Neuroradiology Protocols

NAME

INDICATION

DESCRIPTION
Routine Head CT Trauma

Stroke		 < 4 yrs old:  Conventional (non-spiral) 5 mm x 5 mm axials through entire skull.  Film brain, subdural, and bone windows.   No IV contrast.
> 4 yrs old:  Conventional (non-spiral) 5 mm x 5 mm axials through posterior fossa & 10 mm x 10 mm axials to skull vertex.  Film brain, subdural, and bone windows.  No IV contrast.
Head CT w/ & w/o Contrast Abscess

Contraindication
for MRI such as
aneurysm clips or pacermaker		 pre-contrast:  Conventional (non-spiral) 5 mm x 5 mm axials through posterior fossa & 10 mm x 10 mm axials to skull vertex.   Film brain, subdural, and bone windows.
contrast:  Inject 100 cc Oxilan 300 @ 2 cc/sec, beginning scan after all contrast is injected.
post-contrast:  Conventional (non-spiral) 5 mm x 5 mm axials through posterior fossa & 10 mm x 10 mm axials to skull vertex.  Film brain and subdural windows.
Maxillofacial CT Trauma neck not clear:  Spiral 3 mm x 1.5 mm axials, filming every other (ie, contiguous) images.  Coronal + sagittal 2D reconstructions.  Film soft tissue and bone windows.  No IV contrast.
neck clear:  3 mm x 3 mm coronals through face.  Add 3 mm x 3 mm axials if needed for delineation of fractures.  Film soft tissue and bone windows.  No IV contrast.
Sinus CT Sinusitis routine:  Place BB on right cheek.   Conventional (non-spiral) 4 mm x 4 mm direct coronals through face, perpendicular to hard palate.  Film soft tissue and bone windows.
pre-op:   Place BB on right cheek.  Conventional (non-spiral) 3 mm x 3 mm direct coronals through face, perpendicular to hard palate.  Film soft tissue and bone windows.
Pre-MRI Orbit CT R/O Metal Conventional (non-spiral) 3 mm x 3 mm axials through orbits.  Film bone and soft tissue windows.  No IV contrast.
     
Trauma C-Spine CT Trauma Spiral with 3 mm collimation (2 mm collimation for young child) through cervical spine.  Reconstruct top acquisition at 1.5 mm and lower two acquisitions at 3.0 mm.  Sagittal and coronal 2D reconstructions.  Film soft tissue and bone windows.  No IV contrast.
Soft Tissue Neck CT Abscess Power inject 50 cc Oxilan 300 @ 2 cc/sec, then 50 cc Oxilan 300 at 1 cc/sec.  Begin scanning after 25 sec delay.  Spiral 4 mm x 4 mm axials through cervical spine.  Film soft tissue and bone windows.
Trauma T-Spine CT Trauma Spiral 3 mm x 3 mm axials from at least one vertebral body above to at least one vertebral body below area of pathology.  Film soft tissue and bone windows.   Sagittal and coronal 2D reconstructions.  No IV contrast.
Trauma L-Spine CT Trauma Spiral 3 mm x 3 mm axials from at least one vertebral body above to at least one vertebral body below area of pathology.  Film soft tissue and bone windows.   Sagittal and coronal 2D reconstructions.  No IV contrast.
Temporal Bone CT Cholesteatoma
Petrous fx
Congenital abn		 1.5 mm high resolution axials using bone algorithm, coronal if possible.   Film right/left magnified views (3500W/500L).
     
Routine Brain MRI Routine Sagittal T1 SE, Axial PD/T2 SE, Coronal T1 SE.  No IV contrast.
Trauma Brain MRI Trauma Sagittal T1 SE, Axial PD/T2 SE, Coronal T1 SE, Axial FLAIR, Axial T2* GRE, Axial EP Diffusion.  No IV contrast.
FLAIR Brain MRI White matter dz Sagittal T1 SE, Axial PD/T2 SE, Coronal T1 SE, Axial FLAIR.  No IV contrast.
Stroke Brain MRI Acute infarct Sagittal T1 SE, Axial PD/T2 SE, Coronal T1 SE, Axial FLAIR, Axial EP Diffusion.  No IV contrast.
Congenital Brain MRI Congenital abn Sagittal T1 SE, Axial PD/T2 SE, Axial T1 FSPGR, Coronal T1 SE.    No IV contrast.
Infant Brain MRI Myelination Sagittal T1 SE, Axial PD/T2 SE, Axial T1 SE, Coronal T1 SE.  No IV contrast.
Seizure Brain MRI Partial complex seizures
(ages 5-35 yrs)		 Sagittal T1 SE, Axial PD/T2 SE, Oblique coronal FSEIR 4 mm skip 0 parallel to anterior brainstem, Coronal T1 3D FSPGR 2 mm skip 0 from anterior sella to splenium of corpus callosum using 28 slices.  No IV contrast.
Gadolinium Brain MRI Neoplasm

