pelvic and urinary MRI

Question 1

why might a patient be referred for prostate MRI

Answer 1

• prostate specific antigen (PSA) greater than 4
• abnormal DRE (digital rectum examination / finger up bum to feel prostate)
• surveillance

Question 2

what are prostate lesions staged according to and what is this

Answer 2

PI-RADS (prostate imaging - reporting and data system)

1 = very low
5 = very high likelihood of cancer

Question 3

what 3 sequences are used in PI-RADS / prostate imaging

Answer 3

• t2 w (sag, coronal, axial)

-DWI (axial)

• t1w DCE (dynamic contrast enhanced) (gadolinium makes short t1)

Question 4

in a t1 w image, what does a lesion look like pre and post contrast

Answer 4

pre = hypointense
post = hyperintese

Question 5

what does a confirmed lesion look like in a DWI and ADC map

Answer 5

DWI = hyperintese (restricted diffusion)

ADC = hypointense

Question 6

what do lesions look like on t2w

Answer 6

hypointense (fat filled not fluid)

Question 7

how long does it take enhancement for lesion to show post contrast on t1w

Answer 7

10 seconds

Question 8

note: make patient empty bladder and bowel prior to scan

Question 9

what are 2 things to be considered for prep/causes of motion artefact

Answer 9

peristalsis ( need buscopan?)

respiration (breath hold sequences?)

Question 10

note: DWI is sensitive to magnetic susceptibility (metal artefacts)

Question 11

cancer in uterus or prostate is usually found in which region

Answer 11

transitional zone, uterus

peripheral zone, prostate

Question 12

what does BGCS and RCR stand for (guideline for cervical cancer screening)

Answer 12

British gynaecological cancer society

royal collect of radiologists

Question 13

how many days post biopsy is MRI imaging for cervix cancer needed

Answer 13

7-10 days

Question 14

both T1/2W images needed for cervix cancer, why

Answer 14

t1w = assess para-aortic and pelvic lymph nodes, precedes of hydronephrosis(swollen kidneys/build up urine)

t2w = assess size, position and local tissue invasion

Question 15

what does cervical cancer look like on t2w image

Answer 15

hypointense region in cervix

Question 15

how must you position/align for axial oblique or coronal views of cervix

Answer 15

axial oblique = PERPENDICULAR to servis

coronal = PARALLEL to cervix

Question 16

anteversion = anterior fold/position of uterus
retroversion = posterior fold/position of uterus

Question 17

what sequences are needed to see endometrial cancer

Answer 17

T2W (to assess position, size, location of inaction in myometrium, cetvix etc)

DWI

T1FS (pre and post contrast)

T1w axial (to assess nodes)

Question 18

why do we need t1 FS pre and post contrast

Answer 18

to assess myometrium invasion

Question 19

what would endometrial cancer look like on t2w

Answer 19

hyperintense (lipid filled)

Question 20

how do you want to position for scan of the endometrium/uterus

Answer 20

parallel to the centre of uterus

Question 21

what sequences do you want for endometriosis

Answer 21

t2w
t1w
t1 fs

• not done for finding but more so for surgical planning

Question 22

how does endometriosis look like on T1 image and why

Answer 22

hyperintense (as its blood filled)

Question 23

would you want to use anti-spasmodics in endometriosis scan

Answer 23

yes

Question 24

negative us and MRI cant rule out endometriosis

Question 25

what sequences do u want for renal cell carcinoma

Answer 25

t1w (axial, sag, coronal) t1 FS (asian and post GBCA) T1W axial - breath hold

Question 26

what contrast timings are used for renal cell cancer and why

Answer 26

20s-50s (arterial phase)(identify arterial supply) 80s (nephrogenic phase)

Question 27

why is t1w vibe/FS done for renal cell cardinoma

Answer 27

it uses a fast gradient echo so that image can be take during breath hold

Question 28

what is RAS / fibromuscular dysplasia

Answer 28

renal artery stenosis (narrowing of renal artery) fibro.. = thickening of muscle and fibre tissue in artery leading to narrow vessels (string bead appearance)

Question 29

what sequences are done for renal artery stenosis

Answer 29

- T2W HASTE (FSE) - T1W FLASH (SPOILED GRE) - TWIST (TIME RESOLVED CE MRA)

Question 30

what sequences are done for rectal cancer

Answer 30

- T2W (SAG, AXIAL) - T2W (axial oblique, coronal oblique)

Question 31

what is TNM

Answer 31

staging of cancer - T describes the size of the (primary) tumor and whether it has invaded nearby tissue, - N = nearby (regional) lymph nodes that are involved, - M = distant metastasis

Question 32

generally for lesion you always have to have T2W scan to see spread, size etc