doing MRI
brain, calibration must be done as shown in below image.
6. If the calibration is done without covering the part properly
and if you keep the slices on the uncalibrated part the images
will not be acquired.
7. NEX value should be kept according to need for the better
resolution of the MRI images.
8. Matrix (Frequency and Phase) can be adjusted for the sequences
according to need.
9. Frequency Directions can be kept A-P for Brain Axials, R-L for
axial of other body parts, S-I for Coronal and Sagittal Planes.

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10.Filter for the image can be kept Option B that is high sharp
and some smoothing or D that is high sharp and high
smoothing.
11. The FOV box in every sequence should be given angle if any
plane in localizer is not aligned straight.
12. To copy the planning of the sequence for e.g. you planned T2
axial, now you just need to follow the below given steps to copy
the same planning for remaining axials in the study including
pre and post contrast-
- Selection of the sequence
- View edit
- Copy Rx
- Select T2 axial and click on OK.
- Reset SNR and save series.
*Steps to be followed for sagittal and coronal planning also*

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Meanings of axial, coronal, sagittal and oblique
planes
The anatomical planes are different lines used to divide the human body.
You will commonly see them when looking at anatomical models and pro-
sections. Using anatomical planes allows for accurate description of a
location and allows the reader to understand what a diagram or picture is
trying to show.
There are four planes used sagittal, coronal, transverse and oblique:
1. The sagittal plane passes through the body in vertical line, which
divides the body into right and left sections.

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2. The coronal plane passes through the body in vertical line, which
divides the body into front and back i.e. anterior and posterior
sections.
3. The transverse or axial plane passes through the body in horizontal
line, which divides the body in to upper and bottom i.e. superior and
inferior sections.

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4. The oblique plane is a plane which passes through the coronal,
sagittal and transverse planes at some angle.

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Patient preparation
• Remove all metallic stuff.
• Metallic implant history should be taken (orthopedic,
dental, pacemaker, neuro stimulator etc.)
• Serum-creatine reports must be taken if patient is
having contrast study.
• Patient should be given diagnostic center or hospital
gown and track-pant to wear.

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A. HEAD
Basic anatomy of Brain for radiographer purpose:
• Skull fats
• Cerebrum
• Corpus callosum
• Pituitary gland
• Lateral, 3rd
and 4th
ventricles
• Caudate nucleus, thalamus
• Mid brain, pons, medulla oblongata
• Paranasal sinuses
• Frontal, parietal, temporal and occipital lobe
• Arteries of Circle of Willis and neck
• Cranial nerve, orbital nerve
• Venous sinus

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MRI BRAIN (PLAIN+ CONTRAST)
A. Patient history-
• Headache, hypertension
• Migraine
• Trauma, fall.
• Diabetes
• Follow up scan.
B. Positioning and coil-
• Head first in the brain coil with the central array on the eyebrows.
• Coil selection should be 8NVARRAY coil and give proper cushion
packing around head for better stability.
• For infant and short head structure use 8NVHEAD.
C. Protocol selection and planning-
• MRI brain protocol should be taken after data entry of the patient.
• Sequences taken and their planning should be done as follows-
1. 3 plane localizer- Low quality images are taken for the further planning of
the sequences.
2. Calibration- The brain should be covered perfectly in this step as to get
proper imaging.

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3. FLAIR Axial (FLUID ATTENUATED INVERSION RECOVERY) –
Planning of this sequence should be done on sagittal plane and adjustment
of midline is to be done on coronal and axial planes. Total no. of slices
should be 20 (approx.) or according to the requirement. The first slice
should be at the start of the brain (superior side) in sagittal plane and
keeping the last few slices below the cerebellum, parallel to hard palate
(nose) so that whole brain is covered for axial sequence. Keep the slice in
such angle that 1 slice should pass through hard palate to end of cerebellum.
FOV- 23-24 according to the requirement. Slice thickness- 4-5 mm and
spacing - 2.5-3mm, NEX value can be kept according to need. After
planning the sequence follow the steps of 4th
point as given in
IMPORTANT NOTES.
4. Diffusion axial (B-value 1000, NEX value- 3/4)
5. T2 Gradient axial
6. T2 axial
7. T1 axial
COPY THE PLANNING OF FLAIR AXIAL.
* The Phase FOV for the GRE, T2 and T1 axial can be kept 0.75 to
reduce time*

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8. T1 sagittal- Planning of this sequence should be done on coronal and axial
planes with adjustment of the midline. Total no. of slices should be 19
(approx.) or according to the requirement. The first slice should be at right
side of brain in coronal plane and the last slice at left side, covering the whole
brain from right to left. FOV- 23-24 according to the requirement and
Phase FOV should be 1, Slice thickness- 4-5 mm and spacing - 2.5-3mm.
9. FLAIR or T2 coronal- Planning of this sequence should be done on sagittal
and axial plane with adjustment of the midline. Total no. of slices should be
20 (approx.) or according to the requirement. The first slice should be at
anterior side of brain in sagittal plane and the last slice at Posterior side,
covering the whole brain. FOV- 23-24 according to the requirement and
Phase FOV should be 1 or 0.80, Slice thickness- 4-5mm and spacing- 2.5-
3mm.

