MRI of the Brain (12 & 13) - Past Paper - جامعة التقنية الوسطى

‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title:...

‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of the brain (12 & 13) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ Understanding brain MRI imaging is essential for MRI technologist to perform MRI exams effectively, interpret MRI results accurately, optimize MRI parameters, and keep up-to-date with MRI technology. Brain MRI imaging can provide information about the brain’s anatomy, detect abnormalities, and measure blood flow and diffusion in the brain. MRI technologist can learn about brain MRI imaging through MRI tech programs, continuing education courses, and on the job training. Scientific Content: :‫المحتوى العلمي‬ Anatomical overview Nervous system is a complex network of nerves and cells that carry messages to and from the brain and spinal cord to various parts of the body. It was divided into: - 1- Central nervous system (CNS): - Which include the brain and spinal cord. 2- Peripheral nervous system (PNS): - It consist of the nerves that branch out from the brain and spinal cord. These nerves form the communication network between the CNS and the body parts. Brain: - It consists of three main parts: A- Cerebrum: - It is the largest part of the brain; it consists of two hemispheres. The cortex contains mostly nerve cell bodies and appears as grey matter, below the cortex, nerve fibers traveling toward and away from the cortex forming the white matter. B- Cerebellum: - The second largest part of the brain. It located in the posterior cranial fossa. Its outer layer containing a concentration of cell bodies (grey matter) and its deeper layers containing mostly cell processes and supportive cells (white matter). (fig.1) C- Brain stem: - Which consist of the following parts: - (fig.2) 1-Midbrain: - The bundle of nervous tissue connecting the cerebrum with the cerebellum and spinal cord. 2- Pons: - Located anterior to the cerebellum. The enlarged portion of the brain stem where fibers from the cerebellum join those from the cerebrum and spinal cord. 3- Medulla oblongata: - Form the lower brain stem directly Fig.1:below the pons Alignment and contains of protons with theallexternal the ascending and magnetic descending field. tracts that communicate between the spinal cord and brain.  Fig-1- parts of brain Fig-2- parts of brain stem  MRI brain is a specialist investigation that is used for the assessment of a number of neurological conditions. It is the main method to investigate conditions such as multiple sclerosis and headaches, and used to characterize strokes and space- occupying lesions. Indications of brain MRI: - Tumors: in comparison with CT, MRI has the advantage of detecting lesions in the posterior fossa, at the edge of calvarium and is superior for lesions near the base of the skull and the pituitary fossa. Hemorrhage-Ischemic stroke: Both these conditions are easily detected by MRI. For example, the detection of thrombosis/stenosis is a very promising application of MR angiography. Trauma: In comparison with CT, MRI has the advantage of demonstrating the entire extent of the extracerebral collection plus superior evaluation of diffuse axonal injury and sequelae of trauma. Disadvantages include the longer scanning times and the inability to demonstrate the bony cranium. Degenerative Diseases: MRI is extremely effective in diagnosing multiple sclerosis, subcortical arteriosclerotic encephalopathy, gliosis and syrinx. MRI procedure: Patient position: 1- Patient should be in supine-position. (head first). (Fig.3) 2- Place the patient in the head coil. 3- The patient should be well padded to prevent image degradation or malalignment due to head movement. 4- If the imaging coil has a mirror, ensure the patient is able to see out of the bore to alleviate claustrophobia. (Fig.3) Patient position-head coil Scout slice placement: - 1- Sagittal localizer to obtain axial slices: - Alignment: Parallel to a line joining the splenium and genu of the corpus callosum. - Coverage: A- Superior to inferior: Craniocervical junction to vertex. B-Lateral to medial: Temporal lobes on both sides. C-Posterior to anterior: Occipital to frontal lobes. - Note: We can use a coronal localizer to obtain axial slices also.  2- Sagittal localizer to obtain coronal slices: - Alignment: Parallel to the brainstem. - Coverage: A- Superior to inferior: Craniocervical junction to vertex. B-Lateral to medial: Temporal lobes on both sides. C-Posterior to anterior: Occipital to frontal lobes. Note: We can use axial localizer to obtain coronal slices also. 3-Axial localizer to obtain sagittal slices: - Alignment: Parallel to the falx (If midline shift is evident, a line of best fit should be used). - Coverage: A- Superior to inferior: Craniocervical junction to vertex. B-Lateral to medial: Temporal lobes on both sides. C-Posterior to anterior: Occipital to frontal lobes. - Note: We can use a coronal localizer to obtain sagittal slices also.  