Revision History


In addition to the exam-specific instructions in the following tables, review the following information prior to examination selection and submission. Failure to follow the guidance below may result in failure of the submitted examination.

  • ADC map is now required for brain for TIA DWI sequence. Omission of the ADC map will result in failure of the submitted examination.

  • Failure to meet anatomic coverage and imaging plane specifications may result in failure.


Brain for Suspected Demyelinating Disease, Encephalitis or Acute Disseminated Encephalomyelitis

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Axial, sagittal or coronal dark fluid

  • Must have good discrimination between the brain and CSF

  • Axial must cover convexity to foramen magnum

  • Coronal must cover entire brain from anterior to posterior cranial vault

  • Sagittal must cover entire brain from left to right and the top of the brain to the C2 level

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2.5 mm if coronal

  • Gap ≤ 2.0 mm if axial or sagittal

  • Pixel area ≤ 1.2 mm2

Sagittal T2 FLAIR

  • Must have good water suppression

  • CSF must be hypointense relative to white matter

  • Sagittal must cover entire brain from left to right and the top of the brain to the C2 level

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2.0 mm

  • Pixel area ≤ 2.0 mm2

Axial T2 FLAIR

  • Must have good water suppression

  • CSF must be hypointense relative to white matter

  • Reformatted axial T2 FLAIR images from the 3D sagittal T2 FLAIR are acceptable

  • DIR FLAIR is an acceptable substitute for T2 FLAIR

  • Axial must cover from convexity to foramen magnum

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2.0 mm

  • Pixel area ≤ 1.2 mm2

Axial Bright Fluid

  • CSF must be hyperintense relative to the brain

  • Must have good contrast between the gray matter and white matter

  • Should be a Fast Spin Echo (Turbo Spine Echo, RARE) NOT a gradient echo

  • Axial must cover from convexity to foramen magnum

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2.0 mm

  • Pixel area ≤ 1.2 mm2

Axial or coronal dark fluid post contrast

  • Must have good discrimination between the brain and CSF

  • Axial must cover convexity to foramen magnum

  • Coronal must cover entire brain from anterior to posterior cranial vault

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2.0 mm

  • Pixel area ≤ 1.2 mm2



IAC/Temporal Bones

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Axial or coronal high resolution dark fluid without fat suppression

  • Must have good discrimination of the 7th and 8th cranial nerves

  • Must cover top of IACs to cervical-medullary junction

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 2.0 mm 

  • Pixel area ≤ 0.6 mm2

Axial or coronal high resolution bright fluid

  • Must have good discrimination of the 7th and 8th cranial nerves

  • Must have good membranous labyrinth discrimination

  • Must cover top of IACs to foramen magnum

  • Coronal must cover pituitary to 4th ventricle
  • Slice thickness ≤ 2.0 mm

  • Gap = 0 mm (zero gap)

  • Pixel area ≤ 0.6 mm2

Axial high resolution dark fluid with or without fat suppression post contrast

  • Must have good discrimination of the 7th and 8th cranial nerves

  • Must cover top of IACs to foramen magnum

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 0.2 mm

  • Pixel area ≤ 0.6 mm2

Coronal high resolution dark fluid with or without fat suppression post contrast

  • Must have good discrimination of the 7th and 8th cranial nerves

  • Must cover top of IACs to foramen magnum

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 0.2 mm

  • Pixel area ≤ 0.6 mm2



Brain for TIA or Stroke

Omission of the ADC map will result in failure of the submitted examination

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Sagittal, axial or coronal dark fluid 

  • Must have good discrimination between the brain and CSF

  • Axial must cover the entire brain

  • Sagittal must cover entire brain from left to right and the top of the brain to the C2 level

