MI Neurology Cortical Analysis Tau Workflow - USA

SIEMENS Healthineers MI Neurology Cortical Analysis Tau Workflow Template Effective Date: 10 Aug 2021 | HILS 2223 This training material is based on the medical devices syngo.MI Neurology VB80A and Scenium Cortical Analysis 8.0.0.100897. Job Aid Effective Date: 24 Sep 2024 | QR700012670 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 Ais is applicable to any of the Siemens Healthineers products in which you find this tool. 2 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 MI Neurology Cortical Analysis Tau Workflow SIEMENS Healthineers Table of Contents Tau Workflow Background 4 au Abnormal 005630 AVD S Scale: 0.4 FoV: 30.5x26.9cm MR: W 2721 L 1360.5 PET: W 8649.4 L 4324.7 MI Neurology Tau workflow 1 5 005630_pet1 MI Neurology Tau workflow 2 6 MI Neurology Tau workflow 3 7 New Braak (flortaucipir) ROI category and composite regions 8 Full list of ROIs and belonging to composite regions (1/3) 9 P Full list of ROIs and belonging to composite regions (2/3) 10 Full list of ROIs and belonging to composite regions (3/3) 11 1:06:15 Sagittal 16:55:10 Slice 36/91 3 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 Tau Workflow - Background SIEMENS Healthineers The support for semiquantitative analysis of the tracer Flortaucipir (18F) is added to MI Neurology Cortical Analysis. Tau is a histopathological Braak neurofibrillary tangle staging model. Heiko and Eva Braak originally described the staging of AD-related neurofibrillary pathology in 19911 . Flortaucipir helps to estimate the density and distribution of aggregated tau neurofibrillary tangles (NFT) , which are together with Amyloid plaques important markers for Alzheimer’s disease2. By evaluating specific Regions Of Interest, the distribution pattern of Flortaucipir uptake can be used to define different stages of disease progression. These stages were described by H. and E. Braak and are known as Braak stages. A. Braak stages (post mortem) This sequence was classified by Braak into six key stages with respect to the location of the tangle-bearing neurons and corresponding disease progression: Stage I-II: Transentorhinal involvement; clinically silent cases Transentorhinal (I/II) Limbic (III/IV) Neocortical (V/VI) • B. Tau tracer uptake (PET) • Stage III-IV: Limbic involvement; incipient Alzheimer’s disease • Stage V-VI: Neocortical involvement; fully developed Alzheimer’s disease Stage11 > Stageo Stage ll/| > Stage Stagey > Stage I/IV Fig. 1: Stages in the development of AD-associated tau pathology2 1 Watch the Cortical Analysis e-Learning as well to learn all about handling the tool. 1Braak, H., Braak, E., Neuropathological staging of Alzheimer-related changes. Acta Neuropathol. (1991) 82(4):239–259. 