MRI sequences (Routine brain): Sequence TR TE FA ETL Slice thickness Sagittal (T1) (FSE) 500ms Min - 3-4 5mm Coronal (T2) (FSE) 4550ms 102ms - 13 5mm Axial (DWI) 8000ms 84ms - - 5mm Axial (T2) Flair 8000ms 135ms - 35 5mm, TI=2000 Axial (T2) (FSE) 4000ms 129ms - 27 5mm Axial (SWI) 5000ms Min 90 - 2.4mm Coronal (T1) (FSE) (post GAD) 500ms Min - 3-4 5mm Sagittal (T1) (FSE) (post GAD) 500ms Min - 3-4 5mm Axial (T1) (FSE) (post GAD) 600ms Min - 3-4 5mm Notes: -T1WI provides the most anatomically-relevant images. -Flair images useful for areas of edema or inflammation and used to identify plaques in multiple sclerosis. -DWI was the preferable in case of stroke, abscesses, and cellular tumors since the restricted diffusion was occurs in these pathological conditions. References: :‫المصادر‬ - Step by step MRI: Jaganmohan, V Prasad. - Planning and Positioning in MRI: Anne Bright. - Handbook of MRI scanning: Geraldine Burghart, Carol Ann Finn. - Smith D, Murphy A, Vadera S, et al. MRI brain (summary). Reference article, Radiopaedia.org. - Introduction to sectional anatomy: Michael E. Madden.  ‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of the orbit and Sella turcica (14) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ MRI Technologist need to learn the specific protocols and techniques for performing different magnetic resonance imaging exams. These examinations can help technologist for understanding anatomy and pathology of eye, pituitary fossa, and surrounding structures. Scientific Content: :‫المحتوى العلمي‬ Anatomical overview: - The bony orbits (or eye sockets) are bilateral and symmetrical cavities in the head. They enclose the eyeball and its associated structures. The orbit can be thought of as a pyramidal structure, with the apex pointing posteriorly and the base situated anteriorly. The boundaries of the orbit are formed by seven bones. (fig.1) Roof (superior wall) – Formed by the frontal bone and the lesser wing of the sphenoid. The frontal bone separates the orbit from the anterior cranial fossa. Floor (inferior wall) – Formed by the maxilla, palatine and zygomatic bones. The maxilla separates the orbit from the underlying maxillary sinus. Medial wall – Formed by the ethmoid, maxilla, lacrimal and sphenoid bones. The ethmoid bone separates the orbit from the ethmoid sinus. Lateral wall – Formed by the zygomatic bone and greater wing of the sphenoid. - The bony orbit contains the eyeballs and their associated structures which include: extra-ocular muscles, eyelids, nerves, and blood vessels.  Fig (1) the anterior and lateral views of the bony orbit. Orbits protocol is an MRI protocol comprising a group of MRI sequences as a useful approach to routinely assess the orbits and their related conditions. Indications of orbits MRI: - 1- Retro-orbital lesions: lesions occurring behind the orbit of the eye. 2- Optic disc distortion or pallor: It means that the optic nerve axons have been damaged in variety of disorders. 3- Infection or inflammation (e.g. orbital cellulitis; which is the infection of fat and muscles around the eye). 4- Intra-ocular lesions. 5- Retinoblastoma: is a type of eye cancer that starts in retina, the light sensing layer. MRI procedure: Patient position: 1- Before you bring the patient into the scan room, have the patient remove all eye make-up. 2- Patient should be in supine position (head first). 3- Place the chin up with the Orbital-meatal line +15 to the table top. This position places the optic nerve perpendicular to the table. 4- Turn on the alignment lights. Place the sagittal light on the mid- sagittal line of the patient’s head and the axial line to pass through both outer canthus of the eyes. 5- Place the coils as close as possible to the eye without touching the patient. (fig.2) 6- Immobilize the patient using sponges and straps. 7- Patients should be asked to close the eyes during image acquisition to limit ocular movement that may degrade image quality. The use of an eye mask may be helpful. Alternately, providing the opportunity to the patient to open the eyes between scans may suffice. Fig.2 Patient position-surface coil  Scout slice placement: - 1- Coronal localizer to obtain axial slices. - Alignment: Parallel to a line joining the inferior orbital margins. - Coverage: A-Superior to inferior: Inferior to superior orbital margin. B-Lateral to medial: Zygoma on each side. C-Posterior to anterior: Mid pons to anterior aspect of the globes. - Note: we can obtain axial slices from a parasagittal localizer but the alignment should be in plane with the optic nerve. Axial slices on a parasagittal localizer, aligned to the optic nerve.  