Infection		 pre-contrast:  Sagittal T1 SE, Axial PD/T2 SE, Axial T1 SE
contrast:  Gd (0.1 mmol / kg to max of 20 cc)
post-contrast:  Axial T1 SE, Coronal T1 SE, add Sagittal T1 SE if midline tumor
MS Screen Brain MRI Multiple sclerosis Sag T2 FSE, Axial PD/T2 SE, Axial FLAIR, Coronal T1 SE.  No IV contrast.
IAC MRI Vestibular schwanoma

Facial nerve anomalies		 pre-contrast brain:  Sagittal T1 SE, Axial PD/T2 SE
pre-contrast IAC:  Axial T1 SE 3 mm skip 0
contrast:  Gd (0.1 mmol / kg to max of 20 cc)
post-contrast IAC:  Axial T1 3 mm skip 0 with fat-sat, Coronal T1 SE 3 mm skip 0 with fat-sat
Dynamic Pituitary MRI Microadenoma pre-contrast brain:  Sagittal T1 SE, Coronal T1 SE 3 mm skip 0 thru sella, Axial PD/T2 SE, Dynamic coronal FSE T1 3 slices pre-contrast
contrast:  Gd (0.1 mmol / kg to max of 20 cc)
post-contrast:  Dynamic coronal FSE T1 repeated x 11.  Coronal T1 SE, Sagittal T1 SE sella 3 mm skip 0.  No dynamics for macroadenomas.
     
Circle of Willis MRA Aneurysm 3D TOF MRA of Circle of Willis.  Film Axial MIPs.
MR Venogram Sinus thrombosis 2D TOF coronal MRV of dural venous sinuses (entire head), using inferior sat band.
     
Routine C-Spine MRI Degen spine dz Sagittal T1 SE, Sagittal T2 FSE, 3D Volumetric Axial T2* GRE, Stacked Axial T2 FSE.  No IV contrast.
Trauma C-Spine MRI Trauma Sagittal T1 SE, Sagittal FSEIR, Axial T2 FSE with fat sat.  Target axials to abnormality.  No IV contrast.
Post-Op C-Spine MRI Post-Op spine Sagittal T1 SE, Sagittal T2 FSE, Axial 3D Volumetric T2* GRE, Stacked Axial T2 FSE.  Substitute Axial T1 for T2* GRE if hardware is present.  No IV contrast.
Routine T-Spine MRI Degen spine dz Sagittal T1 SE, Sagittal T2 FSE.  Target stacked T1 FSE axials to abnormality.  No IV contrast.
Trauma T-Spine MRI Trauma Sagittal T1 SE, Sagittal FSEIR, Axial T2 FSE with fat sat.  Target axials to abnormality.  No IV contrast.
Routine L-Spine MRI Degen spine dz Sagittal T1 SE, Sagittal T2 FSE, Graphically prescribed angled axial PD/T2 FSE, Angled T1 stacked axials L3 to S2.  No IV contrast.
Trauma L-Spine MRI Trauma Sagittal T1 SE, Sagittal FSEIR, Axial T2 FSE with fat sat.  Target axials to abnormality.  No IV contrast.
Post-Op L-Spine MRI Post-op spine

Osteomyelitis
Discitis		 pre-contrast:  Sagittal T1 SE, Sagittal T2 FSE, Axial PD/T2 FSE, Axial T1 at level of surgery
contrast:  Gd (0.1 mmol / kg to max of 20 cc)
post-contrast:  Sagittal T1 SE, Axial T1 SE
Tethered Cord MRI Tethered cord Sagittal T1 SE, Sagittal T2 FSE, Axial T1 SE T10 to S2, using interslice gap as needed.  No IV contrast.

For protocol modifications or suggestions, please e-mail Blaine Hart, M.D. (bhart@unm.edu).