Reply To: Kudos to Stephen Kwon/Dr Kang

Hernia Discussion Forums Hernia Discussion Kudos to Stephen Kwon/Dr Kang Reply To: Kudos to Stephen Kwon/Dr Kang

#33179
MarkT
Participant

I think the same holds true for MRI…if you can get dynamic done, that is the way to go. Unfortunately, as GI mentioned for US not everywhere will offer dynamic with MRI either.

I copied this from an old post by Dr. Towfigh:

MRI Protocol for Hernia for non-contrast dynamic MRI pelvis for imaging of occult inguinal hernias:

1. For all of our groin pain MR studies, we have the patient place a fiducial marker on the site of the pain.
2. We prefer 3Tesla MRIs, though 1.5T is acceptable. Open MRIs are not acceptable, as they lose resolution for the pelvis.
3. The following are then acquired:

– Axial, sagittal, and coronal T2 HASTE with breath hold.
– Axial, sagittal, and coronal T2 HASTE with valsalva.
– Single-slice saggital plane dynamic valsalva acquisitions- typically about 5 individual acquisitions, both through and on either side of the fiducial marker.
– Axial T1 gradient echo.
– Axial T2 fat sat (either fast-spin echo or STIR depending on the machine).

Note that some call it a sports hernia protocol, but it is a bit different (most sport hernia protocols don’t do valsalva components).

No reason to use any contrast with MRI (usually oral contrast for CT, can help show bowel and hernia…or IV for inflammation issues).

Important to do dynamic…yes, it is more labour-intensive, can take 45 min. or more to get everything, but the video aspect is key to showing small hernias.

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