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OBSTETRIC MRI: HOW WE DO IT IN SHEFFIELD
Debbie Jarvis, Senior Radiographer, Sheffield University MRI Unit
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OBSTETRIC MRI: A Practical Guide
Patient Management and Care
Placenta and Foetal MRI
Scanning Technique
Sequences Used
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BACKGROUND
First Scans in 1998Number of scans increased from 3 to over 250 per annum
0
50
100
150
200
250
300
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
total
total
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Equipment
GE 1.5T HDx Scanner8 Channel HR Cardiac Coil
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PATIENT MANAGEMENT and CARE
Appointment within 1 week unless clinically indicated otherwise
Partners/Relatives included (at patient
request)
Safety forms completed and checked
Feedback/Results given after scan
Contact details given for further queries
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PATIENT MANAGEMENT and CARE
Patient appropriately dressed
Clear Explanation of Scan
Patient into scanner Feet First either
supine or on side
Radiologist oversees scan
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SCAN TECHNIQUE: Foetal MRI
True Anatomical Planes of Foetus Acquired
Speed is Key
Sequences not annotated, each a localiser for next
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SEQUENCES USED: Foetal MRI
T2w Single Shot Fast Spin Echo
FIESTA- T2w Balanced Gradient Echo
T1w- Fast Gradient Echo/Spoiled GE
FLAIR (brain only)
Diffusion Weighted Imaging
MOVIE
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Single Shot Fast Spin Echo
Core MRI sequenceFast- 2 slices/3 secondsAll 3 planes of Foetus 5mm and 3mm slice thickness, 0 Gap
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FIESTA
Acquired in 3 planes, 5mm slices.Faster than SSFSE so less sensitive to movementHigh SNR and CNR
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T1- Fast Gradient Echo/Fast Spoiled Gradient Echo
FGRE- Better Contrast for Brain- identifies possible bleed- Axial plane 5mm slicesFSPGR- Better Contrast for Body- helps locate Liver/Bowel
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FLAIR and DWI
Useful for identifying/clarifying abnormal signal in brainBrain DWI b-value 700, axial 5mm slicesBody DWI b-value 500-axial 5mm slices-useful to locate kidneys
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MOVIEMultiphase, 45 Seconds to AcquireAsses Swallow/ Diaphragm movement
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MRI of the PLACENTA
Recent increase in referralsAim to determine any invasion and extent (Accreta/Percreta/Increta)
Patients scanned at 32/40 weeksScans Acquired using Anatomical planes of mother and full placental imaged.
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SEQUENCE DEVELOPMENT
Sequence to identify key invasion signs which are:
- Dark intra-placental bands- Uterine bulging- Loss of heterogeneity of placenta signal
Phantom constructed using belly pork and a recently delivered, donated placenta.
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SEQUENCES USED: Placenta MRI
T2w SSFSE
FIESTA
T1 FGRE
DWI
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Placenta SSFSE
5mm- Axial, Sagittal and Coronal 3mm- Axial and Sagittal identifies any dark intra-placental banding and assesses heterogeneity.
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Placenta: FIESTA
4mm slices- whole placenta in axial and sagittal planes. Delineates the placenta/myometrium borders, identifies uterine bulgingPlacenta becomes relatively featureless-banding or heterogeneity is lost.
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Placenta: T1 FGRE
5mm slices- axial and sagittal planes Identifies Haemorrhage and retro-placental bleeding
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Placenta DWI
B value 1000 sec/mm2- placenta higher signal than myometrium3 minute scan- Axial plane only
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Placenta Location
3mm slices parallel/perpendicular to birth canal
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THANKYOU
Sequence TR TE FLIP BW TI PREPTIME NEX
Slice Thickness
/ Slice Gap mm
FOV(Adjustd
to patient)
Freq/ Phase
Matrix
B Value
Scan Time(Secs)
T2 SSFSE Single shot FSE MIN
(2000) 90 - 62.5 - - 1 5 and 3 no gap 38 256/256 28
FIESTA Balanced GE MIN (4.8)
MIN (2.1) 60 125 - - 1 40 4/0 384/256 15
T1 FGRE MIN (5)
MIN (2) 40 31 - 2000 1 5/0 45 192/128 26
T1 BH FSPGR MIN (11.5)
MIN (1.7) 80 31 - - 1 5/0 38 192/128 16
FLAIR Single Shot IR prepared FSE
MIN (2700) 122 - 41 2000 - 0.5 5/1 36 224/224 25
DWI BRAINBODY
EPI 4000MIN 108 - 250 - - 4 5/1.5 40 128/128 700
500 64
MOVIE Multi phase 4.8 3 45 166 - - 1 12/0 40 192/256 44