Diagnostic Radiology

Diagnostic Radiology

MR Defecography WO BODY Protocol

Scan notes:

  • Patient Prep: 

    • Patient to empty bladder and rectum 1 HOUR before getting on table.  
    • Patient to undress from waist down. Provide patient with gown and adult diaper. 


  • Side table set up:

    •  Enema tip
    • Three 60cc syringes filled with ultrasound gel
  • 

Table & Positioning:
    • Several chucks on table where patient’s buttocks will be.
    • Torso coil positioned as you would for Female Pelvis exam.
    • Patient will be supine.
    • Headphones or a way to hear instructions during scanning / loud balanced dynamic scans.
  • Scanning notes:

    • There will be no breath hold scanning. Instead, the patient should be instructed on the various maneuvers they will perform with the dynamic scan. Explain what you mean by Relax, Squeeze (Kegel), Valsalva and Defecation prior to beginning the exam.
  • Scan time is approximately 30 minutes

Last updated: 4/12/19
Charge as: Pelvis WO
Scanner preference: 1.5T or 3T
Coil: Torso Coil

Plane Weighting Mode Slice Gap FAT SAT FOV Notes
Axial T2 TSE 5mm 1mm N 200-240mm Crest through entire perineum. TE 90-100, ETL 15, 2 NSA, Matrix 326-400 (can be lowered to accommodate scan time of 3-4min).
Cor T2 TSE 5mm 1mm N 200-240mm Sacrum to anterior abdominal wall, not necessarily skin to skin. TE 90, FOV 20-24, 5 skip 1, Freq. A/P, 2 NEX, matrix 326-400

Dynamics

Single slice. Place in the midline through pubic symphysis and coccyx. Center lower anal /vaginal canal.
Free breathing. Sense factor = 2. Repeat maneuvers a minimum of two times

Plane Weighting Mode Slice Gap FAT SAT FOV Notes
Dynamic 1 (REST) bTFE Cine 7mm - - 320-350mm (REST). Test scan at rest. Tell patient Relax pelvic muscles as much as you can. Can stop scan early after about 7 -10sec.
Dynamic 2 Squeeze (Kegel) bTFE Cine 7mm - - 320-350mm Squeeze (Kegel). Tell patient to squeeze like they are holding it in (for 3-4 seconds), then relax (for 3-4 seconds) then repeat x1. Then stop scan early if still running.
Dynamic 3 Valsalva (Strain) bTFE Cine 7mm - - 320-350mm Valsalva (Strain). Tell patient to bear down or strain but don't let the gel out if they can help it. Bear down for about 3-4 seconds then relax for about 10 sec. Repeat x1. Stop scan early if needed.
Dynamic 4 Defecation bTFE Cine 7mm - - 320-350mm (Defecation). Tell patient to start defecation when they hear the scanner noise. Start scan. For some people this can take some time and pushing and may last longer than the 200 frames. So you may have to copy the sequence and keep going. Even after gel is expelled keep scanning to watch secondary pushing efforts. Its often helpful to ask the patients if they fell empty or not and to encourage them to keep pushing if not empty. A number of patients can not evacuate most or all of the gel so I wouldn't do more than 3 or 4 repeat defecation sequences if nothing is moving.
MR Defecography WO BODY Protocol image 1
MR Defecography WO BODY Protocol image 2