Brain tumor protocol (MRI)

Last revised by Dr Yair Glick on 02 May 2022

MRI protocol for brain tumor assessment is a group of MRI sequences put together to best approach CNS tumors in general.

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints. 

Sequences

A good protocol for this purpose involves at least:

  • T1 weighted
    • plane: axial and sagittal (or volumetric 3D)
    • sequence: fast-spin echo (T1 FSE) or gradient (T1 MPRAGE)
    • purpose: anatomical overview, which includes the soft tissues below the base of skull
  • T2 weighted
    • plane: axial
    • sequence: T2 FSE
    • purpose: evaluation of basal cisterns, ventricular system and subdural spaces, evaluation of vasogenic edema, and good visualization of flow-voids in vessels
  • FLAIR
    • plane: axial
    • sequence: FLAIR
    • purposeassessment of white-matter tumor involvement and related vasogenic edema
  • diffusion-weighted imaging (DWI)
    • plane: axial
    • sequence: DWI: B=0, B=1000 and ADC 
    • purpose: evaluation of the tumor cellularity 
  • postcontrast sequences
  • susceptibility weighted imaging (SWI)

When assessing gliomas it is relevant to include advanced MRI sequences, such as:

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