Axial T2 brain MRI above the ventricles (MNI ICBM152 template) labelled: skull, white matter, grey matter, scalp. Handwritten note: centrum semiovale: white matter. — MRI: MNI ICBM152 2009b template. Copyright (C) 1993-2004 Louis Collins, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University. Labels added.

MRI Protocol Recommendations & Scan Parameters (2025–2026)

Current (2025–2026) protocol recommendations with representative parameters. Set your scanner vendor to translate sequence names, open a body part, and tick sequences off as you scan.

Updated September 2026 · 109 sources listed

On this page

Find your exam Overview Cross-cutting updates Neuro & spine Brain Spine Musculoskeletal Knee Shoulder Hip Wrist Ankle & foot Techniques & whole-body Body & oncology Prostate Liver Breast Rectum Pancreas & biliary Small bowel Adrenal Kidney Bladder Anal fistula Gynecologic / pelvis Bowel / acute abdomen Obstetric / fetal Cardiac & vascular Heart Vessels (MRA)MRI Patient Positioning Phase-encode direction & saturation bands PACS: definitions, what to send & reformats Field strength: 3 T vs 1.5 T Sources

Representative values, not prescriptions. Parameters vary by vendor, field strength (1.5 T vs 3 T), coil, and local preference, and are increasingly compressed by parallel imaging, compressed sensing, and deep-learning reconstruction. Vendor names map the closest common equivalent and differ by software version. ACR figures are ceilings/minimums, not optimal technique. Defer to your institutional protocol and the linked primary sources. Educational reference, not clinical or safety advice.

Guidelines verified July 2026Representative values. Defer to your institutional protocol.Tip: press Ctrl / ⌘ + P for a clean printable PDF.Spotted an error? Tell us

Vendor terminologyGenericSiemensGEPhilipsCanon

Sequence names switch with the vendor buttons. Generic names describe the pulse-sequence family.^66,67,68

Find your exam

60 protocols by region. Pick one to go straight to its sequences and parameters.

Neuro & spine14 protocols

Brain

Routine brain Acute stroke Multiple sclerosis Epilepsy Brain tumour Dementia / neurodegeneration Pituitary / sella IAM / CPA (hearing loss)

Spine

Cervical (routine)Thoracic (routine)Lumbar (routine)MS cord Infection / discitis Cord compression / whole-spine

All of Neuro & spine

Musculoskeletal14 protocols

Knee

Routine (internal derangement)Cartilage / quantitative MR arthrography (post-op)

Shoulder

Routine (cuff / impingement)MR arthrography (instability)

Hip

Routine / AVN FAI / labral

Wrist

Routine Arthrography (TFCC / instability)

Ankle & foot

Ankle (routine)Forefoot (Morton / plantar plate)

Techniques & whole-body

Fat suppression, 2D vs 3D & acceleration Metal artifact reduction (MARS)Whole-body (MY-RADS / MET-RADS-P)

All of Musculoskeletal

Body & oncology26 protocols

Prostate

mpMRI (PI-RADS v2.1)Screening bpMRI (PRISM)

Liver

Full diagnostic (extracellular agent)Gadoxetate (hepatobiliary)Abbreviated (non-contrast surveillance)

Breast

Full dynamic Abbreviated (Kuhl FAST)

Rectum

Primary staging Restaging (post-neoadjuvant)

Pancreas & biliary

MRCP (standard)Secretin-enhanced MRCP

Small bowel

MR enterography (standard)Abbreviated (non-contrast)

Adrenal

Adrenal mass (adenoma vs non-adenoma)

Kidney

Solid renal mass (ccLS)

Bladder

Bladder cancer (VI-RADS)

Anal fistula

Perianal fistula (St James)

Gynecologic / pelvis

Endometrial cancer Cervical cancer Ovarian / adnexal Endometriosis (deep pelvic)Fibroids / adenomyosis Placenta accreta spectrum

Bowel / acute abdomen

Appendicitis (non-contrast)Acute abdomen in pregnancy

Obstetric / fetal

Fetal MRI (brain ± body)

All of Body & oncology

Cardiac & vascular6 protocols

Heart

Function / ischaemia Cardiomyopathy Myocarditis Iron overload (T2*)

Vessels (MRA)

CE-MRA Non-contrast MRA

All of Cardiac & vascular

Also on this page: MRI Patient Positioning · Phase-encode direction & saturation bands · PACS: definitions, what to send & reformats · Field strength: 3 T vs 1.5 T.

Overview

Cross-cutting 2025–2026 developments that shape every protocol below.

High-Yield Pearls: cross-cutting

MR safety (ACR Manual on MR Safety, 2026): a “full stop” and final check before every entry to Zone IV, routine or augmented (e.g. emergency, anaesthesia); an implant risk-assessment appendix (Appendix 4, added in the 2024 revision); strict Zone III/IV discipline.
Contrast (ACR Manual on Contrast Media, 2026): use a Group II agent, which carries the lowest NSF risk: the macrocyclics gadobutrol, gadoterate and gadoteridol and the linear agents gadobenate and gadoxetate; gadopiclenol is provisional (Group II*). Weight-based dosing; renal-function assessment is optional before a Group II agent rather than a blanket eGFR cut-off.
Contrast-sparing is the trend: biparametric prostate, abbreviated liver/breast, and non-contrast MRA increasingly replace routine gadolinium.
Acceleration & AI: deep-learning reconstruction with parallel imaging cuts scan time substantially. Validate image quality locally before clinical adoption.

Cross-cutting updates

MR safety (ACR)

Full stop / final check before Zone IV entry, routine and augmented (e.g. emergency).¹
Pocketless attire; tether external equipment in Zones III/IV.¹
MR risk-assessment appendix for implants with unclear conditions (Appendix 4, added in the 2024 revision); remote-scanning staffing.^2,3

Contrast media (ACR Manual on Contrast Media, 2026)

Group II agents (macrocyclic and two linear agents; gadopiclenol provisional Group II*): renal-function assessment optional; dialysis, eGFR < 30 and AKI are the at-risk groups before Group I or III agents; cumulative “GBCA burden”.⁴
Breastfeeding need not be interrupted; screening now risk-factor-targeted (CIN → CA-AKI).⁴

Acceleration & AI reconstruction

Deep-learning recon (AIR Recon DL, Deep Resolve, SmartSpeed, AiCE, ACS) layered on parallel imaging + compressed sensing; up to ~85% gradient-time reduction.⁵
Watch for sequence-specific artifacts, oversmoothing/”hallucination”, poor low-field generalisation; validate locally.⁵

Gadolinium trend

Gadopiclenol: high-relaxivity macrocyclic agent, so less gadolinium is needed per examination (see the product label for dosing); FDA use expanded to neonates/infants (2026).⁶
No agent is currently in ACR Group III; Group I agents remain listed (ACR Manual on Contrast Media, 2026, Table 1).⁴

Neuro & spine

Brain and spine. Where a pathology needs a distinct protocol it is listed in full. Set your vendor above to translate sequence names.

High-Yield Pearls: neuro & spine

Routine brain = T1, T2, FLAIR, DWI, SWI (± post-Gd 3D T1). DWI is the non-negotiable sequence (stroke, abscess, CJD, cellularity).
Stroke: DWI + FLAIR + SWI/GRE + MRA in minutes. A DWI-positive / FLAIR-negative mismatch implies onset <4.5 h → thrombolysis candidate in wake-up/unknown-onset stroke (WAKE-UP).
MS (2024 McDonald): 3D FLAIR is the primary detection sequence; central vein sign and paramagnetic rim lesions (optimally 3T SWI) add specificity; gadolinium is increasingly optional.
Epilepsy (HARNESS-MRI): 1 mm-isotropic 3D T1 + 3D FLAIR plus a high-resolution coronal T2 ⊥ the hippocampal long axis.
Brain tumour (BTIP): parameter-matched pre/post 3D T1 is what enables reproducible RANO response assessment.
Spine: sagittal T1 + T2 ± STIR; add fat-sat post-Gd for infection/tumour/post-op; screen the whole spine for cord compression or drop metastases.

Brain

Routine brain

First-line brain screen. Add post-contrast T1 for tumour, infection, or active MS.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEor 3D T1	Ax	500–700	8–15	–	5 / 1	220–240	320×256	Anatomy
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3500–5000	90–110	–	5 / 1	220	384–512	–
FLAIRFLAIRFLAIRFLAIRFLAIR	Ax	8000–9000	90–120	2400–2500	5 / 1	220	256	TI↑ at 3T
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	3000–5000	min	–	4–5	230	128–160	b0/1000; ADC
Susceptibility (SWI)SWISWANSWIpFSBB / SWI	Ax	27	20–40	–	2–3	220	256–320	minIP; blood/mineral
3D T1 IR-GREMPRAGEBRAVO / IR-FSPGR3D TFE3D Fast FE (MP-RAGE)post-Gd if indicated	Sag 3D	1900–2300	2–4	~900	1 iso	240	256	Volumetry

ACR-ASNR-SPR practice pattern.⁷

What each sequence is for

Axial T1: The anatomy picture: grey and white matter are easy to tell apart and fluid is dark. It is also the ‘before’ image, so anything already bright, such as fat or some blood products, is not mistaken for contrast uptake later.
Axial T2: Water is bright, so most disease stands out: swelling (oedema), tumours, old strokes and cysts. The fluid-filled ventricles are bright too, so their size and shape are easy to check.
Axial FLAIR: A T2-type picture with the fluid in the ventricles turned dark. Bright patches that sit right against that fluid, such as MS plaques and small-vessel damage, are no longer hidden by it.
Axial DWI: Shows where water cannot move freely. A new stroke, an abscess, a very cellular tumour or an active MS plaque lights up, and a dark spot in the same place on the ADC map (a calculated picture) confirms it.
Axial SWI: Very sensitive to anything that disturbs the magnetic field, so blood, tiny old bleeds (microbleeds), calcium and clot in vessels show as black dots or lines. The minIP view combines several slices so these are easier to follow.
Sagittal 3D T1 IR-GRE, after contrast if needed: A thin-slice 3D volume that can be re-sliced in any direction. After contrast it shows where the blood–brain barrier has broken down (tumour, infection, active MS); without contrast it can be used to measure brain volume.

References: ACR–ASNR–SPR practice parameter: MRI of the brain (2024).

Acute stroke

Speed-first; DWI+FLAIR+SWI+MRA in minutes. Add neck CE-MRA/TOF for carotid/vertebral. Extended wake-up windows (>4.5–9 h) are evolving, not yet uniform guideline.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	3000–4000	min	–	4–5	230	128–160	b0/1000; ADC (infarct core)
FLAIRFLAIRFLAIRFLAIRFLAIR	Ax	8000–9000	100–120	2400	5	230	256	DWI+/FLAIR− mismatch → likely <4.5 h
Susceptibility (SWI)SWISWANSWIpFSBB / SWIor GRE	Ax	27	20–40	–	3	230	256	Haemorrhage, susceptibility vessel sign
TOF MRATOFTOFTOF (inflow)TOFintracranial	Ax 3D	20–25	3–7	–	0.6–1	200	320	Circle of Willis; large-vessel occlusion
*DSC perfusion (T2 EPI)DSC (T2)DSC (T2)PRESTO / T2DSC (T2)**optional	Ax	1500	30–45	–	5	230	128	Penumbra (PWI)

AHA/ASA; ESO; DWI–FLAIR mismatch; extended windows.^8,9,10,11

What each sequence is for

Axial DWI: The stroke sequence. Brain tissue that has just lost its blood supply turns bright early, often while CT still looks normal, and the bright area marks the core of tissue already damaged.
Axial FLAIR: A new stroke takes some hours to turn bright on FLAIR. Bright on DWI but not yet on FLAIR means the stroke probably began within the last 4.5 hours, which can make a patient who woke up with symptoms eligible for clot-busting treatment.
Axial SWI or GRE: Blood shows as black, so bleeding can be ruled out before clot-busting treatment. A clot stuck in an artery can also show as a black dot or line inside the vessel.
Axial 3D TOF MRA, intracranial: Shows blood flowing in the arteries at the base of the brain without contrast. A blocked large artery shows as a gap, which tells the team the patient may need the clot pulled out (thrombectomy).
Axial DSC perfusion, optional: Tracks a quick injection of contrast through the brain to map blood flow. Tissue with poor flow that is not yet bright on DWI is the penumbra: at risk, but possibly still saveable if the artery is reopened.

References: AHA/ASA guideline, early management of acute ischaemic stroke (2019); ESO guideline, intravenous thrombolysis (2021); ACR–ASNR–SPR practice parameter: MRI of the brain (2024).

Multiple sclerosis

2024 McDonald + 2024 MAGNIMS–CMSC–NAIMS. ≤3 mm/no gap; consistent repositioning for follow-up.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D FLAIRSPACE FLAIRCUBE FLAIRVISTA FLAIRMVOX FLAIR	Sag 3D	5000–8000	~390 eff	1800–2200	1 iso	250	256	Primary lesion detection
3D T1 IR-GREMPRAGEBRAVO / IR-FSPGR3D TFE3D Fast FE (MP-RAGE)pre ± post-Gd	Sag 3D	2000	2–4	~900	1 iso	250	256	Single dose, ~10 min delay
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	4000	90	–	3	230	320	Posterior fossa
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	3000	min	–	4	230	160	Exclude mimics
Susceptibility (SWI)SWISWANSWIpFSBB / SWI	Ax	27	20–40	–	2–3	220	320	Central vein sign / rim lesions (optimally 3T)

McDonald 2024; MAGNIMS–CMSC–NAIMS.^12,13,14

What each sequence is for

Sagittal 3D FLAIR: The main sequence for finding MS plaques: fluid is dark and plaques are bright. Thin 3D slices show them in their typical places (next to the ventricles, at the edge of the cortex, in the brainstem) and can be matched slice for slice on follow-up scans.
Sagittal 3D T1 IR-GRE, before and after contrast: A thin-slice T1 volume. After contrast, active plaques with a leaky blood–brain barrier light up, which shows current inflammation, while older plaques do not.
Axial T2: A second look at the brainstem and cerebellum (the back of the brain), where plaques can be harder to see on FLAIR.
Axial DWI: Helps rule out look-alikes such as a small fresh stroke, which lights up strongly. Some new active plaques also light up, so it is read together with the other sequences.
Axial SWI: Shows a small vein running through the middle of many MS plaques (the central vein sign) and a dark rim around some older plaques that are still slowly active (paramagnetic rim lesions). Both point towards MS rather than other causes of white-matter spots.

References: 2024 MAGNIMS–CMSC–NAIMS consensus on MRI in MS; 2024 McDonald criteria; German Society of Neuroradiology MS MRI consensus (2026).

EpilepsyHARNESS

ILAE HARNESS-MRI. Correct head tilt/rotation on the localiser before the coronal T2.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 IR-GREMPRAGEBRAVO / IR-FSPGR3D TFE3D Fast FE (MP-RAGE)	Sag 3D	2000	2–4	~900	1 iso	256	256	Morphology / cortex
3D FLAIRSPACE FLAIRCUBE FLAIRVISTA FLAIRMVOX FLAIR	Sag 3D	5000–8000	~390 eff	1800–2200	1 iso	250	256	FCD / gliosis
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res	Cor obl	5000–9000	90–110	–	2 / 0	180–200	512	⟂ hippocampal long axis; ~0.4 mm
Susceptibility (SWI)SWISWANSWIpFSBB / SWIif lesion	Ax	27	20–40	–	2–3	220	320	Add post-Gd T1 if tumour/vascular

ILAE HARNESS-MRI.¹⁵

What each sequence is for

Sagittal 3D T1 IR-GRE: A thin-slice 3D volume for the shape of the brain surface. It shows malformations such as thickened cortex, a blurred border between grey and white matter or grey matter in the wrong place, and can be re-sliced along the hippocampus.
Sagittal 3D FLAIR: Makes abnormal brightness stand out: focal cortical dysplasia (a small patch of wrongly formed cortex), scarring (gliosis) and the bright hippocampus of hippocampal sclerosis.
Coronal oblique T2, high resolution: Very thin slices cut straight across the hippocampus. They show its inner layers, so the shrinkage and lost inner structure of hippocampal sclerosis can be seen and the two sides compared.
Axial SWI, if a lesion is found: Added when a lesion is found or suspected: blood, iron and calcium show as black, which helps identify cavernomas, old bleeds and calcified lesions.

References: ILAE HARNESS-MRI recommendations (2019).

Brain tumourBTIP

Standardised BTIP; identical pre/post parameters enable RANO response assessment.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 IR-GREMPRAGEBRAVO / IR-FSPGR3D TFE3D Fast FE (MP-RAGE)pre	Sag 3D	2100 or 5–1521005–155–155–15	min	1100 or 400–4501100400–450400–450400–450	1 iso	256	256	Parameter-matched. BTIP pairs TR 2100 with TI 1100 (Siemens, Hitachi) and TR 5–15 with TI 400–450 (GE, Philips, Canon/Toshiba)¹⁶
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	4000	100	–	≤4 / 0	240	384	–
FLAIRFLAIRFLAIRFLAIRFLAIR	Ax	8000	120	2400	≤4 / 0	240	256	Pre-contrast
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	4000	min	–	4	240	160	b0/1000; ADC (cellularity)
3D T1 IR-GREMPRAGEBRAVO / IR-FSPGR3D TFE3D Fast FE (MP-RAGE)post-Gd	Sag 3D	2100 or 5–1521005–155–155–15	min	1100 or 400–4501100400–450400–450400–450	1 iso	256	256	Identical to pre
*DSC perfusion (T2 EPI)DSC (T2)DSC (T2)PRESTO / T2DSC (T2)**advanced, optional	Ax	1500	30–45	–	5	240	128	Perfusion (rCBV) ± spectroscopy

Consensus BTIP.^16,17

What each sequence is for

Sagittal 3D T1 IR-GRE, before contrast: The ‘before’ volume, set up exactly like the after-contrast volume so the two match slice for slice. Anything bright before contrast, such as blood, is then not mistaken for enhancing tumour.
Axial T2: Water is bright, so the tumour, the swelling around it and any cysts or dead (necrotic) centre show clearly.
Axial FLAIR, before contrast: Fluid in the ventricles is dark, so the bright area around the tumour is easy to outline. That area holds swelling and any tumour that does not take up contrast, so it is compared on every follow-up scan.
Axial DWI: Densely packed tumour cells hold water still, so the most cellular parts look dark on the ADC map. It also helps tell an abscess, which restricts strongly, from a tumour.
Sagittal 3D T1 IR-GRE, after contrast: Shows where contrast leaks through a damaged blood–brain barrier. Because it matches the ‘before’ volume exactly, the enhancing tumour is measured the same way on every scan to judge response to treatment (RANO).
Axial DSC perfusion, optional: Maps how much blood is in each part of the tumour (rCBV). Active tumour usually has a high blood volume, which helps tell regrowth from treatment effects that look the same on the other sequences.

