MRI Protocols
MRI
Head & Neck
MRI Brain Protocol
Indication
Standard protocol for routine brain imaging.
Sequences
MRI Orbits (Plain)
Indication
Optic nerve lesions, extraocular muscle pathology, orbital masses, inflammatory disease.
Patient Prep
None.
Position
Supine, head first, neutral gaze.
Coil
Head coil or dedicated surface coil.
Contrast
None.
Special Notes
In trauma, add thin-slice axial T2W through optic nerve.
Sequences
MRI Neck with Contrast
Indication
Neck masses, lymphadenopathy, tumor staging, vascular lesions.
Patient Prep
NBM 4 hours if sedation needed.
Position
Supine, head first.
Coil
Neck phased-array or head-and-neck coil.
Contrast
Gadolinium 0.1 mmol/kg IV.
Special Notes
For vascular lesions, add MR angiogram.
Sequences
MRI TMJ Protocol
Indication
TMJ pain, dysfunction, disc displacement.
Patient Prep
None.
Position
Supine, head first.
Coil
Surface coil for TMJ.
Contrast
None unless tumor suspected.
Sequences
MRI Pituitary Dynamic Study Protocol
Indication
Microadenoma detection, hormonal disorders.
Patient Prep
None.
Position
Supine, head first.
Coil
Head coil.
Contrast
Gadolinium 0.1 mmol/kg IV.
Sequences
MRI Brain Stroke Protocol
Indication
Acute stroke evaluation.
Patient Prep
None.
Position
Supine, head first.
Coil
Head coil.
Contrast
Not usually needed in acute phase.
Sequences
MRI Brain Screening Protocol
Indication
Headache, seizures, screening for mass lesions.
Sequences
MRI Brain Screening Venogram
Indication
Suspected cerebral venous sinus thrombosis, intracranial venous anomalies, pre/post-op venous evaluation.
Patient Prep
None. Remove metallic items.
Position
Supine, head first, neutral.
Coil
Head coil.
Contrast
Usually not required for TOF/PC; if using CE-MRV: gadolinium 0.1 mmol/kg IV.
Special Notes
Use careful slice placement to include torcula, superior sagittal, transverse and sigmoid sinuses; consider CE-MRV when clot/slow flow is suspected or imaging at 1.5T with suboptimal TOF.
Sequences
MRI Brain Plain
Indication
Non-contrast workup for headaches, seizures, screening for mass/atrophy/ischemia.
Patient Prep
None.
Position
Supine, head first.
Coil
Head coil.
Contrast
None.
Special Notes
Add thin coronal oblique hippocampal sequences if epilepsy is specifically suspected (see epilepsy protocol).
Sequences
MRI Brain Plain with Cisternogram
Indication
Evaluation of cranial nerves, CSF cisterns, arachnoid cysts, CSF leak localization.
Patient Prep
None.
Position
Supine, head first.
Coil
Head coil.
Contrast
Not required for cisternography; use gadolinium if evaluating enhancement/meningeal disease (0.1 mmol/kg).
Special Notes
3D cisternographic images are invaluable for CN deficits and for detecting small CSF collections or subtle nerve compression.
Sequences
MRI Brain Plain and WSS (Whole Spine Screening)
Indication
Symptoms suggesting combined intracranial and spinal pathology (e.g., metastases, demyelination, leptomeningeal disease).
Patient Prep
None.
Position
Supine, head first (continuous exam if scanner/table supports).
Coil
Head coil + spine coil (stitched acquisition or separate blocks).
Contrast
Contrast optional if leptomeningeal disease or spinal metastases suspected (0.1 mmol/kg).
Special Notes
If doing combined exam, arrange stations for continuous workflow to minimize repositioning; use same contrast injection timing if CE required for both brain and spine.
Sequences
MRI Brain Plain and Contrast
Indication
Evaluate enhancing brain lesions, infection, tumor staging, post-op surveillance.
Patient Prep
Standard (screen for renal function/allergies if needed).
Position
Supine, head first.
Coil
Head coil.
Contrast
Gadolinium 0.1 mmol/kg IV (standard extracellular agent). Consider 0.2 mmol/kg for specific indications per local protocol.
Special Notes
Delay ~5–7 minutes for leptomeningeal imaging when indicated; use fat-sat in orbit/skull base regions to detect subtle enhancement.
Sequences
MRI Brain Epilepsy Protocol
Indication
Workup of focal epilepsy, seizure focus localization, cortical malformation, mesial temporal sclerosis.
Patient Prep
None. Consider sleep deprivation if requested.
Position
Supine, head first.
Coil
Head coil.
