Pelvis

12
Pelvis


Table 12.1 Summary of parameters


















































































































































































































































































































1.5 T 3 T
SE SE
Short TE Min–30 ms Short TE Min–15 ms
Long TE 70 ms+ Long TE 70 ms+
Short TR 600–800 ms Short TR 600–900 ms
Long TR 2000 ms+ Long TR 2000 ms+
FSE FSE
Short TE Min–20 ms Short TE Min–15 ms
Long TE 90 ms+ Long TE 90 ms+
Short TR 400–600 ms Short TR 600–900 ms
Long TR 4000 ms+ Long TR 4000 ms+
Short TEL 2–6 Short TEL 2–6
Long ETL 16+ Long ETL 16+
IR T1 IR T1
Short TE Min–20 ms Short TE Min–20 ms
Long TR 3000 ms+ Long TR 300 ms+
TI 200–600 ms TI Short or null time of tissue
Short ETL 2–6 Short ETL 2–6
STIR STIR
Long TE 60 ms+ Long TE 60 ms+
Long TR 3000 ms+ Long TR 3000 ms+
Short TI 100–175 ms Short TI 210 ms
Long ETL 16+ Long ETL 16+
FLAIR FLAIR
Long TE 80 ms+ Long TE 80 ms+
Long TR 9000 ms+ Long TR 9000 ms + (TR at least 4 × TI)
Long TI 1700–2500 ms (depending on TR) Long TI 1700–2500 ms (depending on TR)
Long ETL 16+ Long ETL 16+
Coherent GRE Coherent GRE
Long TE 15 ms+ Long TE 15 ms+
Short TR <50 ms Short TR <50 ms
Flip angle 20–50° Flip angle 20–50°
Incoherent GRE Incoherent GRE
Short TE Minimum Short TE Minimum
Short TR <50 ms Short TR <50 ms
Flip angle 20–50° Flip angle 20–50°
Balanced GRE Balanced GRE
TE Minimum TE Minimum
TR Minimum TR Minimum
Flip angle >40° Flip angle >40°
SSFP SSFP
TE 10–15 ms TE 10–15 ms
TR <50 ms TR <50 ms
Flip angle 20–40° Flip angle 20–40°
1.5 T and 3 T
Slice thickness 2D Slice thickness 3D
Thin 2–4 mm Thin <1 mm
Medium 5–6 mm Thick >3 mm
Thick 8 mm
FOV Matrix
Small <18 cm Coarse 256 × 128/256 × 192
Medium 18–30 cm Medium 256 × 256/512 × 256
Large >30 cm Fine 512 × 512
Very fine >1024 × 1024
NEX/NSA Slice number 3D
Short 1 Small <32
Medium 2–3 Medium 64
Multiple >4 Large >128
PC-MRA 2D and 3D TOF-MRA 2D
TE Minimum TE Minimum
TR 25–33 ms TR 28–45 ms
Flip angle 30° Flip angle 40–60°
VENC venous 20–40 cm/s
VENC arterial 60 cm/s TOF-MRA 3D
TE Minimum
TR 25–50 ms
Flip angle 20–30°

The figures given are for 1.5 T and 3 T systems. Parameters are dependent on field strength and may need adjustment for very low or very high field systems


Male pelvis


Basic anatomy (Figure 12.1)

c12-fig-0001

Figure 12.1 Sagittal section through the male pelvis showing midline structures.


Common indications



  • Localization of undescended testicles
  • Prostatic lesions
  • Carcinoma of the bladder
  • Rectal lesions
  • Infertility
  • Impotence

Equipment



  • Body coil/phased array pelvic coil/multi-array coil and local rectal coil for prostate imaging (can be used in conjunction with a phased/multi-array coil)
  • Compression bands and foam immobilization pads
  • Earplugs/headphones

Patient positioning


The patient lies supine on the examination couch. Foam pads and compression bands can be applied across the patient’s lower pelvis to reduce respiratory and bowel motion (unless the patient cannot tolerate this). The patient is positioned so that the longitudinal alignment light lies in the midline, and the horizontal alignment light passes through a point midway between the pubis symphysis and the iliac crests. If a local rectal coil is used, it should be carefully inserted prior to the examination. Ensure that it is correctly positioned and fully inflated.


Suggested protocol


Coronal breath-hold fast incoherent (spoiled) GRE/SE/FSE T1 (Figure 12.2)

c12-fig-0002

Figure 12.2 Coronal FSE T1-weighted image through the male pelvis.


Acts as a localizer if three-plane localization is unavailable, or as a diagnostic sequence. Thick slices/gaps are prescribed from the coccyx to the anterior aspect of the pubis symphysis. The area from the pubis symphysis to the iliac crests is included in the image.


P 60 mm to A 60 mm


Sagittal localizers used in conjunction with a large FOV are useful to confirm the correct positioning of a rectal coil and to demonstrate nodes and bony metastases in patients with suspected prostatic carcinoma.


L 25 mm to R 25 mm


Sagittal SE/FSE T2


Demonstrates organs that lie in the midline (bladder, rectum, prostate, penis). Medium or thick slices/gaps are prescribed from the left to the right pelvic side walls (Figure 12.3). Unless lymph node involvement is suspected, small structures such as the prostate require high-resolution imaging using the rectal coil and thin slices/gap prescribed through the ROI only. Tissue suppression pulses are often necessary when using FSE sequences.

c12-fig-0003

Figure 12.3 Coronal FSE T1-weighted image through the male pelvis to show slice prescription boundaries and orientation for sagittal imaging.


Axial SE/FSE T2 (Figure 12.4)

c12-fig-0004

Figure 12.4 Axial FSE T2-weighted image through a normal male pelvis (rectal coil in situ).


Demonstrates organs that lie laterally (lymph nodes). Medium or thick slices/gaps are prescribed from the pelvic floor to the iliac crests (Figure 12.5). Unless lymph node involvement is suspected, small structures such as the prostate require high-resolution imaging using the rectal coil and thin slices/gap prescribed through the ROI only. Tissue suppression pulses are often necessary when using FSE sequences.

c12-fig-0005

Figure 12.5

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Jan 10, 2016 | Posted by in MAGNETIC RESONANCE IMAGING | Comments Off on Pelvis

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