References: Brain Tumor Imaging Protocol consensus, gliomas (2015); Standardised brain tumour imaging protocols (Front Radiol 2023); ACR–ASNR–SPR practice parameter: MRI of the brain (2024).

Dementia / neurodegeneration

Reformat coronal-oblique T1 through hippocampi for MTA (Scheltens); optional volumetry.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 IR-GREMPRAGEBRAVO / IR-FSPGR3D TFE3D Fast FE (MP-RAGE)coronal-oblique reformat	Sag 3D	2000	2–4	~900	1 iso	240	256	MTA ⟂ hippocampus
FLAIRFLAIRFLAIRFLAIRFLAIR	Ax	8000	120	2400	5	230	256	Vascular burden
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	4000	100	–	5	230	320	–
Susceptibility (SWI)SWISWANSWIpFSBB / SWI	Ax	27	20–40	–	2–3	220	320	Microbleeds / CAA
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	3000	min	–	4	230	160	Exclude CJD/acute

Radiology Assistant; ACR appropriateness.¹⁸

What each sequence is for

Sagittal 3D T1 IR-GRE, re-sliced coronal oblique: A 3D volume re-sliced straight across the hippocampi. It shows how much the hippocampus has shrunk (the MTA score), which supports Alzheimer’s disease, and the pattern of shrinkage elsewhere points to other dementias.
Axial FLAIR: Shows small-vessel damage as bright patches in the white matter, and old strokes, which can cause or add to memory problems (vascular dementia).
Axial T2: A general check for other causes of memory problems, such as a tumour, old strokes or enlarged fluid spaces.
Axial SWI: Tiny old bleeds show as black dots. Many dots near the brain surface point to cerebral amyloid angiopathy, where amyloid builds up in the walls of small vessels.
Axial DWI: Shows a recent small stroke, and the bright cortex or deep grey matter of Creutzfeldt–Jakob disease (CJD), a rare cause of rapidly worsening dementia.

References: Radiology Assistant: dementia, role of MRI (2026 update); ACR–ASNR–SPR practice parameter: MRI of the brain (2024).

Pituitary / sella

Thin-section sella; dynamic post-contrast for microadenoma. Representative standard technique.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEpre	Sag & Cor	400–600	10–15	–	2–3 / 0	160–180	320–512	Small FOV, thin
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Cor	3000	90	–	2–3	160–180	384	Chiasm, cysts
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)dynamic post-Gd	Cor	min	min	–	2–3	160–180	256	~6 phases (microadenoma)
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEpost-Gd	Sag & Cor	400–600	10–15	–	2–3	160–180	320	Delayed

What each sequence is for

Sagittal and coronal T1, before contrast: Thin close-up slices of the gland before contrast. They show its size and shape, the normally bright back part (posterior pituitary) and anything already bright, such as bleeding into a tumour.
Coronal T2: Shows the optic chiasm (where the optic nerves cross) above the gland, so any upward push from a tumour is seen, and helps tell fluid-filled cysts from solid tumour.
Coronal dynamic 3D T1 spoiled GRE, after contrast: Fast repeated scans as contrast arrives. The normal gland lights up first and a small tumour (microadenoma) more slowly, so for a short time it stands out as a darker spot.
Sagittal and coronal T1, after contrast (delayed): Later pictures show the whole tumour, its relation to the optic chiasm and whether it has grown sideways into the cavernous sinus around the carotid artery.

References: ACR Appropriateness Criteria: neuroendocrine imaging (2019).

IAM / CPA (hearing loss)

Thin 3D heavy-T2 (CISS/FIESTA-C/DRIVE) + post-Gd T1 for CN VII/VIII. Representative standard technique.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D heavy-T2 SSFPCISSFIESTA-C3D DRIVE / bFFE3D True SSFP	Ax 3D	6–10	3–5	–	0.5–0.6 iso	150–160	320	Membranous labyrinth, CN VII/VIII
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEpre	Ax	500	12	–	3	180	320	IAM fat
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEpost-Gd fat-sat	Ax & Cor	500	12	–	3	180	320	Vestibular schwannoma
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	4000	90	–	3–4	200	320	Posterior fossa

What each sequence is for

Axial 3D heavily T2-weighted (SSFP): Fluid in the inner ear and around the nerves is very bright, and the facial and hearing/balance nerves show as thin dark lines. It shows the cochlea and balance canals, and a small tumour as a dark lump in the bright fluid.
Axial T1, before contrast: The ‘before’ picture. Anything already bright, such as fat (a lipoma) or blood, is then not mistaken for an enhancing tumour.
Axial and coronal T1 fat-sat, after contrast: A vestibular schwannoma takes up contrast and lights up in the canal or at the cerebellopontine angle, and two planes show its size. Fat suppression stops bright fat near the petrous apex from looking like enhancement.
Axial T2: Checks the brainstem and the rest of the brain for other causes of hearing loss or dizziness, such as MS plaques or a stroke.

References: ACR–ASNR–SPR practice parameter: MRI of the head and neck (2023); EANO guideline: vestibular schwannoma (2020).

Pediatric

Feed-and-wrap for infants; fast HASTE/single-shot “quick-brain” for shunted hydrocephalus (no gadolinium, no sedation).^20,21
<24 months myelination incomplete, so FLAIR insensitive to FCD; retain early scans for comparison.¹⁵
Macrocyclic Gd, single dose, omit where not needed.²²

Spine

Cervical (routine)

Add fat-sat post-Gd T1 for infection/tumour/post-op.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Sag	500–700	10–15	–	3 / 0.3	240–280	384	Marrow, alignment
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100–120	–	3 / 0.3	240–280	384	Cord, discs
STIRSTIRSTIRSTIRSTIR	Sag	3000–4000	40	1.5T: 150–1703T: ~205–225¹⁰⁹	3	240–280	320	Oedema / trauma
Axial multi-echo GREMEDICMERGEmFFEmEcho FEor Ax T2 FSE	Ax	600–800	15–20	–	3–4 / 1	160–180	256–320	Foramina, cord

Representative routine protocol.¹⁹

What each sequence is for

Sagittal T1: Fat in normal bone marrow is bright, so anything that replaces it, such as tumour, infection or a fracture, shows as a darker patch. It also shows the alignment of the vertebrae.
Sagittal T2: Bright spinal fluid outlines the cord, so disc bulges, narrowing of the canal and bright spots inside the cord (swelling, MS, injury) are seen down the whole neck.
Sagittal STIR: Fat is switched off so water stands out: after an injury it shows bone bruising, fractures and torn ligaments, and it shows marrow swelling from infection or tumour.
Axial multi-echo GRE (or axial T2): Cross-sections at each disc show the nerve exit holes (foramina) and the shape of the cord. Gradient echo is less upset by spinal fluid pulsing in the neck and helps tell a disc from a bony spur.

References: ACR–ASNR–SABI–SSR practice parameter: MRI of the adult spine (2023).

Thoracic (routine)

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Sag	500–700	10–15	–	3–4 / 0.5	320–400	384	Wide coverage; count levels
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100–120	–	3–4	320–400	384	Cord
STIRSTIRSTIRSTIRSTIR	Sag	3500	40	1.5T: 150–1703T: ~205–225¹⁰⁹	3–4	320–400	320	Oedema
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3500	100	–	4	180–200	256	Through ROI

Representative routine protocol.¹⁹

What each sequence is for

Sagittal T1, large field of view: Bright marrow fat shows fractures and bone deposits as darker areas. The large view reaches the neck so the vertebrae can be counted from the top and the right level named.
Sagittal T2: Bright spinal fluid outlines the thoracic cord, showing pressure from discs or masses and bright spots inside the cord.
Sagittal STIR: Fat is switched off, so marrow swelling from a fresh fracture, infection or a tumour deposit stands out.
Axial T2, through the level of concern: Cross-sections at the level of concern show whether a disc or mass presses on the cord or nerve roots, and from which side.

References: ACR–ASNR–SABI–SSR practice parameter: MRI of the adult spine (2023).

Lumbar (routine)

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Sag	500–700	10–15	–	3–4 / 1	280–320	384	Marrow, alignment
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100–120	–	3–4 / 1	280–320	384	Discs, canal
STIRSTIRSTIRSTIRSTIRoptional	Sag	3500	40	1.5T: 150–1703T: ~205–225¹⁰⁹	3–4	280–320	320	Oedema / infection
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3500–4500	100	–	3–4 / 1	180–200	320	Angled through discs
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEoptional	Ax	600	12	–	3–4	180–200	320	Foraminal fat

Representative routine protocol.¹⁹

What each sequence is for

Sagittal T1: Normal marrow is bright, so fractures, bone deposits and infection show as darker areas. It also shows one vertebra slipping forward on the next (spondylolisthesis).
Sagittal T2: Healthy discs are bright and worn discs darker. It shows disc bulges and narrowing of the spinal canal along the whole lumbar spine.
Sagittal STIR, optional: Added when infection, a fresh fracture or a tumour is possible: fat is switched off, so marrow swelling stands out.
Axial T2, angled through the discs: Slices angled along each disc show exactly where a disc presses on a nerve root, and narrowing of the canal and the nerve exit holes.
Axial T1, optional: Fat around the nerves in the exit holes is bright, so a nerve squeezed by a disc or bony overgrowth shows where that fat is lost.

References: ACR–ASNR–SABI–SSR practice parameter: MRI of the adult spine (2023).

MS cord

MAGNIMS cord protocol; slice ≤3 mm.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3500	100–120	–	3	260–280	384	Cord lesions
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEor STIR	Sag	3000	30	–	3	260–280	384	≥2 of 3 sagittal contrasts
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3500	100	–	3	160–180	256	Full cord coverage (confirmation)
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEpost-Gd if active	Sag & Ax	600	12	–	3	260	320	Active lesions

MAGNIMS–CMSC–NAIMS.¹⁴

What each sequence is for

Sagittal T2: Shows MS plaques as bright patches along the length of the cord.
Sagittal PD (or STIR): A second sagittal picture with a different weighting. PD and STIR make small cord plaques easier to see, and a spot seen on two different sequences is more likely to be a real plaque.
Axial T2: Cross-sections confirm the plaques seen on the sagittal images and show where in the cord they sit.
Sagittal and axial T1, after contrast if active: Given only when needed: new, active plaques take up contrast while older ones do not.

References: 2024 MAGNIMS–CMSC–NAIMS consensus on MRI in MS; ACR–ASNR–SABI–SSR practice parameter: MRI of the adult spine (2023).

Infection / discitis

Fat-sat post-Gd essential for epidural/paraspinal collection.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Sag	500–700	12	–	3–4	280–320	384	Marrow, endplates
STIRSTIRSTIRSTIRSTIRor T2 fat-sat	Sag	3500	40	1.5T: 150–1703T: ~205–225¹⁰⁹	3–4	280–320	320	Discitis/osteomyelitis
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3500	100	–	4	180–200	256	Canal, paraspinal
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEpost-Gd fat-sat	Sag & Ax	600	12	–	3–4	280	320	Abscess / epidural phlegmon

Representative protocol.¹⁹

What each sequence is for

Sagittal T1: In infection the bright marrow fat on both sides of the disc turns dark, and the endplates (the bone surfaces touching the disc) look blurred or worn away.
Sagittal STIR (or T2 fat-sat): Fat is switched off, so the infected disc and the swollen marrow above and below it are bright.
Axial T2: Shows collections and swelling in the spinal canal and in the muscles beside the spine.
Sagittal and axial T1 fat-sat, after contrast: Contrast separates an abscess (a pus pocket with a bright rim and dark centre) from phlegmon (inflamed tissue that enhances all the way through), and fat suppression stops bright fat hiding the enhancement.

References: ACR–ASNR–SABI–SSR practice parameter: MRI of the adult spine (2023).

Cord compression / whole-spine

Acute cord compression or cauda equina: large-FOV whole-spine screen.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3500	100	–	3–4	400+ (2 stations)	384	Whole spine (compression / drop mets)
STIRSTIRSTIRSTIRSTIR	Sag	3500	40	1.5T: 150–1703T: ~205–225¹⁰⁹	3–4	400+	320	Marrow lesions
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3500	100	–	4	180–200	256	Targeted level
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE± post-Gd	Sag	600	12	–	3–4	400+	320	Leptomeningeal / mets

What each sequence is for

Sagittal T2, whole spine: Covers the whole spine to find every level where the cord or the nerve roots at the bottom (cauda equina) are squeezed, and shows abnormal signal in the cord itself.
Sagittal STIR, whole spine: Fat is switched off, so tumour deposits and fractures in the vertebrae show as bright spots along the whole spine.
Axial T2, at the level of concern: Cross-sections through each level of concern show how tightly the cord or nerves are squeezed and from which side, which helps plan treatment.
Sagittal T1, with or without contrast: Before contrast, tumour deposits show as dark areas in the bright marrow fat. After contrast, deposits on the surface of the cord and nerve roots (leptomeningeal spread) can light up.

References: NICE NG234: spinal metastases and cord compression (2023); ACR–ASNR–SABI–SSR practice parameter: MRI of the adult spine (2023).

Musculoskeletal

Each joint lists its routine protocol plus pathology-specific/arthrography protocols in full. ACR figures are accreditation ceilings, not optimal technique.

High-Yield Pearls: musculoskeletal

Fat-sat fluid-sensitive (PD/T2 or STIR) on ≥1 plane finds marrow & soft-tissue oedema; T1 maps marrow and anatomy. ACR figures are accreditation ceilings, not optimal technique.
MR arthrography: dilute gadolinium to ~2 mmol/L (~1:200) intra-articular; the ABER view is key for the anteroinferior labrum / HAGL in shoulder instability.
Positioning drives the diagnosis: oblique-coronal ∥ supraspinatus (cuff), oblique-axial along the femoral neck (cam/alpha angle), radial reformats for the acetabular labrum, short-axis ⊥ metatarsals for Morton neuroma.
Metal (MARS): high receiver bandwidth, short TE, FSE not GRE, and STIR not spectral fat-sat; add SEMAC / MAVRIC-SL 3D multispectral for severe hardware artifact.
Whole-body (MY-RADS): axial DWI (b 50 & ~900) + Dixon T1; overall study quality is usually limited by DWI quality.

Knee

Routine (internal derangement)

Fat-sat on ≥1 plane. ACR max 4 mm / 0.6 mm².

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
PD TSE/FSEPD TSEPD FSEPD TSEPD FSE	Sag	2500–3500	30–40	–	3–3.5 / 0.3	140–160	320–384	Menisci; ~0.4 mm
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Sag	3000–4000	40–60	–	3–3.5	140–160	320	Cartilage, cruciates
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Cor	3000	40	–	3	140–160	320	Collaterals, menisci
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	Ax	3000	60	–	3–4	140–160	288	Patellofemoral cartilage
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEor Dixon	Cor	500–700	12	–	3–4	140–160	320	Marrow (non-FS)

ESSR 2024; ACR MSK.^26,33

What each sequence is for

Sagittal PD: A sharp anatomy picture. The menisci are dark triangles, so a tear shows as a bright line reaching their surface; the cruciate ligaments are seen along their length.
Sagittal PD fat-sat: Fat is switched off, so fluid and swelling are bright: bone bruises, cartilage damage, torn cruciate ligaments and joint fluid stand out.
Coronal PD fat-sat: The front-on view adds the collateral ligaments on the inner and outer sides of the knee and the middle part of each meniscus.
Axial T2 fat-sat: Cross-sections show the kneecap and the groove it runs in, so cartilage damage behind the kneecap and signs of a kneecap dislocation are seen.
Coronal T1 (or Dixon): Without fat suppression, normal marrow is bright, so a hidden fracture line or marrow replaced by disease shows as dark.

References: ESR Essentials: MRI of the knee, ESSR (2024); ACR–SPR–SSR practice parameter: MRI of the knee (2025).

Cartilage / quantitative

Quantitative T2/T1rho used in research and early OA; not yet routine clinically.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D isotropic TSESPACECUBEVISTA3D MVOXfat-sat 3D	Sag 3D	1200	30	–	0.5–0.7 iso	150	320	Morphological cartilage; reformats
T2 mappingMyoMaps T2T2 mapT2 mappingT2 mapping	Sag	1500	multi-echo	–	3	140	320	Collagen/water; T1rho adjunct
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Sag/Cor	3000	40	–	3	140–160	320	Routine base

AJR 2024.³¹

What each sequence is for

Sagittal 3D isotropic TSE fat-sat: Thin 3D slices that can be re-sliced in any direction, so the cartilage surface can be followed around the curved joint to find thinning, cracks and defects.
Sagittal T2 mapping: Measures the T2 time at each point in the cartilage and shows it as a map. Longer times point to early breakdown of the cartilage structure, before a defect can be seen.
Sagittal and coronal PD fat-sat: The standard knee pictures, so the menisci, ligaments and bone marrow are checked alongside the cartilage study.

References: ACR–SPR–SSR practice parameter: MRI of the knee (2025); Quantitative cartilage T2 and T1rho mapping (AJR).

MR arthrography (post-op)

Post-op meniscal re-tear / cartilage. Macrocyclic Group II GBCA.

✓	Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
	T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Sag/Cor/Ax	500–700	min	–	3	140–160	320	Dilute Gd ~2 mmol/L intra-articular
	T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	one plane	3000	60	–	3	140–160	288	Loose bodies, oedema

Gd dilution vs field.²⁷

What each sequence is for

Sagittal, coronal and axial T1 fat-sat, after joint injection: Dilute contrast injected into the knee is bright and fat is dark. Contrast running into a repaired or trimmed meniscus shows a new tear, which is hard to tell from old surgical change on routine MRI.
T2 fat-sat, one plane: A fluid-sensitive view shows bone marrow swelling and problems outside the joint that the contrast images cannot show, and helps show loose fragments.

References: ACR–SPR–SSR practice parameter: MRI of the knee (2025); ESR Essentials: MRI of the knee, ESSR (2024).

Shoulder

Routine (cuff / impingement)

ACR max 4 mm / 0.8 mm².

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
PD TSE/FSEPD TSEPD FSEPD TSEPD FSE	Ax	2500–3000	30	–	3–4 / 0.3	140–160	320	Labrum, biceps
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat / STIR	Obl-Cor	3500	50–60	–	3–4	140–160	320	∥ supraspinatus (cuff)
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Obl-Sag	3000	40	–	3–4	140–160	288	Cuff muscles, Goutallier
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Obl-Cor	500–700	12	–	3–4	140–160	320	Marrow, fatty atrophy

ACR MSK.³³

What each sequence is for

Axial PD: Cross-sections show the labrum (the rim of cartilage around the socket), the biceps tendon in its groove and the front and back of the joint.
Oblique coronal T2 fat-sat (or STIR): Slices angled along the supraspinatus tendon show the rotator cuff from end to end, so a tear shows as bright fluid in a gap in the dark tendon.
Oblique sagittal PD fat-sat: Cuts across the cuff tendons and their muscles like slices of bread, showing which tendons are torn and how bulky the muscles are.
Oblique coronal T1: Without fat suppression, fat is bright: cuff muscle that has shrunk and turned to fat after a long-standing tear shows clearly, which affects whether a repair is likely to work. The marrow is checked for fractures too.