Contrast
Not routinely required; use 0.1 mmol/kg if tumor/vascular malformation suspected.
Special Notes
Acquire coronal slices orthogonal to the long axis of hippocampus; thin slices (2–3 mm or less) improve detection of mesial temporal sclerosis and focal cortical dysplasia.
Sequences
MRI Brain Complete with Angiogram
Indication
Comprehensive intracranial evaluation including parenchyma and arterial vasculature (aneurysm, AVM, occlusion).
Patient Prep
Check renal function if contrast planned. Remove metallic objects.
Position
Supine, head first.
Coil
Head coil.
Contrast
If CE-MRA used: gadolinium 0.1 mmol/kg IV, consider saline chaser and bolus timing (or automated bolus).
Special Notes
For small aneurysms or stent follow-up, add high-resolution 3D TOF and consider CTA correlation; use MRA protocol optimized for spatial resolution.
Sequences
MRI Brain and Pituitary
Indication
Pituitary adenoma detection/staging, hypopituitarism, visual symptoms.
Patient Prep
None. Screen for renal function if contrast planned.
Position
Supine, head first.
Coil
Head coil.
Contrast
Gadolinium 0.1 mmol/kg IV — dynamic injection is essential for microadenoma detection.
Special Notes
Dynamic coronal imaging is critical — start imaging immediately with bolus injection to capture early enhancement differences between normal pituitary and adenoma.
Sequences
MRI Brain and Orbits
Indication
Combined intracranial disease with orbital involvement — optic neuritis, tumor extension, orbital cellulitis.
Patient Prep
None. Remove eye makeup/metal.
Position
Supine, head first, eyes neutral.
Coil
Head coil or dedicated orbital surface coil if available.
Contrast
Gadolinium 0.1 mmol/kg IV for inflammation/tumor.
Special Notes
Use small FOV, thin slices through orbits; instruct patient to keep eyes closed and avoid blinking or movement if possible.
Sequences
MRI Brain (P) MRA MRV
Indication
Comprehensive intracranial arterial and venous mapping (aneurysm, AVM, venous thrombosis).
Patient Prep
Screen renal function if contrast planned.
Position
Supine, head first.
Coil
Head coil.
Contrast
CE-MRA/MRV use gadolinium 0.1 mmol/kg IV; adjust timing for venous phase imaging.
Special Notes
When performing CE studies, do arterial and venous phases as required with appropriate bolus timing or automated bolus detection.
Sequences
MRI Angiogram Brain and Neck Vessels
Indication
Suspected carotid/vertebral stenosis, dissection, aneurysm, vasculopathy.
Patient Prep
Check renal function if contrast planned. Remove neck jewelry.
Position
Supine, head first; neck neutral.
Coil
Head & neck phased-array coil.
Contrast
Gadolinium 0.1 mmol/kg IV for CE-MRA.
Special Notes
For suspected dissection, include T1 fat-sat to detect intramural hematoma; plan neck coverage from aortic arch to skull base if clinically indicated.
Sequences
Spine
MRI Lumbar Spine Protocol
Indication
Standard protocol for back pain and radiculopathy.
Sequences
MRI Whole Spine Screening
Indication
Screening for metastases, infection, demyelination.
Patient Prep
None.
Position
Supine, head first.
Coil
Spine coil.
Contrast
None unless indicated. Special Notes:
Sequences
MRI LS Spine Protocol
Indication
Low back pain, disc disease, infection.
Patient Prep
None.
Position
Supine, head first.
Coil
Spine coil.
Contrast
None unless infection/tumor.
Sequences
MRI Dorsolumbar Spine Protocol
Indication
Dorsal/lumbar pain, disc disease, tumor.
Patient Prep
None.
Position
Supine.
Coil
Spine coil.
Contrast
As needed.
Sequences
MRI Dorsal Spine Protocol
Indication
Dorsal pain, disc herniation, tumor.
Patient Prep
None.
Position
Supine.
Coil
Spine coil.
Contrast
As needed.
Sequences
MRI Cervical Spine Protocol
Indication
Neck pain, radiculopathy, myelopathy.
Patient Prep
None.
Position
Supine.
Coil
Neck or spine coil.
Contrast
As needed.
Sequences
Abdomen & Pelvis
MRI Pelvis with Contrast (Male)
Indication
Male pelvic masses, prostate lesions, post-contrast evaluation of pelvic pathology.
Patient Prep
NBM 4 hours; bowel preparation if needed; empty bladder unless bladder imaging required.
Position
Supine, head first.
Coil
Body phased-array coil.
Contrast
Gadolinium, 0.1 mmol/kg IV, bolus injection with power injector.
