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MRI > Week 10: Chest > Flashcards

Week 10: Chest Flashcards

1
Q

What are the four studies that can be performed in the chest?

A
  1. MRI brachial plexus.
  2. MRI cardiac.
  3. MRA chest.
  4. MRI breast.
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2
Q

Of the four studies, which is the only one where the patient is inserted into the bore prone, headfirst?

A

MRI breasts

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3
Q

Other than MRI breasts, how should the patient be positioned in the bore for the other studies of the chest?

A

Supine, headfirst

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4
Q

Similar to most MRI studies, the body of the patient should be positioned with the midsagittal line perpendicular to the alignment light. This is true for all studies of the chest. True or false?

A

False; MRI brachial plexus has the body offset, with the affected side perpendicular to the alignment light.

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5
Q

Given that MRI breasts are performed with the patient prone, what landmark should be used instead of mid sternum?

A

T5 thoracic vertebrae

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6
Q

All studies of the chest use the mid sternum landmark, except for ___________, which is slightly superior at the sternal notch.

A

MRI brachial plexus

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7
Q

What coil is used for MRI brachial plexus, MRI cardiac, and MRA chest?

A

8 channel cardiac phase array coil

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8
Q

What coil is used during MRI breast exams?

A

Breast coil

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9
Q

Which chest studies use contrast?

A
  1. MRA chest.
  2. MRI breast.
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10
Q

What is the order of procedures when using IV contrast?

A
  1. Patient receives IV line with confirmed flow, check for air.
  2. Collect Pre-contrast images.
  3. Begin power injector and collect CINE images simultaneously
  4. Start Post-contrast scan once the contrast is detected on CINE images
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11
Q

MRI Cardiac studies utilize gating to acquire images during moments of stillness. Gating uses ______ and ________ to monitor movement during the scan.

A
  1. EKG leads
  2. Respiratory Bellows
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12
Q

In regard to EKG monitoring or gating during MRI cardiac, when is image acquisition performed

A

Between the R-R interval (distole)

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13
Q

What sequence options are utilized during MRI brachial plexus?

A
  1. Flow compensation on.
  2. No phase wrap on.
  3. Saturation pulses, perpendicular to phase direction.
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14
Q

What sequence options are utilized during an MRI cardiac?

A
  1. Respiratory monitors.
  2. Dating.
  3. Trigger parameters.
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15
Q

What sequence option is utilized during MRI breasts?

A

Saturation bands

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16
Q

Where are saturation bands placed during MRI breasts? Why?

A

Laterally of the chest wall, posterior to the breasts. To ensure that any motion behind the breasts (breathing, pectoral muscles, back muscles, etc.) Doesn’t interfere with the imaging of the breast tissue.

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17
Q

Which study of the chest utilizes saturation bands, posterior and anterior to the given volume slab?

A

MRA chest

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18
Q

What are the five protocols of an MRI brachial plexus?

A
  1. Axial*
  2. Coronal oblique IR.
  3. Coronal oblique*
  4. Sagittal*
  5. ABER view*
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19
Q

3 of the protocols for MRI brachial plexus are left vague (*). What determines how the protocols are weighted? (T1, PD, T2, etc…)

A

The facility protocol

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20
Q

MRI brachial plexus axial protocol views the brachial plexus in cross-sectional, covering from ______ to ________.

A
  1. C3-C4
  2. Just below axilla
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21
Q

“Viewing on the short axis” and “viewing in cross section” are synonymous. True or false?

A

True

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22
Q

What is the approximate sliced thickness of the coronal oblique protocols of the MRI brachial plexus?

A

~2mm

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23
Q

How far must the coronal plane be obliqued for the coronal oblique protocols of the MRI brachial plexus?

A

The coronal plane must be obliqued until it follows/lines up with the long axis of the brachial plexus

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24
Q

The coronal oblique protocols of MRI brachial plexus follows the long axis of the brachial plexus. What does the IR protocol evaluate?