References: ACR–SPR–SSR practice parameter: MRI of the shoulder (2024); ACR MRI accreditation: MSK module parameters (2025).

MR arthrography (instability)

Instability work-up; ABER view essential.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Ax	500–700	min	–	3	140–160	320	Dilute Gd ~2 mmol/L; Bankart/SLAP
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Obl-Cor	500–700	min	–	3	140–160	320	Superior labrum
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Obl-Sag	500–700	min	–	3	140–160	320	–
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat, ABER	ABER obl-ax	500–700	min	–	3	140–160	320	Anteroinferior labrum, PASTA, HAGL
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	one plane	3000	60	–	3	140–160	288	Cuff / oedema

Gd dilution; ABER.²⁷

What each sequence is for

Axial T1 fat-sat, after joint injection: Dilute contrast stretches the joint and fills any gap, so a tear of the front-lower labrum after a dislocation (Bankart lesion) shows as contrast running under or through the labrum.
Oblique coronal T1 fat-sat: Shows the top of the labrum where the biceps tendon attaches, the site of SLAP tears.
Oblique sagittal T1 fat-sat: Shows the socket face-on, so where a labral tear sits around the rim and how far it runs can be described.
ABER oblique axial T1 fat-sat: The arm is placed up behind the head (abduction and external rotation). This pulls the front-lower labrum and capsule tight, so small tears that lie flat in the normal position open up, and partial tears on the underside of the cuff show better.
T2 fat-sat, one plane: A fluid-sensitive view shows bone bruising from a dislocation, such as the dent in the back of the humeral head (Hill-Sachs lesion), and problems that do not connect with the joint.

References: ACR–SPR–SSR practice parameter: MRI of the shoulder (2024).

Hip

Routine / AVN

AVN, marrow, referred pain.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
STIRSTIRSTIRSTIRSTIRor T2 fat-sat	Cor (pelvis)	3500	40	1.5T: 150–1703T: ~205–225¹⁰⁹	4–5	340–380	320	Both hips, marrow, AVN screen
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Cor (pelvis)	500–700	12	–	4–5	340–380	384	Marrow, AVN
PD TSE/FSEPD TSEPD FSEPD TSEPD FSE	Ax (small-FOV)	2500	30	–	3–4	160–180	320	Symptomatic hip
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	Cor (small-FOV)	3000	60	–	3–4	160–180	288	Labrum, effusion

What each sequence is for

Coronal STIR (or T2 fat-sat), whole pelvis: A large view of both hips with fat switched off. It shows stress fractures, early avascular necrosis (bone death from lost blood supply) and problems in the other hip or pelvis that can cause the pain.
Coronal T1, whole pelvis: Bright marrow fat makes the dark line at the edge of dead bone in avascular necrosis stand out, as well as fracture lines and marrow replaced by disease.
Axial PD, small field of view: A close-up of the painful hip showing the labrum, cartilage, tendons and joint capsule in cross-section.
Coronal T2 fat-sat, small field of view: A close-up front-on view with fat switched off: joint fluid, tears of the labrum at the top of the socket and cartilage damage show clearly.

References: ACR–SPR–SSR practice parameter: MRI of the hip and pelvis (2026).

FAI / labral

Radial reformats around the femoral neck are key.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
PD TSE/FSEPD TSEPD FSEPD TSEPD FSE	Obl-Ax	2500	30	–	2–3	160	320	Along femoral neck: alpha angle (cam)
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEradial	Radial	2500	30	–	3	160	320	Acetabular clock-face labrum
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	Cor/Ax	3000	60	–	3	160–180	288	Chondrolabral
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat, arthrography (optional)	3 planes	500–700	min	–	3	160	320	Dilute Gd ~2 mmol/L distension

ACR MSK.³³

What each sequence is for

Oblique axial PD, along the femoral neck: Slices along the femoral neck show the bump at the head–neck junction in cam-type impingement; the alpha angle that measures it is taken here.
Radial PD: Slices arranged like the spokes of a wheel around the femoral neck cut straight across the labrum all the way round the socket, so a tear or a cam bump can be placed on a clock face.
Coronal and axial T2 fat-sat: Fluid-sensitive views show labral tears, damage where the labrum meets the cartilage, and bone swelling or cysts.
T1 fat-sat in three planes, arthrography (optional): When contrast is injected into the joint it stretches the capsule and runs into tears of the labrum and cartilage, making small defects easier to see.

References: Lisbon Agreement on FAI imaging, part 3 (2021); ACR–SPR–SSR practice parameter: MRI of the hip and pelvis (2026).

Wrist

Routine

Smallest FOV in MSK. ACR max 3 mm / 0.3 mm².

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Cor-obl	500–600	min	–	2–3 / 0.2	80–100	256–320	SL ligament, marrow; ~0.3 mm
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Cor-obl	2500–3000	40	–	2–3	80–100	256–320	TFCC, ligaments
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Ax	2500	40	–	3	80–100	256	Tendons, carpal tunnel
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	Cor	3000	60	–	2–3	80–100	256	Oedema

ACR MSK.³³

What each sequence is for

Oblique coronal T1: High-detail anatomy of the small wrist bones and their ligaments, including the scapholunate ligament. Bright marrow fat shows a hidden scaphoid fracture or dead bone (avascular necrosis) as a dark area.
Oblique coronal PD fat-sat: Fluid is bright and fat dark, so tears of the triangular fibrocartilage (the cushion on the little-finger side, TFCC) and the small ligaments show as bright lines.
Axial PD fat-sat: Cross-sections show every tendon around the wrist and the median nerve in the carpal tunnel, so tendon inflammation, tears and nerve compression can be seen.
Coronal T2 fat-sat: A strongly fluid-sensitive view that shows bone bruising, fractures and joint fluid.

References: ACR–SABI–SPR–SSR practice parameter: MRI of the wrist (2022).

Arthrography (TFCC / instability)

Three-compartment injection for intrinsic ligament / TFCC tears.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Cor	500–600	min	–	2	80–100	320	Dilute Gd; TFCC / ligaments
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Ax	500–600	min	–	2–3	80–100	256	–
3D isotropic TSESPACECUBEVISTA3D MVOXor 3D GRE	Cor 3D	1000	min	–	0.4 iso	90	320	Intrinsic ligaments

What each sequence is for

Coronal T1 fat-sat, after joint injection: Dilute contrast injected into the wrist joints outlines tears of the TFCC and the small ligaments between the carpal bones, and the front-on view shows where they are.
Axial T1 fat-sat: Cross-sections check the tears in a second plane and show the front and back parts of the small ligaments.
Coronal 3D isotropic TSE (or 3D GRE): Very thin slices of the whole wrist that can be re-sliced in any direction, to follow the tiny ligaments between the carpal bones along their length.

References: ACR–SABI–SPR–SSR practice parameter: MRI of the wrist (2022).

Ankle & foot

Ankle (routine)

Dixon efficient; oblique planes for ATFL. Ankle has no dedicated ACR table.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Sag	500–700	12	–	3 / 0.3	140–160	320	Marrow, tendons
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Ax	3000	40	–	3	140–160	288	Tendons, ligaments (ATFL obl)
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat	Sag	3000	40	–	3	140–160	288	Achilles, plantar fascia
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	Cor	3000	60	–	3	140–160	288	Osteochondral, ligaments

What each sequence is for

Sagittal T1: Anatomy of the ankle and hindfoot: bright marrow fat shows hidden fractures and dead bone as dark areas, and the dark tendons stand out against fat.
Axial PD fat-sat: Cross-sections show every tendon around the ankle and the ligaments on the outer side, including the anterior talofibular ligament (ATFL), the one most often torn in a sprain.
Sagittal PD fat-sat: The side view shows the Achilles tendon and the plantar fascia under the heel along their length, so thickening, partial tears and ruptures are seen.
Coronal T2 fat-sat: The front-on view shows the top of the talus, where cartilage and bone injuries (osteochondral lesions) occur, and the ligaments on the inner (deltoid) and outer sides.

References: ACR–SPR–SSR practice parameter: MRI of the ankle and hindfoot (2026).

Forefoot (Morton / plantar plate)

Planes prescribed relative to the metatarsals. ACR forefoot 3 mm / 0.4 mm².

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat, short-axis	Short-ax	3000	60	–	3 / 0.3	100–120	256	⟂ metatarsals (Morton, plantar plate)
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEshort-axis	Short-ax	500	12	–	3	100–120	256	Neuroma (T1-iso), marrow
PD TSE/FSEPD TSEPD FSEPD TSEPD FSEfat-sat, long-axis	Long-ax	3000	40	–	3	100–120	256	Plantar plate
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEfat-sat	Sag	3000	60	–	3	100–120	256	–

ACR MSK.³³

What each sequence is for

Short-axis T2 fat-sat: Slices across the forefoot show each space between the long bones (metatarsals), so a Morton neuroma, fluid in the small bursae between the metatarsal heads and plantar plate injury can be seen.
Short-axis T1: A Morton neuroma shows as a dark teardrop against the bright fat between the metatarsal heads. Bright marrow also shows stress fractures as dark lines.
Long-axis PD fat-sat: Slices along each toe show the plantar plate (the tough pad under each toe joint), where a tear lets the toe become unstable.
Sagittal T2 fat-sat: The side view shows the metatarsals along their length for stress fractures and bone swelling, and the tendons under the toes.

References: ACR–SPR–SSR practice parameter: MRI of the fingers and toes (2023); ACR MRI accreditation: MSK module parameters (2025).

Techniques & whole-body

Fat suppression, 2D vs 3D & acceleration

Spectral fat-sat = best SNR but fails off-isocentre/near metal; STIR = most uniform; Dixon (increasingly default) gives water/fat/in/opposed in one acquisition.²³
2D FSE is the workhorse; 3D isotropic (SPACE/CUBE/VISTA/MVOX) gives sub-mm reformats, but ACR still requires each plane separately acquired.^24,25
DL-accelerated / abbreviated joint protocols validated with preserved accuracy.²⁸

Metal artifact reduction (MARS)

Optimise first: high bandwidth, thin slices + large matrix, short TE, FSE/TSE + STIR (avoid GRE near metal).

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
STIRSTIRSTIRSTIRSTIR	Cor/Ax	4000	30	1.5T: 1503T: ~205–225¹⁰⁹	3–4	per joint	320	High BW 400–540 Hz/px; STIR not spectral FS
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEVAT / SEMAC	per joint	600	min	–	3–4	per joint	320	View-angle tilt; SEMAC-CS through-plane
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSESEMAC / MAVRIC-SL	per joint	4000	80	–	3–4	per joint	256	3D multispectral

Skeletal Radiology 2024; MAVRIC-SL 2025.^29,30

What each sequence is for

Coronal and axial STIR: Metal spoils fat suppression that relies on fat’s exact frequency, but STIR switches fat off by timing instead, so it still works near implants. It shows fluid, infection and bone swelling around the metal.
T1 with VAT or SEMAC, planes to suit the joint: A T1 with metal-correction methods that shrink the black and bright smudges around the implant. It shows the bone next to the implant, fractures and signs of loosening.
T2 with SEMAC or MAVRIC-SL, planes to suit the joint: A metal-reduction sequence that collects signal from a range of frequencies around the metal. It shows fluid collections, soft-tissue reactions to implant wear and infection close to the implant.

References: Managing hardware-related metal artefacts in MRI (Skeletal Radiol 2024); ACR–SPR–SSR practice parameter: MRI of the knee (2025).

Whole-body (MY-RADS / MET-RADS-P)

Myeloma / metastatic prostate; overall quality is usually limited by DWI quality.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)multi-station	Ax	long	min	STIR	5–6	multi	128	b50–100 & 800–900; ADC
Dixon (fat/water)DixonFLEX / IDEALmDixonWFS (Dixon)T1, multi-station	Ax	min	dual-echo	–	5–6	multi	256	Water/fat/in/opposed
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEand T2 FSE/STIR	Sag	600	12	–	4	whole spine	384	Whole spine

MY-RADS.³²

What each sequence is for

Axial DWI, multi-station: Scans the body in blocks (stations). Myeloma and cancer deposits in the bone marrow show as bright spots on the high b-value images, and the ADC map helps judge response to treatment.
Axial T1 Dixon, multi-station: Makes separate fat and water pictures in one scan. Normal marrow contains fat and marrow filled with tumour loses it, so disease shows as dark areas on the fat picture.
Sagittal T1 and T2 or STIR, whole spine: Detailed side views of the whole spine show vertebral fractures, marrow deposits and any pressure on the spinal cord.

References: MY-RADS whole-body MRI in myeloma (Radiology 2019); ESR Essentials: bone marrow MRI in oncology, ESSR (2026).

Pediatric

Smaller FOV, child-sized coils, higher relative resolution; shorter protocols reduce sedation.³⁴
JIA: fluid-sensitive FS/STIR + T1; fat-sat T1 post-Gd within ~5–10 min for enhancing synovitis; DWI emerging as a non-contrast biomarker.^35,36
Normal physes / red marrow can mimic pathology; pair fluid-sensitive FS with a fat-sensitive (T1/Dixon) sequence.

Body & oncology

Structured systems (PI-RADS, LI-RADS, MY-RADS) specify acquisition and interpretation. Screening/surveillance uses biparametric or abbreviated, contrast-sparing protocols, listed separately in full.

High-Yield Pearls: body & oncology

Structured systems define both acquisition and interpretation: PI-RADS v2.1 (prostate), LI-RADS (liver), VI-RADS (bladder), O-RADS (ovary), ccLS (renal), MY-RADS (whole-body).
Prostate: mpMRI = T2 + DWI (high b ≥1400) + DCE (≤15 s temporal); biparametric screening (PRISM) drops contrast and the endorectal coil.
Liver: extracellular agent for the dynamic study; gadoxetate adds a ~20-min hepatobiliary phase; abbreviated non-contrast (T2 + DWI) for HCC surveillance.
Breast: image on days 7–14 of the cycle to lower background enhancement; Kuhl abbreviated (FAST, ~3 min) approaches full-protocol accuracy.
Rectal (ESGAR): high-resolution oblique T2 ⊥ the tumour; DWI is integral to restaging (residual tumour vs fibrosis); no routine DCE.
Chemical shift (in/opposed-phase): adrenal adenoma if signal-intensity index >16.5%; also detects microscopic fat in renal masses (ccLS).
Obstetric/fetal & PAS: 1.5 T, no contrast, no sedation; single-shot T2 is the workhorse; placenta accreta uses the 7 SAR–ESUR features.

Prostate

mpMRI (PI-RADS v2.1)

3T preferred, 1.5T acceptable; endorectal coil optional.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax obl	3000–5000	100–120	–	3 / 0	120–200	320–384	+ sag/cor; ~0.4–0.7 mm; zonal anatomy
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	3000–5000	min	–	3–4	200–220	96–128	b0-100, 800-1000 + high b≥1400 (acq/calc); ADC
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)DCE	Ax 3D	min	min	–	3	200–220	192	Temporal res ≤15 s; post-Gd
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Ax	500–700	10	–	4–5	300–360	256	Haemorrhage, nodes, bone

PI-RADS v2.1.³⁷

What each sequence is for

Oblique axial T2, plus sagittal and coronal: Detailed pictures of the prostate’s zones. T2 is the main sequence for the central (transition) zone, and it shows whether a tumour breaks through the capsule or reaches the seminal vesicles.
Axial DWI: Cancer holds water still, so it is bright on the high b-value images and dark on the ADC map. DWI is the main sequence for the outer (peripheral) zone, where most cancers arise.
Axial 3D T1 DCE: Fast repeated scans during a contrast injection. Early, focal enhancement can raise a borderline finding in the outer zone to a higher score.
Axial T1, large field of view: Blood left after a biopsy is bright on T1 and can hide or mimic cancer. The larger view also checks lymph nodes and pelvic bones for spread.

References: PI-RADS v2.1 (Eur Urol 2019); Radiology Assistant: prostate cancer, PI-RADS v2.1.

Screening bpMRI (PRISM)New

PRISM (JAMA Oncology, June 2026): no contrast, no endorectal coil; stage-gated 2-step read; ≤15 min.

✓	Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
	T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax + 1 ortho	3000–5000	100–120	–	3 / 0	120–200	320	≤15 min total
	DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	3000–5000	min	–	3–4	200–220	96–128	b0/800 + high ~b1500; ADC

PRISM; PI-QUAL v2.^38,39,40

What each sequence is for

Axial T2, plus one other plane: Detailed pictures of the prostate zones, with no contrast. In the screening read, a spot counts only if it shows on both the axial T2 and the high b-value DWI.
Axial DWI: The main cancer-finding sequence: cancer is bright on the high b-value images and dark on the ADC map. With T2 it keeps the screening scan short and free of contrast.

References: PRISM screening MRI standards (JAMA Oncol 2026); PI-QUAL v2 (Eur Radiol 2024).

Liver

Full diagnostic (extracellular agent)

Multiphasic dynamic; chemical-shift for steatosis/iron.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)in/opposed-phase	Ax 3D	min	dual-echo	–	3–4	360–420	256	Chemical shift
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE± fat-sat	Ax/Cor	1500–2500	80–100	–	5–6	360–420	320	Lesion characterisation
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	5–6	360–420	128	b0/50, 400–500, 800; ADC
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)dynamic post-Gd fat-sat	Ax 3D	min	min	–	3	360–420	256	Late arterial / PV / delayed

LI-RADS 2024.^41,42

What each sequence is for

Axial 3D T1, in-phase and opposed-phase: Two echoes in one breath-hold. Tissue that holds both fat and water turns darker on the opposed-phase image (fatty liver, fat inside a nodule), while iron makes the liver darker on the in-phase image.
Axial and coronal T2, with or without fat-sat: Water-rich lesions are bright: cysts and haemangiomas are very bright, while cancers are usually only mildly bright.
Axial DWI: Solid tumours and liver metastases hold water still and stand out as bright spots, which helps find small lesions.
Axial 3D T1 fat-sat, dynamic after contrast: Scans timed to the contrast arriving in the liver. A typical liver cancer (HCC) lights up brightly in the late arterial phase, then turns darker than the liver later (washout), often with a bright rim (capsule).

References: ACR–SABI–SAR–SPR practice parameter: MRI of the liver (2025); ACR LI-RADS; Abbreviated MRI for HCC surveillance (RadioGraphics 2020).