2- Axial localizer to obtain coronal slices: -Alignment: Parallel to a line joining the posterior orbital margins, Perpendicular to the cribriform plate. - Coverage: As per axial scans. - Note: We can use a sagittal localizer to obtain a coronal slice also. MRI sequences (orbits) Sequence TR TE FA ETL Slice thickness Axial (T2) Flair 9500ms 132ms - 36 5mm, TI=2375 Axial (T1) Flair (FS) 3000ms 17ms - 10 3mm, TI=1200 Axial (T1) (Flair) (FS) (post GAD) 3000ms 17ms - 10 3mm, TI=1200 Coronal (T1) (Flair) (FS) (post GAD) 3000ms 17ms - 10 3mm, TI=1200 Sella turcica (Pituitary region): The upper surface of the body of sphenoid bone is shaped like a Turkish saddle. This area is called the Sella turcica. It has a raised anterior border known as the tuberculum sellae, a raised posterior border called the dorsum sellae, and a low area in the center called the hypophyseal fossa (a.k.a. pituitary fossa). The pituitary gland, an important part of your body’s endocrine system, sits in the hypophyseal fossa. It is covered by a protective layer called the diaphragm sellae, which attaches to the anterior and posterior borders of the Sella turcica. (fig.3)  (fig.3) Sella turcica MRI (pituitary region): A systematic approach to the pituitary region is crucial as small lesions can have a profound impact on the patient, and can be subtle even on high-quality dedicated MRI imaging. Successful assessment of the pituitary region relies not only on a clear understanding of the local anatomy but also on the relatively wide variety of pathologies that occur in the region. Indications: - 1-Macroadenoma. 2-Microadenoma or prolactinoma. 3-Delayed onset or precocious puberty 4-Galactorrhoea. 5-Menstrual irregularity or amenorrhea.  MRI procedure: Patient position: 1- Patient should be in supine-position (head first). 2- Place the patient in the head coil. 3- Immobilize the patient using sponges and straps. Scout slice placement: - 1- Coronal localizer to obtain sagittal slices. -Alignment: Parallel to the falx cerebri. - Coverage: A- Superior to inferior: Floor of the sphenoid sinus to the genu of the corpus callosum. B-Lateral to medial: Cavernous sinus on each side. C-Posterior to anterior: Ventral aspect of the pons to the anterior clinoid process. -Note: We can use the axial localizer to obtain a sagittal slice also. 2-Sagittal localizer to obtain coronal slice: -Alignment: Perpendicular to the floor of the Sella on a sagittal image. - Coverage: As for the sagittal plane. - Note: -Note: We can use the axial localizer to obtain a coronal slice also but the alignment should be perpendicular to the midline of the brain. MRI Sequences (pituitary region) Sequence TR TE FA ETL Slice thickness Sagittal (T1WI) SE 500 Min - - 3mm Coronal (T2WI) FSE 4000 120 - 27 3mm Coronal (T1WI) SE 450 Min - - 3mm Coronal (T1WI) SE (post GAD) 450 Min - - 3mm Sagittal (T1WI) SE (post GAD) 675 Min - - 2mm Coronal (T1WI)-Dyn study (post GAD) 400 Min - - 3mm References: :‫المصادر‬ - Step by step MRI: Jaganmohan, V Prasad. - Planning and Positioning in MRI: Anne Bright. - Handbook of MRI scanning: Geraldine Burghart, Carol Ann Finn. - Gaillard F, Balthazar S, Bell D, et al. Pituitary MRI (an approach). Reference article, Radiopaedia.org. - Introduction to sectional anatomy: Michael E. Madden.  ‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of cervical spine (15) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ Learning about cervical spine MRI is essential for MRI technologist to perform MRI exams effectively, interpret MRI results accurately, ensure patient safety, understand anatomy and pathology, and collaborate with other healthcare professionals. Scientific Content: :‫المحتوى العلمي‬ Anatomical overview: - Exiting the cranium via the foramen magnum, the spinal cord is contained within the vertebral column. It gives off nerves on each side between each of the bones in the spine, commencing with the first cervical nerve root between the base of the skull and the first cervical vertebra. Intervertebral discs between each vertebra, commencing at the C2/3 level, facilitate flexibility of movement, cushion the bones from shock, and assist in maintaining alignment. Ligaments supporting the spine include the anterior and posterior longitudinal, intimately attached to the bodies of the vertebrae. Connecting the laminae of each of the vertebral bodies from C2 to S1 are the ligamentum flava. The intertransverse and interspinous ligaments connect the transverse processes and spinous processes of the vertebrae, respectively. Finally, the nuchal ligament extends from the occiput to the spinous process of the seventh cervical vertebra. The vertebral arteries course through the transverse foramen of the sixth to first cervical vertebra. (fig.1) (Fig.1) Normal anatomy of cervical spine Fig.1: Block diagram of a typical magnetic resonance imaging scanner. -MRI of cervical spine: The MRI cervical spine protocol encompasses a set of MRI sequences for the routine assessment of the cervical spine. - Indications of cervical spine MRI: - 1- Degenerative disc disease which include: - Disc herniation and radiculopathy. - Suspected spinal canal stenosis. 2-Spinal trauma, suspected C.S fractures, spinal epidural hematoma. 3-Spinal tumors or vertebral metastasis. 4-Inflammation and autoimmune conditions which include: - Multiple sclerosis. - Inflammatory arthritis. 5-Spinal infection such as vertebral osteomyelitis. 6-Spinal vascular malformation. 7-Spinal cord infarction. 8-Congenital spinal malformation. 