MR Applications Fundamentals - Part 1 STEP Workbook

MR Applications [TYPE OF WORKBOOK HERE] | [SYSTEM NAME HERE] Fundamentals Part 1 STEP Week 2 Classroom Workbook Education & Workforce Solutions SIEMENS Your potential is calling. Healthineers MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Welcome A Message from Nanci Wozniak Welcome to your training experience with Education & Workforce Solutions. I want to personally thank you for choosing Siemens Healthineers. We are honored to have you as our partner and hope you will enjoy this course. Our teams strive to ensure your priorities and needs are met. We sincerely appreciate your hard work around what really matters - the human side of health care. You are our heroes. Thank you for being part of the Siemens Healthineers family and we look forward to our partnership with you. Nani llig Nanci Wozniak Vice President, Education & Workforce Solutions CX SV USA – Customer Service Organization Siemens Healthineers Clinical Training and Continuing Education Contact Information Customer Care Center - Clinical Application Support: Call 1-800-888-7436 PEPconnect https://pep.siemens-info.com/en-us 2 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Contents Welcome.......................................................................................................2 Contents .......................................................................................................3 Course Description ........................................................................................4 Day 1............................................................................................................5 Archiving & Deletion..................................................................................8 Archive Flags ...........................................................................................23 Coil Independent Protocols ......................................................................35 User & Role Management.........................................................................52 Introduction ............................................................................................55 Introduction to Enhanced DICOM .............................................................74 Enhanced DICOM (eMR)...........................................................................82 Filters ...................................................................................................101 Filter Parameter Card........................................................................104 Raw Data Filter.................................................................................106 Normalization Filter..........................................................................110 Image Filter .....................................................................................125 Distortion Correction........................................................................132 Coil Combination .............................................................................136 GOBrain & GOBrain+..............................................................................142 Overview.........................................................................................146 GOBrain...........................................................................................150 GOBrain+.........................................................................................154 MR Advanced Neuro Sequences..............................................................156 SPACE ..............................................................................................160 MPRAGE...........................................................................................177 SWI..................................................................................................182 PETRA..............................................................................................195 TGSE................................................................................................203 StarVIBE...........................................................................................207 3 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Day 2........................................................................................................210 Time-of-Flight (ToF) Principle .................................................................214 Phase Contrast (PC) ...............................................................................261 Vessel Wall Imaging ...............................................................................275 NATIVE and QISS Non-Contrast MRA .......................................................281 NATIVE TrueFISP ...............................................................................285 Non-CE Peripheral MRA ....................................................................302 Quiescent-Interval Single-Shot (QISS)................................................318 MR MSK Imaging ...................................................................................341 Coils & Positioning ...........................................................................345 MSK Parameters ...............................................................................370 MSK Protocols ..................................................................................389 MapIT - T1, T2, T2* Maps .................................................................404 myExam Large Joint Assist & GOKnee 3D...........................................427 Day 3........................................................................................................475 Diffusion Weighted Imaging ..................................................................479 Theory.............................................................................................480 Sequences .......................................................................................485 RESOLVE ..........................................................................................492 Quiet Diffusion ................................................................................505 BLADE .............................................................................................508 HASTE .............................................................................................514 Parameters ......................................................................................521 Diffusion Modes...............................................................................522 Options ...........................................................................................541 SMS.................................................................................................542 Phase Correction for EPI Diffusion .....................................................549 Diffusion Tensor Imaging (DTI)...............................................................553 Arterial Spin Labeling (ASL)....................................................................579 Introduction.....................................................................................582 ASL 2D.............................................................................................586 Pulsed ASL 2D..................................................................................593 Pseudo-Continuous ASL 2D...............................................................598 ASL 3D, PASL 3D & Pseudo-Continuous ASL 3D ..................................605 ASL 3D.............................................................................................606 PASL 3D...........................................................................................608 4 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Day 2........................................................................................................210 Day 4........................................................................................................620 Time-of-Flight (ToF) Principle .................................................................214 Dynamic Susceptibility Contrast (DSC)....................................................624 Phase Contrast (PC) ...............................................................................261 Perfusion Parameter Card .................................................................629 Vessel Wall Imaging ...............................................................................275 Perfusion Maps ................................................................................633 NATIVE and QISS Non-Contrast MRA .......................................................281 BOLD/fMRI.............................................................................................644 NATIVE TrueFISP ...............................................................................285 Theory.............................................................................................648 Non-CE Peripheral MRA ....................................................................302 Stimulation......................................................................................652 Quiescent-Interval Single-Shot (QISS)................................................318 Protocols..........................................................................................661 MR MSK Imaging ...................................................................................341 Parameter Cards...............................................................................671 Coils & Positioning ...........................................................................345 MR Neuro 3D ...................................................................................679 MSK Parameters ...............................................................................370 MR Spectroscopy ...................................................................................682 MSK Protocols ..................................................................................389 Overview.........................................................................................686 MapIT - T1, T2, T2* Maps .................................................................404 Metabolites in the Brain....................................................................696 myExam Large Joint Assist & GOKnee 3D...........................................427 Sequences .......................................................................................703 Day 3........................................................................................................475 Workflow.........................................................................................717 Diffusion Weighted Imaging ..................................................................479 Clinical Image Examples ...................................................................728 Theory.............................................................................................480 Sequences .......................................................................................485 RESOLVE ..........................................................................................492 Quiet Diffusion ................................................................................505 BLADE .............................................................................................508 HASTE .............................................................................................514 Parameters ......................................................................................521 Diffusion Modes...............................................................................522 Options ...........................................................................................541 SMS.................................................................................................542 Phase Correction for EPI Diffusion .....................................................549 Diffusion Tensor Imaging (DTI)...............................................................553 Arterial Spin Labeling (ASL)....................................................................579 Introduction.....................................................................................582 ASL 2D.............................................................................................586 Pulsed ASL 2D..................................................................................593 Pseudo-Continuous ASL 2D...............................................................598 ASL 3D, PASL 3D & Pseudo-Continuous ASL 3D ..................................605 ASL 3D.............................................................................................606 PASL 3D...........................................................................................608 5 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Course Description Course Overview: The MR STEP Applications Fundamentals 1 – Week 2 is a four and one-half-day course. It focuses on MR Neurology, Musculoskeletal, non-contrast MR Angiography, and Advanced Neuro techniques. Participants are also provided information on archiving, enhanced DICOM, protocols, and parameters. This course includes both lecture and Instructor-led practice on a Siemens Healthineers MAGNETOM MR System. Upon completion of this course, you will be able to: • Recall the archiving features and settings • Identify the Coil Independent protocols and features • State the User & Role Management features • Explain the difference, features and applications of DICOM and Enhanced DICOM • Define the various filters used for data acquisition • Recall the features of GOBrain and GOBrain+ • Explain the MR Neuro pulse sequence techniques and applications • List the MR Angiography sequence techniques and applications • Describe the NATIVE and QISS sequence techniques and applications • Identify the Musculoskeletal sequence techniques and applications • Explain Diffusion theory, sequences and applications • Identify Diffusion Tensor Imaging sequences and applications • Recall the Arterial Spin Labeling (ASL) Perfusion sequences and applications • Summarize Dynamic Susceptibility Contrast (DSC) Perfusion sequences and applications • Identify BOLD and fMRI sequences and applications • Explain MR Spectroscopy and the available sequences and applications 6 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Day 1 SIEMENS Healthineers .. STEP Siemens Technologist Education Program Archiving MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 7 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Archiving • Archiving & Deletion • Autorouting • Archiving & Protocol Settings • Job Settings • PhoenixZIP Archiving • Multi Environment Profiles • Archive Flags 2 Unrestricted © Siemens Healthineers, 2023 Notes 8 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Identify the basic set up for Archiving and Deletion • Recall how to set up Autorouting • List Archive and Protocol Settings • State the automatic retries available for network jobs in Job Settings • Recall the options for PhoenixZIP archiving • List the features of Multi Environment Profiles • Describe the options for Archive Flags 3 Unrestricted © Siemens Healthineers, 2023 Notes 9 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archiving & Deletion SIEMENS Healthineers ... MR Applications Fundamentals 1 Archiving & Deletion 4 Unrestricted © Siemens Healthineers, 2023 Notes 10 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archiving & Deletion SIEMENS Healthineers ... Basic Setup Admin Portal > Technical Configuration MAGNETOM Vida Administration Portal SIEMENS NXVSIM / medadmin Free (Restricted Remote Access) 1. PACS‐based Installation Technical Configuration Quality Assurance Clinical Configuration Site Information Archiving 2. Specify the Archive Nodes – sets the Archive Remote Service 1 Media-based (No PACS is configured, in this case manual archiving is advised) Licensing PACS-based State in the Patient Browser. User and Role Administration Use the following DICOM Nodes NEURO-WORKSTATION as Archives PACS DICOM Nodes v PACS2 (no SC) Nodes without Storage Commitment ("no SC") do not provide confirmation 3. Specify the Default Archive DICOM Data Handling of archiving. Therefore permanent 2 data storage is not ensured, what Archiving and Deletion may result in data loss. • Enables the Archive button in the Patient Exclude from Archive Autorouting Browser. 3 Archive Default Archive PACS Job Settings Media Compression Enable automatic archiving • Marks data for archiving in the MR Export Path Start automatic archiving at 01:00 4 MPPS Completion Stop scheduling archive jobs at ]02:00 View&GO Distribution step. DICOM Study Description Automatic Deletion PhoenixZIP = = PACS . Disable automatic deletion (No scheduled d 4. Automatic Archiving – works on data 5 Check STS fill level every 3 marked ‘To be archived’ (default check‐in Scheduled deletion above 0,00 + % (low watermark) status with MR XA30). Start scheduled deletion at ]04.00 Immediate deletion above 4 % (high watermark) 5. Automatic Deletion Start deletion with oldest stored images Short Term Storage (STS) DICOM Blog Save 5 Unrestricted © Siemens Healthineers, 2023 Notes 11 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archiving & Deletion SIEMENS Healthineers ... Basic Setup Automatic Archiving MAGNETOM Vida Administration Portal SIEMENS NXVSIM / medadmin Free (Restricted Remote Access) • If enabled, images will be automatically archived Installation Technical Configuration Quality Assurance Clinical Configuration Site Information Archiving during a pre‐defined time Remote Service Media-based (No PACS is configured, in this case manual archiving is advised) PACS-based Licensing • Default check‐in status of all results in Patient User and Role Administration Use the following DICOM Nodes NEURO WORKSTATION rchives PACS DICOM Nodes Nodes without Storage Commitment Browser is To be archived PACS2 ( no SC) ("no SC") do not provide confirmation DICOM Data Handling of archiving. Therefore permanent data storage is not ensured, what Archiving and Deletion may result in data loss. Exclude from Archive Autorouting Automatic Deletion Default Archive PACS Job Settings Media Compression Enable automatic archiving If enabled, automatic deletion deletes data that has Export Path Start automatic archiving at 01:00 MPPS Completion Stop scheduling archive jobs at ]02:00 02:00 the status Archived or Not to be archived. DICOM Study Description Automatic Deletion PhoenixZIP . Disable automatic deletion ( No scheduled deletion is performed, in this case manual deletion is advised) Enable automatic deletion Check STS fill level every 30 minutes Scheduled deletion above 80.00 ¢ % (low watermark) Start scheduled deletion at ]04:00 Immediate deletion above 85.50 % (high watermark) Start deletion with . least used images oldest stored images Short Term Storage (STS) High watermark os DICOLU Stop Total STS Size 475.12 GB Current fill level 13.08 % Save 6 Unrestricted © Siemens Healthineers, 2023 Notes 12 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Autorouting SIEMENS Healthineers ... In addition to the distribution functionality Autorouting rules for Scan Results can be configured. The Scan Results are everything created while scanning and does not include any results created in MR View&GO. Two sets of rules are pre‐defined but not active by default. • Scan Results – all results obtained while scanning, including in‐line functions (e.g., composing) are automatically transferred to a defined target (e.g., PACS). • Advanced Visualization (AV) Results – AV are results from the syngo.via workflows at the scanner, excluding MR View&GO results, will be transferred on Complete. If you have configured Autorouting of Scan Results, any results created in MR View&GO (e.g., ranges) are not sent using the Autorouting rules, and should be sent using the Distribution Step. 7 Unrestricted © Siemens Healthineers, 2023 Notes 13 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Autorouting SIEMENS Healthineers ... Configuration Pre‐defined rules ready to use: Installation Technical Configuration Quality Assurance Clinical Configuration Site Information • Scan Results (Acquisition/LHS) Autorouting Rules Remote Service Edit / Create Rule AV Results (RHS/not MR View&GO) Licensing Condition Name Scan Results New Rule Rename Rule Delete Rule • User and Role Administration Type Category Operator Value DICOM Nodes Dicom Header Attrib Creator Identifier (0( Equals ACQUISITION and Dicom Header Attrib v Image Type (0008,0 DoesNotContain MOSAIC Configure your own! DICOM Data Handling Archiving and Deletion Add Line Exclude from Archive Save Rule Save Rule As Autorouting Choose Routing Target Autorouting triggered from: Job Settings NEURO WORKSTATION PACS (default) Media Compression PACS2 • Acquisition Export Path Add Rule • AV Applications MPPS Completion Autorouting Rule List DICOM Study Description Check to set rule as active Head-Exams -> NEURO-WORKSTATION Apply rule • Not from MR View&GO! PhoenixZIP fmri -> PACS2 immediate Scan Results 2 -> PACS2 during default archiving/send time period ¥ MPR -> PACS (default archive) Apply for operation AV Image Results -> PACS (default archive) Media imported objects Scan Results > PACS (default archive) Received and retrieved objects v Saved and sent objects May conflict with Default Archive handling: data excluded by these rules might be sent from Remove From List the Distribution Step by default. Save @ Ready. 8 Unrestricted © Siemens Healthineers, 2023 Notes 14 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Autorouting SIEMENS Healthineers ... How to create a new rule? 1. New Rule. Installation &# Technical Configuration Quality Assurance Clinical Configuration Site Information Autorouting Rules 1 Select attributes and matching Remote Service Edit / Create Rule 2. Condition Name My Rule New Rule Rename Rule Delete Rule Licensing criteria. User and Role Administration Type Category Operator Value Delete 2 Dicom Header Attrib v Series Description (1 Contains mddw DICOM Nodes and Dicom Header Attrib v Study Description (C Contains Science 3. Save Rules. DICOM Data Handling and Dicom Header Attrib Study Description (C DoesNotContain Clinic Select Archiving and Deletion Add Line More ... 4. Choose Routing Target. Exclude from Archive 3 Save Rule Save Rule SOP Class UID (0008,0016) Autorouting Creator Identifier Choose Routing Target NEURO-WORKSTATION (0021,SIEMENS MR 5. Add Rules. lob Settings 4 PACS (default) SDR 01,01) Media Compression PACS2 Application Identifier (0021,SIEMENS MR SDR 01,02) > 6. Activate Rules. Export Path 5 Add F Clinical Result MPPS Completion Attribute Autorouting Rule List (0009,SIEMENS 7 DICOM Study Description Check to set rule as active SYNGO INDEX 7. Apply Rules: v Head-Exams -> NEURO-W SERVICE,0062) Apply rule PhoenixZIP V fmri -> PACS2 Image Type immediate Scan Results 2 -> PACS2 • Immediate 6 (0008,0008) during default archiving/send time period ¥ MPR -> PACS (default arch v AV Image Results -> PACS Series Description Apply for operation Media imported objects Scan Results -> PACS (def (0008,103E) Received and retrieved objects • Saved and sent objects Body Part Examined (0018,0015) Saved and sent objects Protocol Name (0018,1030) Remove From List Study Description (0008,1030) Performed Procedure Save Step Description @ Save is successful. (0040,0254) 9 Unrestricted © Siemens Healthineers, 2023 Notes 15 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Autorouting & MR View&GO SIEMENS Healthineers ... MR View&GO results do not consider Autorouting rules. Send and Archive • What you see is what you get in the Distribution Step. Preview Description # Images • Possible conflict with Default Archive handling: data excluded Number = PACS by Autorouting Rules might be sent from Distribution Step by cine_segmented_lax_3Ch 1 / 25 default. 2 cine_segmented_lax_4Ch h / 25 Autorouting is (mainly) required if radiologist wants to review images in parallel to current examination. O cine_segmented_lax_2Ch 1 / 25 MR View&GO triggers archiving after closing the patient with AAhead_scout_MPR_sag Save and Send. AAhead_scout_MPR_tra Choose the Send button to intermediately send data. Distributes results according to current status and does not close MR 99 PhoenixZIPReport 3 View&GO workflow. Send Close 10 Unrestricted © Siemens Healthineers, 2023 Notes 16 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Autorouting & MR View&GO SIEMENS Healthineers ... Archiving intention synchronized with Patient Browser. Send and Archive Archiving in the Distribution Step is now synchronized Number |Preview Description " Images * * ARCHIVE with the Patient Browser. cine_segmented_lax_3 ... 1/25 cine_segmented_lax_4 ... 1/25 Checked To be Archived Ex cine_segmented_lax_2 ... Not Checked Not to be Archived 1/25 PhoenixzipReport O Series Series Number Series Description Modality # Instances in ... Series Archived B + 1 cine_segmented_lax_3Ch MR 2 cine_segmented_lax_4Ch MR 3 cine_segmented_lax_2Ch MR 99 PhoenixZIPReport SR 11 11 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 17 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archiving & Protocol Settings SIEMENS Healthineers ... Disable Auto Transfer to PACS: USER >> head >> library >> diffusion >> ep2d_diff_3scan_trace_p2 General • Disables autorouting, this is independent Protocol Parameters Load Images to MR View&GO Voice Commands of rule set. Auto Store Images Execution • Disables the Default Archive checkbox in Image Management Disable auto transfer to PACS Auto Load the MR View&GO Distribution Step Copy References • Effects all data output from the protocol, including in‐line processing, all phases, etc. • If Enabled, Patient Browser archive status is set to Not to be archived OK Cancel @ 1 IdenticalCI 12 Unrestricted © Siemens Healthineers, 2023 Notes 18 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Job Settings SIEMENS Healthineers ... Automatic Retry for Network Jobs: SIEMENS NXVSIM / medadmin Free (Restricted Remote Access) Retries Installation Technical Configuration O Quality Assurance Clinical Configuration • • Delays Site Information Automatic Retry for Network Jobs • Multiplication factor Remote Service Number of retries for network transfer jobs 2 Licensing Delay of first retry 30 sec Multiplication factor for subsequent retries 2.0 User and Role Administration DICOM Nodes DICOM Data Handling Archiving and Deletion Exclude from Archive Autorouting Job Settings Media Compression Export Path 13 Unrestricted © Siemens Healthineers, 2023 Notes 19 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PhoenixZIP Archiving SIEMENS Healthineers ... Automatic Sending Enabled/Disabled Installation 8ª Technical Configuration Quality Assurance Clinical Configuration Site Information PhoenixZIP • Excludes PhoenixZIP from Autorouting • Disables the Default Archive checkbox in Remote Service Automatic Sending Enabled MR View&GO Distribution Step Licensing Enabled • If disabled, the Patient Browser archive User and Role Administration Enabled status is set to Not to be archived DICOM Nodes - PhoenixZip is included in Autorouting DICOM Data Handling The "Default Archive" target is preselected in the View&GO Distribution Step UI Archiving and Deletion Exclude from Archive Disabled Autorouting PhoenixZip is excluded from Autorouting Job Settings - The "Default Archive" target is not selected in the View&GO Distribution Step UI Media Compression Export Path MPPS Completion Manual sending is not affected by this setting at all. DICOM Study Description PhoenixZIP Save 14 Unrestricted © Siemens Healthineers, 2023 Notes 20 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Multi Environment Profiles SIEMENS Healthineers ... Supports customers with different working Installation Technical Configuration Quality Assurance Clinical Configuration Site Information environments that may have more than Environment Profiles Environment Profiles one RIS, PACS, institution name, default Remote Service Current loaded profile: Profile A - Profile A with PACS_A and ency in the Licensing RIS_A archive or auto‐routing rules (since XA50). acquired data. User and Role Administration DICOM Nodes Multiple profiles can be configured in Save the current configuration as a| New Profile DICOM Data Handling Admin Portal and activated according to Auditing to Syslog Server Automatically save the current profile when activating other current needs. Profile A Profile A with PACS_A and RIS_A Activate Rename Update Delete Profile 2021-12-29 14:32:41 Switch between different institutions using Profile B Profile B with RIS_B and PACS_B Activate Rename Update Delete Profile system (e.g., institution A in the morning 2021-12-29 14:32:28 and institution B in the afternoon), each has their own dedicated configuration requirements. 15 Unrestricted © Siemens Healthineers, 2023 Notes 21 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Multi Environment Profiles SIEMENS Healthineers ... These are two different profiles configured in the Admin Portal that contain different Institution Names, default RIS and PACS. Profile A is active, and the respective settings are propagated in the UI. Healthineers Scheduler Patient Registration Progra Patients (al medico), 9.38 57 74) Patient, Institut A Medical Information Examination Information JustDicomFIS * Last Name | Patient Date and Titre MR Knee 3D First Name Institut A Alerts *10/20/1901, Male R$_201402260332987 MM KNEE 30 Medical lets MR Knee Sk 2D *10/20/1981, Male 10X 201402200331434 10ME KNES 20 MR LSpine Dot Engine *10/23/1911, Male RS_201402260330567 MRI LLIMBAR SP MR Onco Liver 1_201402200329487 LUI ABDOMEN WIWO CO .. 11/3/2021 MR Shoulder 2D Dot Engine 3º Technical Configura *10/20/1981, Male RG_201402260320345 MIN SHOULDER 20 W/O .. 11/5/2021 Environment Profiles MR Shoulder 3D Dot Engine "10/20/1981. Male Environment Prosles RS_201402260326234 MRI SHOULDER 30 W/O_. 11/3/2021 Remole Service Current loaded profile. Profile A - Profile A with JustD Panther, Paulchen Licensing syngo Plaza the acquired data. *11/011981, Atale RS 201402260515123 MIMA BRAIN WID CONTR. 11/5/2021 User and Hole Administration Patient family, Max given aou middle aof "6/1987, Other DICOM Nodes Save the current configuration as a New Profile DICOM Data Handling Patient, B Auditing to Syslog Server Patient, Institu Automatically save the current profis when activating other Profile A Profile A with JustDICOM and syngo Plaza aient Institut B 4121-11-05 20 25 23 Profile D Profile B with RIS_B and PACS_B 2021-11-05 20:24:21 16 Unrestricted © Siemens Healthineers, 2023 Notes 22 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Multi Environment Profiles SIEMENS Healthineers ... These are two different profiles configured in the Admin Portal that contain different Institution Names, default RIS and PACS. Profile B is activated the respective alternative settings for the second institution are propagated in UI. Healthineers ^ 18 2 111 / 2021. 11.05-2016-25. SIEMENS Healthineers Patient. Institut B * 11/5/1980 M 2021.11.05-20:16:35_ Scheduler MR View&GO HAL Patient, Insttut 83 2021:11.05-20 16:25-STD-1 3.12 2.1107.5.993 Hospital Name D Patient, Institut B "11/1988 M4. 33Y MAGNETUN Vida 2021 11:05-20.16.25-8Tp-1:3.12.2.1107.5.38.3 11AVIG88. M. 33Y CURRENT MRXA51 CURRENT Patients (2 resultis), 8:15:27 PM) Patient, Institut B Medical Information Examination Information 11:5/2021 PH 11/5/2021 Mhesc_eccrt_MPR_sap All Today Last Name | Patient sitting Dugnoss Patient Procedur First Name Institut B Patient, B *11/5/1999, Male 2021.11.05 12:15:51 ... Medical Alerts Patient, Institut B *11/5/1900, Male 2021.11.05-20:16:25- . faient 10 2021.11.08 20:16:25.5TD Institution tex | Make MAGNCTOM Vile Administration Portal Height | 6 m MILMENS Heckthineers NXVSIM / medadmin Free (Restricted Remote Access) · Weight 180 Installation ª Technical Configuration Quality Assurance 1.57 Clinical Configuration Sie Information Environment Profiles AMhead_scout 28 4 % Environment Profiles Remole Service Current loaded profile: Profile B - Profile B with RIS_B and C maistency in the Licensing PACS_B acquired data User and Role Administration DICOM Nodes current configuration as a New Profile DICOM Data Handling Auditing to Syslog Server ly save the current profile when activating other ........ Paname Update Delete Proble 17 Unrestricted © Siemens Healthineers, 2023 Notes 23 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Multi Environment Profiles SIEMENS Healthineers ... A new user account with the role Technologist can be configured, which enables a technologist to access the Admin Portal and switch profiles (options for this role are limited) compared to the IT Administrator user role. Clinical Administrator (e.g., default user) is also able to switch profiles in the Admin Portal. Technical Configuration Quality Assurance Clinical Configuration Site Information Environment Profiles Environment Profiles Remote Service Current loaded profile: Profile B - Profile B with RIS_B Caution: Switching profiles during scanning may cause inconsistency in the Are you sure you want to activate the profile "Profile B"? and PACS B acquired data. Some settings in the activated profile require software restart to take Profile A Profile A with JustDICOM and syngo Plaza Activate effect. 2021-11-05 20:25:23 Profile B Profile B with RIS_B and PACS_B Activate 2021-11-08 14:41:26 Note: when activating a new profile, a software restart is required. 18 Unrestricted © Siemens Healthineers, 2023 Notes 24 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... MR Applications Fundamentals 1 Archive Flags 19 Unrestricted © Siemens Healthineers, 2023 Notes 25 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... Status icons in Patient Browser Series Series Number Series Description Series Archived Exported cine_segmented_lax_3Ch To be archived 2 cine_segmented_lax_4Ch Notto be archived 3 cine_segmented_lax_2Ch Q ueued forarchiving 4 cine_segmented_sax Archived 99 PhoenixZIPReport Archive failed 20 Unrestricted © Siemens Healthineers, 2023 Notes 26 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers .. Data check‐in To be archived • All scanned data is checked‐in as To be archived by default • Deletion protected as data with a To be archived status will not be deleted automatically if Auto Deletion is enabled in the Administration Portal Results (1 results, 2:41:41 PM) Series Patient Name Patient ID Study Archived + Series Number Series Description Modality Series Archived Software Features, MR XA30 XA30A 8/1 cine_segmented_lax 3Ch MR cine_segmented_lax 4Ch MR cine_segmented_lax_2Ch MR UN 99 PhoenixZIPReport SR Instances Insta ... Acquisition Date an ... Number of Frames Archive Status Repetition Tin 1 8/18/2020 12:28:5 ... 25 FO 41.40 m 21 Unrestricted © Siemens Healthineers, 2023 Notes 27 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... Patient Browser aber Series Description Modality # Instances in ... Series Archived • Propagates flags to higher levels 41 ep2d_diff_b50_400_800_tra_p3_trig-R ... MR X Archive status indicates relevant data has been 42 ep2d_diff_b50_400_800_tra_p3_trig-R ... PR • 51 T1_Images_B1corr MR sent to at least one of the configured archive T1_Images_81corr PR MR nodes but provides no target information. 53 T2starMap_f12d_tra_mbh T2Star_Images MR T2Star_Images PR - - - - W • Patient Browser considers Storage Commitment: 82 ep2d_perf_p2_MoCo MR 60 Queued for archiving, Archived, Archive Failed. 83 TTP_ep2d_perf_p2_MoCo MR 1 end and Archive MR VIEW&GO MR View&GO Num .. . Preview Description PACS F DUMMY.NO ... • Displays Archive/Send status for each node cp2d_di_b30-400_80 .. Stack 2x2 Stack 5 x 4 • Storage Commitment considered 1_Images_ 81cor • Flag synchronization with Patient Browser is T2starMap_02_tra_mbh 71210 triggered with Send, Save and Send and Save and rastar_ Images Pause > 82 cp2d.pert_p2_Moco TTP_sp2d_pert_p2_Mo. Sand Cose VI II 22 Unrestricted © Siemens Healthineers, 2023 Notes 28 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... Propagation of To be archived status to Results Series higher level. Study Archived Corrected + Series Number Series Description Modality # Instances in ... Series Archived 1 New data checked‐in To be archived cine_segmented_lax_3Ch MR • 2 CITe_ocymented lay 4Ch MR Clear indication at a Study level 3 cine_segmented_lax_2Ch Eo • 99 PhoenixZIPReport SR To there is some data that needs to be 4 AAhead_scout_MPR_sag MR 5 AAhead_scout MPR tra MR To archived. Result Series Study Archived Corrected Series Number Series Description Modality # Instances in ... Series Archived cine_segmented_lax_3Ch MR X imo conmented lax 4Ch MR cine_segmented_lax_2Ch - - 99 PhoenixZIPReport PR AAhead_scout_MPR_sag MR AAhead_scout_MPR tra MR AAhead_scout MPR tra Instances Insta ... Acquisition Date a ... A Image Comments Image Type Number of Fra ... Archive /tat ... Cont Original, Prim ... Original, Prim ... Original, Prim ... Original, Prim ... 23 Unrestricted © Siemens Healthineers, 2023 Notes 29 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... Propagation of Archived status to a Results Series higher level. Study Archived Corrected + Series Number Series Description Modality # Instances in .. Serios Archived cine_segmented_lax_3Ch MR IX cine_seymich lav 4Ch MR cine_segmented_lax_2Ch MR PhoenixZIPReport SR AAhead_scout_MPR_sag MR AAhead_scout_MPR_tra MR AAhead_scout MPR tra MR Instances Insta ... | Acquisition Date a ... | Image Comments Image Type Number of Fra ... | Archive Stat ... Repe 1 5/1/2020 6:42:57 PM RR 1007 +/- 39; 7 h ... Original, Prim ... 25 24 Unrestricted © Siemens Healthineers, 2023 Notes 30 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... Propagation of Queued for archiving status to higher level. Study Archived| Corrected + Series Number Series Description Modality # Instances in ... Series Archive cine_segmented_lax_3Ch MR cine segmented_lax_4Ch MR 3 cine_segmented_lax_2un 99 PhoenixZIPReport 4 AAhead_scout_MPR_sag MR 5 AAhead_scout_MPR_tra MR 6 AAhead_scout_MPR_tra MR 7 AAhead scout MPR tra Propagation of Error status to higher level Series Study Archived Corrected + Series Number Series Description Modality # Instances in ... Series Archived To 41 ep2d_diff_b50_400_800_tra_p3_trig-R. 42 ep2d_diff_b50_400_800_tra_p3_trig-R. T1 Images B1corr 52 T1_Images_B1corr 53 T2starMap_f12d_tra_mbh MR 54 T2Star_Images MR 55 T2Star_Images PR 82 ep2d_perf_p2_MoCo MR WIR 83 TTP_ep2d_perf_p2_MoCo 25 Unrestricted © Siemens Healthineers, 2023 Notes 31 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers' ... Patient Browser & MR View&GO Serie Archiving OK Study Archived Corrected + Series Number Series Description Modality # Instances in ... Series Archived • cine_segmented_lax_3Ch MR cine_segmented_lax_4Ch MR cine_segmented_lax_2Ch MR PhoenixZIPReport SR AAhead_scout_MPR_sag MR AAhead scout MPR tra MR Send and Archive Num ... . Preview Description # Images PAS DUMMY-NO ... cine_segmented_lax_3 .. 1/25 cine_segmented_lax_4 .. 1125 5 cine_segmented_lax_2 ... 1/25 AAhead_scout_MPR_sag AAhead_scout_MPR_tra PhoenixZIPReport Send Close 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 32 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers' ... Patient Browser & MR View&GO Series Flag synchronization on Send, Save Study Archived Corrected + Series Number Series Description Modality # Instances in ... Series Archived • cine_segmented_lax_3Ch MR and Send, and Save and Pause cine_segmented_lax_4Ch MR cine_segmented_lax_2Ch MR • If you uncheck a series in the 99 PhoenixZIPReport SR MR Distribution Step and press, Send, AAhead_scout_MPR_sag AAhead_scout_MPR_tra MR Save and Send, or Save and Pause, 6 AAhead_scout MPR tra MR the status is transferred to the send and Archive Patient Browser as Not to be Num ... Preview Description #Images| PACS| DI AMY- NO ... archived ne_segmented_lax_3 ... 1/25 cine_segmented_Jax_4. 1/25 M ine segmented lax.2. 1/25 M To AAhend _Scout _MPR . 500 Ahead_scout_MPR_tra AAhead scout MPR_tra PhoenixzipReport send Close 27 27 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 33 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers' ... Patient Browser & MR View&GO Series • Queued for archiving (Storage Study Archived Corrected + Series Number Series Description Modality # Instances in ... Series Archived Commitment). 1 cine_segmented_lax_3Ch MR X 2 cine_segmented_lax_4Ch MR • Distribution Step considers Storage 3 cine_segmented_lax_2Ch MR 99 PhoenixZIPReport SR Commitment (new with MR XA30 EX 4 AAhead_scout_MPR_sag MR 5 AAhead_scout_MPR tra MR 6 AAhead scout MPR tra MR 7 AAhead scout MPR tra MR end and Archive Num ... . Preview Description DUN cine segmented lux. 3. cine segmented Lax 4 1/25M ne_segmented_ Jax,2 AAhead_SCOut_ MPR.829 Athread scout_MPR. tra AAhead_scout_MPR_ tra AAhead_scout_MPR_ tra PhoenixzapReport Sand Case 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 34 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers' ... Patient Browser & MR View&GO S Series Study Archived| Corrected + Series Number Modality • Archive failed after Storage Series Description # Instances in ... Series Archived 41 ep2d_diff_b50_400_800_tra_p3_trig-R ... Commitment fail (time‐out) 42 ep2d_diff_b50_400_800_tra_p3_trig-R ... 51 T1_Images_B1corr • Distribution Step considers Storage 52 T1_Images_B1corr 53 T2starMap_f12d_tra_mbh Commitment (new with MR XA30) 54 T2Star_Images 55 T2Star_Images 82 ep2d_perf_p2_MoCo 60 83 TTP_ep2d_perf_p2_MoCo Send and Archive Num ... . Preview Description # Images ACS - DUMMY - NO ... ep2d_diff_b50_400_00 ... TI_Images_BIcorr 1/64 + 53 T2starMap_Ad_tra_mbh 7/210 12star Ima 1/ 30 ep2d_perf_p2_Moco 601 1 ... TIP cp2d perf p2 Mo ... 