Interactive Transcript
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Now let's discuss some specific protocols for
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evaluation of pathology in pregnant patients.
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First, let's talk about
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evaluation of the appendix.
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Appendicitis is a common issue that pregnant
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patients deal with, and so it's important
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to know how these patients should be imaged.
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I'd like to point out that the typical
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appendicitis protocol in MRI should be
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the same for adult and pediatric patients.
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It's a non-contrast examination that uses
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multiplanar, single-shot T2-weighted images.
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The reason that we want to do single
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shot T2 is that it's a shorter exam, and
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so there is the decreased potential for
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degrading the images by motion artifact.
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We also obtain diffusion-weighted
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imaging of the abdomen and pelvis,
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and a coronal fat-saturated T2-weighted image.
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And so what we're trying to accomplish
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by obtaining these specific sequences
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is highlighting any inflammatory changes
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within and around an abnormal appendix.
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So on the T2-weighted images, we would see
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periappendiceal fluid and tissue edema.
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We may see diffusion restriction
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within an inflamed appendix.
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And so the way that you will find the appendix
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on MRI is you will look for the cecum.
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And you will next identify the ileocecal
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valve, which is here in this patient.
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Once you've found the ileocecal valve
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and terminal ileum, you will be within
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the neighborhood of the appendix.
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And so here it is for this patient
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as this linear tubular structure
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in the right lower quadrant.
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Next, let's talk about the protocol
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for general evaluation of the abdomen.
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This is very similar to a liver protocol
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MRI, which you may perform for hepatobiliary
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pathology or generalized abdominal pain.
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We'll first obtain multiplanar
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scout images, axial and coronal
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T2-weighted images of the abdomen.
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We'll perform in-phase and out-of-phase
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images to look for microscopic fat deposition,
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diffusion-weighted imaging with a corresponding
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ADC map, and a pre-contrast axial T1 of the abdomen.
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It's important to note that because we're
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imaging a pregnant patient, we won't
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perform the traditional post-contrast
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sequences which would then follow.
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And then if you're doing an MRCP for evaluation
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of the biliary tree, you can also add coronal
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single-shot T2-weighted imaging of the abdomen.
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Lastly, let's discuss protocols
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for imaging the placenta.
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Again, we'll perform a multiplanar localizer.
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And then we'll perform coronal,
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sagittal, and axial T2-weighted
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images of the abdomen and pelvis.
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You'll obtain both steady-state free
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precession and single-shot turbo spin
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echo images of the abdomen and pelvis.
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At most institutions, this
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is where the protocol stops.
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You can, however, add non-contrast T1-
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weighted images if the patient is having
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vaginal bleeding or if there's concern for
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placental abruption or retroplacental hematoma.
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Some institutions will also add
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diffusion-weighted imaging to act as a
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surrogate for blood flow and help further
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delineate the boundaries of the placenta.
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And then, as always, no intravenous
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contrast is used for this study.
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