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When evaluating a patient, MRI is clinically indicated IMMEDIATELY when neurological deficit is present and 4-6 weeks when the patient fails to respond to care.  When ordering, here are the details of WHAT to order.  This is directly from Dr. Robert Peyster, Neuroradiologist.  

 

The following are the 2019 protocols for ordering MRI's and must be included in your prescription when sending your patients. This MUST be strictly adhered to. You must "up your game" and not let the imaging companies abuse your patients at the expense of accurate clinical findings.  More information can be found in the MRI courses at http://university.teachdoctors.com/index.php?option=com_content&id=13&view=article&type=courses&course-search=MRI&Itemid=272

Below the 2 types of recommendations. One is very good, and the latter is the industry standard. After that, there are some explanations of some of the tests that you will not understand until you conclude the MRI course. 

Print this out for your records.

 

The following is a VERY GOOD Sequence

Cervical

1.T1 Sagittal 3mm

2.T2 Sagittal 2.5mm

3.T2 Axial or gradient 2.5mm

4.STIR sagittal 2.5 mm

Thoracic

1.T1 Sagittal 3mm

2.T2 Sagittal 2.5mm

3.T2 Axial 2.5mm

4.STIR sagittal 2.5mm

Lumbar

1.T1 Sagittal 3mm

2.T2 Sagittal 3mm

3.T2 Axial 3mm

4.STIR Axial 3mm

5.Stacking Axial view 3mm

No Skip

 

The Following are the optimal sequences if your imaging center has the technology

Cervical

1.T1 Sagittal 2.5mm

2.Dixon in Phase T2 Sagittal 2.5mm

3.Merge Axial 2.5mm

Thoracic

1.T1 Sagittal 2.5mm

2.Dixon in Phase T2 Sagittal 2.5mm

3.Merge Axial 2.5mm

Lumbar

1.T1 Sagittal 2.5mm

2.Dixon in Phase T2 Sagittal 2.5mm

3.Merge Axial 2.5mm

4.L4/L5 & L5/S1 Angled through disc at  T2

No Skip

 

The Dixon method is an MRI sequence based on chemical shift and designed to achieve uniform fat suppression. It has been gaining popularity as it has some advantages over other fat suppression techniques, namely: 

1.suppression of fat signal is more uniform and less affected by artifacts than many other techniques

2.can be combined with a variety of sequence types (e.g. spin echo, gradient echo, and steady state free procession sequences)

3.can be combined with a variety of weightings (e.g. T1, T2 and proton density)

4.provides images with and without fat suppression from a single acquisition

 

MERGE ("Multiple Echo Recombined Gradient Echo") is a spoiled T2*-weighted sequence for spinal and musculoskeletal imaging developed by GE Healthcare. The corresponding Siemens sequence is called MEDIC ("Multi-Echo Data Image Combination"), while the Philips sequence is called M-FFE("Merged Fast Field Echo"). Hitachi offers ADAGE ("Additive Arrangement Gradient

The basic sequence is pictured right. By reversing the frequency-encoding gradient rapidly, several individual gradient echoes can be generated at different TEs. The number of echoes is limited by T2*-decay, but typically between 3-5 echoes are recorded.

The individual echoes are magnitude reconstructed and then combined into a single image using a sum of squares algorithm.  Echo"). Acquisition may be in either 2D or 3D mode.

 

5.not only shows presence of microscopic fat but it can also quantify the amount of fat

 

PLEASE TAKE NOTICE: © Copyright CMCS Management, Inc - Dr. Mark Studin 2015 - This information is intended for educational purposes only. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon is prohibited.