1122 7 Send Close 29 29 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 35 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Archive Flags SIEMENS Healthineers ... Export Failure Status send and Archive • No errors in the notes for configured Export Targets were shown previously Number 4 Preview Description # Images JustDicomPACS syngo.Pla THISWILLFAIL • Now errors in sending the data (e.g., AAhead_scout 1/128 DVD) are displayed in the Send & Archive AAhead_scout_MPR_sag 175 Dialog AAhead_scout_MPR_cor 1/ 3 AAhead_scout_MPR_tra 1/3 PhoenixZIPReport Series E Note: information is still missing in the Serie ... Series Description Modality # Inst ... Series Archived Exported Series Date and Time 1 AAhead scout MR 5/9/2022 11:44:48 PM Patient Browser. 2 AAhead scout MPR_sag MR 5/9/2022 11:44:53 PM 3 AAhead scout MPR cor MR 5/9/2022 11:44:53 PM 4 AAhead_scout_MPR_tra MR 5/9/2022 11:44:53 PM 99 PhoenixZIPReport SR 5/9/2022 11:44:54 PM 30 Unrestricted © Siemens Healthineers, 2023 Notes 36 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Independent Protocols SIEMENS Healthineers Coil Independent Protocols MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 37 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Coil Independent Protocols • Auto Coil Select • Coil Independent Protocols • Conversion Rules to Import Protocol • Edit Coil Selection Mode & Find Dialog 2 Unrestricted © Siemens Healthineers, 2023 Notes 38 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • List the features of Auto Coil Select • Identify Coil Independent Protocols in myExam Cockpit • Recall the Conversion Rules to Import Protocols • Recite how to edit Coil Selection Mode & Find Dialog 3 Unrestricted © Siemens Healthineers, 2023 Notes 39 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Introduction SIEMENS Healthineers ... Motivation Goal • High in‐house efforts in local coil lab for defining and • Some protocols in Siemens Tree are stored in ACS implementing coil conversion rules mode • Protocols are not easily exchangeable, even between • Merging of similar system types into one family tree to similar systems significantly reduce internal maintenance efforts when • Prolonged loading and saving time for protocols due to using internal Protocols coil information being stored • Supports all main‐line MR systems with the latest protocol configuration Conclusion: • Increased efficiency while working in the myExam A more efficient solution is needed. Cockpit and when working with Protocols 4 Unrestricted © Siemens Healthineers, 2023 Notes 40 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Auto Coil Select SIEMENS Healthineers ... Improvements Extension of the existing Auto Coil Select modes. Routine Contrast Resolution Geometry System Physio Inline Sequence • ACS All but spine – selects all coils in FoV except Miscellaneous Adjustments Adjust Volume Tx/Rx the spine coil (e.g., used for ortho and breast Coil Selection Auto Coil Select ... Coil Combination Adaptive Combine ... Auto Coil Select imaging) ACS All but spine MSMA ACS Restricted • ACS Restricted – user can pre‐define coil classes Manual Sagittal Matrix Optimization Off and coil compartments for which ACS is executed Coronal A >> P during run‐time Transversal F>>H Coil Focus Flat Auto Coil Select can be used for the first localizer protocol. Coil position detection is performed prior to Virtual Coils first measurement. Both were implemented with MR XA20 software 5 Unrestricted © Siemens Healthineers, 2023 Notes 41 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Auto Coil Select & Coil Coverage SIEMENS Healthineers ... Coil Coverage 48 sec 1| Auto @ 3 1.0x1.0x5.0 mm3 1.00 Enables you to adapt the sensitivity for automatic Routine Contrast Resolution Geometry System Physio Inline Sequence Miscellaneous Adjustments Adjust Volume Tx/Rx coil selection, by involving fewer or more coils for Coil Selection Auto Coil Select Coil Combination Adaptive Combine a given FoV. • Minimize: 30% Coil Selection 2 X • Standard: 15% Coil Coverage Standard • Generous: 5% Minimize → minimum amount of overlap required between Generous the FoV and the coil segment to automatically activate the segment. Close 6 Unrestricted © Siemens Healthineers, 2023 Notes 42 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Auto Coil Select SIEMENS Healthineers ... Implementation Siemens Tree User Tree All protocols in the Siemens Tree are stored using one Manual mode can be used and stored in the User Tree. of the three available ACS modes (Auto Coil Select, ACS All but spine, ACS Restricted). Manual mode will be converted to one of the ACS modes when the protocol is imported to a different system or No protocols in the Siemens Tree are stored using software version! Manual coil selection mode. 7 Unrestricted © Siemens Healthineers, 2023 Notes 43 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Auto Coil Select SIEMENS Healthineers ... ACS Restricted SIEMENS >> spectroscopy >> prostate_1H > body-array >> 12_tse_tra_p3_fast 1:02 min : Auto @ 3 @ 0.4x0.4x3.0 mm3 1.00 Coil Selection Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Execution Miscellaneous Adjustments Adjust Volume Tx/Rx Coil Coverage Standard Image Management Coil Selection ACS Restricted Coil Combination Adaptive Combine Auto Load Copy References Selected Coils Available Coils MSMA S.C.T Matrix Optimization Off Head Posterior Head Anterior Sagittal R>>L Neck Anterior Breast Left Coronal A>> P Neck Posterior Breast Right Transversal H>> F Coil Focus Flat Spine HandWrist 1 HandWrist 2 HandWrist 3 Virtual Coils Foot/Ankle TO Foot/Ankle FA Close OK Cancel Click on … to open the Coil Selection window Configure coil compartments to be used for ACS 8 Unrestricted © Siemens Healthineers, 2023 Notes 44 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Auto Coil Select SIEMENS Healthineers ... ACS Restricted Coil / Coil Compartment Description Coil / Coil Compartment Description Head Anterior 16/20/64ch, 20/64ch TCS, Pediatric coil; 4 All body coils supported (30/18/12/16ch, 18/12ch compartments per coil Body BM, 24ch Contour) Head Posterior 16/20/64ch, 20/63ch TCS, Pediatric coil; 4 Flex 4ch Flex (large & small) compartments per coil Includes Special Purpose coil Neck Anterior 16/20/64ch, 20/63ch TCS; 4 compartments per coil UltraFlex 18ch Flex (large & small) Neck Posterior 16/20/64ch, 20/63ch TCS; 4 compartments per coil Shoulder Shoulder large/small, ShoulderShape Knee 15/18ch Knee coil Breast Right 2,4,7,10,16,18ch; 2 compartments per coil (e.g., for unilateral breast examinations) Endorectal Medrad Coil Breast Left 2,4,7,10,16,18ch; 2 compartments per coil (e.g., for unilateral breast examinations) Peripheral Angio 36/16ch Peripheral Angio coil HandWrist 1 3 compartments – for fingers, metacarpals, wrist Loop 4/7/11 cm HandWrist 2 3 compartments – for fingers, metacarpals, wrist BC HandWrist 3 3 compartments – for fingers, metacarpals, wrist Spine 72/48/32/24 with or without BM Respiratory Sensor MNO, Tx/Rx coils are not listed in the available coils dialog. If they are plugged in Foot/Ankle TO 2 compartments – for toes, metatarsals no other coil can be selected Foot/Ankle FA 2 compartments – for foot, ankle 9 Unrestricted © Siemens Healthineers, 2023 Notes 45 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Independent Protocols in myExam Cockpit SIEMENS Healthineers ... The Coils Parameter Card is not available in myExam Cockpit if one of the ACS modes is selected. Virtual Coils can be used to add coils for testing purposes; note the virtual coils selection will not be stored in the protocol if using one of the ACS modes. Routine Contrast Resolution Geometry System Physio Inline Sequence Routine Contrast Resolution Geometry System Physio Inline Sequence Miscellaneous djustments Adjust Volume Tx/Rx Coils Miscellaneous| Adjustments|Adjust Volume|Tx/Rx Coil Selection ACS Restricted ... Coil Combination Adaptive Combine BO1 802 BO3 MSMA S - C -T Sagittal R>>L Matrix Optimization Off Coronal A>> P Transversal F >> H Coil Focus Flat Virtual Coils SP1 SP 2 SP3 SP4 SP5 SP 6 SP7 SP8 Body Virtual Coils 10 Unrestricted © Siemens Healthineers, 2023 Notes 46 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Dependent Protocols during Acquisition SIEMENS Healthineers ... Behavior during acquisition is the same as before. • When a protocol is opened in the queue the Coils parameter card is available • The coil selection can be changed manually in GSP segments or on Coils parameter card Routine Contrast Resolution Geometry System Physio Inline Sequence Coils Miscellaneous Adjustments Adjust Volume TX/RX BO1 802 BO3 SP1 SP 2 SP 3 SP 4 SP5 SP 6 SP SP8 Body Virtual Coils 11 Unrestricted © Siemens Healthineers, 2023 Notes 47 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Conversion Rules for Importing Protocols SIEMENS Healthineers ... XA30A and Future Software ACS All but spine may not be the appropriate Coil Selection mode for all former Manual Mode protocols, therefore these protocols will be underlined post conversion, and should be checked. Customers should be guided to use protocols from the Siemens Tree, which support the new functionality, instead of converting the ‘older’ VE11 protocols. Default and Coil Memory Modes are no longer available with syngo MR XA30 software. Pre‐conversion Coil Selection mode Conversion Post‐conversion Coil Selection mode 1. Default converts to ACS 2. Coil Memory converts to ACS 3. Manual converts to ACS All but spine (underlined) 12 Unrestricted © Siemens Healthineers, 2023 Notes 48 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Conversion Rules for Importing Protocols SIEMENS Healthineers ... XA30A and Future Software Old Manual mode protocol converts to ACS All but spine and is underlined post conversion. localizer_default 00:03 USER >> CoilSelection >> test >> conversionTest >> localizer_Manual General Localizer ACS 3 3 sec 4 Auto2 2 0.7x0.7x8.0 Upgrade Info 00:03 Protocol Parameters Contrast Resolution Geometry System Physio Inline Sequence Protocol was converted on 4/27/2020: Localizer CoilMemory 00:03 Voice Commands Miscellaneou Adjust Volume Tx/Rx Scan Window Adjustments 5.60 + 6.10 ms Execution Localizer Manual 00:03 Image Management Coil Selection ACS All but spine Coil Combination Adaptive Combine ... Coil Selection Manual + ACS All spine Auto Load Copy References Do not show this information again MSMA S . C . T . Sagittal R >> L Matrix Optimization Off Coronal A>> P Transversal H >> F Coil Focus Flat Virtual Coils OK Cancel CUpgrade Info 13 Unrestricted © Siemens Healthineers, 2023 Notes 49 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Edit Coil Selection Mode with Find Dialog SIEMENS Healthineers ... Edit multiple protocols simultaneously myExam Cockpit - Explorer Explorer Program Editor Right‐click on the: Browse Import Export Edit Simulate X • Region USER_TREE cine trufi • Exam or frequency scout cine flash • Program whole-spine tagging >neck soft tissue >thorax Select the Find … option to open the Find and Set Parameters dialog. heart Cardiac Assist localizer morphology function Collapse El cine tru El frequen Find ... El cine fla Copy Ctrl+C E tagging Paste dynamic Delete tissue cha MyoMap: Rename flow Print ... angiogra Export ... angiogra Check License breast Convert abdomen Edit Properties ... 14 Unrestricted © Siemens Healthineers, 2023 Notes 50 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Edit Coil Selection Mode with Find Dialog SIEMENS Healthineers ... Find and Set Parameters USER_TREE Find and Set Parameters • If the Exam Directory name is entered, all protocols in Q the directory can be selected via the Select all button whole-spine Name & func • Click on Edit selected to edit the selected items > neck soft tissue Location Selected Element >thorax Type All Step Types heart Cardiac Assist Path Name localizer USER_TREE/heart/function/cine trufi retrospective gating morphology USER_TREE/heart/function/cine trufi cine_trufi_retro function USER_TREE/heart/function/cine trufi cine_trufi_retro_reduced_fov El cine trufi USER_TREE/heart/function/cine trufi cine_trufi_retro_arryth USER_TREE/heart/function/cine trufi cine_trufi_retro_cs_2_shot E frequency scout USER_TREE/heart/function/cine trufi cine_trufi_retro_cs_8_shot E cine flash USER_TREE/heart/function/cine trufi ventricular volume tagging USER_TREE/heart/function/cine trufi cine_trufi_retro_10sl_invf dynamic USER_TREE/heart/function/cine trufi cine_trufi_retro_10sl_invf_reduc ... > tissue characterization USER_TREE/heart/function/cine trufi cine_trufi_retro_cs_2_shot_10sl ... USER TREE/heart/function/cine trufi radial MyoMaps flow angiography angiography ce (Select all Unselect all breast abdomen [ pelvis female [ pelvis male [ tmj Edit selected Cancel shoulder 15 Unrestricted © Siemens Healthineers, 2023 Notes 51 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Edit Coil Selection Mode with Find Dialog SIEMENS Healthineers ... 1. Check the Coil Select Mode box. Find and Set Parameters 2 X 2. Select ACS mode. 3. Accept Changes to update all selected Protocol Parameters Voice Commands System > Miscellaneous protocols with the selected ACS mode. Execution Go to Isocenter AutoAlign Image Management Auto Load Table position Note: currently you are unable to define the 0 4 m Reference Coil Select Mode Auto Coil ... coil compartments for ACS Restricted using Sagittal R >> L Coronal A>>P Coils Auto Coil Select ACS All but spine the Find and Set Parameters dialog window. Transversal F >>H ACS Restricted Manual Resolution > Filter Image Distortion Correction Accept Changes Cancel 16 Unrestricted © Siemens Healthineers, 2023 Notes 52 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Hints and Feedback SIEMENS Healthineers ... Coil information not stored in the protocol when using one of the ACS modes. As long as a protocol uses one of the ACS modes, the coil information is not stored when the protocol is saved in myExam Cockpit. This also applies to virtual coils that are configured in myExam Cockpit. Coil information is only stored if Manual mode is selected. This behavior is as expected. Coil Position Detection Fails. Sometimes the Coil Position Detection may fail. If the coil position is not known, Auto Coil Select cannot select the appropriate coil elements located in the FoV. If this problem frequently occurs for a particular coil, protocols using this coil could be stored using Manual mode, with all coil elements selected. Hint: check the position of the displayed coil elements in the Coils parameter card relative to the body image. If elements are displayed in the top left corner, this indicates the coil position is not known. 17 Unrestricted © Siemens Healthineers, 2023 Notes 53 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers User & Role Management MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 54 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... User & Role Management • Introduction to User and Role Management • Relation of Groups, Users, Roles, & Tasks • Basic User Configuration • Changing Passwords • Create User Accounts • Assign Users, Groups to Roles ‐ Admin Portal 2 Unrestricted © Siemens Healthineers, 2023 Notes 55 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Describe User and Role Management • Define the relation of Groups, Users, Roles, & Tasks • Explain the basic user configuration • Recall how to changing passwords • Summarize how to create user accounts • Recall how to assign Users, Groups to Roles in the Administrator Portal 3 Unrestricted © Siemens Healthineers, 2023 Notes 56 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Introduction SIEMENS Healthineers ... MR Applications Fundamentals 1 User & Role Management Introduction 4 Unrestricted © Siemens Healthineers, 2023 Notes 57 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Introduction Login Role pwd meduser Technologists No pwd medadmin IT admin adm$pwd$4$med$ clinadmin Clinical admin adm$pwd$4$med$ (must change after 1st login) medclient Technologist client$pwd$4$med$ (MR satellite console) 5 Unrestricted © Siemens Healthineers, 2023 Notes 58 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Introduction Advanced User Overview • An Advanced User can use additional features and functionalities which are associated with certain user roles. • Roles are a central element of the authorization system. • A set of tasks is assigned to a role, so a user will only be allowed to perform a task if their user account has been assigned to a role that includes this task. • Windows User Management allows the creation of new users and to configure their respective authentication and authorizations for Numaris/X. • Only local users have the required authorization to operate Numaris/X systems; Active Directory is not supported. 6 Unrestricted © Siemens Healthineers, 2023 Notes 59 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Relation of Groups, Users, Roles, and Tasks User Manager can create users and user groups, assign users to user groups (done in Windows User (1) Management). Role Manager • Assign roles to user/user group is done in the Role (2) User Manager Manager • Assign clinical tasks (permissions) to roles is done in the Role Manager. (3) Reading Clinical Physician Technologist IT Administrator Administrator • If a group is assigned a role, then each user in the group has this role (4) • A user/user group may be assigned several roles, Role Manager so permissions are accumulative 1. Clinical User – Windows user 2. Assignment should be sufficient in most cases, so do Clinical Role – Windows user group 3. not change! syngo Role – Authorization Store role 4. syngo Task – Authorization Store task 7 Unrestricted © Siemens Healthineers, 2023 Notes 60 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Access to Advanced User & Role Administration User Manager access to the local windows user MAGNETOM Skyra Administration Portal SIEMENS Heolthineers' NXVSIM / medadmin Free (Restricted Remote Access) management (). Installation Technical Configuration Quality Assurance Clinical Configuration Site Information User and Role Administration Remote Service Users and Groups Associated with Roles User or Group Role Role Manager access to the syngo role manager User and Role Administration NXVSIM\clinadmin ClinicalAdministrator DICOM Nodes BUILTIN\Administrators ITAdministrator (based on ). DICOM Data Handling NXVSIM\alocal MR_Service Auditing to Syslog Server NXVSIM\aremote MR_Service Everyone Technologist Add Access to User and Role configuration tools i) Your changes will only apply after the affected user next logs in. Advanced User and Role Administration require an additional login with administrator 1 To access the management functions of the loca rights (IT Administrator). User Manager Role Manager XX1 OF 8 Unrestricted © Siemens Healthineers, 2023 Notes 61 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Default Users after installation Meduser the standard syngo MR user (password not needed) is logged on the when startup without authentication is configured. The default role is Technologist; other roles may be assigned. clinadmin has the ability to perform clinical administration and configuration tasks (e.g., saving MR View&GO default layout, favorite tools, User Tree password protection). The default role is Clinical Administrator; other roles may be assigned. Medadmin is used for a local windows administrator. The default roles are IT Administrator and MR IDEA; other roles may be assigned. Medclient is an account for the syngo MR Workplace; it is the same role as meduser (Technologist). 9 Unrestricted © Siemens Healthineers, 2023 Notes 62 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Default Users after installation Preset roles are delivered with syngo platform. Technologist is able to perform common clinical routine tasks; myExam Cockpit access. Every user has this role assigned as default. Clinical Administrator is able to perform clinical administration and configuration tasks. (e.g., setting MR View&GO default layout, favorite tools). • myExam Cockpit Administrator rights (e.g., User Tree password protection) • DICOM node configuration; configure auto‐routing rules IT Administrator as above plus they are able to perform technical administration tasks. (e.g., change startup options, scanner configuration). • Windows administrator rights • Audit trail setup 10 Unrestricted © Siemens Healthineers, 2023 Notes 63 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Default Users after installation Additional syngo MR Specific Roles MR_Service is able to perform serveral MR tasks during service (e.g. restart MARS). MR_IDEA is enable research customers to perform tasks required in sequence development. Every user in the local Adminstrators group has this role as default. Researcher is able to leave Kiosk Mode without being prompted for credentials. In syngo MR XA software, the permission to disable the Patient Safety Watchdog will not be granted by a syngo task; a special Meas Password is provided to dedicated users (like Numaris/4). Never change role or task names!. 11 Unrestricted © Siemens Healthineers, 2023 Notes 64 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Default Users after installation Please refer to Operator Manual – Advanced User for more detail regarding the specific tasks available. Task Name Default Roles Authorized Function COMPLETE_READ_WORKITEM Technologists Allows the authorized user to save a workflow and to send the result to the archive. CONF_WORKPLACE_SETTINGS Clinical Administrator Allows the authorized user to configure the _PERMISSION IT Administrator idle time after when the workplace is locked, and a lock screen is activated to protect the system against unauthorized access. DATA_CORRECTION_AND_ Clinical Administrator Allows correction and rearrangement of REARRANGEMENT IT Administrator patient and study data. Technologists DATA_PERMANENT_DELETION Clinical Administrator Allows data to be permanently deleted from IT Administrator the local database. Technologists 12 Unrestricted © Siemens Healthineers, 2023 Notes 65 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Basic User Configuration Key Messages • The syngo MR XA software always runs under the meduser default account • If startup authentication is activated, an additional user must be added • The default meduser account should be able to perform clinical administration tasks, the account should be assigned to a Clinical Administrator role. • Only change passwords using the syngo dialog. 13 Unrestricted © Siemens Healthineers, 2023 Notes 66 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Require Authentication on Startup Access Control is only visible when the current user has an IT Administrator role assigned and is found in the Configuration Panel. Configuration Panel Client Settings Advanced Visualization • If Require authentication on startup is not selected (default), the system auto‐starts and directly shows the Home Screen without Access Control further authentication required Require authentication on startup • Desktop User is Meduser Meduser Primary role: Technologist 14 Unrestricted © Siemens Healthineers, 2023 Notes 67 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Require Authentication on Startup If Require authentication on startup is selected, Configuration Panel an authentication window is shown during Client Settings Advanced Visualization system auto‐start. Access Control Desktop User is the authenticated user. Require authentication on startup SIEMENS .. Healthineers syngo MR User accounts need to be configured in advance yngo MR XA51 and assigned roles. User Name medadmin Password • Only user accounts that are assigned to at least Domain U73D23 one syngo role can log onto Numaris/X. OK Cancel Change Password ... • Authentication is to identify a user, which is the basis and pre‐requisite for access control Copyright @ Siemens Healthcare GmbH 2017-2022. All rights reserved. MedAdmin and logging of relevant user activities. Primary role: IT-Administrator Additional roles: Technologist 15 Unrestricted © Siemens Healthineers, 2023 Notes 68 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Leaving Kiosk Mode • Enables access to Windows taskbar and file system (like Advanced User in Numaris/4) Capstack • Select keyboard combination Tab and Delete and Most used Send to PACS/Default Node (large + ) simultaneously SIEMENS .. Healthineers File Explorer Snipping Tool and provide password (or any Paint Windows user with IT Administrator role) syngo MR Acrobat Reader DC Admin Cmd syngo MR XAS1 Administration Portal • User switch to medadmin is not the same as leaving Authorization Store User Name medadmin Kiosk Mode, but the login credentials are the same Password Camtasia Studio Domain U73D23 Create SaveLoq • User roles , & OK Cancel have different roles and permissions, but windows Change Password ... Environment Shell Export Import access is not implied by a user switch Copyright @ Siemens HealthcarelGmbH 2017-2022. All rights reserved M M Microsoft SQL Server 2008 Mirmenft SAI Server 2016 p syngo localhost • Switching only possible if scan not running • Reenter Kiosk mode by selecting the same keyboard combination again 16 Unrestricted © Siemens Healthineers, 2023 Notes 69 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Leaving Kiosk Mode Privileges gained with Leaving Kiosk Mode versus User Privileges gained with Leaving Kiosk Mode versus User switching to medadmin. switching to medadmin. As a medadmin User (IT Administrator role) you can: In non‐Kiosk mode you can: • Perform certain configurations within syngo • Access Windows file system, start Windows Explorer • Access to myExam Cockpit Administrator for User Tree • Open cmd‐shells, run tools (logviewer, mdb, etc.) password management, etc.… To leave Kiosk mode you must know the username and password of a user who has an IT Administrator role; the default user account has these privileges. 17 Unrestricted © Siemens Healthineers, 2023 Notes 70 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers .. Changing the Password Depending on site security policy, the password may need to be changed at regular intervals. SIEMENS ... Healthineers New users are given a User Name, and password by the system administrator. The password is temporary syngo MR by default. syngo MR XA51 1. Open the Authentication window and select User Name. User Name medadmin Password O 2. Click Change Password. Domain 073D23 3. Enter the old password for authentication, and OK Cancel Change Password ... type new password into field provided. Copyright @ Siemens Healthcare GmbH 2017-2022. All rights reserved . 18 Unrestricted © Siemens Healthineers, 2023 Notes 71 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 User & Role Management SIEMENS Healthineers ... Password Policy Account Lockout Policies: There are no Numaris/X specific rules for user‐names or Account lockout threshold = 10 invalid password passwords. But the Windows password policy enforces • attempts. complexity requirements by default. New password must meet the following minimum requirements. • Account lockout duration = 30 minutes. • Reset account lockout counter after 30 minutes. Passwords: • Cannot contain the user’s account name or parts of the user's full name that exceed two consecutive characters • Must be at least 14 characters in length • Must contain characters from 3 of the following categories • English uppercase characters (A through Z) • English lowercase characters (a through z) • Digits (0 through 9) Non‐alphabetic characters (e.g., !, $, #, %) • 19 Unrestricted © Siemens Healthineers, 2023 Notes 72 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Creating Local User Accounts for Numaris X SIEMENS Healthineers ... Creating the User account is performed by the Lead lusrmgr - [Local Users and Groups (Local)\Users] MR Technologist. They have administrator rights and File Action View Help DIE are logged on to the Administration Portal: Local Users and Groups (Local) Name Full Name Description Actions Users Groups alocal Local Service Account Users 1. Select User Role and Administration tab and click aremote Remote Service Account BuiltInAdmi ... Built-in account for adn More Actions User Manager. clinadmin clinadmin db_owner Database owner user DefaultAcco ... 2. Right‐click Users and choose New User. kgwuser KGW user New User ? X Kylie Martin Kylie Mart Lead Technologist 3. Complete user information in the New User dialog. mars2 User name: MedAdmin Full name: MR Lead Technologist Select the Password never expires box (optional). medclient Medclient 4. MedGuest Description: meduser Meduser 5. Click Create. OpenAppsS ... OpenApp OpenAppsU ... OpenApp Password: .............. SyngoCmd0 SyngoCm| Confirm password: .............. 6. Complete information for an additional user or SyngoCmd1 SyngoCm click Close. SyngoUserO SyngoUse User must change password at next logon SyngoUser2 SyngoUse User cannot change password Password never expires 7. Complete steps to assign User to a Role. Account is disabled Help Create Close 20 Unrestricted © Siemens Healthineers, 2023 Notes 73 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Assigning Users or Groups to Roles via Administration Portal SIEMENS Healthineers ... [1 of 2] Assigning a Clinical Administrator Role to the MAGNETOM Skyra Administration Portal - a > SIEMENS Heolthineers NXVSIM / medadmin Free (Restricted Remote Access) Lead Technologist user account. Installation Technical Configuration Quality Assurance Clinical Configuration Site Information User and Role Administration They have administrator rights and are logged on Remote Service Users and Groups Associated with Roles to the Administration Portal and know the name User or Group Role User and Role Administration NXVSIM\clinadmin ClinicalAdministrator of the Windows user or user group to be DICOM Nodes BUILTIN\Administrators ITAdministrator DICOM Data Handling NXVSIM\alocal authorized. NXVSIM\aremote MR_Service Auditing to Syslog Server Everyone Technologis ..... 1. Select Technical Configuration and then User Add and Role Administration. The User and Role i) Your changes will only apply after the affected user next logs in. Administration window opens, and a table Advanced User and Role Administration 1) To access the management functions of the local machine, use the buttons below. with the current role assignments is displayed. User Manager Role Manager 2. Click Add to add a new assignment. 21 Unrestricted © Siemens Healthineers, 2023 Notes 74 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Assigning Users or Groups to Roles via Administration Portal SIEMENS Healthineers .. [2 of 2] 3. From the Role list, select the role that you MAGNETOM Skyra Administration Portal SIEMENS Healthineers NXVSIM / medadmin Free (Restricted Remote Access) want to assign. A Installation Technical Configuration Quality Assurance Clinical Configuration 4. In the Windows User or Group field, type the Site Information User and Role Administration name of the windows user or Group. Remote Service Users and Groups Associated with Roles Licensing 5. Click Add. User or Group Role User and Role Administration NXVSIM\clinadmin ClinicalAdministrator DICOM Nodes NXVSIM\Kylie Martin ClinicalAdministrator DICOM Data Handling BUILTIN\Administrators ITAdministrator The new role assignment is displayed in the table. Auditing to Syslog Server NXVSIM\alocal MR_Service NXVSIM\aremote MR_Service Everyone Technologist To delete a role assignment, click the Delete icon Domain/host na Lead Technologist ClinicalAdministrator at the end of the corresponding row of the table. i Your changes will only apply after the affected user next logs in. Advanced User and Role Administration i To access the management functions of the local machine, use the buttons below. User Manager Role Manager 22 Unrestricted © Siemens Healthineers, 2023 Notes 75 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Introduction to Enhanced DICOM SIEMENS Healthineers Introduction to Enhanced DICOM MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 76 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Introduction to Enhanced DICOM • DICOM Overview • Enhanced DICOM • Interoperability Mode • DICOM Format ‐ Export Data 2 Unrestricted © Siemens Healthineers, 2023 Notes 77 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Describe the difference between DICOM and Enhanced DICOM • Identify Interoperability Mode features • Explain how to export DICOM data 3 Unrestricted © Siemens Healthineers, 2023 Notes 78 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SIEMENS Healthineers ... MR Applications Fundamentals 1 DICOM 4 Unrestricted © Siemens Healthineers, 2023 Notes 79 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM SIEMENS Healthineers ... Digital Imaging and Communication in Medicine DICOM® is the international standard for medical images and related information. It defines the formats for medical images that can be exchanged with the data and quality necessary for clinical use. DICOM is primarily used for storing and transmitting medical images enabling the integration of medical imaging devices such as scanners, servers, workstations, printers, network hardware, and picture archiving and communication systems (PACS) from multiple manufacturers. DICOM® is recognized by the International Organization for Standardization as the ISO 12052 standard. DICOM Digital Imaging and Communications in Medicine 5 Unrestricted © Siemens Healthineers, 2023 Notes 80 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Display the DICOM Header SIEMENS Healthineers ... Numaris X platform 1. In the Patient Browser, select a series in the Series list. Series Series Number Series Description Modality # Instances in ... | Series Archived| Exp. + 3 AAhead_scout_MPR_cor 2. In the Instances list, right‐click and select Display DICOM 4 AAhead_scout_MPR_tra 5 vessel_scout_head_MSUM Header in the context menu. 16 vessel_scout_head_MSUM 7 vessel_scout_head_MSUM 8 vessel_scout_head_MSUM 9 tof fl3d tra 10 tof_f13d_tra_MIP_SAG 11 tof_f13d_tra_MIP_COR Display DICOM Header 7 x 17 tof flad tra MIP TRA TOF & PC, Training (1/1/1956) NOV Values ( Length ) Instances Attribute Name Tag VM Group 0002 Length Ins ... Acquisition Date an ... Image Comments Image Type Number of Fra ... Repetition Time + File Meta Information Version (0002,0001) 00 01 (2) Media Storage SOP Class UID (0002,0002) "1.2.840.10008.5.1.4.1.1.4.1 (27) 9/2/2020 8. 13:25 ... 136 21.00 ms Open Media Storage SOP Instance UID (0002,0003) "1.3.12.2.1107.5.2.50.175601.202009020848! Transfer Syntax UID (0002,0010) "1.2.840.10008.1.2.1" (19) View as Read-Only Implementation Class UID (0002.0012) "1.3.12.2.1107.5.2" (17) Open with Implementation Version Name (0002,0013) "SIEMENS" (7) View as Read-Only with Specific Character Set (0008,0005) "ISO_IR 100" (10) Image Type (0008,0008) "DERIVED" (7) Set Archive state "PRIMARY" (7) "MIP_TRA" (7) "NORM" (4) Correct Instance Creation Date (0008,0012) "20200902" (8) Split to New Series Instance Creation Time (0008,0013) "084733.692500" (13) Delete Del SOP Class UID (0008,0016) "1.2.840.10008.5.1.4.1.1.4.1" (27) SOP Instance UID (0008,0018) "1.3 12 2 1107 5 2 50.175601 202009020848 Display DICOM Header Study Date (0008,0020) "20200902" (8) Delete Frames from Instance Series Date (0008.0021) "20200902" (8) Content Date (0008.0023) "20200902" (8) Acquisition DateTime (0008.002A) "20200902084733.692500" (21) Study Time (0008.0030) "083344.500000" (13) Series Time (0008,0031) "084858.000000" (13) Content Time (0008,0033) "084858.000000" (13) 6 Unrestricted © Siemens Healthineers, 2023 Notes 81 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM format SIEMENS Healthineers ... Numaris 4/syngo.classic Shortcomings of previous formats Name: Syngomr2004v_spectros ... AH ID: SAS000014 VAST ZRI DoB:9/4/1962 Date: 1/22/2004 • Basic application support of the old MR Time: 9: 10:10 AM No.7 Image (90s) Cho+Cr INAA PatC: x 1.8 • Private attributes inhibit interoperability PACS Graphic problems TT TI: XX Angle: 90:00 TR: 1690.00 FOV: • No interoperability of private syngo object‐ TE: 135:00 ImC:Ser 7 c:HE1-4_nc_4 Matrix W: 00502 oriented graphics PF C : 00219 Name.Syngomi 2004v_cardiacx -. Inst ZRI D.SAS000013 el ja_sta Model Avanto Do8 7/30/1956 174 Name Syngom/2004v_cardiacx Inst ZRI Bad quality of DICOM Overlay graphics CHELA po_f Date: 1/22/2004 Time: 3:09: 10 PM ca ID.SAS000013 apode Majar2008_s_Model Avanto • No:16" DoB 7/30/1956 10.07m Falwnf Name:Syngom:2004v_cardiacx. AF Inst ZR PatC.Additional Info maoooooooc". Date:1/22/2004 Time:3:08:49 PM LIED.SAS000013 Model Avanto (DICOM group 6000) No. 18" DoB 7/30/1956 Organ HEART PatC Additional Info ma:ooooooote: 1/22/2004 Time: 2:04:56 PM No: 1 PatC:Additional Info maxooooooo< x20 Pas Porta Ras TT:5.00 ST.5.00 TE Angle:30.00 TR: 98 87 FoV:75.00 TE:3 20 Ime Study Comment Max Lengtho Matrix 256/0/0/179 W: 00232 SO.CT PH C: 00151 7 7 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 82 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Header SIEMENS Healthineers' ... Numaris 4/syngo.classic Shortcomings of previous formats • Proprietary objects: Tensor, Spectroscopy, Mosaic, … • No interoperability • Archiving problems Memory footprint • Phoenix data • Inefficient structure 8 8 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 83 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM (eMR) SIEMENS Healthineers ... MR Applications Fundamentals 1 Enhanced DICOM (eMR) 9 Unrestricted © Siemens Healthineers, 2023 Notes 84 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Previous DICOM Format to Enhanced DICOM SIEMENS Healthineers ... New DICOM Objects New DICOM Objects: Numaris/4 (syngo.classic) – Interoperability Mode Numaris X (syngo.native) – Enhanced Mode (eMR) MR Image, Mosaic Enhanced MR Secondary Capture Image Enhanced MR Color CsaNonImage (Spectroscopy) MR Spectroscopy CsaNonImage (Tensor) Raw Data syngo Object Oriented Graphics/DICOM Overlay Grayscale Softcopy Presentation State Structured Reports (PhoenixZIP) Structured Reports (PhoenixZIP) Secondary Capture Image Multi‐frame Grayscale Word Secondary Capture Image 10 Unrestricted © Siemens Healthineers, 2023 Notes 85 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM Format SIEMENS Healthineers ... From Single‐Frame to a Multi‐Frame Structure MR Image 1 MR Image 2 MR Image 3 MR Image 4 MR Image 5 MR Images Single‐frame Enhanced MR Image (eMR) Enhanced MR Image Multi‐frame • • More efficient memory structure More efficient memory structure • • Per frame data Faster read/write, less file I/O Faster read/write, less file I/O Shared data Pixel • • Unit to handle: slice group/volume, no single slice! Unit to handle: slice group/volume, no single slice! 11 Unrestricted © Siemens Healthineers, 2023 Notes 86 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM SIEMENS Healthineers ... Interoperability versus eMR Interoperability Mode [Series = 6 instances of 1 image] eMR Mode [Series = 1 instance of 25 images] Example : MR Neuro Series Example : CMR Series Instance 1 Instance 2 Instance 3 Instance 4 Instance 5 Instance 6 Instances Instance Nu ... Acquisition Date and Time Image Type 19/09/2018 20:15:23 Original; Primary; M; NORM; DIS2D; FM; FIL; MFSPLIT Instances 2 19/09/2018 20:15:23 Original; Primary; M; NORM; DIS2D; FM; FIL; MFSPLIT 3 19/09/2018 20:15:23 Original; Primary; M; NORM; DIS2D; FM; FIL; MFSPLIT Instance Number | Image Comments Original; Primary; M; NORM; DIS2D; FM; FIL; MFSPLIT Image Type Number of Frames 19/09/2018 20:15:23 5 19/09/2018 20:15:23 Original; Primary; M; NORM; DIS2D; FM; FIL; MFSPLIT 1 RR 1007 +/- 39; 7 h ... Original, Primary, CINE, NONE 25 6 19/09/2018 20:15:23 Original; Primary; M; NORM; DIS2D; FM; FIL; MFSPLIT 12 12 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 87 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM SIEMENS Healthineers ... Features Lower memory footprint, more efficient structure. The Attributes are much more, strict, and structured: Phoenix protocol data is only done once per Multi‐frame! • More strict definitions • Get rid of the optional attributes Navigation capabilities: Dimension Index, Stacks, Position • Extended MR Parameter (timing, acquisition index, Temporal Position Index supports correct sorting techniques, coils, etc.) and display. Application support: • Diffusion Better performance DICOM Networking, Export, Loading. • ASL Color support, Graphics: • Cardiac Supplemental Palette Color Lookup Table • Color Maps • 10.9mm- • Real World Value Mapping • Real World Value 0.9 Color Pixel Mapping • • High quality standard graphics with Presentation States 10.5 13 13 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 88 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM SIEMENS Healthineers ... Presentation State (PR) Grayscale Softcopy Presentation State (GSPS): Presentation States A separate DICOM object that contains information • label/annotation • on how a particular image should be displayed • windowing • zoom • Windowing, zoom, panning, rotations, … • panning High quality graphics (label, annotation, line, circle) • rotations • • PR is referencing the Image  only Enhanced MR Images from acquisition having references to the PR • Graphics for Enhanced MR Images require a PR! No other graphics allowed (private graphics, Series Overlay Bitmap)! Series Number Series Description Modality 1,046 t2 tse tra_p2_s2 3mm PR PR • Grayscale Softcopy PR supports colored t2 tse tra p2 s2 3mm ND MR t2 tse_tra_p2_s2_3mm MR graphics!  