MRI Procedure Of Knee

1. MRI Protocol Of Knee
Subodh Dhungana
Chitwan Medical College

2. Coronal Anatomy Of Knee Of MRI

3. Mid-Sagittal Anatomy Of Knee

4. Indications
• Meniscal Disorder
– Non-Displayed and displayed tears
– Discoid Menisci
– Meniscal Cysts
• Marrow abnormalities
– Avascular necrosis, marrow edema syndromes and stress fracture
• Congenital and development conditions
– Blount disease, dysplasia, normal variants
• Synovial based disorders
– Symptomatic plicae, synovitis, Bursitis and popliteal cyst
• Muscle and tendon disorder
– Stress, Partial and complete tears, Tendonitis, Tendonopathy

5. • Mechanical Knee Symptoms
– Catching, Locking, Snapping, Erepitus
• Vascular Conditions
– Entrapment, Aneurysm, Stenosis, Occlusion
• Neoplasms of bone, joint of soft tissue
• Ligament tears
– Cruciate, collateral, Retinacular
• Osteochondral Fractures
• Osteochondritis
• Degenerative Chondrosis
• Chondromalacia
• Acute Trauma
• Fractures

6. Contraindications
• Any electrically, magnetically or mechanically
activated implant (e.g. cardiac pacemaker, insulin
pump biostimulator, neurostimulator, cochlear
implant, and hearing aids)
• Intracranial aneurysm clips (unless made of
titanium)
• Pregnancy (risk vs benefit ratio to be assessed)
• Ferromagnetic surgical clips or staples
• Metallic foreign body in the eye
• Metal shrapnel

7. Patient Preparation
• A satisfactory written consent form must be taken from the
patient before entering the scanner room
• Ask the patient to remove all metal objects including keys,
coins, wallet, cards with magnetic strips, jewellery, hearing
aid and hair pins
• If possible provide a chaperone for claustrophobic patients
(e.g. relative or staff )
• Offer earplugs or headphones, possibly with music for extra
comfort
• Explain the procedure to the patient
• Instruct the patient to keep still
• Note the weight of the patient

8. Patient Positioning
• Feet first supine
• Position the knee in the knee coil and
immobilise with cushions
• Centre the laser beam localiser over the lower
border of Patella

10. Localiser
• Three plane localiser must be taken
• Usually takes less than 25 sec. time
• T1 weighted low resolution image

11. Sequences
• PD Fat Sat. Axial 3mm
• PD Fat Sat. Coronal 3mm
• T1 TSE Sagittal
• T2 STIR Sagittal
• T2 (MEDIC) Sagittal
• PD Fat Sat. Coronal Oblique 2mm For ACL
• PD Fat Sat. Sagittal Oblique 2mm For ACL

12. PD Fat Sat. Axial 3mm
• Plan axial slices on Coronal Plane; angle the position block
parallel to the medial and lateral condyle of femur
• Approriate angle must be given in sagittal plane i.e.
perpendicular to the line of femur and tibia
• Slices must be sufficient to cover the knee joint from the
tibial tuberosity up to the line of superior border to the
patella.
• Phase direction in axial section must be right to left(to
avoid artifacts from popliteal artery pulsation)
• Saturation bands above and below the axial block will
reduce further pulsation artifacts

14. Parameters

15. PD Fat Sat. Coronal 3mm
• Plan the Coronal Slices on Axial Plane; angle the
position block parallel to the Medial and Lateral
Condyle of Femur
• Angle must be given in sagittal Plane i.e. parallel to the
mid line of Femur and Tibia
• Slices must be sufficient to cover the Knee joint from
the Patella down to the line of Poiplital Artery
• Phase directions in the axial scans must be head to
feet(to avoid artifacts from popliteal artery pulsation)
• Saturation bands are used above and below the
coronal block to reduce further pulsation artifacts

17. Parameters

18. T1 TSE Sagittal
• Plan the sagittal slices on axial plane; angle the
position block parallel to the lateral condyle of femur
(parallel to the femur )
• Appropriate angle must be given in coronal plane(
parallel to the mid line of Femur and Tibia)
• Slices must be sufficient to cover the knee joint from
lateral condyle up to medial condyle
• Phase direction in axial scans must be from head to
feet ( to avoid pulsation artefacts from politeal artery
pulsation)
• Saturation bands above and below the sagittal block
will reduce further arterial pulsation artefacts

20. Parameters

21. T2 STIR Sagittal
• Plan the sagittal slices on Axial plane; angle the
position block parallel to the lateral condyle of the
femur (parallel to the ACL)
• Appropriate angle must be given in coronal plane
(parallel to the mid line of Femur and Tibia)
• Slices must be sufficient to cover slices from lateral
condyle to medial condyle
• Phase direction in axial scans must be from head to
feet ( to avoid pulsation artefacts from politeal artery
pulsation)
• Saturation bands above and below the sagittal block
will reduce further arterial pulsation artefacts

23. Parameters

24. T2* (MEDIC) Sagittal/ 3D mFFE WATS
• Plan the Sagittal slices on Axial plane; angle the
position block parallel to the lateral condyle of
Femur(parallel to ACL)
• Appropriate angle must be given in Coronal plane
(parallel to mid line of femur and tibia)
• Slices must be sufficient to cover knee joint from
lateral condyle to medial condyle.
• Phase direction in axial scans must be from head to
feet ( to avoid pulsation artefacts from politeal artery
pulsation)
• Saturation bands above and below the sagittal block
will reduce further arterial pulsation artefacts

26. Parameters

27. PD Fat Sat. Coronal Oblique 2mm For
ACL
• Plan the Coronal Oblique Slices on Sagittal plane; angle
the position block parallel to the ACL
• Appropriate angle must be given in Coronal Plane
parallel to the Medial And Lateral condyle of Femur
• Slices must be sufficient to cover the ACL
• Phase direction for coronal oblique must be Right to
Left to avoid pulsation artefacts from Popliteal Artery
• Applying Saturation band above and below the coronal
block will further reduce arterial pulsation artefacts

29. Parameters

30. PD Fat Sat. Sagittal Oblique 2mm For
ACL
• Plan the sagittal oblique slices on Axial plane;
angle the position block parallel to ACL
• Appropriate angle must be given in Coronal plane
parallel to ACL
• Slices must be sufficient to cover ACL
• Phase directions in sagittal scans must be Right to
Left to avoid pulsation artefacts from Popliteal
artery
• Saturation bands above and below the Coronal
block will further reducew arterial pulsation
artefacts

32. Parameters

33. Protocol Used In Our Department
(1.5T Philips Achieva)
 Survey
 T2W TSE TRA
 PDW SPAIR TRA
 PDW mSPIR SAG
 T2W TSE SAG
 PDW mSPIR COR
 T1W TSE SAG
 T2W TSE COR
 3D mFFE WATS SAG
 SURVEY

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37. QUESTIONS????
• Name the ligament and Minisci of Knee.
• What are the indications for MRI of Knee?
• What are the contraindications for MRI Knee?
• What are the general sequences of knee
protocol?
• What are the additional sequences for the ACL?
• Why phase direction angle must be given in axial
scan from head to feet?

38. THANK YOU!!!!!