MRI Exam-Specific Parameters: Head and Neck Module (Revised 4-6-2022)

Katie Albus

Modified on: Fri, 13 Jan, 2023 at 3:46 PM

Revision History

In addition to the exam-specific instructions in the following tables, review the following information prior to examination selection and submission. Failure to follow the guidance below may result in failure of the submitted examination.

ADC map is now required for brain for TIA DWI sequence. Omission of the ADC map will result in failure of the submitted examination.
Failure to meet anatomic coverage and imaging plane specifications may result in failure.

Brain for Suspected Demyelinating Disease, Encephalitis or Acute Disseminated Encephalomyelitis
Required Sequences	Category A: Pulse Sequence and Image Contrast	Category B: Anatomic Coverage and Imaging Planes	Category C: Spatial Resolution
Axial, sagittal or coronal dark fluid	Must have good discrimination between the brain and CSF	Axial must cover convexity to foramen magnum Coronal must cover entire brain from anterior to posterior cranial vault Sagittal must cover entire brain from left to right and the top of the brain to the C2 level	Slice thickness ≤ 5.0 mm Gap ≤ 2.5 mm if coronal Gap ≤ 2.0 mm if axial or sagittal Pixel area ≤ 1.2 mm²
Sagittal T2 FLAIR	Must have good water suppression CSF must be hypointense relative to white matter	Sagittal must cover entire brain from left to right and the top of the brain to the C2 level	Slice thickness ≤ 5.0 mm Gap ≤ 2.0 mm Pixel area ≤ 2.0 mm²
Axial T2 FLAIR	Must have good water suppression CSF must be hypointense relative to white matter Reformatted axial T2 FLAIR images from the 3D sagittal T2 FLAIR are acceptable DIR FLAIR is an acceptable substitute for T2 FLAIR	Axial must cover from convexity to foramen magnum	Slice thickness ≤ 5.0 mm Gap ≤ 2.0 mm Pixel area ≤ 1.2 mm²
Axial Bright Fluid	CSF must be hyperintense relative to the brain Must have good contrast between the gray matter and white matter Should be a Fast Spin Echo (Turbo Spine Echo, RARE) NOT a gradient echo	Axial must cover from convexity to foramen magnum	Slice thickness ≤ 5.0 mm Gap ≤ 2.0 mm Pixel area ≤ 1.2 mm²
Axial, sagittal or coronal dark fluid post contrast	Must have good discrimination between the brain and CSF	Axial must cover convexity to foramen magnum Coronal must cover entire brain from anterior to posterior cranial vault	Slice thickness ≤ 5.0 mm Gap ≤ 2.0 mm Pixel area ≤ 1.2 mm²

IAC/Temporal Bones
Required Sequences	Category A: Pulse Sequence and Image Contrast	Category B: Anatomic Coverage and Imaging Planes	Category C: Spatial Resolution
Axial or coronal high resolution dark fluid without fat suppression	Must have good discrimination of the 7^th and 8^th cranial nerves	Must cover top of IACs to cervical-medullary junction	Slice thickness ≤ 3.0 mm Gap ≤ 0.2 mm Pixel area ≤ 0.6 mm²
Axial or coronal high resolution bright fluid	Must have good discrimination of the 7^th and 8^th cranial nerves Must have good membranous labyrinth discrimination	Must cover top of IACs to foramen magnum Coronal must cover pituitary to 4^th ventricle	Slice thickness ≤ 2.0 mm Gap = 0 mm (zero gap) Pixel area ≤ 0.6 mm²
Axial high resolution dark fluid with or without fat suppression post contrast	Must have good discrimination of the 7^th and 8^th cranial nerves	Must cover top of IACs to foramen magnum	Slice thickness ≤ 3.0 mm Gap ≤ 0.2 mm Pixel area ≤ 0.6 mm²
Coronal high resolution dark fluid with or without fat suppression post contrast	Must have good discrimination of the 7^th and 8^th cranial nerves	Must cover top of IACs to foramen magnum	Slice thickness ≤ 3.0 mm Gap ≤ 0.2 mm Pixel area ≤ 0.6 mm²