9-Suspected complications of spinal surgery. 10-Follow up of findings on other examinations. -MRI procedure: - Patient position: Place the coil on the magnet table and plug it in. Place patient supine, head first. Rest the head and neck in the coil. Position the superior end of the coil at the base of the skull. This position should include C1 on a sagittal image so that you can count vertebra for localization purpose. (fig.2)  Fig.2 patient position (cervical-spine MRI) Scout slice placement: - 1-Coronal localizer to obtain sagittal slices. - Alignment: Parallel to the long axis of the spinal cord. - Coverage: A-Superior to inferior: Craniocervical junction to second thoracic vertebra. B-Lateral to medial: Vertebral pedicles on each side. C-Posterior to anterior: Spinous processes to prevertebral tissues. - Sagittal slices can be used to demonstrate the following: 1-Vertebral alignment. 2-Bony integrity and end plate disruption. 3-Herniated disc. 4-Space occupying lesions within the spinal canal and spinal canal stenosis. 5-Ligamentum flavum. 6-Syrinx. 2-Sagittal localizer to obtain axial slice -Alignment: Perpendicular to the long axis of the cervical cord. - Coverage: A-Superior to inferior: Pedicle of the third cervical vertebra to the pedicle of the first thoracic vertebra. Post trauma, scans should commence at the base of the skull. B-Lateral to medial: Intervertebral foramina on each side. C-Posterior to anterior: Spinous processes to prevertebral tissues. - Axial slices can be used to demonstrate the following: 1-Herniated disc. 2-Paravertebral extension of masses into the soft tissue. 3-Sagittal localizer to obtain coronal slice: -Alignment: Parallel to the long axis of the spinal cord. Some obliquity will most likely be required to achieve this. - Coverage: A-Superior to inferior: Craniocervical junction to the second thoracic vertebra. B-Lateral to medial: Transverse processes on each side. C-Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies. - Coronal slices can be used to demonstrate the following: 1- Space occupying lesions within the spinal canal. 2- Lateral compression of nerve roots. 4-Axial localizer to obtain sagittal oblique slice: -Alignment: A-Perpendicular to the nerve roots as they exit the cervical canal in the mid cervical spine. An angle of approximately 45° should be expected. B-Verify that the slices will cover the nerve roots and foramina on each side at the superior and inferior cervical spine. C-Bilateral scans may be performed simultaneously or separately. -Coverage: A-Superior to inferior: Craniocervical junction to the first thoracic vertebra. B-Lateral to medial: Nerve root origins at the edge of the cervical cord to the lateral aspect of the spinal foramen. C-Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies. -Note: Complementary to the axial images, this view assists in demonstrating the severity of foraminal impingement. MRI Sequences (Cervical spine) Sequence TR TE FA ETL Slice thickness Sagittal (T2) (FSE) 3400 102 - 14 3mm Sagittal (T1) (FSE) 450 14 - 4 3mm Sagittal (STIR) 2888 60 - 10 3mm/TI=110 Corona (T1) (FSE) 575 13 - 2 3mm Axial (T1) (FSE) (post GAD) 625 Min - 3 4mm Sagittal (T1) (FSE) (post GAD) 450 4 - 4 3mm  - Optional sequences: 1- Sagittal (DWI): evaluation of spinal cord ischemia. 2- Sagittal or axial MR-perfusion: evaluation of tumors for their vascularization. References - Step by step MRI: Jaganmohan, V Prasad. - Planning and Positioning in MRI: Anne Bright. - Handbook of MRI scanning: Geraldine Burghart, Carol Ann Finn. - Feger J, Er A, Yap J, et al. Cervical spine protocol (MRI). Reference article, Radiopaedia.org.  ‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫ تقنيات األشعة‬:‫قسم‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of thoracic & lumbar spine (16) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ Dorsal and lumbar spine MRIs are among the most common MRI procedures performed, this is because the lower back is a common site of pain and injury. Both dorsal and lumbar spine MRI can be a complex procedure, as it requires the patient to be positioned in a specific way and the MRI technologist to be able to identify and image a variety of anatomical structures. Scientific Content: :‫المحتوى العلمي‬ Anatomical overview: The thoracic spine (often shortened to T-spine) forms the middle part of the vertebral column. It extends from below C7 of the cervical Q/ Define spine to the repetition above time L1 of the lumbar spine. There are 12 (TR)? thoracic vertebra, termed T1-T12. The thoracic spine is unique due to its articulation with ribs via costal facets. The ribs restrict the movement of the thoracic spine somewhat. The thoracic spine is otherwise the most mobile of all spinal column segments. Relative to cervical and lumbar vertebrae, thoracic vertebrae have: (fig.1) medium-sized, heart shaped vertebral bodies. medium-sized round vertebral canals. prominent transverse processes with costal facets. long spinous processes angulating downwards. (Fig.1) A portion of the thoracic vertebral column.  