PROTOCOLS
A Check the clinical indication and choose the correct protocol
B Read any scanning notes to ensure correct positioning and orientation
C Perform the sequences in the order indicated - this is important to ensure a diagnosis in the event the scan is abandoned
Protocols are available for
• Sciatica / Radiculopathy / Leg pain / Cauda equina
• Low back pain / Rule out malignancy / Limited Spine protocol
• Spondyloarthritis (sometimes written SPA) 'Inflammatory Spine Disease'
• Pars defect Pars stress fracture Spondylolysis
• Neck and arm pain
• Sacroiliitis
• Sacral insufficiency fracture
• Brachial plexus / Thoracic Inlet
• Scoliosis
• Thoracic pain
IMPORTANT SCANNING NOTES
• Sagittal sections - scan between tips of transverse processes
• Slice thickness 3mm or better FOV 12-14cm unless otherwise stated
• If there is no leg pain, axials are often not required
• Do not confuse sacroiliitis (generally younger patients) with Sacral insufficiency (generally older) protocols
Sciatica / Radiculopathy / Leg pain / Cauda equina
• Sagittal T2
• Sagittal T1
• Axial T2
• Axial T1
• Sagittal STIR
Low back pain / Rule out malignancy / Limited Spine protocol
• Sagittal STIR
• Sagittal T1
Spondyloarthritis / SPA / Inflammatory Protocol
• Sagittal STIR - thoracolumbar spine - scan between tips of transverse processes
• Sagittal T1 - thoracolumbar spine
• Sacroiliitis protocol see below
• Sag STIR C Spine only if there are specific neck symptoms
Pars defect / Pars stress fracture / Spondylolysis
• Sagittal STIR 3mm
• Sagittal T1 3mm 512*512 matrix
• Axial VIBE (pseudoCT) Isotropic 3D T1 weighted GRE
(Siemens = VIBE, GE = LAVA, Phillips = Thrive)
Please use the following parameters:
TR = 6-8 ms, TE = 2-3 ms, FOV 16-20cm, Slice 0.6-1mm, FA 10, NEX 2, Isotropic matrix > 300 and Reconstruct into sagittal images
• Axial T2
• Axial T1
Neck and arm pain
• Sagittal T2
• Sagittal T1
• Sagittal STIR
• Axial T2*
Sacroiliitis
• Coronal T2 Dixon angled along posterior margin of S2
• Coronal T1 same angulation
• Axial FSPD
• Coronal same angulation T1 3D VIBE (Protocol: TR/TE of 7 ms/2.45 ms, 20 cm FOV, 1 mm slice thickness)
Sacral insufficiency fracture
• Coronal STIR
• Coronal T1 - do not mix up protocol with sacroiliitis
Brachial plexus / Thoracic Inlet
• Coronal T1
• Coronal FSPD
• T2 Space TSE STIR isometric 380*380 matrix 0.9mm 3000/175ms
• Axial T2
• Sagittal T1 - on affected side
Scoliosis
• Coronal FSPD
• Sagittal T2 - may need two sets above and below apex
• Sagittal T2 - C spine if not already included
• Axial T2 - through apex
• Axial T2 - through cauda equina
Thoracic Pain
• Sagittal T2 include C Spine if numbering needed
• Sagittal T1
• Axial T2 - if needed
• Axial T1 - if needed
• Sagittal STIR