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10. T1 Axial+Gado- copy the planning of Flair axial.
11. T1 Coronal+Gado- copy the planning of Flair coronal.
12. Sagittal 3D FSPGR (Fast spoiled gradient echo) + Gado - Planning for
this sequence is same as sagittal plane. The only difference is here you have
slab instead of slices. Keep the Locs per slab between 55-60 approx or
according to the need with slice thickness 3-4mm, so that whole brain is
covered.
13. FLAIR axial post contrast is taken if patient is having brain TB history.
For this you just need to copy flair axial sequence and paste after 3d sequence
renaming it as Flair axial+Gado/contrast
For the post processing of Diffusion weighted image to get ADC
(apparent diffusion coefficient) follow the steps-
STEP 1- Go to browser- select diffusion sequence and open it in
FUNCTOOL.
STEP 2- Click on ADC on right side of PC, a small window will come of
processing thresholds.
STEP 3- There will be two sliders for adjustment, first is noise and second
is upper. Keep the upper at max and adjust the noise slider to avoid the

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noise in processed image. The pixels line should be properly covered for
part of interest, there shouldn’t be any gap between pixel lines.
STEP 4- Now in the 4th
block do the right click and without leaving go to
color ramps in that click on gray levels so that you can get a gray white
image of ADC.
STEP 5- Click on FILE/SAVE/REPORT – FUNCTIONAL MAPS
STEP 6- Now select ALL – MULTIPLE LOCATION, click next then
select SAVE AS PROCESSED IMAGE and SAVE.
Pathology:
• Tuberculous meningitis (TBM)
• Neurocysticercosis (NCC)
• Brain metastases
• Glioblastoma
• Meningioma
• Subdural hemorrhage (SDH)
• Age related atrophy
TUBERCULOUS MENINGITIS (TBM)

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NEUROCYSTICERCOSIS (NCC). BRAIN METASTASES
GLIOBLASTOMA MENINGIOMA

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SUBDURAL HEMORRHAGE (SDH)
AGE RELATED ATROPHY
MILD

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MODERATE
SEVERE

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MRI ORBIT (PLAIN+ CONTRAST)
A. Patient history-
• Vision loss, diplopia or dual vision, visual disturbance
• Trauma, eye injury
• Hypertension, diabetes
B. Positioning and coil -
• Coil selection should be 8NVARRAY coil.
• MRI orbit protocol should be taken after data entry of the patient.
1. 3 plane localizer- low quality images are taken for the further planning of
the sequences.
2. Calibration
3. Brain screening - Includes FLAIR axial, DWI and GRE axial should be
done.
4. T2 axial can be taken with low or high quality for planning if no brain
screening is done.
5. STIR (SHORT TAU INVERSION RECOVERY) coronal- Planning of
this sequence should be done on axial plane perpendicular to optic nerve and
adjustment of midline is to be done on sagittal and axial plane. Total no. of
slices should be 15 (approx.) or according to the requirement. The first slice
should be at the start of the lenses and the last slice towards the brain stem,
covering the whole orbit and orbital nerve. FOV 16-18 according to
requirement. Slice thickness- 3mm and spacing 0.5 to 1 mm.

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6. T2 coronal
7. T1 coronal
Copy the planning of STIR coronal.
8. STIR axial- Planning of this sequence should be done on stir coronal and
sagittal plane parallel to optic nerve with adjustment of midline. Total no. of
slices should be 15 (approx) or according to the requirement. The first slice
should be at the start of superior border of the orbit and the last slice at the
inferior border, also keep extra slices at superior and inferior of orbit so that
whole anatomy is covered. FOV 16-18 according to requirement. Slice
thickness- 3mm and spacing 0.5 to 1 mm.
9. T1 Axial- Copy the planning of STIR axial.

