Comments on: Neuro Protocols

By: mdmarchand

mdmarchand — Tue, 19 Jan 2010 19:43:08 +0000

one more point – we use a vibe (siemens) seq w/FS (GE equivalent=FMPSPGR, VIBRANT, FAME or LAVA) pre and post as our workhorse post con imaging ST neck. It is a T1 weighted gradient echo sequence acquired as a slab – very fast acquisition time, very good spatial resolution, can cut into 2 mm images etc. Any experience with this seq or similar seq for neck imaging? I am worried about the contrast detection issue, but images are so detailed it might be worth the tradeoff here

By: mdmarchand

mdmarchand — Tue, 19 Jan 2010 19:00:32 +0000

In general with head and neck imaging, your protocols do not fat sat the pre T1 – several of my partners state they have found pre T1 w/FS to be helpful in the past and they want to keep pre T1 FS images going forward. I like the standard T1 personally, your thoughts on the value of pre T1 w/ FS. Several state a case in the past where they would have called enhancement without the pre FS T1…

Also, your CN 5 protocol is fairly short, with no pre con T1 images – is that all you do? Why the MRA as opposed to a CISS/FIESTA?

I was taught that sgpr T1 seq do not show enhancement as well as standard T1 seq – your CN 5 includes an spgr seq, your thoughts on less than ideal contrast detection (ucsd does the same seq as you).

I see a mix of STIR and T2 with FS in the orbit protocol – what is the rationale for one over the other? We lean toward STIR with head and neck imaging.

Lastly, our referring neurology group sees a high volume of MS patients. We have seen STIR imaging of the posterior fossa to be superior to other sequences (including PD) in the detection of wm lesions and now our ms protocol includes an axial stir seq

By: rhwiggins

rhwiggins — Tue, 14 Jul 2009 21:26:23 +0000

Thanks, Dr. Hoang. Yes, we sometimes forget that with cranial nerve work-ups, we always need to image from the origin nucleus all the way out through the end organ. Usually (except for 10 and 11 obviously) if you start behind the pontomedullary junction and go out anteriorly through the face you have most of them covered if you forget the mid brain anatomy! I have also seen the opposite of your examples where a tongue atrophy case only looked at the face and tongue itself, and missed a lesion above hypoglossal.

By: jennykh

jennykh — Tue, 14 Jul 2009 19:56:09 +0000

Thanks for this post, Rick. We are in the process of revising our head and neck MRIs. I think your dedicated protocol for CN7 to include the parotid is great. Many centers may defer to doing an IAC MRI for CN7, but I have had two recent examples whereby the cause of the facial nerve palsy was from inflammation and tumor arising from the parotid gland.

I agree, more people should comment!

By: rhwiggins

rhwiggins — Mon, 13 Jul 2009 19:52:33 +0000

Hello?!?!?!? come on people, show some love here! none of you even have anything to share, or even a comment?!?!?!?! How could this have 1,457 views and no comments?!?!?!?! I’m going to tell Mauricio!!!!