Musculoskeletal MRI protocol
Radiology Department, National University Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
This protocol was presented at the Malaysian Society of
Radiographers Magnetic Resonance Imaging Seminar, 18-20 July 2008 in Kuala Lumpur , Malaysia.
The authors propose a musculoskeletal (MSK) magnetic
resonance imaging (MRI) protocol using selected sequences for common
orthopaedic indications. Selected sequences allow optimal visualisation of the
indicated pathology while screening for other common conditions. The authors
emphasise the need for standard positioning of the patient and standard
orientation of scan planes to facilitate comparison with follow-up scans. © 2010
Biomedical Imaging and Intervention Journal. All rights reserved.
Keywords: MSK MRI protocol, selected sequences, standard
positioning and orientation of scan planes
The authors propose a magnetic resonance imaging (MRI)
scan protocol using selected sequences for common orthopaedic indications.
Suggestions for scan parameters, planes for scan localisers, the orientation of
the scan planes and the scan coverage are included. This protocol was compiled
for the Avanto 1.5T MRI scanner (Siemens, Erlangen, Germany) used in the
Outline of the protocol
This protocol was tabled according to the parts of the
musculoskeletal system for quick and easy reference. There are six columns with
headings of ‘scan parameters’, ‘sequences’, ‘localiser’, ‘orientation of scan
planes’, ‘coverage’ and ‘comments’.
Under ‘scan parameters’, the authors have suggested the
radiofrequency (RF) coils to use, how to position the patient in the scanner,
the centring point of the scan and the field of view (FOV) of the scan. Scan
parameters will vary slightly according to the make and strength of different
The authors list selected sequences under the ‘sequences’
column. Sequences are selected for optimal visualisation of the indicated
pathologies while allowing for the screening of other common conditions. Extra
sequences can be added after these selected sequences are reviewed. The number
of sequences varies according to the indication of the scan. Some protocols
have thin-slice three dimensional (3D) gradient echo (GE) sequences preferably
done with isotropic voxels for multiplanar reconstruction (MPR). The interslice
gap is 20%. Names of some examples of these 3D sequences have been listed where
applicable. All listed T1 sequences are spin echo (SE) sequences. All the T2
weighted sequences are turbo spin echo (TSE) sequences to reduce scanning time.
An interslice gap of 10% is used for SE and TSE sequences.
‘Localiser’ or ‘scanogram’ is the plane of the pilot image
used to plan the orientation of the scan planes and the coverage of the scan.
Under ‘orientation of scan planes’, the authors describe
how the plane of the scan should be orientated. Standard positioning of the
patient together with standard orientation of scan planes will produce standard
images. These standard images will facilitate comparison with follow-up scans.
Under ‘coverage’, the range of the scan to ensure adequate
coverage of the anatomy of the body part imaged is described.
Under the ‘comment’ column, other sequences which may be
helpful in confirming the diagnosis of the indicated pathology is suggested.
The authors did not include tumour imaging aside from
screening for metastasis in the spine and for pigmented villonodular synovitis
(PVNS) of the knee. MSK infections aside from infective spondylodiscitis were
also not included. In the authors' department, MRI imaging of tumour and MSK
infection is individualised according to the site and size of the lesion. In
cases of an MSK tumour, the sequences done often depend on the contents of tumour
As with any MRI protocol, periodic revision is necessary
with the advent of new technical development and knowledge.
The authors thank Dr. Leanne Seeger of the David Geffen
School of Medicine, University of California, Los Angeles, for her generosity
in providing us with her MSK MRI protocol on which ours was based. The authors
also thank Mr Muhammad Eirfan Bin Adnan, MR Application Specialist of Siemens
Healthcare Malaysia for his valuable suggestions.
The musculoskeletal MRI protocol is available for download
as a PDF file at: http://biij.org/2010/2/e16/supp1.pdf
Kaplan PA, Helms CA, Dussault R et al., eds. Musculoskeletal MRI. 1st edition. Philadelphia, USA: WB Saunders, 2001.
|Received 9 July 2009; received in revised form 10 August
2009; accepted 15 August 2009
Correspondence: Radiology Department, National University Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia. Tel.: (603) 9170 7824; Fax: (603) 9170 7824; E-mail: email@example.com (Sook-Pei Tan).
Please cite as: Tan SP, Suraya A, Sa'don S, Ruzi A, Zahiah M,
Musculoskeletal MRI protocol, Biomed Imaging Interv J 2010; 6(2):e16