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10. STIR Sagittal Right Eye- Planning of this sequence should be done on stir
axial and stir coronal, parallel to Right Optic nerve in axial and adjustment
of the midline is to be done in coronal. Total no. of slices should be 15
(approx) or according to the requirement. The slices must be sufficient to
cover the right orbit starting from lateral to medial side. FOV 16-18
according to requirement. Slice thickness- 3mm and spacing 0.5 to 1 mm.
11. STIR Sagittal Left Eye- Planning of this sequence should be done on stir
axial and stir coronal, parallel to Left Optic nerve in axial and adjustment of
the midline is to be done in coronal. Total no. of slices should be 15 (approx)
or according to the requirement. The slices must be sufficient to cover the
left orbit starting from lateral to medial side. FOV 16-18 according to
requirement. Slice thickness- 3mm and spacing 0.5 to 1 mm.

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12. T1 Fatsat Coronal+ Gado - copy the planning of STIR coronal.
13. T1 Fatsat Axial+ Gado - copy the planning of STIR Axial.
14. T1 Fatsat Sagittal+Gado (Rt.Eye) - Copy the planning of STIR Sagittal
right eye.
15. T1 Fatsat Sagittal+Gado (Lt.Eye) - Copy the planning of STIR Sagittal
left eye.
16. T1 Fatsat Axial pre contrast can be taken if required.
Pathology:
• Orbital lesions
• Optic nerve neuritis
• Optic nerve glioma
• Optic nerve sheath meningioma
ORBITAL LESIONS OPTIC NERVE NEURITIS

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OPTIC NERVE GLIOMA OPTIC NERVE SHEATH MENINGIOMA
MRI PITUITARY/SELLA
(PLAIN+CONTRAST)
A. Patient history-
• Hormones hypersecretion
• Delayed of puberty
• Non-specific headache
• Follow up scan.
B. Positioning and coil –

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• Mri Pituitary protocol should be taken after data entry of the patient.
1. 3 Plane localizer
2. Calibration
3. Brain screening - T2 Flair Axial, Diffusion Axial and T2 Gre Axial
(Gradient)
4. T2 Axial Thin (optional) - Slices should be enough to cover the Pituitary
gland or Sella for the further planning for the sequences.
5. T2 Sagittal Thin - Planning of this sequence should be done on flair or T2
axial and adjustment of the midline should be done on axial and coronal
plane. Slices must be sufficient to cover the pituitary gland, approx no. of
slices can be kept 12. Slice can be increase if there is big mass or lesion
in pituitary. Keep the first slice at the right side of pituitary and the last
slice at the left side in both planes. Slice thickness can be kept 2.5 - 3 mm
and spacing 0.5-1 mm.
6. T1 Sagittal Thin- copy the planning of T2 Sagittal thin.
7. T2 Coronal Thin - Planning of this sequence should be done on flair or T2
axial and T2 Sagittal thin with adjustment of the midline. Slices must be
sufficient to cover the pituitary gland, approx no. of slices can be kept 12.
Keep the first slice at the anterior side of pituitary and the last slice at the
posterior

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side, covering from anterior border of sphenoid sinus to anterior border of
pons. Slice thickness can be kept 2.5 - 3 mm and spacing 0.5-1 mm.
8. T1 Coronal Thin- copy the planning of T2 Coronal thin.
9. Dynamic contrast study for Pituitary (coronal view) - Planning for this is
done on T2/T1 sagittal and flair or T2 axial with the midline adjustment.
Keep the no. of slices 6/7 with thickness 2.5-3 mm and spacing 0.3-0.5 so
that whole pituitary gland is covered. After planning the sequence run the
prescan mode manually, in first run pre contrast or mask will come then
inject the contrast 10ML or according to weight by hand or injector as soon
as you start the scan after prescan mode. There are total 7/8 phases in this
dynamic scan or can be more if you increase the slice. Keep the FOV 18-
20.

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10. If there is big lesion seen in pituitary region then you can give routine
contrast according to patient weight.
11. T1 Fatsat Sagittal+ Gado- copy the planning of T2 Sagittal thin and put
the shim.
12. T1 Fatsat Coronal+ Gado- copy the planning of the T2 Coronal Thin.
13. 3D Axial FSPGR+ Gado should be taken of whole brain (non- Fatsat).
Pathology:
• Microadenomas
• Macroadenomas
• Pituitary mass
MICROADENOMA MACROADENOMA
PITUITARY MASS

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MRI ORAL CAVITY/NECK/
ORAL CAVITY + NECK/BASE OF
SKULL/PNS/PAROTID/
TEMPORAL BONE
(PLAIN+CONTRAST)
A. Patient history-
• Infection of bone or soft tissue
• Facial abscess
• Trauma, fall
• Pre-operative evaluation of tumor
• Follow up scan.
• Head first in the brain coil with the central array on the end of nose.
• MRI oral cavity protocol should be taken after data entry of the patient.
1. 3 Plane localizer
2. Calibration

