MR Pediatric Enterography W/WO Protocol

Revised - 8/13/2013
Charge as Abdomen W/WO, and Pelvis W/WO

Patient Prep: The patient can continue to drink liquids but should not have solid food from 4 hours before the exam.

Coil: Size to patient
Localizer
(REF scan)
Mode Slice Gap FAT SAT FOV Scan Range
COR T2 TSE SS BH 5mm 1mm None Fit to Patient Entire abdomen, and pelvis, skin to skin
AXIAL T1 MS FFE 5.4mm 1mm WATS (Proset) Fit to Patient Above diaphragm through pubic symphysis
AXIAL T2 TSE SS 3mm 0.5mm SPAIR Fit to Patient Above diaphragm through pubic symphysis
AXIAL 2D bTFE bTFE 5mm 0.5mm STIR Fit to Patient Entire abdomen, and pelvis, skin to skin
COR 2D bTFE bTFE 4mm (-2)mm None Fit to Patient Entire abdomen, and pelvis, skin to skin
AXIAL T2 FSE 3mm 0.5mm SPAIR Fit to Patient Pelvis ONLY, Top of iliac crests through entire perineum (to below lesser tochanters of femurs)
Contrast Injection
AXIAL T1 MS FFE 5.4mm 1mm WATS (Proset) Fit to Patient Above diaphragm through pubic symphysis
COR T1 Thrive 3D SPAIR Fit to Patient Entire abdomen and pelvis, skin to skin

Notes:

See additional instructions below for more details.
Position patient in scanner head first, PRONE ( to minimize abdominal motion)
Images must be checked by radiologist or radiology resident before patient leaves.

Additional Instructions

Fix the order in RIS if needed:

1.Choose the “Enterography” order in QDOC. This includes both abdomen and pelvis.

Contrast Worksheet:

Located at the end of this document.

Contrast / Meds:

2.Volumen:

  1. Amount the patient needs to drink is 20 mL/kg, up to but not exceeding 1800 mL. The nurse will prepare this contrast. If this is for an inpatient, VIP the contrast to the floor with drinking instructions attached.
  2. The rad nurse (or floor nurse if for an inpatient) will give the contrast to the patient.
  3. Patient must start drinking 90 min before study, finishing 15 min before imaging.
  4. The nurse will tell you when the patient started drinking so you can prepare to have the scanner available. If this is for an inpatient, tell them what time to have the patient start drinking.

3.Omniscan:

  1. Patient will receive Omniscan (or ½ dose Multihance if required), dosed by weight.
  2. This is not a dynamic study, so you don’t have to load the power injector.
  3. Omni (or Multihance) contrast is given immediately after 2nd dose of glucagon is given.

4.Glucagon:

  1. Glucagon 0.5 mg IV total dose, divided into two doses.
  2. 1st dose: Nurse gives 0.25 mg IV immediately after localizing sequences have been performed.
  3. 2nd dose: Nurse gives second 0.25 mg IV after pediatric Radiologist checks the pre gad images. Omni (or Multihance) contrast is given immediately after the 2nd glucagon dose is given.
  4. Remember to charge for the glucagon
MR Enterography glucagon order image

 

MR Room / Patient Positioning:

  1. Body Coil
  2. Patient prone! If patients absolutely cannot tolerate being prone, supine is ok but less optimal.
  3. Make sure patient is comfortable.
  4. These are breath holds

Important Notes:

  1. Use two stacks (separate "upper" and "lower" sequences) if needed to cover a large area. The rads don't calculate liver volumes on these patients routinely. It's ok to clip the liver dome to image in one station.
  2. You may SLIGHTLY clip the liver dome to retain one stack.
  3. Don't clip the pelvis.
  4. MAKE A SCREEN SHOT: Make a screen shot stating if the patient was able to drink the volume and how much glucagon the patient received during the exam. This is also a great place to document the amount of contrast if you did not add it onto the sequence.

3pl scoutAX T2 SSFSE

Sequences

Use protocol "PEDS ENTEROGRAPHY"

  1. 3 plane Localizer: Reposition if needed! Cover entire abd/pelvis in one station. 
  2. Calibration:  Center between the pelvis and the abdomen
  3. COR T2 SSFSE:  Cover entire abdomen, pelvis and kidneys. 5mm slice thickness, 6mm gap
  4. AX T1 FS:  Cover entire abdomen and pelvis. 5mm slice thickness, 6mm gap. (This sequence will soon replace the COR 2D and 3D FIESTA/BFFE sequences).
  5. AX T2 FS:  Small FOV (from hip to hip only), cover pelvis through perineum. 3mm slice thickness, 0.5mm gap
  6. AX 2D BFFE (FIESTA on GE): Cover entire abdomen and pelvis. 5mm slice thickness, 6mm gap
  7. COR 2D BFFE (FIESTA on GE): Cover entire abdomen and pelvis. 5mm slice thickness, 6mm gap
  8. COR 3D BFFE (FIESTA on GE): Cover entire abdomen and pelvis. 4mm slice thickness, 1mm gap
  9. UPLOAD ALL IMAGES TO PACS
      1. Call Rad to check images
      2. When Rad approves images, the nurse must give 2nd dose of glucagon
      3. Hand-inject MRI contrast (Omni or Multihance).
      4. Start scanning the post images immediately.
  10. POST AX WATS (also called T1 Fat Sat):  Cover entire abdomen/pelvis. 5mm slice thickness, 6mm gap
  11. POST COR THRIVE (also called T1 Fat Sat):  Cover entire abdomen/ pelvis. 5mm slice thickness, 6mm gap
  12. PAGE PEDS RADIOLOGIST  TO CHECK IMAGES