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MRI Brain Without Contrast

MRNo contrastNeuro

Indications

Headache with red flags
Acute stroke / TIA
Seizure (new onset)
Altered mental status
Suspected MS / white matter disease
Trauma
Dizziness / vertigo
Cognitive decline / dementia

Patient prep

MRI safety screening for implants/devices
Remove all metallic objects
No fasting required
Head coil; foam padding to limit motion

Contrast

None / non-contrast

Technique

Supine, head-first in dedicated head/neuro coil (typically 20-32 channel)
Align to orbitomeatal line; angle axials along anterior/posterior commissure (AC-PC) line
Whole-brain coverage from vertex through foramen magnum
DWI critical for acute stroke; SWI/GRE for microbleeds/blood products

Series / Sequences

#	Series / Sequence	Plane	Weighting / Recon	Thickness	Notes
1	Sag T1	sagittal	T1	4-5 mm	Localizer/anatomy; midline structures
2	Ax DWI/ADC	axial	DWI	4-5 mm	Single-shot EPI, b=0 and b=1000; essential for ischemia
3	Ax T2 FSE	axial	T2	4-5 mm
4	Ax FLAIR	axial	FLAIR	4-5 mm	TI ~2000-2500 ms; white matter/edema; CSF must null
5	Ax T1	axial	T1	4-5 mm
6	Ax SWI or GRE	axial	T2*	3-4 mm	Microhemorrhage, calcium, blood products

Key points

DWI/ADC mandatory for stroke and to detect restricted diffusion (abscess, epidermoid).
FLAIR best for periventricular/cortical lesions; add Cor FLAIR for mesial temporal/seizure work-up.
Add coronal high-res T2/FLAIR through temporal lobes for epilepsy.
If acute infarct found, consider MRA head/neck.

References

• ACR-ASNR-SPR Practice Parameter for Performing and Interpreting MRI of the Brain
• Radiopaedia: MRI brain (an approach) link
• ACR Appropriateness Criteria: Headache

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.