Brain for TIA or Stroke Omission of the ADC map will result in failure of the submitted examination
Required Sequences	Category A: Pulse Sequence and Image Contrast	Category B: Anatomic Coverage and Imaging Planes	Category C: Spatial Resolution
Sagittal, axial or coronal dark fluid	Must have good discrimination between the brain and CSF	Axial must cover the entire brain Sagittal must cover entire brain from left to right and the top of the brain to the C2 level Coronal must cover entire brain from anterior to posterior cranial vault	Slice thickness ≤ 5.0 mm Gap ≤ 2.5 mm if coronal Gap ≤ 2.0 mm if axial or sagittal Pixel area ≤ 1.2 mm²
Axial diffusion weighted imaging (DWI) including ADC map	Must include ADC map and B value must be ≥ 800	Axial must cover the entire brain	Slice thickness ≤ 5.0 mm Gap ≤ 2 mm Pixel area ≤ 4 mm²
Axial or coronal T2 FLAIR	CSF must be hypointense relative to white matter Must have good water suppression	Axial must cover the entire brain Coronal must cover entire brain from anterior to posterior cranial vault	Slice thickness ≤ 5.0 mm Gap ≤ 2 mm Pixel area ≤ 1.2 mm²
Axial bright fluid	SF must be hyperintense relative to the brain Must have good contrast between the gray matter and white matter	Axial must cover the entire brain	Slice thickness ≤ 5.0 mm Gap ≤ 2 mm Pixel area ≤ 1.2 mm²
*Axial or coronal T2 weighted gradient echo**	CSF must be hyperintense relative to the brain Susceptibility weighted imaging or SWAN sequence is an acceptable substitute, if submitted the CSF need not be hyperintense relative to the brain	Axial must cover the entire brain Coronal must cover entire brain from anterior to posterior cranial vault	Slice thickness ≤ 5 mm Gap ≤ 2.5 mm Pixel area ≤ 1.2 mm²

Orbits for Vision Loss or Tumor
Required Sequences	Category A: Pulse Sequence and Image Contrast	Category B: Anatomic Coverage and Imaging Planes	Category C: Spatial Resolution
Axial dark fluid	Must have good optic nerve sheath discrimination Fat must be bright	Must cover entire orbits and optic nerves	Slice thickness ≤ 3.0 mm Gap ≤ 1.0 mm Pixel area ≤ 1.0 mm²
Coronal bright fluid with fat suppression which includes STIR or frequency-selective fat suppression techniques	Must have good optic nerve discrimination Must have good fat suppression	Must cover eyelids to dorsum sella	Slice thickness ≤ 5.0 mm Gap ≤ 1.0 mm Pixel area ≤ 1.0 mm²
Axial dark fluid with fat suppression post contrast	Must have good optic nerve sheath discrimination Must have good fat suppression	Must cover entire orbits and optic nerves	Slice thickness ≤ 3.0 mm Gap ≤ 1.0 mm Pixel area ≤ 1.0 mm²
Coronal dark fluid with fat suppression post contrast	Must have good optic nerve sheath discrimination Must have good fat suppression	Must cover eyelids to dorsum sella	Slice thickness ≤ 5.0 mm Gap ≤ 1.0 mm Pixel area ≤ 1.0 mm²

Pituitary with Contrast Enhancement
Required Sequences	Category A: Pulse Sequence and Image Contrast	Category B: Anatomic Coverage and Imaging Planes	Category C: Spatial Resolution
Sagittal dark fluid	Must have good discrimination between brain and CSF	Must cover from medial temporal lobe to medial temporal lobe	Slice thickness ≤ 3.3 mm Gap ≤ 0.3 mm Pixel area ≤ 0.6 mm²
Coronal dark fluid	Must have good discrimination between brain and CSF	Must cover from orbital apex to dorsum sella	Slice thickness ≤ 3.3 mm Gap ≤ 0.3 mm Pixel area ≤ 0.6 mm²
Sagittal dark fluid post contrast	Must have good discrimination between brain and CSF	Must cover from medial temporal lobe to medial temporal lobe	Slice thickness ≤ 3.3 mm Gap ≤ 0.3 mm Pixel area ≤ 0.6 mm²
Coronal dark fluid post contrast	Must have good discrimination between brain and CSF	Must cover from orbital apex to dorsum sella	Slice thickness ≤ 3.3 mm Gap ≤ 0.3 mm Pixel area ≤ 0.6 mm²

Revision History for this Article
Date	Section	Description of Revision(s)
12-12-19	All	Article created; FAQs incorporated; No criteria changes
12-16-19	Brain for TIA or Stroke	Sagittal, axial or coronal dark fluid: Correct the Gap from </= 2.5 mm if axial or sagittal to </= 2.0 mm if axial or sagittal.
12-17-19	Brain for TIA or Stroke	Axial diffusion weighted imaging (DWI) including ADC map: Changed B value must be ≤ 800 to ≥800
1-8-2020	Brain for TIA or Stroke	Axial diffusion weighted imaging (DWI) including ADC map: Changed gap to ≤ 2 mm
1-8-2020	Orbits for Vision Loss or Tumor	Coronal bright fluid with fat suppression which includes STIR or frequency-selective fat suppression techniques: Change gap to ≤ 1.0 mm.
1-17-2020	Brain for Suspected Demyelinating Disease, Encephalitis, or Acute Disseminate Encephalomyelitis	Sagittal T2 Flair- Changed pixel area to ≤ 2.0 mm²
4-9-2020	IAC/Temporal Bones	Axial or coronal high resolution dark fluid without fat suppression: Corrected gap from ≤ 2.0 mm to ≤ 0.2 mm.
4-6-2022	Brain for Suspected Demyelinating Disease, Encephalitis, or Acute Disseminate Encephalomyelitis	Required Sequences: Added sagittal to the post contrast sequence

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