RadteraMRI Orbits With and Without Contrast
MR+ ContrastHead & Neck
Indications
- Proptosis / orbital mass
- Optic neuritis
- Thyroid eye disease
- Vision loss
- Suspected orbital/optic nerve tumor (glioma, meningioma)
- Cranial neuropathy
Patient prep
- MRI safety screening (exclude intra-ocular metallic FB; obtain orbit radiograph/CT if concern)
- IV access for contrast
- Head coil
- Instruct patient to fixate gaze to reduce eye motion
Contrast
Agentgadolinium-based
RouteIV
Dose0.1 mmol/kg
TimingPost-contrast fat-suppressed T1
Technique
- Small FOV targeted to orbits with thin slices (2-3 mm)
- Fat suppression essential on T2 and post-contrast T1 (orbital fat obscures pathology and enhancement)
- Axial and coronal planes; oblique sagittal along optic nerve helpful
- Include brain screening for optic pathway/demyelination
Series / Sequences
| # | Series / Sequence | Plane | Weighting / Recon | Thickness | Notes |
|---|---|---|---|---|---|
| 1 | Ax T1 orbits | axial | T1 | 3 mm | Pre-contrast anatomy/fat |
| 2 | Ax T2 fat-sat | axial | T2 FS | 3 mm | Optic nerve edema/neuritis |
| 3 | Cor T2 fat-sat (STIR) | coronal | T2/STIR | 3 mm | Optic nerve cross-section, muscles |
| 4 | Ax FLAIR brain | axial | FLAIR | 4-5 mm | Demyelination screen |
| 5 | Ax T1 post fat-sat | axial | T1 +C FS | 3 mm | |
| 6 | Cor T1 post fat-sat | coronal | T1 +C FS | 3 mm |
Key points
- Fat saturation is critical—without it orbital fat masks lesions and enhancement.
- Optic neuritis: T2/STIR hyperintensity and enhancement of the optic nerve; pair with brain FLAIR for MS.
- Watch for fat-sat failure near air-bone interfaces; consider Dixon technique.
- Confirm no orbital metallic foreign body before scanning.
References
• ACR-ASNR Practice Parameter for MRI of the Head
• Radiopaedia: Orbital MRI protocol link
• ACR Appropriateness Criteria: Orbits, Vision and Visual Loss
• Radiopaedia: Orbital MRI protocol link
• ACR Appropriateness Criteria: Orbits, Vision and Visual Loss
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.