Coronal T1
Coronal STIR
Sagittal STIR (optional - depending on body part)
Axial PD
Axial FSE T2 with Fat Sat
Axial Post Gad FMPSPGR with Fat Sat

Coronal T1
Coronal STIR
Sagittal STIR (optional - depending on body part)
Axial PD
Axial FSE T2 with Fat Sat
Axial Post Gad FMPSPGR with Fat Sat

MR of the Shoulder

General Indications: For evaluation of the rotator cuff and glenoid labrum. Shoulder MR requires meticulous attention to details. The anatomy is complex and evaluation of the pathology is difficult even with well performed exams.

Routine Exam

* TR=3500; TE=100-120 for T2. Use TE=80 for fat sat T2 sequences.
** FOV is somewhat dependent on patient size. In general the smallest possible FOV should be used.
*** Oblique coronal plane is determined by using the supraspinatous muscle tendon and aligning along its long axis. If the muscle is not visible, then the glenoid fossa may be used as a landmark. The oblique sagittal plane is perpendicular to the oblique coronal.

MR of the Knee

General Indications: To evaluate for injury to ligaments, bones, cartilage, muscle, and menisci. Because the degree of injury can be extensive, and because the structures involved run in multiple and complex planes, all three planes need to be evaluated.

Routine Exam

*T2 FSE TR=4000-5000, TE=100-120.
** Phase needs to be superior to inferior.

MR of Ankle for Posterior Tibial Tendon and Peroneal Tendons

General Indications: This protocol is designed to evaluate the posterior tibial tendon, the flexor tendons, and the peroneal tendons. It may need to be modified depending on the exact clinical indication. It is very difficult to design one protocol which covers all possible pathologies of the ankle. One important concept to bear in mind is the complex course which these tendons follow. The tendons as they enter the foot become oblique to the tendons in the distal leg by an amount that is determined by the degree of plantar flexion of the foot. This protocol is designed with this in mind. Please also remember that the planes given are the anatomic planes of the body.

Routine Exam

Use extremity coil.



MR Hip For AVN

General Indications: This protocol is primarily designed for evaluating the hips for AVN. However, it is sufficiently general enough that it can be used for the evaluation of non-specific hip pain. Any other indications should be reviewed by the radiologist. Both hips are included in the coronal sequences because of the frequency of occult AVN in the asymptomatic hip.

Routine Exam

Use body coil at VA, use torso coil at UNMH.

MR Hip/Pelvis For Trauma

General Indications: This is designed primarily as a screening exam to exclude an occult hip or pelvis fracture in the elderly or in an individual with a suspected stress fracture. Use Coronal T1 and FSTIR from AVN hip protocol.

MR Achilles’ tendon injury

General Indications: To evaluate for Achilles tendon rupture or other pathology related to the Achilles’ tendon. The most important concept in this exam is that the proximal portion of the tendon must be visualized so that the size of the tear can be ascertained. Because of this the FOV on the sagittals may need to be increased and stacked axials may need to be performed.

Routine Exam

Use extremity coil.

MR Elbow For Biceps Rupture

General Indications: This protocol is designed to specifically evaluate for injury to the distal biceps tendon. There is a separate protocol for collateral ligament injury. All other indications must be reviewed by the resident. Like the Achilles tendon, the proximal portion of the tendon must be visualized. This means that the FOV may need to be changed on the sagittals and that stacked axials may need to be performed. The exam also needs to extend to the level of the biciptal tuberosity on the radius.

Routine Exam

*See below for planes. The sagittals need to be protocoled from the axials.


MR Elbow for Collateral Ligament Injury

General Indications: This examine is designed to evaluate the collateral ligaments of the elbow. Because of the small size of these structures a small FOV and large matrix size is desirable.

Routine Exam

MR Wrist for TFC Tear or Ligament Tear

General Indications: To evaluate the TFC and the intrinsic ligaments of the wrist. Because of the very small size of the structures a small FOV and high matrix size is needed. This is accomplised with the coronal GRE and T1. Remember that coronal is defined by the true anatomic plane of the wrist. Since almost no one holds their wrist in this position, the coronals must be prescribed from the axials, and thus the axials should be done first. If the history is to evaluate a ganglion or other mass the this will have to be prescribed at the time.

Routine Exam

Use wrist coil, small FOV, and center over radiocarpal joint.

MR of Shoulder Following Arthrography (MR Arthrogram)

General Indications and Procedure: A MR shoulder arthrogram is generally performed to evaluate the labrum and glenohumeral ligaments. For this reason high resolution axials are needed. It is my experience that a 12 cm FOV is the optimal FOV. A smaller FOV causes too much signal loss. However, a quadrature coil might do better. Because of the possibility of associated rotator cuff pathology a T1 oblique coronal is also obtained, with T1 weighting to evaluate for articular sided and full thickness tears and with T2 weighting to evaluate for bursal sided partial tears. The oblique sagittal plane is obtained with a fat saturated T1 sequence to evaluate for subtle small full thickness tears that could be obscured on the T1 coronal sequence by the bright fat.
For the actual arthrogram, one performs a routine arthrogram of the shoulder EXCEPT that only a small amount of radiographic contrast is used to confirm position, followed by 15-22 cc of saline doped with gadolinium (50 cc normal saline + 0.3 cc Gd-DTPA).

Routine Exam

Note: Please see routine shoulder for planes.

MR Elbow Following Arthrography

Like in the routine examination of the elbow for collateral ligament tear, the
sagittal and coronal planes must be proscribed from the axials. Thus these
must be done first. (Please see collateral ligament protocol for planes.)

At the University try the dual 3 in coils. If a large elbow might have to try something else.

Osteomyelitis of the heel protocol

Exam is perfromed to evaluate for ostemyelitis of the heel. If possible a vitamin E capsule should be placed near the soft tissue ulcer or swelling. As always these numbers are not rigid. Parameters may need to be modified to meet the needs of any given exam.

*Indicates slice thickness/skip



True coronal plane - need to cover whole calcaneus

Osteomyelitis of the midfoot and forefoot protocol

This protocol is designed to evalutae for osteomyelitis of the midfoot and forefoot. As always these numbers are not rigid. Parameters may need to be modified to meet the needs of any given exam.

*Indicates slice thickness/skip



oblique coronal plane

axial for 1^stMT osteo axial for 2^nd-4^th MT osteo

Morton’s neuroma protocol

A Morton’s neuroma is a painful lesion which occurs between the 2^nd and 3^rd or 3^rd and 4^th metatarsals. It is often a subtle lesion requiring attention to detail and high resolution images.

oblique coronal plane -- center over MTPs


Axial plane

Biphasic Post-Gd Wrist

This techinque utilizes IV Gd to achieve a arthrographic effect. The first phase takes advantage of the Gd to enhance inflammatory tissue and the second phase occurs as the Gd diffuses into the joint. It can be used to study the TFCC and the intraosseous ligaments. Please see routine wrist for TFCC protocol for the planes.
If at all possible, the patient should be placed with the wrist in the center of the bore. Try laying the patient prone, bolster the head and the shoulder of the effected wrist., and place hand over head.

The sequences must be done in the order listed