MR Epilepsy/Seizure WWO Neuro Protocol

Last updated: 6/8/2020
Charge as: Brain WWO
Scanner preference: 3T only. If patient has an implant unsafe for 3T, OK to scan on MR2 1.5T Ingenia.
Coil: Head

Exam data must include: Age/DOB, Exam Date, Gender, and ID

Landmark at nasion/glabella (±50mm), you must re-landmark in the brain if another body part is scanned first.

  • Keep the 3D box as straight as possible.
  • No patients with shunts or major artifact-causing items.
  • Braces are usually okay, if there is not a great deal of motion, keep head tightly padded.
  • Kyphosis prop up hips not head coil.
  • Keep patient at Isocenter For patients with small heads and long necks or large heads:
    • Keep FOV box positioned higher than normal but not beyond ±50mm from glabella
    • May need to reduce/enlarge the FOV for the individual (not beyond 24 - 25.6)
    • FOV must include all of scalp, nose and chin.

Required Scan Parameters

Following parameters remain consistent:

1. Plane – sagittal
2. Mode – 3D
3. T1 weighted - Always
4. Matrix – 192 x 192
5. NEX / NSA – 1
6. Slice thickness – 1.2 mm
7. Spacing – 1.2 mm
8. Number of slices – 160 - 170
9. FOV 24 – 25.6

NOTE: Some NeuroQuant parameters vary depending on scanner manufacturer & field strength

NeuroQuant Failures (And How to Avoid Them)

Patient Motion

  • Run NeuroQuant sagittal 3D first
  • Pad head securely
  • Use all motion reduction techniques except changing scan parameters

Artifacts

  • Surgical resections, shunts, metal (some are not compatible)
  • Incompatible with NeuroQuant
  • Tumors > 15cc
  • Contrast media - scan Non Contrast

Low SNR

  • Follow recommended scan parameters

Tissue contrast Error

  • Put saline bags on either side of patient's head
  • Sat bands
  • Follow recommended scan parameters

Incorrect landmark

  • Must landmark at nasion/glabella
  • Can be ± 50mm from Nasion - should be as close as possible in all 3 planes
  • Re - landmark, if C-spine was done first as part of a double study

Network Issue

  • Echo test failure – call your network admin
  • Resend series
  • Error report “Series is missing slices”

Unsupported MR Sequence

  • Delete incorrect series from queue monitor
  • Resend Sag 3D T1 series
Plane Weighting Mode Slice Gap FAT SAT FOV Notes
SAG 3D T1 MPRAGE 3D TFE 1mm 1mm None 23cm Extend slice coverage 1-2 mm beyond the skin margin, not necessarily to cover the ears. This ensures adequate coverage/signal on the AX and COR MPRs. Generate OBL COR and AXIAL MPRs from this sequence. Send only 3D to three nodes: NQ_HIPPO_VOL Node, NQ_MULTISTRUCTURE Node, NQ_TRIAGE_BRAIN Node
AX MPR Angle to Corpus. Reconstruct as 1.3mm skip 1.3mm.
OBL COR MPR Whole brain, perpendicular to temporal lobe
AXIAL SWI T1 FFE 2mm -1mm None 20cm Parallel to Temporal Lobe
AXIAL T2 TSE 3mm 1mm None 23cm Parallel to Temporal Lobe
AXIAL DWI 2mm Voxel SE EPI 3mm 0.3mm SPIR 23cm Angle to Corpus- Skull Base to Vertex
OBL COR T2 STIR TSE 2mm 0.2mm STIR 23cm Whole brain, perpendicular to temporal lobe
OBL COR FLAIR TSE 3mm 1mm None 23cm Whole brain, perpendicular to temporal lobe
Optional:AX (GPI) MPRAGE 3D ISO ISO None Do not change Optional if requested: DO NOT ANGLE. Limited Coverage. Cover inferior aspect of temporal lobes to vertex. Scan time will be long (6-8 Minutes). Run on 3T scanners only.

Contrast injection

Plane Weighting Mode Slice Gap FAT SAT FOV Notes
AXIAL T1 TSE 4mm 1mm None 23cm Angle to Corpus- Skull Base to Vertex
COR T1 FAT SAT TSE 4mm 1mm SPIR 23m Frontal through Occipital Bone
MR Protocol Epilepsy Seizure Brain for Ingenia in Radiology