CT VB80 What's New - USA

SIEMENS Healthineers syngo.via CT VB70-VB80 What‘s New Job Aid Template Effective Date: 10 Aug 2021 | HILS 2223 This training material is based on the medical device syngo.MM Oncology VB80A. Job Aid Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Disclaimer SIEMENS Healthineers syngo.via Q Scanner AI-Rad Companion V syngo.via Syngo Carbon View&GO Space Please keep in mind that the user interface may differ slightly from what is shown in this Job Aid. The actual usage of the tool may differ slightly on the different host systems, for example on syngo.via, Syngo Carbon Space, syngo.via View&GO, AI-Rad Companion or on the scanner. However, the intended purpose of the tool is the same. The tool functionality defined in this Job Aid is applicable to any of the Siemens Healthineers products in which you find this tool. 2 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 syngo.via CT VB70-VB80 What‘s New Job Aid SIEMENS Healthineers Table of Contents Extension of MM Oncology 4 Large matrix support 5 Iodine threshold for non necrotic region analysis SIEMENS 7 Healthineers Interactive Spectral Imaging (ISI) 9 Support for NAETOM Alpha 13 Extension of Dual Energy application classes 14 Extra-Cellular Volume (ECV) 16 Lung Mono 31 DE Application Class in NAEOTOM Alpha 37 Bone Removal Feature Improvement 41 3 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers syngo.via CT VB70-VB80 What‘s New Job Aid Extension of MM Oncology 4 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Large matrix support SIEMENS Healthineers Large matrix images are supported depending on the type of MM Oncology Reading measurement. 3D Reading Type Support RECIST 1.1 RECIST, Solid Lesion, Sub Solid Lesion/Lung CAD Yes Solid Liver Lymph Generic RECIST Lesion Node Solid Lesion Liver, Lymph Node, Generic, Liver Arterial No Enhancement Fraction (AEF) Subtolld Lesion Auto 7nom • RECIST, Solid Lesion and Sub Solid Lesion: Any matrix supported Lung CAD ACT Onco Auto • Lung CAD only runs on square matrices of 512x512, 768x768, and Roard 7oom 1024x1024. Trending 5 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Iodine Threshold SIEMENS Healthineers Clinical background of necrotic lesions measurement The size of the tumor is not the only measure of interest A • when physicians assess medication effect of tumor burden. • In some cases, the size does not change, but the activity of the tumor does, or the tumor becomes necrotic. • In this case measuring should not only consider the size, but also the iodine enhancement of the tumor. • Iodine enhancement could be less in necrotic regions compared with that of healthy tissue. • Measurements based on iodine concentration may improve accuracy of tumor burden evaluation. 6 6 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Iodine Threshold for non-necrotic lesion analysis SIEMENS Healthineers The existing Advanced HU Statistics feature on the CT Segmentation mini toolbar has been extended to include Iodine Threshold. It enables tissue labeling based on iodine concentration not on HU. The feature is only available for Dual Energy images. 15 _ HU 30 + HU Upper Threshold Lower Threshold Upper Threshold Lower Threshold lodine Threshold Modify Undo Redraw Hide Density Edit Target Lesion Contour Modify Undo Redraw Hide Density Edit Contour Target Lesion VB70 VB80 The Iodine Threshold option is not shown if Virtual Unenhanced / Liver VNC volumes are not available. 15 _ HU Upper Threshold Lower Threshold Modify Unda Redraw Hide Density Edit Target Lesion Contour 7 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Measurement results SIEMENS Healthineers Lower Threshold: 100 HU Iodine Threshold: 100 HU (or μg /cm3) L4VOI RECIST 1.1 Diam.: 90.3 mm Max. Orth. Diam : 79.9 mm Volume: 295.004 ml Vol. 2=11 00.0 HU: 236.503 ml (80.2%) MIX / VNC / IODINE REIST 1.1 Diam : 90.3 mm Mean: 130.2 HU/ 46 9 H0/63:1 HU L4VOI1 Mas Orth Diam : 79 9 7. RECIST 1.1 Diam.: 90.3 mm Volume 116. 