4 2Alzheimer, A., Über eigenartige Krankheitsfälle des späteren Alters. Z ges Neurol Psychiatr. (1911) 4:356–385. Job Aid Effective Date: 24 Sep 2024 | QR700012670 3Braak, H., et al., Stages of the pathologic process in Alzheimer disease: Age categories from 1 to 100 years. J Neuropathol Exp Neurol. (2011) 70(11):960-9. Unrestricted © Siemens Healthineers, 2024 MI Neurology Cortical Analysis Tau workflow 1 SIEMENS Healthineers MI General Data Selection All Data Basic Dynamic Display Time WE - Dual Intensity Planar MI Neuro Gated Stripe Subtraction Functional Fused Volume Launch the workflow directly from Axial 3x ... Axial 3x ... Strip ... • Fused 2x3 Cardiac AC Cardiac the syngo.via browser, or from the AC - NAC MI Neuro Compare Striatal Analysis Workflow Selection x OpenApps tool within MI General. . MI Organ Processing OpenApps • Based on information found in the Digital Marketplace DICOM Tag Radiopharmaceutical syngo MBF Which type of study is being performed? (0018,0031) either the Amyloid or O Amyloid (for assessment of amyloid plaques) the Tau workflow will be launched. Favorite Tools X MI Neuro DB O Tau (for assessment of neurofibrillary tangles) Without proper information a Comparison Ares Reset OpenApps Contr ... Windowi ... selection dialog pops up. auto Custom Automatic Cardiac 1:2 Layout FAST ... Note : The system will attempt to determine the type of study automatically based on the Text Radiopharmaceutical (0018,0031). If the Radiopharmaceutical is set correctly at the scanner, • this dialog will not be shown. This feature is part of your upgrade Automatic Hide Cardise Registrat ... Graphics MI Neuro Cortical Analysis if you already own the Amyloid Hide Lines Radial Brain AC- Ranges PC Plaque application. Parallel Reset VOI Sphere Ranges Layout E 4DM OK Exit Cardiac Snap Lock Planes Referen .... Referen ... Corridor4DM Snapshot Visual FAST Alignment Ranges Cedars-Sinai Cardiac Suite 5 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 MI Neurology Cortical Analysis Tau workflow 2 SIEMENS Healthineers View Annotations Tools Help abc MI Neuro Cortical Analysis unnamed unnamed 18F AV-1451 Same familiar workflow begins with Tau_Abnormal_005630 AVD A Scale: 0.4 Fov: 29.6x26.9cm Tau_Abnormal_005630 AVD S Tau_Abnormal_005630 AVD S 1. Scale: 0.4 Fov: 29.6x26.9cm Scale: 0.4 Fov: 30.5x26.9cm Fusion to MR -1-1-1 MR: W 2721 L 1360.5 |-/- -- -- MR: W 2721 L 1360.5 |-/- -- -- MR: W 2721 L 1360.5 PET: W 8649.4 L 4324.7 PET: W 8649.4 L 4324.7 PET: W 8649.4 L 4324.7 1 005630_pet1 005630_pet1 005630_pet1 fusing Patient Data to new Tau Fusion to Template Analysis template. Color Maps PET MR 2. The Analysis step summarizes 77% R R Trans cy SUVRs for flortaucipir specific ROIs MR PET 3 and composite regions based Norma n Re Inferic bellar Conca v Show around Braak stages. Regi Interest Key Images Braak ucipir) MR:01-Jan-2012 11:06:15 PET:01-Jan-2012 16:55:10 Axial |MR:01-Jan-2012 11:06:1 91 PET: 01-Jan-2012 16:55:1 Coronal |MR:01-Jan-2012 11:06:15 Slice 46/109 |PET:01 -Jan-2012 16:55:10 Sagittal 2 Slice 36/91 Side M 4 Amyg lortauc ... B 46 3. Braak (flortaucipir) is selected by Amyg -) (flort ... L 1.37 1.51 Braak Summary Normalization region: Inferior cerebellar cortex (flortaucipir) Composite Region: Braak I-II (flortaucipir) Amyg R) (flor ... R 1.27 1.41 Cauda rostral ... B 0.98 1.08 Composite Region Volume-weighted Mean Ratio default in Tau mode. Cauda rostral ... L 1.00 1.11 Braak I (flortaucipir) 1.48 Ratio Caud: 0% rostral ... R 0.96 1.06 Braak II (flortaucipir) ROI 1.53 Left Mean Right Mean Volume-weighted M ... Minimum Maximum Caudal anterior ci ... 