MR Urogram W/WO Protocol

Scan Notes:

  • Cover through the perineum. Ok to clip the liver dome if needed.
  • Load Power injector with weight based gad and saline.
  • Scan upper and lower axial stacks.
  • Keep foley catheter at gravity to keep urinary bladder empty and facilitate visualization of the distal ureters unless otherwise instructed by radiologist.
  • Call rad to check images before giving Lasix. 
  • Plan the sequences in advance as much as possible so you can appropriately time the Lasix injection. 

Last updated: 4/12/19
Charge as: Abdomen W/WO
Scanner preference: Scan on MR1 or MR2. 1.5t only.
Coil: Torso Coil 
Scan time: approximately 1.5 hours

ORDERS: 
Ordering MD must put in orders in EPIC for IV Lasix, IV saline, and foley catheter placement.

FOLEY CATHETER PLACEMENT: 
Rad RN will place and remove the catheter for outpatients. The floor nurse will place the catheter for all inpatients. 

IV HYDRATION: 
IV hydration for one hour before study with normal saline 4 cc/kg/hr for first 10 kg of body weight, 2 cc/kg/hr for next 10 kg of weight, and 1 cc/kg/hr for each additional kg of weight. 

IV LASIX:
Dosage = 0.5 mg/kg, max 20 mg. IV Lasix is given approximately 15 minutes before MR contrast. 

  • Outpatients: Lasix is kept in MRI. 
  • Inpatients: Lasix is ordered from the pharmacy.
Plane Weighting Mode Slice Gap FAT SAT FOV Notes
AXIAL T1 TFE 5mm 1mm None Fit to Patient Cover above liver through the entire perineum. Two stacks if needed.
AXIAL T2 TSE MV MS 5mm 1mm SPIR Fit to Patient Cover above liver through the entire perineum. Two stacks if needed.

GIVE LASIX

  • Rad must check images before Rn injects Lasix
  • IV Lasix should be given approximately 15 minutes before MR contrast. 
  • Plan the sequences in advance as much as possible so you can appropriately time the Lasix injection. 
  • RN to inject Lasix
Plane Weighting Mode Slice Gap FAT SAT FOV Notes
SAG T2 TSE MV MS 5mm 1mm SPIR Fit to Patient Entire abdomen and perineum, skin to skin.
COR T1 TFE 5mm 1mm None Fit to Patient Entire abdomen and perineum, skin to skin.
COR T2 TSE 5mm 1mm SPIR Fit to Patient Entire abdomen and perineum, skin to skin.
COR T2 THICK SLAB MRCP WITH MIP Angle as shown below to include the kidneys and bladder.
COR post Lasix T2 TSE 5mm 1mm SPIR Fit to Patient Entire abdomen and perineum, skin to skin.

Contrast Injection

Call rad to check images before giving contrast. Ask if they want to see the images before the patient gets off the table.

  • Inject contrast @ 0.1ml/sec. Start scan and inject gad at the same time.
  • Preferred as a dynamic injection with the power injector. 

  • Check the Dynamic tab: “Continuous scanning” for the first 5 minutes, and then 1 dynamic every 10 seconds.

  • This sequence is 20 minutes long. Once the scanner has completed running the first 5 minutes of continuous scanning it will pause and then will automatically start again for the timed delays. Don’t worry that the scanner has stopped as it’s just a timed sequence with long pauses built in. Do not stop the scan.
Plane Weighting Mode Slice Gap FAT SAT FOV Notes
Cor Obl Dynamic FFE Dynamic (See above notes about injection) Through kidneys and ureters. Include bladder. Don't change the FOV of this sequence unless the patient truly doesn't fit. If you have to change the FOV, you must check the dynamic timing to ensure it hasn't altered. If it's changed, you will need to manually adjust all of the dynamics.
COR T1 TFE 5mm 1mm SPIR Fit to Patient Same as Pre
AXIAL T1 TFE 5mm 1mm SPIR Fit to Patient Same as Pre
COR mDixon FFE 2mm 1mm None Fit to Patient Same as Pre
MR Urogram WWO Protocol image