It references grayscale pixel! t2_tse_cor_p2_s2_3mm_ND MR t2_tse_cor_p2_s2_3mm MR 10 t1_se_sag_ND MR 14 14 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 89 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM SIEMENS Healthineers ... Presentation State (PR) est 30.06.2016.2 2016.06.30-13:10:57-DST-1.3.12.2.1107.5.2.30.92003 MR Anlagenzentrum Mir Nichts, Tu A MR Anlagenzentrum -6/30/1992, M, 24Y daGama 2016.07.26-12:07:11-DST-1.3.12.2.1107.5.2.30.92003 NUMARIS/X VA10A *7/26/1972, M, 44Y NUMARISIX VATO t1_vibe_e-dixon_tra_bh_in HFS R2Star_Images Liver Evaluation -----.......................... STUDY ID 3 STUDY ID 2de5d2f5-f65c-49 voxels mean fit error 6/30/2016 7/26/2016 74 2:37:11 PM 12:27:30 PM ROI 3,9% 6 IMA 1 FRM 71 11 IMA 1 FRM 30 Segmentation Volume 44026 2.3% Segmentation ROI 1000 /s Fat signal fraction 60% 5cm mean sta ROI 7.3% 14.1% Segmentation Volume 2.7% 7.6% ROI Segmentation TP 0 TR 4.0 TE 2.5 SP F103.5 TR 293.0 SL 3.01 TE 2.5 SP F87.0 TA 11.04 SL 5.0/1.0 BW 1044.0 FoV 380*309 TA 16.7 OS^-1 R2 400s^- p4 MAGN/DIXON/IN_PHASE/NORM/DIS2D 240*320 BW 465.0 V 380*285 Tra p2 MAGN/T2*/R2_STAR_MAP/DIS2D 153p*256 A1/SAT2 Zoom 1.75 BO1-3;SP2,3 711 A1/PFP/SAT1 ZOOM Fy f13d279 C. mean 308 BO1-3;SP3-5 std f12d7 / 60 ROI 26.78^-1 18.95^-1 Segmentation Volume 45.5s^-1 32.0s^-1 Enhanced MR (Multi‐Frame) Enhanced MR + Color Map + PR Secondary Capture + PR 15 15 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 90 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Enhanced DICOM SIEMENS Healthineers ... Presentation State (PR) PR (presentation state) series is only visible in the Patient Browser, it is not available in MR View&GO. Series Series Series Number Series Description Modality # Ins + 1,046 t2_tse_tra_p2_s2_3mm_PR PR 8 t2_tse_tra_p2_s2_3mm_ND MR 5 t2_tse_tra_p2_s2_3mm MR 19 t2_tse_cor_p2_s2_3mm_ND MR t2_tse_tra_p2_$2_3m 12_tse_tra_p2_$2_3m 2_tse_tra_p2_52_3m t2_tse_cor_02_2_3 t2 tse_cor_p2_52_3 6 t2_tse_cor_p2_s2_3mm MR 10 t1_se_sag_ND MR 7 t1_se_sag MR 99 PhoenixZIPReport SR 4 AAhead_scout MPR tra MR 2 AAhead_scout_MPR_sag MR t1_se_sag_ND t1_se_sag PhoenixZIPReport 3 AAhead_scout MPR cor AAhead_scout IMPR_t AAhead_soout_MPR MR 1 AAhead_scout MR Instances Instances Insta ... Acquisition Date and Time SOP Class UID Echo + Insta ... Acquisition Date and Time SOP Class UID 10/15/2020 3:49:03 PM 16 16 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 91 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM SIEMENS Healthineers ... Interoperability Mode Compatibility, Export & Formats syngo.via Enhanced DICOM. syngo.via syngo.MR Enhanced DICOM support: DICOM, Patient Browser, Viewing, 3D, Filming. No Enhanced DICOM: MR Applications, Exam. MR PACS PACS Vendor dependent. Aspects: archiving, 2D, 3D, 4D, PR support? sMMWP Many PACS do not fully support Enhanced DICOM. DICOM information can get lost, and images could be wrongly displayed, color information gets lost, etc. 17 Unrestricted © Siemens Healthineers, 2023 Notes 92 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... DICOM Remote Node Configuration - Diagnose & Rep Installation 3º Technical Configuration Quality Assurance -ª Clinical Configuration Admin Portal > Technical Configuration > Site Information xx DICOM Remote Node Editor Remote DICOM Nodes Remote Service Role PACS Manufacturer Siemens Healthcare Model Other Licensing Host Name SOB1 Host Name jwgvb10ass01 nslookup • Define or edit format for each network User and Role Administration IP Address IP Address 146.254.162.36 Test(ping) DICOM Nodes Logical Name SOB1 Location Logical Name PACS node Local DICOM Node Location AE Title Port Port AE Title Remote DICOM Nodes Decision needed: which format to be DICOM Data Handling MEDPC SCP 104 SCU JWGVB10ASS01 • MEDPC SCU Storage 104 SCP JWGVB10ASS01 sent to which node MR Configuration MEDPC SCP 104 SCU StorageCommitment • If PACS (or any other DICOM node) does MEDPC SCP 104 SCU JWGVB 10A3801 SCU Query/Retrieve 104 SCP JWGVB10ASS01 not fully support Enhanced DICOM then MEDPC SCP 104 a conversion to the old DICOM format MEDPC Scu UpsWatch must be configured in Admin portal. MFDPC SCU Worklist This is known as "Interoperability SmartTips MEDPC SCP Mode". SCU 104 Mpps If configuration issues, don’t MEDPC SCU Print waste time   DICOM Splitter or MR Export Rules Call CCC ! Save Cancel 18 Unrestricted © Siemens Healthineers, 2023 Notes 93 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers .. DICOM Remote Node Configuration DICOM Remote Node Editor > Storage Settings xx MR Export Rules MR Image Conversion Properties for sending to node: PACS (no archive) M Convert GSPS for MR Images Separate Series for MR and SC Color V Transfer Syntaxes to be Excluded SOP Class Name SOP Class UID Unsaved Changes Multiframe Conversion All SOP Classes M Convert Enhanced MR and related GSPS Computed Radiography Image Separate Series for MR and SC Color V 1.2.840.10008.5.1.4.1.1.1 Digital X-Ray Image - for Presentation 1.2.840.10008.5.1.4.1.1.1.1 M Exclude BOLD Images Activate for PACS transfer to avoid problems with mass data Digital X-Ray Image - for Processing 1.2.840.10008.5.1.4.1.1.1.1.1 Digital Mammography X-Ray Image - for Presentation 1.2.840.10008.5.1.4.1.1.1.2 M Convert Enhanced MR and related PCSPS Separate Series for MR and SC Color V Digital Mammography X-Ray Image - for Processing 1.2.840.10008.5.1.4.1.1.1.2.1 >> Ninital Intra Oral Y Dau Imana for Dracantation 1 7 840 10008 5 1 4 1 1 12 M Convert Enhanced MR Color LUT and related GSPS Separate Series for MR and SC Color V Header Correction Ruleset M Convert Enhanced MR Color and related CSPS These changes may affect system interoperability and DICOM conformance. We strongly recommend testing communication with the selected node for correctness before M Convert Multiframe Color SC setting it to productive. If encapsulation is enabled, header correction will be disabled for non-supported M Convert Multiframe Grayscale Word SC and related GSPS Applied Header Correction Rules i Do not convert Enhanced MR Images for remote syngo.via nodes because of interoperability reasons Handle Acquisition Time Handle Patient's Age Handle Patient's Sex Handle Patient's Weight and Size Multiframe Conversion Result Structure Normalize Patient's Age Remove All Private Data Elements Storage Commitment M Preserve original Series Number for each converted Multiframe Image Disable If you use a node without storage commitment ("No SC") as archive node, you will not Separate Series for each converted Diffusion Multiframe Image receive IHE-compliant confirmation of archiving. The archive state is only updated based on the transfer result. Permanent data storage is not ensured and data loss may Separate Series for each converted DTI Multiframe Image Don't activate. This might result in a result. Check whether changes affect autorouting rules or the archive configuration. 1 high amount of series Destination: Same as Storage Separate Series for each converted Perfusion Multiframe Image ] Don't activate. This might result in a high amount of series Encapsulate Non-Supported Objects This might result in a high amount of Enable 1 If you enable this option, non-supported objects will be encapsulated in the Separate Series for each converted GRASP Multiframe Image i series Select Format: "Basic Text Structured Report" or "Secondary Capture Image" format depending the user's selection. Separate Series for each converted TWIST Multiframe Image 1 This might result in a high amount of Basic Text Structured Report Further processing of sent images is possible after images are retrieved to the Secondary syngo.via system. series Capture Image Check whether changes affect autorouting rules or header correction rules. Separate Series for each converted Multiframe Image (all other) 19 Unrestricted © Siemens Healthineers, 2023 Notes 94 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Multiframe Conversion MR Export Rules MR Image Conversion DICOM Object (SOP Class) Abbreviation M Convert GSPS for MR Images Separate Series for MR and SC Color V MR Image MR Multiframe Conversion Convert Enhanced MR and related GSPS Separate Series for MR and SC Color V Enhanced MR Image eMR M Exclude BOLD Images i Activate for PACS transfer to avoid problems with mass data Enhanced MR Color eMRC Convert Enhanced MR and related PCSPS Separate Series for MR and SC Color V Separate Series for MR and SC. Color V Grayscale Softcopy Presentation State GSPS / PR M Convert Enhanced MR Color LUT and related GSPS M Convert Enhanced MR Color and related CSPS Secondary Capture SC M Convert Multiframe Color SC M Convert Multiframe Grayscale Word SC and related GSPS Mutliframe Grayscale Word SC MF SC Do not convert Enhanced MR Images for remote syngo.via nodes because of interoperability reasons Multiframe Color SC MF C SC Option Conversion Example Convert GSPS for MR Images MR + PR  MR (with Overlay Bitmap) PR Graphics will be converted to Bitmap (burned in) Convert Enhanced MR and related GSPS eMR + PR  MR incl. Overlay (b/w graphics) Example: “normal” acquisition output, Inline VF, MR + SC (color graphics) Segmentations Convert Enhanced MR Color LUT and related GSPS eMR + PR  MR + SC Example: Perfusion MAPs, T2 MAPs Convert Enhanced MR Color and related GSPS eMRC  SC Example: Diffusion Color FA MAPs Convert Multiframe Color SC MF C SC  SC Example: currently not used Convert Multiframe Grayscale Word SC MF SC  SC Example: Evaluations, graphs, tables, … 20 Unrestricted © Siemens Healthineers, 2023 Notes 95 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Multiframe Conversion MR Export Rules MR Image Conversion DICOM Object (SOP Class) Abbreviation M Convert GSPS for MR Images Separate Series for MR and SC Color V MR Image MR Multiframe Conversion M Convert Enhanced MR and related GSPS Separate Series for MR and SC Color V Enhanced MR Image eMR M Exclude BOLD Images i Activate for PACS transfe to avoid problems with mass data Enhanced MR Color eMRC Convert Ennanced MR and related PCS Separate Series for MR and SC Color V M Convert Enhanced MR Color LUT and related GSPS wat Series for MR and SC Color v Grayscale Softcopy Presentation State GSPS / PR M Convert Enhanced MR Color and related CSPS Secondary Capture SC M Convert Multiframe Color SC Convert Multiframe Grayscale Word SC and related GSPS Mutliframe Grayscale Word SC MF SC i Do not convert Enhanced MR Images for remote syngo.via nodes Multiframe Color SC MF C SC Option Exclude BOLD Images: Conversion Example Convert GSPS for MR Images with BOLD after a conversion from multi‐ to single‐frame, a large amount MR + PR  MR (with Overlay Bitmap) PR Graphics will be converted to Bitmap (burned in) instances can result (>10000), whereas some PACS may refuse to accept the Convert Enhanced MR and related GSPS eMR + PR  MR incl. Overlay (b/w graphics) Example: “normal” acquisition output, Inline VF, data. Therefore, we can exclude BOLD data from a multi‐frame to a single‐ MR + SC (color graphics) Segmentations frame conversion. Convert Enhanced MR Color LUT and related GSPS eMR + PR  MR + SC Example: Perfusion MAPs, T2 MAPs Convert Enhanced MR Color and related GSPS eMRC  SC Example: Diffusion Color FA MAPs Convert Multiframe Color SC MF C SC  SC Example: currently not used Convert Multiframe Grayscale Word SC MF SC  SC Example: Evaluations, graphs, tables, … 21 Unrestricted © Siemens Healthineers, 2023 Notes 96 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Grayscale Softcopy Presentation State (GSPS) Enhanced MR + GSPS Classic MR (incl. Overlay Graphic) SiemensTest, DTI 2017.05.18-10:53:37-DST-1.3.12.2.1107.5.99.3 "1/1/1947. F. 70Y CURRENT 5/18/2017 11_mprage_sag_p? ists 51 cm Latest Multiframe Conversion 10:54:40 AM 1001001 IMA 97 Convert Enhanced MR and related GSPS Separate Series for MR and SC Color Y Interoperability Mode Exclude BOLD Images Activate for PACS transfer to avoid problems with mass data EM Convert Enhanced MR Color LUT and related GSPS Sepatale Senes for MR and SC Color Store SC Color Images only Display [Grayscale Path] Enhanced MR + GSPS Enhanced MR + GSPS Classic MR + Secondary Capture (RGB) Interoperability Mode cm IF Display SPF217.4 FoV 305-380' [Color Path*] 105p.224 Tra Zoom 0.96 Zoom 0.67 Bt corrected TI map NORMDIS2D/GSPS/MF SPLIT Enhanced MR + GSPS 81 corrected T1 ma Color specifications part of Presentation State or Supplemental Palette Color LUTs are included in Image Instance. 22 22 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 97 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Multiframe Conversion Result Structure Convert Enhanced MR and related PCSPS Separate Series for MR and SC Color V Original eMR Series Interoperability Mode – Interoperability Mode – M Convert Enhanced MR Color LUT and related GSPS All Images in one Series Number no separate Series separate Series M Convert Enhanced MR Color and related CSPS Separate Series for MR and SC Color Store SC Color Images only M Convert Multiframe Color SC Separate Series for MR and SC Color V 1 1001 / 1 1001 / 1 M Convert Multiframe Grayscale Word SC and related GSPS i Do not convert Enhanced MR Images for remote syngo.via nodes because of interoperability reasons 2 2001 / 2 2001 / 2 Multiframe Conversion Result Structure 3 3001 / 3 3001 / 3 M Preserve original Series Number for each converted Multiframe Image Separate Series for each converted Diffusion Multiframe Image Don't activate. This might result in a 4001 / 4 Separate Series for each converted DTI Multiframe Image i high amount of series 4001 / 4 4002 / 4 Separate Series for each converted Perfusion Multiframe Image 4 (4 Multi‐frames) Don't activate. This might result in a 4003 / 4 high amount of series Separate Series for each converted GRASP Multiframe Image i This might result in a high amount of 4004 / 4 series Separate Series for each converted TWIST Multiframe Image This might result in a high amount of 5 (2 Multi‐frames) 5001 / 5 5001 / 5 series Separate Series for each converted Multiframe Image (all other) 5002 / 5 6 (1 Multi‐frame with 6001 / 6 (MR Images) 6001 / 6 (MR Images + Color PR graphics) 6001 / 6 (SC Snapshot) SC Snapshot) Additional interoperability modes in Admin Portal: separate Separate Series for MR and All images in one Series series options for Perfusion, TWIST and GRASP since XA31. SC Color 23 Unrestricted © Siemens Healthineers, 2023 Notes 98 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Conversion Settings Enhanced Mode Interoperability Mode MR Export Rules MR Image Conversion MR Export Rules- MR Image Conversion Convert GSPS for MR Images Separate Series for MR and SC Color V M Convert GSPS for MR Images Separate Series for MR and SC. Color V Multiframe Conversion Multiframe Conversion Convert Enhanced MR and related GSPS Separate Series for MR and SC Color V M Convert Enhanced MR and related GSPS Separate Series for MR and SC Color V Exclude BOLD Images Activate for PACS transfer to avoid problems with mass data M Exclude BOLD Images Activate for PACS transfer to avoid problems with mass data Convert Enhanced MR and related PCSPS Separate Series for MR and SC Color Convert Enhanced MR and related PCSPS Separate Series for MR and SC Color Convert Enhanced MR Color LUT and related GSPS Separate Series for MR and SC Color V M Convert Enhanced MR Color LUT and related GSPS Separate Series for MR and SC Color Convert Enhanced MR Color and related CSPS M Convert Enhanced MR Color and related CSPS Convert Multiframe Color SC M Convert Multiframe Color SC Convert Multiframe Grayscale Word SC and related GSPS M Convert Multiframe Grayscale Word SC and related GSPS i Do not convert Enhanced MR Images for remote syngo.via nodes because of interoperability reasons i Do not convert Enhanced MR Images for remote syngo.via nodes because of interoperability reasons Multiframe Conversion Result Structure Multiframe Conversion Result Structure Preserve original Series Number for each converted Multiframe Image M Preserve original Series Number for each converted Multiframe Image Separate Series for each converted Diffusion Multiframe Image Separate Series for each converted Diffusion Multiframe Image Separate Series for each converted DTI Multiframe Image i Don't activate. This might result in a high amount of series Separate Series for each converted DTI Multiframe Image i Don't activate. This might result in a high amount of series Separate Series for each converted Perfusion Multiframe Image i Don't activate. This might result in a high amount of series Separate Series for each converted Perfusion Multiframe Image 1 Don't activate. This might result in a high amount of series Separate Series for each converted GRASP Multiframe Image 1 This might result in a high amount of series Separate Series for each converted GRASP Multiframe Image i This might result in a high amount of Separate Series for each converted TWIST Multiframe Image This might result in a high amount of series Separate Series for each converted TWIST Multiframe Image i This might result in a high amount of series Separate Series for each converted Multiframe Image (all other) Separate Series for each converted Multiframe Image (all other) 24 Unrestricted © Siemens Healthineers, 2023 Notes 99 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Testing X Test data of all SOP classes on systems is used for Import interoperability testing on site (PACS, Workstations, K:\DICOMTestImages Burning robot, …) > MED_SYSTEM (C:) Name Size Date Y MED_SYSTEM (K:) Abdomen CustomerSeq AbdomenMAP Representatives from customer site must be CustomerSeqParamCardConfig Cardiac available to make a first decision. Since DicomExport DICOMTestimages GSP configurations may be needed for the other Abdomen Spectroscopy > AbdomenMAP systems. Cardiac DTI GSP Spectroscopy Expect adjustments of the settings during the first ScreenCapture few weeks ! Import Cancel Results (6 results, 4:35:57 PM) Patient Name Patient ID Date of Birth Study Date a ... Study Descripti ... Accession Nu ... Study Archived Correct + SiemensTest, AbdomenMaps 123456-SMR -... 7/2/1973 5/18/2017 3: ... whole body o ... SiemensTest, Spectroscopy 3333-SMR-77 ... 4/24/1971 5/18/2017 1: ... breast Breast ... SiemensTest, DTI 2017.05.18-1 ... 1/1/1947 5/18/2017 10 ... Head clinical I ... SiemensTest, Abdomen 2017.05.18-0 ... 1/1/1967 5/18/2017 9: ... Abdomen Ab ... SiemensTest, GSP-Graphic 2017.03.06-1 ... 3/6/1973 3/6/2017 12: ... head clinical li ... SiemensTest, Cine_CS_bh SP 6/8/1957 3/3/2017 11: ... heart Cardiac ... 25 Unrestricted © Siemens Healthineers, 2023 Notes 100 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Interoperability Mode SIEMENS Healthineers ... Improved Graphics Handling Before XA51 Free.Max_20210305_12, Volunteer 1348 Free.Max_20210305_12, Volunteer59 Free.Max_20210305_12, Volunteer59 SA8001042 SA8001042 SAS001042 "1/1/1962, M. 59Y HFS "1/1/1962, M. 59Y "1/1/1962, M, 59Y • No Reference Line was possible on PACS on Spine CURRENT CURRENT 3/5/2021 CURRENT 3/5/2021 STUDY 3/5/2021 AAVerif confirm plus tra yes_dtt AAVerif confirm plus tra yes_#1 AAWerif confirm plus tra yes latoot latoot latest Labels # 0498A10000002276 #0499A10000002276 # 049SA10000002276 STUDY ID 1835 3/5/2021 12:16:18 PM 12:16:18 PM 12:16:18 PM 5000 IMA 1 • Modality images and secondary capture color A 22.9 images have no graphics and parameters ucm 22.9 SP L1.0 SP P14.3 FoV 146.850 FoV 300*850 With XA51 Sag Cor LOCALIZER/CPR Zoom 0 10 Zoom 1.35 Zoom 1.35 W 632 LOCALIZER/CPR* W 632 292 292 youthetic CPR im • Modality images & secondary capture Color Images inthete CPR image CPR/GSPS/MFSPLIT includes graphics Free.Max_20210305_12, Volunteer59 Free.Max_20210305_12, Volunteers Free.Max_20210305_12, Volunteer59 SA8001042 8A9001042 SAS001042 1/1/1962, M. 59Y "1/1/1962, M. 59Y "1/1/1962, M, 59Y 3/5/2021 3/5/2021 3/5/2021 • Modality Images: Graphics (DICOM Overlay AAVerif confirm plus tra yes_dt! AAVerif confirm plus tra yes_#1 AAverif confirm plus tra yes latest latest latest # 0499A10000002276 #049SA10000002276 Graphics) *PUOY ID 18 STUDY ID 1835 12:16:18 PM 3/5/2021 12.16.18 PM 5000 IMA 1 • Note: reduced graphics quality compared to original 22.9 SL 94.5 22.9 presentation state graphics (BITMAP graphics) A Fey.P.P14.3 LIZERICPRIC IZERICPRIX Zoom 1.34 2954 -512 Synthetic CPR CPRIGSPS 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 101 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DICOM Format SIEMENS Healthineers ... Export Data Export to DICOM Node (Network) Open Open with Digam Spoglie Import Export Correct DICOM data format related to Admin. Portal configuration. Export Data Export to File System Patient Series des ... Instances Optical Disc . File System Network MSK - Knee - AERA AAhead Properties to define DICOM Format. Storage space sufficient MSK - Knee - AERA AAhead MSK - Knee - AERA AAhead Destination CA MSK - Knee - AERA T1_Images 1 MSK - Knee - AERA T2_Images Browse 1 MSK - Knee - AERA T2Star_I ... MSK - Knee - AERA T2Star_I ... Properties Compressed MSK - Knee - AERA Create DICOM File System AAKnee Include Image Viewer on Dis MSK - Knee - AERA AAKnee Image Conversion MSK - Knee - AERA AAKnee 1 Enhanced MSK - Knee - AERA Phoenix ... 19 Enhanced MSK - Knee - AERA R2_Images Interoperability 1 MSK - Knee - AERA AAhead MSK - Knee - AERA AAhead MSK - Knee - AERA AAhead MSK - Knee - AERA AAhead MSK - Knee - AERA AAhead 1.20 GB, 96 Instances Clear List Export Close 27 Unrestricted © Siemens Healthineers, 2023 Notes 102 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Filters SIEMENS Healthineers Filters MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 103 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Filters • Parameter Card • Raw Data Filter • Normalize Filter • Distortion Correction • Coil Combination 2 Unrestricted © Siemens Healthineers, 2023 Notes 104 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Recognize the various Filters on the parameter card • Explain the features and applications of the Raw Data Filter • Identify the features and applications for the Normalize Filter • Indicate the features and applications for Distortion Correction • Recall the uses for coil combination 3 Unrestricted © Siemens Healthineers, 2023 Notes 105 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Filter Parameter Card SIEMENS Healthineers ... MR Applications Fundamentals 1 Filter Parameter Card 4 Unrestricted © Siemens Healthineers, 2023 Notes 106 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Filter SIEMENS Healthineers ... Parameter Card Raw Filter is in the upper left corner. 0 2:44 min Auto @ None 0.4x0.4x4.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Distortion Correction is always Common Acceleration Filter activated in NX software (2D or 3D). Raw Filter Normalize Prescan ... Elliptical Filter ... Different Normalize options are Prescan available to correct for signal variations Image Filter Off due to the receive coil profiles. Prescan Image Based B1 Filter Image Filter on protocol level, may be Distortion Correction 2D applied additionally to the implicit 2D image filters selected in the 3D Administration portal. Every filter selection has an interactive options button. 5 Unrestricted © Siemens Healthineers, 2023 Notes 107 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Raw Data Filter SIEMENS Healthineers ... MR Applications Fundamentals 1 Raw Data Filter 6 Unrestricted © Siemens Healthineers, 2023 Notes 108 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Raw Data Filter SIEMENS Healthineers ... Smoothing k‐space to reduce Gibbs (Truncation) artifacts Raw Filter Elliptical Filters every line in both the phase and frequency Only smoothens edges of k‐space. encoding direction. • Can be 2D (in‐plane) or 3D (volume, for 3D sequences) • Different filter strength can be applied • Less reduction of Gibbs but less blurring effects • Stronger effect but more image blurring 7 Unrestricted © Siemens Healthineers, 2023 Notes 109 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Raw Data Filter SIEMENS Healthineers ... Smoothing k‐space to reduce Gibbs (Truncation) artifacts Routine Contrast Resolution Geometry System Physio Inline Sequence Gibbs Ringing (Truncation) artifacts: Common Acceleration Filter Gibbs artifacts occur because of Fourier aw Filter Normalize Prescan ... • transformations Elliptical Filter • In MRI, we are restricted of sampling a finite Image Filter number of frequencies and must therefore approximate the image by using only a relatively few harmonics Distortion Correction 2D ... • Hence, the Fourier series is cut short or truncated with ringing artifacts as a result Solution: to filter the k‐space data with a smoothly decreasing window. 8 Unrestricted © Siemens Healthineers, 2023 Notes 110 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Raw Data Filter SIEMENS Healthineers' ... Smoothing k‐space to reduce Gibbs (Truncation) artifacts Raw Data Filter • Reduced Gibbs ringing artifacts Without Raw Data Filter With Raw Data Filter • But since the high spatial frequencies are smoothed images are more blurry 9 9 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 111 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalization Filter SIEMENS Healthineers ... MR Applications Fundamentals 1 Normalization Filter 10 Unrestricted © Siemens Healthineers, 2023 Notes 112 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... To correct for B1‐receive field variations Correction of signal variation due to varying @ 2:44 min 4 Auto @ None @ 0.4x0.4x4.0 mm3 1.00 receive sensitivity: Routine Contrast Resolution Geometry System Physio Inline Sequence Common Acceleration Filter • It‘s not correcting for SNR • It‘s not correcting for contrast variation! Raw Filter Normalize Prescan Elliptical Filter M ... Different approaches to derive filter for the Image Filter Prescan coil profiles: Off • Prescan Prescan • Image Based Image Based Distortion Correction 2D ... B1 Filter • B1 Filter 11 Unrestricted © Siemens Healthineers, 2023 Notes 113 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... To correct for B1‐receive field variations Background High density coils with small receive elements show a strong spatial variation in the receive profile. The resolution of the PSN map needs to be adapted to the variation steepness. Theoretical Coil Profile of a Single Coil Element 1 0.8 0.6 0.4 Signal (relative) 0.2 0 0 5 10 15 20 Distance 12 Unrestricted © Siemens Healthineers, 2023 Notes 114 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... To correct for B1‐receive field variations Normalization and Signal‐to‐Noise Ratio (SNR) Surface coils have a very high sensitivity, so it has higher Signal‐to‐Noise Ratio (SNR) close to the coil, and a decreased SNR more distant to Intensity the coil. To homogenize the signal over the Field‐of‐View (FoV), the Signal and the noise are multiplied by a filter function, opposite to the signal function. There is a higher amplification for signal more distant to the coil, so the noise is more amplified. Images become noisier in the center of the FoV. 13 Unrestricted © Siemens Healthineers, 2023 Notes 115 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... To correct for B1‐receive field variations Without Normalization With Normalization 14 14 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 116 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Prescan Normalization (PSN)* Prescan Normalize (PSN)* derives knowledge Ö 2:44 min Auto @ None 0.4x0.4x4.0 mm3 1.00 of the coil sensitivity profile using a Prescan Routine Contrast Resolution Geometry System Physio Inline Sequence performed with the Body and Array coil, Common Acceleration Filter assuming the body coil profile is homogenous. Raw Filter Normalize Prescan Elliptical Filter ... Prescan Y It calculates a filter function for the array coil Off profile by comparing both images with each Filter Prescan Normalize Prescan Image Based other. Mode Normal B1 Filter Moderate Normal Broad Range This is the preferred Normalization technique Unfiltered Images in most applications. Close *The PSN mode is automatically triggered depending on the selected coil. 15 Unrestricted © Siemens Healthineers, 2023 Notes 117 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Prescan Normalization (PSN) Normal uses a signal Unfiltered Normal Broad Range Moderate threshold used to avoid noise enhancement in 22181 regions far from the coils. Broad Range the threshold RAN is decreased, so a wider range of the object is TP OI SP H7.9| normalized (e.g., L‐spine in 5. 3009 00 128 00 128 FOX 230-220 0.0 128 HC1-7;NC1.2 T Tra-Con(-6.3)>Sag(0.2) 3T Kurs"Resolution/1 9710411/14.10.06-10:06:30 HC1-7;NC1.2 adrion Line 1 Tra obese patients). 198281_17 /80 HC1-7:NC1 2 Bition Line 1 1se201_17 /80 3T Kurs"Resolution/19710411/14.10.06-10:06:30. W 1220 18:291_17/80 3T Kurs"Resolution/1 9710411/14.10.06-10:06:30. 3T Murs Resolution/19710 1114 10 06-10 06.30. ....... Moderate is progressively ........ Signal weakened, so the optical impression can be less max noisy (e.g., body max ....................... applications). Correction 16 16 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 118 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Prescan Normalization (PSN)* Prescan Resolution Acquisition Time Acquisition Time Better image homogeneity  the PSN Matrix Size resolution should scale with the sensitivity (Standard/Quiet) Quiet Variant profile of the receive coils. Standard 32x32x64 4.3 s / 6.2 s 6.2 s Coils with smaller receive elements would benefit from a higher PSN resolution, as their Medium 64x64x64 sensitivity profile covers a smaller spatial region. Resolution (with iPAT) 5.7 s / 8.4 s 8.4 s PSN mode is automatically triggered depending 15.2 s on the selected coil: High 9.8 s /15.2 s 96x96x96 (with iPAT) (w/o iPAT = 31 s, (w/o iPAT = 49 s, Examples: Resolution Breast 18ch, Head 32, Head/Neck 64 Coils: e.g., VE line) e.g., VE line) • Matrix size 64x64x64 *The PSN mode is automatically triggered depending on the selected coil. • Endorectal/Prostate Coils: Matrix size 96x96x96 17 Unrestricted © Siemens Healthineers, 2023 Notes 119 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Prescan Normalization (PSN) Previous implementation Implementation in NX (32x32x64) (64x64x64) 18 18 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 120 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Image Based Image Based Normalization algorithm Algorithm Condition when to be applied extracts the coil sensitivity profile from images without an additional Prescan. It is a Head Only the head coil is selected. self homogenization algorithm. At least spine matrix coil and body matrix coil are selected. There are three (3) different modes available Abdominal Optional: Additional endorectal coil can be that are automatically selected depending on selected. the body region. Restriction: No additional coils are allowed. • Head and body surface coil uses prior The following filter intensities can be chosen: knowledge about the coil sensitivities • Weak (Cut off=20; Width=3) • If other coils are used, a low pass filter is Standard • Medium (Cut off=20; Width=4) applied • Strong (Cut off=20; Width=5) • Free (Cut off=1…99; Width=2…16) 19 Unrestricted © Siemens Healthineers, 2023 Notes 121 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... B1 Filter Image Based Normalization algorithm Filter Bias B1 filter is a homomorphous (homomorphism = structure‐preserving map Intensity Medium between algebraic structures) filter. • The B1 filter works like Image based Prescan Normalize Medium normalization with a low pass filter, but Weak Unfiltered Images Medium with a more sophisticated filter algorithm Strong • The Prescan and Image based normalization filters only work slice by slice (2D), and the B1 filter takes signals from neighboring slices into account (3D) • Can be combined with Prescan Normalize Close in NX software 20 Unrestricted © Siemens Healthineers, 2023 Notes 122 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Prescan versus Image Based versus B1 filter – Head example Flip Angle variations in the head are small compared to prismo-head, CSTC "28/04/1962, M. 54Y 12 STUDY 1 28/04/2016 variations found in the body. However, the homogeneity 1249:03 29 MA 16 / 27 requirements are higher. B1 shading is typically composed of both transmit (B1+) and receive shading (B1‐). MF 1.00 Flip Angle map TR 600.0 TE60 TA 01:20-2 BY 250.0 Pre‐scan normalize Unlike the Image Based or B1 filter, Prescan Normalize MADNORMEM3 does not normalize the flip angle (transmit) related prisma-head, CSTC prisma-head, CSTC .28/04/1962, M. 54Y 12 28/04/1962, M, 54Y signal variations. STUDY 1 STUDY 1 28/04/2016 28/04/2016 12:58:37 1249:03 32 MA 16 / 27 35 MMA 16 / 27 Prescan and Image based normalization are applied slice by slice (2D filter). Neighboring slices might be normalized slightly differently. TR 600.0 TR 600.0 TE 60 (head) normalize B1 filter (w/o PSN) The B1 filter works similar like the low pass filter with a TA 01: 20'2 TA 01:20-2 BW 250.0 MIND/NORMENO_2FL BW 250.0 MANDINORMFM3_2FL ALAFP A1FFP more sophisticated filter algorithm. HE1-4 "se201 /90 HE1-4 21 21 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 123 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter – Special options SIEMENS Healthineers ... Left/Right Balancing for brain imaging (correction for PSN) Goal is to improve PSN by correcting for the Above Below Receive profile left/right asymmetry of the body coil‘s receive Ernst angle Ernst angle profile (B1‐). 1.2 ABAB 1.1 Approach • Correct the BC receive profile 𝑅𝑅𝑅𝑅 BC making it symmetric along the left‐right direction B1+  A B 0.9 0.8 • Calculate the BC receive profile B1‐ from the BC . transmit B1+ map using the principle of Excited reciprocity (receive profile = mirrored transmit signal  Transmit B1+ map profile). Note: 𝑅𝑅𝑅𝑅 BC can’t be measured directly. B1‐  pTX system is required to measure single‐channel 2 • B1 maps 1.1 Only suited for measurements where signal PSN     1 • decreases with increasing flip angle ( e.g., 0.9 FLASH above Ernst angle, partly T2 TSE, IR TSE) PSN+L‐R A B 0.8 ........................ balance     22 22 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 124 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Left/Right Balancing for brain imaging (correction for PSN) Parameter only visible if: 0 1:25 min | Auto @ None 0.7x0.7x4.0 mm3 1.00 • pTX system used Routine Contrast Resolution Geometry System Physio Inline Sequence • Head Coil is installed Miscellaneous Adjustments Adjust Volume PTx Tx/Rx • GRE or TSE sequence used B1 Shim TrueForm pTx Volume Excitation Slice-sel. Preconditions for Auto‐mode: • Patient Position: Supine • Head Coil selected (no TX/RX) • Prescan Normalize applied Slice Orientation tilted not more than LR Balancing Auto • Off 25° in Sagittal orientation Auto • GRE Sequence: Flip Angle sufficiently Patient-specific intensity correction to optimize the signal symmetry in the left and right larger than Ernst angle brain hemispheres. The algorithm is based on a B1 map which is automatically measured. If set to 'Auto', the system automatically determines if the correction is suited for the current protocol settings. 23 Unrestricted © Siemens Healthineers, 2023 Notes 125 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Normalize Filter SIEMENS Healthineers ... Left/Right Balancing for brain imaging (correction for PSN) FLASH FLASH TSE TSE PSN PSN with Left/Right Balancing PSN PSN with Left/Right Balancing AHR 24 24 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 126 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers ... MR Applications Fundamentals 1 Image Filter 25 Unrestricted © Siemens Healthineers, 2023 Notes 127 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers ... Image Filter is used to postprocess blurred or Routine Contrast Resolution Geometry System Physio Inline Sequence noisy images. Common Acceleration Filter • Adaptive filters search for conspicuous Raw Filter Normalize Image B ... ... structures in the image Elliptical Filter M ... • Subsequently, the filter checks if these are Image Filter V ... either random or part of other structures • Filters consider the local distribution of signal intensity and the course of local Distortion Correction 2D ... tissue structures 26 Unrestricted © Siemens Healthineers, 2023 Notes 128 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers ... There are three (3) different intensity values Image Filter Settings X for the Image Filter. • Sharp: this filter has the weakest effect Intensity Medium • Medium: this filter has a medium effect Edge Enhancement 34 • Smooth: this filter is the strongest Medium Smoothing Sharp Unfiltered Images Each of these filters can be modified. Medium Smooth They are refined by two (2) additional parameters. • Edge Enhancement • Smoothing Close 27 Unrestricted © Siemens Healthineers, 2023 Notes 129 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers .. Refining the filter options: Image Filter Settings ? X Edge Enhancement controls the edge ntensity Medium enhancement. Edge Enhancement 3 (i.e., borders or regions with very different signal Smoothing intensities). Unfiltered Images The corresponding Intensity can be modified: • Less enhancement (1,2) • No change (3) • Stronger enhancement (4,5) Smoothing controls the noise reduction. Close The corresponding Intensity can be modified: • Less smoothing (1,2) • No change (3) • Stronger smoothing (4,5) 28 Unrestricted © Siemens Healthineers, 2023 Notes 130 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers ... Where to activate the Image Filter The Image filter can be selected and Job Viev set in different instances: Short Term Storage Maintenance MeasUid Protocol Name Patient Name . Progress Raidnie Status Action Data Publisher MR Reconstructions t2_qtse_dark-fluid_tra YYY 1. Inline within the protocol in the Media Network Edit Protocol for Retrospective Reconstruction Routine Contrast Resolution Geometry System Physio Inline Sequence Print Common Acceleration Filter Parameters Filter tab. Workflows Raw Filter Normalize Image B ... Elliptical Filter 2. Offline in MR View&GO using: HEADER nage Filter V [en] AMBAS • Favorite Tools (intensities only, ImageFilter Properties Distortion Correction 20-m without further refinement) Smooth • Right bottom corner menu Edge Enhancement Parameter Name 3. Inline using Retrospective Smoothin cm reconstruction via the Job View Medium 5 5 5 5 3 3 3 3 (need raw data on MaRS) Edge Enhancement Powermeter changes are not checked for consistency hence preparation of recorstruction evert might occur. i need to be checked carefully Smoothing If an image filter has already been Sharp Position Display Single IR Calculation Correction Tools + × applied (inline or offline), no further Edge Enhancement ImageFilter Smooth Smoothing Subtracti ... Addition Multiplic ... Division Arithmetic Motion ADC & b- 2D Mean ImageFil .. ImageFilter Smooth Correction value Distorti ... Smooth image filters can be applied! ImageFilter Medium Postprocessing ImageFilter Smooth OK Cancel ImageFilter Sharp ImageFilter Medium MR Color LUT show in ImageFilter Sharp Reset Windowing 29 Unrestricted © Siemens Healthineers, 2023 Notes 131 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers ... Examples of different filter and settings These images show the effect MEDIUM using with different filter Enhancement 3 Smoothing 3 intensities and filter settings. ORIGINAL Example: pineapple without/with Example pineapple with filter intensities different filter intensities Medium and different Edge Enhancement and Smoothing settings 30 30 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 132 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Image Filter SIEMENS Healthineers' ... Image Labels The image labels informs if an Image Filter ARH was/wasn't applied. Brain MR MAGNETOM Skyra "1/1/1980, M, 40Y MAGNETOM Skyra syngo MR XA30 CURRENT HFS 7/31/2020 +LPH Filter Intensity types: Results Filter_t2_qtse_dark-fluid_tra latest • FSH = Sharp, STUDY ID 82db7bb5-f3df-43 9:40:56 AM • FSM = Smooth 1011 IMA 1 FRM 10/27 • FM = Medium The numbers show the Edge Enhancement and Smoothing strengths (No numbers: default 3_3). RPF 1cm FM3_3 means: 2D SL 4.0 • Filter Intensity = Medium SPC 5.2 F • Edge Enhancement = 3 TI 2500.0 TR 9000.0 TE 84.0 TP O SP F38.2 • Smoothing = 3 BW 284.0 FoV 213 220 MAGNINAVAIL/FIL/NORM/DIS20/FM3_3 217*320s Tra>Cor(-2)>Sag(-1) Zoom 3.43 HE 1-4 qtir2d1 17 /150 W 759 C 379 Not for diagnostic use 31 31 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 133 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Distortion Correction SIEMENS Healthineers ... MR Applications Fundamentals 1 Distortion Correction 32 Unrestricted © Siemens Healthineers, 2023 Notes 134 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Distortion Correction SIEMENS Healthineers ... Geometrical Distortions due to Gradients non‐linearity MR images have geometrical distortions, especially images with a large FoV and images acquired far away from the Demo_Pelvis_Male Belgium_MAC isocenter. OID 55040540167 71/1/1955, M. 64Y CURRENT 6/12/2019 These geometric distortions, like compression and curvature, occur at the edges of images. 2D and the 3D #XA11B Sola STUDY ID 1a33088 11:22:00 AM distortion correction can correct these geometrical 1001 IMA 1 FRM 1/15 distortions. Note: If the geometrical distortion is too strong, the Distortion Correction may have problems correcting. In some cases, after the correction, the images may still have geometrical distortions. TR 3020 0 TE 108.0 TA 01:00*2 BVV 123.0 p2 MAGN/NAVAIL/RESAMP/NORM/F M2_3/FIL/ND A2/PFP C24;C24 *tseR2d1 43 / 142 33 33 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 135 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Distortion Correction SIEMENS Healthineers ... Geometrical Distortions due to Gradients non‐linearity Non‐linearities of the gradient fields are stored on the P system, individual setting for each gradient system (i.e., XJ, XQ, etc.)