462 ml (39 523 ) L4VOI1 Max. Orth. Diam.: 79.9 mm RECIST 1.1 Diam.: 90.3 mm Max. Orth. Diam.: 79.9 mm Volume: 295.004 ml Volume: 295.004 ml Vol. >= 100.0 HU: 236.503 ml (80.2%) FOR lodine >= 100.0 HU: MIX / VNC / IODINE Volume: 116.462 ml (39.5%) Mean: 130.2 HU/ 46.9 HU/ 83.1 HU MIX / VNC / IODINE Mean: 167 8 HU/ 43.1 HU/ 124.5 HU 100 - HU 100 _ HU Upper Threshold Upper Threshold Lower Threshold lodine Threshold Lower Threshold lodine Threshold Undo Modify Undo Redraw Hide Edit Modify Density Redraw Edit Target Lesion Target Lesion Hide Contour Contour Density • Based on the CT HU. • Based on the iodine. • Volume based on voxels with more than • Volume based on iodine with more than 100HU or 100 μg 100 HU. /cm3 . (The unit changes depending on the configuration • Calculated in ml and %. of iodine images). • Calculated in ml and %. 8 8 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Interactive Spectral Imaging (ISI) SIEMENS Healthineers • ISI is now available in MM Oncology*. R Reset L4VOI1 CT 2 RECIST 1.1 Diam.: 56,1 mm Mond Mono+ Max. Orth. Diam.: 44,8 mm • The ROI and CT Segmentation tools simultaneously kev Volume: 51,488 ml VNC lodine Density: 0,6 mg/ml lodine Uptake: 33,0 mg display the mean HU value of the diagnostic CT image Mixed MIX / VNC /LODINE Mean: 68,4 HU/ 46.6 HWY 21,8 HU lodine (e.g., Mixed, Mono+), the VNC image and the Iodine Maps are independent of and in addition to the chosen VB70 CT Layout VB70 CTDE Layout representation. • Replacement of Mean NMI / Mean HMI line in evaluation label with MIX or Mono+ / VNC/L_VNC / L1VON1 CT_2 IODINE or L_IODINE. RECIST 1.1 Diam.: 73.2 mm Max. Orth. Diam.: 50.9 mm Volume: 116.599 ml Mean NMI: -44.5/ 21.4/ 66.0 HU lodine Density: 1.7 mg/ml lodine Uptake: 203.0 mg Please note: No fused VNC/Iodine representation based on SPP** provided via interactive image text (as it is in MM VB60 CTDE Layout Reading and syngo.CT extended functionality). * Part of syngo.via MI Workflows 9 ** Spectral Postprocessing Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2022 Unrestricted © Siemens Healthineers, 2024 Interactive Spectral Imaging (ISI) SIEMENS Healthineers New Features • An interactive image text (with on-the-fly input image generation from SSP) includes: L4VOI1 CT 2 R RECIST 1.1 Diam.: 56,1 mm Max. Orth. Diam.: 44,8 mm Volume: 51,488 ml • A representation switch to switch image impression. Mono lodine Density: 0,6 mg/ml kev Reset lodine Uptake: 33,0 mg Existing measurements are preserved after the switch. Mono+ MIX / VNC /IODINE VNC Mean: 68,4 HU/ 46.6 HJW/ 21,8 HU Mixed An interactive keV/ratio slider to change interactively lodine • the image impression for the Mono+ representation Triplet of values for ROI and the mixed ratio. CT Layout measurement • A triplet of values (Mixed, VNC, Iodine) for ROI measurements for measurements for Lesion Segmentation. Replacement of NMI/HMI. • 10 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2022 Unrestricted © Siemens Healthineers, 2024 Measurement Results – SIEMENS Healthineers Name and Layout The following Dual Energy information can be measured Virtual depending on the layout used: Layout Liver VNC Unenhanced Mix / L_VNC / L _ IODINE for Liver VNC DECT Liver X • DECT Liver 3D X • Mix / VNC / IODINE for Virtual Unenhanced DECT Liver 3D 2TP X • Density in mg/ml DECT Liver 4 TP X • Iodine Uptake in mg DECT X DECT 3D X DECT 3D 2TP X DECT 4TP X SPP on non-DE X (called VNC) 11 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Measurement Results – SIEMENS Healthineers Comparison of software version VB60 and above The name of the mean value is different for Liver VNC and Virtual Unenhanced. Up to VB60 VB60 and above L3VOI1 CT_2 RECIST 1.1 Diam.: 34,3 mm L9VON1 CT 2 RECIST 1.1 Diam.: 36,1 mm Max. Orth. Diam.: 22,6 mm Max. Orth. Diam.: 29,1 mm Volume: 5 987 ml Volume: 11,334 ml Liver VNC lodine Density: -0,3 mg/ml Mean HMI: -84,3/ -85,9/ -1,6 HU lodine Uptake: -3,7 mg Todine Density: -0, 1 mg/ml MIX / L_VNC / L_IODINE lodine Uptake: -0,5 mg Mean: -6,8 HU/ -30 HU/ -4,0 HU L6VOI1 CT_2 VOI1 CT_2 RECIST 1.1 Diam.: 8,9 mm RECIST 1.1 Diam.: 28,8 mm Max. Orth. Diam.: 13,7 mm Max. Orth. Diam.: 19,0 mm Virtual Unenhanced Volume: 5,630 ml Volume: 1 888 ml lodine Density: -0,5 mg/ml Mean NMI: 37,9/ 323,2/ 282,4 HU lodine Uptake: -2,9 mg Todine Density. 