The MRI thoracic spine protocol encompasses a set of MRI sequences for the routine assessment of the thoracic spine. Indications of thoracic spine MRI: 1-Myelopathy. 2-Herniated disc. 3-Primary malignancy. 4-Secondary malignancy. 5-Radiculopathy. 6-Syrinx. 7-Benign tumor. 8-Multiple sclerosis. 9-Scoliosis. MRI procedure (thoracic spine): Patient position: 1-Place the phased array coil on the magnet table and plug the phased array coil port. 2-Position patient supine, and either head or feet first. A feet first position may be preferred by claustrophobic patients. 3-Place arms at the sides or above the head, whichever is most comfortable for the patient. 4-Use accessories such as the knee bolster and blankets to make the patient as comfortable as possible. 5-Place the axial alignment light 2 cm above the xiphoid which is approximately T7. 6-Explicitly instruct the patient not to move during the scan, e.g.: don’t shift hips or move legs.  Scout slice placement: - 1-Coronal localizer to obtain sagittal slice. -Alignment: Parallel to the long axis of the spinal cord. - Coverage: A-Superior to inferior: Seventh cervical vertebra to first lumbar vertebra. B-Lateral to medial: Vertebral pedicles on each side. C-Posterior to anterior: Spinous processes to prevertebral tissues. -Sagittal slices can be used to demonstrate: - 1-Vertebral alignment. 2-Syrinx. 3-Cord displacement within the canal due to cord herniation or intradural mass. 4-End plate disruption. 5-Herniated disc. 6-Space occupying lesions within the spinal canal. 7-Conus medullaris. 2-Coronal localizer to obtain axial slice -Alignment: Perpendicular to the long axis of the thoracic cord. - Coverage: A-Superior to inferior: As required by the radiologist, covering from the pedicles of one vertebra above and below the vertebrae of interest, e.g. if T8–10 is of interest, scan from the pedicles of T7 to T11. B-Lateral to medial: Intervertebral foramina on each side. C-Posterior to anterior: Spinous processes to prevertebral tissues. -Axial slices can be used to demonstrate the following: 1- Herniated disc. 2-Canal stenosis. 3-Space occupying lesions within the spinal canal. 4-Paravertebral extension of masses into the soft tissues. 5-Syrinx. 3-Sagittal localizer to obtain coronal slice - Alignment: Parallel to the long axis of the spinal cord. - Coverage: A-Superior to inferior: Seventh cervical vertebra to the first lumbar vertebra. B-Lateral to medial: Transverse processes on each side. C-Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies of C7 and L1. -Coronal slices can be used to demonstrate the following: 1-Scoliosis. 2-Space-occupying lesions within the spinal canal. 3-Syrinx. 4-Compression laterally on the nerve roots. MRI Sequences (thoracic spine) Sequence TR TE FA ETL Slice thickness Sagittal (T2) (FSE) 3500 102 - 16 4mm Sagittal (T1) (SE) 400 Min - - 4mm Sagittal (STIR) 3000 85 - 8 4mm/TI=150 Axial (T2) (FSE) 3000 102 - 32 4mm Axial (T1) (Dual SE) 350 Min - 2 3mm Corona (T1) (Dual SE) 500 13 - 2 3mm Axial & sagittal (T1) (FSE) (FS) (post 550 Min - 4 5mm GAD) -Optional sequences: 1-Chemical shift imaging (T1 GRE) (IP) & (OP) (Sagittal plane). -Purpose: Tissue characterization of bone tumor. 2-DWI (Sagittal plane). -Purpose: Evaluation of spinal ischemia. Lumbar spine: The lumbar spine (often shortened to L- spine) consists of five adjacent vertebrae of the lower vertebral column, in some cases it is possible to find 4 or 6 vertebrae as an anatomical variant. They participate in the lumbar lordosis, a natural curve in the spine, that is convex anteriorly. Articulations of the facet (zygapophyseal) joints permit flexion/extension and abduction movements. Rotation is greatly limited, and may occur only slightly at the lumbosacral joints. (fig.2)  (Fig.2) Lumbar spine The MRI lumbar spine protocol encompasses a set of MRI sequences for the routine assessment of the lumbar spine. Indications of lumbar spine MRI: 1-Disc prolapse with cord or nerve root compression. 2-Syrinx. 3-Discitis. 4-Evaluation of conus in patients with appropriate symptoms. 5-Arachnoiditis. MRI procedure (lumbar spine) Patient position: 1-Place the phased array coil on the magnet table and plug the phased array coil port. 2- Patient should be in supine-position. 3-A feet-first orientation may be preferred by anxious patients. 4-Adjust the patient so that the anatomy of interest is center over the selected coil. 5-Use accessories such as the knee bolster, to flatten the lumbar curve and bring it closer to the coil, and blankets to make the patient as comfortable as possible.  Scout slice placement: - 1-Coronal localizer for sagittal slice - Alignment: Parallel to the long axis of the spinal cord. - Coverage: A-Superior to inferior: Conus to second sacral vertebra. Coverage should include the twelfth thoracic vertebra, even if the conus is below this level. B-Lateral to medial: Vertebral pedicles on each side. C-Posterior to anterior: Spinous processes to prevertebral tissues. - Sagittal slices can be used to demonstrate the following: 1-Vertebral alignment. 2-Canal stenosis. 