Magnetic Resonance Imaging

These examinations are performed only at our 3 Gibbon facility. State of the art cardiac gated techniques are used, and each examination includes a four-chamber view, one or more long axis views and short axis views using black-blood and cine bright-blood techniques. Alterations in planes are made for specific requests targeting the focus of interest. Most often, gadolinium contrast agent is administered for perfusion imaging as well as delayed enhancement imaging of myocardial fibrosis. Quantitative measurements for function or flow velocity can also be performed if requested. Anatomic imaging of the aorta and coronary arteries can also be included if requested. Common indications include suspected cardiac mass, arrhythmogenic right ventricular dysplasia, sarcoid or other myocarditis, obstructive cardiomyopathy; defining cardiac anatomy, and delineating infarcted myocardium. MRI is the most comprehensive method for evaluating cardiac anatomy, function and myocardium in a single examination.

Anatomic imaging of vascular structures, mediastinal or hilar masses, thymus. MRI is highly sensitive in distinguishing between solid tissue and cystic structures in the lungs or mediastinum, and for evaluating loculated effusion or collection, etc. MRI is also highly sensitive for distinguishing between perfused vs. nonperfused nodules. Note, however, that CT is more sensitive for detecting small lung nodules. 

Evaluation of size of aorta, presence or absence of dissection or aneurysm or rupture. The exam can also be tailored for evaluation of pulmonic vasculature, such as for pulmonary embolus, patent ductus, pulmonary vein anatomy or stenosis, etc. Most often, MRA Chest includes injection of gadolinium contrast agent.

These examinations include full evaluation of all abdominal structures above the iliac crest, but additional information regarding the clinical question and focus of information is helpful for tailoring and interpreting the examination. MRI provides a more comprehensive assessment of abdominal organs than any other single diagnostic test. Useful indications include evaluation of the liver, including pre- or post liver transplant evaluation; pancreatitis; biliary obstruction; and detection or characterization of masses in the liver, pancreas, kidneys, adrenal glands, spleen or bowel. Masses that are indeterminate on other imaging methods can often be diagnosed definitively by MRI, thereby avoiding invasive procedures or the need for lengthy follow-up imaging. MRI is the best imaging test for detecting and grading diffuse liver disease, including hepatitis, cirrhosis, iron overload and fatty liver disease. Most often, a gadolinium contrast agent is injected, typically using a dynamic multiphase technique. An MRCP survey is included in most abdominal examinations.

If requested, we can add high resolution MRCP as well as the routine survey MRCP to a comprehensive abdominal examination.

Anatomic imaging of the abdominal viscera and diaphragm is combined with dynamic stress imaging to show motion or the diaphragm or abdominal structures during breathing and Valsalva maneuver.

Eovist, a new gadolinium contrast agent, is FDA approved specifically for evaluating liver lesions, but its 50 percent excretion via biliary pathways provides potential for other clinical applications. Eovist can be used to improve distinction between focal nodular hyperplasia vs. adenoma, more clearly detect and delineate some liver masses such as metastases, and to evaluate biliary and gallbladder anatomy and function. Eovist is administered at reduced dose, so clarity of vascular structures and many enhancing tissues may be less than what would be obtained using standard gadolinium-enhanced abdominal MRI.

This is a specialized, tailored exam designed to estimate iron concentration as well as describe its relative distribution, for distinction between hemochromatosis vs. other forms of iron overload such as transfusional siderosis. In a comprehensive iron overload measurement protocol, we use three different techniques for estimating iron concentration. In most cases, gadolinium contrast agent is not used, and the examination is not tailored for optimal evaluation of disorders other than iron overload.

This is a brief targeted examination to detect or exclude acute appendicitis. Most commonly, this is used for young or pregnant individuals to avoid ionizing radiation. In a nonpregnant individual, gadolinium contrast agent is administered to improve diagnostic confidence, but for pregnant women, gadolinium contrast agent is not used.

This is a tailored examination of the abdomen and pelvis, for imaging small and large intestines, most often in patients with inflammatory bowel disease or other suspected pathology. MRE is a desirable alternative to CT for individuals with inflammatory bowel disease who may need repeated examinations, to avoid excessive ionizing radiation. Most MREs are performed at our Jefferson Center City Imaging facility. Patients are instructed to drink 2 liters of oral contrast upon arrival, and immediately prior to imaging take an anti-peristaltic agent (Levsin) sublingually, as prescribed by their ordering physician. Gadolinium contrast agent is also used.