8,8 mg/ml MIX / VNC / IODINE lodine Uptake: 16,6 mg Mean: 8,4 HU/ 24,7 HU/ -16,4 HU 12 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 SPP2.0 and SPP2.1 images are supported SIEMENS Healthineers SPP2.0 and SPP2.1 images, which are acquired in NAEOTOM Alpha, are supported in MM Oncology workflow with VB80. SIEMENS Healthineers NAEOTOM Alpha 13 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers syngo.via CT VB70-VB80 What‘s New Job Aid Extension of Dual Energy application classes 14 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Extension of Dual Energy application classes SIEMENS Healthineers Extra-Cellular Volume (ECV) Lung Mono Bone Marrow in NAEOTOM Alpha 15 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers Extension of Dual Energy application classes Extra-Cellular Volume (ECV) 16 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Dual Energy application subclasses SIEMENS Healthineers The following Dual Energy application subclasses are available with VB80: • Liver Extra-Cellular Volume (ECV) (Subclass of Liver VNC) RAF • Heart Extra-Cellular Volume (ECV) (Subclass of Heart PBV) • Lung Mono (Subclass of Lung Analysis) 17 17 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Liver ECV and Heart ECV SIEMENS Healthineers The ECV (extracellular volume) map can only be evaluated for contrast enhanced CT scans. It is typically used for late scans with a delay of three to five minutes between contrast media injection and the CT scan. The measurement is available only for Dual Energy images. • Liver ECV O It can help to quantify fibrosis in chronic hepatitis patients. • Heart ECV It helps to characterize pathologies affecting the heart muscle (myocardial fibrosis/scars). RAF 18 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 ECV – Extracellular Volume SIEMENS Healthineers Clinical background: • Assess pathological tissue changes (scars, fibrosis, etc.). • In affected areas, iodine leaks into the ECV and remains there for a while. The ECV map is calculated from the iodine enhancement map, the contrast enhancement CE as defined by the tool DE Normalize Contrast, and the hematocrit value HCT in % provided by the user. The ECV is given in percent and calculated as: ECV = (100% - HCT) ⋅ Iodine Enhancement ÷ CE The ROI DE Normalize Contrast must be placed into the aorta or another large vessel for a meaningful evaluation. 19 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Hematocrit (HCT) SIEMENS Healthineers Hematocrit is the percentage by volume of red cells in your blood. Composition of blood Blood is made up of red blood cells, white blood cells and platelets, suspended in plasma. Plasma Buffy coat White blood cells, platelets Hematocrit Red blood cells 20 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Available scanners for Heart ECV and Liver ECV SIEMENS Healthineers • Heart ECV and Liver ECV subclasses are available for the following dual Application Class Heart PBV source scanners: Base Application Class Heart PBV Create New Delete • SOMATOM Drive • SOMATOM Definition Flash Application Subclasses Heart PBV • SOMATOM Force • SOMATOM Definition Dual Energy Spectra DS ... 100/140KV DS ... 100/140KV Algorithm Drive/Flash ... 80/5n140kV arameters Material [ Drive/Flash ... 100/5n140kV Force ... 70/5n150kV Force ... 80/5n150kV CT Force ... 90/5n150kV Force ... 100/5n150kV Force ... 80/140kV 21 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Liver ECV SIEMENS Healthineers Workflow – 1. Switch to Liver VNC SIEMENS ... 194_4Ph_LiverCirrosis_ICU X Healthineers .... * 5/12/2022 M 194_4Ph_LiverCirrosi ... TTTTTTTTTTTTTTTTTTT CT Dual Energy CT Dual Energy Extend Layout Result Table Heart Archive Removal Polation Results Results Application Profile Abdomen (CA) 200 [HU] COD Body Bone Removal Liver VNC Resolution Maximum [HU] 3071 _ Default lodine Ratio 2.04 ¢ Calculate HCT [% R 0 Findings Navigator 10cm Name Value Source O [HU] F Tools L a 50.00% Synch Align Full Text Hide Hide Lines Reset SL MPR FUSION min Graphics Timepoi ... 600 W 500 DE VNCAOD 150 250 +C Edit Snapshot Print Export Undo Redo Layout Image Image 2:06 PM 22 22 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Liver ECV SIEMENS Healthineers Workflow – 2. Normalization SIEMENS .... Healthineers' .... 194 4Ph LiverCirrosis ICU × * 5/12/2022 M 194 4Ph LiverCirrosi ... CT Dual Energy Q + Distance Line CT Dual Energy Dual Energy ROI Circle Pixel Lens NACO Extend Layout Result syngu Marker Contrast Arrow Table Heart Archive Angle Removal Ipolation Text T Application Profile Abdomen (CA) 200 Lide Normalize Contrast Body Bone Removal Liver VNC ROI to set a reference contrast enhancement Resolution Maximum [HU] 3071 Default lodine Ratio 2.04 Calculate HCT [%] R × 0 Findings Navigator 10cm Name Value Source Moi O [HU Tools L a 50.00% Synch Align Full Text Hide Hide Lines Reset Graphics Timepoi ... MPR FUSION SL min DE VNCAOD 600 W 500 +C 150 C 250 Edit Snapshot Print Export Undo Redo KU Layout Image Image 2:07 PM ............................................................................................................................................................................................................................................ 