MR Adult Female Pelvis for Cervical Cancer Staging W/WO BODY Protocol
Last updated: 12/8/2023
Charge as: Pelvis W/WO
Scanner preference: 1.5T or 3T
Coil: Torso Coil
- This is the Cervical Cancer protocol, except obliques are relative to the endocervical canal rather than the endometrial canal.
- Send ADC maps and subtractions
- FOV: do not include patient’s arms
Resources
Plane | Weighting | Mode | Slice | Gap | FAT SAT | FOV | Notes |
---|---|---|---|---|---|---|---|
COR | T2 | SSTSE BH | 5mm | 1mm | N | Top of kidneys → pelvis. Sacrum → anterior abdominal wall | CONFIRM GOOD COIL PLACEMENT. Large FOV to include kidneys. Pelvic pathology is often related to renal pathology. |
SAG | T2 | TSE | 4mm | 1mm | N | 200-240 mm. Acetabulum → Acetabulum | Consider using an anterior Sat band if lots of abdominal wall motion. If there is a pelvic mass, please scan to include the whole mass. Matrix 256 x 256 |
AXIAL OBL | T2 | TSE | 3mm | 0.5mm | N | 200-240 mm/ Fit to Patient. Uterus → rectum | Perpendicular to the endocervical canal. Use all planes to obtain true axial of the endocervical canal (see images below). Resulting image should be a true “donut.” Matrix 512 x 256-512. Freq A-P. |
AXIAL OBL | T2 | DWI | 4mm | 1mm | SPIR | Match AX OBLIQUE | Trigger & track. Free-breathing sequence, so please position slices accordingly. B=0, 500, 1000. |
AX | T1 | TSE | 5mm | 1mm | N | 20-24 mm/Fit to Patient. Top L5 → perineum | Freq A-P to avoid bowel motion ghosting into uterus and bladder. If there is a pelvic mass, please scan to include the whole mass. |
SAG | T1 | 3D THRIVE precontrast | -- | -- | Y | 20-24 mm. Acetabulum → Acetabulum | Non-high resolution THRIVEs. |
Dynamic Contrast Injection | |||||||
SAG dynamic (40 seconds, 1 minute, 90 seconds) | T1 post | 3D THRIVE post contrast BH | -- | -- | Y | 20-24 mm. Acetabulum → Acetabulum | NON-high resolution THRIVEs. Perform at 40s, 60s, 90s post contrast. |
3 minutes post AX | T1 | 3D THRIVE post contrast BH | -- | -- | Y | 20-24 mm/Fit to Patient. Top L5 → perineum | NON-high resolution THRIVEs. Perform at 180s post contrast |
AX | T2 post | TSE | 4mm | Y | Top L5 → perineum |
![MRI Cervical CA Coverage Img 1](/sites/default/files/2023-12/Cervical%20CA%20Coverage%201_0.jpg)
Sequence Planning
- The MR sequences are planned relative to the long axis of the cervical canal.
- The axial plane is perpendicular to the long axis of the cervical canal.
- The coronal plan is parallel to the long axis of the cervical canal.
![MRI Cervical CA Coverage Img 2](/sites/default/files/2023-12/Cervical%20CA%20Coverage%202.jpg)
Pitfall: variations in cervical anatomy
The position of the cervical canal needs to be taken into account and the perpendicular and parallel MRI sequences need to be planned accordingly.
![MRI Cervical CA Coverage Img 3](/sites/default/files/2023-12/Cervical%20CA%20Coverage%203.jpg)
Example showing how flexion, and in particular version impact sequence planning.
- In this case there is anteversion of the cervix and retroflexion of the uterus.
- Remember that in cervical cancer, the axial sequences are planned perpendicular to the cervical canal.
![MRI Cervical CA Coverage Img 4](/sites/default/files/2023-12/Cervical%20CA%20Coverage%204.jpg)
Another example showing the cervix in retroversion and the uterus in anteflexion.
See how this variation in position impacts the corresponding sequence planning.