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PCH Neuroradiology Order and Contrast Recommendations Signs and symptoms BRAIN Acute Trauma, Acute Mental Status changes, New Focal Neuro Defict Headache, Developmental Delay, Vomiting, First Seizure, Ataxia, Weakness, Macrocephaly/Microcephaly, Autism MRI Protocol and Contrast Notes Emergent CT; Defer Outpatient MRI Send patient to ED for urgent evaluation Standard MRI Brain w/o contrast Will detect virtually all pediatric intracranial abnormalities. Contrast can be added at the time of imaging after Radiologist review if further evaluation needed Recurrent seizures/epilepsy Epilepsy Protocol MRI Brain w/o contrast Skull/Scalp Lesion Soft Tissue/LCH Protocol MRI Brain w and w/o contrast Consider Neurology/Epileptologist referral Consider CT Head without first. CT is preferred for evaluation of calvarial bone involvement Consider sending patient to ED for concurrent evaluation Consider Endocrine referral Neurological signs with Fever Short stature, Precocious puberty Ptosis, Strabismus, Visual disturbance SPINE Back pain, radiculopathy Standard MRI Brain w and w/o contrast Pituitary Protocol MRI Brain w and w/o contrast Standard MRI Brain w and w/o AND MRI Orbits w and w/o contrast Standard spine MRI w/o contrast Specify one or more levels: Cervical, Thoracic, Lumbar Neck pain, radiculopathy Standard cervical spine MRI w/o contrast Consider Standary MRI brain for atypical neck pain, possible Chiari I malformation Back pain with fever Standard spine MRI w and w/o contrast Specify one or more levels: Cervical, Thoracic, Lumbar Brachial Plexus evaluation Brachial Plexus Protocol Cervical SpineMRI Indicated for patients with upper brachial plexus symptoms. If shoulder mechanism dysfunction is suspected in addition or instead of, order MRI shoulder without contrast Sacral dimple Standard lumbar spine MRI w/o contrast Indicated for all patients > 4 months. Less than 4 mos can consider screening US HEAD & NECK Neck mass, lymphadenopathy Standard MRI Neck w and w/o contrast Eye pain Facial mass Standard MRI Orbits w and w/o contrast Standard MRI Face w and w/o contrast Hearing loss MRI Brain and Internal Auditory Canal (IAC) without contrast TMJ pain/dysfunction MRI TMJ w and w/o contrast Neuro CT Orders Notes CT Head without contrast with 3D reconstructions CT Head with contrast only CT Neck with contrast CT Sinus without contrast CT Orbits with contrast Consider CT Neck first. Detects/localizes most masses/lymphadenopathy. MRI can further characterize Consider CT orbits w contrast if suspect orbital cellulitis Order with and without contrast if acute onset/suspect infectious/inflammatory process is suspected Neuro CT studies are rarely performed with AND without contrast because of DOUBLE radiation. CT is Primary study for the exclusion of acute or advanced intracranial disease. Contrast is rarely indicated. The addition of contrast is rarely useful. Consider MRI without instead Primary evaluation of neck mass or lymphadenopathy Not indicated for primary evaluation of acute sinus disease. Consider for cases of nonresolving sinus disease Primary evaluation for orbital cellulitis. For trauma/fracture evaluation CT orbits without contrast PCH Neuroradiologists are available for consultation at 602.933.1212
