BODY ABDOMINAL MRI

PATIENT NAME PHYSICIAN’S PROTOCOL FORM – UW Madison 6-8-10 Reeder/Trotter

DOB
MR # DATE RADIOLOGIST

LIVER –- MRCP –– STEATOSIS (MRE) MRCP w & w/o NPO 4 hrs 8ch Cardiac or 8ch Body UPPER
Request: MRI Abdomen / MRCP w & w o
_ __ MONITORED __ __ NON MONITORED 1. 3 pl SSFSE arc Quiet breathing
2. Ax Cal Quiet breathing Single dose contrast@2 ml/sec
__ _ _ USE EOVIST 1mL/10lbs dose & in place of 7 min post use: 3. Cor T2 SSFSE arc Expiration
+c 1. 5 min NAV LAVA 4. 3D MRCP Cor T2 arc DUCTS resp trig
+c 2. 20 min NAV LAVA 5. 2D MRCP Ax T2 ssfse DUCTS I nclude most of the liver and the pancreas
Note: If using EOVIST for Liver MRI, Multihance must be used for MRA 6. 2D MRCP Cor T2 ssfse DUCTS resp trig
7. In/Out Phase Ax Diaphragm to bifurcation Expiration
__ __ ADD: Delayed scans 1 - 2 hours
1. Ax T13d fat 2. Ax LAVA BH Flip 30 3. Ax NAV LAVA (or Ax LAVA BH Flip 40) 8. Upper Ax DWI Asset Expiration **Send to Source
_ ___ ADD: Cholangiocarcinoma/ PSC 9. Lower Ax DWI Asset Expiration **Send to Source
10–12 min delayed AxT13dfat 10. T1 Pre Ax 3d fat LIVER and PANCREAS Expiration
+c 11. T1 Arterial Ax 3d fat Smartprep - Tracker in aorta @ inferior liver
____ CHECK scans with radiologist for POSSIBLE DELAYS +c 12. T1 50sec Portal venous Ax 3d fat 50 secs after end of during scan
If done on PM shift, DO NOT CHECK w/ resident.
+c 13. RT T2 FRFSE-XL fat Ax respiratory trig Diaphragm to bifurcation
Do not reschedule. If necessary patient may be called back.
+c 14. T1 7min Ax 3d fat Expiration
____ MRCP w & wo Single dose contrast
__ __ OPT: ROUX EN-Y (MRCP using EOVIST with NAVLAVA) OPT: ROUX EN Y **USE EOVIST with 5, 10, 15, 30 min BH LAVAs
INTERVAL BH LAVAs and 20 min and a 20 min NAV LAVA and check for additional delays
____ PANCREATIC CYSTIC LESION wo No contrast PRE LIVER TX - TIPS w & w/o 8ch Body FULL coil only
** Patients MUST have a prior Contrast enhanced Abdominal MRI or MRCP Request: MRI / MRA Abdomen w & w o
____ LIVER – ROUTINE MRI w & wo Single dose contrast Note: When using EOVIST for Liver MRI, Load contrast for 2
Multihance must be used for MRA portion
_ _ _ LIVER - HEPATOMA SURVEY MRI w & wo Single dose contrast injections
1. 3pl SSFSE arc Quiet breathing
** Patients MUST have either prior UW Abdominal CT or MRI. 2. Ax Cal Quiet breathing
Single dose for MRI and
____ LIVER - STEATOSIS/FIBROSIS MRI w & wo Single dose 3. Cor T2 SSFSE arc Expiration 20mL for MRA
4. RT T2 fat Ax resp trig Diaphragm to bifurcation If using EOVIST for Liver,
____ LIVER– HEMOCHROMATOSIS MRI w & wo Single dose 5. Upper Ax DWI Asset Expiration must use Multi for MRA
6. Lower Ax DWI Asset Expiration
____ LIVER - DONOR MRI w & wo Single dose AND two hour delays 7. In/Out Phase Ax Diaphragm to bifurcation Expiration
__ _ LIVER SEGMENTATION 3d Rendering 8. T1 Pre Ax 3d fat Expiration
+c 9. T1 Arterial Ax 3d fat Smartprep - Tracker in aorta @ inferior liver
