MR Pediatric Liver Mass MRCP WWO or with Secretin Protocol

Scan Notes:   
- Images must be checked by radiologist or radiology resident before giving contrast and before the patient gets off the table. 
- Make screenshot of amount of Volumen and glucagon was given and send to Pacs. 
- Please do subtractions on mDixons: (subtraction = each of 3 post-contrast sequences – pre-contrast sequence).

If ordered as Liver Mass WWO Secretin:   
    This exam is basically a LIVER MASS with MRCP, so use the same protocol sequences. There is a protocol built into MR1.
    The MRCP is a dynamic.
    SECRETIN: An adult dose of 16 μg (0.2 μg/kg body weight in children) is used.
    At the commencement of injection, a baseline scan is obtained, followed by coronal SSFSE images (2-second scanning time) every 30 seconds for 10 minutes.
    In healthy subjects, the maximal effect of IV secretin is between 7–10 minutes.
    We prefer the use of 300 mL of proprietary silicone-coated superparamagnetic iron oxide particle suspension (ferumoxsil, GastroMark, Mallinckrodt Medical) (Fig. 1A, 1B) taken orally a few minutes before the MRI examination.

Last updated:3/28/19
Charge as: Abdomen W/WO with MRCP
Scanner preference: 1.5T or 3T
Coil: Torso or Cardiac
Contrast: Gad (and Secretin if ordered)

Plane Weighting Mode Slice Gap FAT SAT FOV Notes
AXIAL T1 TSE MV MS 3.5mm 1mm None Fit to Patient Above diaphragm to iliac crests
AXIAL T2 TSE MV MS 3.5mm 1mm SPAIR Fit to Patient Above diaphragm to iliac crests
COR STIR TSE MV MS 3.5mm 1mm STIR Fit to Patient Entire abdomen, skin to skin
COR DWIBS IR EPI SS 5mm 1mm None Fit to Patient Entire abdomen, skin to skin
Axial 3D-mDixion pre 2.25eff Fit to Patient Scan Liver
COR T1 TSE MV MS 3.5mm 1mm None Fit to Patient Optional: Only if requested by a radiologist.Entire abdomen, skin to skin
SAG STIR TSE MV MS 3.5mm 1mm STIR Fit to Patient Optional: On any patient with neuroblastoma or paraspinal mass - or if requested by a radiologist.Entire abdomen, skin to skin

Contrast injection

 Power Inject: Bolus trak in sagittal plane: trigger when contrast reaches SMA

Plane Weighting Mode Slice Gap FAT SAT FOV Notes
AXIAL 3 phase dynamic 3D-mDixon post 2.25eff Fit to Patient Bolus trak in sagittal plane: trigger when contrast reaches SMA: 3 phases, one right after another (roughly 30, 60, 90 seconds).Scan liver.
AXIAL 3D-mDixon delayed 2.25eff Fit to Patient Exactly 4 minutes after contrast injection.Scan liver.
AXIAL T1 TSE MV MS 3.5mm 1mm SPIR Fit to Patient Above diaphragm to iliac crests
COR T1 TSE MV MS 3.5mm 1mm SPIR Fit to Patient Entire abdomen, skin to skin
AXIAL 3D-mDixon delayed 2.25eff Fit to Patient Exactly 10 minutes after contrast injection.Scan liver.
SAG T1 TSE MV MS 3.5mm 1mm SPIR Fit to Patient Optional: On any patient with neuroblastoma or paraspinal mass- or if specifically requested by a radiologist.Entire abdomen, skin to skin