CT/MRI protocols

Available CT and MRI protocols (under construction)

Neuro:  CT angiogram head: Usually the best study to evaluate arterial occlusion and aneurysms due to higher spatial resolution.
MRI angiogram head: Can be performed without or with contrast. With contrast is superior.

CT brain without contrast 
(acute trauma, acute stroke, ER presentation headache)
CT brain without and with contrast (Neurologic symptoms with known primary, neurologic symptoms not MRI compatible, older patients unable to tolerate MRI) Contrast is primarily useful for metastatic disease, tumors and vascular anomalies so it is only occasionally useful.
CT Sinus:
CT temporal bone: Best for evaluating ossicles or for temporal bone fracture.
CT orbits with contrast: 1st line for infection/abscess. Inferior to MRI orbit for optic nerve evaluation.
CT Facial bones: 
CT Panorex: Replaces mandible films

Routine MRI brain with and without contrast (History: Headache, stroke, AVM concern, dementia, metastatic disease concern) Contrast can be very useful on MRI as many things on MRI are better evaluted or only seen with contrast. Most centers routinely scan brains with contrast.
MRI Brain without contrast (Neurologic symptoms and GFR < 30).
Seizure protocol with contrast:  Contrasted protocol with special sequences for Temporal lobe
Multiple Sclerosis protocol with contrast:  Contrasted protocol with special sequences for MS regions.
MRI orbits with contrast (Blurred vision, vision loss, papilledema, optic nerve atrophy/abnormality) Contrasted study with dedicated orbit sequences without and with contrast.
Pituitary MRI protocol with contrast: Hyper/hypogonadism, Pituitary tumor, abnormal FSH/TSH, acromegaly, cushings) Includes dynamic thin section enhancement images of pituitary.
IAC/skull base protocol with contrast: ((vertigo/dizziness, acoustic neuroma, sensory neural hearing loss, facial paralysis, mastitis, temporal bone tumor, pulsitile tinnitis) Thin sections through the skull base to evaluate the IAC 7th/8th nerves.

CT angiogram neck: Evaulate carotid arteries. Superior to ultrasound
CT neck with contrast: Masses, adenopathy, abscess, epiglotitis.
CT neck without contrast: Contrast allergy.
Limited CT neck for parotid mass with contrast:

Chest: 
CT chest without contrast: Small pulmonary nodule follow-up
CT chest with contrast: Lung mass, pneumonia
CT pulmonary angiography (with contrast):: PE protocol
CT angiogram aorta/chest: Subclavian stensosis, Aorta abnormalities, vertebral artery evaluation
HRCT chest without contrast: Evaluate for interstitial lung disease. Can be performed in inspiration and expiration in prone position for greatest accuracy.

Body: 
CT abdomen and pelvis with oral and IV contrast: Abdominal pain, appendicitis. Acute trauma can be performed with just IV contrast.
Renal colic protocol (noncontrast): looking for renal stones
Triphasic CT abdomen: Non-contrast abdomen, Arterial phase abdomen, venous phase abdomen and pelvis: Looking for liver/renal/adrenal masses
CT Urogram: Hematauria workup. Concern stone vs. neoplasm, replaces IVP. Non-contrast CT abdomen. Contrast is injected to fill the collecting systems. Then contrast injected to evaluate the kidneys and whole abdomen and pelvis scanned.
MRI Liver, Kidney, or Adrenal: Always performed with contrast. Evaluate masses or cysts.
MR Cholangiogram: Non-contrast MR of the biliary system. Looks for stones, stenosis, or obstruction.
MRI Pelvis for soft tissue mass: Pelvic or uterine masses. Performed with contrast.

Bone: 

Osteomyelitis protocol: Need contrast to visualize any abscess that may be present wtihin the edema.

CT shoulder: Acute trauma, Non-MRI compatible patients. Looks mainly at bones. Can be performed with arthrogram.
MRI shoulder: Without contrast. Can be performed with athrogram to better evaluate for labral tears.
CT hip: Acute trauma
MRI Pelvis: Without contrast. To look for fracture, osteonecrosis, labral tears. If concern for osseous mass use contrast. Arthrogram can improve detection of labral tears.
CT pelvis: Acute trauma
MRI Knee: Without contrast. Best for most knee problems. Arthrogram can be used in post-surgical patients.
CT knee: Acute fracture, non-MRI compatible. Arthrogram can be performed. CT ankle: MRI ankle: MRI tibia/fibula: Shin splints/fracture without contrast. Soft tissue mass/osseous mass perform with contrast.

Spine: If patient is not MRI compatible CT myelogram can be performed to improve visualization if necessary. Use IV contrast if there is concern for tumor or infection.

CT Cervical spine:
CT Thoracic Spine
CT lumbar spine: MRI Cervical spine:
MRI Thoracic Spine
MRI lumbar spine: 

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