Adrenal MRI protocol

Indications

This protocol is most frequently used to characterize incidentally detected adrenal masses (incidentalomas) found on other imaging modalities.

Preparation

• IV contrast agent: None used routinely. If radiologist chooses to administer contrast, use 1 mmol/kg gadopentetate dimeglumine at 2 cc/s

• Oral contrast agent: None

• At completion of exam, page radiologist to check if intravenous contrast is necessary

• Give patient 2 L nasal oxygen

• Continue axial single-shot fast-spin echo FS to level of bladder

Exam sequences

1. (1) Coronal T1 spoiled gradient echo BH – Anatomic overview. Assess for adrenal mass. Be certain that “adrenal” masses are really in the adrenal gland.

2. (2–3) Axial T1 in and out of phase (IP/OOP) – Assess for intracellular lipid (microscopic fat) within adrenal lesions. This is by far the most important sequence for the adrenal gland.

3. (4) Axial T2 single-shot fast-spin echo – Identify T2-bright lesions within the adrenal glands.

4. (5) Axial T2 single-shot fast-spin echo FS – Compare to prior sequence to identify macroscopic fat.

5. (6) Radiologist check for contrast. If contrast is to be used run:

6. (7) Volume-interpolated gradient echo BH pre.

7. (8) Volume-interpolated gradient echo BH post 20 seconds.

8. (9) Volume-interpolated gradient echo BH post 1 minute.

9. (10) Volume-interpolated gradient echo BH post 2 minutes.