Special Notes
For suspected prostate cancer, add high-resolution T2W small FOV through prostate and DWI with ADC map.
Sequences
MRI Pelvis with Contrast (Female)
Indication
Uterine and adnexal masses, pelvic inflammatory disease, staging of pelvic malignancies.
Patient Prep
NBM 4 hours; optional mild rectal/antispasmodic medication; empty bladder unless instructed otherwise.
Position
Supine, head first.
Coil
Body phased-array coil.
Contrast
Gadolinium 0.1 mmol/kg IV.
Special Notes
For endometrial cancer staging, add high-resolution thin-section sagittal and axial oblique T2W through uterus.
Sequences
MRI Pelvis (Male)
Indication
Non-contrast evaluation of pelvis in males.
Patient Prep
Empty bladder; bowel prep if indicated.
Position
Supine.
Coil
Body coil.
Contrast
None.
Special Notes
Add STIR coronal if bone lesions suspected.
Sequences
MRI Pelvis (Female)
Indication
Non-contrast assessment of female pelvic organs.
Patient Prep
As above.
Position
Supine.
Coil
Body coil.
Contrast
None.
Special Notes
Add 3D T2W for uterine anomaly evaluation.
Sequences
MRI Urography (MRU - Male)
Indication
Evaluation of urinary tract obstruction, tumors, anomalies.
Patient Prep
NBM 4 hrs; hydration encouraged; diuretics if indicated.
Position
Supine.
Coil
Body phased-array coil.
Contrast
Gadolinium 0.1 mmol/kg IV; delayed urographic phase images. Special Notes:
Sequences
MRI Urography (MRU - Female)
Indication
Evaluation of urinary tract obstruction, tumors, anomalies.
Patient Prep
NBM 4 hrs; hydration encouraged; diuretics if indicated.
Position
Supine.
Coil
Body phased-array coil.
Contrast
Gadolinium 0.1 mmol/kg IV; delayed urographic phase images.
Special Notes
Same as MRU (Male) with inclusion of pelvic sequences to assess uterus/adnexa if indicated.
Sequences
MRI Cholangiopancreatography (MRCP)
Indication
Biliary obstruction, choledocholithiasis, pancreatitis.
Patient Prep
NBM 4–6 hrs.
Position
Supine.
Coil
Body coil.
Contrast
Usually none for MRCP.
Special Notes
Optional post-contrast if needed.
Sequences
MRI Scrotum Protocol
Indication
Testicular mass, torsion, trauma, infection.
Patient Prep
None.
Position
Supine.
Coil
Surface coil over scrotum.
Contrast
As indicated.
Sequences
MRI Prostate Protocol
Indication
Cancer detection, staging, prostatitis.
Patient Prep
NBM 4 hrs; enema 2 hrs before; antiperistaltic agent.
Position
Supine.
Coil
Phased-array pelvic coil.
Contrast
Gadolinium 0.1 mmol/kg IV.
Sequences
MRI Abdomen Pelvis (Male)
Indication
Comprehensive abdominal and pelvic evaluation in males — liver, pancreas, adrenals, kidneys, bowel, prostate (if indicated).
Patient Prep
NBM 4–6 hrs (reduces bowel motion/intestinal fluid), remove metallic objects, encourage hydration. Consider negative oral contrast (water) if pancreatic/biliary imaging preferred. Check renal function prior to contrast. Antiperistaltic agent (e.g., glucagon) optional to reduce motion.
Position
Supine, head first.
Coil
Body phased-array coil (multichannel).
Contrast
Standard extracellular gadolinium 0.1 mmol/kg IV. If using hepatobiliary agent (gadoxetic acid), follow agent-specific dosing and timing for hepatobiliary phase.
Special Notes
Use respiratory triggering or breath-hold sequences for liver and upper abdomen. For liver lesion protocol, ensure optimal arterial and portal venous timing. For renal/urography needs, include delayed excretory-phase imaging. If evaluating prostate, add endorectal coil only if institutionally used; otherwise use phased-array pelvic coil and dedicated prostate protocol.
Sequences
MRI Abdomen Pelvis (Female)
Indication
Comprehensive abdominal and pelvic MRI in females — evaluate liver, adnexa, uterus, cervix, ovaries, bladder, bowel. Useful for pelvic pain, masses, staging gynecologic malignancies.
Patient Prep
NBM 4–6 hrs, empty bladder if specified (some protocols prefer partially filled bladder for pelvic anatomy), antiperistaltic agent optional. Check renal function for contrast. Consider pre-menstrual cycle timing for endometrial/peritoneal evaluation when applicable.
Position
Supine, head first.
Coil
Body phased-array coil.