A

Interruptions along the nerve tract; tumors, fluid, masses, etc.

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25
Q

The sagittal protocol of MRI brachial plexus shows cross-sectional views of the nerves entering and exiting the __________.

A

Thoracic outlet

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26
Q

The ABER protocol of MRI brachial plexus is very similar to that of the sagittal. What is different about the patient position?

A

Patients arms above their head

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27
Q

What effect does the patient positioning have on the anatomy during the ABER protocol of MRI brachial plexus?

A

Putting the patient’s arms above their head compresses the thoracic outlet, thus showing the effect it has on the brachial plexus nerves.

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28
Q

What is the thoracic outlet? What two important anatomical structures are found within within it?

A
  1. The space between the clavicle and the first rib.
  2. The brachial plexus and the subclavian vein.
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29
Q

What is the brachial plexus and where does it originate?

A
  1. A network of nerves.
  2. Originates at the level of C5-T1
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30
Q

The brachial plexus runs perpendicular to the right and left subclavian artery and vein. True or false?

A

False; parallel

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31
Q

What is the most common clinical concern for MRI brachial plexus?

A

Thoracic outlet syndrome (TOS)

32
Q

What is TOS and what does it cause?

A
  1. Compression of the thoracic outlet and impingement of brachial plexus.
  2. Pain and numbness of the shoulder, arm, and hands
33
Q

What are the five protocols of MRI cardiac exams?

A
  1. Axial*
  2. Vertical long axis
  3. Horizontal long axis.
  4. Short axis
  5. 3 chamber view.
34
Q

The mediastinum is a large compartment in the chest that separates the lungs from its contents, which includes?

A
  1. Heart
  2. Esophagus
  3. Trachea
  4. Thymus
  5. Lymph nodes
  6. Large blood vessels
35
Q

The axial protocol of MRI cardiac views the mediastinum, and covers the heart and lungs from __________ to __________.

A
  1. The apex of the heart
  2. The diaphragm
36
Q

What is viewed on the vertical long axis protocol of MRI cardiac?

A

The entire left ventricle, including the anterior and inferior walls and apex

37
Q

Which MRI cardiac protocol is ideal for chamber measurements?

A

Horizontal long axis

38
Q

What is viewed on the horizontal long axis protocol of MRI cardiac?

A

The septal and lateral walls

39
Q

The vertical long axis protocol of an MRI cardiac is ideal for volumetric measurements. True or false?

A

False; the short axis protocol

40
Q

What is viewed on the short axis protocol of MRI cardiac?

A

Left and right ventricles

41
Q

What four anatomical structures/phenomena are viewed during the three chamber protocol of MRI cardiac?

A
  1. Aortic valve.
  2. Aortic root
  3. Ventricular outflow.
  4. Mitral valve
42
Q

Where does the pulmonary vein arise from?

A

The left atrium

43
Q

Which chamber of the heart is the most anterior? Most posterior?

A
  1. Right ventricle.
  2. Left atrium.
44
Q

Which chamber of the heart is the most anterior? Most posterior?

A
  1. Right ventricle.
  2. Left atrium.
45
Q

Which heart chamber has the thickest myocardium?

A

Left ventricle

46
Q

What structure prevents backflow of blood from the left ventricle into the left atrium?

A

Bicuspid (aka mitral valve)

47
Q

What two structures are best visualized on sagittal images of the heart?

A
  1. Ascending aorta
  2. Descending aorta
48
Q

What area of the heart has the fastest blood flow and why?

A
  1. The ascending aorta.
  2. Because of how close it is to the heart muscles.
49
Q

From where do the coronary arteries originate from?

A

The aortic root

50
Q

What three arteries arise from the aorta?

A
  1. Brachiocephalic.
  2. Left common carotid.
  3. Left subclavian.
51
Q

What are the sinoatrial nodes?

A

The natural pacemakers of the heart that supply electrical signals that initiate heart muscle contraction

52
Q

Where is SA node located?