23 23 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Liver ECV SIEMENS Healthineers Workflow – 3. Draw ROI SIEMENS ... Healthineers ... R 194 4Ph LiverCirrosis ICU X * 5/12/2022 M 194 4Ph LiverCirrosi ... ETTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT CT Dual Energy CT Dual Energy FOV Extend Reset Layout Contrast Result ROI Text Draw a ROI on the aorta Table Heart Punch Archive Publish Removal Isolation Mask Results Results Norm. ROI CT for the normalization. Application Profile Abdomen (CA) App: L_120/ H_120 Mean: 133.0/ 82.1 HU 200 [HU] Body Bone Removal Liver VNC Contrast Enhancement: 75.4 HU Resolution Maximum [HU] 3071 _ Default lodine Ratio 2.04 ¢ Calculate O HCT [% R 0 Findings Navigator 10cm Name Value Source O [HU] F Tools L a 50.00% Synch Align Full Text Hide Hide Lines Reset Graphics Timepoi .. MPR FUSION SL min DE VNCAOD 600 151 +C 150 C 75 Edit Snapshot Print Export Undo Redo Layout Image Image 2:08 PM 24 24 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Liver ECV SIEMENS Healthineers Workflow – 4. Enter HCT Value SIEMENS Healthineers 194 4Ph_LiverCirrosis ICU ? =$. x * 5/12/2022 M 194_4Ph_LiverCirrosi ... =B. CT Dual Energy CT Dual Energy FOV Extend Reset Optimum ROI Text Layout Contrast State Hematocrit value HCT Table Heart Archive Isolation Results Publish Removal Results Norm. ROI CT (%) should be provided Application Profile Abdomen (CA) App: L_120/ H_120 Mean: 133.0/ 82.1 HU 200 [HU] Body Bone Removal by the user. Liver VNC Contrast Enhancement: 75.4 HU Resolution Maximum [HU] 3071 Default lodine Ratio 2.04 Calculate ICT [% ] 44 + R 2 x x Findings Navigator 10cm Name Value Source O [HU] F Tools L a 50.00% Synch Align Hide Hide Lines Reset Graphics Timepoi .. MPR FUSION SL min DE VNCAOD 600 150 151 +C C 75 Edit Snapshot Print Export Undo Redo Layout Image 2:08 PM 25 25 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Liver ECV SIEMENS Healthineers Workflow – 5. ECV Results SIEMENS . Healthineers 194_4Ph_LiverCirrosis ICU X * 5/12/2022 M 194_4Ph_LiverCirrosi ... CT Dual Energy A CT Dual Energy [1] CT FOV Extend Reset Optimum ROI Text Layout Contrast State App: VNC/ CM/ ME 70 Mean: 51.3/ 29.8/ 81.1 HU After clicking on the ECV Table Heart Punch Archive Publish Removal Isolation Mask Results Results ECV: 22.2 % icon, the result image is Application Profile Abdomen (CA) Body Bone Removal displayed. You can measure Liver VNC ECV with ROI. Resolution Maximum [HU] 3071 4 Default lodine Ratio 2.04 Calculate O HCT [% ] 44 ¢ R 2 . × Findings Navigator Ocm Name Value Source M [1] ROI 7.29 c ... DE CT Tools L Norm. ROI CT a 50.00% Synch Align Full Text Hide Hide Lines Reset Graphics Timepoi ... MPR FUSION App: L_120/ H_120 SL min DE VNC/ECV Mean: 133.0/ 82.1 HU 600 W 151 +C Contrast Enhancement: 75.4 HU C 75 Edit Snapshot Print Export Layout Image Image Undo Redo 2:09 PM 26 26 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Publications – Liver ECV (1/2) SIEMENS Healthineers Extracellular volume fraction obtained by dual-energy CT depicting the etiological differences of liver fibrosis Conclusion*: ECV in alcoholic liver disease is higher than that in other Kumi Ozaki1,6 D . Takashi Ohtani2 . Shota Ishida2,3. Shohei Higuchi4 . Tomokazu Ishida2 . Kouki Takahashi2. Yuki Matta2 . Hirohiko Kimura1 . Toshifumi Gabata5 etiologies in the advanced stages of fibrosis, and etiological differences in ECV Received: 28 December 2022 / Revised: 23 February 2023 / Accepted: 23 February 2023 The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023 affect the staging performance of fibrosis. Abstract Purpose To assess etiological differences in extracellular volume fraction (ECV) and evaluate its influence on staging performance. Methods A total of 166 patients with normal liver (n= 14) and chronic liver disease related to viral hepatitis (n=71), alcohol (n=44), and nonalcoholic steatohepatitis (NASH) (n=37) underwent dual-energy CT (DECT) of the liver (5-min