Elbow MRI : Protocol and Planning
Indications for Elbow MRI
- Marrow abnormalities (e.g. bone contusions, osteonecrosis, marrow oedema syndromes, and stress fractures)
- Synovial-based disorders ( e.g. synovitis, tenosynovitis, bursitis, and ganglion cysts)
- Infections of bone, joint, or soft tissue (e.g. osteomyelitis, osteochondritis, osteoarthritis )
- Evaluation of suspected cartilaginous defects
- Evaluation of intra-articular loose bodies
- Neoplasms of bone, joint or soft tissue
- Avascular necrosis
- Nerve Impingement
- Fractures in children
- Soft-tissue masses
- Occult fracture
- Ligament tear
Contraindications
- Any electrically, magnetically or mechanically activated implant (e.g. cardiac pacemaker, insulin pump biostimulator, neurostimulator, cochlear implant, and hearing aids)
- Intracranial aneurysm clips (unless made of titanium)
- Pregnancy (risk vs benefit ratio to be assessed)
- Ferromagnetic surgical clips or staples
- Metallic foreign body in the eye
- Metal shrapnel or bullet
Patient preparation for Elbow MRI
- A satisfactory written consent form must be taken from the patient before entering the scanner room
- Ask the patient to remove all metal objects including keys, coins, wallet, cards with magnetic strips, jewellery, hearing aid and hairpins
- If possible provide a chaperone for claustrophobic patients (e.g. relative or staff )
- Offer earplugs or headphones, possibly with music for extra comfort
- Explain the procedure to the patient
- Instruct the patient to keep still
- Note the weight of the patient
Positioning for Elbow MRI
- Position the patient in supine position with head pointing towards the magnet (head first supine)
- Position the elbow in small flex coil and immobilize with sand bags
- Centre the laser beam localiser over the elbow joint
- Register the patient on the scanner as 'head first supine'
Recommended Elbow MRI Protocols and Planning
Elbow MRI localiser
A three-plane localizer must be taken at the beginning to localize and plan the sequences. Typically, these localizers take less than 25 seconds and can be achieved using T1 weighted low-resolution scans. It is advisable to obtain additional localizers until you have acquired accurate axial, coronal, and sagittal localizer images.
T2* medic \PD Fat saturated axial 3mm SFOV
Plan the axial slices on the coronal plane and angle the positioning block parallel to the medial and lateral humeral epicondyles. Check the positioning block in the other two planes. An appropriate angle must be used in the sagittal plane (perpendicular to the humerus and ulna). Slices must be sufficient to cover the whole elbow joint from 1 inch above the olecranon fossa to one inch below the radial tuberosity. Adding saturation bands on the top and bottom of the axial block will help reduce the arterial pulsation artifacts. The phase direction must be anteroposterior to avoid wrap-around and motion artifacts from the abdomen.
Parameters T2*
TR 800-1200 | TE 15-25 | FLIP 30 | NEX 2 | SLICE 3 MM | MATRIX 256X256 | FOV 100-110 | PHASE A>P | GAP 10% | oversample nil or 30% |
T1 tse axial 3mm SFOV
Plan the axial slices on the coronal plane and angle the positioning block parallel to the medial and lateral humeral epicondyles. Check the positioning block in the other two planes. An appropriate angle must be used in the sagittal plane (perpendicular to the humerus and ulna). Slices must be sufficient to cover the whole elbow joint from 1 inch above the olecranon fossa to one inch below the radial tuberosity. Adding saturation bands on the top and bottom of the axial block will help reduce the arterial pulsation artifacts. The phase direction must be anteroposterior to avoid wrap-around and motion artifacts from the abdomen.
Parameters
TR 400-500 | TE 15-20 | FLIP 150 | NEX 2 | SLICE 3 MM | MATRIX 256X256 | FOV 100-110 | PHASE A>P | GAP 10% | oversample nil or 30% |
T1 tse coronal 3mm
Plan the coronal slices on the axial plane and angle the positioning block parallel to the medial and lateral humeral epicondyles. Check the positioning block in the other two planes. An appropriate angle must be used in the sagittal plane (parallel to the humerus and ulna). Slices must be sufficient to cover the whole elbow joint from the anterior to posterior aspect. Adding saturation bands on the top and bottom of the coronal block will help to reduce arterial pulsation artifacts. The phase direction must be head to feet with a minimum of 100% oversampling to avoid wrap-around and pulsation artifacts.
Parameters
TR 400-500 | TE 15-20 | FLIP 150 | NEX 2 | SLICE 3 MM | MATRIX 256X256 | FOV 110-130 | PHASE H>F | GAP 10% | oversample 100% |
T2 stir coronal 3mm
Plan the coronal slices on the axial plane and angle the positioning block parallel to the medial and lateral humeral epicondyles. Check the positioning block in the other two planes. An appropriate angle must be used in the sagittal plane (parallel to the humerus and ulna). Slices must be sufficient to cover the whole elbow joint from the anterior to posterior aspect. Adding saturation bands on the top and bottom of the coronal block will help to reduce arterial pulsation artifacts. The phase direction must be head to feet with a minimum of 100% oversampling to avoid wrap-around and pulsation artifacts.
Parameters
TR 3000-4000 | TE 110 | FLIP 130 | NEX 2 | SLICE 3MM | MATRIX 320X320 | FOV 110-130 | PHASE H>F | GAP 10% | TI 130 |
T2* medic \PD Fat saturated sagittal 3mm
Plan the sagittal slices on the axial plane and angle the positioning block perpendicular to the medial and lateral humeral epicondyles. Check the positioning block in the other two planes. An appropriate angle must be used in the coronal plane (parallel to the humerus and ulna). Slices must be sufficient to cover the whole elbow joint from the medial to lateral aspect. Adding saturation bands on the top and bottom of the sagittal block will help reduce arterial pulsation artifacts. The phase direction can be head to feet with 100% oversampling or anteroposterior with 20% oversampling to avoid wrap-around artifacts.
Parameters MEDIC
TR 800-1200 | TE 15-25 | FLIP 30 | NEX 2 | SLICE 3 MM | MATRIX 256X256 | FOV 100-110 | PHASE H>F | GAP 10% | oversample 100% |