W hen to order CT vs.

MRI
Physicians’ guide on when to order CT or MRI for body imaging,
muscolosketal imaging and neurologic imaging.

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 BODY IMAGING

CT MRI
Lungs • CT with contrast for initial screening of lung disease, Unless directed by a radiologist, it is not recom-
generalized chest pain or other lung pathology. mended to order an MRI for initial evaluation of
• CT with contrast when looking for PE or Lung mass. lung or mediastinal pathology. A radiologist may
• CT without contrast to follow up pulmonary nodules. recommend an MRI of the chest subsequent to CT
for further evaluation.

Breast MRI of the breast is indicated when:

• A patient has breast cancer and is scheduled for surgery.
• A physician wants to follow the effectiveness of chemotherapy.
• A patient is at high risk of developing breast cancer.
• A patient has very dense breasts which limits the sensitivity of mammography.
• A patient has breast implants.
• A patient has had breast reconstruction following cancer surgery.
• A patient’s mammogram/ultrasound shows a suspicious spot.
Breast MRI is not designed to replace traditional mammography, but in certain clinical situations, a physician
may order a breast MRI in order to provide additional information to complement a mammogram.

Heart CTA with intravenous contrast for evaluation of the MRI with and without contrast for evaluation of
coronary arteries. (Cardiac CTA) myocardial infarction, cardiac viability, cardiac func-
tion or morphology. (Cardiac MRI)

Abdomen/ For generalized screening of abdominal pain, order a CT with iv and oral contrast.
Pelvis For more specific concerns, see individual organs below.

Liver/ For initial workup of the liver, a CT with contrast If there is a known liver lesion or biliary system le-
Biliary should be ordered. sion, it is best to order an MRI/MRCP with con-
trast. If MRI is contraindicated, order a CT with
contrast, Liver protocol.

Pancreas For initial workup of the pancreas, a CT with contrast, Pancreatic protocol should be ordered.
You will then be directed by the radiologist as to if an MRI is needed.

Spleen If there is no known abnormality but there is a con- If there is a known splenic lesion it is best to order an
cern and a general screen is needed, order a CT with MRI with contrast.
contrast.

Kidneys CT without contrast if there is concern for hematuria, If there is a known renal lesion for which follow up is
flank pain or renal stone. required, it is best to order an MRI with contrast.
For full evaluation of the renal collecting system and
ureters order a CT IVP.

Adrenal For initial evaluation of the adrenal glands it is best to order a CT with and without contrast, Adrenal
Glands protocol. If the finding is indeterminate the radiologist will recommend follow up with an MRI with
contrast which should be definitive.
 BODY IMAGING

CT MRI

Bowel CT of the abdomen and pelvis without contrast for evaluation of appendicitis.
For all other concerns related to the bowel, it is best to order a CT of the abdomen and pelvis with iv
and oral contrast. If iv contrast cannot be given due to renal insufficiency, CT with oral contrast will
suffice.

Uterus/ MRI with and without contrast for evaluation of the uterus and ovaries.
Ovaries

Bladder For evaluation of bladder pathology, order an MRI of the pelvis with contrast. If MRI is contraindi-
cated, order a CT with and without contrast.

Aorta/ CTA with contrast of the chest, abdomen, pelvis or any combination for aortic aneurysm, dissection or
Vascular follow-up of aortic endograft placement.
For upper and lower extremity vascular imaging either MRA or CTA may be ordered.
For evaluation of the mesenteric or renal arteries either MRA or CTA may be ordered.

MUSCULOSKELETAL IMAGING

CT MRI
Muculoskeletal CT is utilized under certain circumstances in evalu- MRI is the most accurate examination available for
ation of the bony structures and is usually requested joints and the surrounding tendons, ligaments, and
specifically by the orthopedic surgeon. For most cartilage. It is especially helpful for any sports-
musculoskeletal issues, MRI is the imaging proce- related injuries. MRI is also helpful for persistent
dure of choice. unexplained joint pain in the elderly as it very sen-
sitive in the detection of occult fracture in patients
with osteopenia or osteoporosis.

NEUROLOGIC IMAGING

CT MRI
Soft Tissue CT with contrast for evaluation all neck pathology MRI with and without contrast for evaluation of
Neck except for parotid, tongue and nasopharyngeal masses. parotid, tongue and nasopharyngeal masses or if
recommended after initial CT.

Paranasal CT without contrast for initial sinus evaluation. MRI with and without contrast for evaluation of
Sinuses sinus neoplasm or invasive inflammatory process if
recommended after initial CT.
 NEUROLOGIC IMAGING

CT MRI
Brain CT without contrast for initial evaluation • MRI with and without contrast for evaluation of infection, inflam-
of trauma/hemorrhage. mation and neoplasm. If MRI contraindicated then a CT with and
without contrast.
• MRI without contrast for brain screen, acute stroke, TIA, dementia
evaluation.
• MRI with and without contrast for all others including suspected
infection, inflammation, known malignancy, seizure, pituitary and
orbit pathology.

Face CT without contrast for initial evaluation all patholo- MRI face with and without contrast subsequent to initial
gies including trauma. CT evaluation.

Orbits CT without contrast for trauma evaluation or with MRI with and without contrast for initial evaluation
and without contrast if MRI contraindicated. infection, inflammation, neoplasm.

Temporal CT without contrast for evaluation ossicles and other MRI with and without contrast for hearing loss and tin-
Bone bony structures. Initial evaluation for all congenital, nitus. If recommended following initial CT.
infectious, inflammatory and neoplastic processes.

Neck Ves- CTA with and without contrast for circle of Wil- • MRA without contrast for intracranial circulation-
sels, Circle lis and with contrast only for neck vessels if there is a circle of Willis.
of Willis and contraindication to MRI or for additional evaluation • MRA with and without contrast for neck vessels.
Intracranial subsequent to initial MRA. • MRV with contrast for intracranial veins and dural
Circulation venous sinuses.

Temoro- CT without contrast if MRI contraindicated. MRI without contrast

mandibular
Joints (TMJ)

Spine CT without contrast for trauma. MRI with and without contrast for evaluation infection, inflammation,
neoplasm. If MRI is contraindicated then a CT with and without contrast
should be performed.
MRI without contrast for neck and back pain with/without radiculopathy,
or after initial CT for trauma.
MRI with and without contrast for myelopathy, spinal cord compression,
post operative spine, known malignancy and suspected infectious or inflam-
matory process.