! offcenter scanned • 2D (DIS2D) and 3D (DIS3D) distortion correction slices could show • DIS3D needs at least 3 parallel slices, no conversion distortion artefacts Iso (Gradient Non-Linearity back to ND Inhomogeneities) Since software version syngo MR XA10A patient table • DIS2D/3D is always applied, allows mixing of magnet bore isocentered slices images from different table positions and planning nearly show no distortions of slices independent to the table position (i.e., except Spectroscopy) DIS2D DIS3D 34 Unrestricted © Siemens Healthineers, 2023 Notes 136 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Distortion Correction SIEMENS Healthineers ... Geometrical Distortions due to Gradients non‐linearity In‐plane Distortion Correction Through‐plane Distortion Correction Original 2D Distortion 3D Distortion Image Correction Correction 35 35 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 137 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Combination SIEMENS Healthineers ... MR Applications Fundamentals 1 Coil Combination 36 Unrestricted © Siemens Healthineers, 2023 Notes 138 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Combination SIEMENS Healthineers ... Multiple receive coil elements MRI typically uses coil arrays 2:44 min & Auto @ None 0.4x0.4x4.0 mm3 1.00 (i.e., coils consist of multiple coil elements). Routine Contras Resolution Geometry System Physio Inline Sequence Miscellaneous Adjustments Adjust Volume Tx/ RX To generate a final MR image, all information Coil Selection Auto Coil Select Coil Combination Adaptive Combine from the multiple coil elements must be Sum of Squares Adaptive Combine combined. There are two (2) ways to MSMA S -C-T combine coils: Sagittal R>> L Matrix Optimization Off • Sum of Squares  combination of Coronal A >> P reconstructed Images of each individual Transversal F >> H Coil Focus Flat coil element into one combined MR image • Adaptive Combine,  combines k‐space of all coil elements into one combined Virtual Coils k‐space. 37 Unrestricted © Siemens Healthineers, 2023 Notes 139 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Combination SIEMENS Healthineers ... Sum of Squares versus Adaptive Combine Combined image Combined k‐space Head/Neck‐64‐coil with 64 elements. Head/Neck‐64‐coil with 64 elements. Each coil element measures an independent image Each coil element measures an independent k‐space 38 38 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 140 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Combination SIEMENS Healthineers ... Sum of Squares vs. Adaptive Combine Sum of Squares (SoS) works in Image domain. Adaptive Coil Combine (AAC) works in frequency domain. • It is the most robust coil combination with no known artifacts • More optimal in areas with low SNR compared to SoS • Phase information gets lost, so it is not suitable for • Phase is preserved phase reconstructions like flow measurements • Missing absolute reference for the phase, which can • Not as robust in areas with low SNR compared to result in phase singularities (worm artifacts) Adaptive Coil Combine (AAC) Improved by new algorithm since syngo MR E11. 39 39 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 141 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Combination SIEMENS Healthineers ... Coil Focus Limitation of Coil Elements 3:37 min 1 Auto @ None 0.4x0.4x5.0 mm3 ? 1.00 Special option for some coils (e.g., Body 18, Routine Contrast Resolution Geometry System Physio Inline Sequence Spine 32). Miscellaneous Adjustments Adjust Volume Tx/RX Coil Selection Auto Coil Select ... Coil Combination Adaptive Combine Flat: All coil elements are used. MSMA S-C - T Sagittal R>>L Matrix Optimization O Center: Coronal A>> P Ignores the most outer coil elements of each Transversal F>> H Coil Focus Flat segment (e.g., B18  only the 4 inner Flat elements are used). Center • It helps to use smaller FOVs in Left‐Right Virtual Coils direction • Center is used by AutoAlign Spine to avoid aliasing artifacts 40 Unrestricted © Siemens Healthineers, 2023 Notes 142 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coil Combination SIEMENS Healthineers ... Coil Focus Example Flat Center ..... ..... ........ ....... ....... ......... ............................... 41 41 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 143 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain & GOBrain+ SIEMENS Healthineers GOBrain & GOBrain+ MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 144 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... GOBrain & GOBrain+ • GOBrain • GOBrain+ 2 Unrestricted © Siemens Healthineers, 2023 Notes 145 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Review the features and benefits for GOBrain • Review the features and benefits for GOBrain+ 3 Unrestricted © Siemens Healthineers, 2023 Notes 146 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents. GOBrain – 5 Minute Protocol: achieved on a MAGNETOM Skyra with the Head 32 coil. Total examination time can take up to 6 minutes depending on system field strength and coil density. 4 Unrestricted © Siemens Healthineers, 2023 Notes 147 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Overview SIEMENS Healthineers ... MR Applications Fundamentals 1 GOBrain & GOBrain+ Overview 5 Unrestricted © Siemens Healthineers, 2023 Notes 148 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain & GOBrain+ SIEMENS Healthineers ... Fast, push‐button Diagnostic Brain Examinations Clinically validated brain exams with multiple orientations and all relevant contrasts. Reduce the need for sedation and rescans. $ Improve patient throughput and reduce costs per scan. 6 6 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 149 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain & GOBrain+ SIEMENS Healthineers' ... Push‐button quality imaging AutoAlign Head LS ensures consistency in imaging and Routine Contrast esolution eometry System Physio Inline Sequence reduces possible errors in planning. lice Group 1 + - FOV Read 230 ¢ mm Slices 22 ¢ FoV Phase 89.5 ¢ 9 Slice Thickness 5.0 mm Standard Localizer Distance Factor 30 % 7000.0 - ms Position R2.2 A38.3 F10.8 TE 93.00 ms Orientation T > C14.3 > S-0.7 Averages W Phase Encoding Dir. R >> L Concatenations 2 Phase Oversampling 0 % AutoAlign Head > Brain Guidance Parameters AutoAlign Head LS Slices are aligned by AutoAlign at the level of the corpus callosum and along a line through the genu (anterior) and the splenium (posterior). Note that if you change slice positions manually, it might be impossible to reproduce these exact slice positions for subsequent protocols and follow-up examinations. 7 7 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 150 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain & GOBrain+ SIEMENS Healthineers ... Tim 4G RF architecture & ultra‐high‐density coils MAGNETOM Skyra 3.OT XQ >> SIEMENS >> head > GOBrain > GOBrain 00:14 GOBrain GOBrain+ Vida-XQ_2Tx_64Rx_MNO AAhead_scout AutoAlign Scout t1_f12d_sag_p2_256 00:41 HN64: 04:36 HN64: 09:51 SIEMENS t2_tse_tra_p3_256 01:02 HN32: 04:59 HN32: 10:14 t2_tse_dark-fluid_tra_p2_256 01:52 HN20: 05:11 HN20: 11:30 head Brain Assist ep2d_diff_mddw_12_p2 01:07 HN16: 05:27 HN16: 11:46 clinical libraries advanced applications libraries ep2d_tra_hemo 00:06 GOBrain E GOBrain El GOBrain_HN64 MAGNETOM Aera El GOBrain GOBrain GOBrain+ El GOBrain+_HN64 HN20: 05:56 HN20: 13:48 With an efficient acquisition of the core exam, HN16: 06:05 HN16: 13:57 additional scans can be acquired more easily within the patient imaging slot (e.g., ASL, SWI, TOF) 8 Unrestricted © Siemens Healthineers, 2023 Notes 151 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain SIEMENS Healthineers ... MR Applications Fundamentals 1 GOBrain 9 Unrestricted © Siemens Healthineers, 2023 Notes 152 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain SIEMENS Healthineers ... A new, faster standard in brain examinations GOBrain1 push‐button brain exam in 5 minutes2 Sag T1 Ax T2 Ax DarkFluid Ax T2* Hemo AutoAlign Localizer Ax DWI 14s 41s 62s 96s 80s 6s 4:59 Images courtesy of Massachusetts General Hospital and Athinoula A. Martinos Center for Biomedical Imaging. Images acquired on MAGNETOM Skyra with Head 32. 1 Prakkamakul et al. Ultrafast brain MRI: Clinical deployment and comparison to conventional brain MRI at 3T. J Neuroimaging 2016. 10 10 2 Achieved on a MAGNETOM Skyra with Head 32 coil. Total exam times will vary with system field strength and coil density with up to 6 minutes on a MAGNETOM Aera. Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 153 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain SIEMENS Healthineers ... Clinically validated Clinically validated by Massachusetts Ultrafast Brain MRI: Clinical Deployment and Comparison General Hospital for several clinical to Conventional Brain MRI at 3T conditions Supada Prakkamakul *, Thomas Witzel *, Susie Huang, Daniel Boulter, Maria J. Borja, Pamela Schaefer, Bruce Rosen, Documented to assist in the diagnosis of Keith Heberlein, Eva Ratai, Gilberto Gonzalez, Otto Rapalino From the Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA (SP, SH, PS, ER, GG, OR); Department of Radiology, Athinoula multiple clinical conditions including¹: A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA (TW, SH, BR, ER, GG); Neuroradiology Division, Department of Radiology, Ohio State University, Columbus, OH (DB); Neuroradiology Division, Department of Radiology, New York University School of Medicine, New York, NY (MJB); Siemens Medical Solutions USA, Charlestown, MA (KH); and Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand (SP). • Stroke • Hemorrhage ABSTRACT • Neoplasm BACKGROUND AND PURPOSE: To compare an ultrafast brain magnetic resonance imaging (MRI) protocol to the conventional • Infection protocol in motion-prone inpatient clinical settings. METHODS: This retrospective study was HIPAA compliant and approved by the Institutional Review Board with waived inform • Demyelination consent. Fifty-nine inpatients (30 males, 29 females; mean age 55.1, range 23-93 years) who underwent 3-Tesla brain MRI using ultrafast and conventional protocols, both including five sequences, were included in the study. The total scan time • Post‐operative findings for five ultrafast sequences was 4 minutes 59 seconds. The ideal conventional acquisition time was 10 minutes 32 seconds but the actual acquisition took 15-20 minutes. The average scan times for ultrafast localizers, T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted, T2 *- weighted sequences were 14, 41, 62, 96, 80, 6 seconds, respectively. Two blinded neuroradiologists independently assessed three aspects: (1) image quality, (2) gray-white matter (GM-WM) differentiation, and (3) diagnostic concordance for the detection of six clinically relevant imaging findings. Wilcoxon signed-rank test was used to compare image quality and GM-WM scores. Interobserver reproducibility was calculated. RESULTS: The ultrafast T1-weighted sequence demonstrated significantly better image quality (P = . 005) and GM-WM differ- entiation (P < .001) compared to the conventional sequence. There was high agreement (> 85%) between both protocols for the detection of mass-like lesion, hemorrhage, diffusion restriction, WM FLAIR hyperintensities, subarachnoid FLAIR hyperintensities, and hydrocephalus. CONCLUSIONS: The ultrafast protocol achieved at least comparable image quality and high diagnostic concordance compared to the conventional protocol. This fast protocol can be a viable option to replace the conventional protocol in motion-prone inpatient clinical settings. 11 1 Prakkamakul et al. Ultrafast brain MRI: Clinical deployment and comparison to conventional brain MRI at 3T. J Neuroimaging 2016. Unrestricted © Siemens Healthineers, 2023 Notes 154 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain SIEMENS Healthineers ... Contrast injection may be clinically indicated for several neurological diseases. Tumors, Inflammatory, Neoplastic Demyelinating Infections Vascular diseases diseases pathologies 12 12 Images courtesy of Massachusetts General Hospital and Athinoula A. Martinos Center for Biomedical imaging. Images acquired on MAGNETOM Skyra with Head 32. Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 155 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain+ SIEMENS Healthineers ... MR Applications Fundamentals 1 GOBrain+ 13 Unrestricted © Siemens Healthineers, 2023 Notes 156 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOBrain+ SIEMENS Healthineers ... Push‐button diagnostic brain exam including post‐contrast AutoAlign 15s Sag T1 1:12 min Ax DarkFluid 1:28 min Ax T2* 1:42 min Ax T1 1:10 min Contrast 0:25 min Ax DWI & ADC 1:10 min Ax T2 0:48 min Ax T1 1:10 min T1 MPRAGE 3:55 min GOBrain+: 13:15 min 14 14 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 157 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Advanced Neuro Sequences SIEMENS Healthineers MR Advanced Neuro Sequences MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 158 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... MR Advanced Neuro Sequences • SPACE • MPRAGE • Susceptibility Weighted Imaging (SWI) • PETRA • Turbo Gradient Spin Echo (TGSE) • StarVIBE 2 Unrestricted © Siemens Healthineers, 2023 Notes 159 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Recall the features and applications for SPACE • Recall the features and applications for MPRAGE • Recall the features and applications for Susceptibility Weighted Imaging (SWI) • Recall the features and applications for PETRA • Recall the features and applications for TGSE • Recall the features and applications for StarVIBE 3 Unrestricted © Siemens Healthineers, 2023 Notes 160 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... The information presented in this MR Advanced Neuro Sequence presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.” 4 Unrestricted © Siemens Healthineers, 2023 Notes 161 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... MR Applications Fundamentals 1 Sampling Perfection with Application‐optimized Contrast using different flip angle Evolutions (SPACE) 5 Unrestricted © Siemens Healthineers, 2023 Notes 162 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Compressed Sensing (CS) CS implementation for SPACE 3D incoherent under‐sampling (Poisson disc algorithm) Variable Density Poisson • • L1 wavelet regularization in three spatial dimensions Disc Sampling • Non‐linear iterative reconstruction using sensitivity encoding and FISTA • Multi‐GPU implementation for faster reconstruction Protocols for Neuro Applications ky • T1 • T1 Dark‐fluid • T2 • T2 Dark‐fluid • DIR • IAC kz 6 Unrestricted © Siemens Healthineers, 2023 Notes 163 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Compressed Sensing SIEMENS Healthineers ... Balancing Data Consistency vs. Sparsity Importance of an appropriate balancing Appropriate Reconstruction Overemphasis on total between data consistency and Transform Parameters Variation Transform Sparsity: • Left: image result with a correct weighting (λ) • Right: result if sparsity is weighted too strongly (λ too high) Sparsity is higher, noise lower, but a strong compromise in data consistency. (i.e., image is blurry and does not depict the anatomy correctly!) 7 7 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 164 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE Compressed Sensing (CS) SIEMENS Healthineers .. Regularization: Denoising Denoising Mode and Strength Routine Contrast Resolution Geometry System Physio Inline Sequence The CS SPACE parameter is required due to the Common Acceleration Filter large range of supported contrasts and Acceleration mode CS applications of SPACE! ase Partial Fourier Total Factor 4.0 Balancing Consistency versus Sparsity (≥XA31) CS Reconstruction Reference Scans Integrat ... • Denoising strength = 1 ‐ 100 Denoising Mode Manual • Regularization = 10‐5 ‐ 10‐1 Reference Lines PE 24 + Denoising Strength 2 The optimal value depends on contrast, Reference Lines 3D 24 + resolution, receive coils, acceleration factor and the preference of the radiologist The number of iterations is fixed (15). Close 8 Unrestricted © Siemens Healthineers, 2023 Notes 165 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Compressed Sensing (CS) – Denoising Manual Mode Automatic Mode Manual Mode Denoising Strength 8 Denoising Strength 25 Denoising Strength 50 Noise and undersampling artifacts Blurry / Patchy images 9 9 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 166 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Compressed Sensing (CS) – Motion Sensitivity Acceleration NoGRAPPA p2 CS acc 5 5e-4 20180629_25_vidaXT 25 _vidaxl 2018.06.29-13:06:06-DST-1.3.12.2.1107.5.99.3 MAGNETOM Vida 9-13:06:06-DST-1.3.12.2.1107.5.99.3 MAGNEW VAN *6/29/1967. F. 51Y MR XA11. F. 51Y CURRENT HFS 6/29/2018 +LPH .LPH 12_space_tra tra_2_RR latest STUDY ID 9ab0a409-fbe4:40 1:38:39 PM 9ab0a409-mbe4-40 10 IMA 1 FRM 35/56 0 36/56 IF IF TP F435 R TR 1500 0 TE 138.0 SP F444.0 TP F435 SL 1.4 SPF448.4 TA07:31 SL 1.8 BW 504.0 FoV 190*190 FOV 180*180 MAGN/NORMFM3 2/FIL/DIS2D 256-320 Tra J/NORM/FM3_2/FIL/DIS2D 288*288 A2/SAT1 Zoom 1.72 Tra Zoom 1.91 SP3,4 351 351 spcR_1200100 79 79 10 10 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 167 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers' ... Compressed Sensing (CS) – Phase Partial Fourier Hint: turn Off Phase Partial Fourier, if not strictly PPF OFF PPF ON necessary (e.g., for MRCP). HAL HAL AFL Double structures in PE direction 11 11 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 168 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Compressed Sensing (CS) – Limitations Features Not Supported : Limitations: • Slice Partial Fourier • Motion artifacts are more pronounced with CS SPACE • NATIVE SPACE and appear in phase and slice encoding directions • Multiple measurements • Higher acceleration leads to reduced image sharpness • Image based filter and more under‐sampling artifacts • Real part reconstruction (True IR) • Phase Partial Fourier can cause blurring and ringing artifacts • Ringing artifacts are visible in some protocols • High memory usage  very high‐resolution protocols/high number of channels is not supported with low‐end systems 12 Unrestricted © Siemens Healthineers, 2023 Notes 169 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Magnetization Preparation SPACE Magnetization Preparation Options: Routine Contrast Resolution Geometry System Physio Inline Sequence Common Dynamic Non‐sel. IR TR 7000.0 ms Fat-Water Contrast Fat Saturation STIR, T1 dark‐fluid, or T2 dark fluid. TE 379.00 - ms Fat Saturation Strong Non‐sel. T2‐IR MTC Dark Blood T2 dark‐fluid. Magn. Preparation Non-sel. T2 prep. IR Blood Suppression Off None Non-sel. IR Non‐sel. DIR T2 Prep. Duration Non-sel. T2-IR Wrap-up Magn. None Double Inversion Recovery (i.e., suppress 2 Flip Angle Mode Non-sel. DIR Non-sel. T2 prep. IR tissues simultaneously). Reconstruction Magnitude Non‐sel. T2 prep IR T2 dark‐fluid  new preparation pulse module for improved T2 dark‐fluid imaging. 13 Unrestricted © Siemens Healthineers, 2023 Notes 170 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... T2 Dark‐Fluid – Preparation Non‐sel. IR • Like 2D TSE dark‐fluid • Requires long TR and TI for good T2 contrast • Longer acquisition time with SPACE Non‐sel. T2‐IR • Additional T2 preparation within Inversion preparation to allow shorter TR while maintaining T2 contrast • Residual hyper intense CSF is often observed Non‐sel. T2 prep. IR • Also performs T2 preparation but decoupled from the Inversion • Less sensitive for CSF flow effects  better CSF suppression • introduced with syngo MR XA20A and VE11E 14 14 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 171 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... T2 Dark‐Fluid 180° TI TSE Acquisition IR 90° 180° 90° TI TSE Acquisition T2‐IR T2 Preparation + Inversion 90° 180° ‐90° 180° TI TSE Acquisition T2 prep.‐IR T2 Preparation Inversion 15 Unrestricted © Siemens Healthineers, 2023 Notes 172 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... T2 Dark‐Fluid t2_spc_dark‐fluid_sag_p2 t2_spc_dark‐fluid_sag_p2, TR/TI 7000/2050 T2‐IR Non‐sel. T2 prep. IR Flow related artifacts removed 16 16 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 173 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... T2 Dark‐Fluid with T2prep. IR and CS t2_spc_dark‐fluid_cs5.6_iso TA = 4min 1x1x1mm³, Denoising Strength 15 17 17 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 174 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Double Inversion Recovery (DIR) Neuro Application HORA MARCA ITOCTBLADES1 22 PCTF1 TIRA MARCA DOCTBLAGES1 228 BETFIE • To suppress CSF and white brain matter simultaneously • Increased white matter lesion conspicuity ConSog 3 • Excellent for detecting MS lesions Challenges • Compared to T1 or T2 weighted imaging, the overall signal 1.00 TI 3000 0 TR 7500.0 TI 3000 0 TE 309 0 TR 7500.0 BWV 790.0 TE 309.0 is low (gray matter is the only signal source) A DI MPRMAR TPO BY 790 0 SPR187 DI MPRMFR AUREPAS SL15 CHEAHEP Sap Cor(-3.3)>Tra(+1 9) AUIREIPES :por 341_215n / ver CHEAHER • Reduced resolution to compensate low signal L MRC4 /7DC784ABE51225 /5CTF1E/ Patient with multiple sclerosis lesions 18 18 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 175 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... CS Double Inversion Recovery (DIR) dir_spc_sag_cs7_iso 2 averages, 4 min 30 sec, 1.2*1.2*1.3mm Iso Considerable IQ improvement due to averaging 19 19 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 176 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Double Inversion Recovery (DIR) Conventional Inversion Recovery (IR) After an inversion pulse, the acquisition starts after a duration of TI. Double Inversion Recovery (DIR) TI Two independent inversion pulses are played out with two independent TI times (TI1 and TI2). Two different tissues can be suppressed at the same time, Conventional IR in product white matter and CSF. Neuro Application TI2 Standard used parameters to suppress CSF and White TI1 Matter are TI1 = 3000 ms and TI2 = 450 ms for 1.5T and 3T. DIR 20 Unrestricted © Siemens Healthineers, 2023 Notes 177 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SPACE SIEMENS Healthineers ... Double Inversion Recovery (DIR) MS lesions in Dark‐Fluid TIRM and DIR‐SPACE Routine Contrast Resolution Geometry System Physio Inline Sequence Common Dynamic TR 7500.0 ¢ ms Fat-Water Contrast Fat Saturation ... TE 318.00 ¢ ms Fat Saturation Strong MTC Dark Blood Magn. Preparation Non-sel. DIR Blood Suppression Off TI 1 3000 ms Recommended Inversion Times to Suppress both CSF and White Matter: rap-up Magn. None Flip Angle Mode T2 Var TI[1 ] = 3000 ms TI[2] = 450 ms onstruction Magnitude T2 Dark‐Fluid TIRM DIR‐SPACE 21 21 Courtesy of Dr. Marc D. Shapiro, NSI, Winter Park, Florida Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 178 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MPRAGE SIEMENS Healthineers ... MR Applications Fundamentals 1 MPRAGE 22 Unrestricted © Siemens Healthineers, 2023 Notes 179 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MPRAGE SIEMENS Healthineers' ... Morpho Quality Check ADNI: Alzheimer's Disease Neuroimaging Initiative t1_mprage_sag_p2 05:12 • Protocol follows ADNI guidelines, allows follow‐up of Morpho patients with Alzheimer's Disease or MS HAL SKYA • Customer can contribute to ADNI multi‐center study, only if Image Quality is high ADNI will accept data • Recommend protocol for syngo.via to automatically 9 IMA 97 / 176 segment and measure the volumes of the different brain structures; results are compared to a reference data base Results display in image comments Image quality: high / low / to be confirmed. AFL Processing steps Background region segmentation MF 1.00 • • Detection of artifactual voxels :TI 900.0 10cr TR 2300.0 TE 3.0 P Noise distribution analysis TA 05:09 BW 240.0 SP L11. • p2 MIND/NORM SL 1. FoV 248*25 248*25 Sag>Tra(1.8)>Cor(-0.4 *1301 16ns / 9 Image quality: high NUONN 23 23 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 180 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MPRAGE SIEMENS Healthineers' ... Morpho Quality Check Noise Quality Control Quality Index 2 = 1.49%  Normalised Number of Sample Voxer intensity 150 Image quality: high BACKGROUND DETECTION OF NOISE AIR ARTIFACTUAL DISTRIBUTION DECISION (QI2<5.7%) SEGMENTATION VOXELS ANALYSIS Noise Quality Control Back ground HHistograen Ch_Fit Artifacts(300) Quality Index 2 = 12.24% 30 150 250 350 200 500 050 750 250 Low quality scan Quality index 1 Quality index 2 24 24 Ref: Mortamet B., MRM:62(2), 365‐372 (2009) Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 181 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MPRAGE SIEMENS Healthineers ... MP2RAGE MPRAGE with two readouts at different TI times 1 2nd MPRAGE after one Inversion pulse 0.8 readout • Provides T1 contrast with reduced B1 sensitivity (UNIform contrast) 0.6 • Designed for homogeneous T1w Imaging, T1 0.4 Mapping and Morphometry 1st MPRAGE 0.2 • Interleaved acquisition of two image volumes readout with differing contrasts 0 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 ‐0.2 Used for: ‐0.4 Improved segmentation and T1 mapping. Fluid and white matter suppression. ‐0.6 Magn. Preparation Non-sel. IR Multiple sclerosis imaging. ‐0.8 TI 1 700 ¢ ms ‐1 T1 2 . 700 2500 ms ms Flip Angle 1 4 4 - deg 3T 25 Unrestricted © Siemens Healthineers, 2023 Notes 182 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MPRAGE SIEMENS Healthineers ... MP2RAGE avantoSQ_20110902 MIRCO /SD 4EEF 6532FA451 Quarto MROS /SDNEEF6532FA45/10 "9/2/1 986, F. 25Y kw avantoSQ_20110902 UNIform contrast kw 321995, F.25Y STUDY 1 9/2/2011 11:00:28 AM Combining the two images in a novel fashion to create T1‐ 16 MA 83 / 160 weighted images where the result image is free of PD contrast, T2* contrast, reception bias field (B1‐), and, to first order, transmit field inhomogeneity (B1+): ∗ ·GRETI2 MP2RAGE = real ( GRETI1 GRETI1 + GRETI2 2 ) 2 A1/IR HE1-4 "tf13d1_16ns /5 avantoSQ_20110902. kw 122 *9/2/1986 E 2SY STUDY 1 T1 Mapping 9/2/20117 11:00-28 AM 19 IMA 83 F160 Inline T1 mapping based on a pixelwise T1 fitting procedure (if MapIt license available). 26 26 Published report of technique: Marques et al. Neuroimage 49;1271‐81 (2012) Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 183 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SWI SIEMENS Healthineers ... MR Applications Fundamentals 1 Susceptibility Weighted Imaging (SWI) 27 Unrestricted © Siemens Healthineers, 2023 Notes 184 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Conventional Sequence (GRE) Susceptibility Weighted Imaging • 3D high resolution T2* weighted α FLASH sequence to detect susceptibility differences RF time • Flow compensated in all 3 directions (slice, read, phase) to exclude flow Gz related phase variations (only first contrast) Gy • Contrast • T2*‐weighted (TE=20ms at 3T) Gx • Enhancement by application of phase masks • Minimum intensity projections (mIP) Signal • Typical acceleration 2x1 Gradient Echo 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 185 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Wave‐CAIPI Sequence (GRE_wave) Wave‐CAIPIRINHA SWI 3D high resolution T2* weighted FLASH α k‐space Trajectory sequence. RF kz time Parallel imaging with: Gz • 2D‐CAIPIRINHA under‐sampling pattern • Corkscrew k‐space readout Gy .......... trajectory ky Gx kx Improved slice profile with tailored excitation pulse. Standard Cartesian Wave‐CAIPIRINHA Signal Acquisition of 1 or 2 contrast(s). Gradient Echo Each contrast is flow‐compensated. 29 Unrestricted © Siemens Healthineers, 2023 Notes 186 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Wave‐CAIPI Sequence (GRE_wave) Wave‐CAIPIRINHA limitations Routine Contrast Resolution Geometry System Inline Routine Contrast Resolution The main orientation must be transverse Common Acceleration Filter Slab Group 1 • to avoid fold‐in artifacts cceleration mode Wave -. Advanced Reconstruction |Off Slabs Wave-CAIPI Phase Partial Fourier |Off Slices per Slab 32 - • An external reference scan Slice Partial Fourier Off Distance Facto 20 % (GRE/Separate) is mandatory Reference Scans GRE/S .. Asymmetric Echo Off Position Isocenter Oscillating wave gradients lead to a higher Acceleration Factor PE • 2 - Orientation Transversal acoustic noise level compared to Reference Lines PE 30 Elliptical Scanning Phase Encoding Dir. A>> P Acceleration Factor 3D 14 conventional GRE sequence Phase Oversampling 0 4 % Reference Lines 3D 30 4 Slice Oversampling 0,0 % • Many further limitations/requirements are met by dimming the respective Routine Contrast Resolution Geometry System Inline Sequenc Geometry System parameters Part 1 Part 2 Assistant Sequence Name fl_r 100 + Hz/Px • Wave‐CAIPI is only available in the Dimension 3D GRE_wave sequence and the Wave‐CAIPI Asymmetric Echo Off license is required Excitation Slab-sel . RF Pulse Type Normal Gradient Mode Fast Flow Compensation On Segments Interpolation 30 Unrestricted © Siemens Healthineers, 2023 Notes 187 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Applications ¥2546/05 +7/5/69;35Y R 2004Y STUDY 1 3/11/05 Sensitive to venous blood, hemorrhage and iron 1:49:05 PM 3 IMA 7 /24 storage. Extremely sensitive to bleeding in gray matter/white matter boundaries. Other potential applications: • Occult vascular diseases, e.g. cavernomas, angiomas IK 462U.U TE 98.0 TA 03:01 JVV 13U.U MIND NORM HINDINORM SL 5.0 0V 173*230 GOSH as • Stroke and hemorrhage 4,1 :HE1-4;NE2 T2‐TSE ATAR Dark fluid TSE 346*512s | 'tse2d1_13 / 150 d:HE1-4;NE2 Tra *tir2d1_25 / 150 808 439 • Brain tumors ¥ 2546JUS *7/5/69,35Y MR 2002Y ¥2546/05 *7/5/69,35Y MR 200 STUDY 1 3/11/05 STUDY 1 3/11/05 • Trauma 1:54:00 PM 6 IMA 8 / 24 1.56.34 PM 9 IMA 20 / 28 • Alzheimer’s disease R MF 1.00 10cm MF 1.00 DIE TR 48.0 TE 40.0 SP H58.6 TA 03:06 SP H61.4 SL 5.0 3W 80.0 Fo¥ 181*230 02 VIND SL 5.0 T2* FLASH 176*448s ToV 173 200 Tra 41 SWI 134*256s 878 d:HE1-4;NE2 Tra 421 fl3dir / 20 W 4078 C 2292 31 31 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 188 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Clinical Cases Shearing injury in the corpus collosum and thalamus Venous Angioma Conventional: T2* SWI Conventional: T2 SWI 32 32 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 189 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Protocols Protocols MAGNETOM Sola MAGNETOM Vida SWI and SWI_WAVE protocols are provided in the head region. ... >> head >> library >> SWI wave caipi • Fast and high‐resolution protocols t2_swi_tra_p2_1.6mm 05:51 are available for 64/128Ch systems t2_swi_wave4_2mm 02:50 and 64Ch head coil t2_swi_tra_p2_2mm 05:34 • Protocols are included in clinical t2_swi_wave6_64ch-head-coil 01:50 libraries when relevant (e.g., lesion, wave caipi atrophy, white matter lesions) • 2D‐FLASH with a longer TE could be t2_swi_wave4_2mm 02:28 swi_wave4_high-res_64ch-head-coil 04:20 an alternative solution if no SWI Restricted to 64/128ch systems license is available 33 Unrestricted © Siemens Healthineers, 2023 Notes 190 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Wave‐CAIPI: Fast Protocol GRE GRE_wave vid Vida_Head Erlangen Uniklinikum Germany_MAC_3aaaa1626 *01.01.1973, F, 47Y MAGNETOM Vida vid Vida_Head Erlangen Uniklinikum Germany_MAC_3aaaa1626 *01.01.1973, F, 47Y MAGNETOM Vida CURRENT MR XA31 07.10.2020 HFS ALPH CURRENT HFS 12_swi_tra_p2_1.5mm_SM 07.10.2020 +LPH 12_swi_wave6_64ch-head-coil_SW # XA31A latest STUDY ID 3aaaa1626 # XA31A 08:09:14 STUDY ID 3aaaa1626 5 IMA 1 FRM 46/80 08:22:26 11 IMA 1 FRM 45/80 20 1 cm 20 1cm F 2,0 F TR 27,0 TP O TR SP H19,8 TR 30,0 TAC TA 04:52 BW 120,0 FoV 199*220 TE 20,0 FoV 194*220 p2 MAGN/SWI/NORM/DIS2D 223*256s TA 01:40 SP H20,6 Tra>Tra(-90) BW 101.0 A1 Zoom 2,18 p6 MAGN/SWI/NORM/DIS2D 279*352s Tra>Tra(-90) HE1-4 W 593 A1 Zoom 1,59 *swi3dir /15 C 279 HE1-4 593 swiW3dir /15 279 TA = 4:52 min, R = 2 TA = 1:40 min, R = 6 34 34 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 191 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Wave‐CAIPI: High Resolution Protocol GRE GRE_wave Vida Head Erlangen Uniklinikum Germany_MAC_3aaaa1626 Vida_Head Erlangen Uniklinikum *01.01.1973, F. 47Y MAGNETOM Vida Germany_MAC_3aaaa1626 MR XA31 *01.01.1973, F. 47Y MAGNETOM Vida CURRENT HFS VAAUT 07.10.2020 +LPH CURRENT HFS 07.10.2020 t2_swi_tra_p2_1.5mm_SW +LPH latest swi_wave4_high-res 64ch- 54ch-head-coil_SI latest # XA31A STUDY ID 3aaaa1626 # XA31A 08:09:14 STUDY ID 3aaaa1626 5 IMA 1 FRM 46/80 08:24:16 13 IMA 1 FRM 45/80 20 SL 1,5 20 F 2,0 F TR 27,0 TE 20,0 TP O TR 30,0 TA 04:52 SP H19,8 TE 19,8 TP O SP H20,6 BW 120,0 FoV 199*220 TA 04:10 p2 MAGN/SWINORM/DIS2D 223*256s Tra>Tra(-90) BW 99,0 FoV 192*220 p4 MAGN/SWI/NORM/DIS2D 420'480s Tra>Tra(-90) HE1-4 Zoom 2,18 W 593 A1 Zoom 1,16 swi3dir /15 C 279 HE1-4 W 762 swiW3dir /15 C 369 TA = 4:52 min, R = 2 TA = 4:10 min, R = 4 0.89 x 0.86 mm2 in‐plane resolution 0.46 x 0.46 mm2 in‐plane resolution 35 35 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 192 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... User Interface Automatic reconstruction of SWI Routine Contrast Resolution Geometry System Inline Sequence • Select SWI Common | Dynamic TR 30.0 ms Fat-Water Contrast Standard • For SWI image generation, a phase‐mask is TE 20.00 ¢ ms calculated and multiplied with the magnitude image Dark Blood Additional minimum intensity projections (mIP) of Magn. Preparation None • the SWI image are reconstructed Contrasts (8‐image sliding window) SWI Flip Angle Reconstruction Mode defines computed results: 15 + deg Reconstruction Magnitude Magnitude • Magnitude: SWI and mIP Magn./Phase • Magn/Phase: Magnitude, filtered Phase, 1 GRE SWI and mIP Contrasts 8 GRE_wave Contrasts 36 Unrestricted © Siemens Healthineers, 2023 Notes 193 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Data processing Magnitude and high‐pass filtered phase images are used for image reconstruction. • Remove field drift artifacts present in original phase images by applying a high‐pass filter Filtered phase images are used to create Magnitude • a phase mask during post‐processing FFT M x (PM)4 • The magnitude image is digitally HP Filter Mapping multiplied by this phase mask several times until the desired mix of phase information is obtained k‐space Data SWI • SW image with both magnitude and phase information is created Original Phase Phase Mask (PM) Unwrapped Phase 37 37 Ref: Haacke et al. MRM 52:612 (2004) and/or Sehgal et al. JMRI 22:439 (2005) Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 194 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Phase images Biophysics Oxygenated arterial blood  diamagnetic Deoxygenated venous blood  paramagnetic Tissues with different susceptibility will have different phases. • Paramagnetic  phase is bright* • Diamagnetic  phase is dark* Note: not considering phase aliasing! Caveat: different effects can alter the contrast in phase images, so care must be taken in interpreting phase images (not recommended!). 38 38 * Related to left‐handed coordinate system (e.g. Siemens systems) Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 195 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Susceptibility Weighted Imaging (SWI) SIEMENS Healthineers ... Clinical applications Improved detection of hemorrhage, micro‐ 2D Dark‐Fluid TIRM SWI T2 SWI bleeding (diffuse axonal injury), hemorrhagic transformation like methemoglobin, hemosiderin. Detection of occult vascular disease (cavernomas, angiomas, telangiectasias). Hemorrhage Venous Angioma T2* Shearing injury Cavernous angioma CT Subarachnoid Cerebellar bleed 39 39 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 196 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... MR Applications Fundamentals 1 Pointwise Encoding Time Reduction with radial Acquisition (PETRA) 40 Unrestricted © Siemens Healthineers, 2023 Notes 197 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers' ... What is it? PETRA is a 3D (half) radial sequence. It is virtually inaudible, just ~ 3 dB above ambient noise. MPRAGE PETRA GRAPPA 2, 0.95²x1 mm³ 0.95³ mm³ TA ~ 6 min TA ~ 6 min 95 dB(A) 64.9 dB(A) 41 41 Courtesy Dr. Ida, Ebara Hospital Tokyo, Japan Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 198 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... Ideal – Quiet 3D Half‐Radial Imaging Slow gradient switching, started before the excitation pulse. RF TX RX TX Radial is acquired with constant gradient TX/RX amplitude. Slow Slew Rate Readout (ADC on) =Length of half‐radial ~ Gradient 1.5 ms TR 3D Radial 42 Unrestricted © Siemens Healthineers, 2023 Notes 199 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... Real – Quiet 3D Half‐Radial Imaging THW = Tx‐Rx switching time of the coil. • No signal reception possible during THW, TX TX Gradient is already on RF RX TX/RX • Results in a hole in center k‐space THW The hole needs to be taken care of: • Minimize THW Gradient • Cover center of k‐space separately TR • Pointwise Encoding (i.e., each point is phase encoded individually) 3D Radial 43 Unrestricted © Siemens Healthineers, 2023 Notes 200 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... What about possible contrasts? Intrinsic contrast of PETRA (low flip angle): 28/04/ EPA • Very weak PD‐like contrast 5 IMA 183 / • No real clinical use T1 contrast: • With 180°preparation pulse and appropriate inversion time TI • MPRAGE‐like contrast behavior 180 TX RX 0cm TI MF 1.00 IL 1300.0 TE O.1 CAVE: contrast enhancement due to possible ambiguity with the Inversion BW 400.0 SP F38.1 M/ND/NORM/FS/FIL SL 0.94 FoV 300*300 Recovery magnitude reconstruction: shorter (contrast‐enhanced) T1 might in 320*320 some instances show less signal. Resize: 4X Orig: 320 x 320 Tra *Petra3d1_8000 / 6 W 1087 C 516 44 44 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 201 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... What about possible contrasts? THW = TEmin = 70 µs @ 5:57 min /| Auto 0.9x0.9x0.9 mm3 . 