equilibrium-phase images) between January 2020 and July 2022. The iodine densities of the parenchyma and aorta were measured and ECV was calculated. Comparisons of ECV between each etiology and METAVIR fibrosis stage were statisti- cally analyzed (p <0.05). Results ECV in each etiology and all patients significantly increased with higher fibrosis stage (p <0.001) and showed a strong or moderate correlation with fibrosis stage (Spearman's p; all patients, 0.701; viral hepatitis, 0.638; alcoholic, 0.885; NASH, 0.791). In stages F2-F4, ECV in alcoholic liver disease was significantly larger than those for viral hepatitis and NASH (p<0.05); however, no significant difference in stage F1 was found among the three etiologies. The cutoff values and areas under the receiver operating characteristic curve (AUC-ROCs) for discriminating fibrosis stage (2 F1-> F4) were higher for alcohol (cutoff values and AUC-ROC; 20.1% and 0.708 for > F1, 23.8% and 0.990 for > F2, 24.3% and 0.968 for > F3, and 26.6% and 0.961 for _ F4, respectively) compared with those for the others. Conclusion ECV in alcoholic liver disease is higher than that in other etiologies in the advanced stages of fibrosis, and etiological differences in ECV affect the staging performance of fibrosis. 27 https://doi.org/10.1007/s00261-023-03873-6 Effective Date: 26 Sep 2024 | QR700012654 *These statements are inferences from the publication. Siemens Healthineers is not responsible for the study and the results. Unrestricted © Siemens Healthineers, 2024 Publications – Liver ECV (2/2) SIEMENS Healthineers Check Tor Quantification of liver extracellular volume using dual-energy CT: updates utility for prediction of liver-related events in cirrhosis Conclusion*: The fECV score derived from DECT allows prediction of LREs in cirrhotic Seongjun Bak1 . Ji Eun Kim1 . Kyungsoo Bae1 . Jae Min Cho1 . Ho Cheol Choi1 . Mi Jung Park1 . Hye Young Choi1 . Hwa Seon Shin1 . Sang Min Lee1 . Hyun Ok Kim2 patients. Received: 12 November 2019 /Revised: 22 January 2020 / Accepted: 8 April 2020 C European Society of Radiology 2020 Abstract Objectives To determine whether quantification of liver extracellular volume fraction (fECV) using dual-energy CT (DECT) allows prediction of liver-related events (LREs) in cirrhotic patients. Methods This retrospective study included 305 cirrhotic patients who underwent dual-source DECT imaging and had serum markers analyzed within 2 weeks of initial CT imaging. The fECV score was measured using an iodine map of equilibrium-phase images obtained 3 min after contrast injection at 100/140 Sn kVp. The association of the fECV score and serum markers with LREs was investigated. A risk model combining the fECV score (<27 versus >27%) and serum albumin level (<4 versus > 4 g/ dL) was constructed for LRE prediction. Results An increased fECV score (odds ratio, 1.27; 95% confidence interval (CI), 1.15, 1.40) was independently associated with decompensated cirrhosis at baseline (n = 85) along with the Model for End-Stage Liver Disease score (odds ratio, 1.32; 95% CI, 1.07, 1.63). Among patients with compensated cirrhosis, 10.5% (23 of 220) experienced LREs during the median follow-up period of 2.0 years (decompensation, n = 14; hepatocellular carcinoma, n = 9). The fECV score (hazard ratio, 1.40; 95% CI, 1.22, 1.62) and serum albumin level (hazard ratio, 0.26; 95% CI, 0.09, 0.73) were independent predictors of LRE. The mean times to LRE among the high (16.5 months, n = 18) -, intermediate (25.6 months, n = 44) -, and low (30.5 months, n = 158)-risk groups were significantly different (p < 0.001). Conclusions The fECV score derived from DECT allows prediction of LREs in cirrhotic patients. Key Points . The extracellular volume fraction (fECV) score derived from the iodine map of dual-energy CT (DECT) was independently associated with the presence of hepatic decompensation. . The fECV score derived from the iodine map of DECT can predict liver-related events (LREs) in patients with cirrhosis. · Equilibrium-phase scanning in dual-energy mode is recommended as part of liver CT in cirrhotic patients because it can provide a prognostic indicator for LRE development. 