A

In the right atrium, very close to the entrance of the superior vena cava

53
Q

What receives the electrical signal produced by the SA node?

A

The atrioventricular node

54
Q

Once the AV node receives the electrical signal, it relays it to the ________________.

A

Bundle of His

55
Q

The AV node only sends signal through to the Bundle of His once a certain condition has been met; what condition?

A

Once the ventricles have filled with blood

56
Q

The bundle of his passes the signal it received from the AV node to the atria. True or false?

A

False; it passes signal to the ventricles

57
Q

The bundle of His uses __________ to disperse signal to the ventricles.

A

The purkinje fibers

58
Q

The heart has just contracted and the empty ventricles are once again relaxed. From there, explain the steps of ventricle contraction.

A
  1. Blood begins filling the relaxed ventricles.
  2. SA node creates an electrical signal and sends it to the AV node
  3. AV node receives signal.
  4. The ventricles become full of blood, so the AV node then relays signal to the bundle of his.
  5. Bundle of His takes signal and disperses it amongst both ventricles via the purkinje fibers.
  6. Ventricles receive signal, contract, and push blood out.
59
Q

What’s the difference between depolarization versus contraction?

A

Depolarization is the electrical trigger, while contraction is the physical response

60
Q

Diastole is the contraction phase, while systole is the relaxation phase. True or false?

A

False; diastole is relaxation and systole is contraction, hence why imaging is completed during diastole as there is no movement.

61
Q

What are the seven deflections of an EKG?

A
  1. P wave.
  2. PQ segment
  3. Q wave
  4. R wave
  5. S wave
  6. ST segment
  7. T wave
62
Q

The first deflection, the P wave, corresponds to the SA node’s signal production within the _______ atrium.

A

Right

63
Q

The Q-, R-, and S wave correspond to depolarization of what areas, respectively?

A
  1. Q: interventricular septum.
  2. R: main ventricular mass.
  3. S: the base of the heart.
64
Q

The last deflection, the T wave, prepares for the next heart beat via what?

A

Repolarization

65
Q

The time it takes the SA node’s electrical signal to travel to and be received by the AV node corresponds to what EKG deflection?

A

PQ segment

66
Q

What happens during ST segment of an EKG?

A

Ventricular contraction and blood outflow

67
Q

What are the protocols of an MRA chest?

A
  1. Axial localizer.
  2. Sagittal-oblique 3D SPGR/FLASH (pre and post contrast)
68
Q

The axial localizer protocol of an MRA chest covers inferior to superior; from the top of the _________, up to the top of the ______________.

A
  1. Kidneys
  2. Aortic arch
69
Q

How is the degree of obliquity determined during the sagittal-oblique protocol of an MRA chest?

A

Starting from the axial localizer, plot slices to run parallel with the direction of the aortic arch.

70
Q

How is the degree of obliquity determined during the sagittal-oblique protocol of an MRA chest?

A

Starting from the axial localizer, plot slices to run parallel with the direction of the aortic arch.

71
Q

What is the slice thickness for the sagittal-oblique 3D SPGR/FLASH protocols?

A

1mm

72
Q

Why does the sagittal-oblique protocol use the SPGR/FLASH sequence for an MRA chest?

A

The low flip angle and T1-weighted appearance makes it optimal for contrast enhancement.

73
Q

What are the protocols of MRI breasts?

A
  1. 3 plane localizer
  2. Bilateral axial IR
  3. Sagittal T2 (unilateral)
  4. Axial 3D SPGR/FLASH Fat Sat (pre and post contrast)
  5. Coronal MPR
74
Q

How is the Axial 3D SPGR/FLASH Fat sat plotted during MRI Breasts?

A

Plot the isotropic volume slab off of the sagittal and coronal planes, covering whole breast, parallel with nipples

75
Q

Why is it important to ensure the volume slab is isotopic for the axial 3D protocol of MRI breasts?

A

To achieve multi-planar reconstruction

MRI (11 decks)

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