1.00 • Zero TE Routine Contrast Resolution Geometry System Sequence Common • Solid structures with ultra short T2 Dynamic become visible (e.g., head cushion, coil, TR 1 3.3 TR1: Repetition time for each repetition TR2: Time between two inversion pulses Standard headphone, earplugs, etc.) TE 0.07 - ms Waiting time between the acquisitions • All RF pulses are non‐selective and the next inversion pulse: 22 ms FOV must be large enough (~300mm) Magn. Preparation Non-sel. IR 2 Repetition Times: TI 1 TR 1 = Time between two excitation 1300 + T11: Inversion time after very first inversion • T12: Inversion time after all other inversions pulses (echo spacing) • TR 2 = Time between two IR pulses Flip Angle 6 deg 2 Inversion Times: • TI 1 = time for the very first IR • TI 2 = time for all other IR pulses 45 Unrestricted © Siemens Healthineers, 2023 Notes 202 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... Protocol Parameters Slices per slab and Slice thickness 5:57 min & Auto @ 0.9x0.9x0.9 mm 1.00 Dimmed since k‐space acquisition is isotropic Routine Contrast Resolution Voxel Size Sequence Common Acceleration Reconstruction: 0.94x0.94x0.94 mm (i.e., only readout in all dimensions). Filter Acquisition: 0.94x0.94x0.94 mm3 FoV Read 300 mm Radial Views: FoV Phase 100.0 + % Radial Views 60000 ¢ More numbers are better for image quality Slice Thickness 0.9 mm but increases also scan time. Base Resolution 320 Recommendations: 60000 ‐ 65000 for voxel size 0.9 ‐ 1.0 (if too small = blurry images). Bandwidth: Gradient constant during TR, therefore Bandwidth should not be too high  max. Gradient Strength 10‐12mT depends on FoV. 46 Unrestricted © Siemens Healthineers, 2023 Notes 203 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PETRA SIEMENS Healthineers ... Recommendations Use large FoVs (e.g., > 270mm for head scanning). TR1 and TE should be minimum Use HeadCoil only to avoid folding artifacts. TI‐Pulse • TIs=1300/900, TR2 minimum, Waiting Time ~ 0 ms (see Bandwidth – should not be too high. tool p) → more SNR, ti Recommended values • TIs=1300/500, TR2 large enough to have Waiting time ~ • FoV 300mm → max. gradient strength 10mT 400ms → more CNR • FoV 200mm → max. gradient strength 12mT (tooltip on bandwidth) Radial Views • If spherical ring around the head, bandwidth is Recommendations: 60000 ‐ 65000 for voxel size 0.9 ‐ 1.0 too high (if too small = blurry images). Artifacts in paranasal sinuses (maxillary sinus) Flip Angles (FA) TI1 too short. Limited FA range due to the very short TR. • TI1 ~ 1300ms no artifact (but less CNR) FA = 6°optimal (if too small less SNR). • TI1 ~ 900ms cloudy structures in maxillary sinuses (but better T1‐contrast) 47 Unrestricted © Siemens Healthineers, 2023 Notes 204 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 TGSE SIEMENS Healthineers ... MR Applications Fundamentals 1 Turbo Gradient Spin Echo(TGSE) 48 Unrestricted © Siemens Healthineers, 2023 Notes 205 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 TGSE SIEMENS Healthineers ... Turbo Gradient Spin Echo / GRASE – GRAdient Spin Echo Fast TSE based sequence Combination of Spin Echo and 90° 180° 180° • Gradient Echoes RF • Each Spin Echo is surrounded by additional gradient echoes to fill k‐space even faster GS S • Refocusing pulses are re‐phasing the spin de‐phasing caused by GR R static inhomogeneity Applications GP P • T2 weighted anatomical images with high resolution in a shorter MR scan time • 3D ASL Perfusion GRE SE GRE • BLADE Diffusion 49 Unrestricted © Siemens Healthineers, 2023 Notes 206 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 TGSE SIEMENS Healthineers ... Protocols and Parameter TGSE for T2 weighted imaging TGSE for 3D‐ASL T2 >> 12_tgse_tra_512 ? > perfusion >> asl_3d_tra_fast ? X 8 2:57 min 1| Auto 0.4x0.4x4.0 mm3 1.00 & 2:50 min Auto @ None 2.0x2.0x5.5 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Routine Contrast Resolution Geometry System Physio Sequence Part 1 1Part 2 Assistant Part 1 Part 2 Sequence Name tgse Bandwidth 271 + Hz/Px Sequence Name tgse Bandwidth 2298 + Hz/Px Echo Spacing 4.72 ms Dimension 3D Echo Spacing 0.54 ms Excitation Standard RF Pulse Type Normal RF Pulse Type Normal Turbo Factor Turbo Factor 12 Gradient Mode Normal Gradient Mode Fast Segments 9 + EPI Factor Reordering Centric EPI Factor 21 For T2 weighted imaging, recommended EPI factor ≤3 for better image quality 50 Unrestricted © Siemens Healthineers, 2023 Notes 207 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 TGSE SIEMENS Healthineers ... Application examples TGSE for T2 weighted imaging TGSE for 3D‐ASL TR/TE= 4000/85 TR/TE= 6250/155 EPI Factor 3 EPI Factor 7 Turbo Factor 7 Turbo Factor 7 51 51 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 208 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 StarVIBE SIEMENS Healthineers ... MR Applications Fundamentals 1 StarVIBE 52 Unrestricted © Siemens Healthineers, 2023 Notes 209 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 StarVIBE SIEMENS Healthineers ... Neuro Stack of radial trajectory for data acquisition. SIEMENS ... >> head >> library >> StarVIBE • Oversampling of k‐space center orbits • To reduce motion artifacts, also good for regions with involuntary motion (e.g., eye movement) 03:44 perfusion t1_starvibe_tra_1.5mm BOLD t1_starvibe_cor_1.8mm 04:25 Neuro protocols available in head and c‐spine regions. BLADE SWI flow Head32 HeadNeck_20_TCS QUIET StarVIBE SyMR 53 Unrestricted © Siemens Healthineers, 2023 Notes 210 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 StarVIBE SIEMENS Healthineers' ... Neuro StarVIBE for C‐Spine StarVIBE for Orbits skyraptx13_20140401_01 skyraptx13_20140401_01 skyraptx13_20140401_01 AFL Hospital skyraptx13_20140401_01 kw Kw *4/1 /1991, M, 23Y 4M/1991, M, 23Y *4/1/1991. M. 23Y kw Skyra MR E11 4/1/1991, M, 23Y STUDY 1 14/1/2014 STUDY 1 HFS 4/1/2014 .LPH STUDY 1 4/1/2014 9:43:38 AM 32 IMA 13/40 9:46:33 AM 9:38:03 AM 33 IMA 13 / 40 30 IMA 13 / 28 30 IMA 14 / 28 TEIG ITA 02:50 BWV 820.0 SPF116 3/ M/NORM/DIS2D A1FFS HE4; NE1,2, SP1 *113d1 17 t1_starvibe_tra_2.5mm t1_starvibe_tra_2.1mm t1_starvibe_tra_1.5mm 54 54 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 211 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Day 2 SIEMENS Healthineers MR Angiography Techniques MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 212 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Angiography Techniques • Time‐of‐Flight (ToF) • Phase Contrast • Vessel Wall imaging 2 Unrestricted © Siemens Healthineers, 2023 Notes 213 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Identify Time‐of‐Flight (ToF) techniques and applications • Describe Phase Contrast techniques and applications • List Vessel Wall imaging techniques and applications 3 Unrestricted © Siemens Healthineers, 2023 Notes 214 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... The information presented in this MR Angiography presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.” A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents. 4 Unrestricted © Siemens Healthineers, 2023 Notes 215 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time-of-Flight (ToF) Principle SIEMENS Healthineers ... MR Applications Fundamentals 1 Time‐of‐Flight (ToF) Principle 5 Unrestricted © Siemens Healthineers, 2023 Notes 216 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... Theory Where the idea comes from? Skyra VE11C, Head AH MRC34/6ED53102946256/9F14 ... Skyra VE11C, Head AH MRC34/6ED53102946256/9F14. Skyra VE11C, Head AH MRC34/6ED53102946256/9F14 ... Siemens *28/11/1964, F, 50Y Skyra Siemens MR E11 *28/11/1964, F, 50Y Skyra Siemens MR E11 *28/11/1964, F, 50Y Skyra STUDY 1 HFS MR E11 +LPH STUDY 1 HFS HFS 2/09/2015 2/09/2015 +LPH STUDY 1 2/09/2015 +LPH 3:27:11 PM Head Neck_16ch 8 IMA 11 / 27 3:53:44 PM Head Neck_16ch 3:28:34 PM Head Neck_16ch 14 IMA 11 / 27 9 IMA 11 / 27 .......... EMF 1.00 MF 1.00 MF 1.00 TR 250.0 TE 2.5 TR 600.0 TP O TE 6.0 TR 600.0 TA 01:16 TE 12.0 BW 355.0 SP F8.1 TA 02:08*2 TP O SL 4.0/1.2 BW 250.0 SP F8.1 MIND NORM/FM3_2/FIL SL 4.0/1.2 TA 02:08*2 MIND NORM BW 250.0 FoV 220*220 FoV 206*220 MIND NORM FM3_2/FIL FOY 206 A1 256*320s 432*512s | H1U;H2L Tra>Cor(-5.5) A1 H1U;H2L Tra>Cor(-5.5) A1 *f12d1 /70 ₩ 1494 752 *se2d1 /70 W 1327 H1U; H2L *se2d1 /70 FLASH SE SE + Blood Suppression 6 6 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 217 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (TOF) SIEMENS Healthineers ... Principle Flow‐Related Enhancement (FRE). Fast Blood Flow In SE and GRE sequences, inflowing spins show high signal Vessel Signal intensities because they have not seen previous excitation and refocusing pulses and are not saturated as the static tissue within the slice. O • Results in bright signal of vessels running through‐plane Vessel • If vessels are running in‐plane spins will see several RF pulses and hence also get saturated Slice Factors affect the FRE: Slow Blood Flow • TR • Flip Angle • Slice Thickness • Vessel/Slice Orientations, etc. Vessel Slice 7 Unrestricted © Siemens Healthineers, 2023 Notes 218 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (TOF) SIEMENS Healthineers ... Sequence Background suppression In comparison to conventional T1 weighted imaging, tissue a contrast from static tissue is irrelevant for angiography. RF Shorter TR will result in even stronger signal saturation from static tissue and result in lower background signal. M However, inflowing fresh blood yields higher signal intensity! Conclusion: Short TR FLASH! … Magnetization of static tissue --- Magnetization of inflowing blood ‐‐‐ 8 Unrestricted © Siemens Healthineers, 2023 Notes 219 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Sequence The basic sequence is a Flow Compensated T1. a FLASH Sequence TE Flow compensation is applied in all three spatial directions to maximize the vessel signal. Gslice Parameter Setup Shortest TR. Shortest TE or Shortest Opposed‐Phase TE. Gphase .......................................................................... • Short TE to minimize signal losses from phase dispersion • Opposed TE to reduce background signal from fat, usually preferred! Gread 9 Unrestricted © Siemens Healthineers, 2023 Notes 220 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Maximum Intensity Projection (MIP) To show all the vessel information in one image Maximum Intensity Projections (MIP) are calculated after the data acquisition. To obtain useful vessel information during data acquisition consider the: • Flow Velocity • Flow Direction • Slice Orientation 10 10 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 221 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Maximum Intensity Projection (MIP) Projects in the visualization plane the voxels with Maximum Intensity that fall in the way of parallel rays traced from the viewpoint to the plane of projection. Original Measured Images Projection Image 11 11 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 222 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Postprocessing Maximum intensity projections Dynamic Subtraction Cardiac MIP Composing Enable in the protocol Inline MIP MIP Sag Save Original Images v parameter card. MIP Cor M MPR Sag MIP Tra V MPR Cor MIPs in Sag, Cor and Tra can be calculated MIP Time MPR Tra inline. Radial MIP Radial MIPs can be inline generated in Number of Radial Views one pre‐defined axis. Axis of Radial Views H-F L-R • L‐R  view order cor‐tra‐cor A-P • A‐P  view order tra‐sag‐tra H-F • H‐F  view order cor‐sag‐cor Offline reconstruction via MR View&GO. 12 Unrestricted © Siemens Healthineers, 2023 Notes 223 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Postprocessing Rotating MIP VRT (Volume Rendering Technique) 13 13 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 224 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Flow Velocity versus Acquisition Type Unsaturated blood flows into the slice/slab and generates a high signal. Slab 1 If the blood is subject to several excitation pulses its signal gets saturated, too. Slab 2 Blood signal depends on the slice/slab Single Multi thickness, TR, Flip Angle, and Flow Slab Slice Velocity. Slab 3 Fast and Intermediate Flow 3D multi‐slab measurement. (e.g., Intracranial arteries, Slab 4 Carotid arteries) Slow flow 2D multi‐slice. (e.g., Venous sinuses, Peripheral arteries). Fast Flow velocity Slow 14 Unrestricted © Siemens Healthineers, 2023 Notes 225 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... 2D versus 3D 2D Time of Flight 3D Time of Flight Offers relatively short imaging times with excellent Where the imaged anatomy encompasses a relatively sensitivity to slow flow. small area and vessels run in various orientations. Imaging of long vascular segments is possible (such as the High spatial resolution and high signal‐to‐noise allowing entire aorta or lower extremity arteries). reformation in any direction. Disadvantages Disadvantages Insensitivity to in‐plane flow and patient motion artifacts Relative insensitivity to slow flow and saturation effects that may create misregistration artifacts. that limit maximum slab thickness of each acquisition. Imaging times are longer than 2D ToF techniques. Motion artifacts affect all slices 15 Unrestricted © Siemens Healthineers, 2023 Notes 226 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Flow Direction versus Saturation Bands Vessel Signal F>>H visible Each blood spin flowing into the slice/slab generates high signal. Saturation is needed to exclude either arteries or veins. Slab 1 Saturation band above or below slice/slab, depends on the flow direction and vessel to be observed (arteries versus veins). Slab 2 Example: Arteries observed, flow feet to head Slab 3 (e.g., carotids) • Saturation band placed above saturates inflowing blood from veins Slab 4 • Acquisition from head to feet to avoid saturation of arterial blood 16 Unrestricted © Siemens Healthineers, 2023 Notes 227 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Flow Direction versus Saturation Bands Conventional Saturation Region Routine Contrast Resolution Geometry System Physio Inline Sequence May be useful to saturate certain areas. Common AutoAlign Navigator Saturation im Planning Suite (e.g., arteries in 2D TOF for veins). Saturation Region + Special Saturation Tracking H Special Saturation: Tracking Band Gap Tracking H Always parallel to slice/slab group • • Saturation band will follow slice/slab Thickness Parallel H Parallel F group, and saturate the through‐plane direction (e.g., veins) None Special Saturation: Parallel Bands Parallel to imaging volume, saturates through plane flow. • One Saturation Band above or below • Two Saturation Bands with one on each side of Volume 17 Unrestricted © Siemens Healthineers, 2023 Notes 228 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Special Saturation – Tracking Bands @ 3:38 min 1| Auto @ 2 0.5x0.5x0.8 mm3 1.00 @ 3:38 min 1; Auto @ 2 0.5x0.5x0.8 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Routine Contrast Resolution Geometry System Physio Inline Sequence Common Dynamic Angio Common AutoAlign Navigator Saturation im Planning Suite Saturation Region Special Saturation Tracking H Gap 10.00 - mm Thickness 40.00 - mm Flow Direction F>> H TONE Ramp 70 18 Unrestricted © Siemens Healthineers, 2023 Notes 229 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Special Saturation – Tracking Bands Slab 1 Slab 1 Slab 1 Slab 1 xxxxxxxxxxxxxxxxXXXXXXXXXXXXXX Slab 2 Slab 2 .................................... Slab 2 ............................... Slab 2 ............................................... ................................................. f. ................. Slab 3 Slab 3 Slab 3 ...... . ... ..... ...... Slab 3 Slab 4 Slab 4 Slab 4 Slab 4 -+ 19 Unrestricted © Siemens Healthineers, 2023 Notes 230 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Conventional Saturation HAR HAR Test Test T! 2020.09.03-11:52:50-DST-1.3.12.2.1107.5.99.3 2020.09.03-11:52:50-DST-1.3.12.2.1107.5.99.3 5 IMA 1 FRM 14/28 3 IMA 1 FRM 2/3 6, IMA 1 RPF RPH . -- - F ========= TP O TP 0 SP A8.9 SP F24.3 FoV 220*220 FoV 259*259 FoV 259*259 p2 MAGN/NORM/DIS2D ag>Cor(9)>Tra(1) ... IMPR/RESAMP/NORM/DIS3D Cor>Sag(-10)>Tra(-8) IMPR/RESAMP/NORM/DIS3D Tra>Cor(9)>Sag(-1) t1_qtse_dark-fluid_sag_p2 ₾1787 AAhead_scout_MPR_cor 711 AAhead_scout_MPR_tra' W 576 854 336 274 Not for diagnostic use Not for diagnostic use 1 Not for diagnostic use ILL 20 20 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 231 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Slice Orientation and Saturation To maximize the flow enhancement effects, it’s better to Oblique Orientation Sag>Cor plan the slices perpendicular to the direction of vessel. Then it‘s possible to see Sagittal Sinus (i.e., to the inflowing blood spins!) Anlagenzentrum Example: 2D ToF for Sagittal Sinuses. The result is sensitive to the slice orientation. • Provides a suitable slice oblique • Appropriate for most vessels in a single direction (e.g., ACS Peripherals) 5 cm MF 1.00 TR 35.9 TE 7.9 TA 01:09 TP 0 BW 300.0 SP F55.3 p2 GSPIND SL 90.0i 220*220 384*5121 HE3,4 NE1,2 Tra *pc3di /15" 578 201 21 21 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 232 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers' ... Slice Orientation and Saturation 2D ToF for Sagittal Sinuses. With oblique slice planning no Oblique Slice Group Strict Sagittal Slice • chenzhanquan saturation of inflowing spins 17.08.01-14:47:46-STD-1.3.12 Hospital chenzhanquan *8/1/1954, M, 63Y MR E11 17.08.01-14:47:46-STD-1.3.12. *8/1/1954, M, 63Y MR E11 • Without oblique planning (i.e., strict STUDY 1 8/1/2017 STUDY 1 3:10:54 PM 8/1/2017 3:14:43 PM 19 IMA 1 /1 23 IMA 1 /1 sagittal) signal from sagittal sinuses gets lost • Regional Saturation Band is used to suppress inflowing arteries • Tracking Sat Band is not suitable in AR AL this case MF 1.00 10cm: MF 1.0 TR 24.0 TR 24.0 TE 7.0 TA 04.89*45 TE 7.0 TP O BW 90.0 SP L4.0 TA 04.89*45 SL 91.44 BW 90.0 SP R1.4 MIP_SAGIND NORM FoV 250*250 MIP_SAGIND NORM SL 91.44 256p*256 FoV 250*250 A1/PFP/SAT1 A1/PFP/SAT1 256p*256 HE1-4 Sag>Cor(10.0) HE1-4 Sag>Cor(-1.2) *f12dir_t70 /60 obliqu C 678 279 *f12dir_t70/ 60 saggite 682 278 22 22 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 233 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... 3D TOF Multi‐Slab with TONE TONE is a special excitation pulse, Tilted Optimized Non‐ uniform Excitation. • Ramped RF‐pulses (i.e., asymmetric pulses with Flip Angles that vary as a function of position) • TONE is providing a linear Flip Angle ramp to maintain a uniform blood signal in the imaging volume • Produces increased signal from protons at the exit side of the imaging volume HF (a) Small Large 23 Unrestricted © Siemens Healthineers, 2023 Notes 234 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers .. 3D TOF Multi‐Slab with TONE The TONE ramp value reflects the ratio between the two Routine Contrast Resolution Geometry Flip Angles at both edges of the slab. Common Dynamic Angio TR 20.0 - ms TE 3.11 ¢ ms TD 0.00 - ms Flip Angle = 20° Flip 2 = 23.5° Routine Contrast MTC Common Dynamic Angio Magn. Preparation None Flip 1 = 16.5° Flip Angle Mode Constant z ip Angle Flip 1 = 16.5° 20 deg Flip Angle = 20° (because 16.5/23.5 = 0.7) Tone Ramp = 70%c Flip 2 = 23.5° Flow Direction F>>H TONE Ramp 70 % Flip Angle = 16.5º - 23.5º 24 Unrestricted © Siemens Healthineers, 2023 Notes 235 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... 3D TOF Multi‐Slab with TONE Relations between TONE and real Flip Angles (FA) FA center = (FA1+FA2)/2 (flip angle shown in FA • FA2 parameter card) FA center • TONE ramp= FA1/FA2 • TONE ramp range between 20 ‐ 100% FA1 In previous software the TONE ramp has only three (3) levels: • Slow = 30% • Medium = 50% • Fast = 100% TONE ramp = 100% means NO TONE ramp is used. For slower Flow Velocities, a steeper ramp might be z needed → smaller TONE values (e.g., to depict smaller vessels). 25 Unrestricted © Siemens Healthineers, 2023 Notes 236 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... 3D TOF Multi‐Slab with TONE Effect of different TONE ramps TOF & PC, Training No clinical TOF & PC, Training No clinical TOF & PC, Training No clinical Training AGNETOM Vida Training *1/1/1 956, F. 64Y MAGNETOM Vida Training Better enhancement of small *1/1/1956, F. 64Y "1/1/1956, F. 64Y MAGNETOM Vida CURRENT MR XA20 MR XA20 HE'S CURRENT MR XA20 9/2/2020 9/2/2020 HES CURRENT OLPH +LPH 9/2/2020 HE'S .LPH vessels with higher TONE ramps. to(_13d_tra_MP_Radials.01 o(_113d_tra_MIP_Radials.03 tof_13d_tra_MP_Radials 04 Istest Latest latest STUDY ID 15689204-4684:47 STUDY IO 8:47:33 AM However, too high of a TONE R R ramp increases background TP O TR 21 0 TP O signal variation. D2 MAGNMPINNORMOIS20 ov 206-68 . SP RO.6 TE J4 SP RO.6 FOV 200*68 TA01 19"4 92 MAGNUMPINORMOIS20 661-768s1 BWV 188.0 FOV 200*68 661-768s 1 g.Cor(-1)>Tra(1) p2 MAGN/MIP/NORM/DIS2D .Con(-1)>Tra(1) Zoom 1.00 617 A1/9AT1 Zoom 1.01 HE1,3,4 617 • Stronger suppression with 323 TONE Ramp 70% TONE Ramp 100% TONE 100% TONE Ramp 50% higher Flip Angles clinical • Step‐wise variation from slab ETOM Vida to slab 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 237 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Background Suppression Effects of TR Effects of FA Effects of TE Increasing TR allows more time for T1 Increasing Flip Angle decreases signal Signal loss due to spin‐phase relaxation and hence higher signal. from static tissue due to greater dispersion at long TE values. • Greater inflow enhancement may saturation. be possible • For rapidly flowing vessels, Generally, TE is selected to be the • Background tissue also increases, increasing Flip Angle leads to more minimum allowable for a given pulse with loss of vessel conspicuity background suppression with sequence. improved conspicuity of vessels Longer TR lengthens scan time. • For slowly flowing vessels, however, With applied flow compensation in the Flip Angle may need to be read this usually results in TE's on the Shorter TR reduces (vessel) signal. reduced order of 3‐7 ms. Typical TR values are generally in the Depending on the application, Flip Selecting a TE close to a Fat‐Water range of 15‐35 ms for both 2D and 3D Angles from 30° to 70° are commonly Opposed Phase (e.g., 2.2, 4.4 or 6.6 ToF MRA. used for 2D TOF and 10° to 30° for 3D ms at 1.5T) may be useful for TOF with TONE pulses. improving background suppression 27 Unrestricted © Siemens Healthineers, 2023 Notes 238 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Background Suppression Effects from TE Use the shortest Opposed TE. • Suppresses more‐fat signal • Better depictions of small vessels • However, might introduce more intravoxel dephasing due to longer TE than minimum TE and hence more susceptibility effects leading to signal loss TONE=60 TONE=60 TE in shortest Opposed‐Phase Shortest TE 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 239 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Background Suppression Fat Suppression 8 8:36 min Auto @ 2 0.3x0.3x0.5 mm3 1.00 High signal from fat may obscure vessels or mimic Routine Contras Resolution Geometry System Physio Inline Sequence pathology, particularly at the skull base where Common Dynamic abundant fatty marrow may create artifacts Scan Assistant ? X around the carotid and vertebral arteries Your last change Fat suppression may be applied: ? Fat-Water Contrast Standard -> Fat Saturation • Better background suppression possible • However, with Fat Saturation, minimum TR will Magn. Preparatio will adapt the following parameters: TR 21.0 + 33.0 ms increase which will increase scan time. OK Undo Flip Angle Mo Flip Angle 20 + deg Reconstruction Magnitude 29 Unrestricted © Siemens Healthineers, 2023 Notes 240 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Background Suppression Fat suppression Standard High signal from fat may obscure vessels or mimic pathology, particularly at the skull base where abundant fatty marrow may create artifacts around the carotid and vertebral arteries. Fat Suppression may be applied: • Better background suppression possible • However, with Fat Saturation, minimum TR will Fast Water Excitation increase which will increase scan time • Worse slice profile with Water Excitation results in signal loss at edges of each slab 30 30 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 241 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Background Suppression Magnetization Transfer Signal Free Water Compared to protons from free water, protons MT Pulse from macromolecules have a very broad frequency spectrum and are usually not visible in MR due to ultra‐short T2 times. • However, due to water exchange excited spins Bound Water from macromolecules can transport excitation states to the free water pool primarily via Frequency dipole‐dipole interactions Proton Exchange • By applying RF saturation pulses off‐center to Signal free water resonance frequency, Signal from free water signal macromolecules get excited and transfer decreases saturation effects • Results in better background suppression, but Bound Water increases TR, scan time, and SAR Frequency 31 Unrestricted © Siemens Healthineers, 2023 Notes 242 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Background Suppression Without MTC With MTC MF 1 24 MF 2.11 MF 1.24 Less contrast Higher Contrast TR 31.0 TE 7.0 TA 01:59+3 Shorter Scan Time, due to a Longer Scan Time due to a BW 100.0 p2 MIP_SAG/ND A1/SAT1/MT ctHE3,4 shorter TR longer TR *f13dir_150 / 25 Carillo-Hinds, Jol Carillo-Hinds, Jolanta *3/15/1988, F, 23Y 11.05.31-15:02:46-D *3/1 5/1 988, F, 23Y | 3/15/1988, F,237 11.05.31-15:02:46-DST-1.3.12. *3/15/1988, F, 23Y STUDY 1 STUDY 1 6/3/2011 STUDY 1 11:59:41 AM 6/3/2011 6/3/2011 11:59:41 AM 12:05:10 PM 20 IMA 1 /1 21 IMA 1/1 25 MA 1 /1 32 32 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 243 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... POCS Reconstruction Projection onto Convex Sets (POCS) HPR Proband T 2019.09.09-09:04:52-DST-1.3.12.2.1107.5.99.3 Trainingscenter Proband T • If Partial Fourier is used (e.g., Asymmetric Echo) Trainingscenter *8/8/1947, M, 71Y MAGNETOM Sola 2018.08.08-09:04:52-DST-1.3.12.2.1107.5.99.3 MR XA11 *8/8/1947, M. 71Y CURRENT HFS CURRENT 8/8/2018 ·LPH 8/8/2018 POCS performs true k‐space reconstruction rather tor_n3d_tra_POCS_OFF_MIP_Radials tor_n3d_tra_POCS_RS_MIP_COR latest latest than zero‐filling. • Only available when using adaptive coil combine mode. A A TR 28.0 IPO Better spatial resolution but lower SNR. SPA20.3 • TE 7.2 SL 0.0i TR 28.0 TP O TA01:14º4 FoV 190-210 TE 7 2 SP A20:3 SL 210.0i BW 100.0 p2 MAGN/MIP/NORM/DIS2D 551p-640s | TA01:14-4 FoV 190*68 a(13)>Sag(-1) BW 100.0 551p*640s | Zoom 1.70 P2 MAGNIANGIO ra(13)>Sag(-1) W 513 31.4 A1/PFP/SAT1 Zoom 1.70 AHR graphy >> TOF > tof_fl3d_tra ? Proband T Trainingscenter Proband T Trainingscenter 2018.08.08-09:04:52-DST-1.3.12.2.1107.5.99.3 *8/8/1947. M. 71Y MAGNETOM Sola 2018.08.08-09:04:52-DST-1.3.12.2.1107.5.99 3 *8/8/1947, M, 71Y MAGNETOM Sola 5:58 min Auto @ 2 0.5x0.5x0.5 mm3 MR XA11 1.00 MR XA11 CURRENT HFS CURRENT HFS 8/8/2018 +LPH 8/8/2018 +LPH tof_#13d_tra_POCS_RS Routine Contrast Resolution tof_f13d_tra_POCS_OFF System Physio Inline Sequence latest latest STUDY ID 4f487146-1760-47 Common Acceleration Filter 9:23:49 AM Raw Filter Coil Combination Adaptive Combine ... Elliptical Filter F POCS Read & ... Off Read & Slice 33 33 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 244 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Limitations Intravoxel Dephasing and signal loss due to slow flow. Visualizing MR signal from flowing tissue. • Laminar flow is coherent  bright signal • Slow or no flow  dark / no signal • Turbulent flow is incoherent  signal loss due to spin dephasing effects Clinical Applications. • Stenosis might be overestimated • Aneurysm might be underestimated Possible Solutions. Flow Compensation to reduce the dephasing from motion, short TE to reduce susceptibility. Area of Signal Loss 34 Unrestricted © Siemens Healthineers, 2023 Notes 245 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers' ... Limitations Overestimation of Stenosis. • Exaggerated sensitivity to vessel stenosis due to disruption of laminar flow. • Over‐estimation of stenosis is possible. a ToF DSA CE_MRA DSA Overestimation 35 35 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 246 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Limitations Underestimation of Aneurysm. Signal Loss from Aneurysm • In case of an Aneurysm the blood may have a very slow or even no flow, hence gets saturated • Results in reduced vessel signal which causes an underestimation CE‐MRA ToF 36 36 Ref: Nael K et al., AJNR 2006, 27(10) 2118‐2121 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 247 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Signal Loss from very slow flow 1.5T 3T DSA 37 37 MAGNETOM Sonata and Trio. Courtesy of J. Gaa, F. Zanella, U. Frankfurt, Germany Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 248 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Protocols for Large Z‐coverage SIEMENS >> neck soft tissue >> angiography >> TOF - carotids SIEMENS > neck soft tissue >> angiography >> TOF - carotids > tof_f13d_tra ? TOF with large z-coverage General 3:38 min 1| Auto @ 2 @ 0.5x0.5x0.8 mm3 1.00 Protocol Parameters Routine Contras Resolution Geometry System Physio Inline Sequence tof fl3d tra 03:38 Voice Commands Execution Slab Group 1 FOV Read 200 ¢ m TOF thin slices Image Management Slabs 8 FoV Phase 75.0 % Auto Load tof_f13d_tra_iso 03:24 Slices per Slab 24 Slice Thickness 0.8 mm Copy References Distance Factor Slab Thickness: 19.20 mm -25 % TR Slab Group Thickness: 120.0 mm TOF 2D Position Isocenter ... TE 3.11 - ms tof_f12d_tra 02:29 Orientation Transversal ... Averages Phase Encoding Dir. A>> P Concatenations SIEMENS > head >> angiography >> TOF Phase Oversampling 0 % AutoAlign Slice Oversampling 16.7 % tof_f13d_tra 05:33 TOF with large z-coverage tof_f13d_tra_large 05:27 OK Cancel 38 Unrestricted © Siemens Healthineers, 2023 Notes 249 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Protocols for Large Z‐coverage Combined Intracranial and Extracranial. TT.06.01-18:03 *12/14/1988:03:52-DST-1.3.12.2 .... 4.28:53 PM, 10cm 3D FLASH ToF MIP MF 1.00 GRAPPA 3 TR 24.0 Voxel 0.3x0.3x0.8 mm TE 7.0 TA 01:43*4 BW 103.0 MIP_SAG/DIS2D/COMP_MIP Fov 26 150,8 TA: 7:41 min A1/PFP/SAT1 Head/Neck 64 Channel Coil *f13dir_t70 / 25 39 39 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 250 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing Implementation Variable density Poisson Disc sampling • 3D incoherent under‐sampling (Poisson disc algorithm) • L1 wavelet regularization in three spatial kz dimensions • Non‐linear iterative reconstruction using sensitivity encoding and FISTA ky • Multi‐GPU implementation for faster Compressed Sensing ToF reconstruction Acceleration 6.8; TA 3:30 min 40 40 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 251 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing Sira -f Sira -1 The combination of improved spatial resolution and significant scan time reductions with all the neuro coils: 64 channel, 32 channel, and the pediatric array. RFP REP Conventional ToF Compressed Sensing ToF Acceleration 1.7, TA 5:48 min Acceleration 7.2, TA 2:57 min 49% Voxel meas: 0.5×0.5×1.0 mm3 Voxel meas: 0.6×0.6×0.6 mm3 Voxel interp: 0.3×0.3×0.5 mm3 Voxel interp: 0.4×0.4×0.4 mm3 Shorter scan time 41 41 Data courtesy of Dr. Michael Kean, The Royal Children‘s Hospital Melbourne Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 252 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing Conventional ToF Compressed Sensing ToF Acc. 3, TA 4:00 min Acc. 12.6, TA 2:00 min Voxel: 0.8×0.8×1.2 mm3 Voxel: 0.6×0.6×0.6 mm3 → Adding angiographic evaluation to fast (0.6 mm)3 2:00 min ischemic protocol 42 42 Data courtesy of Prof. Tilman Schubert, University Hospital of Basel, Switzerland Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 253 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing SIEMENS > head >> angiography >> TOF @ 3:25 min 1| Auto @ 7.2 0.4x0.4x0.4 mm3 1.00 tof_f13d_tra 05:33 Routine Contrast Resolution Geometry System Physio Inline Sequence TOF with large z-coverage Common Acceleration Filter tof_f13d_tra_large 05:27 Acceleration mode CS Advanced Reconstruction Off Phase Partial Fourier Off 2D TOF Total Factor 7.2 Slice Partial Fourier Off tof_f12d_sag_obl 02:52 Reference Scans Integrat ... Asymmetric Echo Weak tof_f12d_paracor 02:09 GRE/Separate Integrated TOF Cs Reference Lines PE 24 Elliptical Scanning tof_cs_acc4.4 05:03 Reference Lines 3D 24 Integrated reference tof_cs_acc7.2 03:25 scan recommended since it is more robust tof_cs acc10.3 02:40 tof_cs_acc12.0_large 03:51 43 Unrestricted © Siemens Healthineers, 2023 Notes 254 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing SIEMENS >> head >> angiography >> TOF 8 3:25 min | Auto @ 7.2 0.4x0.4x0.4 mm3 1.00 tof_f13d_tra 05:33 Routine Contrast Resolution Geometry System Physio Inline Sequence Common Acceleration Filter TOF with large z-coverage FoV Read 220 mm tof_f13d_tra_large Trajectory Cartesian 05:27 FoV Phase 90.6 % 2D TOF Slice Thickness 0.4 mm tof_f12d_sag_obl 02:52 Base Resolution 384 ¢ Voxel Size tof_f12d_paracor 02:09 Phase Resolution 99 % Reconstruction: 0.38x0.38x0.40 mm3 TOF Cs Slice Resolution 66 % Acquisition: 0.58x0.57x0.61 mm3 tof_cs_acc4.4 05:03 Interpolation 1.50 ¢ tof_cs_acc7.2 03:25 tof_cs_acc10.3 02:40 tof_cs_acc12.0_large 03:51 44 Unrestricted © Siemens Healthineers, 2023 Notes 255 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing PAT =2, 5:33min CS Acc. =4.4, 4:59min 3:59:31 PM 16 IMA 1 FRM 1 CURRENT FIMA 1 FRM 1/ CURRENT RF A SPA17 3 8 IMA 1 FRM 1/1 CURRENT :54:44 PM CURRENT 2 IMA 1 FRM 1/1 MA 1 FRM 11 2MAI FRM 11 RF A SPARTA CS Acc. =7.2, 3:15min CS Acc. =10.3, 2:25min 45 45 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 256 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Compressed Sensing MAT FRM 1/1 TOF CS_ tof_cs_acc4.4 05:03 CS Acc. tof_cs acc7.2 03:25 = 4.4 tof cs acc10.3 02:40 5 cm 8 IMA 1 FRM 1/1 tof_cs_acc12.0_large 03:51 CS Acc. = 7.2 Uses: → Isotropic Voxels! 54:44 PM 2 MA 1 FRM 19 → Integrated Reference Lines → Interpolation 1.5 CS Acc. = 10.3 Sein 46 46 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 257 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Segmented ToF (a) Conventional TOF Saturation module upratrochipar artery - spoil spoil spoil spoil spoil spoin spoin praorbital- artery Anterior cerebral artery Middle cerebral artery ADC ADC 3 -______ Posterior communicating artery ADC ADC ADC ADC ADC Angular artery- Ophthalmic Posterior cerebral artery_ TR Basilar artery (b) Segmented TOF Internal maxillary artery artery- spoin spoil spoil spoil 11 - verte 1 ADC ADC ADC ADC ADC ADCÌ ADC ADC Time saving --------------------- artery 47 Ref: Zhang Zihao et,al Magnetic Resonance Imaging . Volume 33 (9), Pages 1043–1050 Unrestricted © Siemens Healthineers, 2023 Notes 258 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Segmented ToF Segmented ToF introduced with MAGNETOM Amira and Sempra with dedicated protocols provided. Routine Contrast Resolution Geometry System Angio Sequence Part 1 | Part 2 |Assistant Sequence Name fl_r Bandwidth 78 + Hz/Px >> head > angiography >> ToF Dimension 3D tof_f13d tra 05:11 Asymmetric Echo Allowed tof fl3d_tra_segmented 03:52 Excitation TONE tof_cs4.0_f13d_tra 03:14 ToF with large z-coverage Gradient Mode Normal tof_f13d_tra_large 06:28 Flow Compensation On Segments 3 + tof_f13d_tra_large_segmented 04:53 3 Segments. 16 48 Unrestricted © Siemens Healthineers, 2023 Notes 259 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... Segmented ToF Segmented ToF is also possible with other systems, however no dedicated protocols are available. @ 3:22 min 4 Auto @ 2 0.3x0.3x0.5 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence TR increases, however, that is the time Part 1 Part 2| Assistant between the Venous Saturation Pulses, Sequence Name fl_r Bandwidth 186 + Hz/Px true TR decreases! Dimension 3D Echo Spacing 9.32 | ms Sequence Type Gre Asymmetric Echo Weak Scan Assistant Excitation TONE Optimization None ? x RF Pulse Type Normal Define Segments ? Your last change Segments 4 Gradient Mode Fast will adapt the following parameters: Flow Compensation Slice/Read Segments 4 TR 21.0 - 48.8 ms Reordering Linear OK Undo 49 Unrestricted © Siemens Healthineers, 2023 Notes 260 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers' ... Segmented ToF TUIZU TO Image Examples from the Sempra. _f13d_tra_large_MIP_SAG test • 4 segments, ~20% scan time reduction head neck tof 2018.09.10-17:21:15-STD-1.3.12.2.1107.5.99.3 • With Segmented ToF the effective TR is 3/28/1 968, F, 50Y MAGNETOM Sempra MR XA12 CURRENT HFS JUDY ID 0c2d960f-b521-4c reduced resulting in lower vessel signal [of_13d_tra_large_MIP_SAG atest IMA 1 FRM 1/1 STUDY ID Oc2d960f-b52f-4c • Reducing the Flip Angle can recover vessel 6:41:32 PM 21 IMA 1 FRM 1/1 signal • Venous contamination is possible TR 26.0 TE 7.2 TA 01.06*6 R 26.0 p2 MAGNIANGIO/NORM/F M/F IU/DIS2D sagacor- 1 9 84 7.2 A1/PFP/SAT1 HL; HU .01:06*6 *13dir_170/ 25 FoV 180+103 TUIZU TU f_f13d_tra_large_fast_MIP_SAG head neck tof test 2018.09.10-17:21:15 STD-1.3.12.2.1107.5.99.3 ^3/28/1 968, F, 50Y MAGNETOM Sempra MR XA12 CURRENT HFS TUDY ID Oc2d960f-b52f-4c of_13d_tra_large_fast_MIP_SAG 46:58 PM atest 5 IMA 1 FRM 1/1 STUDY ID Oc2d960f-b52f-4c p:46:58 PM 25 IMA 1 FRM 1/1 ILF. AL.F. ILI 1E 7.2 TA 47.93^6 p2 MAGN/ANGIO/NORM/FM/FIL/DIS2D Sag-Cor(-).Tra R 26.0 SP LO.2 A1/PFP/SAT1 m 0 84 HL; HU E 7.2 *13d1r4170 / 25 A 47.93*6 SL 180.0i FoV 180*103 50 50 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 261 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers' ... Segmented ToF Image Examples from the Vida AHL AHL TOF & PC, Training No clinical TOF & PC, Training No clinical TOF & PC, Training Training MAGNETOM Vida Training MAGNETOM Vida Training • 4 segments, ~20% scan time "1/1/1956, F. 64Y *1/1/1956, F. 64Y "1/1/1956. F. 64Y CURRENT MR XA20 CURRENT MIR XA20 CURRENT 9/2/2020 HFS HE'S OLPH 9/2/2020 .LPH 9/2/2020 reduction tof_13d_tra:01 1of_13d_seg_tra 01 Bor_tijd_seg_tra latest latest ladest Latest STUDY ID 15+89204-4694 STUDY ID 1500920 • With segmented ToF the 8:44:48 AM 9 IMA1 FRM 87/136 30 MAT FRM 87/136 LEIMAT FRM 871 effective TR is reduced resulting RAH RAH 20 F cos SL 05 E SPC 0.5 SPC 0.5 F in lower vessel signal TR 21.0 TR 48.8 TR 48.8 TE 3.4 TP O SP F29.1 TE 3.4 TP O SP F29.1 TE 3.4 TP O Reducing the Flip Angle can TA01:19%4 FOV 181-200 TA 47.12%4 FOV 181 200 TA 47.12 4 SP F29.1 FOV 181-200 • BWV 186.0 P2 MAGNNORI 641*76851 BWV 186.0 661-768SI BW 186.0 661-76851 n(9)>Sap[.1) P2 MAGNINORMDIS Cor(.9)>Sag(-1) P2 MAGNINORMDIS or(.9)>Sag(-1) AT/SATI Zoom 0.72 AT/SATI Zoom 0.71 AT/SAT1 Zoom 0.71 recover vessel signal HE1,3,4 220 HE1,3,4 "13dir/ 20 116 HE1,3,4 "13dir4 / 20 116 "11301:4/15 116 • Venous contamination possible TOF & PC, Training No clinical TOF & PC, Training No clinical TOF & PC, Training Training *1/1/1956, F. 64Y MAGNETOM Vida Training AONETOM Vida Training *1/1/1 956, F. 64Y *1/1/1956. F. 64Y CURRENT MR XA20 MR XA20 9/2/2020 HFS CURRENT HE'S CURRENT .LPH 9/2/2020 OLPH 9/2/2020 lof_13d_tra_MP_TRA tof_13d_seg_tra_MIP_TRA 01 Bor_tijd_seg_tra_MIP_TRA IM . sall latest latest Latest STUDYID 15483206 $30:53 AM APPMATERM 19 1cm SL 68.0 SPC 0.5 SPCO5 680 TP O TR 48.8 TE 3.4 TP O TR 48.8 SP F38.3 TA47.12"4 SP F38.3 TE 3.4 FOV 181 200 TA 47.12.4 Fev101-200 661*7685 1 BWV 186.0 FOV 181 200 BW 186.0 Cor(.9)-Sap(.1) p2 MAGNMP_TRA/NORM/DIS2D 661 76851 Cor(9)>>Sag(-1) D2 MAGNIMIP_TRA/NORMDIS2D Zoom 0.71 AT/SATI Zoom 0.71 AT/SATI 452 457 184 HE1,3,4 HE1,3,4 -13dir4/ 20 *1301:4/15 Osegmento FARO SEcomento FATS 51 51 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 262 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast (PC) SIEMENS Healthineers ... MR Applications Fundamentals 1 Phase Contrast (PC) 52 Unrestricted © Siemens Healthineers, 2023 Notes 263 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast SIEMENS Healthineers ... Sequence Design Phase Contrast (PC) A subtraction technique, analogous to conventional X‐ray MIP 3D PC Venography angiography. Sag Cgr 14 Gradient Pulses are used to sensitize flowing blood (flow encoding) at a given velocity (VENC). A reference image with no Flow Sensitization is acquired. Subtraction produces images of only moving protons. 53 53 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 264 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast SIEMENS Healthineers ... Sequence Design Phase Contrast is a FLASH based Pulse Sequence. Four Data Sets are acquired: a TE • With Flow Compensation gradients but without RF Flow (Velocity) Encoding Bipolar Gradients time ................... • With Flow Encoding in Slice Direction Gslice • With Flow Encoding in Phase Direction • With Flow Encoding in Read Direction Gphase Gread 54 Unrestricted © Siemens Healthineers, 2023 Notes 265 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast SIEMENS Healthineers ... Sequence Design Allows separate flow in individual directions and to quantify the velocity. Provides better background suppression than ToF due to the subtraction. Too fast flow leads to phase shifts greater than 180, so called aliasing. • Depending on the velocity of the object • Depending on the amplitude of the bipolar Gradient‐Pulse (flow‐encoding gradient, or VENC‐Gradient) Inferior‐Superior Posterior‐Anterior 55 55 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 266 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Phase versus Velocity Considering the Phase after providing a bipolar gradient. • Stationary Spin: Φ =0, (Phi) signal refocused Bipolar Gradients Stationary Spins • Constant Flow: Φ V = YATV phase ∝ velocity +A Phase must be between –π to + π. Moving Spins ........... It’s important to avoid phase aliasing, (i.e., VENC value should be defined  appropriately). -A ........... Φ V = YATu v Gradient moment ∝ velocity ‐1 Phase ∝ Velocity A stronger gradient or a longer gradient Gradient Moment ∝ Velocity ‐1 duration is used for smaller VENC. 56 Unrestricted © Siemens Healthineers, 2023 Notes 267 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... VENC Scout Velocity Encoding (=VENC) is usually set on 24 sec 1| Auto @ 2 1.3x1.3x6.0 mm3 0.52 the maximum velocity of the measured Routine Contrast Resolution Geometry System Physio Angio Sequence area. Common Subtraction Cardiac MIP Composing Flow Mode Single Dir. If VENC is too large the SNR is low. Encodings 4 - Rephased Images v Velocity enc. [cm/s] Direction Magnitude Images 40 If VENC is too low, there is Phase aliasing Through Plane 50 Magnitude Sum (Phase shift > 180°). 60 70 A VENC Scout can be scanned to know Phase Images maximum flow in advance (must be adapted from heart). • Slice perpendicular to the vessels • Flow Mode: signal direction • Multiple VENCs (up to 5) with direction in through‐plane • Check phase aliasing in the phase images 57 Unrestricted © Siemens Healthineers, 2023 Notes 268 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... VENC Scout VENC ~ Vmax x 1.2. In this example, VENC= 50cm/s shows no phase aliasing. So, we take VENC= 60cm/s for the measurement! VENC 30cm/sec VENC 40cm/sec VENC 50cm/sec VENC 60cm/sec 58 58 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 269 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Vessels with different Velocities VENC = 10 cm/sec VENC = 30 cm/sec VENC = 60 cm/sec 59 59 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 270 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Protocols SIEMENS ... >> head >> angiography >> PC-arterial flow_pc3d_tra_venc40 04:36 flow_pc3d_tra_venc75 04:18 angiography Vessel Scout TOF PC-arterial SIEMENS SIEMENS >> head >> angiography >> PC-venous-sinuses PC-venous-sinuses flow_pc3d_sag_fast 12:58 Vessel-wall flow_pc3d_sag 07:31 angiography Vessel Scout TOF PC-arterial PC-venous-sinuses Vessel-wall 60 60 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 271 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers .. Parameters Flow Mode Ö 7:31 min Auto @ 2 0.6x0.6x0.9 mm3 1.00 Single direction Routine Contrast Resolution Geometry System Physio Flow nline • Sequence • Single velocity • Free Flow Mode Single Vel. Encodings Single Dir. Single Vel. Rephased Images v Reconstructed images Velocity enc. [cm/s] Free Magnitude Images Rephased images 20 Through Plane • A>> P Magnitude Sum M • Magnitude images F >> H • Magnitude sum • Phase images Phase Images Others TR & TE must be at minimum for flow measurements. Acquisition is at Iso‐center ( ISO mode). 