  • Coronal must cover entire brain from anterior to posterior cranial vault

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2.5 mm if coronal

  • Gap ≤ 2.0 mm if axial or sagittal

  • Pixel area ≤ 1.2 mm2

Axial diffusion weighted imaging (DWI) including ADC map

  • Must include ADC map and B value must be ≥ 800

  • Axial must cover the entire brain

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2 mm 

  • Pixel area ≤ 4 mm2

Axial or coronal T2 FLAIR


  • CSF must be hypointense relative to white matter

  • Must have good water suppression

  • Axial must cover the entire brain

  • Coronal must cover entire brain from anterior to posterior cranial vault

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2 mm

  • Pixel area ≤ 1.2 mm2

Axial bright fluid

  • SF must be hyperintense relative to the brain

  • Must have good contrast between the gray matter and white matter

  • Axial must cover the entire brain

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 2 mm

  • Pixel area ≤ 1.2 mm2

Axial or coronal T2* weighted gradient echo

  • CSF must be hyperintense relative to the brain

  • Susceptibility weighted imaging or SWAN sequence is an acceptable substitute, if submitted the CSF need not be hyperintense relative to the brain

  • Axial must cover the entire brain

  • Coronal must cover entire brain from anterior to posterior cranial vault

  • Slice thickness ≤ 5 mm

  • Gap ≤ 2.5 mm

  • Pixel area ≤ 1.2 mm2



Orbits for Vision Loss or Tumor

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Axial dark fluid

  • Must have good optic nerve sheath discrimination

  • Fat must be bright

  • Must cover entire orbits and optic nerves

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm 

  • Pixel area ≤ 1.0 mm2

Coronal bright fluid with fat suppression which includes STIR or frequency-selective fat suppression techniques

  • Must have good optic nerve discrimination

  • Must have good fat suppression

  • Must cover eyelids to dorsum sella

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Axial dark fluid with fat suppression post contrast

  • Must have good optic nerve sheath discrimination

  • Must have good fat suppression

  • Must cover entire orbits and optic nerves

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Coronal dark fluid with fat suppression post contrast

  • Must have good optic nerve sheath discrimination

  • Must have good fat suppression

  • Must cover eyelids to dorsum sella

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2



Pituitary with Contrast Enhancement

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Sagittal dark fluid

  • Must have good discrimination between brain and CSF

  • Must cover from medial temporal lobe to medial temporal lobe

  • Slice thickness ≤ 3.3 mm

  • Gap ≤ 0.3 mm 

  • Pixel area ≤ 0.6 mm2

Coronal dark fluid

  • Must have good discrimination between brain and CSF

  • Must cover from orbital apex to dorsum sella

  • Slice thickness ≤ 3.3 mm

  • Gap ≤ 0.3 mm 

  • Pixel area ≤ 0.6 mm2

Sagittal dark fluid post contrast

  • Must have good discrimination between brain and CSF

  • Must cover from medial temporal lobe to medial temporal lobe

  • Slice thickness ≤ 3.3 mm

  • Gap ≤ 0.3 mm

  • Pixel area ≤ 0.6 mm2

Coronal dark fluid post contrast

  • Must have good discrimination between brain and CSF

  • Must cover from orbital apex to dorsum sella

  • Slice thickness ≤ 3.3 mm

  • Gap ≤ 0.3 mm

  • Pixel area ≤ 0.6 mm2





Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes

12-16-19Brain for TIA or StrokeSagittal, axial or coronal dark fluid: Correct the Gap from </= 2.5 mm if axial or sagittal to </= 2.0 mm if axial or sagittal.
12-17-19Brain for TIA or Stroke

Axial diffusion weighted imaging (DWI) including ADC map: Changed B value must be ≤ 800 to ≥800


1-8-2020Brain for TIA or StrokeAxial diffusion weighted imaging (DWI) including ADC map: Changed gap to ≤ 2 mm
1-8-2020Orbits for Vision Loss or TumorCoronal bright fluid with fat suppression which includes STIR or frequency-selective fat suppression techniques: Change gap to ≤ 1.0 mm.
1-17-2020Brain for Suspected Demyelinating Disease, Encephalitis, or Acute Disseminate EncephalomyelitisSagittal T2 Flair- Changed pixel area to ≤ 2.0 mm2      




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