Gadoxetate (hepatobiliary)

Add hepatobiliary phase ~20 min post-injection.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)in/opposed-phase	Ax 3D	min	dual-echo	–	3–4	360–420	256	Chemical shift
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE± fat-sat	Ax	1500–2500	80–100	–	5–6	360–420	320	–
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	5–6	360–420	128	b0/50, 400, 800; ADC
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)dynamic post-Gd	Ax 3D	min	min	–	3	360–420	256	Arterial / PV / transitional
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)hepatobiliary phase	Ax 3D	min	min	–	3	360–420	256	~20 min post-injection

LI-RADS; AMRI.^41,43

What each sequence is for

Axial 3D T1, in-phase and opposed-phase: Checks the liver and any nodule for fat and iron before contrast: fat darkens on the opposed-phase image and iron on the in-phase image.
Axial T2, with or without fat-sat: Shows cysts and haemangiomas as very bright, which separates them from solid nodules.
Axial DWI: Small cancers and metastases hold water still and show as bright spots.
Axial 3D T1, dynamic after contrast: Shows how nodules light up as contrast arrives. With this agent washout is judged only on the portal venous phase, because liver cells start taking up the contrast soon after (the transitional phase).
Axial 3D T1, hepatobiliary phase: Working liver cells take up this contrast and turn bright; most cancers and metastases have no working liver cells, so they stay dark and stand out.

References: ACR–SABI–SAR–SPR practice parameter: MRI of the liver (2025); ACR LI-RADS.

Abbreviated (non-contrast surveillance)

Non-contrast HCC surveillance ~10 min.

✓	Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
	T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE± fat-sat	Ax	1500	90	–	5–6	380	256	Surveillance
	DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	5–6	380	128	b0/500/800; ADC

AMRI.⁴³

What each sequence is for

Axial T2, with or without fat-sat: Shows nodules against the background liver. Very bright ones are usually cysts or haemangiomas, while a mildly bright nodule needs a closer look.
Axial DWI: The main detection sequence without contrast: small cancers hold water still and show as bright spots.

References: Abbreviated MRI for HCC surveillance (RadioGraphics 2020).

Breast

Full dynamic

Days 7–14 of cycle (premenopausal) to minimise background parenchymal enhancement.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)pre, fat-sat	Ax 3D	min	min	–	≤1–1.5	320–360	384	Bilateral high-res
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)dynamic post ×4–5, fat-sat	Ax 3D	min	min	–	≤1–1.5	320–360	384	≤60–90 s/phase; subtraction + MIP; kinetics
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3000–4000	90	–	3–4	320–360	384	Cysts, oedema
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	4	320–360	128	b0/800; SPAIR; adjunct

EUSOBI; DWI WG.^44,46

What each sequence is for

Axial 3D T1 fat-sat, before contrast: The ‘before’ picture of both breasts. It is subtracted from the later scans so only tissue that takes up contrast is left.
Axial 3D T1 fat-sat, dynamic after contrast: Repeated scans after contrast. Cancers usually light up early, and how the signal then behaves over the next minutes (keeps rising, levels off or falls) helps tell cancer from benign change.
Axial T2: Fluid is bright, so cysts are recognised and swelling (oedema) in the breast or skin is seen.
Axial DWI: An add-on: cancers usually restrict water movement, which helps separate them from benign spots that also take up contrast and can avoid some biopsies.

References: ACR practice parameter: contrast-enhanced breast MRI (2023); EUSOBI / ESR Essentials: breast screening (2024); EUSOBI breast DWI consensus (2020).

Abbreviated (Kuhl FAST)

~3 min; diagnostic accuracy ≈ full protocol.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)pre, fat-sat	Ax 3D	min	min	–	≤1.5	320–360	384	–
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)1st post, fat-sat	Ax 3D	min	min	–	≤1.5	320–360	384	Single post; subtraction + MIP
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEoptional	Ax	3000	90	–	4	320–360	320	± DWI

Kuhl FAST.⁴⁵

What each sequence is for

Axial 3D T1 fat-sat, before contrast: The baseline for subtraction, so only tissue that takes up contrast shows on the post-contrast image.
Axial 3D T1 fat-sat, first scan after contrast: A single early scan after contrast. Subtracting the baseline and stacking all slices into one projection (MIP) shows a cancer as a bright spot on one overview image.
Axial T2, optional: Optional: fluid is bright, which helps recognise cysts and some benign lumps.

References: Abbreviated breast MRI, Kuhl (J Clin Oncol 2014); EUSOBI / ESR Essentials: breast screening (2024).

Rectum

Primary staging

No routine DCE; spasmolytic optional.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100	–	3	200–240	320	Planning
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res	Obl-Ax	3000–4000	100	–	3 / 0	160–200	320–512	⟂ tumour; mrT, mrCRM, EMVI; <1 mm
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res	Obl-Cor	3000	100	–	3	160–200	320	Low tumours / anal canal
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	3–4	200–240	128	b0/800–1000; nodes

ESGAR/Radiology Assistant.⁴⁷

What each sequence is for

Sagittal T2: A side view of the rectum and pelvis. It shows the tumour’s length and height and is used to plan the angled slices that follow.
Oblique axial T2, high resolution: The main staging images, cut straight across the tumour. They show how far it has grown through the bowel wall, how close it is to the mesorectal fascia (the surgeon’s cutting plane) and tumour inside veins (EMVI).
Oblique coronal T2, high resolution: For low tumours, slices along the anal canal show whether the tumour reaches the sphincter muscles, which guides the choice of operation.
Axial DWI: Tumour and lymph nodes show as bright spots, which helps find them. How deep the tumour goes and whether nodes are involved are judged on the T2 images, not on DWI.

References: ESGAR rectal cancer consensus, part I: primary staging (2026); Radiology Assistant: rectal cancer MR staging.

Restaging (post-neoadjuvant)

DWI integral to distinguishing residual tumour from fibrosis.

✓	Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
	T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res	Obl-Ax	3000–4000	100	–	3	160–200	320–512	Fibrosis vs tumour
	DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	3–4	200–240	128	High b (residual tumour)

ESGAR Part II.⁴⁷

What each sequence is for

Oblique axial T2, high resolution: After treatment much of the tumour can turn into dark scar (fibrosis). These slices, in the same plane as before treatment, show how much scar and how much tumour-like signal is left.
Axial DWI: Leftover tumour stays bright on the high b-value images while scar does not, so DWI is the main tool for telling a complete response from remaining tumour.

References: ESGAR rectal cancer consensus, part II: restaging (2026); Radiology Assistant: rectal cancer MR staging.

Pancreas & biliary

MRCP (standard)

Heavily T2W; static bile/pancreatic fluid bright.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
3D heavily-T2W FSESPACE (MRCP)CUBE (MRCP)VISTA (MRCP)MVOX / FASE-3D	Cor obl 3D	resp-trig	500–700	–	1–1.5 iso	300–360	320	MIP / reformats
2D thick-slab SS-FSEHASTE slabSSFSE slabSShTSE slabFASE slab	Cor radial	–	800–1000	–	40–60 slab	300	256	Quick overview
Single-shot FSEHASTESSFSESShTSEFASE	Ax/Cor	–	90	–	4–5	320–380	256	Parenchyma, ducts
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)± post-Gd	Ax 3D	min	min	–	3	360	256	If mass/inflammation

ABC of MRCP.⁴⁸

What each sequence is for

Coronal oblique 3D heavily T2-weighted FSE: Only still fluid (bile and pancreatic juice) stays bright, so the bile ducts and pancreatic duct appear like a tree that can be turned and re-sliced in any direction. Stones and narrowings show as dark gaps or tapering.
Coronal radial 2D thick-slab single-shot FSE: Thick slabs taken like the spokes of a wheel, each in one breath-hold. They give a quick overview of the whole duct system, even when a patient cannot keep still for the 3D scan.
Axial and coronal single-shot FSE: Thin T2 slices show the ducts in cross-section, where small stones show as dark dots in bright bile. Small stones can be hidden on the thick slabs and 3D projections, so these slices are checked too.
Axial 3D T1, with or without contrast: Added when a mass or inflammation is suspected: contrast shows tumours and inflamed tissue in the pancreas and around the ducts.

References: The ABC of MRCP (Insights Imaging 2012).

Secretin-enhanced MRCP

IV secretin stimulates exocrine flow (duct dynamics / compliance).

✓	Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
	2D thick-slab SS-FSEHASTE slabSSFSE slabSShTSE slabFASE slabserial	Cor slab	–	800–1000	–	40–50 slab	300	256	Serial ~10–15 min post-secretin
	3D heavily-T2W FSESPACE (MRCP)CUBE (MRCP)VISTA (MRCP)MVOX / FASE-3D	Cor obl 3D	resp-trig	600	–	1–1.5 iso	320	320	Baseline anatomy

Secretin-MRCP.⁴⁸

What each sequence is for

Coronal 2D thick-slab single-shot FSE, repeated: The same slab is repeated after an injection of secretin, a hormone that makes the pancreas release fluid. The pancreatic duct fills and widens and fluid arrives in the duodenum, which shows duct narrowings, leaks and how well the pancreas works.
Coronal oblique 3D heavily T2-weighted FSE: The standard 3D duct picture, taken before secretin, for the duct anatomy and any stones.

References: The ABC of MRCP (Insights Imaging 2012).

Small bowel

MR enterography (standard)

~1–1.5 L oral contrast for distension + antiperistaltic agent.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Single-shot FSEHASTESSFSESShTSEFASE	Cor + Ax	–	90	–	4–5	380–420	256	± fat-sat; distension
Balanced SSFPTrueFISPFIESTAbFFETrue SSFP	Cor + Ax	min	min	–	4–5	380–420	256	Wall, mesentery
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	5	380–420	128	b0/800; inflammation
Cine bSSFPCINE TrueFISPFIESTA cinebFFE cineTrue SSFP cinemotility	Cor	min	min	–	8–10	400	192	~20 s/level
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)dynamic post-Gd fat-sat	Ax 3D	min	min	–	3	380–420	256	Enteric-phase mural enhancement

SAR consensus.⁴⁹

What each sequence is for

Coronal and axial single-shot FSE, with or without fat-sat: Fluid-filled bowel is bright and the wall grey. It shows thickened bowel wall and, with fat suppression, bright swelling in the wall from active Crohn’s inflammation.
Coronal and axial balanced SSFP: Hardly affected by bowel movement. It shows the bowel wall, the fat and vessels around the bowel (mesentery), including crowded vessels next to inflamed bowel (the comb sign), and lymph nodes.
Axial DWI: Inflamed bowel wall and abscesses restrict water movement and light up, which helps find active disease and collections.
Coronal cine bSSFP: A short film of the bowel moving. A true narrowing (stricture) stays fixed while normal bowel squeezes and relaxes, and diseased segments often move less.
Axial 3D T1 fat-sat, dynamic after contrast: Inflamed bowel wall takes up contrast strongly in the enteric phase, and the contrast images also show fistulas and abscesses.

References: ESGAR/ESPR small-bowel imaging technique consensus (2017); SAR consensus: Crohn small-bowel strictures (Radiology 2025).

Abbreviated (non-contrast)

≤5 sequences, <12 min room time, no IV contrast.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Single-shot FSEHASTESSFSESShTSEFASE	Cor + Ax	–	90	–	4–5	380–420	256	± fat-sat
Balanced SSFPTrueFISPFIESTAbFFETrue SSFP	Cor	min	min	–	4–5	400	256	Wall
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	5	400	128	b0/800

Abbreviated MRE.⁴⁹

What each sequence is for

Coronal and axial single-shot FSE, with or without fat-sat: Shows the fluid-filled bowel, thickened wall and, with fat suppression, swelling in the wall from active inflammation.
Coronal balanced SSFP: Motion-resistant pictures of the bowel wall and the fat and vessels around it.
Axial DWI: Stands in for contrast when looking for inflammation: inflamed bowel wall restricts water movement and lights up.

References: ESGAR/ESPR small-bowel imaging technique consensus (2017); SAR consensus: Crohn small-bowel strictures (Radiology 2025).

Adrenal

Adrenal mass (adenoma vs non-adenoma)

Chemical-shift (in/opposed-phase) is the workhorse: intracellular-lipid signal drop-out on opposed-phase → lipid-rich adenoma (signal-intensity index >16.5%, or visual dropout vs spleen). Lipid-poor/indeterminate → dynamic post-Gd (or CT washout). DWI does not reliably separate adenoma from malignancy.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T1 dual-echo GRE (in/opp)2-echo FLASH / VIBE Dixon2-echo SPGR / LAVA-Flexdual-echo FFE / mDIXONDual-echo Fast FEchemical shift	Ax	min	1.5T: in ~4.4 / opp ~2.23T: in ~2.2 / opp ~1.1¹⁰⁹	–	4–5	320–400	256	Adenoma drop-out; SI index >16.5%
T2 TSE/FSET2 TSE / HASTET2 FSE / SSFSET2 TSE / SShTSET2 FSE / FASE± fat-sat	Ax/Cor	1500–2500	90	–	4–5	320–400	256	Cyst, phaeo (light-bulb), necrosis
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)dynamic post-Gd, fat-sat	Ax 3D	min	min	–	3	320–400	224	Lipid-poor / indeterminate; phaeo, ACC, mets
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)adjunct	Ax	long	min	–	5	320–400	128	b0/800; does not separate adenoma vs malignancy

ACR incidental adrenal white paper; chemical-shift MR.^78,79

What each sequence is for

Axial T1 dual-echo GRE, in-phase and opposed-phase: The main test. Most adrenal adenomas have fat inside their cells, so they turn darker on the opposed-phase image than on the in-phase image; cancers and metastases usually do not.
Axial and coronal T2, with or without fat-sat: Fluid is bright: cysts are very bright, a phaeochromocytoma can be very bright too, and dead (necrotic) areas in a large tumour show up.
Axial 3D T1 fat-sat, dynamic after contrast: Added for masses that do not darken on the opposed-phase image. It shows how the mass enhances, whether it has a dead centre and whether it invades nearby structures.
Axial DWI, add-on: An add-on only: it helps spot the mass, but adenomas and cancers can look the same on DWI, so it does not decide the diagnosis.

References: Chemical shift MRI of the adrenal gland (RadioGraphics 2016); ACR white paper: incidental adrenal masses (2017).

Kidney

Solid renal mass (ccLS)ccLS

Clear-cell Likelihood Score (ccLS 1–5) for indeterminate small (cT1) solid renal masses. Three core features: T2 signal of the enhancing tissue, corticomedullary-phase enhancement, and microscopic fat (in/opposed-phase drop-out); DWI and macroscopic fat are adjuncts. Subtraction confirms true enhancement.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSE (+ SS-FSE)T2 TSE / HASTET2 FSE / SSFSET2 TSE / SShTSET2 FSE / FASE	Ax + Cor	2000–4000	90	–	3–4	320–380	320	Predominant T2 signal of enhancing tissue
T1 dual-echo GRE (in/opp)2-echo FLASH / VIBE Dixon2-echo SPGR / LAVA-Flexdual-echo FFE / mDIXONDual-echo Fast FEchemical shift	Ax	min	dual-echo	–	3–4	320–380	256	Microscopic (intracellular) fat drop-out
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	4–5	320–380	128	b0/800; adjunct feature; ADC
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)multiphase post-Gd, fat-sat	Ax/Cor 3D	min	min	–	3	320–380	224	Corticomedullary (key) / nephrographic / excretory; subtraction

ccLS (Radiology, How We Do It).⁸⁰

What each sequence is for

Axial and coronal T2, plus single-shot FSE: Compares the solid part of the mass with the kidney cortex. Clear-cell cancer, the commonest kidney cancer, is usually brighter; papillary cancer and fat-poor angiomyolipoma are usually darker.
Axial T1 dual-echo GRE, in-phase and opposed-phase: Tiny amounts of fat inside cells make the tissue darker on the opposed-phase image, a feature that favours clear-cell cancer.
Axial DWI: A supporting feature used in some branches of the score: marked restriction points away from clear-cell cancer.
Axial and coronal 3D T1 fat-sat, multiphase after contrast: Scans timed as contrast passes through the kidney. Strong enhancement in the early (corticomedullary) phase is typical of clear-cell cancer, and subtracting the pre-contrast image proves the mass truly enhances.

References: Clear cell likelihood score, How We Do It (Radiology).

Bladder

Bladder cancer (VI-RADS)VI-RADS

VI-RADS (1–5) predicts detrusor (muscularis propria) invasion. Moderate bladder distension; image before biopsy/TURBT or ≥2 weeks after. T2 (structural) + DWI + DCE combine into the score; DWI is the dominant sequence.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res, small-FOV	Ax + Sag + Cor	3000–5000	100	–	3–4	200–250	320–384	Muscularis propria integrity; VI-RADS structural
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)dominant	Ax (± Sag)	long	min	–	3–4	200–250	128	b0/800–1000 + calc b1400–2000; stalk/interface
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)DCE	Ax (± Sag) 3D	min	min	–	≤3	220–260	224	~30 s temporal; early tumour vs muscle enhancement

VI-RADS (Panebianco, Eur Urol 2018).⁸¹

What each sequence is for

Axial, sagittal and coronal T2, high resolution: The bladder’s muscle wall is a dark line on T2. Detailed views in three planes show whether the tumour stays on the inner surface or breaks into or through that dark line.
Axial DWI, with or without sagittal: The main sequence for judging invasion: tumour is bright and the muscle wall grey. Bright tumour reaching into the muscle suggests invasion, while a dark stalk or dark thickened inner layer under the tumour suggests it has not.
Axial 3D T1 DCE, with or without sagittal: The inner lining and the tumour light up early, before the muscle wall, so early enhancement reaching into the muscle suggests invasion.

References: VI-RADS (Eur Urol 2018).

Anal fistula

Perianal fistula (St James)

Small-FOV centred on the anal canal; plane axial- and coronal-oblique orthogonal/parallel to the canal. St James grade 1–5 (intersphincteric → trans-sphincteric → supralevator, ± abscess/secondary tracks) + active vs fibrotic (T2/STIR-bright + enhancement = active). No luminal contrast needed.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res, small-FOV	Ax-obl + Cor-obl	3000–4000	90	–	3 / 0	180–220	320	Tract, internal opening, sphincter relation (St James)
T2 FSE fat-sat / STIRT2 TSE FS / STIRT2 FSE FS / STIRT2 TSE SPAIR / STIRT2 FSE FS / STIR	Ax-obl + Cor-obl	3000–4000	90	1.5T: 150–1803T: ~205–225¹⁰⁹	3	180–220	320	Active tract/abscess bright; secondary extensions
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Ax-obl	500–700	10	–	3–4	200–240	256	Anatomy, ischioanal fat planes
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	4	200–240	128	b0/800; abscess restricts; adjunct to post-Gd
T1 spoiled GRE fat-sat post-GdVIBE FS post-GdLAVA FS post-GdTHRIVE FS post-GdFast FE FS post-Gd	Ax-obl + Cor-obl	min	min	–	3	180–220	256	Active (enhancing) vs fibrotic; abscess wall

MRI of perianal fistulas (RadioGraphics 2025).⁸²

What each sequence is for

Oblique axial and oblique coronal T2, high resolution: Detailed pictures angled to the anal canal show the sphincter muscles and the fistula tract crossing them, so the tract can be graded (St James) and its opening into the anal canal found.
Oblique axial and oblique coronal T2 fat-sat or STIR: Fat is switched off, so fluid-filled active tracts and abscesses are very bright and side branches are easier to follow.
Oblique axial T1: Shows the anatomy and the fat beside the anal canal (ischioanal fossa), where a tract or scar shows as a dark line crossing the bright fat.
Axial DWI: An add-on: pus in an abscess restricts water movement strongly and lights up.
Oblique axial and oblique coronal T1 fat-sat, after contrast: Active, inflamed tracts take up contrast while healed, scarred tracts do not, and an abscess shows as fluid with an enhancing rim.

