Why centre on the xiphoid for a dorso-lumbar spine?

The xiphoid sits roughly over the thoracolumbar junction, so centring there puts both the lower thoracic and the lumbar spine in the coil and the FoV, with the T11–L2 junction near the middle.

Why count up from S1?

S1 is the one level that is easy to recognise on a lumbar sagittal, so counting up from it gives a reproducible number for every disc. Note any transitional vertebra and keep the same counting reference for every series and the report.

Why does each disc need its own axial stack?

The discs change angle along the lumbar curve, so one straight block cuts most of them obliquely and fakes bulges. A short stack parallel to each disc shows every level true.

Dorso-lumbar spine MRI protocol

One exam for the lower thoracic and the lumbar spine together. The thoracolumbar junction is where fractures, conus lesions and metastases hide, and with so many similar vertebrae in one field, counting the levels correctly is most of the job.

By the ScanFlo Editorial Team · Updated 12 October 2026

In this section · Protocols

Protocols/Spine

Video language

When this study is used

Back pain or radiculopathy where the level is unclear, or spans the thoracolumbar junction.
Trauma: the T11–L2 junction is the commonest site of spinal fracture.
Suspected conus medullaris lesion, cord compression or cauda equina syndrome.
Suspected metastasis, infection (discitis) or collapse at more than one level.

Patient & coil positioning

Head-first supine, straight on the spine coil, arms by the sides and clear of the field of view.
A pad under the knees flattens the lumbar curve and helps the patient lie still.
Centre the laser on the xiphoid, the lower tip of the sternum, so the lower thoracic and the lumbar spine both sit in the coil.

Localizer

Three-plane localizer. The sagittal must reach from the lower thoracic spine to the sacrum. Identify the levels by counting up from S1 (or down from C2 on a whole-spine localizer) and keep that reference for every series.

Sequence planning

For each sequence below you get the reference line the slice group follows, how much it covers, and why the sequence is in the protocol at all. Plan against the localizer, not by eye.

Sagittal T2 TSE

Sagittal

Planning: On the coronal, parallel to the spinal cord. On the axial, along the line from the centre of the vertebral body to the spinous process, so the slices fall on the midline. Cover from one transverse process to the other; a 350 mm FoV fits the lower thoracic spine and the sacrum in together. Anterior saturation band over the aorta and the chest wall.

Why: Myelogram effect over the whole region: cord, conus, discs and canal in one view.

Sagittal T1 TSE

Sagittal

Planning: Copy the T2 sagittal's slices (Copy Parameter → Slices).

Why: Anatomical map and marrow signal: fracture lines, marrow replacement, fat in haemangiomas.

Axial T2 TSE (one stack per disc)

Axial

Planning: A separate stack for each disc, each parallel to its own disc on the sagittal. The lower thoracic discs lean at almost the same angle; in the lumbar curve the angle changes from disc to disc, and L5–S1 is the steepest. 3–5 slices per disc, centred on the nucleus, with no overlap in the canal.

Why: Disc, canal, conus and nerve-root assessment level by level.

Coronal STIR (T2 TIRM)

Coronal

Planning: On the sagittal, parallel to the spine, covering the vertebral bodies and the canal from front to back.

Why: Marrow oedema and fluid: acute fracture, metastasis, discitis and paraspinal collections.

In the video

The video scans a ScanFlo Dorso-Lumbar Spine case. The angles are that patient's, so follow the landmarks, not the numbers.
Sagittal T2: 13 slices, 4 mm, 10% gap, FoV 350 mm, TR 3000 / TE 101 ms; this spine is straight, so the block is almost straight on the coronal. The T1 sagittal (TR 500 / TE 8 ms) copies it with Copy Parameter → Slices.
Axial T2: nine per-disc slice groups from the lower thoracic spine to L5–S1 (30 slices, 4 mm), TR 6080 / TE 101 ms; L5–S1 tilts about 22° on the sagittal and L4–L5 about 9°.
Coronal STIR: 15 slices, 4 mm, 20% gap, leaning about 9° on the sagittal.
The queue takes about 5½ minutes; the video shows the scan as a time-lapse.

Representative parameters

Treat these as ranges. Field strength, coil and vendor all move the numbers. What must not move is understanding why each sits where it does.

Sequence	Field	Matrix / FOV	Notes
T2 TSE sagittal	1.5–3 T	320–384 / 35 cm	Phase H–F; anterior sat band
T1 TSE sagittal	1.5–3 T	320–384 / 35 cm	Marrow, anatomy
T2 axial	1.5–3 T	256–320 / 20–22 cm	One stack per disc
STIR coronal	1.5–3 T	256 / 35–38 cm	Fracture, metastasis, infection

Artifacts & how to fix them

Artifact	Typical cause	Mitigation
Aortic and cardiac ghosts	Pulsation in front of the thoracic spine	Anterior sat band; phase head-to-foot on the sagittal
Breathing motion	Chest wall and diaphragm in the field	Sat band over the chest; coach quiet breathing
CSF flow voids	Pulsatile CSF behind the thoracic cord	Flow compensation; confirm on the axial before calling a lesion
Inhomogeneous STIR	Large FoV, lung and bowel gas	Shim on the spine only

What am I looking at?

You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:

Finding	Sequence to check	How it reads
Acute compression fracture	Coronal STIR + sagittal T1	Bright marrow oedema on STIR; dark band or lost height on T1
Conus lesion	Sagittal T2	Swollen or bright conus; compare its tip level with the counting reference
Metastasis	Sagittal T1	Dark marrow replacing the normal bright fat, often several levels
Discitis	STIR + T2	Bright disc and both adjacent end-plates, with loss of the end-plate line

Review checklist

Lower thoracic spine to the sacrum on one sagittal, conus included.
Levels counted from S1 and the same reference used for every series.
T1 sagittal copied from the T2, slice for slice.
Axial stacks angled per disc and not overlapping in the canal.
STIR fat suppression uniform from top to bottom.

Mistakes that cost repeats

Miscounting levels in a long field of similar vertebrae, and labelling the wrong disc.
A FoV too small to show both the thoracolumbar junction and the sacrum.
One straight axial block for discs that change angle down the lumbar curve.
No anterior sat band, so aortic and breathing ghosts cross the canal.

Common questions

Why centre on the xiphoid for a dorso-lumbar spine?: The xiphoid sits roughly over the thoracolumbar junction, so centring there puts both the lower thoracic and the lumbar spine in the coil and the FoV, with the T11–L2 junction near the middle.
Why count up from S1?: S1 is the one level that is easy to recognise on a lumbar sagittal, so counting up from it gives a reproducible number for every disc. Note any transitional vertebra and keep the same counting reference for every series and the report.
Why does each disc need its own axial stack?: The discs change angle along the lumbar curve, so one straight block cuts most of them obliquely and fakes bulges. A short stack parallel to each disc shows every level true.

Try it in ScanFlo: Plan the axial stacks for the nine discs, then count the levels twice: once up from S1 and once down from the top of the field. If the two counts disagree, find the transitional vertebra before you label anything. See ScanFlo MRI →

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