Specialities

Stroke Protocol

Stroke is a common and serious disorder. On average, every 40 seconds, someone in the United States has a stroke with an estimated mortality rate of 5.5%.

MRI has been demonstrated to be very sensitive for early detection of acute stroke (ischemia )- as early as 15 min. It is an essential examination for all stroke patients.

Technical consideration

A comprehensive MR stroke protocol has three essential components:

  1. Parenchyma imaging that identifies the presence and size of an irreversible infarcted core and determines the presence of hemorrhage.
    1. DWI (diffusion weighted imaging) that can detect ischemic tissue within minutes of its occurrence and has emerged as the most sensitive and specific imaging technique for acute ischemia.
    2. FLAIR that helps to age the infarction and permits the detection of subtle subarachnoid hemorrhage.
    3. GRE to detect parenchymal hemorrhage.
  2. MR angiogram to determine the presence of proximal arterial occlusion and/or intravascular thrombus that can be treated with thrombolysis or thrombectomy.
  3. Perfusion imaging to determine the presence of hypoperfused tissue at risk for subsequent infarction if adequate perfusion is not restored.

MRA Protocol

What is magnetic resonance angiography?

Magnetic resonance angiography (MRA) is one of the innovations in the field of MRI to evaluate both healthy and diseased vessels in the brain ,neck and other parts of body without the use of any IV contrast. However , contrast may be given in some cases.

MRA is particularly valuable in screening for atherosclerosis, or hardening of the arteries. Over time, fat can be deposited along the walls of medium and large arteries in the body, causing them to become narrowed or even blocked. This blockage can eventually lead to a transient ischemic attack or even a stroke.

MRA helps to detect a brain aneurysm, which is an abnormal widening or ballooning of a cerebral vessel. Brain aneurysms occur when an injury or congenital defect weakens the wall of the vessel. Aneurysms are particularly dangerous because they can burst and cause potentially fatal intracranial bleeding.

MRA is helpful in assessing vascular malformations, which occur when blood fail to develop normally before birth. The affected vessels become tangled and change the normal flow of the blood through the brain. Some patients have headaches and seizures, but others have hemorrhage and subsequent neurologic damage

MRA may aid in evaluating some types of headaches.

What are the advantages and disadvantages of MRA?

  • Compared with catheter angiography, MRA is less invasive, less expensive, and faster to perform.
  • For conventional angiography, a catheter is inserted though the patient's groin and threaded up into the artery in the brain. MRA does not require this catheter. As a result, it eliminates related complications such as possible damage to an artery.

In addition, because MRA relies on the natural magnetic properties of hydrogen atoms in the body, injections of contrast material are not always needed. This feature is especially important in patients who have had allergic reactions to contrast agents or have renal impairmrnt.

One drawback of MRA is that it does not depict small vessels or extremely slow blood flow as well as conventional angiography does. However, with its advantages, MRA is a good examination for many patients.

Epilepsy Protocol

Benefits of epilepsy MRI protocol

The advent of high-resolution MRI with a dedicated epilepsy protocol has significantly increased the frequency with which pathologic causes for epilepsy are identified. This has had a dramatic clinical impact on the evaluation and management of epilepsy, because MRI findings can assist with classification, determine prognosis for remission, predict long-term intractability to antiepileptic medications, and identify potential surgical candidates.The International League Against Epilepsy (ILAE) guidelines for neuroimaging in patients with epilepsy (1997) recommends a dedicated epilepsy protocol MRI for all patients with a new-onset seizure.

Epilepsy Protocol

Epilepsy protocol includes the entire brain from nasion to inion, T1-weighted MPRAGE or SPGR images 1.5-mm slice thickness with no intervening gap. These images are acquired in a coronal oblique plane perpendicular to the long axis of the hippocampus, which is particularly important when evaluating temporal lobe epilepsy (TLE).

The sequence enhances gray/white matter differentiation, which is crucial to the analysis of cortical architecture.An epilepsy protocol MRI also includes coronal and axial FLAIR sequences with a 2- to 3-mm slice thickness and a 0- to 1-mm interslice gap. A conventional thin-slice (3-mm), T2-weighted, axial and coronal sequence is also obtained.

Hippocampal sclerosis

Hippocampal sclerosis (HS) is characterized by neuronal loss and gliosis. HS is the most common pathologic substrate of surgically treated epilepsy in adults and is seen in 67% of patients. When evaluating the medial temporal structures (hippocampus, amygdala, entorhinal cortex, and parahippocampal gyrus), one should evaluate the size, signal, shape, and dual pathology (SSSD).