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3. STIR coronal- Planning of this sequence is done on sagittal and axial plane
with adjustment of the midline for a proper coronal image. Slices must be
sufficient to cover the oral cavity from the lips to the anterior side of cervical
spine. Keep the total slice 20- 25, thickness 3-4mm and spacing 0.5-1mm,
FOV 16 as per requirement.
4. T1 coronal- copy the planning of stir coronal.
5. STIR Sagittal- Planning of this sequence is done on STIR coronal and axial
plane with adjustment of the midline for a proper sagittal image. Slices must
be sufficient to cover the oral cavity from the right side of mandible to the
left side. Keep the no. of slice 20-24, thickness 3-4mm and spacing 0.5-
1mm, FOV 16 as per requirement.

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6. STIR axial- Planning of the sequence is done on stir sagittal and coronal
plane with adjustment of the midline. Slice must be sufficient to cover the
oral cavity from superior side (hard palate) to the inferior side (vocal cord).
Keep the slices 24, slice thickness 3- 4mm, spacing 0.5-1mm, FOV 15-16 as
per requirement.
7. T2 axial- copy the planning of stir axial.
8. T1 axial- copy the planning of stir axial.
9. Diffusion axial - copy the planning of stir axial and keep b-value 1000/800
with NEX 4.
10. Merge axial (If required) - copy the planning of stir axial.
11. T1 Fatsat coronal + gado- copy the planning of stir coronal.
12. T1 Fatsat axial+ gado- copy the planning of stir axial.
13. T1 Fatsat Sagittal+ gado- copy the planning of stir sagittal.
14. T1 Fatsat axial pre contrast can be taken if required.
Pathology:
• CA tongue
• Tongue abscess

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CA TONGUE TONGUE ABSCESS
• For the given studies in this topic the protocol will remain same only the
anatomical area will be changed.
• The FOV size and slices changes according to the requirements.
• If you don’t get T1 FAT-SATURATED sequence of post contrast
properly which means- the sequences of post contrast didn’t get fat
suppressed, you can take IDEAL sequence in all three plane.

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MRI EPILEPSY PROTOCOL OR
TEMPORAL LOBE
EPILEPSY (TLE)
A. Patient history-
• Convulsion
• Recurrent seizures
• MRI TLE protocol should be taken after data entry of the patient.
1. 3 plane localizer
2. Calibration
3. Brain screening - FLAIR axial, DWI and GRE axial.
4. FLAIR Coronal thin- Planning of this sequences should be done on axial
and sagittal plains with adjustment of the midline. Cover the temporal lobe
from anterior to posterior perpendicular to hippocampus in sagittal plane.
Slices must be sufficient to cover whole hippocampus. Keep no. of slices
18-20, thickness- 2.5-3mm with spacing 0.3-0.6mm as per requirement.
5. T2 Coronal thin- copy the planning of FLAIR coronal.

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6. 3D SPGR (Spoiled Gradient Recalled Echo) Coronal for
HIPPOCAMPUS- Planning of this 3d sequence will be same as FLAIR
coronal. Locs per slab must be sufficient to cover whole temporal lobe.
7. Instead of above 3D sequence you can also take COR T2 IR.
8. If you need to take more sequences for Brain you can take T2 and T1
axials, T1 sagittal.
Pathology:
• Mesial temporal sclerosis
• Ganglioglioma
• Gliosis

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MESIAL TEMPORAL SCLEROSIS
GANGLIOGLIOMA GLIOSIS

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MRI VERTIGO PROTOCOL
A. Patient history-
• Giddiness, vertigo
• Tinnitus and imbalance
• Head first in the brain coil with the central array on the
eyebrows.
• MRI vertigo protocol should be taken after data entry of the
patient.
2. Calibration
3. Brain screening - FLAIR axial, DWI and GRE axial.
3D FIESTA (Fast imaging employing steady-state acquisition)
Axial - Planning of this sequence should be done on coronal plane
with midline adjustment on sagittal and coronal plane. Cover the
7th and 8th cranial nerve, starting the slab from below
hippocampus in coronal plane and covering till cerebellum. Give
angle according to hard palate in sagittal plane to get proper
opening of both nerve. Locs per slab must be sufficient to cover
this 2 cranial nerve properly.