____ PRE LIVER TX / TIPS - MRI & MRA w & wo +c 10. T1 50sec Portal venous Ax 3d fat 50 secs after end of during scan
Note: When using EOVIST for Liver MRI, Multihance must be used for MRA +c 11. T1 Post 2 Ax 3d fat immediately to follow 50 sec post
SMA, celiac & hepatic vessels /Behind aorta posterior  most of liver anterior
LIVER ROUTINE w & wo 8ch CARDIAC / 8ch Body UPPER
12. Pre Cor T1 3d LAVA-XV Expiration
1. 3pl SSFSE arc Quiet breathing
+c 13. Dur Cor T1 3d LAVA-XV Fluoro trigger
2. Ax Cal Quiet breathing Single dose contrast@2 ml/sec +c 14. Post 1 Cor T1 3d LAVA-XV Immediately to follow during
4. Cor T2 ssfse arc Expiration
+c 15. Post 2 Cor T1 3d LAVA-XV Immediately to follow Post 1
5. In/Out Phase Ax Expiration Diaphragm to bifurcation
+c 16. Cor 3d fat Liver Volume Expiration Must include entire liver
6. Upper Ax DWI Asset Expiration **Send to Source
LIVER HEMOCHROMATOSIS w & w/o 8ch CARDIAC / 8ch Body UPPER
7. Lower Ax DWI Asset Expiration **Send to Source
1. 3 pl SSFSE arc Quiet breathing
8. T1 Pre Ax 3d fat Expiration
2. Ax Cal Quiet breathing Single dose contrast@2 ml/sec
+c 9. T1 Arterial Ax 3d fat Smartprep Tracker in aorta @ inferior liver
3. Cor T2 SSFSE arc Expiration
+c 10. T1 50sec Portal venous Ax 3d fat 50 secs after end of during scan
4. RT T2 FRFSE-XL fat Ax resp trigger Diaphragm to bifurcation
+c 11. RT T2 FRFSE-XL fat Ax respiratory trig Diaphragm to bifurcation
5. In/Out Phase Ax Expiration Diaphragm to bifurcation
+c 12. T1 7min Ax 3d fat
6. Ax 3d T2* IDEAL Liver Expiration
LIVER HEPATOMA SURVEY w & wo 8ch CARDIAC / 8ch Body UPPER *For series 8 – 12 only do 4 slices @ mid liver.
All slices must be at exact same location and must have the exact same prescan values.
1. 3pl SSFSE arc Quiet breathing Single dose contrast@2 ml/sec
2. Cor T2 ssfse arc Expiration 7. Ax fgre T1 TE 4.5 Flip 90 Auto prescan - do NOT bypass
3. In/Out Phase Ax Expiration Diaphragm to bifurcation 8. Ax fgre Intermediate TE 4.5 Flip 20 Do not autoprescan, manual only
4. T1 Pre Ax 3d fat Expiration 9. Ax gre Intermediate TE 9 Flip 20 Do not autoprescan, manual only
+c 5. T1 Arterial Ax 3d fat Smartprep- Tracker in aorta @ inferior liver 10. Ax gre T2 TE 14 Flip 20 Do not autoprescan, manual only
+c 6. T1 50sec Portal venous Ax 3d fat 50 secs after end of during scan 11. Ax gre Long TE T2 TE 21 Flip 20 Do not autoprescan, manual only
+c 7. T1 2min Ax 3d fat 2 min after end of during scan 12. T1 Pre Ax 3d fat Expiration
+c 8. RT T2 FRFSE-XL fat Ax respiratory trig Diaphragm to bifurcation +c 13. T1 Arterial Ax 3d fat Smartprep - Tracker in aorta @ inferior liver
+c 14. T1 50sec Portal venous Ax 3d fat 50 secs after end of during scan
LIVER – STEATOSIS/FIBROSIS w & wo +c 15. T1 Post 2 Ax 3d fat Immediately to follow 50 sec post
To be done on MR4 only
1. 3pl SSFSE arc expiration
Single dose contrast@2 ml/sec LIVER DONOR w & wo 2 hour delayed imaging
8ch CARDIAC / 8ch Body UPPER