61 Unrestricted © Siemens Healthineers, 2023 Notes 272 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Image Results Magnitude Right ‐ Left Anterior ‐ Posterior Superior ‐ Inferior Combined (Mag Sum) Phase Flow Velocity: VENC= 30 cm/s 62 62 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 273 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Image Results STUDY ID (5289204-4684-47 9:58:30 AM STUDY ID 15€89204-4684-47 61 IMA 1 FRM 20 /40 9:58:30 AM STUDY ID f5e 89204-4684-47 62 IMA 1 FRM 20/40 9:58:30AM 63 IMA 1 FRM 1/1 A LILLE 10cm SL SL TR 91.8 TP O TR 91.8 E TP O TR 91.8 TE 9.3 Rephased .S.P.R2.1. TE 9.3 TP O TA 03:57 TA03:57 Magnitude . _SPR.2.1 TE 9.3 TAU3:57 MIP of SP. R.O. 6 BW 199.0 FoV 220*220 384*5121 BW 199.0 FoV 220*220 384*5121 BW 199.0 FoV 220*220 p2 MAGN/T1/NORM/DIS2D p2 MAGNIANGIO/ADD/NORM/DIS2D p2 MAGN/ANGIO/ADD/NORM/DIS2D 384*5121 Images Sag A1/SAT1 Sum Sag A1/SAT1 Magnitude Sum Sag A1/SAT1 Zoom 1.20 Zoom 1.21 Zoom 1.24 HE1-4;NE2 W 264 HE1-4;NE2 W 306 HE1-4;NE2 362 *pc3d1 /7 C 106 *pc3d1 / 7 C 121 *pc3d1 / 7 141 63 63 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 274 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Comparison with TOF TOF & PC, Training No clinical TOF & PC, Training Training Training Mo Clinical "1/1/1 956, F. 64Y GNETOM Vida "1/1/1956, F. 64Y MAGNETOMY428 MR XA20 CURRENT CURRENT 9/2/2020 OLPH 83H 9/2/2020 tof_113d_tra tof_13d_tra_MIP_TRA latest latest STUDY ID f5e89204-4684- STUDY ID 150 09204-4004-47 0:46:10 AM 9 IMA 1 FRM 69/1 36 RAH 1cm arcos 0.5 arcos 000 TR 21.0 TR 21.0 TE 3.4 TP O TA01:19 4 SP F38.1 TE 3.4 TP O TA01:19 4 SP F 38.3 BW 186.0 BW 186.0 FoV 181 200 p2 MAGN/NOR 661 7689 1 661*768$ I or(-9)>Sag(-1) p2 MAGN/MIP_TRANORM/DIS2D Cor(-9)>Sag(-1) A1/SAT1 Zoom 0.72 A1/SAT1 Zoom 0.71 HE1,3,4 390 1.68 HE1,3,4 394 *113dir / 20 *13dir / 20 245 TOF & PC, Training No clinical TOF & PC, Training Training Training *1/1/1956, F. 64Y ONETOM Vida *1/1/1956, F, 64Y ONE JORNAL CURRENT MR XA20 CURRENT 9/2/2020 HFS +LPH 9/2/2020 flow_pc3d_tra_venc75_MSUM flow_pc3d_tra_venc75_MSUM_MIP_TRA latest latest STUDY ID 15e89204-4684-47 STUDY ID 15889204-4084-47 10:14:34 AM 80 IMA 1 FRM 64/128 RAH RAH 1cm 1cm SL 115.2 TR 48.1 TR 48.1 TE 5.7 TP O TE 5.7 TP O TA 04:18 SP F38.8 TA 04:18 SP F38.3 BW 300.0 BW 300.0 FoV 180*240 02 MAGN/ANGIO/ADD/NORMVDIS2D ra>Cor(-9)>Sag(-1) D2 MAGN/ANGIOIADD/NORM/DIS2D 200*512s I Cor(-9)>Sag(-1) A1 A1 Zoom 1.07 HE1-4;NE2 HE1-4;NE2 560 *pc3d1 /10 *pc3d1 /10 234 64 64 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 275 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Contrast MRA SIEMENS Healthineers ... Summary Advantages Reference Velocity values of different vessels • Well‐suited for depiction of slow flow ( veins) Vessel Vessel velocity (cm/s) • Based on Phase dependent T2 effects Cerebral artery 40‐65 • Slice Orientation is independent of flow • Also, possible after CM Aorta 100‐175 • No T1 shine‐through effect of blood products Carotid artery 80‐120 compared to ToF MRA (MRA of AVM’s or External iliac artery 80‐120 aneurysm in the presence of hemorrhage) Carotid syphon 55 Disadvantages Common femoral artery 115 3D with 4 scans: Very long scan times. Basilar artery 40 Velocity must be known in advance. Superficial femoral artery 90 Vertebral artery 40 Popliteal artery 70 Sagittal sinus vein 10 Peripheral vein 5‐10 65 Unrestricted © Siemens Healthineers, 2023 Notes 276 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Vessel Wall Imaging SIEMENS Healthineers ... MR Applications Fundamentals 1 Vessel Wall Imaging 66 Unrestricted © Siemens Healthineers, 2023 Notes 277 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Vessel Wall Imaging SIEMENS Healthineers ... Introduction Dot Cockpit - Explorer Explorer Program Editor Browse Import Export Edit Simulate X 7 SIEMENS ... >> neck soft tissue > angiography > TOF - carotids Vessel Plaque TOF with large z-coverage tof_f13d_tra 03:38 neck soft tissue Angio Dot Engine TOF thin slices > clinical libraries library tof_f13d_tra_iso 03:24 angiography TOF 2D Vessel Scout TOF - carotids tof_f12d_tra 02:29 Vessel-wall 67 Unrestricted © Siemens Healthineers, 2023 Notes 278 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Vessel Wall Imaging SIEMENS Healthineers ... Dissection Arterial Dissection A B The arterial wall consists of different layers. Intramural hematoma Dissection occurs as abnormal, and usually abrupt, Periadventitial inflammation Cystic medial necrosis formation of a tear along the inside wall of an artery. True lumen Fibromuscular dysplasia As the tear becomes larger, it forms a small pouch - Lumen Medial degeneration and fragmentation which is called the false lumen. - Tunica intima Tunica intima Endothelium Basal lamina of endothelium Basal lamina of endotheliun Blood that accumulates inside this false lumen can Internal elastic lamina Internal elastic lamina Normal External elastic lamina External elastic lamina generate blood clots, thickens the artery wall and can Tunica media Artery Tunica media artery Tunica adventitia Dissection Tunica adventitia block blood flow. C True lumen- Cervical artery dissection is a dissection of any of the Intimal rupture- Intramural hematoma arteries in the neck. • Carotid artery dissection • Vertebral artery dissection Tunica intima Endothelium Basal lamina of endothelium Internal elastic lamina External elastic lamina Tunica media Tunica adventitia 68 Ref images: https://healthjade.com/vertebral‐artery/ Unrestricted © Siemens Healthineers, 2023 Notes 279 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Vessel Wall Imaging SIEMENS Healthineers ... Protocols Arterial Dissection 3.OT XQ . >> SIEMENS >> head > angiography >> Vessel-wal The most common finding of dissection on MRI is Vida-XQ 21x 64RX MNO _3D SPACE _ crescent‐shaped intramural hematoma. t1_space_fs_sag_iso_0.6mm 05:56 SIEMENS Intramural hematoma is easily distinguished from the head surrounding tissue on fat‐suppressed T1‐weighted Brain Assist clinical libraries images. advanced applications libraries GOBrain library 3.OT XQ > neck soft tissue > angiography > Vessel-wall Intramural hematoma is bright on T1‐weighted images angiography Vida-XQ_2Tx_64Rx MNO 3D SPACE in its subacute stage; however, signal characteristics of E Vessel Scout t1_space_fs_sag_iso_0.9mm 06:02 E TOF SIEMENS intramural hematoma change with time after the E PC-arterial t2_space_fs_sag_iso_0.9mm 05:04 E PC-venous-sinuses initial injury. E Vessel-wall Special Purpose Coil [ neck soft tissue Angio Assist t1_se_fs_tra_blood-suppr. 03:26 In contrast, T2 signal changes are hyperintense to the [] clinical libraries library t1_se_fs_tra_blood-suppr_smallFoV 03:19 surrounding structures for the first two months. angiography E Vessel Scout • High resolution, fat saturated T1‐ (or T2‐) weighted, E TOF - carotids Spin‐Echo based sequence with blood suppression E Vessel-wall 69 Unrestricted © Siemens Healthineers, 2023 Notes 280 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Vessel Wall Imaging SIEMENS Healthineers ... Protocols High‐resolution T1‐weighted Spin‐Echo imaging with Fat Saturation. 70 70 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 281 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Vessel Wall Imaging SIEMENS Healthineers ... Internal Carotid Artery occlusion PD with FS ovoid eccentric hyperintensity in Right ICA CE‐MRA of the neck T2 TSE Axial shows loss of flow Shows an Infarct in the vessel 71 71 Courtesy of Dr. Sumita Kundu, M.D., DMRD; Dr. S. K. Sharma M.D. Kalkata/India Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 282 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE and QISS Non-Contrast MRA SIEMENS Healthineers NATIVE and QISS Non‐Contrast MRA MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 283 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Archiving • NATIVE TrueFISP • Time‐of‐Flight (ToF) 2D • NATIVE SPACE • Quiescent‐Interval Single‐Shot (QISS) 2 Unrestricted © Siemens Healthineers, 2023 Notes 284 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Describe the NATIVE TrueFISP sequence, benefits and applications • Identify the Time‐of‐Flight (ToF) 2D sequence and applications • Describe the NATIVE SPACE sequence, benefits and applications • Describe the Quiescent‐Interval Single‐Shot (QISS) sequence, benefits and applications 3 Unrestricted © Siemens Healthineers, 2023 Notes 285 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents. The information presented in this NATIVE and QISS presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.” 4 Unrestricted © Siemens Healthineers, 2023 Notes 286 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... MR Applications Fundamentals 1 NATIVE TrueFISP 5 Unrestricted © Siemens Healthineers, 2023 Notes 287 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... The Inversion pulse is used to enhance the contrast between flowing and static magnetization. Waiting for a TI time • The background and slow flow (e.g., veins) signal could be (partially) suppressed • The fresh blood keeps flowing into the inverted slab • Acquire the image and the blood signal is high Inversion pulse Inflow Imaging Inflowing arterial blood Inflowing arterial blood Inflowing arterial blood The inverted slab is larger than the imaging slab to have better suppression from veins. Imaging Static tissue Static tissue Inflowing venous blood Static tissue Inflowing venous blood Inflowing venous blood TI TI 6 6 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 288 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers' ... NATIVE TrueFISP is a flow‐dependent technique. The blood volume needed for imaging is directly proportional to the stroke volume. • Using ECG trigger, the scan could be more efficient • TI could be shorter, then TA is also reduced Image after MIP This is challenging if patient has a low stroke volume/minute and if the flow in general is low in the region of interest. Normal Stroke Volume Low Stroke Volume 7 7 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 289 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... To compensate the signal loss due to the low stroke volume, we could increase TI (>RR interval). ECG Disadvantages: longer TA and higher background signal. Inversion Pulse Time Routine Contrast Resolution Geometry TI Common AutoAlign Navigator Saturation Inversion Normal Stroke TrueFISP TrueFISP Graph. Sel. Inversion 1 Volume Readout Readout TI 620 - ms Thickness 150.00 - m TI TrueFISP Readout Low Stroke Volume 8 Unrestricted © Siemens Healthineers, 2023 Notes 290 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... To compensate the respiratory motion during the SIEMENS >> abdomen >> angiography >> NATIVE_TrueFISP 3D renals measurement, two approaches could be used. localizer 00:24 1. Respiratory synchronization to obtain high resolution 3D images. respiratory triggered • With navigator (e.g., 1D PACE) • Respiratory belt native_trufi3d_tra_resp_trig 01:41 2. Free Breathing Can be used with no respiratory synchronization ECG triggered with Navigator • where appropriate (e.g., renal transplants) native_trufi3d_tra_nav_ecg 00:19 • Greatly accelerates scan time angiography >> NATIVE_TrueFISP 3D renals >> native_trufi3d_tra_resp_trig ngiography > NATIVE_TrueFISP 3D renals > native_trufi3d_tra_nav_ecg Ö 1:41 min Auto @ 2 @ 1:33 min 1 Auto @ 2 Routine Contrast Resolution Geometry System Physio Routine Contrast Resolution Geometry System Physio Signal Cardiac PACE Signal Cardiac PACE 1st Signal/Mode Resp./Trigger Resp. Control Gate Average Cycle No Signal ms Scout Mode 9 Unrestricted © Siemens Healthineers, 2023 Notes 291 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers' ... Use 1D PACE as the trigger method Routine Contrast Resolution Geometry System Physio Inline Sequence 1. Plan the navigators (avoid placing them through the Signal Cardiac PACE kidney or the renal arteries). Resp. Control Gate 2. Run the measurement in Scout Mode. Scout Mode 3. Repeat and the Open the Sequence and enter the Tracking Factor 0.60 ¢ Scout Duration 19 Chronologic Position Before Echo value from the Position Histogram (Pos. Histogram) Scout TR 100 ms into Search Position. Accept Window # 4.00 - mm Pos. Histogram (Mode 130) 4. Remove the Scout and start the official scan. Accept Position (green) 128.00 - mm Search Window # 32.00 40 IMA2 FRM 415 9 IMA 1 FRM 12/1,81 Search Position (red) 130 mm -30 -20 10 ov 435-329 143-42.0 100 140 POR MAGNINORANDIS2D 3 MAGNINORM/DIS2D 10 10 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 292 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... Resp. Control of 1D PACE Gate: the image data are only accepted if the diaphragm position is within the acceptance window. Gate & Follow: if the navigator result is within the ngiography > NATIVE_TrueFISP 3D renals > native_trufi3d_tra_nav_ecg acceptance window, the positions of the slices to be 19 sec Auto @ 2 measured are offset in accordance with the navigator Routine Contrast Resolution Geometry System Physio result and the measurement is resumed with the next Signal Cardiac PPARE iteration of the loop structure. Otherwise, the current Resp. Control Gate loop is repeated. Scout Mode Gate & Follow Gate Monitor only: the navigator signals are calculated and Monitor Only Tracking Factor Off displayed in the usual way, but they are not used to control the measurement. Off: navigator control is disabled. 11 Unrestricted © Siemens Healthineers, 2023 Notes 293 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... Planning of the Acquisition slab and the Inversion slab. The inversion slab is larger than the imaging slab. The imaging slab covers the renal arteries. 9 IMA 1 FRM 1/18 9 IMA 2 FRM 4/5 IMA 1 FRM 12/181 Imaging slab Pre‐saturation slab IF SP R40.0 OV 430*430 OV 430*430 FOV 430 P2 MAGN/NORMIDIS2D Sag>Tra(3) p2 MAGN/NORM/DIS2D ocalizer_bh 2 MAGN/NORM/DIS2D 411 localizer_bh localzer bh C 164 iagnostic use Not for diagnostic use Not for diagnostic use 12 12 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 294 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... Navigator planning and image results. ............... .......................... ................. ........................................................................................ × ......................................... .................................................................................................................. ................................................... ................................................................................ ........................................................................ 13 13 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 295 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers' ... During the scan, the inline display window shows the information. • Remaining percentage of data acquisition Mode 128 • Acceptance rate Ima 65% Accept 46% 5240 • Data acquired within the green box is be used for image £220 reconstruction -200 -180 160 129 F140 +120 £100 -80 -60 40 159 171 182 194 205 14 14 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 296 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... With ECG triggering • Allows optimal timing of scan in relation to blood flow ECG • In some cases, more efficient as each TI can be guaranteed to include a systolic event Inversion pulse Time • Can reduce motion blurring from TI 600‐800ms pulsatile vessels Normal Stroke TrueFISP Volume Readout Without ECG triggering • Can be used for convenience Low • Needs longer Inversion Times to TrueFISP Stroke TI~1200ms guarantee a good volume of non‐ Readout Volume inverted blood TrueFISP No ECG TI~1200ms Readout Trigger 15 Unrestricted © Siemens Healthineers, 2023 Notes 297 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... Abdominal Angiography • Normal upper abdominal arterial anatomy • Note demonstration of hepatic, splenic, proximal SMA, renals, etc. • Proximal gastro‐duodenal artery seen but distally is lost due to bowel motion which cannot be compensated for 16 16 Courtesy Dr. Carr and Dr. Sheehan, North Western Memorial Hospital Chicago Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 298 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers' ... Patient with Renal Artery Stenosis CE MRA NATIVE TrueFISP TR = 3.5ms, TE = 1.2ms TR = 866.3ms, TE = 1.6ms TA = 13.27 s TI = 790ms, TA = 3:21 mins Slice = 1.2mm, Res. = 227x384 Slice = 1mm, Res. = 216x304 17 17 Courtesy Dr G Houston & S Gandy, Ninewells Hospital, Dundee UK Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 299 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... Patient with Patent Renal Arteries. CE MRA NATIVE TrueFISP TR = 3.4ms, TE = 1.2ms TR = 1116ms, TE = 1.5ms TA = 12.85 s TI = 1000ms, TA = 2:35 mins Slice = 1.2mm, Res. = 227x384 Slice = 1mm, Res. = 216x304 18 18 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 300 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... Transplanted Kidney TA = 4:36 mins TI = 1200 ms, Voxel Size = 1x1x1 mm3 19 19 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 301 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers' ... IVC Signal Suppression CAMRI_Atil CAMRI_Atil TH CAMRI Atil Sms 46 IMA 1 / 1 1/8/2010 901 BO1 SP2 SP3 BO2 BO2 BO2 TPO 94 428 COR/NORM/DIS2D SP P9.7 Resp_cor_no_ECG_MIP_COR 360*360 MF COR/NORM/DIS2D Cor Resp_cor_no_ECG_MIP_COR oV 360-3 93 MIR COR/NORM/DIS2D esp_cor_no_ECG_2IRS_ y SP P Resp. Trigger Resp. Trigger Resp. Trigger TI=800ms TI=1300ms TI1=1300ms, TI2=800ms 20 20 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 302 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE TrueFISP SIEMENS Healthineers ... MR Vena Portae TI1 TI2 3D Half‐Fourier TSE 3D True SSFP TI1=1200ms, Thickness=150mm, suppress the signal of liver, heart, and thoracic descending aorta TI2=1100ms, Thickness=200mm, suppress Inferior Vena Cava (IVC) 21 21 Ref: Shimada K et al., JMRI 29: 1140‐1146 (2009) Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 303 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Non-CE Peripheral MRA SIEMENS Healthineers ... MR Applications Fundamentals 1 Non‐CE Peripheral MRA 22 Unrestricted © Siemens Healthineers, 2023 Notes 304 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Time‐of‐Flight (ToF) SIEMENS Healthineers ... 2D ToF is a conventional and common technique ography > angiography > TOF legs > tof_f12d_tra_ecg ? for non‐contrast‐enhanced peripheral 3:12 min 4 Auto 1.1x1.1x3.5 mm3 1.00 Routine Contrast Resolution Geometr System Physio Angio angiography. Sequence Signal 1st Signal/Mode ECG/Trigger ECG triggering is used to acquire images during Average Cycle No Signal ms systole and to maximize the inflow effects. Captured Cycle not set- Acquisition Window 800 - ms 0.8 1.6 4[s] The venous signal is suppressed by using a Trigger Pulse Concatenations 48 + tracking saturation band. Trigger Delay 90 ms Phases SIEMENS > peripheral angiography >> angiography >> TOF legs Routine Contrast Resolution Geometry System Physio Angio Sequence Common AutoAlign Saturation Tim Planning Suite localizer 00:10 Saturation Region Special Saturation Tracking F tof_f12d_tra_ecg 02:12 Gap 10.00 mm Thickness 40.00 - mm 23 Unrestricted © Siemens Healthineers, 2023 Notes 305 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 2D TOF SIEMENS Healthineers ... Parameters Routin Contras Resolution Geometry Common Dynamic NATIVE Trainingscenter TR 458.0 + ms *10/15/1 956, M, 64Y MAGNETOM Sola MR XA20 FFS TE 3.70 % ms Shortest CURRENT 10/16/2020 0.00 ms Opposed Phase TE tof_f12d_tra_ecg_COMP TD latest MTC STUDY ID 34207904-df28-41 10:19:17 AM Magn. Preparation None R MIP SL 5 cm full 50 ¢ deg TT 375.0 A Flip Angle TR 467.0 TE 7.0 BW 200.0 TP H299 MIP : MAGN ANGIO/COMPOSED/NORM DIS2D SP P14.9 MTC CT 142p*320 A1/PFP/SAT1 Cor 308 Flow Direction H>> F Define the direction of *f12d1 r25 / 50 120 the Tracking Sat‐Band 24 24 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 306 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 2D TOF SIEMENS Healthineers ... Limitations of 2D TOF in non‐contrast enhanced peripheral angiography. • Longer scan time • Difficulties of optimizing the trigger delay • Signal loss due to in‐plane flow saturation • Signal loss due to turbulence, slow or saturation of retrograde flow • Signal loss due to susceptibility artifacts • Motion sensitive 2D TOF DSA 2D TOF In‐Plane Flow Saturation Motion Artifact 25 25 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 307 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 TOF 2D SIEMENS Healthineers' ... 2D TOF Retrograde flow CE‐MRA 2D‐TOF Metal Susceptibility Artifact DSA 26 26 Ref: Kaufman JA et al., AJR:171, July 1998 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 308 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... NATIVE SPACE is a flow‐sensitive 3D Turbo Spin Echo (TSE) sequence. Systole Diastole The contrast is based on the difference in the Flow signal‐intensity between diastole and systole. Artery Signal intensity in systolic phase. Vein TECG Arteries: dark Veins: bright Vein Signal intensity in diastolic phase. Signal Signal Arteries: bright differences Veins: bright from veins Signal differences from arteries After the subtraction, most of the information Artery from arteries is kept. TECG 27 Unrestricted © Siemens Healthineers, 2023 Notes 309 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... Acquire the images in systolic and diastolic phases, then calculate the S.I. diastole – S.I. systole = NATIVE SPACE results subtraction results. Signal Vein Artery TECG Systole Diastole 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 310 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... The flow sensitivity can be enhanced by using the additional spoiler gradients. 180 180 180 180 180 The signal difference between diastolic and 90 systolic phases would be amplified. RF Standard GR Flow‐sensitized GR Systole Systole Diastole Diastole S.I. S.I S.I. S.I The effects of flow‐spoiled Flow-spoiled Flow-spoiled pulse pulse gradients on signal intensity between fast and slow flow. Artery Vein Artery Vein Artery Vein Artery Vein 29 Unrestricted © Siemens Healthineers, 2023 Notes 311 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers' ... How to determine the optimal cardiac phases for the measurement? 2D TD scout. • Single slice on the interested region, perpendicular to the vessels • Prospective triggered measurement • 2D CINE scan • High flow velocity shows high signal in the images .................................................................................. SIEMENS >> peripheral angiography >> angiography > NATIVE_SPACE legs FastView 00:24 cine_TD_scout 00:15 native_space_cor_ecg 04:54 Generic Views 30 30 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 312 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... Mean (%) Trigger Time: 0.32 sec Mean: 518 Load the TD scout images to Time Curve. Ratio: 2379.79 % • Place the ROIs in the arteries • Find the timing for the diastole (TDmin) and 2250 the systole (TDpeak) 2000 Min / Max: 15.00 /256.00 Mean/SD: 135.38 /70.46 1750 Area: 0:34 cm2 Min / Max: 107.00 /765.00 In NATIVE 3D mode. Sum: 2166.00 Mean/SD: 518.00 /246.85 16 Pixels Area: 0.24 cm2 Sum: 4662.00 TC4 9 Pixels Min / Max: 85.00 /159.00 • TDmin=0 (usually, not always) Mean/SD. 120:57 /32.13 1500 Area: 0.14 cm2 Sum: 844.00 • TDpeak=(TTmax‐ 30) 7 Pixels 1250 jiography >> angiography >> NATIVE_SPACE legs >> native_space_cor_ecg ? Note: & 2:27 min / Auto 2 4 @ 1.0x1.0x 1.0 mm3 @ 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence 750 • For a multi‐station scan, you could plan TD Signal Cardiac PACE scout for each station to find the optimal TD 1st Signal/Mode FCG/Trigger Average Cycle No Signal ms peak and TD min values Captured Cycle -not set- Acquisition Window ms • If using STIR, then TI should be considered 889 0.8 1.6 4[s] Trigger Pulse Concatenations into the TD settings Max. Trigger Delay 300 ¢ ms NATIVE 3D Mode ak Flow 300 ms TR 589.0 ¢ ms TD Min Flow ms Flow Sensitivity Default Measurements 2 31 31 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 313 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... The protocol uses a Set‐n‐Go setup and enables inline composing using the adaptive algorithm. The composed results are generated after the scan. iography > angiography >> NATIVE_SPACE legs >> native_space_cor_ecg ? >> @ 2:27 min 1; Auto @ 4 1.0x1.0x1.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Common AutoAlign Navigator Saturation Tim Planning Suite Set-n-Go Protocol Inline Composing Step +- Normalize Off Table Position H 470 - mm Save non-normalized Composing Function Adaptive Series Description 32 32 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 314 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... 3D syngo NATIVE SPACE provides an optimal solution. Ultrashort Echo‐Spacing allows collection of a complete partition of a 3D data set in approximately 200ms. Typical Spatial Resolution 0.9x0.9x1.5 mm. Scan Times around 3 minutes per station, depending on the heart rate. 33 33 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 315 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... NATIVE SPACE results NATIVE SPACE results CE‐MRA CE MRA results 34 34 Courtesy Dr Lee, NYU Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 316 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... Applications in other regions Co> Tra 35 35 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 317 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers' ... It strongly depends on the pulsation of the vessels. Low pathologic pulsation or irregular heart rates would lead to image quality problems. In some pathologic cases (e.g., stenosis) the timing can be different in right and left leg. It is very motion sensitive due to the subtraction. Image quality problems in pelvic region include: • B1 inhomogeneity in 3T • Minimum flow data are difficult to obtain TWIST QISS NATIVE‐SPACE 36 36 Ref: Ward EV et al., J Magn Reson Imaging. 2013 Dec; 38(6): 10.1002/jmri.24124 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 318 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NATIVE SPACE SIEMENS Healthineers ... If the peak comes too early, then it is not appropriate to set the TDmin=0. • Data window duration ~ 200ms • Acquired data has contamination from the peak flow → Low contrast S.I. Jiography >> angiography >> NATIVE_SPACE legs >> native_space_cor_ecg ? X 2:27 min | Auto @ 4 @ 1.0x1.0x 1.0 mm 1.00 Routine Contrast Resolution Geometry TDmin=0 System Physio Inline Sequence Signal Cardiac PACE Acquisition window (diastole) 1st Signal/Mode ECG/Trigger Acquisition window (systole) Average Cycle No Signal ms 0 200 400 600 800 Captured Cycle -not set Trigger Time Acquisition Window 889 + ms S.I. 0.8 1.6 4[s] Trigger Pulse Concatenations 1 + Max. Trigger Delay 300 ms NATIVE 3D Mode TDmin≠0 Data window duration: 204 ms Data window start: 304 ms TD Peak Flow 300 m Acquisition window (diastole) TR 589.0 - ms TD Min Flow 0 ms Acquisition window (systole) low Sensitivity Default Measurements 2 + 0 200 400 600 800 37 Unrestricted © Siemens Healthineers, 2023 Notes 319 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Quiescent-Interval Single-Shot (QISS) SIEMENS Healthineers ... MR Applications Fundamentals 1 Quiescent‐Interval Single‐Shot (QISS) 38 Unrestricted © Siemens Healthineers, 2023 Notes 320 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... QISS is a non‐contrast‐enhanced MR angiography technique 58 21109 00 POST-1.3.12 .. that uses a 2D TrueFISP or FLASH sequence for data acquisition. R‐wave Cor Cor ECG 90° Sat pulse 90° Tracking Original Sat pulse Time (imaging slice) publication (venous spins) Readout 100ms QI A A Fat sat Product 90° Tracking Sat pulse 90° Sat pulse (venous spins) (imaging slice) Standard Tracking Sat TR‐FOCI Tracking Sat 39 39 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 321 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Sequence Steps: 1. Saturation slab suppresses the venous inflow. ECG 2. Saturation slice suppresses the signal of the tissues. 3. Waiting for QI, roughly coinciding Time with the period of rapid systolic Arterial flow arterial flow. 4. Providing the fat sat pulse, and TI TD starting the scan (single‐shot, QI TrueFISP slice by slice). Saturation of Saturation of venous inflow imaging slice Fat sat k‐space center E 40 40 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 322 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Typical parameters and results: • Steps 7‐10 with 50 Slices each • Slice Thickness = 3mm • Distance Factor = ‐20% • FoV = 400mm x 65% • Matrix = 400 • Flip Angle = 50‐120° • Partial Fourier = 5/8 • PAT = 2‐3 • TD = 100ms • TI = 345ms 41 41 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 323 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Workflow Basic QISS Assist Program Auto Breath‐Hold Commands • Angio Patient View for breath‐hold setups It is enabled in the patient view. • The guidance view for ECG positioning • FastView Localizer (or Set‐n‐Go*) General Parameters Breath-Hold Parameters • QISS protocol enabling Auto Timing function Exam Strategy QISS Auto Breath-Hold Commands V English (United ...... ... >> peripheral angiography >> angiography »> QISS Pause Between Breath-Holds 15 - s QISS Angio Patient View V QISS PERU positioning Generic Views QISS is disabled. Do the following to enable it : FastView 00:33 Select automatic voice commands in Patient View. qiss_trufi_tra_ecg 06:08 O QISS *If the system does not have FastView feature use set‐n‐go to configure the localizer scan. 42 Unrestricted © Siemens Healthineers, 2023 Notes 324 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Guidance View for ECG positioning Protocol adaptions depending on the heart rate ECG should be positioned over the shoulder to avoid • RR interval < 800 → TrueFISP with iPAT factor 3 interferences or susceptibility effects from the PERU • RR interval > 800 → TrueFISP with iPAT factor 2 transmitter unit. Guidanc Parameters Position the patient feet first and supine. Queue Enable Auto Timing For this examination it may be useful to position the GSP Conditions PERU next to the patient's head (as shown in the Series Label Captured Cycle › › Other 800.C picture). Auto Load This can help to reduce gradient interferences or Auto Timing artifacts in the vicinity of the PERU transmitter unit. QISS AutoTiming will adapt the following parameters if the conditions are not met Conditi ... Parameter Limit Increment 0 Acceleration Factor PE V 3.0 1.0 43 Unrestricted © Siemens Healthineers, 2023 Notes 325 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... ECG Challenges Gradient Interference Susceptibility Effects Gradient Coil Gradient Coil Imaging Slices Imaging Slices Gradient Coil Gradient Coil ECG/gradient Susceptibility interference artifacts 44 44 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 326 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... ECG Challenges Susceptibility artifacts can be removed by positioning PERU in the head direction. Gradient Coil Gradient Coil Artifacts Gone 45 45 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 327 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Planning Workflow 1. Select number of Steps (up to 12 steps possible). 2. Enable Auto Breath‐Hold Commands and define the Concatenations per Step. 3. Select Steps that use breath‐hold measurements. 3 1:38 min | Auto @ 2 @ 0.5x0.5x3.0 mm3 1.00 QISS arameter 45 sec 1 Auto 2 @ 0.5x0.5x3.0 mm3 1.00 QISS Parameters Adapt the number of steps to be measured according to the patient's height and select the range of voice Adapt the number of steps to be measured according to commands. the patient's height and select the range of voice Number of Steps 8 + Number of Steps 8 Auto Breath-Hold Commands Auto Breath-Hold Commands Concatenations per Step 3 + Breath-hold Duration: 3 x 15.0 s W UI 46 Unrestricted © Siemens Healthineers, 2023 Notes 328 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers' ... Planning Workflow 4. Switch On Group Graphics to move whole ico = EO= slabs together. Add Slice 3 Point Radial Saturat. Group Gap +/- FOV H- Slices Band Graphic Stack +H Line Mode Package Over- Group Mode Mode sampling 5. Change the Step Number to adapt the patient size or focus on specific regions. NATIVE QISS Parameters IMA 1 FRM 12/18 Adapt the number of steps to be measured according to the patient's height and select the range of voice commands. Number of Steps Auto Breath-Hold Commands Concatenations per Step 3 4 A Breath-hold Duration: 3 x 15.4 s TP O SP A42.0 FoV 430*430 p2 MAGN/NORM/DIS2D Cor localizer_bh[1] L W 47 47 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 329 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Planning Workflow 6. 3D Distortion Correction is used as the standard in myExam QISS Assist. 7. An Overlap is needed for the adjacent slice stack. This is automatically planned for 3D Distortion Correction in QISS Add‐In. 8. If 2D Distortion Correction is selected, it is planned without an overlap. ography >> angiography > QISS >> qiss_trufi_tra_ecg Ö 46 sec NATIVE Routine Contrast Resolution Geometry System 1 IMA 1 FRM 12/18 Common Acceleration Filter Raw Filter Elliptical Filter POCS Off 10cm A Overlap = 4 Slices TPU Distortion Correction 3D ... SP A42.0 FoV 430*430 p2 MAGNINORM/DIS2D Cor localizer_bh[1] W 163 C 64 48 48 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 330 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Workflow Results QISS XA11A 2D Distortion Correction QISS XA20A 3D Distortion Correction H va20_Fh3_32_pa36_AB va20_Fh3_32_pa36_AB 2019.03.28-13:16:51-STD-1.3.12.2.1107.5.99.3 MAGNETOM Sola fit 2019.03.28-13:16:51-STD-1.3.12.2.1107.5.99.3 MAGNETOM Sola fit *3/27/1961, F, 58Y MR XA20 *3/27/1961, F, 58Y MR XA20 CURRENT FFS CURRENT FFS 3/28/2019 3/28/2019 qiss_trufi_tra_ecg_COMP_CO 4 qiss_trufi_tra_ecg_COMP latest latest STUDY ID 223ea2e1-514a-4f 1:24:55 PM STUDY ID 223ea2e1-514a-4f 1:47:49 PM |R 10cm 10cm SL full L full SPC 1.0 SPC 1.0 A A TI 345.0 TI 345.0 TR 718.8 TR 718.8 TE 2.0 TE 2.0 BW 658.0 TP H96 BW 658.0 MIP : p2 MAGN/COMBINE/DIS2D SP P29.8 MIP : p2 MAGN/COMPOSED NORM DIS3D SP P17.1 520p*800 1 CT 520p*800 1 A1/SR/PFP/SAT1/FS Cor CT 787 A1/SR/PFP/SAT1/FS Cor W 777 *tfi2d1_142 / 120 388 *tfi2d1_142 / 120 C 388 COMBINE 49 49 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 331 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Scan Workflow Start the scan 1. After the planning, click Go button to start the 2. All steps run consecutively from the most measurement. distal step (F>H direction). localizer localizer astView - 2 qiss_trufi_tra_ecg 05:02 FastView 3.1 qiss_trufi_tra_ecg 3 qiss_trufi_tra_ecg 2 05:02 Delete Skip Stop Pause Continue Copy&G Go Cancel 50 Unrestricted © Siemens Healthineers, 2023 Notes 332 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Scan Workflow 3. Imaging Series – one series for each segment and one COMP series shown in 3D generates a MIP image inline composed result. (i.e., Inline MIP is not enabled). ATIVE Trainingscenter *10/15/1956, M, 64Y MAGNETOM Sola MR XA20 CURRENT FFS 10/16/2020 qiss_trufi_tra_ecg_COMP_FILT 2 24 qiss_trufi_tra_ecg latest 25 qiss_trufi_tra_ecg_1 STUDY ID 34207904-df28-41 10:34:27 AM 26 qiss_trufi_tra_ecg_2 27 qiss_trufi_tra_ecg_3 Images from each MIF 28 0cm qiss_trufi_tra_ecg_4 single Step. full 29 qiss_trufi_tra_ecg_5 TT 472.5 A TI 345.0 30 TR 667.6 qiss_trufi_tra_ecg_6 TE 1.7 BW 658.0 TP F62 31 qiss_trufi_tra_ecg_7 MIP : p2 MAGN/COMPOSED/NORM/DIS2D SP P22.9 CT 32 A1/SR/PFP/SAT1/FS Cor qiss_trufi_tra_ecg COMP *tf12d1_142/120 108 33 qiss_trufi tra_ecg_COMP_FILT 51 51 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 333 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Protocols High Resolution protocols SIEMENS > peripheral angiography > angiography >> QISS_library Can be used for repetition of single steps with a smaller RR interval > 800 ms slice thickness. qiss_trufi_tra_ecg 00:46 FLASH protocols FLASH protocols are only available for 3T. qiss_flash_tra_ecg_bh 01:40 Use FLASH if there are too many TrueFISP artifacts (susceptibility/dark rim artifacts). qiss_trufi_tra_highres_ecg 01:40 RR interval < 800 ms qiss_trufi_tra_fast_hr_ecg 00:39 qiss_flash_tra_fast_hr_ecg_bh 01:21 qiss_trufi_tra_fast_hr_highres_ecg 01:22 52 Unrestricted © Siemens Healthineers, 2023 Notes 334 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... High Resolution protocols High Resolution protocols are available in the QISS_library. High Resolution protocols can be used for repetition of single steps with a smaller slice thickness. Slice thickness 1.5mm 53 53 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 335 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Susceptibility Challenges TrueFISP & Standard Shim TrueFISP & Manually Shim FLASH & Standard Shim Protocol available @3T 54 54 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 336 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... ECG vs. Pulse Trigger ECG triggering can obtain a much better result than Pulse Triggering. Reason: the Quiescent Interval (QI) for inflow mainly overlaps the period of slow flow when using pulse triggering. Possible solution: increase the trigger delay to acquire the data after the next trigger pulse → scan time doubled!! ECG trigger (delay=100ms) Pulse trigger (delay=0ms) 55 55 Ref: Edelman RR et al., Magn Reson Med. 2010 April ; 63(4): 951–958. doi:10.1002/mrm.22287 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 337 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Clinical Example QISS provides non‐CE peripheral MRAs for patients with renal insufficiencies at comparable accuracy to contrast enhanced MRA1. Patient Case: • 79‐year‐old male • History of hypertension, prostate cancer and ischemic cardiomyopathy • Assessment of the left tibial vessels with CE MRA was limited by venous contamination Findings Occlusion of the anterior tibial arteries. CE MRA QISS 1 Hodnett, AJR Am J Roentgenol.‐197(6):1466 56 56 Courtesty of: Northwestern University, Chicago, US Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 338 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Clinical Example Patient with PAD Patient with Stents QISS MRA CTA DSA QISS MRA CTA DSA Ref: Varga‐Szemes et al. JACC: CARDIOVASCULARIMAGING, Vol. 10 , No. 10, 2017:1116‐24 57 57 Accuracy of Non–Contrast‐Enhanced QISS MRA Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 339 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers ... Clinical Example Prerequisites: Recommended configurations • VE11A APP_THP or higher • Tim Whole Body Suite • syngo NATIVE • Dedicated Peripheral Angio coil • Tim Planning Suite or • MyExam Angio Assist or SIEMENS • Adv. Assist Imaging Package 58 58 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 340 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 QISS: Quiescent‐Interval Single‐Shot SIEMENS Healthineers' ... Clinical Example Signal loss within the vessel. 1kommas_recht 1komma5_rechts Skyra Anonymous MR E11 O FFS The artifact is caused by interplay of a local SHRRENT +LPH CURRENT 5/11/2017 Series 9> 1. 2 «Series 9> latest tri‐phasic flow pattern, the saturation preparation pulses and the imaging module in SIMAn a FRMna amAn a. FRM n.a RPH QISS. SL 0 1 cm SPCOS SL SPC 0.5 0.5 • It is possible to reduce the artifact by TT 475.0 F TI 345.0 TI 345.0 LA TR 755.2 TR 755.2 TE 2.4 TE 2.4 increasing the gap between the imaging BWV 650.0 TP O BW 650.0 MPR THICK : ... NORM/DIS2D SP H58.1 208p*208 MPR THICK : ... NORM oBp-208 CT CT A1/SR/PFP/SAT1/FS Tra>Cor(11)>Sag(-3) slice and the saturation slab Corp Trat- 112-829522 15K 542 A1/SR/PFP/SAT1/FS 15K *tfi2d1_116/ 120 218 "tfi2d1_116 / 120 • Drawback: the degree of venous suppression decreases 1komma5_rechts Skyra Anonymous MR E11 FFS +LPH CURRENT 5/11/2017 -Series 9- 1, 2 latest 9 iMAn. FRMna 9:13:04 AM AHR LAF MPR SL 0.5 SPC 0.5 full TI 345.0 TT 475.0 TI 345.0 LIP TR 755.2 TR 755.2 TE 2.4 TP O TE 2.4 BW 650.0 MPR THICK: ... NORM/DIS2D BP R90.1 BW 650.0 MIP : p2 M/NORM/DIS2D CT 08p*208 A1/SR/PFP/SAT1/FS )>Tra(4) CT A1/SR/PFP/SAT1/FS 15K 542 218 15K *tf12d1_116/120 "ti2d1_116 / 120 59 59 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 341 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 NonCE Peripheral Angiography SIEMENS Healthineers ... HA 2D TOF NATIVE‐SPACE QISS 60 60 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 342 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR MSK Imaging SIEMENS Healthineers MR MSK Imaging MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 343 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... MR MSK Imaging • Coils and Positioning • Arthrography • Parameters • Protocols • myExam Large Joint Assist 2 Unrestricted © Siemens Healthineers, 2023 Notes 344 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Identify coils and positioning • Describe Arthrography for MSK imaging • Explain the various parameters used for MSK imaging • List the protocols used for MSK imaging • Describe the benefits and parameters for myExam Large Joint Assist 3 Unrestricted © Siemens Healthineers, 2023 Notes 345 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents. Siemens Healthineers MAGNETOM MR systems are not labeled for use with implantable medical devices. FDA has not evaluated the safety and effectiveness of these systems for use with implantable medical devices. Siemens Healthineers does not assume any responsibility or liability for the operation of a MAGNETOM MR System with any implantable device. Please direct any safety related questions to your facility’s MR Safety Officer (MRSO), MR Medical Director (MRMD), or Directing Radiologists. Competition product descriptions, comparison and specifications contained in this document are based on interpretation of available data at the time this material was being prepared [include date] and may require independent verification. Specifications have been obtained from competition brochures, websites, and other independent published sources. The information presented in this MR Musculoskeletal is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. 