References: MRI of perianal fistulas (RadioGraphics).

Gynecologic / pelvis

Endometrial cancer

ESUR 2025, aligned to 2023 FIGO.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100	–	3–4	200–240	320	–
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEsmall-FOV, short-axis uterus	Obl	3000	100	–	3–4	200–240	320	Myometrial invasion
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax obl	long	min	–	3–4	220–260	128	b0/800–1000
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)DCE	Sag 3D	min	min	–	3	240	224	Invasion depth (equilibrium)
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Ax	500	10	–	5	320	256	Nodes

ESUR endometrial.⁵⁰

What each sequence is for

Sagittal T2: A side view of the uterus showing the tumour in the cavity, the dark inner layer of the muscle (junctional zone) and the cervix below.
Oblique T2, short axis of the uterus, small field of view: Slices cut straight across the uterus through the tumour show how deep it has grown into the muscle wall, the main staging question.
Oblique axial DWI: Tumour restricts water movement and is bright against the darker muscle, which helps judge the depth of invasion and find small deposits and nodes.
Sagittal 3D T1 DCE: The tumour takes up less contrast than the surrounding muscle, so its deepest edge shows as a darker area against brighter muscle.
Axial T1: A large view of the pelvis to check the lymph nodes along the pelvic vessels and the bones.

References: ESUR endometrial cancer guidelines (2025).

Cervical cancer

T2 + DWI for staging/response/recurrence; DCE optional.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100	–	3–4	200–240	320	–
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEsmall-FOV ⟂ cervix	Obl-Ax	3000	100	–	3–4	180–220	320	Parametrial invasion
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax obl	long	min	–	3–4	220–260	128	b0/800–1000
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)DCE optional	Sag 3D	min	min	–	3	240	224	Research / recurrence

ESUR cervical.⁵¹

What each sequence is for

Sagittal T2: Shows the tumour in the cervix, how far it extends up into the uterus or down into the vagina, and its relation to the bladder and rectum.
Oblique axial T2, perpendicular to the cervix, small field of view: Slices cut straight across the cervix show whether the tumour breaks through the dark ring of cervical tissue into the fat beside it (the parametrium), a key point in choosing between surgery and chemoradiotherapy.
Oblique axial DWI: Tumour is bright on DWI, which helps show its size and edges, find lymph nodes and tell remaining tumour from scar after treatment.
Sagittal 3D T1 DCE, optional: Optional; mainly a research tool, and it may help when recurrence is suspected.

References: ESUR cervical cancer guidelines (2021).

Ovarian / adnexalO-RADS

O-RADS MRI risk score from solid-tissue enhancement: DCE time-intensity curve (low / intermediate / high) vs the outer myometrium; a non-DCE pathway uses delayed post-contrast enhancement relative to myometrium.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEsmall-FOV	Sag + Ax + Cor	3000–4000	100	–	3–4	200–240	320	Solid tissue, locules, fat/fibrous
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Ax	500–700	10	–	4–5	300–340	256	Fat vs blood (pair with FS)
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Ax	500–700	10	–	4–5	300–340	256	Endometrioma/haemorrhage vs fat
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	4–5	300–340	128	b0/800–1000; solid components
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)DCE	Ax 3D	min	min	–	≤3	240–300	224	15 s temporal, start 30 s pre-Gd, 4 min; TIC vs myometrium

O-RADS MRI (ACR).⁶⁹

What each sequence is for

Sagittal, axial and coronal T2, small field of view: Shows the inside of the mass: fluid spaces, walls and any solid tissue. Solid tissue that is very dark on T2 and on DWI is fibrous and usually benign.
Axial T1: Fat and blood are both bright on T1; this is the first half of the test that tells them apart.
Axial T1 fat-sat: If the bright area goes dark with fat suppression it is fat, as in a dermoid; if it stays bright it is blood, as in an endometrioma or a bleeding cyst.
Axial DWI: Solid tissue that stays dark on the high b-value images is reassuring; bright solid tissue needs the contrast study to judge risk.
Axial 3D T1 DCE: Solid tissue is timed against the outer muscle of the uterus: tissue whose signal rises faster than the muscle’s (a high-risk curve) points to cancer.

References: ACR O-RADS MRI risk stratification.

Endometriosis (deep pelvic)

ESUR 2025: fasting + antiperistaltic agent, moderate bladder filling, ± bowel / vaginal-rectal opacification; compartment-based reporting; T1 fat-sat is key to confirm haemorrhagic foci.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEhigh-res, multiplanar	Sag + Ax + Cor	3000–4000	100	–	3–4	200–250	320–384	DIE: uterosacrals, torus, pouch of Douglas, rectovaginal
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Ax	500–700	10	–	4–5	300–340	256	Baseline
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSEfat-sat	Ax (± Sag)	500–700	10	–	4–5	300–340	256	Confirm blood products (T1-bright persists)
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSEcover kidneys	Cor	3000	100	–	4–5	350–400	320	Ureteric involvement / hydronephrosis

ESUR endometriosis 2025.⁷⁰

What each sequence is for

Sagittal, axial and coronal T2, high resolution: Deep endometriosis shows as dark, scar-like thickening that pulls organs together. These views check the ligaments behind the cervix, the pouch of Douglas, the rectum and the bladder.
Axial T1: Fat and old blood are both bright; this is the comparison picture for the fat-suppressed T1.
Axial T1 fat-sat, with or without sagittal: Old blood stays bright when fat is switched off, so endometriomas and small bleeding spots of endometriosis stand out.
Coronal T2 including the kidneys: A large view up to the kidneys shows whether endometriosis has narrowed a ureter and made the kidney swell (hydronephrosis).

References: ESUR endometriosis MRI consensus (2025).

Fibroids / adenomyosis

ESUR leiomyoma: pre-uterine-artery-embolisation map: fibroid number/size/FIGO location + enhancement (viability); report coexisting adenomyosis (junctional zone >12 mm; affects UAE outcome).

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Sag	3000–4000	100	–	4	240–280	320	Fibroid map (FIGO), junctional zone
T2 TSE/FSET2 TSET2 FSET2 TSET2 FSE	Ax	3000–4000	100	–	4	240–280	320	Number, size, location
T1 TSE/FSET1 TSET1 FSET1 TSET1 FSE	Ax	500–700	10	–	5	300–340	256	Haemorrhagic/red degeneration
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	4–5	300	128	b0/800; atypical/rapid-growth (sarcoma caution)
3D T1 spoiled GREVIBELAVATHRIVE3D Fast FE (Quick3D)DCE / post-Gd	Sag + Ax 3D	min	min	–	3	260–300	224	Viability pre-UAE (non-enhancing = poor target); ovarian supply

ESUR leiomyoma.⁷¹

What each sequence is for

Sagittal T2: Fibroids are usually dark, round masses. The side view shows where each sits relative to the lining and outer surface of the uterus (its FIGO type) and the thickness of the inner muscle layer (junctional zone), which is thickened in adenomyosis.
Axial T2: A second plane to count and measure the fibroids and show where they lie.
Axial T1: A fibroid that is bright on T1 has bled inside (red degeneration).
Axial DWI: Helps check an unusual-looking mass: the rare cancer leiomyosarcoma usually restricts water movement, while ordinary fibroids vary.
Sagittal and axial 3D T1, dynamic or after contrast: Shows whether each fibroid still has a blood supply before embolisation; a fibroid that does not enhance has already lost its blood supply.

References: ESUR leiomyoma MRI guidelines (2018).

Placenta accreta spectrum

Obstetric, usually 3rd trimester; NO gadolinium; moderate bladder filling. SAR–ESUR 7 MRI features: dark intraplacental T2 bands, placental bulge, myometrial thinning, bladder-wall interruption, focal exophytic mass, abnormal vascularity, heterogeneity.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Single-shot FSEHASTESSFSESShTSEFASET2, heavily-weighted	Sag + Ax + Cor	–	90	–	4	300–400	256	No contrast; dark T2 bands, bulge, myometrial thinning
Balanced SSFPTrueFISPFIESTAbFFETrue SSFP	Sag + Ax	min	min	–	4	300–400	256	Uterine/bladder interface, serosa
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)optional	Ax	long	min	–	5	350–400	128	Optional: placental boundary delineation

SAR–ESUR PAS consensus.⁷²

What each sequence is for

Sagittal, axial and coronal single-shot T2: Each slice is taken so quickly that the baby’s movement does not blur it. The pictures show signs of placenta growing into the uterine wall: dark bands in the placenta, bulging of the uterus and thinning or loss of the muscle layer.
Sagittal and axial balanced SSFP: Shows the blood vessels in and under the placenta and the border between uterus and bladder; abnormal vessels and a broken bladder-wall line point to invasion.
Axial DWI, optional: Optional: the placenta is bright on DWI, which can make its edge against the uterine wall easier to see.

References: SAR–ESUR placenta accreta spectrum consensus (2020).

Bowel / acute abdomen

Appendicitis (non-contrast)

US-first; MRI when ultrasound is inconclusive, the imaging of choice in pregnancy and often in children (no ionising radiation). 1.5 T preferred (limits fetal heating); no oral/IV contrast. Positive: dilated (>7 mm) blind-ending tubular structure, wall oedema, periappendiceal fluid/fat stranding, restricted diffusion.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Single-shot FSEHASTESSFSESShTSEFASE	Ax + Cor	–	90	–	4–5	300–360	256	Large-FOV survey; blind-ending tube
Single-shot FSE (STIR)HASTE TIRMSSFSE STIRSShTSE STIRFASE STIRfat-sat / STIR	Ax + Cor	–	90	1.5T: 150–1803T: ~205–225¹⁰⁹	4–5	300–360	256	Periappendiceal fluid, fat stranding
3D T1 spoiled GRE (Dixon)VIBE DixonLAVA-FlexmDIXON3D Fast FE Dixonin/opposed-phase	Ax	min	dual-echo	–	3–4	320–380	256	Appendicolith, blood, fat planes (no Gd)
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	4–5	300–360	128	b0/800; inflamed wall, abscess
Balanced SSFPTrueFISPFIESTAbFFETrue SSFPoptional	Cor	min	min	–	4–5	320–380	256	Motion-robust; free fluid, bowel

ACR AC Right Lower Quadrant Pain 2022; MR appendicitis in pregnancy.^73,74

What each sequence is for

Axial and coronal single-shot FSE: Fast T2 pictures of the abdomen that hold up despite breathing. They find the appendix, a thin blind-ending tube, and show whether it is swollen and fluid-filled.
Axial and coronal single-shot FSE with fat suppression (STIR): Fat is switched off, so inflammation around the appendix shows as bright fluid and hazy fat.
Axial 3D T1 Dixon, in-phase and opposed-phase: Shows blood as bright and the fat planes around the bowel, without contrast.
Axial DWI: An inflamed appendix wall and any abscess restrict water movement and light up.
Coronal balanced SSFP, optional: Optional: motion-resistant pictures of the bowel loops and any free fluid.

References: ACR Appropriateness Criteria: right lower quadrant pain (2022); MRI of abdominal pain in pregnancy (RadioGraphics 2012).

Acute abdomen in pregnancy

Non-contrast maternal survey for non-obstetric acute abdomen/pelvis: appendicitis, cholecystitis/choledocholithiasis, adnexal torsion, ovarian-vein thrombosis, urolithiasis/hydronephrosis, bowel obstruction. 1.5 T; multiplanar; add thick-slab MRCP if biliary.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Single-shot FSEHASTESSFSESShTSEFASE	Ax + Cor + Sag	–	90	–	4–5	350–400	256	Diaphragm→pubis survey; fluid/oedema
Single-shot FSE (STIR)HASTE TIRMSSFSE STIRSShTSE STIRFASE STIRfat-sat / STIR	Ax + Cor	–	90	150–180	4–5	350–400	256	Inflammation, oedema
3D T1 spoiled GRE (Dixon)VIBE DixonLAVA-FlexmDIXON3D Fast FE Dixonin/opposed-phase	Ax	min	dual-echo	–	3–4	350–400	256	Blood, fat, adrenal; no Gd
DWI (SS-EPI)DWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI/FASE)	Ax	long	min	–	5	350–400	128	b0/800; abscess, torsion, bowel
Balanced SSFPTrueFISPFIESTAbFFETrue SSFP	Cor + Ax	min	min	–	4–5	380–420	256	Bowel, ovarian vein, free fluid
2D thick-slab SS-FSE (MRCP)HASTE slabSSFSE slabSShTSE slabFASE slabif biliary	Cor radial	–	800–1000	–	40–60 slab	300	256	Choledocholithiasis / CBD

MR acute abdomen in pregnancy (RadioGraphics).⁷⁴

What each sequence is for

Axial, coronal and sagittal single-shot FSE: Fast T2 pictures from the diaphragm to the pubis in three planes. They show the appendix, gallbladder, kidneys, ovaries and bowel, and any fluid or swelling.
Axial and coronal single-shot FSE with fat suppression (STIR): Fat is switched off, so inflammation around an organ such as the appendix, gallbladder or bowel shows as bright fluid.
Axial 3D T1 Dixon, in-phase and opposed-phase: Blood is bright on T1, so bleeding, for example into an ovarian cyst, is seen without contrast.
Axial DWI: Inflamed tissue and abscesses restrict water movement and light up, which helps find the source of pain.
Coronal and axial balanced SSFP: Blood vessels are bright on this sequence, so a clot in the ovarian vein shows as a dark filling defect; it also shows bowel loops and free fluid.
Coronal radial 2D thick-slab MRCP, if biliary: Added when the pain may come from the gallbladder or bile ducts: bile is bright, so a stone in the common bile duct shows as a dark gap.

References: MRI of abdominal pain in pregnancy (RadioGraphics 2012); ACR Appropriateness Criteria: right lower quadrant pain (2022).

Obstetric / fetal

Fetal MRI (brain ± body)

Complementary to neurosonography; 1.5 T standard (3 T acceptable; ACR–SPR: minimal fetal risk); NO contrast, NO maternal sedation. Single-shot T2 is the workhorse, re-planned to fetal anatomy for every stack; keep SAR in normal operating mode and minimise scan time.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Single-shot FSE (T2)HASTESSFSESShTSEFASEworkhorse	3 planes to fetal brain	–	90–140	–	3–4 / 0	small (fetal head)	256	Re-plan each stack; cortex, ventricles, posterior fossa
Single-shot FSE (T2)HASTESSFSESShTSEFASE	3 planes to fetal body	–	90	–	3–4	fetal trunk	256	Thorax/abdomen, lung signal, GI
Balanced SSFPTrueFISPFIESTAbFFETrue SSFP	Multiplanar	min	min	–	3–4	fetal	256	Heart/vessels, spine; motion-robust
T1 spoiled GREFLASH / VIBESPGR / LAVAT1-FFE / THRIVEFast FE	Ax	min	min	–	4–5	fetal	192	Fat, meconium (bowel), haemorrhage, thyroid/liver
DWI / EPIDWI (EPI)DWI (EPI)DWI (EPI)DWI (EPI)	Ax	long	min	–	4–5	fetal	128	b0/600–700; brain injury (ADC), blood/mineral (EPI/T2*)

ACR–SPR fetal MRI parameter; ISUOG fetal MRI 2023.^75,76

What each sequence is for

Single-shot T2, three planes to the fetal brain: Each slice is taken so fast that fetal movement does not blur it. Planned to the fetal head in three planes, it shows the ventricles, the folding of the cortex, the corpus callosum and the back of the brain (posterior fossa).
Single-shot T2, three planes to the fetal body: The same fast T2 planned to the fetal body shows the lungs, diaphragm, kidneys, stomach and bladder; in a diaphragmatic hernia, for example, it shows which organs have moved into the chest.
Balanced SSFP, several planes: Motion-resistant pictures with bright fluid and blood that show the heart and large vessels, and the spine and cord.
Axial T1 spoiled GRE: Meconium in the bowel, blood from a bleed, fat, and the normal thyroid and liver are bright on T1, so it helps map the bowel and find bleeding.
Axial DWI and EPI: DWI can show recent injury to the fetal brain from lack of blood or oxygen, and the fast gradient-echo (EPI) images show blood as dark areas.

References: ACR–SPR fetal MRI practice parameter; ISUOG fetal MRI practice guidelines (2023).

Pediatric

Free-breathing with respiratory navigators/triggering; motion-robust radial acquisitions; feed-and-wrap for infants.⁵²
DL / compressed-sensing acceleration; DL low-dose gadolinium reconstruction to cut contrast burden.
Paediatric IBD MRE: non-contrast / abbreviated protocols + DWI to avoid repeated gadolinium.

Pregnancy

MRI is preferred over CT for non-obstetric acute abdomen/pelvis and may be performed in any trimester when clinically indicated; no proven harm at 1.5 T or 3 T.³
Avoid gadolinium unless essential: GBCAs cross the placenta and have been associated with rare adverse fetal/childhood outcomes (stillbirth/neonatal death, inflammatory/infiltrative skin conditions).⁷⁷
No routine sedation or fasting (unless MRCP); left-lateral decubitus in the 3rd trimester to relieve IVC compression; keep SAR in normal operating mode and minimise acoustic noise and scan time.

Cardiac & vascular

Modular, indication-based (SCMR). Heart protocols are assembled per clinical question; mapping and iron thresholds need local reference ranges.

High-Yield Pearls: cardiac & vascular

Modular SCMR protocols are assembled per clinical question; cine bSSFP is the functional backbone for volumes and wall motion.
Ischaemia: vasodilator (adenosine) stress-first perfusion, then rest; LGE for viability/scar (TI ~300–420 ms, 10–20 min post-Gd; PSIR is less TI-sensitive).
Tissue characterisation: native/post T1 & T2 mapping with ECV; always interpret against local reference ranges.
Myocarditis (2018 Lake Louise): one T2-based plus one T1-based criterion.
Iron (T2*): mid-septal short-axis ROI; >20 ms normal, <10 ms severe (10–20 ms mild–moderate).
MRA: first-pass CE-MRA with bolus timing; QISS or ferumoxytol for non-contrast MRA when GBCA is contraindicated.

