Post on 19-Feb-2018
1
Copyright © Siemens AG 2010. All rights reserved.
Emerging MRI Techniques for Abdominal and Pelvic Imaging
Brian M. Dale, PhD
Page 2 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Background
PhD in Biomedical Engineering – 2004Case Western Reserve UniversityCleveland, OHSequence programmingOptimal design
Collaboration Manager Siemens HealthcareCary, NCIDEA and Physics TeamAbdominal MRI at 3 T
Page 3 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Outline
Hepatic fat quantificationAbdominal workflowMRI of the female pelvis
Cancer characterization with 4D imagingWill not cover in depth
FDA constraintsOverlap with Dr. Lin
ReferencesFritz-Hansen T, Rostrup E, et al. MRM. 1996 Aug; 36(2):225-31, Rijpkema M, Kaanders JHAM, et al. JMRI 2001; 14: 457-463.Parker GJ, Jackson A, et al. In: Proc. ISMRM, 2003. p 1264. Parker GJ, Roberts C, et al. MRM. 2006 Nov;56(5):993-1000.
Page 4 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Fatty Liver Disease Progression
Incidence10% - 24% overallUp to 75% of obese
Primary FLDNAFLDNASH
Secondary FLDAlcoholicHepatitisDrug-inducedSurgically-induced
Page 5 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Cirrhosis
SymptomsFatigue Bleeding/brusingNausea Weight loss Ascites
DiagnosisLiver biopsyFibroTest
IrreversiblePrevent further damageLiver transplant
Wikipedia
Page 6 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
How Can We Detect FLD Early?
Early Stage FLDTreatableAsymptomaticFat is present
MR Signal CharacteristicsShort T1Chemical shift 3.5 ppm
2
Page 7 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Sequence Overview
3D spoiled steady state T1 weightedDual-echo
In-phaseOpposed-phase
Single breath-holdRoutine liver examDixon reconstruction
TerminologySiemens: VIBE DixonGE: Lava IDEALPhilips: mDixon
Page 8 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Physics – Microenvironment Magnetic Shielding
© 2006 Denis Hoa et al, Campus Medica. www.e-mri.org
Page 9 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Opposed Phase – Destructive Interference
© 2006 Denis Hoa et al, Campus Medica. www.e-mri.org
Page 10 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Standard IP/OP Approach
In- and Opposed-Phase ImagesMagnitude reconstructionSignal drop due to fat/water cancellationPure voxels un-cancelledAmbiguous
In-Phase Opposed-Phase
Page 11 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Fat
Wat
er
In-Phase Opposed-Phase
Fat
Wat
er
In-Phase Opposed-Phase
VIBE Dixon Approach
In- and Opposed-Phase ImagesMagnitude and phase reconstructionUnambiguous fat/water separationPhase unwrapping required
Page 12 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Fat Only Water Only
Fat Percentage Map
Quantitative Measure of Fat
3
Page 13 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Remaining Limitations
Unproven for early stage FLDNo good gold standardLiver biopsyFocal disease
Phase unwrapping errorsMathematically ill-posed
Page 14 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Abdominal MR Exam Workflow
Long duration compared to CTExpensiveError prone
Value added timeImage acquisition
Non-value added timeCoil set-upLocalizersAdjustmentsBreathing commandsContrast delayParameter changes
Hardware solutionsDockable tableArray coils
Software solutionsParallel imagingAutomatic localizationParameter optimizationProtocol strategiesAutomatic voice commands
TerminologySiemens: DOTPhilips: Smart ExamGE: ?