2. MRE 4 slices (8 BHs ) expiration
Warn the patient about vibrations 1. 3 pl SSFSE arc Quiet breathing
3. Ax 3d T2* IDEAL arc Liver expiration
2. Ax Cal Quiet breathing Single dose contrast@2 ml/sec
4. Cal scan expiration
3. Cor T2 SSFSE arc Expiration
5. Cor T2 SSFSE arc expiration
4. RT T2 FRFSE-XL fat AX respiratory trig Diaphragm to bifurcation
6. RT T2 FRFSE-XL fat Ax respiratory trig Diaphragm to bifurcation
5. 3D MRCP Cor T2 prep arc DUCTS resp trig
7. In/Out Phase Ax expiration Diaphragm to bifurcation
6. 2D MRCP Ax T2 ssfse DUCTS resp trig
8. T1 Pre Ax 3d FSPGR fat expiration
7. 2D MRCP Cor T2 ssfse DUCTS resp trig
+c 9. T1 Arterial Ax 3d FSPGR fat Smartprep Tracker in aorta @ inferior liver
8. In/Out Phase Ax Scan from Diaphragm to bifurcation
+c 10. T1 1min Portal venous Ax 3d FSPGR fat 60 sec after end of during scan
9. Ax 3d T2* IDEAL Liver Expiration
Post process using IDEAL button in browser page
+c 11. T1 2min Ax 3d FSPGR fat expiration 2 mins after end of during scan Send processed Water & Fat series to ALI, Source images to ALI SOURCE
11. T1 Pre Ax 3d fat Expiration
PANCREATIC CYSTIC LESION wo Pt MUST have prior contrast enhanced
+c 12. T1 Arterial Ax 3d fat Smartprep, tracker in aorta @ inferior liver
1. 3 pl SSFSE arc Quiet breathing Abd MRI or MRCP
No contrast +c 13. T1 50sec Portal venous Ax 3d fat 50 secs after end of during scan
2. Cor T2 SSFSE arc Expiration
+c 14. T1 2min Ax 3d fat 2 minutes after end of during scan
3. 3D MRCP Cor T2 arc DUCTS resp trig
+c 15. Delay 2 hours T1 Ax 3d FSPGR fat
4. 2D MRCP Ax T2 ssfse DUCTS resp trig I nclude m ost of liver and pancreas
+c 16. Delay 2 hours T1 Nav LAVA Ax 3d
5. T1 Ax 3d FSPGR fat Expiration LIVER and PANCREAS
 BODY ABDOMINAL MRI
PATIENT NAME PHYSICIAN’S PROTOCOL FORM – UW Madison 6-8-10 Reeder/Trotter
DOB
MR # DATE RADIOLOGIST

RENALS – ADRENAL – ABD w/ PELVIS - GI ADRENAL MRI w/o

8ch CARDIAC / 8ch Body UPPER
No contrast
____ MONITORED or ____ NON MONITORED 1. 3 pl SSFSE arc Quiet breathing
2. Ax Cal Quiet breathing
____ RENAL MRI w & wo Single dose contrast 3. RT T2 FRFSE-XL fat Ax respiratory trig Diaphragm to bifu rcation
4. Cor T2 SSFSE arc Expiration
5. In/Out Phase Ax Expiration Adrenal & Kidneys
____ POST CRYOABLATION RENAL MRI w & wo Single dose contrast ____OPT. IV contrast single dose
Pre, during, post1, post2 Ax T13d spgr fat,
____ APPY ABD PAIN IN PREGNANT PATIENTS wo No contrast (fluoro trigger), **post 2 through pelvis-overlap the dynamic**
Use 8ch BODY array, must include from adrenal glands to bifurcation
____ ADRENAL MRI wo No contrast
___ Opt: IV CONTRAST Single dose contrast COMBINED ABDOMEN – PELVIS MRI w & w/o 8ch Body FULL coil only

1. 3pl SSFSE arc Quiet breathing 8ch Body FULL Single dose contrast@2 ml/sec
____ COMBINED ABD PELVIS MRI w & wo Single dose contrast 2. Ax cal Quiet breathing
3. Abdomen RT T2 fat Ax respiratory trig 8ch Body UPPER
