Does an MRI (Magnetic Resonance Imaging) of the orbits also capture the face?

Does an MRI of the Orbits Also Capture the Face?

Yes, an MRI of the orbits typically includes the face when ordered as "MRI orbits, face, and neck," which is the standard protocol recommended by the American College of Radiology for comprehensive evaluation of orbital and facial structures. 1

Understanding the Standard Protocol

The ACR guidelines consistently refer to this imaging study as "MRI orbits, face, and neck" rather than "MRI orbits" alone, indicating that these anatomic regions are routinely imaged together as a unified protocol. 1

• The face is explicitly included in the standard field of view when evaluating orbital pathology, cranial neuropathies, or head and neck malignancies. 1
• This combined protocol provides comprehensive coverage from the orbits through the neck, capturing all facial soft tissues in the imaging field. 1

Clinical Applications Where This Matters

For Cranial Neuropathy Evaluation

• When assessing cranial nerves (particularly CN X, CN XI, and CN XII), the ACR recommends MRI orbits, face, and neck to evaluate the entire extracranial course of these nerves. 1
• This protocol captures the brainstem, skull base, facial structures, and neck in a single comprehensive examination. 2

For Head and Neck Cancer Staging

• MRI orbits, face, and neck without and with IV contrast is the preferred modality for staging nasopharyngeal carcinoma, sinonasal tumors, and other head and neck malignancies. 1
• The superior soft tissue contrast resolution allows accurate delineation of tumor extent, including invasion of facial structures, skull base involvement, and perineural spread. 1

Important Caveats

Distinguish from MRI Head

• MRI head (brain) does NOT adequately cover the face or orbits for detailed evaluation. 1
• If you need comprehensive orbital and facial imaging, you must specifically order "MRI orbits, face, and neck" rather than "MRI head." 2

Contrast Administration

• Pre- and postcontrast imaging provides the best opportunity to identify and characterize lesions in the orbits and face. 1
• Noncontrast sequences alone may be insufficient for complete evaluation, particularly when assessing for tumors, inflammation, or perineural spread. 1

Technical Requirements

• Thin-cut high-resolution sequences focused on the posterior fossa, posterior skull base, and facial structures should be specified for optimal visualization. 1, 2
• The examination typically adds 10-15 minutes to a standard brain MRI when performed together. 3

Practical Ordering Guidance

Order "MRI orbits, face, and neck without and with IV contrast" when you need:

• Comprehensive evaluation of orbital pathology with assessment of adjacent facial structures 1
• Cranial neuropathy workup requiring visualization from brainstem through extracranial nerve courses 1
• Head and neck cancer staging or surveillance 1

Do NOT order "MRI head" alone if your clinical question involves the orbits or face, as this protocol is optimized for brain parenchyma and will not provide adequate coverage or resolution of these structures. 1, 2