3-End plate and cortical disruption. 4-Defects of the pars interarticularis. 2-Sagittal localizer for axial slice Axial block series planned Axial, planned to each intervertebral disc. on a sagittal localizer. -Alignment: Alignment may vary between sites. Two possibilities are available: 1-As a single block: – in plane with the intervertebral discs. 2- Using multiple angles: – aligned individually to each intervertebral disc space. -Coverage: A-Superior to inferior: Pedicle of the third lumbar vertebra to the pedicle of the first sacral segment for a single block, or from pedicle to pedicle for each individual vertebra. B- Lateral to medial: Intervertebral foramina on each side. C- Posterior to anterior: Medial sacral crest to the prevertebral tissues. - Axial slices can be used to demonstrate the following: 1-Space-occupying lesions within the spinal canal. 2-Paravertebral extension of masses into the soft tissue. 3-Sagittal localizer for coronal slice -Alignment: Parallel to the long axis of the cauda equina. Some obliquity will most likely be required to achieve this. - Coverage: A-Superior to inferior: Conus to second sacral vertebra. Coverage should include the twelfth thoracic vertebra, even if the conus is tethered below this level. B-Lateral to medial: Transverse processes on each side. C-Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies. - Coronal slices can be used to demonstrate the following: 1-Scoliosis. 2- Space-occupying lesions within the cauda equina. -Note: We can use the axial localizer to obtain a coronal oblique slice.  MRI Sequences (lumbar spine) Sequence TR TE FA ETL Slice thickness Sagittal (T2) (FSE) 3600 102 - 16 4mm Sagittal (T1) (Dual SE) 600 Min - 2 4mm Sagittal (STIR) 3000 50 - 8 4mm/TI=150 Axial (T2) (FSE) 3000 102 - 12 4mm Axial (T1) (SE) 350 Min - - 4mm Corona (T1) (Dual SE) 500 13 - 2 3mm Axial (T1) (FSE) (post GAD) 600 Min - 4 4mm References - Step by step MRI: Jaganmohan, V Prasad. - Planning and Positioning in MRI: Anne Bright. - Handbook of MRI scanning: Geraldine Burghart, Carol Ann Finn. - Wong A, Cespedes E, Hacking C, et al. Lumbar spine. Reference article, Radiopaedia.org.  ‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of the neck (17) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ Computed tomography is the preferred modality for imaging of this region, but MRI is useful in determining disease spread to the tongue and the cartilages of the throat. Scientific Content: :‫المحتوى العلمي‬ Anatomical overview: the anatomy within the neck is generally symmetrical and is described as the region between the base of skull and the bony thoracic cage. It contains multiple bony structures, cartilages, blood vessels, and muscles. Indications of neck MRI (soft tissue): 1-Carcinoma of the larynx and hypopharynx. 2-Benign lesions of the larynx. 3-Second or third branchial cleft cyst. MRI procedure (Neck- soft tissue): Patient position: 1- Patient should be in supine-position (head first). 2- Set up the coil (multi-channel neurovascular). The RF coil of choice must provide good signal from the base of skull to below the thoracic inlet. 3- Ask the patient to minimize swallowing during the scanning acquisition to avoid artifacts across the image. Make sure to scan inferiorly to below the aortic arch when vocal cord paralysis is suspected. The vagus nerve that controls the vocal cords extends below the aortic arch. -Other considerations: Patients with diseases of the airways may suffer from respiratory discomfort that may be exacerbated in the supine position. Allowing the patient the opportunity to clear the throat between each pulse sequence may assist in generating images with limited motion artefact induced by swallowing or coughing. Fig.1: Alignment of protons with the external magnetic field. 1-Spin Echo (SE) Pulse Sequence It consists of 90- and 180-degree RF pulses. The excitatory 90-degree pulse flips net magnetization vector along Z-axis into  Scout slice placement: 1-Sagittal localizer for coronal slice: -SLICE ACQUISITION: Anterior to posterior. - SLICE ALIGNMENT: Parallel to the vertebral bodies. - ANATOMIC COVERAGE: Anterior from hyoid bone to the spinous process, superior from the hard palate to the arch of the aorta. -CORONAL SLICES ARE USED TO DEMONSTRATE THE FOLLOWING CONDITIONS: 1-Disease extension lateral to the larynx. 2-Metastatic lymph nodes. 3-Disease extension to the neck cartilages. 2-Sagittal localizer for axial slice -SLICE ACQUISITION: Superior to inferior. - SLICE ALIGNMENT: Parallel to hard palate. -ANATOMIC COVERAGE: For vocal cord paralysis scan from hard palate to arch of the aorta. For neck mass scan from hard palate to sternal notch. 3-Axial localizer for sagittal slice -ALIGNMENT: True sagittal plane. - COVERAGE: As for axial plane. - SAGITTAL SLICES ARE USED TO DEMONSTRATE THE FOLLOWING CONDITIONS: 1-Lesion spread to the base of tongue. 2- Disease extension to the neck cartilages.  