Page 15 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Dot*Day optimizing throughput Engine
PersonalizedBest possible results for virtually any type of patient
GuidedGuides the novice user helping them to scan more expertly
AutomatedWith intelligent, automated workflows a new level of efficiency can be reached
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Page 16 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Personalized
Software for best possible results for virtually any type of patient
Strategies for uniquely tailored, optimized scans configurable to patient condition or clinical question
Avoid failed scans while improving standard of care
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Page 17 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
PersonalizedEvery patient is different – different breathhold
Abdomen and cardiac - just state patients breathhold capability –Dot* adapts to each patient’s breathhold capacity and links to your best scanning protocol to match
Breathhold settings can be changed at any time during the exam
Easy set-up of the best scan for each patient – higher resolution and reduction of errors
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Page 18 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Dot* guides the novice user helping them to scan more expertly
This enables results with greater efficiency at all levels and improved image consistency
Excellent results – guided intuitively
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
4
Page 19 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
MRCP
Guided The right choice when needed
Your decisions are seamlessly integrated into the scanning process
After a decision is taken, Dot* automatically links to yourprotocol and updates the queue
E.g. for Abdomen – MRCP or Diffusion
One click, less mistakes, faster
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Page 20 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
With intelligent, automated workflows – customizable to your standards – a new level of efficiency can be reached
Scans are completed faster and more easily with less chance of errors or repeats
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Automated
Page 21 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Automated Dynamic VIBE Timing
Timing is never off –synchronized contrast timing and breathing
AutoBolusDetection – more accurate contrast timing
Voice commands integrated into the scanning workflow
Automatically played at the right point in time - synchronized timing of scanning and breathing
Personalized voice commands –easy language selection
Easily selectedAutomatically played
*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Page 22 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
AutomatedAutomated abdominal exam
Timing is never off – even inserting sequences between venous and delayed
Intelligent automation – no navigator positioning, no FoVadaptations necessary anymore
Reduced user interaction – be fast, with excellent image quality
Comprehensive liver exam in only 15 min*
Also available for TimCT Onco
Video: 19 s
* Results may vary. Data on file. *The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S..
Page 23 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Remaining Limitations
Unproven time savings
Community acceptance
Customization
Best practices strategies
Page 24 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Standard Female Pelvis Protocol
3-plane localizer
Sagittal, axial, & coronal 2D TSE T2wCongenital anomaliesCancer stagingFibroid treatment planning
Axial 2D TSE T1wCongenital anomaliesCancer stagingFibroid treatment planning
Axial & sag 3D GRE T1w pre- and post-contrastCancer stagingFibroid treatment planning
5
Page 25 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
3D T2w TSE
Acquire 3D isotropic Reformat any plane
Long echo trainT2 decay causes blurringVariable flip angle refocusing
TerminologySiemens: SPACEGE: CUBEPhilips: Vista
Page 26 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Acquired Offline reconstructed
3D TSE T2w MRI w SPACE
Page 27 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Coronal oblique TSE T2w
Sala E, Seminars in Roentgenology, October 2008
Congenital anomalies
Offline Multiplanar Reformat
Page 28 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Coronal oblique TSE T2w
Sala E, Seminars in Roentgenology, October 2008
Cervical cancer
Offline Multiplanar Reformat
Page 29 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Axial oblique TSE T2w
Sala E, Seminars in Roentgenology, October 2008
Endometrial cancer
Offline Multiplanar Reformat
Page 30 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
50 patients (49.4 ± 14.5 yrs)
Ax, cor & sag 2D TSE T2w
Sag SPACE
4 readers
2D TSE T2w vs SPACE
6
Page 31 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Acquisition TimeSagittal 3D (+ Recons)
Ax, cor & sag 2D
Mean ± StDev 6:57 ± 0:58 12:11 ± 2:08
Median 6:36 11:28
Minimum 5:17 9:31
Maximum 10:49 19:07
N = 50, unpublished data
Time Savings
Page 32 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
SPACE2D
2D TSE T2w vs SPACE
Page 33 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
SPACE2D
2D TSE T2w vs SPACE
Page 34 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Image qualityOverall, uterus, ovaries
ContrastEndometrium/junctional zone/myometrium
Cervical epithelium/stroma/parametrium
Vagina/surrounding tissue
N = 50, unpublished data
Results
Page 35 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Lesion detection
N = 50, unpublished data
Qualitative Assessment
Page 36 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
ArtifactsRespiratory motion
Bowel motion
N = 50, unpublished data
Qualitative Assessment
7
Page 37 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
3-plane localizerSingle plane 3D FSE T2wAx 3D dual echo GRE w/wo Gad
“Fast Female Pelvis”
Page 38 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Remaining Limitations
Manual reformat on scannerManual reformat on PACSAutomatic inline reformat
Reformat image qualityOptimal thicknessOblique slices
Small studyMore patientsMore pathologies
Page 39 Sep-2010Copyright © Siemens AG 2010
H CSG MR R&DBrian M. Dale, PhD
Thank You
Acknowledgements
Chen Lin, PhDElmar Merkle, MDVamsi Narra, MDRichard Semelka, MD