This is an alteration of our standard abdominal examination to emphasize imaging of the renal collecting structures using both fluid-weighted (T2-weighted) imaging as well as contrast enhanced excretory imaging following gadolinium contrast agent. MRU is less effective than CT for identifying small renal calculi, but is otherwise highly useful for evaluating the kidneys and renal collecting structures, particularly for identifying soft tissue masses.

This study includes all structures in the true pelvis such as gynecological organs, bladder, etc. It is used for both benign and malignant conditions. MRI provides more comprehensive and definitive imaging than any other examination; this is particularly true for gynecological symptoms, where myomas, adenomyosis, uterine or cervical cancer, adnexal cysts or masses, endometriosis, hydrosalpinx and other abnormalities may coexist and mimic each other on other imaging methods.

MRI is also highly effective for evaluating transplanted kidney or pancreas. This examination is similar to a pelvic comprehensive exam, but includes coronal MRA and MRV.

This is a focused high resolution examination, particularly for staging rectal or prostate cancer but also to evaluate for possible urethral or peri-urethal injury as a cause of incontinence in women. A 3 Tesla unit is used to improve image clarity, and in some instances an intrarectal coil is used for further high resolution.

This involves slight modifications to the pelvis comprehensive protocol, emphasizing the possible presence of fistula, sinus tract or other focus of inflammation, such as in patients with inflammatory bowel disease. Gadolinium contrast agent allows improved clarity of small fistulae and other foci of inflammation that can be difficult to see by CT.

This study can be performed by itself, or as a supplement to a pelvis comprehensive protocol. Anatomic imaging of the pelvic floor and urethra is combined with dynamic stress imaging to show abnormal descent of pelvic structures during Valsalva maneuver. The combination of static and motion video images provided by the study can help determine the anatomic and functional causes of incontinence or problems with defecation. Similar techniques can be used to assess potential herniation of abdominal contents into defects in the abdominal wall.

For patient convenience, abdomen and pelvis examinations can be combined, but dynamic multiphasic (arterial and venous dynamic phase) imaging following gadolinium injection can usually not be performed in both locations. With abdomen emphasis, dynamic imaging is obtained in the abdomen, and more delayed postcontrast imaging is obtained in the pelvis. An example would be evaluation of a primary abdominal process including survey of the pelvis to determine extension into the pelvis.

As above, but dynamic multiphase post contrast imaging can be performed in the pelvis, for pelvis emphasis, and more delayed post-contrast imaging is obtained in the abdomen. An example would be evaluation of pelvic malignancy and inclusion of abdominal imaging to detect abdominal lymph nodes.

This is a "single station" multiphasic MRA from above the mesenteric arteries through and including the common iliac arteries. Arterial and venous phases are included. This allows detailed examination of the aorta, mesenteric branches, renal arteries and common iliac arteries, as well as major venous structures. MRA is most effective for evaluating major arterial branches; for example, MRA can depict stenosis of proximal mesenteric vessels but is less effective for diagnosing mesenteric vasculitis.

Most often, this study is done for evaluation of the aortic arch, subclavian and axillary arteries. Alternatively, this can be used to evaluate one side, including the subclavian artery, axillary artery, brachial artery, etc. Alternatively, the distal upper extremity can be evaluated, such as from forearm to finger tips. If a combination of the above is considered clinically necessary, direct conversation with an attending radiologist is recommended

A single-phase comprehensive survey of nearly the entire arterial system can be obtained by injecting contrast agent and moving the table sequentially. Most commonly, this is performed for individuals with claudication or ischemic lower extremity ulcer disease, to plan prior to surgical or interventional revascularization.

Detailed evaluation of the ankles and feet is possible, but for best and most detailed results, it may be preferable to obtain this as a separate examination rather than as part of an MRA runoff (see above).

Most often, this study is performed using a combination of gadolinium enhanced and nonenhanced time-of-flight (TOF) techniques. This is performed to detect thrombosis or other obstruction of upper extremity veins.

Please note that imaging of the major abdominal and pelvic veins is included in standard comprehensive imaging of the abdomen or pelvis.

Imaging of the deep veins of the thighs and calves is highly accurate using MRI, but can be time consuming so careful consideration of the extent of imaging needed for clinical management should be considered. Consultation with an attending radiologist is recommended.