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4. If you need to take more sequences for Brain you can take T2
and T1 axials, T1 sagittal and FLAIR coronal.
Pathology:
• Benign positional paroxysmal vertigo
• Recurrent vertigo
BENIGN POSITIONAL RECURRENT VERTIGO
PAROXYSMAL VERTIGO (ACOUSTIC NEUROMA)

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MRI BRAIN ANGIOGRAPHY AND
NECK VESSEL
A. Patient history-
• Right and Left sided hemipheresis
• Slurring of speech
• Walking imbalance
• Hypertension and loss of vision
• Facial deviation
• Head first in the brain coil with the central array on the
eyebrows.
• MRI brain angiography and neck vessels protocol should be
taken after data entry of the patient.
2. Calibration of the brain.
3. Brain screening - FLAIR axial, DWI and GRE axial must be
taken.
4. 3D TOF (Time of Flight) for Brain angiography- Planning of

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this sequence should be done on sagittal plane covering the Circle of
Willis region properly with adjustment of the midline in coronal and
axial plane. Locs per slab must be sufficient, covering from above
corpus callosum till end of cerebellum. Apply superior saturation
band and shim before saving the sequence.
5. 3 plane localizer of neck- FOV must be sufficient covering from
hippocampus till aortic arch.
6. Calibration of neck region.
7. 3D TOF for neck vessels- Planning of this sequence should be
done on sagittal and coronal plane covering the neck vessels
properly with adjustment of the midline. Locs per slab must be
sufficient covering from aortic arch till mid of cerebellum. Apply
shim before saving the sequence.

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After acquiring the TOF images do the post processing of
COW and NECK VESSELS.
• For brain angiography post processing follow this pattern for
proper cutoff: inferior-anterior - left/right - anterior (right and left
oblique) - inferior to superior - anterior right and left oblique -
left/right.
• For neck vessels: left/right - left oblique - right oblique - left/right.

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Pathology:
• Infarct
• Artery block
• Hypoplasia
INFARCT RIGHT MCA BLOCK
HYPOPLASIA OF RVA

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B. SPINE
Basic anatomy of Spine for radiographer purpose:
• 7 cervical vertebrae
• 12 dorsal vertebrae
• 5 lumbar vertebrae
• 5 sacrum vertebrae
• 3 coccyx
• Inter vertebral disc
• Spinous process
• Csf
• Spinal cord
• S I joint

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MRI CERVICAL SPINE PLAIN +
CONTRAST
A. Patient history-
• Spine TB, spine cord tumor
• Vertigo or giddiness on/off
• Trauma, post-operative
• Radiating neck pain towards shoulder or upper limbs
• Tingling sensation and numbness in upper limbs
• Head first in the spine coil with the central array on the chin or at
the positioning mark on the coil.
• Coil selection should be 8CTL12 in spine coil.
• This study can also be performed in Brain 8NVARRAY coil
selection in head coil.
• MRI Cervical spine protocol should be taken after data entry of
the patient.
2. Calibration
3. T2 sagittal- Planning of this sequence is done on coronal plane

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with the adjustment of the midline in coronal and axial plane.
Slices must be sufficient to cover cervical spine C2-D1 from right
to left in coronal plane, passing one slice from the middle of the
spinal cord to get a proper view of spinal anatomy. Keep no. of
slices 11-15, thickness- 3- 4mm with spacing 0.5-1mm and
matrix 448x256 for high quality or as per requirement. Keep the
FOV as per required.
4. T1 sagittal- copy the planning of T2 sagittal.
5. T2 Fatsat or STIR sagittal- copy the planning of T2 sagittal and
apply SHIM before saving the sequence.
6. STIR Coronal- Planning of this sequence is done on sagittal
plane with the adjustment of the midline in axial plane. Slices
must be sufficient to cover cervical spine from anterior part of
vertebrae to posterior side (spinous process) in sagittal plane.
Give angle to the slices in sagittal plane as per cervical curvature
to get proper alignment of vertebrae in coronal view. Keep no. of
slices 11-15, thickness- 3- 4mm with spacing 0.5-1mm and
matrix 320x224/192 or as per requirement.

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7. T2 Axial- Planning of this sequence is done on T2 sagittal with
the adjustment of the midline in coronal plane. Slices must be
sufficient to cover cervical spine disc from C2-D1, passing one
slice from the middle of the disc levels to get a proper view of
anatomy. Keep total no. of slices 19(slices can be kept-
23/27/29/34/39 at disc levels or slab form as per abnormalities
detected), thickness- 3-4mm with spacing 0.5-1mm and matrix
320x224/192 or as per requirement.
8. MERGE (Multi-Echo Recombined Gradient Echo) 2D Axial-
copy the planning of T2 axial. This sequence provides greater
sensitivity for spinal lesions.