Heart

Function / ischaemia

Stress first, then ≥10 min before rest; add LGE for viability.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Cine bSSFPCINE TrueFISPFIESTA cinebFFE cineTrue SSFP cine	SA stack + 2/3/4-ch	~3	~1.4	–	6–8 / 2	340–380	~1.8 mm	Function/volumes; ~35–50 ms/phase
Perfusion (SR-GRE/EPI)perfusionperfusionperfusionperfusionvasodilator stress	3 × SA	~2	~1	sat-recovery	8–10	340	128	Adenosine; ~0.05–0.075 mmol/kg first-pass
LGE (IR-GRE/PSIR)PSIR (MAG-IR)MDE / PSIRPSIRPSIR	SA + LAX	R-R	~3	300–420	6–8	340	192	10–20 min post-Gd; PSIR less TI-sensitive

SCMR protocols; cine/LGE params; 2025 perfusion consensus.^53,54,58

What each sequence is for

Cine bSSFP, short-axis stack and 2-, 3- and 4-chamber views: Films of the beating heart with bright blood. The short-axis stack measures the size and pumping of each ventricle, and the long-axis views show wall movement and the valves.
Perfusion, three short-axis slices, vasodilator stress: Watches the first pass of contrast through the heart muscle while a drug (adenosine) widens healthy arteries. Muscle fed by a narrowed artery gets less blood and stays darker, showing where ischaemia is.
LGE (IR-GRE or PSIR), short and long axis: Taken some minutes after contrast, with normal muscle made black. Scar holds on to contrast and shows bright; heart-attack scar starts at the inner lining, and how far through the wall it reaches shows how much muscle could still recover (viability).

References: SCMR standardised CMR protocols (2020); SCMR quantitative perfusion consensus (2025).

Cardiomyopathy

Native T1 ~950–1050 ms (1.5T) / ~1150–1200 ms (3T); use local normals.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Cine bSSFPCINE TrueFISPFIESTA cinebFFE cineTrue SSFP cine	SA + LAX	~3	~1.4	–	6–8	340–380	~1.8 mm	Function, wall thickness
T1 mapping (MOLLI)MyoMaps MOLLIMOLLI / SMART1MapT1 mappingT1 mappingnative + post	SA basal/mid/apical	MOLLI	~1	scheme	8	340	160	ECV with haematocrit
T2 mappingMyoMaps T2T2 mapT2 mappingT2 mapping	SA	–	multi	–	8	340	160	Oedema
LGE (IR-GRE/PSIR)PSIR (MAG-IR)MDE / PSIRPSIRPSIR	SA + LAX	R-R	~3	300–420	6–8	340	192	Mid-wall/patchy = non-ischaemic

SCMR/EACVI mapping.^55,56

What each sequence is for

Cine bSSFP, short and long axis: Measures the size and pumping of each ventricle and the thickness of every wall segment, for example the thick walls of hypertrophic cardiomyopathy.
T1 mapping (MOLLI), native and after contrast: Measures T1 in each part of the heart muscle. Native T1 rises with scarring, swelling or amyloid and falls with iron or Fabry disease; with a blood haematocrit and the after-contrast map it gives the extracellular volume (ECV), the share of muscle that is space between cells.
T2 mapping: Measures water (oedema) in the heart muscle, a sign of active inflammation or recent injury.
LGE, short and long axis: Shows scar. Scar in the middle of the wall or in patches, rather than starting at the inner lining, points to a non-ischaemic cause such as dilated or hypertrophic cardiomyopathy, sarcoid or myocarditis.

References: SCMR standardised CMR protocols (2020); SCMR/EACVI CMR mapping recommendations.

Myocarditis

Updated (2018) Lake Louise: one T2-based + one T1-based criterion.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
Cine bSSFPCINE TrueFISPFIESTA cinebFFE cineTrue SSFP cine	SA + LAX	~3	~1.4	–	6–8	340	~1.8 mm	Function, pericardium
T2 mappingMyoMaps T2T2 mapT2 mappingT2 mapping	SA	–	multi	–	8	340	160	Oedema (T2 criterion)
T1 mapping (MOLLI)MyoMaps MOLLIMOLLI / SMART1MapT1 mappingT1 mappingnative + post / ECV	SA	MOLLI	~1	scheme	8	340	160	T1 criterion
LGE (IR-GRE/PSIR)PSIR (MAG-IR)MDE / PSIRPSIRPSIR	SA + LAX	R-R	~3	300–420	6–8	340	192	Non-ischaemic pattern

Lake Louise 2018.⁵⁷

What each sequence is for

Cine bSSFP, short and long axis: Shows how well the heart pumps and any fluid around the heart (pericardial effusion) when the inflammation spreads to its lining.
T2 mapping: Swelling in inflamed heart muscle raises T2; this meets the T2-based part of the Lake Louise criteria.
T1 mapping (MOLLI), native and after contrast (ECV): Native T1 and ECV rise with swelling and damage; a raised value meets the T1-based part.
LGE, short and long axis: Myocarditis leaves patchy scar in the middle or outer part of the wall, not starting at the inner lining as a heart attack does; this pattern also counts as a T1-based sign.

References: Updated Lake Louise criteria (JACC 2018); SCMR/EACVI CMR mapping recommendations.

Iron overload (T2*)

Cardiac T2* is the gold standard for myocardial iron.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
*T2 mappingT2* mapStarMap / T2mFFE T2T2* mapping**septal ROI	Mid-SA	–	multi (2–18 ms)	–	8–10	340	160	R2=1000/T2; >20 ms normal, <10 severe
Cine bSSFPCINE TrueFISPFIESTA cinebFFE cineTrue SSFP cine	SA + LAX	~3	~1.4	–	6–8	340	~1.8 mm	Function
*T2 mappingT2* mapStarMap / T2mFFE T2T2* mapping**liver	Ax (liver)	–	multi	–	10	380	160	LIC calibration (method-dependent)

T2* thresholds.⁶³

What each sequence is for

Mid short-axis T2* mapping, septal region: Iron makes heart muscle lose signal faster across a series of echoes. The T2* value measured in the septum, the wall between the ventricles, shows how much iron has built up in the heart.
Cine bSSFP, short and long axis: Checks how well the heart pumps, because heavy iron loading can weaken it.
Axial T2* mapping of the liver: The same measurement in the liver estimates its iron load, the body’s main iron store.

References: SCMR standardised CMR protocols (2020); SCMR/EACVI CMR mapping recommendations.

Vessels (MRA)

CE-MRA

General-purpose default; carotid, aorta, peripheral runoff.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
CE-MRA (3D spoiled GRE)CE-MRACE-MRACE-MRACE-MRA	Cor 3D	min	min	–	1–1.5	per station	~1 mm	First-pass Gd; test bolus / bolus tracking
Time-resolved CE-MRATWISTTRICKS4D-TRAKDRKStime-resolved	Cor 3D	min	min	–	1.5–2	per station	~1.5 mm	Dynamic (TWIST/TRICKS/4D-TRAK)
TOF MRATOFTOFTOF (inflow)TOFoptional supplement	Ax 3D	20–25	3–7	–	0.6–1	200	320	Carotid / intracranial

CE-MRA vs TOF.^60,61

What each sequence is for

Coronal 3D CE-MRA (spoiled GRE): A fast 3D scan timed so contrast is bright in the arteries on its first pass. It shows narrowings, blockages and aneurysms, and a timing step (test bolus or bolus tracking) makes sure the arteries are caught before the veins fill.
Coronal time-resolved CE-MRA: Many fast 3D scans in a row show contrast flowing in and out, like a film. It shows the order in which vessels fill, which helps with abnormal artery-to-vein connections (fistulas and malformations) and reduces the need for exact timing.
Axial 3D TOF MRA, optional: No contrast needed: fresh flowing blood is bright. It adds detail of the carotid arteries or the arteries inside the head.

References: ACR–NASCI–SPR practice parameter: body MRA (2025); ACR–ASNR–SNIS–SPR practice parameter: MRA of the head and neck (2025).

Non-contrast MRA

When gadolinium is contraindicated. Ferumoxytol steady-state (off-label) for infants/small vessels.

Sequence	Plane	TR	TE	TI	Slice/gap	FOV	Matrix/res	Other
QISS (non-contrast MRA)QISSQISSQISSQISS	Ax/Cor ECG-gated	R-R	min	quiescent	2–3	per station	~1 mm	Peripheral runoff; renal-safe
TOF MRATOFTOFTOF (inflow)TOF	Ax 3D	20–25	3–7	–	0.6–1	200	320	Carotid / intracranial
Balanced SSFPTrueFISPFIESTAbFFETrue SSFPnavigator, TSLIP	Cor	min	min	inversion	1.5–2	300	~1.3 mm	Renal / aorta

QISS; non-contrast; ferumoxytol.^60,61,62

What each sequence is for

Axial or coronal QISS, ECG-gated: A non-contrast method for the leg arteries: background tissue and veins are suppressed, and fresh arterial blood flows into the slice with each heartbeat, so the arteries are bright. Useful when contrast should be avoided, such as in severe kidney disease.
Axial 3D TOF MRA: Flowing blood is bright without contrast; it shows the carotid arteries and the arteries in the head.
Coronal balanced SSFP with inflow labelling, navigator: Bright-blood 3D imaging of the aorta and kidney arteries without contrast. A labelling pulse darkens the background and the veins so the arteries stand out, and the navigator times the scan to breathing.

References: ACR–NASCI–SPR practice parameter: body MRA (2025); QISS MRA review (Diagnostics 2018).

Pediatric

Free-breathing, navigator & DL-accelerated cine replace multiple breath-holds; validated in children (2025–2026).⁶⁴
Ferumoxytol for CE-MRA / 4D flow in infants and small-caliber low-flow vessels, outperforming gadolinium under anesthesia.⁶⁵
4D flow suits complex CHD anatomy; use pediatric resolution (2–2.5 mm³).⁵⁹

MRI Patient Positioning

Positioning, coil selection, centring landmarks, breathing strategy and comfort/immobilisation for common MRI exams, grouped by region. Expand a region to see the exam cards. Local protocols and coil availability vary; always follow your department’s SOP and manufacturer guidance.

Neuro7 exams

Brain (routine)

Position: Supine, head-first, arms by sides.
Coil: Head / head-neck array.
Landmark / centring: Centre on nasion (glabella); align canthomeatal line.
Breathing: n/a (still).
Immobilisation / comfort: Head cushions, forehead strap, ear plugs + defenders.
Tips / common errors: Keep head straight (rotation skews symmetric structures); pad to reduce motion.

Brain: epilepsy / hippocampal

Position: Supine, head-first, arms by sides.
Coil: Head / head-neck array.
Landmark / centring: Centre on nasion; angle obliques perpendicular to long axis of hippocampus.
Breathing: n/a.
Immobilisation / comfort: Head cushions, strap, hearing protection.
Tips / common errors: Prescribe thin coronal obliques ⟂ hippocampus; minimise head tilt for symmetry.

IAMs / CP angle

Position: Supine, head-first, arms by sides.
Coil: Head / head-neck array.
Landmark / centring: Centre on nasion; thin axial + high-res T2 through IACs.
Breathing: n/a.
Immobilisation / comfort: Head cushions, strap, ear protection.
Tips / common errors: Small FOV thin slices through IACs; symmetry critical for VII/VIII.

Pituitary / sella

Position: Supine, head-first, arms by sides.
Coil: Head array.
Landmark / centring: Centre on nasion; small-FOV coronal + sagittal through sella.
Breathing: n/a; dynamic post-contrast timing if microadenoma.
Immobilisation / comfort: Head cushions, strap, ear protection.
Tips / common errors: Thin (2–3 mm) coronal dynamic; time contrast for microadenoma.

Orbits

Position: Supine, head-first, eyes closed, gaze fixed straight ahead.
Coil: Head array (small surface coil optional).
Landmark / centring: Centre on orbits; fat-sat T2/T1 small FOV.
Breathing: n/a; instruct patient to keep eyes still.
Immobilisation / comfort: Head cushions, strap, ear protection.
Tips / common errors: Eyes still reduces motion blur; use fat suppression for orbital fat.

MRA: Circle of Willis

Position: Supine, head-first, arms by sides.
Coil: Head / head-neck array.
Landmark / centring: Centre on nasion; 3D TOF slab over circle of Willis.
Breathing: n/a.
Immobilisation / comfort: Head cushions, strap, ear protection.
Tips / common errors: Position slab low enough to capture terminal ICA/vertebrobasilar; no contrast for TOF.

Carotid MRA (neck)

Position: Supine, head-first, chin slightly extended, arms by sides.
Coil: Head-neck / neck array.
Landmark / centring: Centre on thyroid cartilage; coronal CE-MRA aortic arch → circle of Willis.
Breathing: Suspend breathing briefly for arch acquisition.
Immobilisation / comfort: Neck support, strap, ear protection.
Tips / common errors: Time the contrast bolus for arterial phase; cover arch to intracranial ICA.

Spine4 exams

Cervical spine

Position: Supine, head-first, arms by sides, shoulders down.
Coil: Head-neck + spine array.
Landmark / centring: Centre on thyroid cartilage (~C4).
Breathing: n/a; quiet breathing.
Immobilisation / comfort: Neck cushion, knee bolster, strap, ear protection.
Tips / common errors: Pull shoulders down to reduce brachial-plexus wrap; saturate swallowing motion.

Thoracic spine

Position: Supine, head-first, arms by sides.
Coil: Spine array (± body array).
Landmark / centring: Centre at mid-sternum (~T6); count from C7 or L5 to level.
Breathing: Quiet breathing.
Immobilisation / comfort: Knee bolster, strap, ear protection.
Tips / common errors: Use a vitamin-E/skin marker or count vertebrae to confirm level.

Lumbar spine

Position: Supine, head-first, knees flexed over bolster.
Coil: Spine array.
Landmark / centring: Centre on iliac crest (~L4).
Breathing: Quiet breathing.
Immobilisation / comfort: Large knee bolster (flattens lordosis), strap, ear protection.
Tips / common errors: Knee bolster reduces lordosis & back pain; sagittal to count levels.

Whole spine

Position: Supine, head-first, arms by sides.
Coil: Head-neck + full spine array (multi-station).
Landmark / centring: Centre first station at orbit; step-table sagittal C-to-sacrum.
Breathing: Quiet breathing.
Immobilisation / comfort: Neck + knee support, strap, ear protection.
Tips / common errors: Composed multi-station sagittal; keep spine straight for stitching.

MSK10 exams

Shoulder

Position: Supine, head-first, affected arm at side, hand supinated (palm up), slight external rotation.
Coil: Dedicated shoulder / flexible surface coil.
Landmark / centring: Centre on humeral head / coracoid; small FOV.
Breathing: n/a.
Immobilisation / comfort: Sandbag/strap on hand to hold external rotation, ear protection.
Tips / common errors: External rotation opens the joint; feet-first if narrow shoulders/claustrophobia.

Elbow

Position: Prone, arm extended overhead “superman” (or supine at side), thumb up.
Coil: Extremity / flexible surface coil.
Landmark / centring: Centre on olecranon / joint line.
Breathing: n/a.
Immobilisation / comfort: Foam pads around elbow, strap, ear protection.
Tips / common errors: Superman position centres elbow in bore; at-side alternative for large/older patients.

Wrist

Position: Prone, arm overhead “superman”, wrist pronated, or at side.
Coil: Wrist / small extremity coil.
Landmark / centring: Centre on radiocarpal joint.
Breathing: n/a.
Immobilisation / comfort: Foam pads, strap, ear protection.
Tips / common errors: Keep wrist in coil isocentre; superman reduces off-centre artefact.

Hand / fingers

Position: Prone, arm overhead “superman”, palm down on coil.
Coil: Small flexible / extremity coil.
Landmark / centring: Centre on metacarpals / affected digit.
Breathing: n/a.
Immobilisation / comfort: Pads to immobilise fingers, strap, ear protection.
Tips / common errors: Immobilise digit; place ROI at isocentre for small FOV/high resolution.

Hip (single)

Position: Supine, feet-first, legs straight, feet gently internally rotated & taped.
Coil: Body / flexible array over hip.
Landmark / centring: Centre on femoral head (~2 cm below ASIS line).
Breathing: Quiet breathing.
Immobilisation / comfort: Foot tape for internal rotation, knee support, ear protection.
Tips / common errors: Internal rotation of foot elongates femoral neck; contralateral hip for AVN compare.

Pelvis / SIJ

Position: Supine, feet-first, legs straight.
Coil: Body + spine array.
Landmark / centring: Centre midway between ASIS and pubic symphysis; oblique coronals along sacrum for SIJ.
Breathing: Quiet breathing.
Immobilisation / comfort: Knee support, strap, ear protection.
Tips / common errors: For SIJ prescribe semi-coronal oblique parallel to sacrum; fat-sat for oedema.

Knee

Position: Supine, feet-first, knee slightly flexed (~10–15°) & externally rotated ~15°.
Coil: Dedicated knee (HD) coil.
Landmark / centring: Centre on inferior pole of patella / joint line.
Breathing: n/a.
Immobilisation / comfort: Knee coil, foam wedge, strap, ear protection.
Tips / common errors: Slight external rotation aligns ACL for sagittal obliques; feet-first eases claustrophobia.

Ankle

Position: Supine, feet-first, ankle in neutral 90° dorsiflexion.
Coil: Ankle / foot (extremity) coil.
Landmark / centring: Centre on medial malleolus / tibiotalar joint.
Breathing: n/a.
Immobilisation / comfort: Coil + pads to hold 90°, strap, ear protection.
Tips / common errors: Neutral 90° avoids magic-angle on tendons; feet-first minimises bore travel.

Foot

Position: Supine, feet-first, foot in coil, toes up (or plantar per pathology).
Coil: Foot / extremity coil.
Landmark / centring: Centre on midfoot / affected region.
Breathing: n/a.
Immobilisation / comfort: Pads to immobilise, strap, ear protection.
Tips / common errors: Angle short-axis to metatarsals for forefoot; small FOV high resolution.

TMJ

Position: Supine, head-first, bite blocks for open/closed mouth series.
Coil: Bilateral small surface (TMJ) coils or head coil.
Landmark / centring: Centre on condyles; thin oblique sagittal ⟂ condylar axis.
Breathing: n/a.
Immobilisation / comfort: TMJ coils, bite block, head strap, ear protection.
Tips / common errors: Acquire closed then open (bite block) to assess disc position/reduction.

Body9 exams

Liver / MRCP

Position: Supine, head-first (or feet-first), arms above head.
Coil: Body array + spine array.
Landmark / centring: Centre on xiphisternum.
Breathing: Breath-hold in expiration; MRCP thick-slab often respiratory-triggered.
Immobilisation / comfort: Arms up on pads, strap, ear protection; belt for navigator.
Tips / common errors: Consistent expiration breath-holds; fast on secretin/fatty-meal per protocol.

Pancreas

Position: Supine, head-first, arms above head.
Coil: Body + spine array.
Landmark / centring: Centre on xiphisternum / L1 level.
Breathing: Breath-hold expiration; dynamic post-contrast phases.
Immobilisation / comfort: Arms up, strap, ear protection.
Tips / common errors: Thin axial dynamic for lesion conspicuity; consistent breath-hold timing.

Adrenals

Position: Supine, head-first, arms above head.
Coil: Body + spine array.
Landmark / centring: Centre on xiphisternum / upper abdomen.
Breathing: Breath-hold expiration.
Immobilisation / comfort: Arms up, strap, ear protection.
Tips / common errors: In/opposed-phase chemical shift for adenoma signal drop.

