Recommended MRI Views for Clinical Imaging
For optimal diagnostic imaging, MRI protocols should include multiparametric sequences with T2-weighted, T1-weighted, and when appropriate, contrast-enhanced sequences, with field strength of at least 1.5T (preferably 3T) and slice thickness of 3mm or less with no gaps between slices.
Brain MRI Protocol
Essential Sequences
- T2-weighted and T2-FLAIR sequences are mandatory for detecting lesions and pathology 1
- T1-weighted sequences before and after contrast administration for evaluating enhancement patterns 1
- Diffusion-weighted imaging (DWI) for detecting acute ischemia, infection, or cellular density changes 1
- For multiple sclerosis evaluation, a minimum of two sets of sagittal images with different contrasts (T2 and proton-density and/or STIR) 1
Recommended Parameters
- Field strength: Minimum 1.5T, with 3T preferred for better resolution 1
- Slice thickness: 3mm or less with no interslice gap 1
- For 2D sequences, in-plane spatial resolution of 1×1mm 1
- For 3D sequences, isotropic voxels of 1mm³ 1
Spine MRI Protocol
Essential Sequences
- Sagittal T2-weighted fast spin-echo (FSE) sequences 2, 3
- Sagittal T1-weighted spin-echo sequences 2, 4
- Axial T2-weighted sequences through areas of suspected pathology 2, 3
- STIR sequences for better bone marrow evaluation 2, 4
Special Considerations
- For cervical spine: Sagittal T2 FSE, sagittal T1 SE, and axial 2D gradient echo (GE) sequences 2
- For lumbar spine: Sagittal T2 FSE, sagittal T1 SE, and axial T2 FSE sequences 2, 3
- T2-weighted Dixon sequences may replace the combination of T1, T2, and fat-suppressed T2-weighted sequences in non-specific low back pain evaluation 3
Plexus MRI Protocol (Brachial/Lumbosacral)
Essential Sequences
- T1-weighted sequences 1
- T2-weighted sequences 1
- Fat-saturated T2-weighted or STIR sequences 1
- Fat-saturated T1-weighted post-contrast sequences when indicated 1
Technical Considerations
- Imaging should include orthogonal views through the oblique planes of the plexus 1
- High-resolution T2-weighted sequences (MR neurography) should be routinely performed 1
- 1.5T may be beneficial to reduce artifact if metal is present in the area of clinical concern 1
Multiple Sclerosis-Specific Protocol
Essential Sequences
- T2-FLAIR for detecting periventricular lesions 1
- T2-weighted sequences for infratentorial lesions 1
- T1-weighted sequences pre- and post-contrast for active lesion detection 1
- Spinal cord imaging (cervical and thoracic) with T2 and T1 post-gadolinium 1
Technical Considerations
- 3D acquisition allows for slice reorientation in all anatomical planes 1
- DWI with b-values of 0,500, and 1000 s/mm² in at least three directions 1
- Temporal resolution for dynamic contrast-enhanced sequences should be 10-15 seconds 1
Prostate MRI Protocol
Essential Sequences
- T2-weighted sequences for anatomical detail 1
- Diffusion-weighted imaging (DWI) for cellularity assessment 1
- Dynamic contrast-enhanced (DCE) sequences for vascularity assessment 1
Technical Considerations
- DCE sequence is most important for detecting recurrence after focal therapy 1
- Both T2W and DWI sequences should be graded out of 3 for lesions within ablation zones 1
- PI-RADS v2.1 scoring should be used for lesions outside ablation zones 1
Common Pitfalls to Avoid
- Inconsistent protocols between follow-up scans making comparison difficult 1, 5
- Inadequate slice thickness or gaps between slices reducing detection of small lesions 1
- Omitting key sequences (e.g., DCE for prostate imaging after focal therapy) 1
- Failing to confirm lesions on multiple planes to avoid false positives due to artifacts 1
- Not comparing current MRI with previous studies when available 1
Special Situations
- For CSF leak evaluation: Heavily T2-weighted sequences with 3D isotropic acquisition for sub-millimeter resolution 1
- For transverse myelitis monitoring: T2-weighted, T2-FLAIR, and gadolinium-enhanced T1-weighted sequences 5
- For patients at high risk of developing opportunistic infections: Brain MRI every 3-4 months with FLAIR, T2-weighted, and diffusion-weighted imaging 1, 5