MRI Sequences (Neck-soft tissue) Sequence TR TE FA ETL Slice thickness Coronal (STIR) (FSE) 4000 68 - 17 5mm Axial (T1) (FSE) 600 Min - 4 5mm Axial (T2) (FSE) 3300 110 - 27 5mm 3D Sagittal (FSPGR) FS - In-phase 40 - 4mm References - Planning and Positioning in MRI: Anne Bright. - Handbook of MRI scanning: Geraldine Burghart, Carol Ann Finn.  ‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of chest (18) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ MRI of the chest including the lungs and mediastinum can be valuable in certain clinical scenarios, but it is less commonly used compared to other imaging modalities like computed tomography for this region. MRI is particularly useful when radiation exposure needs to be minimized or when specific soft tissue characterization is required. Scientific Content: :‫المحتوى العلمي‬ Anatomical overview: The chest or thorax is the region of the bony thoracic cage located between the neck and abdomen. The upper boundary of the chest, the thoracic inlet, is formed by the first thoracic vertebra, the first ribs, and the upper margin of the manubrium. Inferiorly, the chest extends to the level of the thoracic outlet, marked by the diaphragm, which extends between the inferior margin of the sternum and the upper lumbar vertebra. Common indications: 1-Mediastinal mass, e.g. lymphoma and congenital cyst. 2-Neurogenic lesions, e.g. thoracic meningoceles and malignant nerve sheath tumors. 3-Differentiation between lymph nodes and vascular anomalies. 4-Assessment of vascular anomalies of chest (in conjunction with MRA), e.g. thoracic aortic aneurysms. MRI Procedure: Patient position: 1- Patient should be in supine-position (head first). Patients who suffer from claustrophobia may prefer a feet-first orientation. 2- Set-up the coil (Torso-array coil).  Scout slice placement: 1-Coronal localizer for axial slice - Alignment: True axial. - Coverage: A-Superior to inferior: Thoracic inlet to diaphragmatic crura. B-Lateral to medial: Chest wall on each side. C-Posterior to anterior: Thoracic spinous processes to sternum. - Axial slices are used to demonstrate the following: 1-Contents of mediastinum. 2-Morphology of the great vessels and heart. 3-Lymph node location and size. 2-Axial localizer for coronal slice -Alignment: True coronal. - Coverage: As for axial plane. - It is the best plane for demonstrating the costophrenic angles and lung apices.  MRI Sequences: 1 T1WI (FSE) Axial and coronal sections with a 5mm slice thickness to provide detailed anatomical information, including visualization of chest structures such as heart, main vessels and mediastinum. 2 T2WI (FSE) Axial and coronal sections with a 5mm slice thickness to demonstrate differences in tissue water content, making it useful for identifying areas of inflammation, edema, or abnormal tissue within the chest. 3 Fat suppression Distinguish between fat-containing and non-fat sequences tissues, aiding in the assessment of lesions and structures within the chest. 4 DWI sequence With a slice thickness of 5mm to assess tissue cellularity and identifying certain chest lesions. 5 Dyn-study+con Evaluate tissue perfusion with a slice thickness of (GAD-based 5mm. It can help in characterizing lesions based on contrast) their vascularity, particularly useful for assessing vascular lesions and tumors. 6 MRA With a slice thickness of 1-2mm to visualize blood vessels within the chest, including the main arteries and veins, and can be used to detect vascular abnormalities. References - Step by step MRI: Jaganmohan, V Prasad. - Planning and Positioning in MRI: Anne Bright. - Introduction to sectional anatomy: Michael E. Madden. - Handbook of MRI technique: Catherine senior  ‫الجامعة التقنية الوسطى‬ ‫ بغداد‬/‫كلية التقنيات الصحية والطبية‬ ‫ التصوير بالرنين المغناطيسي‬:‫المادة‬ ‫قسم تقنيات األشعة‬ ‫الرابعة‬:‫المرحلة‬ Title: :‫العنوان‬ MRI of abdomen (19+20) Name of the instructor: :‫اسم المحاضر‬ ‫عال سالم صادق‬.‫م‬.‫م‬ Target population: :‫الفئة المستهدفة‬ ‫ المرحلة الرابعة‬/‫طلبة قسم تقنيات األشعة‬ Introduction: :‫المقدمة‬ Learning about abdomen MRI is essential for MRI technologist to perform MRI exams effectively, interpret MRI results accurately, ensure patient safety, understand anatomy and pathology, and collaborate with other healthcare professionals. Scientific Content: :‫المحتوى العلمي‬ -Anatomical overview: The abdomen is generally considered as the region of the body between the chest and pelvis. Typically, the vertebral column contains five lumbar vertebrae, Forming the posterior border of the abdominal cavity. -Liver: - The largest gland in the body, found in the upper abdominal cavity on the right side. It consists of four lobes: - - Right lobe. - Left lobe. - Caudate lobe. - Quadrate lobe. -Gallbladder: - It is a sac located under the liver. It stores the bile produced in the liver. -Common bile ducts: - Transports bile from the gallbladder (via the cystic duct) and the liver (via the hepatic duct) to the duodenum. (fig.1). (Fig.1) Liver and biliary system Fig.1: Block diagram of a typical magnetic resonance imaging scanner. -Indications of liver MRI: 1-Characterization of lesions. -Primary versus metastatic. -Malignant versus benign. 2-Hepatocellular carcinoma. 