0.97 1.08 Caudal anterior ci ... L 0.97 Braak III (flortaucipir) 1.45 1.07 Entorhinal cortex (flortaucipir) Caudal anterior ci ... R 0.98 Braak IV (flortaucipir) 1.42 1.45 1.51 1.47 0.62 2.08 1.08 Braak V (flortaucipir) 1.13 Hippocampus (flortaucipir) 1.53 1.54 1.52 0.88 2.35 4. The already preselected Reference Cuneus (flortaucipir) B 1.13 1.25 Cuneus (L) (florta ... L 1.07 1.19 Braak VI (flortaucipir) 1.11 Cuneus (R) (florta ... R 1.20 1.32 Entorhinal cortex region is the Inferior cerebellar B 1.34 1.48 Braak I-II (flortaucipir) Entorhinal cortex ( ... L 1.31 1.45 1.51 Entorhinal cortex ( .. 1.36 Braak III-IV (flortaucipir) 1.51 1.43 Frontal pole (florta ... 0.99 1.10 Braak V-VI (flortaucipir) 1.12 Braak I-VI (flortaucipir) 1.21 cortex. Frontal pole (L) (fl ... L 0.98 1.08 Frontal pole (R) (fl ... R 1.00 1.11 Fusiform gyrus (flo ... B 1.40 1.55 Early tau (flortaucipir) Fusiform gyrus (L) ... L 1.39 1.53 Meta-temporal (flortauci ... 1.59 1.59 Cuciform Aurilc /D\ Values displayed are body weight SUVs n 1 67 Copy Export Results 6 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 MI Neurology Cortical Analysis Tau workflow SIEMENS Healthineers View Annotations Tools Help + abc MI Neuro Cortical Analysis unnamed unnamed 18F AV-1451 1. Group several ROIs into composite Tau_Abnormal_005630 AVD A Scale: 0.4 FoV: 29.6x26.9cm Tau_Abnormal_005630 AVD Scale: 0.4 Fov: 29.6x26.9cm Tau_Abnormal_005630 AVD S Scale: 0.4 Fov: 30.5x26.9cm Fusion to MR -1-1-1 MR: W 2721 L 1360.5 S MR: W 2721 L 1360.5 MR: W 2721 L 1360.5 PET: W 8649.4 L 4324.7 PET: W 8649.4 L 4324.7 PET: W 8649.4 L 4324.7 005630_pet1 005630_pet1 005630_pet1 regions connected to different Braak Fusion to Template Analysis stages. Color Maps PET MR 2. The table on the right side provides 77% Trans cy SUVR for left, right, volume-weighted, MR - PET min, and max of each ROI comprising Norma n Region Inferic ebellar cortex Y y Show 2 3 the composite regions. Regio nterest Key Images Braak lucipir) MR:01-Jan-2012 11:06:15 ET:01-Jan-2012 16:55:10 Axial |MR:01 -Jan-2012 11:06:1 Slice 23/91 PET:01-Jan-2012 16:55: Coronal |MR:01-Jan-2012 11:06:15 Slice 46/109 | PET:01-Jan-2012 16:55:10. Sagittal lice 36/91 Side Mean Ratio Amyg lortauc ... B 1.32 1.46 Amyg -) (flort ... L Braak Summary Normalization region: Inferior cerebellar cortex (flortaucipir) Composite Region: Braak I-II (flortaucipir) 3. Select these composite regions 1.37 1.51 Amyg R) (flor ... 1.27 1.41 Cauda rostral ... B 0.98 1.08 Composite Region Volume-weighted Mean Ratio Caudi rostral ... L 1.00 1.11 Braak | (flortaucipir) 1.48 Ratio separately from a drop-down menu ROI Caud: 0% rostral ... R 0.96 1.06 Braak II (flortaucipir) 1.53 Left Mean Right Mean Volume-weighted M. Minimum Maximum Caudal anterior ci ... B 0.97 1.08 Braak III (flortaucipir) 1.45 to show left, right, and volume Caudal anterior ci ... L 0.97 1.07 Entorhinal cortex (flortaucipir) Caudal anterior ci ... R 0.98 1.08 Braak IV (flortaucipir) 1.42 1.45 1.51 1.47 0.62 2.08 Cuneus (flortaucipir) B 1.13 1.25 Braak V (flortaucipir) 1.13 Hippocampus (flortaucipir) 1.53 1.54 1.52 0.88 2.35 Cuneus (L) (florta. L 1.07 1.19 Braak VI (flortaucipir) 1.11 weighted mean as well as min and Cuneus (R) (florta ... R 1.20 1.32 Entorhinal cortex B 1.34 1.48 Braak I-II (flortaucipir) Entorhinal cortex ( ... L 1.31 1.45 1.51 max SUVRs for each contributing ROI. Entorhinal cortex ( ... R 1.36 1.51 Braak III-IV (flortaucipir) 1.43 Frontal pole (florta ... B 0.99 1.10 Braak V-VI (flortaucipir) 1.12 1 Frontal pole (L) (fl ... L 0.98 1.08 Braak I-VI (flortaucipir) 1.21 Frontal pole (R) (fl ... R 1.00 1.11 Fusiform gyrus (flo ... B 1.40 1.55 Early tau (flortaucipir) 1.59 4. The Braak Summary panel provides Fusiform gyrus (L) ... L 1.39 1.53 Meta-temporal (flortauci ... 1.59 Curifarm NIFIC / Values displayed are body weight SUVs 1 67 Copy Export Results volume-weighted SUVR for high-level 4 composite regions. 7 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 New Braak (flortaucipir) ROI category and composite regions SIEMENS Healthineers Definition of a new ROI category: Braak (flortaucipir) – and of the following composite regions: • Braak I (flortaucipir) • Braak II (flortaucipir) • Braak III (flortaucipir) • Braak IV (flortaucipir) • Braak V (flortaucipir) • Braak VI (flortaucipir) • Braak I/II (flortaucipir) • Braak III/IV (flortaucipir) • Braak V/VI (flortaucipir) • Early tau (flortaucipir) • Meta-temporal (flortaucipir) 8 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 Full list of ROIs and belonging to composite regions (1/3) SIEMENS Healthineers Braak I (flortaucipir) Entorhinal cortex (flortaucipir) Braak II (flortaucipir) Hippocampus (flortaucipir) Braak III (flortaucipir) Amygdala (flortaucipir) Fusiform (flortaucipir) Lingual (flortaucipir) Parahippocampus (flortaucipir) Braak IV (flortaucipir) Inferior temporal (flortaucipir) Middle temporal (flortaucipir) Insula (flortaucipir) Posterior cingulate (flortaucipir) Caudal cingulate (flortaucipir) Rostral cingulate (flortaucipir) Isthmus cingulate (flortaucipir) Temporal pole (flortaucipir) 9 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 Full list of ROIs and belonging to composite regions (2/3) SIEMENS Healthineers Braak V (flortaucipir) Superior frontal (flortaucipir) Lateral orbitofrontal (flortaucipir) Medial orbitofrontal (flortaucipir) Frontal pole (flortaucipir) Caudal middle frontal (flortaucipir) Rostral middle frontal (flortaucipir) Pars opercularis (flortaucipir) Pars orbitalis (flortaucipir) Pars triangularis (flortaucipir) Lateral occipital (flortaucipir) Parietal supramarginal (flortaucipir) Inferior parietal (flortaucipir) Superior parietal (flortaucipir) Superior temporal (flortaucipir) Transverse temporal (flortaucipir) Precuneus (flortaucipir) Bank superior temporal sulcus (flortaucipir) 10 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024 Full list of ROIs and belonging to composite regions (3/3) SIEMENS Healthineers Braak VI (flortaucipir) Pericalcarine (flortaucipir) Post central (flortaucipir) Pre central (flortaucipir) Para central (flortaucipir) Cuneus (flortaucipir) Meta-temporal Braak (flortaucipir) Entorhinal cortex (flortaucipir) Amygdala (flortaucipir) Fusiform (flortaucipir) Inferior temporal (flortaucipir) Middle temporal (flortaucipir) 11 Job Aid Effective Date: 24 Sep 2024 | QR700012670 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 12 Job Aid Effective Date: 24 Sep 2024 | QR700012670 Unrestricted © Siemens Healthineers, 2024