28 https://doi.org/10.1007/s00330-020-06876-9 Effective Date: 26 Sep 2024 | QR700012654 *These statements are inferences from the publication. Siemens Healthineers is not responsible for the study and the results. Unrestricted © Siemens Healthineers, 2024 Publications – Heart ECV SIEMENS Healthineers Myocardial Characterization with Extracellular Volume Mapping with a First-Generation Photon-counting Detector Conclusion*: Myocardial tissue CT with MRI Reference characterization with photon-counting detector CT–based quantitative Gilberto J. Aquino, MD . Jim O'Doherty, PhD . U. Joseph Schoepf, MD . Benjamin Ellison, MS . Jordan Byrne, MS . Nicola Fink, MD . Emese Zsarnoczay, MD . Elias V. Wolf . Thomas Allmendinger, PhD . extracellular volume analysis showed a Bernhard Schmidt, PhD . Thomas Flobr, PhD . Dhiraj Baruab, MD . Pal Suranyi, MD, PhD . Akos Varga-Szemes, MD, PhD . Tilman Emrich, MD strong correlation to MRI. Background: Photon-counting detector (PCD) CT provides comprehensive spectral data with every acquisition, but studies evaluating myocardial extracellular volume (ECV) quantification with use of ICD CT compared with an MRI reference remain lacking. Purpose: To compare ECV quantification for myocardial tissue characterization between a first-generation PCD CT system and cardiac MRI. Materials and Methods: In this single-center prospective study, adults without contraindication to iodine-based contrast media underwent same-day cardiac PCD CT and MRI with native and postcontrast TI mapping and late gadolinium enhancement for various clinical indications for cardiac MRI (the reference standard) between July 2021 and January 2022. Global and midventricular ECV were assessed with use of three methods: single-energy PCD CT, dual-energy PCD CT, and MRI TI mapping. Quantitative comparisons among all techniques were performed. Correlation and reliability between different methods of ECV quantification were assessed with use of the l'earson correlation coefficient (r) and the intraclass correlation coefficient. Results: The final sample included 29 study participants (mean age + SD, 54 years + 17; 15 men). There was a strong correlation of ECV between dual- and single-energy PCD CT (r= 0.91, P < .001). Radiation dose was 40% lower with dual-energy versus single- energy PCD CT (volume CT dose index, 10.1 mGy vs 16.8 mGy, respectively; P < _001). In comparison with MRI, dual-energy PCD CT showed strong correlation (r = 0.82 and 0.91, both /' < .001) and good to excellent reliability (intraclass correlation coefficients, 0.81 and 0.90) for midventricular and global ECV quantification, but it overestimated ECV by approximately 2%. Single-energy PCD CT showed similar relationship with MRI but underestimated ECV by 3%. Conclusion: Myocardial tissue characterization with photon-counting detector CT-based quantitative extracellular volume analysis showed a strong correlation to MRI. O RSNA, 2023 29 https://doi.org/10.1148/radiol.222030 Effective Date: 26 Sep 2024 | QR700012654 *These statements are inferences from the publication. Siemens Healthineers is not responsible for the study and the results. Unrestricted © Siemens Healthineers, 2024 Hints for ECV SIEMENS Healthineers (Apply to Heart PBV and Liver VNC) • No support for TwinBeam DE and TwinSpiral DE. • No Rapid Results Technology support – manual interaction needed. • ECV maps are stored as DICOM images. A [1] CT App: VNC/ CM/ ME 70 Mean: 51.3/ 29.8/ 81.1 HU ECV: 22.2 % Norm. ROI CT App: L_120/ H_120 Mean: 133.0/ 82.1 HU Contrast Enhancement: 75.4 HU 30 30 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers Extension of Dual Energy application classes Lung Mono 31 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Lung Mono SIEMENS Healthineers Morphology and functional information Lung PBV A Lung Mono A Fischer lines are shown clearer in Lung Mono. 32 32 32 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Comparison of Lung PBV and Lung Mono SIEMENS Healthineers Lung PBV Lung PBV Lung PBV overlay images result from a material decomposition into air/water and iodine with moderate smoothing. This process removes physiological structures like lung fissures. Lung Mono The Lung Mono overlay images display the difference between a monoenergetic image at 40keV and a monoenergetic image at 190keV in A Hounsfield units. Monoenergetic image at 40keV has a high iodine Lung Mono enhancement. Mono energetic at 190keV has a low iodine enhancement. Therefore, the calculation in Lung Mono emphasizes iodine, but retains some of the