MRCP Protocol

What is Magnetic Resonance Cholangiopancreatography (MRCP)?

Magnetic resonance cholangiopancreatography (MRCP) is a special type of MRI exam that produces detailed images mainly of gallbladder, bile ducts, pancreas and pancreaticduct..

It provides a non invasive alternative to Endoscopic Retrograde Cholangiopancreatography (ERCP).

MRCP beautifully demonstrates the CBD without use of any oral or intravenous contrast. It helps to examine diseases of the liver, gallbladder, bile ducts, pancreas and pancreatic duct. These may includes stones, tumors or infection.

Magnetic resonance (MR) spectroscopy Protocol

Overview

Magnetic Resonance (MR) spectroscopy is a noninvasive diagnostic test for measuring biochemical changes in the brain, especially the presence of tumors. While magnetic resonance imaging (MRI) identifies the anatomical location of a tumor, MR spectroscopy compares the chemical composition of normal brain tissue with abnormal tumor tissue. This test can also be used to detect tissue changes in stroke and epilepsy.

How does MR spectroscopy work?

MR spectroscopy is conducted on the same machine as conventional MRI . Spectroscopy is a series of tests that are added to the MRI scan of your brain or spine to measure the chemical metabolism of a suspected tumor.

There are several different metabolites, or products of metabolism, that can be measured to differentiate between tumor types:

  • N-acetyl aspartate
  • Choline
  • Creatine
  • Myoinositol
  • Amino acids
  • Lipid
  • Lactate
  • Alanine

The frequency of these metabolites is measured in units called parts per million (ppm) and plotted on a graph as peaks of varying height  By measuring each metabolite’s ppm and comparing it to normal brain tissue, the neuroradiologist can determine the type of tissue present.

The following MR spectroscopy graph shows the different chemical peaks of a suspected brain tumor-

MRS of brain tumor showing different chemical metabolite.

What does a MR spectroscopy show?

MR spectroscopy can be used to determine tumor type and aggressiveness, and distinguish between tumor recurrence and radiation necrosis. Different metabolites can indicate:

  • Glioma: lower than normal N-acetyl aspartate levels, elevated choline creatinine and lipid levels, and lactate peaks
  • Radiation necrosis: does not have elevated choline levels
  • Meningioma: elevated alanine levels
  • MRS is currently used to investigate a number of diseases in the human body, most notably cancer (in brain, breast and prostate), epilepsy, Alzheimer's Disease, Parkinson's disease and Huntington's Chorea. MRS has been used to diagnose pituitary tuberculosis.
  • Prostate cancer: Combined with a magnetic resonance imaging (MRI) and given equal results, then the three-dimensional MRS can predict the prevalence of a malignant degeneration of prostate tissue by approximately 90%. The combination of both methods may be helpful in the planning of biopsies and therapies of the prostate, as well as to monitor the success of a therapy

Breast MRI Protocol

Indications:

  • Screening high-risk women (women known to be at higher than average risk for breast cancer, either because of a strong family history or a gene abnormalityBRCA1 or BRCA2)
  • gathering more information about an area of suspicion found on a mammogram or ultrasound
  • monitoring for recurrence after treatment

How Breast MRI Is Performed

Unlike a mammogram, which uses X-rays to create images of the breast, breast MRI uses magnets and radio waves to produce detailed 3-dimensional images of the breast tissue. You may need to have a contrast (dye) injected into your arm through an intravenous line. The contrast will help any potentially cancerous breast tissue show up more clearly.This helps the radiologist determine which areas could possibly be cancerous. More tests may be needed after breast MRI to confirm whether or not any suspicious areas are actually cancer.

Procedure

Breast MRI Procedure

You will need to open your hospital gown in front to expose your breasts. Then you lie on your stomach on a padded platform with cushioned openings for your breasts. Each opening is surrounded by a breast coil, which is a signal receiver that works with the MRI unit to create the images. The platform then slides into the center of the tube-shaped MRI machine. You won’t feel the magnetic field and radio waves around you, but you will hear a loud thumping sound. You will need to be very still during the test, which takes around 30 to 45 minutes.

 

MR compatible anesthesia Machine

We have MR compatible Boyle's apparatus in our MR suite to deliver anesthesia for patient requiring sedation during MRI