____ PERITONEAL CARCINOMATOSIS MRI w & wo Double dose 4. Pelvis RT T2 fat Ax respiratory trig 8ch Body LOWER
1. NPO 4 hours contrast 5. Abd–Pelvis Cor T2 SSFSE arc Expiration 8ch Body FULL
2. Arrive 1 hour in advance to start drinking oral contrast 6. Abdomen In/Out Phase Ax Expiration 8ch Body UPPER
3. Oral contrast - Mix PEG 1000 cc In cabinet in MRI 3d area. 7. Pelvis In/Out Phase Ax Expiration 8ch Body LOWER
4. Glucagon - 1.0 mg to be given IM by MRI nurse (let RN know in advance) *Prescribe & save Ser 11 (Post PELVIS Ax T1) B/4 doing Ser 8 – 10 (Ax T1 3ds)
____ MR ENTEROGRAPHY MRI w & wo Single dose contrast
1. NPO 4 hours
M RI Axial T1 3d fat Liver & P ancreas
2. Arrive 1 hour in advance to start drinking oral contrast 8. T1 Pre 3d Ax FSPGR fat Expiration 8ch Body UP P ER only, NOT FULL!!
3. Oral contrast - Volumen Radiologist will order +c 9. T1 Arterial Ax 3d FSPGR fat Smartprep Tracker in aorta @ inferior liver
4. Glucagon – 0.3 mg to be given IV by MR nurse (notify RN in advance) +c 10. T1 50 sec Portal venous Ax 3d FSPGR fat 50 secs after end of the during scan
+c 11. Pelvis T1 Ax 3d FSPGR fat Overlap Liver Ax 3d Post1 8ch LOWER
+c 12. Liver T1 7 min Ax 3d FSPGR fat 8ch Body UPPER
RENAL MRI w & w/o 8ch CARDIAC / 8ch Body UPPER
1. 3 pl SSFSE arc Quiet breathing PERITONEAL CARCINOMATOSIS MRI 8ch Body FULL coil only
1. Must be NPO 4 hours
2. Ax Cal Quiet breathing Single dose contrast@2 ml/sec 2. Arrive in advance to drink oral contrast Double dose contrast@2 ml/sec
3. Cor T2 SSFSE arc Expiration 3. Oral contrast: Mix PEG 1000 cc
4. RT T2 FRFSE-XL fat respiratory trig Kidneys & Liver 4. Glucagon: 1.0 mg to be given IM by MRI nurse (notify RN in advance)
5. In/Out Phase Ax Expiration Kidneys & Liver All scans must include diaphragm to below symphysis and skin to skin
6. Ax DWI Expiration Kidneys *send to source 1. 3pl SSFSE arc Quiet breathing 8ch Body FULL
7. Pre Ax T1 3d fat Expiration Kidneys include liver if possible 2. Ax Cal Quiet breathing 8ch Body FULL
+c 8. Dur Ax T1 3d fat Fluoro trigger 3. Abdomen RT T2 FRFSE fat Ax respiratory trig 8ch Body UPPER
+c 9. Post Ax T1 3d fat 30 seconds after END of During scan 4. Pelvis RT T2 FRFSE fat Ax respiratory trig 8ch Body LOWER
+c 10. Cor T1 3d fat Expiration Kidneys & Liver 5. Cor T2 ssfse arc Expiration 8ch Body FULL
6. Abdomen Ax T2 SSFSE arc Expiration 8ch Body UPPER
POST CRYOABLATION RENAL w & w/o 8ch CARDIAC / 8ch Body UPPER 7. Pelvis Ax T2 SSFSE arc Expiration 8ch Body LOWER
8. Sag T2 FRFSE fat Expiration 8ch Body FULL
1. 3 pl SSFSE arc Quiet breathing Single dose contrast@2 ml/sec Give IM Glucagon
2. Ax Cal Quiet breathing 9. Pre Ax T1 2d fspgr fat Expiration 8ch Body FULL
3. Cor T2 SSFSE arc Expiration +c 10. Dur Ax T1 2d fspgr fat Expiration 8ch Body FULL
4. RT T2 FRFSE-XL fat Ax respiratory trig Kidneys & Liver Prep scan > Breath hold, inject and scan at the same time, continue to breath hold