Contrast
Gadolinium 0.1 mmol/kg IV for adnexal/uterine lesion characterization and staging. Consider DCE for fibroid mapping, adenomyosis, and tumor vascularity.
Special Notes
For endometrial/cervical staging: include thin oblique axial sequences orthogonal to endometrial canal and coronal sequences parallel to cervix. For ovarian masses: combine morphological features on T2/T1 and enhancement pattern with DWI to classify cystic vs solid and suggest benign vs malignant features. If pregnancy suspected, avoid gadolinium unless essential and after discussion with obstetrics.
Sequences
Musculoskeletal
MRI Knee Protocol
Indication
Standard protocol for internal derangement of the knee.
Sequences
MRI Wrist Protocol
Indication
Ligament/tendon injury, fracture, arthritis.
Patient Prep
None.
Position
Prone or supine with arm overhead (“superman”); neutral wrist.
Coil
Dedicated wrist coil.
Contrast
None unless suspected infection/tumor. Special Notes:
Sequences
MRI Thigh Protocol
Indication
Soft tissue mass, infection, trauma.
Patient Prep
None.
Position
Supine.
Coil
Body or extremity coil.
Contrast
As needed.
Sequences
MRI Shoulder Protocol
Indication
Rotator cuff tear, labral injury, instability, arthritis.
Patient Prep
None.
Position
Supine, arm by side in neutral rotation.
Coil
Dedicated shoulder coil.
Contrast
None unless suspected tumor/infection.
Sequences
MRI Sacro-Iliac Joints Protocol
Indication
Sacroiliitis, ankylosing spondylitis, infection.
Patient Prep
None.
Position
Supine.
Coil
Body coil.
Contrast
If infection or tumor suspected.
Sequences
MRI Knee Protocol
Indication
Ligament/meniscus injury, cartilage evaluation.
Patient Prep
None.
Position
Supine, knee in 15° flexion.
Coil
Dedicated knee coil.
Contrast
Only if tumor/infection suspected.
Sequences
MRI Hip Joints Protocol
Indication
AVN, arthritis, labral tear.
Patient Prep
None.
Position
Supine.
Coil
Body coil.
Contrast
If tumor/infection suspected.
Sequences
MRI Foot Protocol
Indication
Trauma, plantar fasciitis, tumor, infection.
Patient Prep
None.
Position
Supine or prone depending on coil.
Coil
Extremity coil.
Contrast
If needed.
Sequences
MRI Elbow Protocol
Indication
Ligament injury, fracture, tumor.
Patient Prep
None.
Position
Supine, arm at side or overhead.
Coil
Extremity coil.
Contrast
If infection/tumor suspected.
Sequences
MRI Brachial Plexus
Indication
Trauma, plexopathy, nerve sheath tumor, inflammatory neuropathy, radiation plexopathy.
Patient Prep
Remove metallic objects; counsel to minimize shoulder motion.
Position
Supine, head first, arms by side; slight arm abduction if tolerated.
Coil
Body coil or large surface coil covering neck to axilla; dedicated neurovascular coils if available.
Contrast
Gadolinium 0.1 mmol/kg IV when tumor or inflammatory plexopathy suspected.
Special Notes
Tailor FOV to side of symptoms; include C5–T1 nerve roots and supraclavicular/axillary segments. Use thin slices and small in-plane voxel size for nerve detail.
Sequences
MRI Ankle Protocol
Indication
Ligament/tendon injury (ATFL, CFL, deltoid), osteochondral lesions, impingement, tendinopathy.
Patient Prep
None.
Position
Supine, foot first, ankle in neutral or slight plantarflexion as needed.
Coil
Dedicated ankle/foot coil.
Contrast
None routinely. Use gadolinium 0.1 mmol/kg for infection/tumor.
Special Notes
If suspected occult fracture or osteochondral lesion, include thin-slice sagittal and coronal images through talar dome; include weight-bearing radiographs correlation if relevant.
Sequences
MRI Angiogram Lower Limbs
Indication
Peripheral arterial disease (claudication, critical limb ischemia), pre-op vascular mapping.
Patient Prep
NBM not required; check renal function if contrast planned. Remove metallic objects from legs.
Position
Supine, head first, legs extended.
Coil
Body phased-array or flexible multicoil array covering abdomen to feet (multi-station).
Contrast
Gadolinium 0.1 mmol/kg — may require split dose for multistation acquisitions or time-resolved sequences with lower single-dose boluses; use saline chaser. Follow local eGFR policy for contrast safety.
Special Notes
Use automated bolus detection or timing bolus for optimal arterial phase across stations; include delayed venous phase if planning revascularization to assess collateral flow.