physiological structures. Because of different methods, Lung Mono provides higher contrast noise ratio. A 33 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Clinical evidence SIEMENS Healthineers Evaluation Of a New Reconstruction Conclusion*: Lung Mono perfusion Technique for Dual-Energy (DECT) imaging allows significant improvement in Lung Perfusion: Preliminary the overall image quality and improved detectability of PE-type perfusion defects. Experience In 58 Patients • Better image quality Juliette Pinilo, MD, Antoine Hutt, MD, Julien Labreuche, PhD, Jean-Baptiste Faivre, MD, • Higher detectability of PE-type perfusion Thomas Flohr, PhD, Bernhard Schmidt, PhD, Alain Duhamel, PhD, Jacques Remy, MD, Martine Remy-Jardin, MD, PhD Purpose: To compare dual-energy (DE) lung perfused blood volume generated by subtraction of virtual monoenergetic images (Lung Mono) with images obtained by three-compartment decomposition (Lung PBV). Material and methods: The study included 58 patients (28 patients with and 30 patients without PE) with reconstruction of Lung PBV images (i. e ., the reference standard) and Lung Mono images. The inter-technique comparison was undertaken at a patient and segment level. Results: The distribution of scores of subjective image noise (patient level) significantly differed between the two reconstructions (p<0.0001), with mild noise in 58.6% (34/58) of Lung Mono images vs 25.9% (15/58) of Lung PBV images. Detection of perfusion defects (segment level) was concordant in 1104 segments (no defect: n=968; defects present: n=138) and discordant in 2 segments with a PE- related defect only depicted on Lung Mono images. Among the 28 PE patients, the distribution of gradient of attenuation between per- fused areas and defects was significantly higher on Lung Mono images compared to Lung PBV (median= 73.5 HU (QI=65.0; Q3=86.0) vs 24.5 HU (22.0; 30.0); p<0.0001). In all patients, fissures were precisely identified in 77.6% of patients (45/58) on Lung Mono images while blurred (30/58; 51.7%) or not detectable (28/58; 48.3%) on Lung PBV images. Conclusion: Lung Mono perfusion imaging allows significant improvement in the overall image quality and improved detectability of PE- type perfusion defects. 34 https://doi.org/10.1016/j.acra.2021.07.023 Effective Date: 26 Sep 2024 | QR700012654 *These statements are inferences from the publication. Siemens Healthineers is not responsible for the study and the results. Unrestricted © Siemens Healthineers, 2024 Lung Mono – How to enable SIEMENS Healthineers CT Dual Energy Configuration You can configure Lung Mono in Application Classes of Application Profiles Application Classes Dual Energy Configuration. Application Class You can choose Lung Mono or Lung PBV in Lung Analysis. Lung Analysis Base Application Class Lung Analysis You cannot choose both at the same time. Create New Delete Application Subclasses Lung PBV Use Lung Mono Lung Vessels Lung Mono Enable / Disable Lung Mono Dual Energy Spectra Drive/Flash/DS ... 80/140kV Vessels Mono Resolution 5 5 + Application Class . Lung Mono Minimum [HU] -500 + -950 ¢ Default Base Application Class Lung Analysis Recommendation: Maximum [HU] 3071 ¢ -600 Create New Delete Application Subclasses Create dedicated lodine Ratio 1.09 Calculate Lung PBV Use Lung Mono Lung Vessels application class Lung Mono Lung Lung Lobe Edit Show Mono Partitions Mixed Dual Energy Spectra Drive/Flash/DS ... 80/140kV 35 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Lung Lobe Segmentation SIEMENS Healthineers Findings details ? X 80 [HU] Lung Analysis DE Parameters Findings Evaluation Volume [cm3] Full Volume [cm3] Below Min [% of Voxels] Above Max [% of Voxels] Enhancement [HU] Rel. Enhancement [%] Total 8382 8653 100 27+/-10 Left and Right Lung Right 4614 4766 55 26+/-10 Left 3768 3886 45 27+/-10 O Parts of Right Lung Right - Upper 1812 1864 22 24+/-10 Right - Middle 794 816 21+/-10 Right - Lower 2009 2086 24 31+/-9 Parts of Left Lung Left - Upper 1931 1984 23 24+/-9 Left - Middle Left - Lower 1837 1903 22 31+/-9 Lung partitioning mode: Lung Lobe Segmentation Minimum (Lung PBV): -960 HU Maximum (Lung PBV): -600 HU Measured Vessel Enhancement: Scaling: 0.15 Use Normalize Contrast tool and recalculate. Save Evaluation results are available with Lung PBV and Lung Mono. D [HU] Each segment is color coded. 