3-Hemangioma. 4-Hydatid cyst. 5-Diffuse liver disease; e.g. cirrhosis. 6-Biliary obstruction; including choledocholithiasis. -MRI procedure: -Patient position: 1-Patient should be in supine-position (head first or feet first). 2-Set up the body coil for the MRI exam. - Scout slice placement: 1-Coronal localizer for axial slice - Alignment: True axial plane. - Coverage: A-Superior to inferior: Dome of the liver to the lowest border of the liver. B- Lateral to medial: Ribs on each side. C-Posterior to anterior: Peritoneum to anterior abdominal wall. - Demonstrates: 1-Individual inspection of liver segments. 2-Disruption of the biliary tree and vascular supply due to invasive disease. 2-Axial localizer for coronal slice. -Alignment: True coronal plane. -Coverage: A-Superior to inferior: Distal lung fields to tail of segment VI. B-Lateral to medial: Ribs on each side. C-Posterior to anterior: Peritoneum to anterior abdominal wall. -Demonstrates: 1-Lesions in the inferior tail and lateral tip of the left lobe. 2-Lesions high within the liver immediately under the diaphragm. MRI Sequences 1 T1WI (FSE) (Slice thickness 5-8mm) (provides detailed anatomical information of abdominal structures, including the liver, spleen, kidneys, and blood vessels). 2 T2WI (FSE) (Slice thickness 5-8mm) (demonstrate differences in tissue water content, making it useful for identifying areas of inflammation, edema, or abnormal tissue within the abdomen). 3 Fat suppression Distinguish between fat-containing and non-fat sequences tissues, which can be useful for characterizing lesions and assessing fatty infiltration of organs. 4 DWI sequence (slice thickness 5-8mm), measures the diffusion of water molecules in tissues and can assist in the evaluation of tissue cellularity and identifying certain abdominal lesions, including tumors. 5 Dyn-study+con (Slice thickness 5-8mm), evaluates tissue perfusion (GAD-based and vascularity, aiding in the characterization of contrast) lesions, particularly for detecting and characterizing liver lesions.  6 (GRE) Sequences (Slice thickness 5-8mm). Sensitive to blood products and hemorrhage, making it useful for detecting vascular abnormalities, such as hemangiomas or vascular malformation. Kidneys and adrenal glands: -Kidneys: The bean-shaped, retroperitoneal organs on either side of the vertebral column typically centered at the level of the 1st lumbar vertebra. Anomalies in formation are common during development, resulting in variations in the shape and location of the kidneys. Within the kidney, fluid and waste products are filtered from the blood to form urine, which is collected in the renal pelvis and drains into the ureters (Fig. 2). -Adrenal glands: Also referred to as the suprarenal glands, these soft, glandular organs are located on the top pole of the kidneys. Roughly pyramidal in shape, their average dimensions in the adult are approximately 5-cm long, 3-cm wide, and 1-cm thick. (fig.2) kidney and adrenal gland -Indications: 1- Adrenal adenoma or adrenocortical carcinoma. 2-Renal cell cancer. 3-Renal cyst. 4-Metastases. 5-Adrenal myelolipoma. 6-Cushing’s syndrome. -MRI procedure: -Patient position: 1-Patient should be in supine-position (feet first), place the patient’s arms over the head. 2-Set up the multi-channel coil and it should be covering the region from the diaphragm to iliac crest. - Scout slice placement: 1-Sagittal localizer for coronal slice. -SLICE ACQUISITION: Anterior to posterior. -SLICE ALIGNMENT: Parallel to spine. -ANATOMIC COVERAGE: From diaphragm to the pubis. Demonstrates: 1-Enlargement of the adrenal glands and/or kidneys. 2- Lesions within the poles of the kidneys. 2-Coronal localizer for axial slice. -SLICE ACQUISITION: Superior to inferior. -SLICE ALIGNMENT: Straight; no angulation of slices is necessary. -ANATOMIC COVERAGE: From diaphragm to iliac crest. - Demonstrates: 1-Enlargement of the adrenal glands and/or kidneys. 2-Encroachment of masses on renal collecting system. -MRI Sequences 1 T1WI (GRE) (Axial slices) (Slice thickness 3-5mm) (provides detailed information of the kidneys and surrounding structures). 2 T2WI (HASTE) (axial and coronal slices) (Slice thickness 3-5mm) (Half Fourier single- (Highlights differences in tissue water content, shot turbo spin- aiding in the identification of renal lesions, echo) inflammation, and structural abnormalities). 3 DWI sequence (Axial) (slice thickness 3-5mm), measures the diffusion of water molecules in renal tissues and can assist in the evaluation of tissue cellularity and identifying renal lesions, including tumors). 4 Dyn-study+con (Slice thickness 3-5mm), tumor enhancement (GAD-based characterization. contrast) References: :‫المصادر‬ - Planning and Positioning in MRI: Anne Bright. - Introduction to sectional anatomy: Michael E. Madden. - Handbook of MRI technique: Catherine senior. Protocol specifics will vary depending on MRI scanner type, specific hardware and software, radiologist and perhaps referrer preference, patient factors e.g. implants, specific indications and time constraints.