Indication
Brain
TIA/Stroke
Study
Comments
If Code Stroke – CT Head w/o contrast
to r/o hemorrhage
Order CT if uncooperative or suspect bleed
MRI DWI will detect acute infarct before CT
Acute Bleed
Severe Headache
Subarachnoid hemorrhage
F/u subarachnoid hemorrhage
F/u subdural hemorrhage
Brain tumor
Suspected brain tumor
METS
Papilledema
CNS Infection
Abscess
Meningitis
AIDS
Dementia
Neurodegenerative disorder
Multiple Sclerosis
MRI Brain w/o contrast and
MRA neck & head
CT Head w/o contrast
MRI Brain w/wo contrast
CT more sensitive than MRI for SAH and acute bleed
MRI may show source such as AVM or aneurysm
MRI Brain w/wo contrast
MRI superior to CT
MRI Brain w/wo contrast
MRI demonstrates abnormal meninges & other
complications of infection
MRI Brain w/wo contrast
MRI Brain w/wo contrast
Trauma
CT preferred over MRI
MRI Brain w/o contrast
Cranial Nerve Deficit
Cerebellar or Brainstem Lesion
Diplopia
Sensorineural Hearing Loss
Tinnitus
Acoustic Neuroma
Bell’s Palsy
Pituitary Tumor
Sinus Thrombosis
Known Aneurysm
Arterial venous malformation
Cavernous Angioma
MRI Brain w/wo contrast
MRI superior to CT
MRI demonstrates white matter changes of aging and
acute and chronic infarcts, Parkinson’s Disease, etc.
Acute plaques may show enhancement with MRI.
MRI superior to CT
CT is indicated for acute trauma.
Trauma MRI more sensitive for nonsurgical trauma, Post
Concussion Syndrome.
MRI superior to CT
MRI Brain w/wo contrast
CT not accurate. Recommend High resolution MR noncontrasted Limited
MRI Brain w/wo contrast
MRI Brain/MRV Head w/o contrast
MRA w/o contrast
MRI superior to CT
Replaces conventional angiography.
Does not replace angiography. Reasonable screening tool
in patients
With family Hx. Satisfactory to R/O aneurysms 5mm or
larger.
Muscloskeletal
Meniscal Tear
Ligamentous/Tendon/MuscleInjury
Bone Contusion
Fracture
MRI w/o contrast
MRI w/o contrast
Avascular necrosis
Cancer
Metastasis
Myeloma
Osteomyelitis
Cellulitis
Infection/Abscess
Soft Tissue Mass.
Osteochondritis Dissecans
Chondomalacia
Bone Tumor
MRI w/o contrast
MRI w/wo contrast
Loose Bodies
MRI w/o contrast
Spine
Herniated Disc – Cervical or Thoracic
Lumbar Herniated Disc
MRI w/o contrast
MRI w/o contrast
Stenosis
If post-surgery, then MRI w/wo
contrast
MRI w/o contrast
Discitis
Osteomyelitis
Metastasis
Epidural Tumor
Compression Fracture
Trauma
Brachial plexus – mass or lesion
Lower Extremity
numbness/tingling/weakness
Radiculopathy
Transverse Myelitis
MRI contrast w/wo contrast
MRI if occult fracture
CT if fracture seen on X-ray and position or alignment is to
be addressed
CT for avulsion or small cortical fractures
Bone scan if MRI is contraindicated
Bone Scan is good for whole body survey for metastasis
3 phase bone scan if MRI contraindicated
Iridium WBC if abnormality on plain x-ray
MRI w/o contrast
MRI w/wo contrast
MRI w/ contrast
MRI w/wo contrast
MRI w/o contrast
MRI chest w/wo contrast
MRI Lumbar spine w/o contrast
MRI thoracic spine w/o contrast
MRI thoracic spine w/wo contrast
Evaluates extent/neurovascular involvement
Contrast essential to distinguish between scar & disc post
surgery.
CT can be adequate in lumbar spine if MRI contraindicated
MRI superior to CT
Chest
Pulmonary Embolus
Aortic Dissection
Lung Nodule, Mass, infiltrate
Interstitial lung disease
Liver – Mass, Hepatoma,
Hemangioma, Cancer/Metastasis,
Hepatitis, Cirrhosis, Fatty Liver,
Abnormal LFTs
Abdominal Pain
Pancreas – Mass, epigastrsic pain
Cancer/mets
Pancreatitis
Renal MRA
Renal mass
Hematuria
Adrenal – Mass/Cysts
Prostate
Uterine Fibroids
Pelvic Mass, pain, Ca/mets,
infection/abscess
Breast CA
Orbit/Head & Neck
Nasopharynx
Tongue
Floor of Mouth
Neck Mass
Soft Tissue Neck
TMJ – pain/discomfort
Orbit Proptosis
Orbit or eye swelling (infection)
Optic nerve visual field defect
Carotid stenosis
CTA Chest with IV contrast
CT chest and/or abdomen with IV
Contrast
CT
High resolution CT w/o contrast
MRI Abdomen w/wo contrast
CT is the most sensitive test
If IV contrast is contraindicated or patient has poor venous
access, V/Q Scan
CT is the most sensitive test
Peripheral nodules – can be imaged without contrast
Hilar nodules – contrast helpful
1-2 mm slices at 5-10 mm increments
MRI Abdomen w/wo contrast
MRA kidneys with contrast
MRI renals w/wo contrast
Renal stenosis
If mass involves vasculature then MRI abdomen w w/o and
MRA with contrast
MRI Abdomen w/o contrast
MRI pelvis w/o contrast
MRI pelvis w/wo contrast
MRI pelvis w/wo contrast
MRI Breast w/wo contrast
CT Neck with contrast
W/wo if stone suspected
MRI only to r/o extension of mas into spinal canal, skull
base or vocal cords
MRI TMJ
CT with IV contrast
MRI with contrast
MRA w/o contrast
No contrast for Grave’s disease
Orbit MRI
Extremities
Upper Extremity = upper any joint
Shoulder, elbow or wrist
Upper other than joint – humerus,
forearm, hand
Cancer
Tumor
Infection
Osteomyelitis
Abscess
Masses
Pain
Muscle/Ligament tear
Injury
Swelling
Tendonitis
Lower Extremity
Lower any joint – knee, hip, ankle
Lower other than joint – femur, tib/fib,
foot
MRI Extremity w/wo contrast
MRI extremity w/o contrast