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library:thoracolumbar_spine [2025/03/11 18:43] – [Tips and Tricks] scottlibrary:thoracolumbar_spine [2025/06/18 02:54] (current) – 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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 {{:library:lspinedorplan.png?600|}}  {{:library:lspinedornormal.png?600|}} {{:library:lspinedorplan.png?600|}}  {{:library:lspinedornormal.png?600|}}
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-====Typical Scan Protocol==== 
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-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. 
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-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\\ 
  
 ====Tips and Tricks==== ====Tips and Tricks====
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 {{:library:3dmyeloprofile.png?600|}}  {{:library:2dhastemyeloprofile.png?600|}} {{:library:3dmyeloprofile.png?600|}}  {{:library:2dhastemyeloprofile.png?600|}}
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 +==T2* Weighting==
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 +{{:library:mergespineprofile.png?600|}}
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 +==T2 Weighting==
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 +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.
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