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9. Myelogram (optional) – Planning of this sequence is done on
axial plane. Place the slice properly in the middle of the spinal
cord to get sagittal and coronal myelogram image.
10. If any abnormality detected in spine or spinal cord it is
recommended to take SAGITTAL DIFFUSION with b value
400.

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If contrast is needed following sequence must be taken-
11. T1 Fatsat Axial pre-contrast - copy the planning of the T2 axial
and apply SHIM before saving the sequence.
12. T1 Fatsat Axial+ Gado- copy the planning of the T2 axial and
13. T1 Fatsat Sagittal+ Gado- copy the planning of the T2 sagittal
and apply SHIM before saving the sequence.
14. T1 Fatsat Coronal+ Gado- copy the planning of the STIR
coronal and apply SHIM before saving the sequence.
*If there is metal implant artifacts in spine region you can
replace MERGE AXIAL with T1 AXIAL*

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MRI CERVICO-DORSAL SPINE
PLAIN + CONTRAST
A. Patient history-
• Spine TB, spine cord tumor
• Radiating pain towards upper limbs
• Tingling sensation and numbness in upper and lower limbs
• Head first in the spine coil with the central array on the chin or at the
positioning mark on the coil.
• Coil selection should be 8CTL123.
• MRI Cervico-Dorsal spine protocol should be taken after data entry of the
patient.
2. Calibration
3. T2 sagittal- Planning of this sequence is done on coronal plane with the
adjustment of the midline in coronal and axial plane. Slices must be
sufficient to cover Cervico-Dorsal spine C2-D5 from right to left in coronal
plane, passing one slice from the middle of the spinal cord. Keep no. of slices
11-15, thickness- 3-4mm with spacing 0.5-1mm and matrix 448x256 for
high quality or as per requirement.

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5. T2 Fatsat sagittal or STIR sagittal- copy the planning of T2 sagittal and
6. STIR Coronal- Planning of this sequence is done on sagittal plane with the
adjustment of the midline in axial plane. Slices must be sufficient to cover
Cervico-Dorsal spine from anterior to posterior in sagittal plane. Give
angle to the slices in sagittal plane as per spine curvature to get
proper alignment of vertebrae in coronal view. Keep no. of slices
11-15, thickness- 3-4mm with spacing 0.5-1mm and matrix 320x224/192
or as per requirement.

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7. T2 Axial- Planning of this sequence is done on T2 sagittal with the
adjustment of the midline in coronal plane. Slices must be sufficient to cover
Cervico-Dorsal spine disc from C2-D5, passing one slice from the middle of
the disc levels to get a proper view of anatomy. Keep total no. of slices
19(slices can be kept- 23/27/29/34/39 as per abnormalities detected),
thickness- 3-4mm with spacing 0.5-1mm and matrix 320x224/192 or as per
requirement.
8. MERGE (Multi-Echo Recombined Gradient Echo) 2D Axial- copy the
planning of T2 axial. This sequence provides greater sensitivity for spinal
lesions.
9. Myelogram (optional) – Planning of this sequence is done on axial plane.
Place the slice properly in the middle of the spinal cord to get sagittal and
coronal myelogram image.

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10. If any abnormality detected in spine or spinal cord it is recommended to take
SAGITTAL DIFFUSION with b value 400.
11. T1 Fatsat Axial pre-contrast - copy the planning of the T2 axial and apply
SHIM before saving the sequence.
12. T1 Fatsat Axial+ Gado- copy the planning of the T2 axial and apply SHIM
before saving the sequence.
13. T1 Fatsat Sagittal+ Gado- copy the planning of the T2 sagittal and apply
14. T1 Fatsat Coronal+ Gado- copy the planning of the STIR coronal and

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MRI CRANIO-VERTEBRAL
JUNCTION
PLAIN + CONTRAST
A. Patient history-
• Severe neck pain with restricted movement
• Tingling sensation and numbness in upper limbs
• This study can also be performed in Brain 8NVARRAY coil selection
in head coil
• MRI CVJ protocol should be taken after data entry of the patient.
2. Calibration
sufficient to cover CVJ with cervical spine till C7 from right to left in
coronal plane, passing one slice from the middle of the spinal cord. Keep no.
of slices 11-15, thickness- 3-4mm with spacing 0.5-1mm and matrix
448x256 for high quality or as per requirement.