Kidneys / MR urography

Position: Supine, head-first, arms above head.
Coil: Body + spine array.
Landmark / centring: Centre midway xiphisternum–umbilicus.
Breathing: Breath-hold; heavily-T2 urography may be respiratory-triggered.
Immobilisation / comfort: Arms up, strap, ear protection; hydration ± furosemide per protocol.
Tips / common errors: Coronal thick-slab T2 urography; dynamic excretory phase for collecting system.

Small bowel: MR enterography

Position: Supine or prone, head-first, arms above head; oral contrast pre-filled.
Coil: Body + spine array.
Landmark / centring: Centre on umbilicus.
Breathing: Breath-hold + free-breathing cine of loops; antiperistaltic agent given.
Immobilisation / comfort: Arms up, strap, ear protection.
Tips / common errors: Ensure adequate luminal distension (oral prep); prone can spread loops.

Rectum

Position: Supine, head-first, arms across chest or up; empty rectum ± gel.
Coil: Body / pelvic array (small FOV).
Landmark / centring: Centre on symphysis pubis; obliques ⟂ tumour axis.
Breathing: Quiet breathing; antiperistaltic agent.
Immobilisation / comfort: Knee support, strap, ear protection.
Tips / common errors: High-res T2 obliques ⟂ tumour long axis; no fat-sat for staging.

Prostate

Position: Supine, head-first, arms across chest.
Coil: Pelvic phased-array (endorectal rarely).
Landmark / centring: Centre on symphysis pubis.
Breathing: Quiet breathing; antiperistaltic agent to reduce rectal motion.
Immobilisation / comfort: Knee support, strap, ear protection.
Tips / common errors: Antispasmodic + empty rectum reduce motion/susceptibility on DWI.

Female pelvis

Position: Supine, head-first, arms across chest.
Coil: Pelvic phased-array (body + spine).
Landmark / centring: Centre on symphysis pubis; obliques along uterine/cervical axis.
Breathing: Quiet breathing; antiperistaltic agent.
Immobilisation / comfort: Knee support, strap, ear protection.
Tips / common errors: Align obliques to uterine axis (endometrium) or cervical canal per indication.

Breast

Position: Prone, head-first, both breasts pendant in coil apertures, arms up.
Coil: Dedicated breast coil (bilateral).
Landmark / centring: Centre on nipple line / mid-breast.
Breathing: Free-breathing; dynamic contrast subtraction.
Immobilisation / comfort: Prone breast coil, pads, strap, ear protection.
Tips / common errors: Ensure breasts fully pendant with no skin folds; symmetric positioning for subtraction.

Cardiac / vascular3 exams

Cardiac: function / viability

Position: Supine, head-first, arms above head; ECG leads placed.
Coil: Cardiac phased-array + ECG gating.
Landmark / centring: Centre on mid-sternum / left chest.
Breathing: Repeated breath-holds in expiration; ECG-gated cine.
Immobilisation / comfort: ECG electrodes, arms up, strap, ear protection.
Tips / common errors: Good ECG trace essential; consistent end-expiration breath-holds for slice registration.

Aorta MRA

Position: Supine, head-first, arms above head; ECG for root.
Coil: Body + spine array (± ECG).
Landmark / centring: Centre over region (arch/thoracic/abdominal).
Breathing: Breath-hold for thoracic; timed CE-MRA bolus.
Immobilisation / comfort: Arms up, strap, ear protection.
Tips / common errors: Time contrast to arterial phase; ECG-gate root for aortic-valve/dissection flap.

Peripheral run-off MRA

Position: Supine, feet-first, legs straight & together, feet padded.
Coil: Peripheral vascular array + body/spine (multi-station).
Landmark / centring: Centre first station at renal arteries; bolus-chase to feet.
Breathing: Suspend breathing for abdominal station.
Immobilisation / comfort: Legs strapped together, foot pads, ear protection.
Tips / common errors: Bolus-chase timing critical to avoid venous contamination distally.

Head & neck / other3 exams

Neck (soft tissue)

Position: Supine, head-first, arms by sides, shoulders down, neutral neck.
Coil: Head-neck / neck array.
Landmark / centring: Centre on thyroid cartilage / hyoid.
Breathing: Quiet breathing; suspend swallowing during acquisition.
Immobilisation / comfort: Neck support, strap, ear protection.
Tips / common errors: Ask patient not to swallow during scans; saturate to reduce swallowing motion.

Brachial plexus

Position: Supine, head-first, arms by sides, shoulders relaxed and down.
Coil: Head-neck + spine array.
Landmark / centring: Centre on lower neck (~C7/T1).
Breathing: Quiet breathing.
Immobilisation / comfort: Neck & shoulder support, strap, ear protection.
Tips / common errors: Coronal/oblique STIR along plexus; drop shoulders to include roots to cords.

Fetal MRI

Position: Supine (or left-lateral decubitus if supine hypotension), feet-first, arms up or by sides.
Coil: Body + spine array over gravid uterus.
Landmark / centring: Centre over uterus per gestation (fundal height).
Breathing: Free-breathing SSFSE single-shot (motion-robust); no breath-hold.
Immobilisation / comfort: Wedge under right hip if needed, strap, ear protection; reassure re: safety.
Tips / common errors: Use fast single-shot to freeze fetal motion; left-tilt avoids aortocaval compression.

Feet-first entry (knee, ankle, foot, lower-limb vascular, pelvis, hip) reduces bore travel and helps claustrophobic patients. Breath-holds are performed in expiration for consistent diaphragm position. Hearing protection is mandatory for every patient.

Phase-encode direction & saturation bands

Two levers that decide where artefacts land, not whether they exist. Ghosting from motion, pulsation and aliasing (wrap) is always mapped along the phase-encode (PE) axis; you rotate that axis, and drop saturation bands, to push those ghosts off the anatomy you care about. Conventions below are widely taught but vendor- and site-dependent; reason from the artefact source, don’t memorise blindly.

Show the full section: Neuro · Spine · Body & pelvis · Cardiac & vascular

The three reasons you swap PE direction

Move motion/pulsation ghosts off the ROI. Ghosts propagate along PE. Put PE perpendicular to the line joining the pulsatile/moving source and the target (e.g. swap so vessel ghosts run head–foot along the spine, not across the cord).
Shorten the scan. Scan time = TR × phase steps × averages. Put the shorter anatomical dimension in phase and cut phase FOV (rectangular FOV) → fewer phase steps → faster. Frequency direction is “free.”
Avoid wrap (aliasing). Orient PE along the dimension that fits the FOV, or add phase oversampling / a sat band over the wrapping tissue.

Neuro

Exam / sequence	PE direction	Why	Example / swap
Axial brain T2 / FLAIR / T1	R ↔ L	L–R is the shorter dimension → rectangular FOV shortens scan; throws CSF & vascular pulsation ghosts side-to-side, away from brainstem & midline.	Swap to A–P if L–R wrap from broad shoulders/positioning.
Sagittal brain	S ↔ I (head–foot)	Keeps A–P vascular/CSF pulsation ghosts out of the sagittal display; foot–head fits the long axis.	A–P acceptable with flow comp.
Orbits (axial/coronal)	R ↔ L	Eye-motion ghosting travels with globe movement (up–down); PE R–L keeps that ghost off the globe & optic nerve.	Add flow comp + thin slices; ask patient to fixate gaze.
IAM / posterior fossa (axial)	R ↔ L	Displaces transverse sinus & basilar pulsation ghosts laterally, off the IACs / CP angle.	Flow comp on T2.
MRA / TOF	R ↔ L (axial slab)	Minimises pulsation ghost across the circle of Willis; combine with flow comp and a superior/inferior travelling sat for arterial vs venous selectivity.	Venous TOF → sat inferiorly; arterial → sat superiorly.

Axial-brain PE choice varies by vendor default (some ship A–P). The reasoning (shorter dimension + pulsation displacement) is what to teach.

Spine

Exam / sequence	PE direction	Why	Sat band
Sagittal C-spine	S ↔ I (head–foot)	Swallowing, pharyngeal motion and carotid pulsation are anterior; if PE were A–P their ghosts would project straight onto the cord. PE S–I runs those ghosts vertically instead.	Anterior sat over pharynx / great vessels.
Sagittal T- / L-spine	S ↔ I (head–foot)	Aortic/IVC pulsation and bowel/respiratory motion are anterior; same logic, keep their ghosts off the canal & cord/conus.	Anterior sat over aorta / bowel.
Axial C-spine	A ↔ P	Shorter neck dimension; combine with anterior sat to knock down swallowing ghost.	Anterior sat.
Axial L-spine	A ↔ P	Fits the FOV; anterior sat suppresses aortic pulsation projecting posteriorly onto discs/canal.	Anterior sat over aorta.

Body & pelvis

Exam / sequence	PE direction	Why	Sat / technique
Axial abdomen (liver, T2/T1)	A ↔ P	A–P is shorter → rectangular FOV; but respiratory ghost also runs A–P onto kidneys/liver, so pair with breath-hold or navigator, not just PE choice.	Breath-hold / respiratory triggering; anterior sat over subcut fat.
Axial abdomen with arm-down wrap	swap to R ↔ L or oversample	Arms in the FOV wrap along phase; oversample or move PE to the non-wrapping axis.	Phase oversampling / lateral sat.
Coronal abdomen/pelvis	R ↔ L	Shorter dimension coronally; keeps aortic pulsation ghost lateral.	Superior/inferior sat to cut in-flow artefact.
Prostate / rectum (axial T2)	R ↔ L	Displaces rectal-gas susceptibility & iliac vessel pulsation laterally, off the peripheral zone.	Anti-peristaltic (hyoscine/glucagon).
MRCP (coronal HASTE/3D)	R ↔ L	Keeps A–P respiratory/duodenal motion ghosts off the biliary tree.	Respiratory triggering + oral negative contrast.

Cardiac & vascular

Exam / sequence	PE direction	Why	Sat / technique
Cardiac cine / black-blood	A ↔ P (with fold suppression)	Chest wall & cardiac motion; PE choice + ECG gating keep ghosts off the myocardium.	Inferior/anterior sat to null in-flowing blood (black-blood double IR); ECG gating.
Contrast MRA	along shortest FOV dimension	Minimise phase steps for speed within the arterial bolus window.	No sat (want vessel signal); centric k-space ordering.

MSK

Exam / sequence	PE direction	Why	Swap / sat
Axial knee	R ↔ L	Popliteal artery is posterior & midline; PE R–L runs its pulsation ghost side-to-side, off the patellofemoral joint & menisci.	Add sat over popliteal vessels if ghost persists.
Sagittal / coronal knee	S ↔ I	Keeps popliteal pulsation ghost running head–foot, not across cruciates/menisci.	Flow comp on PD/T2.
Axial shoulder	A ↔ P	Axillary vessel pulsation runs off the glenoid/labrum; A–P fits the FOV.	Swap or sat if brachial pulsation crosses labrum.
Ankle / foot	S ↔ I or A ↔ P	Posterior tibial vessel pulsation; orient PE to keep ghost off the tibiotalar joint/tendons.	Anterior/posterior sat as needed.
Long-axis limbs / run-off	along limb axis	Fewer phase steps over the long, narrow FOV; keeps vessel ghosts running with the limb.	Travelling sat for run-off.

Saturation bands

Spatial pre-sat A slab that tips & spoils signal from tissue before readout. Place it perpendicular to the flow/motion and between the source and the ROI, never overlapping the ROI. Uses: anterior sat (spine: swallowing, aortic/carotid pulsation, respiration); superior/inferior sat (null in-flowing arterial or venous blood; black-blood cardiac; venous vs arterial MRA selectivity); lateral sat (arm/fold suppression).
Travelling / tracking sat Moves with the slice through the volume and keeps flow suppression consistent across a stack (run-off MRA, TOF).
Chemical (fat) sat Frequency-selective, not spatial; nulls fat everywhere in the FOV (SPAIR/fat-sat). Distinct from spatial sat; combine both when needed.
Cost: each spatial sat pulse adds RF (SAR) and can reduce slices per TR; use the minimum that clears the artefact.

Reference values represent typical practice; always tailor to scanner, coil and patient. Educational content, not a substitute for your department’s validated protocols.

PACS: definitions, what to send & reformats

Getting the right images to the right place is part of the exam. Below: what the archive tiers mean, the minimum series a radiologist expects for each body part, and the reformats (MPRs/MIPs) the radiographer is expected to reconstruct and push before the patient leaves.

Show the full section: Core PACS terminology · What to send & which reformats to build

Core PACS terminology

PACS: Picture Archiving & Communication System, which stores, retrieves, distributes and displays medical images. Talks to modalities and the RIS/EHR via DICOM and HL7.
Primary archive: The authoritative, long-term store of record, the “source of truth” the site is medico-legally required to retain for the full retention period. High-integrity, backed up, usually on-site or primary cloud.
Secondary archive: A second independent copy for redundancy / disaster recovery / business continuity; geographically or logically separate from primary, so loss of one site doesn’t lose the study. May be lower-cost/slower (“nearline”) storage.
VNA: Vendor-Neutral Archive: a storage layer independent of any single PACS vendor, holding images in standard DICOM so multiple PACS/EHR viewers can access one shared copy. Often serves as the primary archive across departments.
On / near / off-line: Tiered storage by access speed: on-line = instant (recent studies, fast disk); near-line = seconds–minutes (older studies, slower/cheaper media); off-line = manual retrieval (archive/tape).
DICOM node / AE title: A network destination on the DICOM network. Each device has an Application Entity (AE) title, IP and port; you “send to” a node by its AE title.
C-STORE / query-retrieve: DICOM services: C-STORE pushes images to a node; C-FIND / C-MOVE (query-retrieve) pulls studies from an archive.
Worklist (MWL): Modality Worklist: the scanner pulls booked patient/exam demographics from the RIS so IDs and accession numbers match automatically (avoids typos & mismatched studies).
Accession number: Unique per-exam identifier from the RIS that ties images ↔ order ↔ report. Wrong accession = study lands on the wrong order.
Series vs study: A study is the whole exam for one accession; a series is one acquisition/sequence within it.
Presentation state (GSPS): Saved annotations, measurements, window/level and reformat orientation stored alongside images so the reader sees what you set up.
Key images / KOS: Key Object Selection: flagged representative images (e.g. the measured lesion) so the reader/clinician finds the finding fast.
Thin vs thick: Thin-slice source data feeds reformats & 3D; thick/averaged series are for quick reading. Archive both when the protocol needs post-processing later.

Send discipline (every exam): verify patient ID & accession from the worklist before pushing · send all acquired series plus required reformats · confirm the study “verified/complete” on PACS before the patient leaves · check both primary and secondary archive received it if your site doesn’t auto-mirror · save presentation state/key images for measured findings.

What to send & which reformats to build

Body part	Series to send	Reformats / reconstructions to make & send
Brain (routine)	All acquired: T1, T2, FLAIR, DWI + ADC map, T2* / SWI, post-Gd T1 (if given).	SWI minIP (thick) for microbleeds/veins; 3D T1 post-Gd → ax/cor/sag MPR; ensure ADC map is generated & sent (not just DWI).
Brain: epilepsy/tumour (3D)	3D FLAIR, 3D T1 (pre/post), DWI+ADC.	Thin-slice 3D → orthogonal MPRs; hippocampal oblique-coronal reformats perpendicular to long axis of hippocampus.
MRA: intracranial / carotid TOF	Source axial images + acquired.	MIP: full-volume + targeted/rotational MIPs (per-vessel), plus keep source images (MIP can hide small aneurysms).
Pituitary / IAM	Thin coronal & sagittal T1/T2 ± dynamic post-Gd.	Small-FOV MPRs if 3D acquired; send dynamic phases in order.
Cervical / lumbar spine	Sag T1, Sag T2 (± STIR), Axial T2 (± T1) through relevant levels.	Axial obliques angled to each disc space for stenosis; if 3D, cor/sag reformats. Confirm level labelling.
MRCP	Thin-slab 3D + thick-slab radial HASTE, axial/coronal T2.	Rotational MIP / radial reprojections of the biliary tree from the 3D volume; send the radial set.
Liver / abdomen (dynamic)	In/out-phase, T2, DWI+ADC, dynamic post-Gd (pre, arterial, portal, delayed / hepatobiliary).	Subtraction (post − pre) for enhancement; label dynamic phases; ADC map; coronal reformat if 3D.
Prostate (mpMRI)	T2 (ax/cor/sag), DWI high-b + ADC, DCE dynamic.	Calculated high-b (e.g. b1400) if not acquired; ADC map; ensure DCE series ordered/labelled; PI-RADS key images.
Pelvis: gynae / rectal	T2 (ax/sag/cor), oblique T2 to organ axis, DWI+ADC, ± post-Gd.	Oblique reformats/acquisitions perpendicular & parallel to organ axis (short-axis to cervix/rectal wall); ADC map.
Cardiac MR	Cines (SA stack, 2/3/4-ch), T1/T2 mapping, LGE, perfusion.	Reformat short-axis stack from long-axis planning; map images (native/post-contrast T1, ECV if computed); send mapping colour overlays + source.
MSK: knee/shoulder/ankle	All planes PD/T2 fat-sat + T1; cartilage/effusion sequences.	If 3D isotropic → orthogonal & oblique MPRs (along ligament/labrum); radial reformats for hip labrum/shoulder.
MSK: 3D isotropic / tumour	Isotropic source + standard planes.	Orthogonal MPRs; long-axis + short-axis to the lesion/bone; whole-lesion measurement key images.
Peripheral / contrast MRA run-off	Source stations, mask & post-contrast.	Subtracted MIPs per station + composed whole-leg MIP; keep source for stenosis grading.

Reformat rule of thumb: always archive the thin-slice source whenever you send a MIP/minIP/MPR. Projections can obscure small lesions, and the reader (or a later re-read) may need to re-reconstruct. Label every reformat clearly (plane + technique) so it is unambiguous in the study.

Retention periods, archive architecture (VNA/primary/secondary) and required reformats vary by jurisdiction and department; follow your local imaging IT and reporting-radiologist standards. Educational content only.

Field strength: 3 T vs 1.5 T

Doubling B₀ roughly doubles SNR, which you can spend on resolution or on speed. It also doubles chemical shift and susceptibility, quadruples SAR, and degrades B₁ uniformity. Whether that trade pays off depends almost entirely on what you are imaging.

Show the full section: What changes when you go from 1.5 T to 3 T · Body-part quick reference · 3 T earns its keep when… · 1.5 T is the better tool when…

What changes when you go from 1.5 T to 3 T

Everything below follows from the field doubling. None of it is vendor-specific.