4 Unrestricted © Siemens Healthineers, 2023 Notes 346 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Positioning SIEMENS Healthineers ... MR Applications Fundamentals 1 Coils & Positioning 5 Unrestricted © Siemens Healthineers, 2023 Notes 347 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... tmj shoulder elbow wrist TMJ Shoulder Elbow Wrist hand hip knee ankle foot Ankle Knee Hip Hand 6 6 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 348 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... TMJ (Temporomandibular Joints) TMJ with HN20 or HN16 0 tmj clinical libraries E general library ] localizer @ T1 E T2 E PD 7 Unrestricted © Siemens Healthineers, 2023 Notes 349 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Shoulder – High element density coils Shoulder with Shoulder Large 16 (SHL) or Shoulder with Shoulder Shape 16 (SHA) Shoulder Small 16 (SHS) ,(2) Optimal fit to patient (3) anatomy with flexible coil elements 8 Unrestricted © Siemens Healthineers, 2023 Notes 350 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Shoulder Shoulder with 4CH Flex Large (FL) Shoulder with UltraFlex Small 18 (UFS) Protocols shoulder ... >> SIEMENS >> shoulder >> library >> BLADE _ high channel coils_ Shoulder Assist pd_blade_cor_256 03:32 E general 2D pd_blade_tra_256 04:17 E general 3D pd_blade_fs_tra_256 04:17 library pd_blade_fs_cor_256 04:17 E localizer t2_blade_tra_320 04:23 E T1 t2_blade_fs_cor_320 04:38 t2_blade_fs_sag_320 04:38 E PD - medium channel coils_ For the Vida Fit: local overheating of Flex Large 4 E 3D pd_blade_sag_320 04:50 Do not use this coil for scanning with table E BLADE • pd_blade_fs_tra_256 04:34 movements (e.g., whole body or angio E QUIET pd_blade_fs_cor_256 03:50 examinations) • Always position the coil iso‐centrically in head‐ clinical libraries 2ª. t2_blade_cor_320 03:51 foot direction (z position). The maximum E general t2_blade_sag_320 03:58 deviation should not exceed ±5 cm in the E arthrography t2_blade_fs_cor_256 03:39 head‐foot direction t2_blade_fs_sag_256 03:54 9 Unrestricted © Siemens Healthineers, 2023 Notes 351 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Elbow Elbow with 4CH Flex Small (FS) Elbow with UltraFlex Small 18 (UFS) Protocols elbow . >> SIEMENS > elbow > library > T2 library _medium channel coils E localizer t2_tse_sag_384 02:34 È T1 f12d_cor_384_2mm 03:52 E T2 E PD t2_me2d_cor_320_2mm 03:54 E 3D t2_tse_stir_cor_256 04:20 E BLADE t2_tse_dixon_sag_256_p2_s2 02:19 clinical libraries general t2_tse_dixon_tra_240_p2_s2 02:13 10 Unrestricted © Siemens Healthineers, 2023 Notes 352 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Wrist Wrist with Hand Wrist 16 (HW) Wrist with UltraFlex Small 18 (UFS) (1) (2) (3) TT 4) (5) 11 Unrestricted © Siemens Healthineers, 2023 Notes 353 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Wrist Wrist with 4CH Flex Small (FS) Protocols wrist ... » SIEMENS >> wrist >> library » PD Off-center library high channel coils pd_tse_tra_320 03:50 El localizer _Position the patient in prone position with the pd_tse_fs_tra_320 04:07 E T1 E T2 pd_tse_tra_384_2.5mm 03:53 E PD pd_tse_fs_tra_320 03:46 E 3D pd_tse_fs_cor_320 03:34 E BLADE pd_tse_fs_sag_320 03:45 clinical libraries El general medium channel coils E carpal-tunnel pd_tse_tra_384 03:56 E arthrography pd_tse_fs tra 256 04:01 pd_tse_fs_cor_320 03:43 12 Unrestricted © Siemens Healthineers, 2023 Notes 354 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Hand Hand with Hand/Wrist 16 (HW) Wrist with UltraFlex Small 18 (UFS) 13 Unrestricted © Siemens Healthineers, 2023 Notes 355 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Hand Hand with 4CH Flex Small (FS) Protocols hand ... >> SIEMENS > hand >> library > T1 Off-center_ library Position the patient in prone position with the _ high channel coils E localizer _high channel coils_ t1_tse_cor_640_2mm 02:47 @ T1 t1_tse_cor_640_2mm 01:48 t1_tse_fs_cor_512 04:37 E T2 t1_tse_fs_cor_640_2mm 02:32 t1_tse_dixon_cor_512 03:16 E PD t1_tse_dixon_cor_576_2mm 04:54 E 3D t1_tse_tra_640_3mm 03:43 t1_tse_tra_576_p2_s2 01:59 t1_tse_fs_tra_512_p2_s2 01:57 medium channel coils t1_tse_cor_640 03:39 14 Unrestricted © Siemens Healthineers, 2023 Notes 356 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Hip Unilateral Hip with UltraFlex Unilateral Hip with 4CH Flex Protocols Large 18 (UFL) Large (FL) Chip >> SIEMENS >> hip >> library >> T1 Hip Assist _ unilateral_ E general 2D bilateral high channel coils El general 2D unilateral E general 3D t1_tse_dixon_cor_unilat_p2_s2 01:39 library 03:33 El localizer t1_tse_dixon_sag_unilat_p2_s2 t1_tse_dixon_tra_unilat_p2_s2 03:34 E T2 E PD _medium channel coils_ E 3D t1_tse_tra_320_unilat 03:39 For the Vida Fit: local overheating of Flex Large 4 EL BLADE E Maplt t1_tse_cor_320_unilat 03:02 • Do not use this coil for scanning with table movements (e.g., whole body or angio E WARP t1_tse_sag_320_unilat 03:45 examinations) E reduced SAR E QUIET t1_tse_tra_fs_256_unilat 03:36 • Always position the coil iso‐centrically in head‐ clinical libraries foot direction (z position). The maximum E general t1_tse_cor_fs_256_unilat 03:47 deviation should not exceed ±5 cm in the head‐ foot direction E femur/acetabulum t1_tse_sag_fs_256_unilat 03:34 E arthrography 15 Unrestricted © Siemens Healthineers, 2023 Notes 357 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Hip Bilateral Hip with BM BO12 or BO18 Protocols Chip ... >> SIEMENS >> hip > library >> T1 Hip Assist _bilateral_ E general 2D bilateral t1_tse_cor_/04_Dilat 04:12 El general 2D unilateral t1_tse_tra_576_bilat E general 3D 04:37 library t1_tse_tra_464_bilat_p2_s2 02:13 E localizer t1_tse_fs_cor_512_bilat 03:59 E T2 t1_tse_fs_tra_448_bilat 04:10 B PD t1_f12d_fs_cor_448_bilat 03:11 B 3D t1_tse_dixon_tra_512_bilat_p2 04:23 E BLADE E Maplt t1_tse_dixon_tra_512_bilat_p2_s2 02:59 E WARP t1_tse_dixon_cor_512_bilat_p2 04:37 E reduced SAR t1_tse_dixon_cor_512_bilat_p2_s2 E QUIET 02:52 clinical libraries fast E general t1_tse_cor_512_bilat E femur/acetabulum t1_tse_tra_512_bilat 01:27 E arthrography 16 Unrestricted © Siemens Healthineers, 2023 Notes 358 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Knee Knee with UltraFlex Large 18 (UFL) Knee with TxRX Knee 18 (8) (7) 17 Unrestricted © Siemens Healthineers, 2023 Notes 359 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Knee Knee with TxRx Knee 15 Knee with TxRX Knee 15 Flare 18 Unrestricted © Siemens Healthineers, 2023 Notes 360 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers .. Knee Knee with 4CH Flex Large (FL) Protocols knee clinical libraries ... >> SIEMENS >> knee >> library >> BLADE For the Vida Fit: local overheating of Flex Large 4 Knee Assist E general _ high channel coils __ • Do not use this coil for scanning with table El general 2D E meniscus pd_blade_cor_384 04.25 movements (e.g., whole body or angio examinations) El general 3D E cartilage pd_blade_tra_384 04:39 • Always position the coil iso‐centrically in head‐ E lesion El ligaments foot direction (z position). The maximum library pd_blade_sag_384_2.5mm 04:30 E bone marrow deviation should not exceed ±5 cm in the head‐ E localizer E arthrography t2_blade_cor_384 04:11 foot direction E T1 t2_blade_tra_384 04:15 E T2 t2_blade_fs_cor_320 04:43 E PD E 3D t2_blade_fs_tra_320 04:30 E BLADE t2_blade_fs_sag_320 04:10 E Maplt medium channel coils El WARP E QUIET pd_blade_cor_320 04:00 pd_blade_fs_cor_320 04:38 19 Unrestricted © Siemens Healthineers, 2023 Notes 361 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Foot and Ankle Foot and Ankle with Foot/Ankle 16 (FA) Ankle with UltraFlex Large 18 (UFL) ) . (3) (2). (3) (4) (1) (5) (6) 20 Unrestricted © Siemens Healthineers, 2023 Notes 362 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Foot and Ankle Foot and Ankle with 4CH Flex Large (FL) Protocols ankle >> SIEMENS >> ankle > library > T1 foot For the Vida Fit: local overheating of Flex Large 4 library _high channel coils_ library • Do not use this coil for scanning with table E localizer t1_tse_cor_512 03:26 El localizer movements (e.g., whole body or angio E T1 E T1 examinations) E T2 t1_tse_cor_480_p2_s2 01.99 E T2 • Always position the coil iso‐centrically in head‐ E PD t1_tse_fs_tra_384 03:52 PD foot direction (z position). The maximum E 3D E 3D deviation should not exceed ±5 cm in the head‐ t1_tse_fs_tra_352_p2_s2 01:41 E BLADE .. >> SIEMENS > foot >> library > T1 2ª. foot direction E QUIET t1_tse_sag_608 03:57 _high channel coils _ clinical libraries t1_tse_dixon_sag_512_p2 04:08 t1_tse_cor_480_p2_52 01:58 El general E articular + cartilage t1_tse_dixon_tra_400_p2_52 02.28 t1_tse_tra 03:30 E achilles tendon t1_tse_dixon_cor_400_p2_s2 02:43 t1_tse_sag 03:30 E arthrography t1_tse_dixon_sag_400_p2_s2 02:43 t1_tse_fs_cor_400_p2_s2 02:05 _medium channel coils_ t1_tse_fs_tra 03:46 t1_tse_tra_448 03:51 t1_tse_fs_sag 03:14 t1_tse_cor_448 03:58 t1_tse_dixon_cor 04:11 21 Unrestricted © Siemens Healthineers, 2023 Notes 363 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 UltraFlex Large/Small 18 SIEMENS Healthineers ... In Amira or Sempra [96x16] systems two coil elements are automatically disabled. 580 + 10 mm 410 + 10 mm 570 + 10 mm 400 + 10 mm 190+ 10 mm XI 285 + 10 mm 180+ 10 mm 275 + 10 mm 289 + 10 mm X O 374 + 10 mm O UltraFlex Large 18 UltraFlex Small 18 22 Unrestricted © Siemens Healthineers, 2023 Notes 364 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 UltraFlex Large/Small 18 SIEMENS Healthineers ... Position the UltraFlex Large 18 in smaller patients in the unilateral hip scan to avoid the signal from the other side. • UltraFlex Large 18 with positioning aids (cushions/pads) ‐or‐ • UltraFlex Small 18 Cushions/Pads 23 Unrestricted © Siemens Healthineers, 2023 Notes 365 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Additional Coils SIEMENS Healthineers ... Loop 4, 7, 11 Special Purpose 4 (1) (1) (2) 2 (A) (B) Spine Peripheral Angio 36 (PA) TxRx CP Head 24 Unrestricted © Siemens Healthineers, 2023 Notes 366 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers' ... Image Examples TMJ with Special Purpose 4 Shoulder with SHS 16 Elbow with FS4 PD TSE @ Essenza T2 TSE FS @ Skyra PD TSE @ Skyra 25 25 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 367 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Image Examples Hand/Wrist with FS4 Wrist with HW16 Hand with HW16 T1 TSE @ Spectra T1 TSE @ Aera 3D VIBE WE @ Amira 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 368 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Image Examples Hip with Body18 Knee with TxRx Knee 15 Knee with PA36 T2 TSE @ Aera T2 qTSE @ Aera T2 SPACE FS @ Skyra 27 27 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 369 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers ... Image Examples Foot with FA16 Ankle with FA16 Foot/Ankle with HN20 T1 TSE @ Aera PD TSE FS @ Prisma 3D MEDIC WE @ Aera 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 370 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Coils & Protocols SIEMENS Healthineers' ... Image Examples UltraFlex Large 18 UltraFlex Small 18 29 29 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 371 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MSK Parameters SIEMENS Healthineers ... MR Applications Fundamentals 1 MSK Parameters 30 Unrestricted © Siemens Healthineers, 2023 Notes 372 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Radial Slices SIEMENS Healthineers ... Used for Femur/Acetabulum exams. Move the mouse to interactively change the number of radial slices and rotate the slices. Rotating axis (through‐plane direction) is defined from the selected reference image. hip 8 IMA 1 FRM 13/25 EO= Add Slice 3 Point Radial Satura Band Group Stack +1 . FOVLL Group Mode Slices Graphics hip Create radial slices perpendicular to the aceta RA Hip Assist library pd_tse_sag_448_radial 03:45 RA [] clinical libraries E general Maplt A El femur/acetabulum TP H7 T2StarMap_cor_4mm_256_unilat 02:21 F SP A5.9 E arthrography 0V 321*380 Cor>Sag(1) TP O p2 MAGN/NORM DIS2D pd_tse_fs_cor_p2_448_bilateral W 408 An FATA C 177 Not for diagnostic use 31 31 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 373 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Radial Slice SIEMENS Healthineers ... Radial Sorting Parameters Prerequisites The parameter in located on the System > Result images must be square. Miscellaneous parameter card. Slices must be recorded with 100% FoV Phase (Visible FoV  without Oversampling). Enabling a continuous, clockwise image numbering for improved PACS reading. Routine Contrast Resolution Geometry System Physio Inline Sequence Miscellaneous djustments| Adjust Volume Tx/RX The starting slice is selected in a way so that in the Coil Selection ACS Restricted Coil Combination Adaptive Combine following series no mirroring‐flip occurs. Radial Sorting No split of images (with identical rows and columns but MSMA S-C -T Matrix Optimization Off different Phase Encoding Direction) into different multi‐ Sagittal R>>L frame DICOM images. Coronal P>> A Coil Focus Flat Transversal H>>F Virtual Coils 32 Unrestricted © Siemens Healthineers, 2023 Notes 374 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Functional Dynamics SIEMENS Healthineers ... TrueFISP – Temporomandibular Joint Dysfunction Closed Open 33 33 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 375 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Functional Dynamics SIEMENS Healthineers ... Spine – Maximum inclination & Neutral Reclination 0mm 0mm 34 34 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 376 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Functional Dynamics SIEMENS Healthineers ... Spine – Maximum inclination & Neutral Reclination 35 35 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 377 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Functional Dynamics SIEMENS Healthineers ... Wrist 36 36 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 378 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Magic Angle SIEMENS Healthineers' ... Magic Angle refers to the increased signal on sequences with short Echo Time (TE). It is seen in tissues with well‐ordered collagen fibers in one direction (e.g., tendon, articular hyaline cartilage, ligaments). This artifact occurs when such fibers are oriented obliquely to the main magnetic field in 54.7°. 3cos2 θm=1 → θm=cos−1 1 =54.7° 3 This Magic Angle artifact appears as hyperintense signal. Increase the TE to reduce the high signal. Reference: https://www.imaios.com/fr/e-Cours/e-MRI/qualite-image-artefacts/angle-magique 37 37 http://mriquestions.com/magic‐angle.html Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 379 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Fat Saturation SIEMENS Healthineers ... Default, the frequency profile is more like a curve. An Water Water offset is needed to not suppress water. Fat Fat Joint Mode, the frequency profile is much sharper and pulse is applied closer to water. • Improves saturation homogeneity, especially for small joints . .............. ............... ..................... • Saturation pulse is longer and SAR slightly increased. Default Joint Knee Mode EGION: KNEE, meas_MID00043_FID02395_AdjFre.dat, fWglobal =- 2.4Hz, fval=0.001 • The Sharp Fat Sat. pulse adds +40Hz shift 0.8 • Available in Amira and Sempra systems 0.6 Fat Peak is broadened • Also applied to SPAIR 0.4 due to the patella anatomy 38 Unrestricted © Siemens Healthineers, 2023 Notes 380 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Fat Saturation SIEMENS Healthineers' ... Joint Mode and Knee Mode Routine Contrast Resolution Geometry System Physio Inline Sequence Common Dynamic TR 3700.0 ms Fat-Water Contrast Fat Saturation TE 40.00 ¢ ms Fat Saturation Weak MTC Fat Suppression Optimization Magn. Preparation None Region Joint cc: 6904881 06.07.2012 14:23:57 MRN: 94595 Age: 047Y F 3.07.2012 14:47:02 Skyra ACC: 6904881 Skyra CC07 Age:047Y F Series Potete_170821 Series #:18 17.03.2f-13.25-04-STD-1.3.12. Putede 170821 Image #:12/21 '@1/21/1989, M. 28Y 17 08 21-13:25-04-510-1 3.92 8/21/1 999, M. 20Y STUDY ! 6-21/2017 STUDY 1 1:29:38 PM 8/21/2017 5 MA 18 /30 11:59:33 PM 12 MMA 18 /30 TR 2700 MF 1.00 TR 2800 TE 35 TE 35 SL -51,02 SL -51,02 FR 3460.0 DIE IR 3460.0 Matrix 384 x 30 Matrix 384 x 30 TE 25.0 3,00 mm 3,00 mm TA 01-33 TP O TE 25.0 BWV 130.0 SPL31.0 A 01:33 3,30 3,30 02 MND/NORM SL3003 BWV130.0 er FOV 160"160 P2 MIND NORM TU AI/SATIFS 180-2564 5>>Tre(37) AISATIES Tte201 65163 E18 78180301 6/163 Default Joint Default Knee Mode 39 39 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 381 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Turbo Spin Echo (TSE) SIEMENS Healthineers' ... Asymmetric Saturation Band One edge is sharp, and the other is smooth. 8 3:55 min Routine Contrast Resolution Geometry Systei Common AutoAlign Navigator Saturation Tim Planning Suite Mostly used for T2 weighted imaging. AES • RF pulse slightly longer • The SAR limits may be reached easily with Saturation Region 1 T1 weighted imaging. Thickness 50.00 - mm Position Isocenter Orientation Transversal Shape Standard Standard 40 40 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 382 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 TSE SIEMENS Healthineers ... Asymmetric Saturation Band Saturation Shape: Standard Saturation Shape: Asymmetric 10cm 41 41 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 383 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐center TSE and Eddy Currents SIEMENS Healthineers' ... Potential Issues: Off‐center imaging with TSE can result in sub‐ optimal image quality (e.g., with sub‐optimal dp_100818_Phantom MRC1 /6DFC805C31 600A/7 2087; mn_20101207 dp 100818_Phantom 10.12.07-12:16:50-STD-1.3.12 ... *8/1 8/1 980, 0, 30Y protocol settings). MR 011 *12/7/1990, M, 20Y STUDY 1 8/18/2010 STUDY 1 4:20:11 PM 12/7/2010 32 MA 13/19 12:23:48 PM 3 IMA 20 / 25 Loss of SNR, blurring, ghosting, banding and local failure of fat saturation. Results might vary from system to system due to manufacturing tolerances. MF 1.00 MF 1.00 TR 4500.0 TE 21.0 TR 5000.0 TA 01:30 TP O TE 46.0 SP F8.3 TP O BW 315.0 SP F19.4 MUND SL 2.5/2.5 TA 03:50 BW 260.0 FoV 180*180 M/NORM/DIS2D SL 2.2/0.22 A1 256*512 FoV 90*90 What can/should be done. SHS Tra A1/PFP/SAT1/SFS 320p*320 'tse2d1_21 /150 ~ 1370 606 HW3 Tra *tse2d1rs9 / 150 Skyra W 742 • Protocol optimization to reduce effects • Activate Flow Comp in the Read direction • Position the Coil closer to Isocenter 42 42 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 384 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐center TSE and Eddy Currents SIEMENS Healthineers ... No Flow Comp Flow Comp in Flow Comp in Flow Comp in Read Direction Slice Direction Read Direction VD11D course Ortho A Anlagenzentrum/4761EF/ VD11D course Ortho Anlagenzentrum/478tera wrist offcentert MRC8 /DDAD15ASADAAD5/3D wrist offcentert EINE MROB DOAD1 5ASADAADS,60. 1324 *04/07/1976, F, 34Y Aera 1324 pm Aera pim MR D11 *04/07/1976, F, 34Y "12/9/1942, M, 68Y MR D11 *12/9/1942, M, 68Y STUDY 1 HFS STUDY 1 STUDY 1 FFS +LPH +LPH STUDY 1 25/01/2011 25/01/2011 12/9/2010 3:38:03 PM MR PLM AWT TEST (Probanden) 12/9/2010 MR PLIA AIN'T TEST (Probanden 11:33:54 11:47:24 7 IMA 13 / 20 10 IMA 13/ 20 8 IMA 14 / 20 3:20:08 PM 3 IMA 14 / 20 MF 1.00 IR 2800.0 TR 2810.0 TR 3860.0 C TE 44.0 TR 3400.0 TE 28.0 DIE TE 32.0 TA 03:49 TP O TE 29.0 TF TA 04:03 TA 03:34 BW 110.0 SP F8.3 TA 03:50 MINORM/DIS2D SL 3.0/0.3 BW 110.0 SP FE BW 130.0 SP F3.1 SP F3.1 SL 3.0A. MNORM.DIS2D BW 130.0 SL 3.0/0.3 FoV 160*160 M/NORM/DIS2D SL 3.0/0.3 oV 160*1 FoV 80'80 MINORMOIS2D FOV 90'90 A1/FS 288*384 288*3 A1/FS Tra A1/FS 256*320s A1FFS 256*320s SHS; SP1 Tra Tra *tseR2d1_7 /180 298 SHS;SP1 127 *tseR2d1rr7 / 180 W THW2,3 2ªtseR2dirs8 /150 568 HW2,3 252 'tseR2dirr8 /150 568 252 43 43 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 385 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐Center Adjustments SIEMENS Healthineers ... Elbow imaging @3T Potential Issues with Off‐center Imaging. ALH Sporadic severe signal loss or shading may occur in off‐center 191213as s Healthineers 2019.12.13-10:05:41-STD-1.3.12.2.1107.5.99.3 *01.01.1953, M, 66Y GNETOM Vida elbow, hand, or wrist imaging. MR XA20 CURRENT HFS Due to an imperfect transmit adjustment (reference voltage too 13.12.2019 +LPH pd_tse_fs_tra_320_p2_s2.01 high) and strong B1 variation across elbow. latest STUDY ID Odd2e955-5a2d-48 10:10:13 3 IMA 1 FRM 11/30 Offcenter Adjustment (since XA31). 18,00 The adjustment strategy Offcenter improves the signal .99 P 78 F 48 | RAF uniformity by: 1cm • Localized transmitter adjustment SPC 2,8 FI • Flip Angle reduction TR 2500,0 TE 32,0 TP F60 TA 02:22 BWV 289,0 FoV 120*120 p2 $2 MAGN/NORM/SH/FIL/DIS2D 448*640 1 Available for SE, TSE, TSE Dixon. Tra>Sag(1)>Cor(-1) A2/SAT2/FS Zoom 0,95 UFS W 342 *tseR2d1rr7 /120 C 134 44 44 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 386 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐Center Adjustments SIEMENS Healthineers ... Elbow imaging @3T Normal AdjTra (722V) & FAexc=90° Offcenter AdjTra (540 V) & FAexc=77° AH AH 20200312as 20200312as 2020.03.12-12:11:57-STD-1.3.12.2.1107.5.99.3 MAGNETOM Lumina 2020.03.12-12:11:57-STD-1.3.12.2.1107.5.99.3 MAGNETOM Lumina *1/1/1952, M, 68Y MR XA20 *1/1/1952, M, 68Y CURRENT HFS CURRENT HFS 3/12/2020 +LPH 3/12/2020 LPH pd_tse_fs_tra_320 pd_tse_fs_tra_320_WIP latest 03 STUDY ID bae3b3a6-589d-48 STUDY ID bae3b3a6-5890-4 12:31:02 PM 6001 IMA 6 7001 IMA 6 RFA RFA 1 cm 1 cm LU O F E TR 3900.0 SP F23.5 TR 3900.0 TP O om TE 29.0 SL 2.5/0.25 TE 29.0 SP F23.5 TA 03:50 TA 03:50 SL 2.5/0.25 BW 300.0 FoV 120*120 FoV 120*120 p2 M/NORM/DIS2D/MFSPLIT 256*320 BW 300.0 Tra>Sag(10)>Cor(-9) p2 M/NORM/DIS2D/MFSPLIT 256*320 Tra>Sag(10)>Cor(-9) A2/SAT1/FS Zoom 1.34 A2/SAT1/FS Zoom 1.35 UFS W 244 UFS 244 *tseR2d1 rr7 /141 C 110 tseR2d1rr7 / 141 110 FatSat strong, joint FOV based z=0, FA 0.85, FatSat strong, joint 45 45 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 387 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐Center Adjustments SIEMENS Healthineers ... Elbow – Proton Density imaging @3T Standard Adjustment Offcenter Adjustment Offcenter Adjustment & Reduced FAexc AH AH EssCourseMaterial EssCourseMaterial EssCourseMaterial 2022.10.18-12:11:13-DST-1.3.12.2.1107.5.99.3 MAGNETOM Vida 2022.10.18-12:11:13-DST-1.3.12.2.1107.5.99.3 MAGNETOM Vida 2022.10.18-12:11:13:DST-1.3.12.2.1107.5.99 3 MAGNETOM Vida *1/1/1989, M, 33Y MR XA50 *1/1/1989, M. 33Y MR XA50 *1/1/1989, M. 33Y MR XA50 10/18/2022 HFS +LPH 10/18/2022 HFS HFS +LPH 10/18/2022 +LPH pd_tse_tra_320.01 pd_tse_tra_320 latest pd_tse_tra_320_FA70_offcenter latest latest latest STUDY ID 2c7b884e-93c8-4a STUDY ID 2c7b884e-93c8-4a STUDY ID 2016 12:21:26 PM 12:39:47 PM 12:41:27 PM 4 IMA 1 FRM 1 3/20 7 IMA 1 FRM 13/20 8 IMA 1 FRM 18/20 RHP RHP RHP Sbc SL SL Spc TR 3900.0 TP O TR 3900.0 TP O TR 3900.0 TE 31.0 SP F58.3 TE 31.0 SP F58.3 TE 31.0 SP F58.3 TA 01:29 FoV 100*100 TA01:29 FoV 100*100 TA01:29 FoV 100*100 BW 299.0 202*288 BW 299.0 202*288 BW 299.0 202*288 p2 MAGN/NORM/DIS2D Tra>Sag(-12)>Cor(-1) p2 MAGN/NORM/DIS2D Tra>Sag(-12)>Cor(-1) p2 MAGN/NORM/DIS2D Tra>Sag(-12)>Cor(-1) A1/SAT1 Zoom 1.91 Zoom 1.91 Zoom 1.91 UFS W 1779 A1/SAT1 A1/SAT1 C 841 UFS W 1779 W 1779 "tseR2d1rr7 / 150 "IseR2d1 rr7 / 150 C 841 UFS "IseR2dirr7 / 150 C 841 Vol exc = 401 V, FAexc = 90° Volexc = 331 V, FAexc = 90° Vol exc = 258 V, FAexc = 70° 46 46 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 388 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐Center Adjustments SIEMENS Healthineers ... Elbow imaging @3T SIEMENS >> elbow >> library >> PD _medium channel coils_ SIEMENS >> elbow >> library >> PD >> pd_tse_fs_tra_320_offcenter ? X General 3:56 min Auto@ 2 @ 0.3x0.3x2.5 mm3 1.00 pd_tse_cor 384 02:57 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Miscellaneous Adjustments Adjust Volume pTx IXIRX pd_tse_sag_384 02:57 Execution Image Management Adjustment Strategy | Offcente Adjustment Tolerance Auto pd_tse_fs_tra_320 03:56 Auto Load BO Shim Standard SliceAdjust Adjust with Body Coil Copy References B1 Shim FastView Confirm Frequency Never pd_tse_fs_tra_320_offcenter 03:56 Offcenter Assume Silicone pd_tse_fs_cor_320 04:33 CoilShim Off pd_tse_fs_sag_320 03:59 pd_tse_dixon_tra_256 04:54 pd_tse_dixon_cor_320 04:23 pd_tse_dixon_sag_320 04.53 pd_tse_dixon_sag_320_p2_s2 02:06 OK Cancel 47 Unrestricted © Siemens Healthineers, 2023 Notes 389 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Off‐Center Adjustments SIEMENS Healthineers ... Elbow imaging @3T SIEMENS >> elbow >> library >> PD >> pd_tse_fs_tra_320_offcenter ? > General 3:56 min / Auto @ 2 0.3x0.3x2.5 mm3 1.00 Flip Angle for excitation pulse can be changed in a Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands TSE sequence by selecting an Offcenter adjustment. Execution Common Dynamic Image Management TR 3900.0 ms Fat-Water Contrast SPAIR Auto Load SIEMENS >> elbow >> library >> PD >> pd_tse_fs_tra_320_offcenter ? x TE Fat Saturation Weak Copy References 32.00 ¢ ms General @ 3:56 min Auto @ 2 @ 0.3x0.3x2.5 mm3 1.00 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence MTC Dark Blood Voice Commands Execution Common Dynamic Magn. Preparation None Image Management IR 3900.0 ms Fat-Water Contrast SPAIR ... Contrasts Auto Load TE 32.00 ¢ ms Fat Saturation Weak Wrap-up Magn. Restore Copy References MTC Dark Blood Flip Angle 1 < > 150 deg Reconstruction Magnitud Magn. Preparation None Flip Angle for Excitation: 80 deg Flip Anale for Refocussina: 150 dea Contrasts Wrap-up Magn. Restore OK Cancel Flip Angle 2 4 80 ‚ deg Reconstruction Magnitude Flip Angle for Excitation: 80 deg Flip Angle for Refocussing: 150 deg OK Cancel 48 Unrestricted © Siemens Healthineers, 2023 Notes 390 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MSK Protocols SIEMENS Healthineers ... MR Applications Fundamentals 1 MSK Protocols 49 Unrestricted © Siemens Healthineers, 2023 Notes 391 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... SMS can reduce scan time or increase the number Routine Contrast Resolution Geometry System Physio Inline Sequence of slices without increasing the scan time. Commor Acceleration Filter Acceleration mode SMS Advanced Reconstruction Off FOV Shift Factor is selected automatically when Phase Partial Fourier Off setting the SMS and PAT factors. In case of suboptimal SNR, an optimization can be Reference Scans TSE/Sep ... achieved by using different settings (manually Acceleration Factor PE adapting the protocol). Reference Lines PE 64 SMS Factor 2 = OV Shift Factor SMS Factor 50 Unrestricted © Siemens Healthineers, 2023 Notes 392 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... T1 Fat‐Sat Coronal PD Sagittal AI AT TR 860.0 TR=650ms, 3 Concats TR=650ms, 2 Concats TR=3640ms TR=1800ms w/o SMS, TA = 4:03 min SMS, TA = 2:42 min w/o SMS, TA = 3:09 min SMS, TA = 2:36 min 51 51 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 393 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... Challenges Larger RF energy is required for Multi‐Band No SMS With SMS 2 pulses. mk 22 3 17 17.03.22-06:11:10-STD mk22 3 17  Increased SAR. 17.03 22-08 11:10-STD- HA *3/22/1957, M, SOY STUDY 1 3/22/2017 STUDY 8.19:00 AM 3/22/2017 SIA 17 /25 8:39:55 AM 10 MA 18/25 Larger number of slices is excited per unit of time.  Slice cross‐talk. TR reduction + Cross‐talk.  Contrast change. iPAT reconstruction + Reduced TR. TR 700 0 E 9.4 TR 700.0 TA 01:51:2 TR H13 TE 94  Reduced SNR. BW 250.0 SPP100 TA 01:51 1P. H13 p2 MNORMXS2D SL 3003 BWV 250.0 SPP11 FOY 240.240 P2 #2 MINORMOIS20 SL 3,00.3 240*3205 FoV 240-240 Cor>Tro(11 4) A2 1114 HE3.4.NE1 2 SP1 Cor>Tra(-11.4) iPAT/SMS reconstruction. tseMB201 3/150 SMS2, 1 concat  Image artifacts (Fat ghost/Residual aliasing /3rd arm artifacts). 52 52 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 394 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... Number of Slices and Concatenations With Simultaneous Multi‐Slice (SMS): |IIII • The number of slices must be a multiple of the SMS factor • The number of slices should be a 1 3 5 7 9 11 13 15 17 19 multiple of an odd number of slices • Example: 20 slices → cross‐talk expected 2 4 6 8 10 12 14 16 18 20 Slice 10 is the last, slice 11 the next  cross talk 53 Unrestricted © Siemens Healthineers, 2023 Notes 395 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... Number of Slices and Concatenations With Simultaneous Multi‐Slice (SMS): • The number of slices must be a multiple of the SMS factor. The number of slices should be a 1 3 5 7 9 11 13 15 17 • multiple of an odd number of slices. • Example: 18 slices → No cross‐talk expected. IIIHIIII 2 4 6 8 10 12 14 16 18 Slice 8 is the last, slice 10 the next  No cross talk 54 Unrestricted © Siemens Healthineers, 2023 Notes 396 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... Improvements XA50 Slice Reordering Optimization Routine Contrast Resolution Geometry System Physio Inline Sequence TSE‐SMS didn’t allow certain slice numbers Slice Group FoV Read 220 - mm depending on the number of concatenations to Slices 28 + FoV Phase 100.0 - % avoid cross‐talk artifacts. Slice Thickness 4.0 - mm Now, with Slice Reordering optimized, all slice Distance Factor 30 % TR 6000.0 - ms numbers (multiple of the slice acceleration factor) Position Isocenter TE 99.00 - ms are supported without causing cross‐talk Orientation Transversal ... Averages artifacts. Phase Encoding Dir. R>> L ... Concatenations 3 + Phase Oversampling 0 % AutoAlign --- ... Consequently: If the SAR level is exceeded the SAR solver won’t change the number of concatenations any longer Slices 28 ............ 104 and the scan time won’t be prolonged. Moreover, the SAR solver performance and the UI performance have been significantly improved resulting in faster calculation times of SAR. 55 Unrestricted © Siemens Healthineers, 2023 Notes 397 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... Summary Where to use it: What is NOT supported: In protocols with multiple concatenations (e.g., T1‐weighted). • BLADE Protocols with many slices (e.g., axial long bone). • WARP/SEMAC • MSMA Where not to use it: • PACE When concatenations were used to reduce cross talk • Physio Trigger (e.g., Dark‐Fluid TIRM). • Quiet Fewer, thin slices with only small gap (e.g., sag spine). • Flow Comp in the Slice Direction Settings for FoV shift factor. • Multiple contrasts When the value is set automatically. Improvement  Ghosting Artifacts Reduction Fat ghosting artifacts due to the chemical shift between fat and water & Slice mis‐registration in combination with SMS. By using optimized Slice Selective and blip gradients during the acquisition, the ghosting artifacts could be reduced. 56 Unrestricted © Siemens Healthineers, 2023 Notes 398 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers' ... DIXON The TSE DIXON sequence was extended to also |20190206_CS Knee 3 2019 02:06-15:22:39-STD-18 support SMS imaging. CURRENT 2/6/2011 bestin_Phase STUDY D 48486500-176-49 4:51:35 PM 24 MA 1 FRM 20:00 Extremely profitable for MSK imaging with iPAT 2 excellent fat sat. 4:12 mins Especially if multiple image contrasts are needed at the same time (in‐phase, water & fat). 2019 02 06-15:22:39-5105 CURRENT 2/6/2019 pa_tse_divon_cor_350 Intestin_Ptiste STUDY D 45486500-6870 4 56:04 PM 26 MA 1 FRM 20.030 SMS 2, iPAT 2 2:28 mins In‐phase image Water image 57 57 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 399 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers' ... DIXON – MAGNETOM Vida iPAT 2, TR 767 ms 5 Concatenations, 60 Slices 6:43 Minutes SMS 2, iPAT 2, TR 632 ms 4 Concatenations, 60 Slices 4:41 Minutes 58 58 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 400 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Simultaneous Multi‐Slice (SMS) Turbo Spin Echo (TSE) SIEMENS Healthineers ... DIXON Various T1, T2 and PD protocols for: >> SIEMENS > hip >> library >> T2 SIEMENS >> hand > library >> T2 .. » SIEMENS >> shoulder >> library >> T2 • Shoulder _bilateral_ t2_tse_stir_cor_384 04:08 _high channel coils Elbow t2_tse_cor_640_bilat 04:37 t2_tse_dixon_cor_448 t2_tse_cor_384 03:18 • t2_fi2d_cor_512_1.5mm • Hand/wrist t2_tse_tra_576_bilat 04:26 03:22 t2_tse_tra_384 03:03 • Hip t2_tse_tra_496_bilat_p2_s2 02:32 t2_me2d_sag_512_1.5mm 02:53 t2_tse_sag_320 02:34 • Knee t2_tse_fs_cor_512_bilat Ankle 03:22 Off-center t2_tse_fs_cor_384 03:56 • t2_tse_fs_tra_512_bilat 04:34 high channel coils_ t2_tse_fs_sag_384 03:52 • Foot t2_tse_fs_tra_400_bilat_p2_s2 02:26 t2_tse_fs_sag_320_2.5mm 04:50 t2_tse_stir_cor_320 03:54 ª t2_tse_stir_cor_512_bilat 04:53 t2_tse_stir_cor_512 04:57 t2_tse_dixon_cor_320 03:56 t2_f12d_cor_512_bilat 03:36 t2_tse_dixon_cor_576_2mm 04:07 t2_tse_dixon_tra_288_p2_s2 t2_tse_dixon_cor_512_bilat_p2 04:34 t2_tse_dixon_sag_288_p2_s2 02:26 t2_tse_dixon_cor_288_p2_s2 01:55 t2_tse_dixon_tra_512_bilat_p2 04:24 t2_tse_dixon_tra_384_p2_s2 t2_tse_dixon_sag_288_p2_s2 01:47 t2_tse_dixon_cor_512_bilat_p2_s2 02:36 t2_fi2d_cor_640_1.5mm 02:28 fast t2_tse_dixon_tra_512_bilat_p2_s2 02:47 t2_me2d_sag_640_1.5mm 04:17 t2_tse_tra_320 01:34 59 Unrestricted © Siemens Healthineers, 2023 Notes 401 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Deep Resolve Boost* (DRB) TSE SIEMENS Healthineers ... Deep Resolve Boost TSE improves the Signal‐to‐Noise (SNR). 2 >> t2_tse_fs_sag_320 ? > It is available for TSE and TSE/SMS sequences with MR XA50 3:49 min | Auto @ 2 @ 0.2x0.2x2.5 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence software. ommon Acceleration Filter If license available, Boost Mode is selected by default. Acceleration mode GRAPPA Deep Resolve On The combination with Deep Resolve Sharp & Elliptical Filter Phase Partial Fourier Off is possible. Deep Resolve The Denoising Strength is available in a drop‐down menu. Reference Scans TSE/Sep .. Acceleration Factor PE Denoising Mode Boost Reference Lines PE 32 Limitations: Denoising Strength Medium Low • TSE/Dixon does not support DRB (only DRG/DRS). Medium • Aliasing artifact  FoV phase larger than the object, High sufficient phase oversampling, optimal PE direction. Deep Resolve Sharp Recommendation: It is recommended to use Siemens prepared Deep Resolve Boost protocols where parameters have been optimized in terms of delivering high image quality reducing the risk of potential artifacts. 60 *Optional License Unrestricted © Siemens Healthineers, 2023 Notes 402 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Deep Resolve Boost* TSE SIEMENS Healthineers ... Conventional GRAPPA Deep Resolve Boost High Deep Resolve Boost Medium + DRS PAT Factor 4 Total Scan Time 90 s 61 61 *Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 403 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Deep Resolve Boost* TSE SIEMENS Healthineers ... PD TSE Fat Sat Matrix 448 Matrix 384 DRB ref/int Matrix 384 DRB ref/sep TA 04:14 TA 01:55 TA 01:45 p2, 2 Averages p3, 1 Averages, 150% OS p3, 1 Avg, 150% OS *Optional License 62 62 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 404 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Deep Resolve Boost* TSE SIEMENS Healthineers ... Special Considerations GRAPPA, an increase in PAT acceleration DRB with PAT 2 DRB with PAT 3 DRB with PAT 4 typically leads to noise amplification and/or aliasing artifacts. In contrast to this, Deep Resolve Boost has the tendency to smooth the image in that case. For both, this effectively leads to a loss in detail, but customers are more familiar with the GRAPPA use case. GRAPPA with PAT 2 GRAPPA with PAT 3 GRAPPA with PAT 4 63 63 *Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 405 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MapIT - T1, T2, T2* Maps SIEMENS Healthineers ... MR Applications Fundamentals 1 MapIt T1, T2, T2* Maps 64 Unrestricted © Siemens Healthineers, 2023 Notes 406 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Biochemical Imaging of Cartilage SIEMENS Healthineers ... Several biochemical imaging techniques that map biochemical changes within the cartilage have been trialed. O T1 mapping* used in dGEMRIC studies to measure Cell the proteoglycan content of the cartilage. O T2 and T2* mapping provides information on the collagen orientation and the water content of the Collagen GAG cartilage. DWI provides information on the anisotropy and O collagen orientation. Magnetization Transfer: collagen orientation. Water/Mobile ions *Optional License 65 Unrestricted © Siemens Healthineers, 2023 Notes 407 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping of Cartilage SIEMENS Healthineers ... dGEMRIC: delayed Gd‐enhanced MRI of Cartilage. Is used to estimate joint cartilage GAG (glycosaminoglycan) content Synovial by measuring T1 values after penetration of the Gd‐DTPA2. Membrane Cartilage The resulting T1 maps are used in cartilage to track proteoglycans. More GAG, the longer T1 relaxation time. Synovial Fluid With dGEMRIC • Pre‐operative staging • Prediction of therapy outcome • Therapy follow‐up GAGS Ligaments The articular cartilage is made up of a matrix containing collagen and alvcosaminoalvcans (GAGs). 66 Unrestricted © Siemens Healthineers, 2023 Notes 408 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping of Cartilage SIEMENS Healthineers ... dGEMRIC: delayed Gd‐enhanced MRI of Cartilage. Glycosaminoglycan is negatively charged. If there is lack of glycosaminoglycan, there is a lack of negative charges. After the injection of an ionic contrast agent, this lack of negative charges is substituted by Gd‐DTPA2. The accumulation of Gd‐DTPA2‐ in the cartilage provokes a T1 shortening. This T1 shortening can be evaluated in a T1 map. 67 Unrestricted © Siemens Healthineers, 2023 Notes 409 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping of Cartilage SIEMENS Healthineers ... The Examination T1 Mapping Outside the Magnet Gold standard for T1 Mapping: Intravenous injection of Gd‐DTPA2‐ (ionic Multiple IR Spin Echo measurement. contrast agent) Very long acquisition time of up to 30 minutes → Patient performs exercise (~ 15‐30 min). makes it challenging clinically. MRI Examination: T1 maps are used to estimate syngo MapIt T1 Mapping: joint cartilage glycosaminoglycan. • It uses a multi‐angle VIBE measurement If low glycosaminoglycan content, the T1 value • The acquisition time is reduced to 3 minutes is shortened. • T1 map is produced by a pixel‐by‐pixel analysis (results are in ms) 68 Unrestricted © Siemens Healthineers, 2023 Notes 410 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping in MapIt SIEMENS Healthineers ... >> Mapit > T1Map_anatomical ? x Auto Angle Calculation ON. 5 4:02 min 4; Auto @ None 0.2x0.2x3.0 mm3 1.00 Routine Resolution Geometry System Physio Inline Sequence Dynamic Liver Subtraction Cardiac MIP Soft Tissue Composing Mapit For a given T1 there is an optimum set of angles: Maplt T1 Map Noise Threshold 15 syngo.MapIt calculates if required by the user. Auto Angle Calculation On Save Original Images The optimum angles correspond to 71% of the T1 Estimate 800 - ms Ernst signal. Flip Angle 1 4 5 deq Flip Angle 1: deg Flip Angle 2: 26 deg Measurements Contrasts Auto angle calculation OFF: TE 2.70 + ms The user can also set up the Flip Angles TR 15.0 ms independently. Routine Contrast Resolution Geometry System Physio Inline Sequence Dynamic Liver Subtraction Cardiac MIP Soft Tissue Composing Maplt Maplt T1 Map Noise Threshold 15 Auto Angle Calculation Of Save Original Images v Flip Angle 1 < > 5 % deg 69 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 411 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping in MapIt SIEMENS Healthineers ... Measurements Maplt >> T1Map_anatomical ? The user can define the number of different Flip Angles: @ 4:02 min & Auto @ None @ 0.2x0.2x3.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Minimum: 2 different Flip Angles Dynamic Liver Subtraction Cardiac MIP Soft Tissue Composing Maplt Maximum: 10 different Flip Angles Maplt T1 Map Noise Threshold 15 + Auto Angle Calculation Off Save Original Images Noise Threshold Signals less than the Noise Threshold are ignored during Flip Angle 1 4 5 deg the fit. If in doubt, leave at the default value. Measurements 2 + Contrasts TE 2.70 - ms TR 15.0 + ms Measurements 2 70 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 412 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping in MapIt SIEMENS Healthineers .. Protocols at 1.5T: 1.5T X .. >> SIEMENS > knee > library >> Maplt T1Map T1Map_p2 Sola-XQ_64Rx _T1 mapping. T1Map 02:41 SIEMENS 3D measurements with different Flip Angles for T1 T1Map_p2 01:28 measurements and calculation. T2* mapping [ knee > [ Knee Assist T2StarMap 01:51 library E localizer T2StarMap_p2 01:01 E T1 T2 mapping E T2 E PD T2Map 02:20 8 3D E BLADE E Maplt E QUIET E WARP 71 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 413 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping in MapIt SIEMENS Healthineers ... Protocols at 3T: 3.0T XQ ... >> SIEMENS > knee > library > Maplt T1Map Vida-XQ_2Tx_64Rx_MNO _high channel coils B1Map _ 11 mapping __ SIEMENS B1 correction: B1map_for_T1_mapping. B1Map_for_T1_mapping 00:11 • Correction of the B1 inhomogeneity included in the T1 T1Map_anatomical 04:02 mapping knee Knee Assist T1Map_p2_anatomical 02:09 • First, measures the B1 inhomogeneity (tfl_b1Map) [ library • Second, calculates the actual Flip Angles of pixels T2 mapping E localizer • Resulting FA maps from the measurement are stored in the memory (in PARC data store [PDS] on MARS) and E T1 T2Map_anatomical 06:35 E T2 used later with T1Map protocols E PD T2* mapping E 3D T2StarMap_anatomical 02:52 T1Map_anatomical or T1Map_p2_anatomical E BLADE 3D measurements with different Flip Angles for T1 El Maplt T2StarMap_p2_anatomical 01:32 measurement and calculation. E WARP E QUIET 72 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 414 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping of Cartilage SIEMENS Healthineers ... T1 Map without B1 Correction T1 Map with B1 Correction 73 73 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 415 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T1 Mapping of Cartilage SIEMENS Healthineers ... 3D GRE image in a patient after micro‐ fracturing at 3T. In the area of Pre‐contrast T1‐map shows no difference Postcontrast T1‐map shows a significant microfracture only slight thinning of the in T1 relaxation times in the repair tissue. drop in T1 values in the repair tissue, which cartilage layer can be seen. corresponds to a low GAG content. 74 74 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 416 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2 Mapping of Cartilage SIEMENS Healthineers ... Information on the collagen orientation and the water T2 has been used to study cartilage repair therapies and content of the cartilage. to provide information on cartilage softening. Cartilage repair therapies (microfracture – MFX – T2 provides information on structural changes in the therapy versus Matrix‐associated Autologous collagen within the cartilage. Chondrocyte Transplantation – MACT – therapy). T2 provides information on changes in the water content Cartilage repair therapies follow up (MACT therapy of the cartilage. follow up). • Compressed areas show less water content → lower T2. • Early Osteoarthritis – OA – detection (femoral Less compressed areas show greater water content → acetabular impingement). higher T2. 75 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 417 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2 Mapping of Cartilage SIEMENS Healthineers ... T2 is measured using a Multi‐Echo Spin Echo Mapit > T2Map_anatomical ? > 6:35 min / Auto @ None 0.4x0.4x3.