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CVJ and cervical spine from anterior to posterior in sagittal plane. Give
angle to the slices in sagittal plane as per CVJ curvature to get
proper alignment of CVJ and vertebrae in coronal view. Keep no.
of slices 11-15, thickness- 3-4mm with spacing 0.5-1mm and matrix
7. T2 Axial- Planning of this sequence is done on sagittal plane with the

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CVJ and cervical spine disc from C2-C7 (if required), passing slices from
above CVJ till C2-3 disc level and one slice from the middle of the
remaining cervical disc level to get a proper view of anatomy. Keep total
no. of slices 23 (slices can be kept- 27/29/34/39 as per abnormalities
detected), thickness- 3-4mm with spacing 0.5-1mm and matrix
8. MERGE (Multi-Echo Recombined Gradient Echo) 2D Axial- copy the
planning of T2 axial. This sequence provides greater sensitivity for spinal
lesions.

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MRI DORSAL SPINE
PLAIN + CONTRAST
A. Patient history-
• Spine TB
• Radiating pain
• Tingling sensation and numbness in upper and lower limbs
• MRI Dorsal spine protocol should be taken after data entry of the patient.
1. Low quality whole spine is to be taken for further planning.
2. 3 plane localizer- cover the dorsal spine C7/D1-D12/L1.
sufficient to cover dorsal spine D1-D12/L1 from right to left in coronal
11-15, thickness 4mm with spacing 0.5-1mm and matrix 448x256 for high
quality or as per requirement.

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dorsal spine from anterior to posterior in sagittal plane. Give angle to the
slices in sagittal plane as per spine curvature to get proper
alignment of vertebrae in coronal view. Keep no. of slices 11-15,
thickness 4mm with spacing 0.5-1mm and matrix 320x224/192 or as per
requirement.

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dorsal spine discs from D1-D12/L1, passing one slice from the middle of the
disc levels to get a proper view of anatomy. Keep total no. of slices 19(slices
can be kept- 23/27/29/34/39 as per abnormalities detected), thickness- 3-
4mm with spacing 0.5-1mm and matrix 320x224/192 or as per requirement.
8. T1 Axial- copy the planning of T2 axial.

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10. If any abnormality detected in spine or spinal cord it is recommended to
take SAGITTAL DIFFUSION with b value 400.

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MRI DORSO-LUMBAR SPINE
PLAIN + CONTRAST
A. Patient history-
• Spine TB
• Radiating pain in lower limbs
• Tingling sensation and numbness in lower limbs
• MRI Dorso-Lumbar spine protocol should be taken after data entry of the
patient.
1. Low quality whole spine should be taken for further planning.
2. 3 plane localizer- cover dorso-lumbar spine D6/7 to S1.
sufficient to cover dorso-lumbar spine D6/7-S1 from right to left in coronal
11-15, thickness 4mm with spacing 0.5-1mm and matrix 448x256 for high

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dorso-lumbar spine from anterior to posterior in sagittal plane. Give angle
to the slices in sagittal plane as per spine curvature to get proper
thickness 4mm with spacing 0.5-1mm and matrix 320x224/192 or as per
requirement.

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dorso-lumbar spine disc from D6-7-S1, passing one slice from the middle
of the disc levels to get a proper view of anatomy. Keep total no. of slices
23 (slices can be kept- 27/29/34/39 as per abnormalities detected),
thickness- 3- 4mm with spacing 0.5-1mm and matrix 320x224/192 or as per
requirement.

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10. If any abnormality detected in spinal cord it is recommended to take

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MRI LUMBAR/LUMBO-SACRAL
SPINE PLAIN + CONTRAST
A. Patient history-
• Spine TB
• Radiating pain in lower limbs
• Tingling sensation and numbness in lower limbs
• If the height of the patient is short, you can use 8CTL345.
• MRI L.S. spine protocol should be taken after data entry of the patient.
1. Low quality whole spine should be taken for further planning.
2. 3 plane localizer- cover lumbo-sacral spine D12-S1.
sufficient to cover L.S. spine D12-S1 from right to left in coronal plane,
passing one slice from the middle of the spinal cord. Keep no. of slices 11-
15, thickness 4mm with spacing 0.5-1mm and matrix 448x256 for high

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L.S. spine D12-S1 from anterior to posterior in sagittal plane. Give angle
to the slices in sagittal plane as per spine curvature to get proper
thickness- 3-4mm with spacing 0.5-1mm and matrix 320x224/192 or as per
requirement.

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L.S. spine disc from D12-S1, passing one slice from the middle of the disc
levels to get a proper view of anatomy. Keep total no. of slices 19(slices can
be kept- 23/27/29/34/39 as per abnormalities detected), thickness- 3-4mm
with spacing 0.5-1mm and matrix 320x224/192 or as per requirement.

