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library:thoracolumbar_spine [2025/03/10 19:54] – [Typical Scan Protocol] scottlibrary:thoracolumbar_spine [2026/06/10 20:54] (current) – [Dorsal Plane] scott
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-=====Thoracolumbar Spine MRI=====+======Thoracolumbar Spine MRI======
  
  
  
-====Scan Coverage and Planning====+=====Scan Coverage and Planning=====
  
 The thoracolumbar spine (TL Spine) is the more complex area of the CNS to scan clinically, as the coverage is much broader since both the full thoracic spine and lumbar spine are included. There are various protocol for scanning the TL spine that can vary quite a bit from clinician to clinician, so it is best to establish clinician preference ahead of time. The most important image to acquire accurately is the sagittal, since this is where pathology is initially identified, and the image from which axial sequences are planned. Poor quality sagittal images will hinder identifying pathology, which can greatly extend scan and anesthesia time. There are two primary paths for TL spine scanning in regards to sagittal imaging: Whole Spine or Separate. The thoracolumbar spine (TL Spine) is the more complex area of the CNS to scan clinically, as the coverage is much broader since both the full thoracic spine and lumbar spine are included. There are various protocol for scanning the TL spine that can vary quite a bit from clinician to clinician, so it is best to establish clinician preference ahead of time. The most important image to acquire accurately is the sagittal, since this is where pathology is initially identified, and the image from which axial sequences are planned. Poor quality sagittal images will hinder identifying pathology, which can greatly extend scan and anesthesia time. There are two primary paths for TL spine scanning in regards to sagittal imaging: Whole Spine or Separate.
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 ===Separate Thoracic and Lumbar=== ===Separate Thoracic and Lumbar===
  
-With separate Thoracic and Lumbar sagittal acquisitions, there are different coverages to consider. For a typical Lumbar sagittal, the FOV should extend from T11 to S2. For a typical Thoracic sagittal, the FOV should extend from T3 to L3. Much like all sagittal planning in the spine, **be sure to use and ODD number of slices**. One important consideration for separate sagittal acquisitions is that it is necessary to ensure overlap between the two acquisitions, and accurate counting of the vertebrae. a reliable anatomic marker for ensuring overlap is the mesenteric arteries coming off from the aorta. If they are present on both Lumbar and Thoracic series, then overlap is guaranteed. It is important to note that these vessels may not be on the mid sagittal slice, but rather a parasagittal image, as shown below. The mesenteric arteries are circled in red.+With separate Thoracic and Lumbar sagittal acquisitions, there are different coverages for the FOV.  
 + 
 +**Lumbar sagittal FOV: T11 to S2** 
 + 
 +**Thoracic sagittal FOV: T3 to L3** 
 + 
 +Much like all sagittal planning in the spine, **be sure to use and ODD number of slices**. One important consideration for separate sagittal acquisitions is that it is necessary to ensure overlap between the two acquisitions, and accurate counting of the vertebrae. A relatively reliable anatomic marker for ensuring overlap is the mesenteric arteries coming off from the aorta. If they are present on both Lumbar and Thoracic series, then overlap is guaranteed. It is important to note two things about using the mesenteric vessels as a landmark: 
 + 
 +  * **The vessels may not be on the mid sagittal slice**, but rather a parasagittal image, as shown below. The mesenteric arteries are circled in red. 
 +  * **The vessels are not always located in the same place**; be sure to communicate with the clinician which disc or vertebrae the vessels are under
  
 {{:library:mesentericsaglumbar.png?600|}}  {{:library:mesentericsagthoracic.png?600|}} {{:library:mesentericsaglumbar.png?600|}}  {{:library:mesentericsagthoracic.png?600|}}
  
-====Sagittal Plane====+====Sagittal Plane Upper and Lower====
  
-On a dorsal image, plan the slices parallel with the spinal cord, with the slices extending at least out to the transverse processes of the vertebrae. See above for the different FOV options for Separate or Whole Spine imaging.+On a dorsal image, plan the slices parallel with the spinal cord, with the slice coverage extending at least out to the transverse processes of the vertebrae. See above for the different FOV options for Separate or Whole Spine imaging.
  
 {{:library:lspinesagplan.png?600|}}  {{:library:lumbarmidsaggood.png?600|}} {{:library:lspinesagplan.png?600|}}  {{:library:lumbarmidsaggood.png?600|}}
 +
 +{{:library:sagsliceplanstir.png?600|}}  {{:library:sagt2uppernorm.png?600|}}
  
 ====Axial Plane==== ====Axial Plane====
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 ====Dorsal Plane==== ====Dorsal Plane====
  
-On a mid sagittal image, plan the slices parallel with the spinal cord. Slices should extend from the aorta dorsally up to the spinous process of the vertebrae. Where there is noted pathology, adjust the angle of the slices a bit for the best visualization.+On a mid sagittal image, plan the slices parallel with the spinal cord. Slices should extend from the aorta dorsally up to the spinous process of the vertebrae. Where there is noted pathology, adjust the angle of the slices a bit for the best visualization. On thoracic spine dorsal imaging, the angle of the slices may be straight parallel to the body, or adjusted to emphasize pathology; be sure to clarify with the clinician.
  
 {{:library:lspinedorplan.png?600|}}  {{:library:lspinedornormal.png?600|}} {{:library:lspinedorplan.png?600|}}  {{:library:lspinedornormal.png?600|}}
  
 +{{:library:dorplanthoracic.png?600|}}  {{:library:dorthoracicnorm.png?600|}}
 +
 +====Tips and Tricks====
 +
 +===Optional Sequences==
 +
 +There is a wide scope of pulse sequences that will find utility in the thoracolumbar spine, depending on patient size, clinical question, and pathology. Some are used frequently even though they are not included in the Typical Protocol above, others are good to know about for specific clinical scenarios.
 +
 +==Myelography==
 +
 +
 +{{:library:3dmyeloprofile.png?600|}}  {{:library:2dhastemyeloprofile.png?600|}}
 +
 +==T2* Weighting==
 +
 +{{:library:mergespineprofile.png?600|}}
 +
 +==T2 Weighting==
 +
 +Most modern scanners will have an option for a Driven Equilibrium pulse sequence that incorporates and additional -90 degree pulse to 'flip back' the transverse magnetization along the Z axis. This has the effect of speeding up longitudinal recovery even for very long T1 tissues like CSF, meaning that it isn't necessary to have very long TR's. When performing a T2 weighted sequence with this modification, TR can be as low as 1500ms in some cases, while maintaining high signal from CSF. On a GE scanner this option is known as **Fast Recovery FSE (FR-FSE)** and can be found in most GE spine protocols. On a Siemens scanner, this is known as **Restore**, and may be a check box on the contrast tab, or may be found in Siemens spine protocols. These options can shorten scan time, especially when only a few slices are needed, as is the case with sagittal spine imaging.
  
-====Typical Scan Protocol==== 
  
-The protocol below represents a full thoracolumbar exam. There is a lot of variation depending on the clinical question and clinician preference. The **minimum** recommended sequences depend on pathology, so no sequences are in bold. 
  
-Sagittal T2 Lumbar\\ 
-Sagittal T2 Thoracic\\ 
-Sagittal STIR Lumbar\\ 
-Sagittal STIR Thoracic\\ 
-Sagittal T1 Lumbar\\ 
-Sagittal T1 Thoracic\\ 
-Axial T2 ROI\\ 
-Axial T1 ROI\\ 
-__Contrast__\\ 
-Sagittal T1 ROI\\ 
-Axial T1 ROI\\