Property	At 3 T	Consequence in practice
SNR	≈ 2× higher	Spend it on thinner slices, smaller voxels, or fewer averages (faster scans).
SAR / RF heating	≈ 4× higher (∝ B₀²)	Fewer slices per TR, longer TR, reduced refocusing flip angles. Constrains long echo-train FSE.
Chemical shift	2× wider (~440 vs ~220 Hz)	More chemical-shift misregistration, but spectral fat-sat is easier, as the fat and water peaks separate further.
Susceptibility / T2*	≈ 2× stronger	Worse metal, air–tissue and haemorrhage artefact. Helps SWI; hurts near lung, bowel, hardware.
B₁ uniformity	Worse (shorter RF wavelength)	Dielectric standing-wave shading in large abdomens, ascites, late pregnancy. Mitigated by dual-source / parallel transmit.
Tissue T1	Longer	Better TOF-MRA background suppression; TI must be re-tuned for STIR, FLAIR, MP-RAGE.
Tissue T2 / T2*	Slightly shorter	Modestly reduced T2 contrast; bSSFP banding more likely (needs shorter TR and good shim).
Implant conditions	More restrictive	Many devices are MR-Conditional at 1.5 T only. Field strength is part of the labelling.

Body-part quick reference

These reflect the common default, not an absolute rule. Most routine work is fully diagnostic at either field; local protocol, coil generation and implant status override anything here.

Body part / exam	Preferred	Why
Brain: routine	Either	Both fully diagnostic; 3 T delivers the same study faster or at higher resolution.
Brain: epilepsy, pituitary, IAM / cranial nerves	3 T	Small-structure detection; sub-mm 3D volumes need the SNR.
Brain: MS (SWI, central vein sign)	3 T	Susceptibility contrast scales with field; rim and central-vein specificity is optimal at 3 T.
Intracranial TOF-MRA	3 T	Longer background T1 improves saturation of stationary tissue → better small-vessel conspicuity.
fMRI / BOLD, MRS, DTI	3 T	BOLD effect and spectral peak separation both scale with field strength.
Prostate mpMRI	3 T	PI-RADS favours 3 T; 1.5 T remains acceptable, and an endorectal coil helps at either field.
Breast	Either	Both validated. 3 T offers spatial/temporal gains provided fat suppression stays uniform.
MSK: small joints (wrist, elbow, ankle), cartilage	3 T	SNR converts directly into the thin slices these joints demand.
MSK: near arthroplasty / metalwork	1.5 T	Half the susceptibility artefact; MAVRIC/SEMAC perform better; wider RF-heating margin.
Spine: cord, small lesions	3 T	Better cord detail, at the cost of more CSF-pulsation artefact.
Spine: post-instrumentation	1.5 T	Susceptibility from pedicle screws and cages obscures far less of the anatomy.
Cardiac: cine / structural	1.5 T	Remains the workhorse: bSSFP banding and SAR both worsen sharply at 3 T.
Cardiac: perfusion, T1 mapping	3 T	Higher SNR and a wider T1 dynamic range benefit these specific sequences.
Lung / thorax	1.5 T	Air–tissue susceptibility is already the limiting factor; doubling it makes things worse.
Abdomen: liver, pancreas, MRCP	Either	3 T is routine on modern dual-transmit systems; 1.5 T is safer with large habitus or ascites.
MR enterography / bowel	Either	1.5 T tolerates bowel-gas susceptibility and bSSFP banding more gracefully.
Fetal / obstetric	1.5 T	Standard of practice; 3 T is not routinely used (SAR and B₁ shading in the gravid abdomen).
Patients with a CIED (pacemaker / ICD)	1.5 T	Most MR-Conditional cardiac devices are labelled for 1.5 T only.
Whole-body / marrow screening	1.5 T	Large-FOV uniformity, and a workable SAR budget across many stations.
Bariatric / large habitus	1.5 T	Fewer dielectric standing-wave artefacts; often the wider bore as well.

3 T earns its keep when…

The structures are small. Pituitary, cranial nerves, cartilage, wrist ligaments; you need the SNR to afford sub-mm voxels.
The contrast mechanism scales with field. SWI, BOLD, spectroscopy and TOF background suppression all improve intrinsically.
Speed matters more than artefact. Trade the extra SNR for shorter breath-holds or higher temporal resolution.
The anatomy sits away from air and metal. Brain, prostate, distal limbs.

1.5 T is the better tool when…

There is metal in the field. Arthroplasty, spinal instrumentation, dental work; artefact and heating both scale up at 3 T.
Air–tissue interfaces dominate. Lung, bowel, skull base, post-operative beds.
You depend on bSSFP. Cardiac cine and fetal imaging; banding is far more manageable at 1.5 T.
SAR is the binding constraint. Long echo trains, many stations, pregnancy, paediatrics, sedated or febrile patients.
The patient is large, or carries an implant. Dielectric shading; and most conditional labelling is written for 1.5 T.

Safety is not an afterthought. Field strength forms part of an implant’s MR-Conditional labelling. A device that is MR Conditional at 1.5 T is not automatically MR Conditional at 3 T. Check the manufacturer’s current Instructions For Use for every implant, every time, and remember the conditions also specify gradient slew rate and SAR limits, not just B₀.

The honest summary. For the overwhelming majority of routine clinical work both field strengths are diagnostic, and the scanner you have is the right one. Field strength changes how comfortably you reach a given image quality; it rarely changes whether the diagnosis is reachable at all. Optimise the protocol before blaming the magnet.

Educational reference. The preferences above reflect common practice and physical principles, not universal mandates; departments, coil generations and vendor implementations legitimately differ. Verify against local protocol and current society guidance.

Sources: ACR Manual on MR Safety (2026 edition) · ACR–SAR–SPR practice parameters · PI-RADS v2.1 (prostate field-strength guidance) · SCMR/EACVI cardiac MR consensus documents · Soher BJ, Dale BM, Merkle EM. A review of MR physics: 3T versus 1.5T. Magn Reson Imaging Clin N Am 2007;15(3):277–90 · Manufacturer Instructions For Use for individual implants.

Calculators for this topic

Pixel / voxel size · Scan time (2D) · Relative SNR

Sources

Primary and authoritative sources, grouped by category. Vendor-nomenclature sources at the end.

Cross-cutting

American College of Radiology. ACR Manual on MR Safety, 2026 edition. acr.org
American College of Radiology. ACR Manual on MR Safety, 2026 edition: Revision History, pp. iv–vi (changes of 1 January 2024 and 1 January 2026). acr.org
Pedrosa I, et al. American College of Radiology Manual on MR Safety: 2024 Update and Revisions. Radiology 2025;315(1):e241405 (summary of the 2024 revision). doi:10.1148/radiol.241405
ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media, 2026 edition. acr.org
Deep Learning–Based Acceleration in MRI. AJNR (2025/2026). ajnr.A8943
FDA expands gadopiclenol (Vueway) to neonates and infants. ITN. itnonline.com

Neuro & spine

Imaging of the Brain: clinical guideline (2024). Carelon. Carelon guidelines (link no longer available)
AHA/ASA 2019 Early Management of Acute Ischemic Stroke. doi:10.1161/STR.0000000000000211
ESO Guidelines on IV Thrombolysis for Acute Ischaemic Stroke. PMC7995316
DWI–FLAIR mismatch in wake-up stroke (review). PMC8881675
Thrombolysis in wake-up stroke based on MRI mismatch (2024). J Neurol Sci. jns-journal.com
2024 McDonald Diagnostic Criteria. National MS Society. nationalmssociety.org
The 2024 Update to the McDonald Criteria: A Guide for Radiologists. AJR. doi:10.2214/AJR.25.33997
2024 MAGNIMS–CMSC–NAIMS consensus on MRI for MS diagnosis. Lancet Neurology. thelancet.com
ILAE HARNESS-MRI recommendations (2019). ilae.org
Ellingson BM et al. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials. Neuro-Oncology (2015);17(9):1188–1198. doi:10.1093/neuonc/nov095
Standardized brain tumor imaging protocols (2023). Front Radiol. frontiersin.org
Dementia: Role of MRI. Radiology Assistant. radiologyassistant.nl
Spine MRI planning & protocols. mrimaster. mrimaster.com
MRI with “feed and wrap” and optimized anesthesia (2024). Front Pediatr. frontiersin.org
Ultrafast brain MRI beyond shunted hydrocephalus. AJNR. ajnr.org
Safety of GBCAs in Children: systematic review (2024). Radiology. doi:10.1148/radiol.241224

Musculoskeletal

Fat-Suppression Techniques for 3-T MSK MRI. RadioGraphics. rg.341135130
3D isotropic vs conventional 2D sequences at 3 T (2025). PMC12296944
ACR MRI Exam-Specific Parameters: MSK Module (rev. 3-5-2025). accreditationsupport.acr.org
ESR Essentials: MRI of the knee (ESSR, 2024). doi:10.1007/s00330-024-10706-7
Shoulder MR arthrography: optimal gadolinium dilution vs field strength. JMRI. doi:10.1002/jmri.20788
Deep-learning abbreviated shoulder MRI (2025). PMC12031227
Managing hardware-related metal artifacts in MRI. Skeletal Radiology (2024). doi:10.1007/s00256-024-04624-4
MAVRIC-SL vs STIR in lumbar instrumentation (2025). PMC12611744
Quantitative Cartilage T2 and T1rho Mapping. AJR (2024). doi:10.2214/AJR.24.31655
MY-RADS: WB-MRI in Myeloma. Radiology (2019). radiol.2019181949
ACR MSK Module parameter table (rev. 3-5-2025). accreditationsupport.acr.org
Imaging in juvenile idiopathic arthritis (2023). Pediatr Radiol. doi:10.1007/s00247-023-05815-2
MRI of the knee in juvenile idiopathic arthritis. PMC7792535
DWI for synovial inflammation in JIA. PMC5635098

Body & oncology

Prostate cancer: PI-RADS v2.1. Radiology Assistant. radiologyassistant.nl
PRISM: Prostate Imaging Standards for Screening MRI. JAMA Oncology (June 2026). PubMed 42275039
New MRI standards for prostate cancer screening. AuntMinnie. auntminnie.com
PI-QUAL v2: prostate MRI quality (2024). Eur Radiol. doi:10.1007/s00330-024-10795-4
CT/MRI LI-RADS 2024 Update: Treatment Response. Radiology. radiol.232408
ACR LI-RADS. acr.org
Abbreviated MRI for HCC Surveillance. RadioGraphics. rg.2020200104
EUSOBI / ESR Essentials: breast screening (2024). Eur Radiol. doi:10.1007/s00330-024-10740-5
Abbreviated breast MRI (Kuhl FAST). PubMed 24958821
EUSOBI Breast DWI Working Group consensus. Eur Radiol. doi:10.1007/s00330-019-06510-3
Rectal Cancer MR Staging / restaging. Radiology Assistant. radiologyassistant.nl
ABC of MRCP. Insights into Imaging. PMC3292642
SAR Consensus: Small-Bowel Crohn Strictures at CT/MRE. Radiology. radiol.243123
Updated ESUR endometrial cancer guidelines (2025). Eur Radiol. doi:10.1007/s00330-025-11700-3
ESUR cervical cancer MRI guidelines. PubMed 33852049
WB-MRI surveillance for pediatric cancer predisposition (2024). Clin Cancer Res. aacrjournals.org

Cardiac & vascular

SCMR Standardized CMR Protocols: 2020 update. PMC7038611
Cine SSFP / LGE / TI parameters. MRIquestions. mriquestions.com
SCMR/EACVI CMR Mapping recommendations. journalofcmr.com
Native T1/T2 at 1.5 T vs 3 T. doi:10.1007/s00508-018-1411-3
Modified (2018) Lake Louise Criteria: meta-analysis. PMC12131415
SCMR Quantitative Myocardial Perfusion CMR (2025). journalofcmr.com
4D Flow CMR Consensus: 2023 update. PMC10357639
QISS MRA: review. PMC6315503
CE-MRA vs 2D TOF for carotid stenosis. AJNR. ajnr.org
Vascular imaging with ferumoxytol. PMC5130335
Cardiac & liver T2* thresholds. PMC8007896
DL-accelerated cine in children (2026). Pediatr Radiol. doi:10.1007/s00247-026-06676-1
Ferumoxytol MRA & 4D flow in pediatric CHD. PMC9777095

Vendor nomenclature

MRI Acronyms: Cross-Vendor Comparison (Siemens Healthineers). PDF
MRI Cross-Vendor Terminology (MRI acronyms). mrimaster. mrimaster.com
Post-contrast 3D T1 TSE (SPACE/CUBE/VISTA/isoFSE/3D MVOX). PubMed. PMID 32017974

Gynecologic (additional)

O-RADS MRI Risk Stratification System (ACR O-RADS MRI Committee). Radiology (2021). radiol.204371
ESUR consensus: MRI for endometriosis; protocol, lexicon, compartment-based (2025). Eur Radiol. doi:10.1007/s00330-025-11611-3
ESUR Guidelines: MR Imaging of Leiomyomas (2018). Eur Radiol. doi:10.1007/s00330-017-5157-5
SAR–ESUR joint consensus: MRI of placenta accreta spectrum (2020). Eur Radiol. doi:10.1007/s00330-019-06617-7

Obstetric & acute abdomen (additional)

ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol. JACR 2022
MR Imaging Evaluation of Abdominal Pain during Pregnancy: Appendicitis & Other Nonobstetric Causes. RadioGraphics. rg.322115057
ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal MRI (2020). acr.org
ISUOG Practice Guidelines (updated): performance of fetal MRI (2023). Ultrasound Obstet Gynecol. doi:10.1002/uog.26129
Ray JG et al. Association Between MRI Exposure During Pregnancy and Fetal/Childhood Outcomes. JAMA (2016). doi:10.1001/jama.2016.12126

Genitourinary & pelvic (additional)

Mayo-Smith WW, et al. Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol (2017). JACR
Chemical Shift MR Imaging of the Adrenal Gland: Principles, Pitfalls, and Applications. RadioGraphics (2016). rg.2016150139
Managing the Indeterminate Renal Mass with the MRI Clear Cell Likelihood Score (How We Do It). Radiology (2021). radiol.210034
Panebianco V, et al. Multiparametric MRI for Bladder Cancer: Development of VI-RADS. Eur Urol (2018);74(3):294–306. europeanurology.com
MRI of Perianal Fistulas: Anatomy, Diagnosis, and Perianal Crohn Disease Treatment Monitoring. RadioGraphics (2025). rg.250033

Neuro & spine (additional)

ACR–ASNR–SPR Practice Parameter for the Performance and Interpretation of Magnetic Resonance Imaging (MRI) of the Brain (revised 2024). American College of Radiology. acr.org
Ellingson BM et al. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials. Neuro-Oncology (2015);17(9):1188–1198. doi:10.1093/neuonc/nov095
Wattjes MP et al. Expert panel consensus guidelines of the German Society of Neuroradiology on the use of MRI in the diagnosis and monitoring of multiple sclerosis. Clin Neuroradiol (2026);36(3):831–854. doi:10.1007/s00062-026-01670-4
Barkhof F, Smithuis R. Dementia: role of MRI (2026 update). The Radiology Assistant. radiologyassistant.nl
Burns J et al. ACR Appropriateness Criteria® Neuroendocrine Imaging. J Am Coll Radiol (2019);16(5S):S161–S173. doi:10.1016/j.jacr.2019.02.017
ACR–ASNR–SPR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Head and Neck (revised 2023). American College of Radiology. acr.org
Goldbrunner R et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-Oncology (2020);22(1):31–45. doi:10.1093/neuonc/noz153
ACR–ASNR–SABI–SSR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Adult Spine (revised 2023). American College of Radiology. acr.org
NICE guideline NG234: Spinal metastases and metastatic spinal cord compression (September 2023). National Institute for Health and Care Excellence. nice.org.uk

Musculoskeletal (additional)

ACR–SPR–SSR Practice Parameter for the Performance and Interpretation of Magnetic Resonance Imaging (MRI) of the Knee (revised 2025). American College of Radiology. acr.org
ACR–SPR–SSR Practice Parameter for the Performance and Interpretation of Magnetic Resonance Imaging (MRI) of the Shoulder (revised 2024). American College of Radiology. acr.org
ACR–SPR–SSR Practice Parameter for the Performance and Interpretation of Magnetic Resonance Imaging (MRI) of the Hip and Pelvis for Musculoskeletal Disorders (revised 2026). American College of Radiology. acr.org
Castro MO, Mascarenhas VV et al. The Lisbon Agreement on femoroacetabular impingement imaging — part 3: imaging techniques. Eur Radiol (2021);31(7):4652–4668. doi:10.1007/s00330-020-07501-5
ACR–SABI–SPR–SSR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Wrist (revised 2022). American College of Radiology. acr.org
ACR–SPR–SSR Practice Parameter for the Performance and Interpretation of Magnetic Resonance Imaging (MRI) of the Ankle and Hindfoot (revised 2026). American College of Radiology. acr.org
ACR–SPR–SSR Practice Parameter for the Performance and Interpretation of Magnetic Resonance Imaging (MRI) of the Fingers and Toes (revised 2023). American College of Radiology. acr.org
Lecouvet FE et al. ESR Essentials: bone marrow MRI in oncology — practice recommendations by the European Society of Musculoskeletal Radiology. Eur Radiol (2026);36(7):5414–5428. doi:10.1007/s00330-025-12307-4

Body & oncology (additional)

Turkbey B et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 update of PI-RADS version 2. Eur Urol (2019);76(3):340–351. doi:10.1016/j.eururo.2019.02.033
ACR–SABI–SAR–SPR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Liver (revised 2025). American College of Radiology. acr.org
ACR Practice Parameter for the Performance of Contrast-Enhanced Magnetic Resonance Imaging (MRI) of the Breast (revised 2023). American College of Radiology. acr.org
ESGAR Rectal Imaging Guideline Group. MRI to guide clinical management of rectal cancer: updated consensus recommendations from ESGAR — part I, primary staging. Eur Radiol (2026);36(6):4592–4607. doi:10.1007/s00330-025-12274-w
ESGAR Rectal Imaging Guideline Group. MRI to guide clinical management of rectal cancer: updated consensus recommendations from ESGAR — part II, restaging and response evaluation. Eur Radiol (2026);36(6):4608–4621. doi:10.1007/s00330-025-12275-9
Taylor SA et al. The first joint ESGAR/ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging. Eur Radiol (2017);27(6):2570–2582. doi:10.1007/s00330-016-4615-9

Cardiac & vascular (additional)

Ferreira VM et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations (updated Lake Louise criteria). J Am Coll Cardiol (2018);72(24):3158–3176. doi:10.1016/j.jacc.2018.09.072
ACR–NASCI–SPR Practice Parameter for the Performance of Body Magnetic Resonance Angiography (MRA) (revised 2025). American College of Radiology. acr.org
ACR–ASNR–SNIS–SPR Practice Parameter for the Performance of Magnetic Resonance Angiography (MRA) of the Head and Neck (revised 2025). American College of Radiology. acr.org

Field strength (additional)

Del Grande F, Santini F, Herzka DA, Aro MR, Dean CW, Gold GE, Carrino JA. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. RadioGraphics (2014);34(1):217–233. doi:10.1148/rg.341135130

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Educational reference for imaging professionals. It does not replace local policy, manufacturer labelling or clinical judgement.

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