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MRI SACRUM AND COCCYX
PLAIN + CONTRAST
A. Patient history-
• Severe pain in hip and lower back
• Head first in the spine coil with the central array on the iliac crest.
• You can put central array on chin and put the localizer position for
axial as I450 in location box.
• This study can also be done using Lower Body Coil selection in Body
coil with feet first.
• MRI Sacrum and Coccyx protocol should be taken after data entry of the
patient.
1. 3 plane localizer- cover sacrum and coccyx region.
2. Calibration
3. STIR sagittal- Planning of this sequence is done on coronal plane with the
sufficient to cover sacrum and coccyx from right to left in coronal plane,
passing one slice from the middle of the spinal cord. Keep no. of slices 20-
25, thickness 4mm with spacing 0.5-1mm or as per requirement.

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4. T1 sagittal- copy the planning of STIR sagittal.
5. STIR Coronal- Planning of this sequence is done on STIR sagittal with the
sacrum and coccyx from anterior to posterior in sagittal plane, parallel to
sacrum and coccyx. Keep no. of slices 15-20, thickness- 3- 4mm with
spacing 0.5-1mm or as per requirement.
6. T1 coronal- copy the planning of STIR coronal.

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7. STIR Axial- Planning of this sequence is done on STIR sagittal with the
adjustment of the midline in STIR coronal. Slices must be sufficient to cover
sacrum and coccyx from L5 to the end of Coccyx. Perpendicular to sacrum
and coccyx. Keep total no. of slices 24 (slices can be kept- 27/29/34/39 as
per abnormalities detected), thickness- 3-4mm with spacing 0.5-1mm or as
per requirement.
8. T2 Axial- copy the planning of STIR axial.
9. T1 Axial- copy the planning of STIR axial.
10. If any abnormality detected it is recommended to take AXIAL
DIFFUSION with b value 400.

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MRI WHOLE SPINE SCREENING
(PLAIN+ CONTRAST)
For the screening of whole spine the following sequences are taken-
1. T2 Sagittal- TOP- covers Cervico-Dorsal region. Coil 8CTL123
2. T2 Sagittal- MID- covers Dorsal. Coil 8CTL234
3. T2 Sagittal- BOTTOM- covers Lumbo-Sacral region. Coil
8CTL456
If you need post contrast whole spine screening take the following
sequences-
1. T1 Fatsat Sagittal+Gado - TOP- covers Cervico-Dorsal region.
2. T1 Fatsat Sagittal+Gado - MID- covers Dorsal region.
3. T1 Fatsat Sagittal+Gado - BOTTOM- covers Lumbo-Sacral
region.
• For high quality use matrix 448X256
• For low quality use matrix 192X192. Mainly used to count the vertebrae.

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Pathology:
• Degenerative disc
• Bulging disc
• Herniating disc
• Thinning disc
• Syrinx
• Koch’s
• Fracture

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• Spinal cord lesions
• Hiramaya
• Sacroilitis
• Coccydynia
DEGENERATIVE DISC BULGING DISC

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HERNIATING DISC THINNING DISC
SYRINX KOCH’S (SPINE TB)

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FRACTURE SPINAL CORD LESIONS
HIRAMAYA (FLEXION) SACROILITIS

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COCCYDYNIA
COCCYGEAL FRACTUR

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Points to be remembered during
spine region scanning
• If the patient is too heavy, crossing 90kg with fats in large quantity you
must activate the no phase wrap option from imaging option to avoid
phase wrap artifact.
• To select the proper coil for study use the option shown in above image-coil
selection-currently connected option inside the coil.
• If the spine study is with the screening of whole spine you have to take the
sequences given in topic- MRI whole spine screening with high matrix.
• To lower the timing of sequence you can adjust the phase FOV according to
patient body fat seen in sagittal and axial planes, only if no phase wrap
option is off.

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• Frequency direction should be kept Superior to Inferior in sagittal and
coronal plane and Right to Left for axial.
• If the patient is having metallic implant and you need Fatsat sequence- you
must take STIR sequence instead of T2 Fatsat.
• If patient is having lesion such as Pott’s Spine- you have to take slices as
slab from start of the lesion till as much as you can cover the seen lesion. For
pre and post contrast axial sequence if the lesion is small- you can take slab
only for that lesion.
• If the patient is having scoliosis you have to increase the no. of slices to
cover the spine properly in sagittal plane. Also need to adjust the axial
slices in stir coronal plane to get better axials image.

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