5. In/Out Phase Ax Expiration Kidneys & scan as rapidly as possible by continuing to press “scan” button.
This is a 2D multi - slice, multi - scan acquisition
6. Ax DWI Kidneys Expiration **Send to Source
+c 11. 3 min Ax T1 2d fspgr fat Expiration 8ch Body FULL
7. Pre Ax T1 3d fat Expiration Kidneys include liver if possible
+c 12. 6 min Cor T1 2d fspgr fat Expiration 8ch Body FULL
+c 8. Dur Ax T1 3d fat Fluoro trigger
+c 9. Ax T1 3d fat 30 sec after END of during scan.
MR ENTEROGRAPHY
+c 10. Cor T1 3d splfat Expiration Kidneys Only R EQUEST: M R I Abdom en and Pelvis w o & w
8 ch BODY Coil ONLY
IV CONTRAST: Single dose @2 ml/sec
APPY-ABD PAIN IN PREGNANT PTS w/o **found under Pelvis in scanner
1. 3 pl SSFSE arc Quiet breathing 8ch Body FULL Position coil to include ORAL CONTRAST: Patient to drink 1 hour
2. Ax Cal Quiet breathing No contrast BELOW Pubic Symphysis prior to scans. R.N. will monitor patient.
1. NPO 4 hours
3. COR T2 SSFSE arc Inspiration 2. Arrive 60 minutes in advance to start drinking oral contrast
4. COR T2 fat sat SSFSE arc Inspiration 3. Oral contrast: Volumen MD will order
5. AX T2 SSFSE arc Inspiration Top of Kidneys to symphysis 4. Glucagon: 0.3 mg to be given IV by MRI nurse x 2 (notify RN in advance)
6. AX T2 fat sat SSFSE arc Inspiration Top of Kidneys to symphysis 5. PATIENT SHOULD BE PRONE (Unless unable)

Optional sequences **Prescribed by Radiologist Scans must include ALL of BOWEL through the Anus
1. 3pl SSFSE arc Expiration 8ch Body FULL
8. Ax Fiesta 2D **Prescribed by Radiologist 2. Ax Cal Expiration 8ch Body FULL
*If you see questionable edema around a structure, this sequence may better define 3. Cor cine FIESTA (Real Time) FREE BREATHING 8ch Body Full
it for you. RN to Give IV Glucagon TECHNOLOGIST Should Set up all scans at this time
9. In/Out Phase Ax Inspiration **Prescribed by Radiologist 4. Cor T2 ssfse arc Expiration 8ch Body FULL
*If you think you see a placental hemorrhage or hemorrhagic cyst. 5. Abdomen Ax T2 SSFSE arc fat Expiration 8ch Body UPPER
10. Ax T2-heavy weighted MRU **Prescribed by Radiologist 6. Pelvis Ax T2 SSFSE arc fat Expiration 8ch Body LOWER
*If you think there is a ureteral stone. 7. Sag 3D-SSFP Expiration 8ch Body FULL\
11. COR OBL T2-heavy weighted MRU **Prescribed by Radiologist RN to Give IV Glucagon
*If you think there is a ureteral stone. 8. Pre Cor 3D LAVA arc ROSE Expiration GW3D 8ch Body FULL
+c 9. 40 sec Cor 3D LAVA arc ROSE Expiration GW3D 8ch Body FULL
* Inject contrast and scan at 40 seconds
+c 10. 2 min Cor 3D LAVA arc ROSE 2 min after inj Exp GW 3D 8ch Body FULL
**GW3D dynamics and Reformat into Coronal and Axial (42 FOV, 3mm x 3mm )
+c 11. Post Abdomen Ax T1 2d fspgr fat Expiration 8ch Body UPPER
+c 12. Post Pelvis Ax T1 2d fspgr fat Expiration 8ch Body LOWER