36 36 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers Extension of Dual Energy application classes DE Application Class in NAEOTOM Alpha 37 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 DE Application Class in NAEOTOM Alpha SIEMENS Healthineers Kidney Stone, Liver VNC, Gout, Bone Marrow, and Lung Analysis are available as DE Application classes for CT Dual Energy. Available DE Application classes in NAEOTOM Alpha: -50 • syngo.CT DE Monoenergetic Plus • syngo.CT DE VNC syngo.CT DE Calculi Characterization*1 • syngo.CT DE Liver VNC without fat map*1 • syngo.CT DE Gout*1 • syngo.CT DE Lung Analysis*1 • syngo.CT DE Bone Marrow*2 • *1 Available for syngo.CT Dual Energy VB71. Not available in the US and some other countries. 38 *2 Available for syngo.CT Dual Energy VB80. Not available in the US and some other countries. Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Pure Lumen of ISI* SIEMENS Healthineers Pure Lumen* is only available for VSPP (Vascular Spectral Postprocessing) data acquired in NAEOTOM Alpha. The calcium is subtracted from all the images so that only the lumen of the vessels remains visible and activates the Pure Lumen image Real lumen representation in all segments. pathologic wall with different Pure Lumen is available in Interactive Spectral Patient received stent as composites Imaging (ISI) of the following workflows: treatment of severe stenosis Severe degree of coronary Calcification masks Pure Lumen reveals • artery disease with the pathology and the underlying reality CT Coronary Analysis calcifications distortsseverity of of the pathology → • • CT Vascular Analysis Cardiac symptoms the stenosis Ability to guide the • persisting  No value cardiologist with non- • MM Oncology delivered invasive imaging in advanced CAD • MM Reading 39 39 39 Courtesy of Medical University of South Carolina, Charleston, USA * Part of the syngo.CT Extended Functionality and available with syngo.via VB60 Effective Date: DD MMM YYYY| HILS/HOOD# Effective Date: 26 Sep 2024 | QR700012654 Effective Date: 13 Sep 2024 | QR700000427 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Unrestricted © Siemens Healthineers, 2024 Pure Lumen – SIEMENS Healthineers Selection in ISI Pure Lumen can be chosen from the ISI In syngo.via CT Vascular Workflow and syngo.via CT context menu by right clicking or by toggling Coronary Workflow, the Remove Calcium icon is the interactive image text until Pure Lumen is displayed if the VSPP data set is loaded. The calcium displayed. removal will be available on the default DE representation. APR MPR CT Vascular SL 0,5 SI 0 5 Mon Pure Lumen key Reset IT Mono+ Remove Bone Edit Remove Marker Table Remov. Pure Lumen Bones Calcium VNC lodine Manual Vessel SURF VNC/lodine Plane 40 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers syngo.via CT VB70-VB80 What‘s New Job Aid Bone Removal Feature Improvement 41 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Bone Removal Feature Improvement* SIEMENS Healthineers The Bone Removal algorithm has been improved in Head and Neck. • The algorithm update will be visible in CT Vascular, CT View&GO part of syngo.CT Extended Functionality. * Only for single energy images 42 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 Bone Removal Feature Improvement – SIEMENS Healthineers Sample Images Some parts of vessels are removed with bone. The bones are removed properly. HPR HPR AS+ NeuroDSA_Carotids_Aneurysm, NYU_USA AS+ NeuroDSA_Carotids_Aneurysm, NYU_USA 2012R0480 Ref.: Neurovascular Gold Definition AS+ 2012R0480 Ref.: Neurovascular Gold *27.09.2011, O *27.09.2011, O Definition AS+ Carotids 0.75 C+ Carotids 0.75 C+ 10.08.2011 10.08.2011 13:45:05 13:45:05 SP A309,9 SP A495,1 A. carotis | int. A. carotis r int. A. carotis | int. RAH A. carotis r ext. RAH A. carotis r int. A. carotis r ext. A. carotis | ext. A. carotis | ext. 0cm 10cm Manip VRT Manip VRT KV 120 KV 120 mAs 400 mAs 400 H37f H37f LAO 26 AL LAO 35 A CRAN 8 CRAN 18 M 512x512 M 512×512 O VB60 Software version VB70 and above 43 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024 SIEMENS Healthineers Please note this learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. © Siemens Healthcare GmbH 2024 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens-healthineers.com 44 Effective Date: 26 Sep 2024 | QR700012654 Unrestricted © Siemens Healthineers, 2024