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Contrast: up to 32 echoes. Liver Subtraction Cardiac MIP Composing Maplt More echoes provides a better fit and each echo Maplt T2 Map Noise Threshold 15 produces an image. Save Original Images TE: set the Echo Time for each echo Flip Angle 180 deg Keep the maximum TE to less than or like expected T2 values. Measurements Contrasts TR: use values higher than 1000 ms. TE 1 < 13.80 ms TR TE 1: 13.80 ms TE 2: 27.60 ms The T2 map is produced by a pixel‐by‐pixel analysis TE 3: 41.40 ms TE 4: 55.20 ms (results in ms). TE 5: 69.00 ms 76 *Optional License Unrestricted © Siemens Healthineers, 2023 Notes 418 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2 Mapping of Cartilage SIEMENS Healthineers ... Axial T2 Map of the cartilage layer of the patella at 7 Tesla. It nicely demonstrates the zonal variation in the collagen 100 fiber network in cartilage in this volunteer. 75 50 25 O T2 (ms) 77 77 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 419 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2 Mapping of Cartilage SIEMENS Healthineers ... Microfracture Therapy (MFX). Creates microfractures in the bone. Cartilage regeneration is promoted by the 75 released blood and marrow. MF X MFX 50 Reduced T2 in the region of MFX therapy. 25 Image courtesy of S. Trattnig, Dept. Radiology, University Vienna 78 78 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 420 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2 Mapping of Cartilage SIEMENS Healthineers ... Matrix‐associated Autologous Chondrocyte Transplantation therapy (MACT). Is an operative procedure using a cell seeded collagen matrix. 75 MACT MACT It is used for the treatment of localized full 50; thickness cartilage defects. 25 Reduced T2 in the region of MACT therapy. Image courtesy of S. Trattnig, Dept. Radiology, University Vienna 79 79 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 421 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2 Mapping of Cartilage SIEMENS Healthineers ... R2 map is also possible. SIEMENS >> knee >> library >> Maplt >> T2Map_anatomical General 0 6:35 min 1 Auto @ None 0.4x0.4x3.0 > > 1.00 Protocol Parameters Routine Contrast Resolution Geometry System Physio equence Voice Commands R2 = 1/T2 (relaxivity values). Execution Liver Subtraction MIP Composing Mapit Image Management Maplt T2 Map Noise Threshold 15 Auto Load Instead of the T2 values in ms (relaxation times), Copy References T2 Map Save Original Images v R2 Map MapIt provides the R2 values in 1/s. Flip Angle 180 ~ deg Measurements Contrasts 54 13.80 13.80 ms TR 1910.0 - ms 27.60 ms TE 3: 41.40 ms TE 4: 55.20 ms TE 5. 69.00 ms OK Cancel 80 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 422 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2* Mapping of Cartilage SIEMENS Healthineers ... T2* Mapping can be used as a substitute for T2 mapping. T2* also has a component which depends on the field change within the voxel: 1/T2′ = γ ΔBinhom resulting from: T2* is the apparent transverse relaxation rate. • Macroscopic field changes (i.e., main field homogeneity, large susceptibility fields from implants) 1/T2* = 1/T2+1/T2 • Macroscopic field changes due to susceptibility variations (i.e., bone‐cartilage interface) T2* has a T2 component: 1/T2 • Microscopic field changes from the microstructure within the voxel 81 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 423 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2* Mapping of Cartilage SIEMENS Healthineers ... T2* is measured using a Multi‐Echo GRE Mapit > T2StarMap_anatomical ? x @ 2:52 min Auto @ None @ 0.4x0.4x3.0 mm3 1.00 sequence. Routine Contrast Resolution Geometry System Physio Inline Sequence Liver Subtraction Cardiac Soft Tissue Composing Maplt Contrast: up to 12 echoes. Maplt T2* Map Noise Threshold 25 ¢ More echoes provides a better fit. T2* Map Save Original Images Each echo produces an image. R2* Map Flip Angle 60 - deg TE: set the Echo Time for each echo. Keep maximum TE to less than or like Measurements Contrasts expected T2* values. 5 TE 1 < > 4.36 ms TR 445.0 ms TE 1: 4.36 ms TE 2: 11.90 ms Bandwidth: use the same bandwidth for all TE 3: 19.44 ms TE 4: 26.98 ms the echoes. TE 5: 34.52 ms Bandwidth 260 Hz/Px Bandwidth 1: 260 Hz/Px T2* map is produced by a pixel‐by‐pixel Bandwidth 2: 260 Hz/Px ymmetric Ech Bandwidth 3: 260 Hz/Px analysis (results in ms). Bandwidth 4: 260 Hz/Px Bandwidth 5: 260 Hz/Px *Optional License 82 Unrestricted © Siemens Healthineers, 2023 Notes 424 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2* Mapping of Cartilage SIEMENS Healthineers ... Axial T2* Map of the cartilage layer of the patella at 7 Tesla. It nicely demonstrates the zonal variation in the collagen 40 fiber network in cartilage in this volunteer. 30 20 10 0 T2* (ms) 83 83 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 425 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2* Mapping of Cartilage SIEMENS Healthineers ... T2* Map should be more efficient than T2 Map. 40 100 SNR of GRE is higher than Spin 30 Echo (SE). 75 Inter Echo Spacing is lower in GRE 20 50 than in SE. 10 25 A small patient study suggests that variability is better with T2* values O 0 than with T2 values. T2* (ms) T2 (ms) Axial T2*Map of the cartilage Axial T2 Map of the cartilage 84 84 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 426 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2* Mapping of Cartilage SIEMENS Healthineers ... Example of MFX Therapy per Cor -2 85 85 Optional License Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 427 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 T2* Mapping of Cartilage SIEMENS Healthineers ... R2* Map is also possible. > Mapit > T2StarMap_anatomica ? > 2:52 min 4 Auto @ None 0.4x0.4x3.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence R2* = 1/T2* (relaxivity values) Liver Subtraction Cardiac MIP Soft Tissue Composing Maplt Maplt T2* Map Noise Threshold 25 Instead of the T2* values in ms (relaxation times), MapIt provides the R2* values in 1/s. T2* Map Save Original Images R2* Map Flip Angle 60 - deg Measurements Contrasts TE 1 4.36 TR 445.0 m TE 1: 4.36 TE 2: 11.90 ms TE 3: 19.44 ms TE 4: 26.98 ms TE 5: 34.52 me 86 Optional License Unrestricted © Siemens Healthineers, 2023 Notes 428 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist & GOKnee 3D SIEMENS Healthineers ... MR Applications Fundamentals 1 myExam Large Joint Assist & GOKnee 3D 87 Unrestricted © Siemens Healthineers, 2023 Notes 429 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers' ... Overview Key Features Hip Dot Engine 1 Hip Assist MAT FRM BITS • Auto IsoCenter Positioning 2 %_ 11_tse_cor_704_bilat 03:10 • Consistent positioning with AutoAlign & E pd_tse_cor_576_bilat pd_tse_fs_cor_512_bilat 03:14 15 t2_tse_fs_cor_512_bilat 03:14 AutoCoverage 6 t2_tse_stir_cor_512_bilat 04:32 7 x 11_tse_tra_576_bilat 03:53 • Limited Parameter card and Guidance 8 pd_tse_fs_tra_448_bilat 03:07 View TP O TP 0 SPALL SP F26.3 FOV 450.450 FOV 450.450 Advanced syngo WARP for through‐plane JMPRIRESAMP/NORMDIS3D Cor>Sag(1) IMPRIRESAMP/NORM/DIS3D • AAHip_Scout_MPR_cor 417 Tra AAHip_Scout_MPR_tra 511 IMPRIRESAMP/NORM/DIS3D Not for diagnostic use 209 AAHip_Scout_MPR_cor E 21:10 Not for diagnostic use Not for diagnostic use susceptibility correction GO Cancel FR Det 3:46 min / Auto @ 2 @ 0.5x0.5x3.0 mm3 1.00 Guidance Parame • syngo BLADE for motion artifact reduction Check the alignment of the coronal • Isotropic 3D measurements & Inline MPR reconstructions 88 88 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 430 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers' ... Overview Strategies Hip Assist ISO @ + + Standard: high image quality in a reasonable scan IMA 1 FRM 8/15 2 % t1_tse_cor_704_bilat 03:46 time with 2D and 3D protocols. 3 pd_tse_cor_576_bilat 03:10 4 pd_tse_fs_cor_512_bilat 03:14 Speed Focus: examine patients in shortest possible 5 t2_tse_fs_cor_512_bilat 03:14 6 t2_tse_stir_cor_512_bilat 04:32 time with accelerated protocols. RA 7 % t1_tse_tra_576_bilat 03:53 Motion‐insensitive (BLADE): compensate for effects pd_tse_fs_tra_448_bilat 03:07 10cm A of motion using BLADE protocols. TP O SP A4.4 FOV 450*450 AAHIP - SEOUL MPR - COP OV 150-45 Cor>Sag(1) High Bandwidth (WARP): optimized strategy for W C 417 IMPR/RESAMP/NORM/DIS3D Not for diagnostic HAR 173 AAHip_Scout_MPR_tra E 24:56 Not for diagnostic use reduction of susceptibility artifacts. be continue commande. GO Cancel Exam Strategy Standard Standard Speed focus WARP Optimizes image quality of knee, hip and shoulder exams. Proposes the most appropriate protocols according to chosen strategy. Ensures reproducible image quality and streamlines large joint examinations. SAR 89 89 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 431 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Overview Large Joint Assist becomes standard since VE11S, XA10* SIEMENS myExam Knee Assist myExam Hip Assist myExam Shoulder Assist (since VD11A*) (since VD13A*) (since VD13A*) 90 90 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 432 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Overview Workflow Concept 2D Workflow Concept 3D Register Load PRESS Register Load PRESS patient protocol region ‘Apply’ 3D AA Scout patient protocol region ‘Apply’ 3D AA Scout AutoAlign AutoAlign Knee/Hip/Shoulder Knee/Hip/Shoulder Alignment Alignment 2D scans 3D scans 2D High Res Scans 3D High Res Scans Auto Referring physician Referring physician requirements 2D protocols requirements 3D protocols processing User input Save reformats as 2D images Calculate MPRs Alignment MPR ranges Sequence run Save to PACS Save to PACS H HI Reporting Report preparation Report preparation 91 Unrestricted © Siemens Healthineers, 2023 Notes 433 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers .. Overview Workflow Concept 2D Workflow Concept 3D Calculate AutoAlign Calculate AutoAlign Shoulder Assist Shoulder Patient View Display AA MPRs V Standard Display AA MPRs V Standard Align 2D Protocols AAShoulder_Scout 00:19 Align 3D Protocols AAShoulder_Scout 00:19 AutoAlign Scout Align MPR Ranges AutoAlign Scout pd_tse_tra_448 03:25 pd_space_cor_iso 08:22 1 Generic Views pd_tse_fs_tra_384 03:34 Select MPRs 1 MPR Assignment pd_space_fs_cor_iso 08:34 1 Generic Views Acquire 3D data 1 MPR Assignment pd_tse_fs_cor 384 02:59 MPR planning ... 2 Generic Views t2_tse_fs_cor 384 Define MPRs MPR Planning 03:56 2 Generic Views Calculate MPRs t1_tse_sag_448 04:27 3 Generic Views t2_tse_fs_sag_384 03:52 3 Generic Views 92 Unrestricted © Siemens Healthineers, 2023 Notes 434 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers .. General 2D Knee Assist @1.5T Knee Assist @ Ortho Patient View Standard Speed focus Motion-insensitive (BLADE) WARP AAknee_scout 00:18 O AutoAlign Scout localizer_sag+cor+tra_high-bw 00:13 Generic Views pd_tse_fs_tra 384 04.14 pd_tse_fs_tra_320 01-53 pd_blade_fs_tra_320 04:18 WARP Generic Views Generic View Generic Views WARP Basic Decision pd_tse_cor_512 04:02 pd_tse_cor_320 01:50 pd_blade_cor_384 04:26 WARP O Generic Views Generic Views Generic Views WARP SEMAC pd_tse_fs_cor_352 03:56 pd_tse_fs_cor_320 01:53 pd blade fs cor 256 02:32 t2_tse_stir_tra_high-bw 04:06 t1_sag_semac 05:26 O Generic Views O Generic Views O Generic Views O Generic Views 9 t1_se_sag_320 03:33 t1_tse_sag_304 01:40 t1_tse_sag_304 01:40 pd_tse_cor_high-bw 03:53 pd_tse_sag_semac 07:15 2 Generic Views 4 Generic Views 6 Generic Views 7 Generic Views 9 pd_tse_sag_432 04:17 pd_tse_sag_368 01:53 pd_blade_sag_320 04:29 t2 tse_stir_cor high-bw 04:27 t2 tse stir sag semac 07:38 O Generic Views Generic Views 6 Generic Views Generic Views 9 t2_tse_fs_sag_320 03:45 pd_tse_fs_sag_320 01:52 pd_blade_fs_sag_304 04:34 t1_sag_high-bw 03:47 t2_tse_stir_cor_semac 06:34 Generic Views Generic Views 6 Generic Views Generic Views pd_tse_sag_high-bw 04:29 8 Generic Views t2_tse_stir_sag_high-bw 04:37 Generic Views ∑ 24:05 mins* ∑ 11:19 mins* ∑ 22:17 mins* ∑ 25:50 mins* ∑ 27:24 mins* 93 Unrestricted © Siemens Healthineers, 2023 Notes 435 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist @1.5T SIEMENS Healthineers ... Lesion Knee Assist GOKnee3D (General 3D Knee Assist) Knee Assist Ortho Patient View GOKnee3D Ortho Patient View V Standard Speed focus AAknee scout V Standard AutoAlign Scout t2_tse_tra_448 03:45 t2 tse tra 384 01:52 AAknee_scout 00:18 Generic Views 4 Generic Views AutoAlign Scout pd_tse_fs_cor_352 03:56 pd_tse_fs_cor_320 01:53 pd_space_sag_iso 04:29 2 Generic Views 5 Generic Views pd_tse_fs_sag_320 04:01 t1_tse_sag_304 O MPR Assignment 01:40 3 Generic Views 6 Generic Views t2_space_fs_sag_iso 05:24 t1_se_sag_320 03:33 pd_tse_fs_sag_320 01:52 1 MPR Assignment 3 Generic Views 6 Generic Views inject contrast agent MPR planning MPR Planning t1_se_sag_320 03:33 t1_tse_sag_304 01:40 3 Generic Views 6 Generic Views t1_tse_fs_cor_320 04:15 t1_tse_fs_cor_288 01:59 ∑ 10:11 mins 2 Generic Views 5 O Generic Views t1_tse_fs_tra_320 03:44 t1_tse_fs_tra_288 02:21 1 Generic Views 4 O Generic Views ∑ 27:05 mins ∑ 13:35 mins 94 Unrestricted © Siemens Healthineers, 2023 Notes 436 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOKnee3D SIEMENS Healthineers ... Uses CAIPIRINHA to accelerate SPACE STUDY ID studyMD Prefi STUDY ID studyIDPrefi 16 IMA 1 FRM 54/192 SIMA PRM 67/240 measurements and is available for 1.5T and 3T. Consists of PD and T2_FS contrast. Scan Time: 3T 9:40min. AHL 1.5T 10:27min. 10cm 95 95 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 437 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 GOKnee3D SIEMENS Healthineers ... CAIPIRINHA SPACE: Reordering Shift 3D _MNO) >> SIEMENS » knee > Knee Assist > general 3D » pd_space_sag_iso ? X No presets available as in VIBE. @ 5:07 min | Auto @ 4 0.5x0.5x0.5 mm3 1.00 Optimal reordering shift must be found Routine Contrast Resolution Geometry System Physio Inline Sequence manually. Common Acceleration Filter Acceleration mode CAIPIRI ... Tip: check the optimal value found for VIBE Phase Partial Fourier Off for similar volume coverage and Total Factor Slice Partial Fourier Off orientation. Reference Scans GRE/Sep .. Acceleration Factor PE 2 ª Reference Lines PE 36 4 Elliptical Scanning Acceleration Factor 3D 2 Reference Lines 3D 24 2 Reordering Shift 3D 96 Unrestricted © Siemens Healthineers, 2023 Notes 438 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign Knee AutoAlign Knee References • Scans a volume in the isocenter and computes the AutoAlign Knee computes the following AutoAlign AutoAlign Knee landmarks references for the knee joint. • The resulting localizer images in transverse, sagittal and • Knee>Standard (Transversal, Sagittal, Coronal) coronal orientations are auto‐loaded into the GSP • Knee>Meniscus segments • Knee>Patella routine • Protocols for specific knee coils can be found in the • Knee>Patella cartilage Siemens Library • Knee>Femur cartilage • Never change the AA Knee Scout • Knee>ACL (Sag>Cor, Sag>Tra) • Knee>PCL The AA references Knee>Meniscus, Knee>Patella cartilage and Knee>Femur cartilage are designed for high reproducibility in follow‐up examinations. 97 Unrestricted © Siemens Healthineers, 2023 Notes 439 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Standard > Transversal Application Standard Transversal scans of the whole knee joint. Alignment • Parallel to the meniscus plane (mainly defined by tibial plateau) • Centered F‐H so that patella and as much of the tibial growth plate as possible are included in a standard protocol with a thickness of 99mm • Centered A‐P so that the patella (+ patella ligament) and as much of the muscle as possible are included in a standard protocol with a FoV of 140mm • If either the tibial growth plate or the patella ligament – tibia connection are not covered in a protocol with a thickness of 99mm, all affected clinical protocols are marked with an AA symbol to indicate that user interaction is required 98 Unrestricted © Siemens Healthineers, 2023 Notes 440 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Standard > Sagittal Application Standard Sagittal scans of the knee joint. Alignment • Centered F‐H so that patella and as much of the tibial growth plate as possible are included • Centered R‐L so that the femur, tibia and as much of the fibula as possible are included in a standard protocol with a thickness of 90mm • Centered A‐P so that the patella (+ patella ligament) and as much of the muscle as possible are included in a standard protocol with a FoV of 140mm • If parts of the femur or the tibia are not covered within the FoV of a protocol with a thickness of 90mm, all affected clinical protocols are marked with an AA symbol to indicate that user interaction is required 99 Unrestricted © Siemens Healthineers, 2023 Notes 441 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Standard > Coronal Application Standard Coronal scans of the knee joint. Alignment • Centered F‐H so that patella and as much of the tibial growth plate as possible are included • Centered A‐P so that the femur, tibia as much of the fibula as possible, and if applicable, the patella are included in the FoV of a standard protocol with a thickness of 90mm • If parts of the femur or the tibia are not covered within the FoV of a protocol with a thickness of 90mm, all affected clinical protocols are marked with an AA symbol to indicate that user interaction is required 100 Unrestricted © Siemens Healthineers, 2023 Notes 442 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Meniscus Application Sagittal/coronal meniscus imaging with a group of parallel slices. Meniscus 2D imaging with a radial slice group. Meniscus 3D imaging with an additional radial MPR reconstruction. Alignment • Parallel to the medial tibial plateau (quite independent of different tibia‐femur angulations in follow‐ups) • Centered in the center of the two menisci (no Application 1 Application 2 auto‐adaptation to cover whole knee joint) 101 Unrestricted © Siemens Healthineers, 2023 Notes 443 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Patella Routine Application Standard patella imaging. Supports a small FoV (without offset) and a large FoV (with offset towards posterior) because the A‐P center point is fixed in the joint space between patella and femur. Alignment • Parallel to the meniscus plane (Knee>Meniscus) • F‐H center shifted so that patella (with margin) and as much of the tibial plateau as possible are covered by a standard protocol with a thickness of 80mm • A‐P center lies in the joint space between the patella and the femur 102 Unrestricted © Siemens Healthineers, 2023 Notes 444 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Patella Cartilage Application Special patella cartilage imaging. Supports a small FoV (without offset) and a large FoV (with offset towards posterior) because the A‐P center point is fixed in the joint space between the patella and femur. Alignment • Perpendicular to the patella disc • The center lies in the center of the patella cartilage 103 Unrestricted © Siemens Healthineers, 2023 Notes 445 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > Femur Cartilage Application Special femur cartilage imaging. Used for example for monitoring an arthritic process or the progress of a knee therapy. Blumensaat Line Alignment • Center point lies in the intercondylar pit • Orientation is derived from the Blumensaat Line Can serve as a basis for semi‐automated positioning of - - . 0 - individual slice groups in the medial or lateral condyle. 104 Unrestricted © Siemens Healthineers, 2023 Notes 446 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > ACL (Sag>Cor) Application Right Knee: positive tilt Sag>Cor • Sagittal imaging of the anterior cruciate ligament (ACL). Left Knee: negative tilt Sag>Cor Sagittal slices are tilted towards the coronal plane. • Based on bony landmarks, therefore independent of the status or existence of the ACL itself. • Used for example in the suspected case of cruciate ligament rupture or post‐surgery scans. • Detects laterality and applies the tilt (+/‐) accordingly. Alignment Tilted Sag>Cor by 15 degrees (+/‐), starting from the midsagittal plane that is provided by the AA reference Knee>Standard (Sagittal). 105 Unrestricted © Siemens Healthineers, 2023 Notes 447 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > ACL (Sag>Tra) Application • Sagittal imaging of the anterior cruciate ligament (ACL). Sagittal slices are tilted towards the transverse plane Right Knee: negative tilt Sag>Tra • Based on bony landmarks, therefore independent of Left Knee: positive tilt Sag>Tra the status or existence of the ACL itself • Used for example in the suspected case of cruciate ligament rupture or post‐surgery scans • Detects laterality and applies the tilt (+/‐) accordingly Alignment Tilted Sag>Tra by 8 degrees (+/‐), starting from the midsagittal plane that is provided by the AA reference Knee>Standard (Sagittal) 106 Unrestricted © Siemens Healthineers, 2023 Notes 448 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Knee Assist SIEMENS Healthineers ... AutoAlign References – Knee > PCL Application • Sagittal imaging of the posterior cruciate ligament (PCL) • Based on bony landmarks, therefore independent of the status or existence of the PCL itself • Used for example in the suspected case of cruciate Right Knee: positive tilt Sag>Tra ligament rupture or post‐surgery scans Left Knee: negative tilt Sag>Tra • Detects laterality and applies the tilt (+/‐) accordingly Alignment Tilted Sag>Tra by 15 degrees (+/‐), starting from the midsagittal plane that is provided by the AA reference Knee>Standard (Sagittal) 107 Unrestricted © Siemens Healthineers, 2023 Notes 449 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Shoulder Assist SIEMENS Healthineers ... General 2D Shoulder Assist @1.5T Shoulder Assist Shoulder Patient View V Standard Speed focus Motion-insensitive (BLADE) AAshoulder_scout 00:23 AutoAlign Scout pd_tse_fs_tra_288 04:30 pd_tse_fs_tra_256 01:42 pd_blade_fs_tra_256 04:04 Generic Views Generic Views Generic Views pd_tse_cor_384 04:29 pd_tse_cor_256 01:13 pd_blade_cor_256 04:24 Generic Views 3 Generic Views 5 Generic Views pd_tse_fs cor 320 04:14 pd_tse_fs_cor_256 01:31 pd_blade_fs_cor 256 04:04 Generic Views 3 Generic Views 5 Generic Views t2_tse_fs_cor_320 04:27 t2_tse_fs_cor_256 02:43 t2_blade_fs_cor_304 03:35 Generic Views 3 Generic Views 5 Generic Views t1_se_sag_320 03:48 t1_tse_sag_320 01:35 t1_tse_sag_320 01:35 2 Generic Views 4 Generic Views 6 Generic Views t2_tse_fs sag 320 04:54 t2 tse_fs_sag_256 02:02 t2 blade fs_sag_288 04:54 2 Generic Views 4 Generic Views 6 Generic Views ∑ 26:45 mins ∑ 11:09 mins ∑ 22:59 mins 108 Unrestricted © Siemens Healthineers, 2023 Notes 450 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Shoulder Assist SIEMENS Healthineers ... General 3D Shoulder Assist @1.5T Shoulder Assist Shoulder Patient View V Standard AAshoulder_scout 00:23 AutoAlign Scout pd_space_cor_iso 07:51 1 O MPR Assignment pd_space_fs_cor_iso 07:33 O MPR Assignment MPR planning MPR Planning ∑ 15:47 mins 109 Unrestricted © Siemens Healthineers, 2023 Notes 451 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Shoulder Assist SIEMENS Healthineers ... AutoAlign Shoulder AutoAlign Shoulder references Scans a volume in the isocenter and computes the AutoAlign Shoulder computes the following AutoAlign AutoAlign Shoulder landmarks. references for the shoulder joint • Shoulder>Paratransversal The resulting localizer images in transverse, sagittal and • Shoulder>Paracoronal coronal orientations are auto‐loaded into the GSP • Shoulder>Parasagittal segments. Never change the AA Shoulder Scout. 110 Unrestricted © Siemens Healthineers, 2023 Notes 452 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Shoulder Assist SIEMENS Healthineers ... AutoAlign References – Shoulder > Paratransversal Application: Basic alignment for visualizing… Positioning • Overall shoulder anatomy • Initially centered by the glenoid center • Acromioclavicular joint (ACJ) • Shift in H‐F direction to center the organ box • Rotator cuff • Shift in M‐L direction to center the organ box laterally • Glenoid • Humeral head • Tip of scapula Alignment Orientation Single oblique Tra>Sag rotation. To be aligned with axis defined by glenoid center and ACJ center (yellow dashed line). Blue Box = Slice Group Red Box = Region of Interest 111 Unrestricted © Siemens Healthineers, 2023 Notes 453 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Shoulder Assist SIEMENS Healthineers ... AutoAlign References – Shoulder > Paracoronal Application: Basic alignment for visualizing… $15mm • Labrum • Glenoid cavity/humeral head interface, along with rotator cuff muscles Alignment Orientation Single oblique Cor>Sag rotation. To be aligned with scapula. Positioning • Initially centered by the center of humeral head (A‐P) and Blue Box = Slice Group glenoid cavity (L‐R and H‐F) Red Box = Region of Interest • Shift in M‐L direction to include a maximum gap of 1cm laterally • Shift in F‐H direction for positioning cranial edge of the slice group to maximum 15mm above organ box 112 Unrestricted © Siemens Healthineers, 2023 Notes 454 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Shoulder Assist SIEMENS Healthineers ... AutoAlign References – Shoulder > Parasagittal Application: Basic alignment for visualizing… $15mm • Labrum • Glenoid cavity/humeral head interface, along with rotator cuff muscles Alignment Orientation ----- Single oblique Sag>Cor rotation. To be aligned with scapula (as per Paracoronal but 90 degrees rotated). Positioning Blue Box = Slice Group • Initially centered by the center of humeral head Red Box = Region of Interest • Shift in M‐L direction to center the organ box • Shift in F‐H direction for positioning cranial edge of the slice group to maximum 15mm above organ box 113 Unrestricted © Siemens Healthineers, 2023 Notes 455 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... General 2D Bilateral Hip Assist @1.5T Hip Assist Hip Patient View Standard Speed focus WARP AAhip_scout 00:29 AutoAlign Scout localizer_high-bw 00:09 O Generic Views pd_tse_fs_tra_448_bilat 04:28 pd_tse_fs_tra_448_bilat 01:34 pd_tse_tra_high-bw_bilat 02:54 1 Generic Views 3 Generic Views 5 Generic Views pd_tse_fs_cor_640_bilat 03:49 pd_tse_fs_cor_448_bilat 01:44 pd_tse_cor_high-bw_bilat 03:50 2 O Generic Views 4 Generic Views 6 O Generic Views pd_tse_cor_704_bilat 03:58 pd_tse_cor_512_bilat 01:38 t1_tra_high-bw_bilat 02:47 2 Generic Views O Generic Views 5 O Generic Views t1 tse tra 512 bilat 03:31 t1_tse_tra_448_bilat 01:28 t1_cor_high-bw_bilat 02:38 21 O Generic Views . 3 Generic Views 6 O Generic Views t1_tse_cor_640_bilat 03:58 t1_tse_cor_448_bilat 01:55 t2_tse_cor_high-bw_bilat 02:58 > 2 Generic Views 4 Generic Views 6 Generic Views t2_tse_fs_cor_448_bilat 04:11 t2_tse_fs_cor_448_bilat 01:51 t2_tse_stir_cor_high-bw_bilat 03:22 > 2 Generic Views Generic Views 6 O Generic Views t2_tse_stir_cor_384_bilat 04:30 t2_tse_stir_cor_320_bilat 01:57 2 Generic Views Generic Views ∑ 28:54 mins* ∑ 12:36 mins* ∑ 19:07 mins* 114 Unrestricted © Siemens Healthineers, 2023 Notes 456 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... General 2D Unilateral Hip Assist @1.5T Standard 33:26mins Hip Assist Hip Patient View Speed focus 22:25 mins Standard Speed focus WARP AAhip_scout 00:29 AAhip_scout 00:29 AAhip_scout 00:29 WARP 24:14 mins O AutoAlign Scout O AutoAlign Scout AutoAlign Scout SEMAC 24:30 mins t1_tse_cor_256_unilat 04:09 t1_tse_cor_256_unilat 02:23 localizer_high-bw 00:20 O Generic Views 3 O Generic Views pd_tse_fs_tra_288_unilat 04:12 pd_tse_fs_tra_256_unilat 02:49 WARP Generic Views O Generic Views WARP Basic Decision pd_tse_fs_cor_288_unilat 04:43 pd_tse_fs_cor_256_unilat 02:52 WARP Generic Views O Generic Views WARP SEMAC pd_tse_fs_sag_256_unilat 04:20 pd_tse_fs_sag_256_unilat 02:52 t1_tse_cor_high-bw_unilat 03:32 t1_tse_cor_semac_unilat 05:05 2 Generic Views O Generic Views 5 O Generic Views Generic Views pd_tse_cor_352_unilat 03:58 pd_tse_cor_256_unilat 02:17 pd_tse_tra_high-bw_unilat 03:49 pd_tse_cor_semac_unilat 04:53 Generic Views 3 O Generic Views Generic Views Generic Views pd_tse_sag_336_unilat 03:22 pd_tse_sag_256_unilat 02:25 pd_tse_cor_high-bw_unilat 04:24 t2_tse_cor_semac_unilat 07:37 > 2 Generic Views O Generic Views 5 Generic Views Generic Views t2_tse_sag_256_unilat 03:50 t2_tse_sag_256_unilateral 02:55 pd_tse_sag_high-bw_unilat 03:48 t2_tse_stir_cor_semac_unilat 06:06 > 2 Generic Views O Generic Views 6 O Generic Views O Generic Views t2_tse_stir_cor_208_unilat t2_tse_stir_cor_256_unilat 03:23 t2_tse_sag_high-bw_unilat 03:57 Generic Views 23 O Generic Views 6 O Generic Views t2_tse_stir_cor_high-bw_unilat 03:55 5 Generic Views 115 Unrestricted © Siemens Healthineers, 2023 Notes 457 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... General 3D Bilateral Hip Assist @1.5T Hip Assist Hip Patient View V Standard AAhip_scout 00:29 AutoAlign Scout pd_space_cor_iso_bilat 07:00 1 O MPR Assignment pd_space_fs_cor_iso_bilat 7:38 21 MPR Assignment MPR planning MPR Planning ∑ 15:07 mins 116 Unrestricted © Siemens Healthineers, 2023 Notes 458 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign Hip AutoAlign Hip references • Scans a volume in the isocenter and computes the AutoAlign Hip computes the following AutoAlign AutoAlign Hip landmarks references for the hip joint. • The resulting localizer images are auto‐loaded into the • Hip (Both) Transversal GSP segments • Hip (Both) Paracoronal • Bilateral Hips – coronal and transverse MPR’s are • Hip (Single) Paratrasversal calculated • Hip (Single) Transversal • Unilateral Hips – sagittal, coronal and transversal MPR’s • Hip (Single) Paracoronal are presented • Hip (Single) Parasagittal • Never change the AAHip Scout • Hip (Single) Femur Axis 117 Unrestricted © Siemens Healthineers, 2023 Notes 459 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... When registering a patient, the laterality must be provided. The laterality is used later to automatically configure unilateral AutoAlign settings. Limitation: can only be done during registration (not during Workflow). Program Selection ¿ 4:09 min ; Auto @ None 0.7x0.7x3.0 mm3 1.00 * SIEMENS » hip » Hip Assist » general 20 unilateral Routine Contrast Resolution Geometry System Inline Sequence Load Program to Queue Physio RF Transmit Mode Slice Group 1 FoV Read 180 - mm Any Polarization Slices 30 FoV Phase 100.0 % Body Part and Laterality Slice Thickness 3.0 - mm Hip Right Distance Factor 10 + % TR 600.0 - ms Patient Orientation Position Isocenter TE 11.00 - ms Head First Supine Orientation Coronal ... Averages 1 Phase Encoding Dir. R>>L Concatenations Phase Oversampling 200 9 AutoAlign Hip > Para Cor R ... 118 Unrestricted © Siemens Healthineers, 2023 Notes 460 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Both) Transversal Application: Basic alignment for visualizing… • Femoral head • Acetabulum • Greater and lesser trochanters Alignment Orientation 1 =20mm ! Inplane rotation. Aligned with axis connecting the centers of the two femoral heads (pure transverse orientation). Positioning Centered by the medial points between centers of the two Blue Box = Slice Group femoral heads. Red Box = Region of Interest 119 Unrestricted © Siemens Healthineers, 2023 Notes 461 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Both) Paracoronal Application: Basic alignment for visualizing… • Femoral head • Acetabulum • Greater trochanter Alignment Orientation Single oblique Cor>Sag rotation. Aligned with axis connecting the centers of the two femoral heads. Positioning -.-.- F‐H centered by the medial points between tops of two Blue Box = Slice Group femoral heads. Red Box = Region of Interest 120 Unrestricted © Siemens Healthineers, 2023 Notes 462 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Both) Paratransversal Application: Basic alignment for visualizing… • Femoral head • Acetabulum • Greater and lesser trochanters Alignment Orientation Single oblique Tra>Sag rotation Aligned with femoral neck 1. - .- Positioning Organ box centered Blue Box = Slice Group Red Box = Region of Interest 121 Unrestricted © Siemens Healthineers, 2023 Notes 463 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Single) Transversal Application: Basic alignment for visualizing… • Femoral head • Acetabulum • Greater and lesser trochanters Alignment Orientation . -...-. No rotation . -. Pure transversal Positioning Initially centered by the femoral head center. Organ box centered. Blue Box = Slice Group Red Box = Region of Interest 122 Unrestricted © Siemens Healthineers, 2023 Notes 464 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Single) Paracoronal Application: Basic alignment for visualizing… • Femoral head • Acetabulum • Greater and lesser trochanters Alignment Orientation .-.- No rotation. . -. t. -. Single oblique Cor>Sag rotation. To be aligned with femoral neck. Positioning To optimally cover femoral head, acetabulum, greater and lesser trochanters. Blue Box = Slice Group Red Box = Region of Interest 123 Unrestricted © Siemens Healthineers, 2023 Notes 465 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Single) Parasagittal Application: Basic alignment for visualizing… • Femoral head • Acetabulum • Greater and lesser trochanters Alignment Orientation - . - .-. Single oblique Cor>Sag rotation. To be aligned with femoral neck (for Paracoronal but 90° rotated). ..- Positioning To optimally cover femoral head, acetabulum, greater and lesser trochanters. Blue Box = Slice Group Red Box = Region of Interest 124 Unrestricted © Siemens Healthineers, 2023 Notes 466 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Hip Assist SIEMENS Healthineers ... AutoAlign References – Hip > (Single) Femur Axis Application: Basic alignment for visualizing… Rotating slice group for visualizing anatomies in a single hip with respect to the femoral axis. • Femoral head • Femoral neck • Acetabulum Alignment Rotation axis – Femoral neck axis. Positioning – center of femoral head. First Slice – parallel to femoral shaft. Other Slices – are generated by rotation clockwise with respect to the femoral neck axis. Blue Box = Slice Group Red Box = Region of Interest 125 Unrestricted © Siemens Healthineers, 2023 Notes 467 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – Ortho Patient View Ortho Patient View behaves like a Basic Patient View with some optimized pre‐configured settings. Queue GSP View Tools Image Text On Group Graphics On Reference Lines Default Extent Mode Number of Slices Protocol Table Position Off Coil Positions On Adjust Volume Off Physio Display Default Expand Third Segment Default View-Graphics Scroll Display Slice Groups Default Display Order Default 126 Unrestricted © Siemens Healthineers, 2023 Notes 468 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – AutoAlign Scout AutoAlign_Scout, auto load is configured to load AutoAlign MPR’s to GSP for subsequent protocols. Parameters Queue All GSP Series Label GSP Segment 1 GSP Segment 2 GSP Segment 3 Auto Load Processing MPR MPR MPR AutoCoverage AutoTiming View Sagittal Coronal Transversal 127 Unrestricted © Siemens Healthineers, 2023 Notes 469 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – AutoAlign AutoAlign configures clinical protocols with AutoAlign reference for consistent slice positioning and minimal user interaction. 3.0T XQ (Vida-XQ_2Tx_64Rx_MNO) > SIEMENS > knee > Knee Assist > general 2D >> pd_tse_fs_tra_448 ? General 4:07 min Auto @ 2 @ 0.3x0.3x3.0 mm3 1.00 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Execution Slice Group 1 FoV Read 140 mm Image Management Slices 30 FoV Phase 100.0 ¢ % Auto Load Slice Thickness Copy References 3.0 - mm Preview Distance Factor 10 % TR 3500.0 ms Position Isocenter TE 31.00 ms Orientation Transversal ... Averages 2 7 ... Phase Encoding Dir. R>>L ... Concatenations 1 4 Phase Oversampling 50 % AutoAlign Knee > Standard 128 Unrestricted © Siemens Healthineers, 2023 Notes 470 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – Generic Views AddIn Generic Views AddIn is used to configure the Guidance Card, Parameter Card, and ... >> shoulder > Shoulder Assist > general 2D AutoCoverage. Parameters V Standard Guidance AAShoulder_Scout 00:19 AutoAlign Scout Slices FOV Read 160 + mm pd_tse tra 448 03:25 Slice Thickness 3.0 mm FOV Phase Generic Views 100.0 ¢ % pd_tse_fs_tra_384 03:34 Guidance rameters Generic Views pd_tse_fs_cor_384 02:59 TR 3700.0 ¢ ms 2 Generic Views Concatenations 1 + t2_tse_fs_cor_384 03:56 2 Generic Views t1_tse_sag_448 04:27 3 Generic Views t2_tse_fs_sag_384 03:52 3 Generic Views Check the alignment of the transversal plane. 129 Unrestricted © Siemens Healthineers, 2023 Notes 471 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – AutoCoverage Example: adapts the number of slices to cover the Guidance Parameters Enable AutoCoverage anatomy for the selected organ box. Queue Organ box Shoulder > Para Transversal GSP Series Label Propagate changes to all following protocols Keep the FoV constant (i.e., recommended for MSK). Auto Load Keep FOV constant AutoCoverage AutoCoverage will execute the following manipulations Auto Timing Note: Propagate changes to all following protocols Parameter Limit ncrement Slices 30.0 ¢ 1.0 not configured in Siemens protocols. SAR Assistant SAR Assistant TR, Flip Angle Min Flip Angle 120 deg Max. TR 4000.0 ms 130 Unrestricted © Siemens Healthineers, 2023 Notes 472 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – Copy Reference Copy Reference: 3.0T XQ (Vida-XQ_2Tx_64Rx_MNO) > SIEMENS > shoulder > Shoulder Assist > general 2D Center of Slice Groups and Saturation Regions copies Shoulder Assist Shoulder Patient View the slice group orientation if modified by the user. V Standard Speed focus AAShoulder_Scout 00:19 AAShoulder_Scout 00:19 Recommendation: if the slice thickness is the same AutoAlign Scout AutoAlign Scout between protocols, configure Copy Reference Slices. pd_tse_tra 448 03:25 pd_tse_tra 320 01:29 Generic Views 4 Generic Views pd_tse_fs tra 384 03:34 pd_tse_fs_tra_320 01:16 1 Generic Views 4 Generic Views pd_tse_fs_cor 3 Slices and saturation regions 59 pd_tse_fs_cor 320 01:43 2 Generic Views 5 Generic Views t2_tse_fs_cor 384 03:56 t2_tse_fs_cor_320 02:36 2 Generic Views 5 Generic Views t1_tse_sag_448 04:27 t1_tse_sag_320 01:37 3 Generic Views 6 Generic Views t2 tse_fs_sag_384 03:52 t2_tse_fs_sag_320 02:10 3 Generic Views 6 Generic Views 131 Unrestricted © Siemens Healthineers, 2023 Notes 473 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – MPR Planning & MPR Assignment AddIn MPR Planning: configuration of the MPR ranges (FoV, number of slices, etc.). Shoulder Assist Shoulder Patient View V Standard MPR Assignment: configuration of the ranges AAShoulder_Scout 00:19 reconstructed for individual protocols. AutoAlign Scout pd_space_cor_iso 08:22 Recommendations: O MPR Assignment Only one MPR Planning step per Strategy or non‐myExam pd_space_fs_cor_iso 08:34 Assist program. 1 MPR Assignment MPR planning step should be identical for all strategies MPR planning ... within a program. MPR Planning Only one MPR Planning step per myExam Assist program if the MPR Planning step is expanded over all strategies. 132 Unrestricted © Siemens Healthineers, 2023 Notes 474 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – MPR Planning & MPR Assignment AddIn MPR Planning MPR Assignment Configures all ranges that may be required for the Assigns the ranges reconstructed for individual myExam Assist program. protocol steps. Queue Guidance + Parameters Guidance GSP Layout 2 images B A Parameters Generate the following selected MPRs Auto Load MPR Planning "NOTICE: please configure Tooltip Tooltip Queue cor guidance text here" GSP tra sag Series Label cor sag Auto Load AutoCoverage Auto Timing MPR Assignment Add MPR range Remove MPR range i Remember to select the desired MPR ranges to be processed in the corresponding MPR Assignment steps. 133 133 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 475 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 myExam Large Joint Assist SIEMENS Healthineers ... Configuration – MPR Planning & MPR Assignment AddIn MPR Planning MPR Assignment Customize by adding or removing MPR ranges. Assign ranges reconstructed for individual protocol steps. Queue Guidance + - Parameters Guidance GSP Parameters Generate the following selected MPRs Auto Load tra FOV Height x Width 120 mm x 100 % Queue MPR Planning cor tra Slice Thickness 2.0 mm GSP sag Series Label cor Slice Dist. Factor % ACL sag Slices 25 Auto Load ACL Patella AutoCoverage Patella Image Numbering H >> F AutoTiming AutoAlign Knee > Patella, Routine MPR Assignment Position Iso Center Add MPR range Orientation Transversal Remove MPR range Remember to select the desired MPR ranges to be processed in the corresponding MPR Assignment steps. 134 Unrestricted © Siemens Healthineers, 2023 Notes 476 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Day 3 SIEMENS Healthineers Diffusion Weighted Imaging MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 477 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Diffusion Weighted Imaging • Theory • Basic applications • Sequences • Parameters • Simultaneous Multi‐Slice (SMS) Diffusion 2 Unrestricted © Siemens Healthineers, 2023 Notes 478 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Recall Diffusion Weighted Theory • List the basic Diffusion Weighted applications • Identify the sequences used for Diffusion Weighted imaging • Recall the parameters used for Diffusion Weighted imaging • List the features and applications for SMS Diffusion imaging 3 Unrestricted © Siemens Healthineers, 2023 Notes 479 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... The information presented in this Diffusion presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.” 4 Unrestricted © Siemens Healthineers, 2023 Notes 480 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... MR Applications Fundamentals 1 Diffusion Weighted Imaging Theory 5 Unrestricted © Siemens Healthineers, 2023 Notes 481 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Theory Diffusion Weighted Imaging SIEMENS Healthineers ... Theory Brownian Motion Low Cellular Tissue The mobility of water is driven by thermal agitation (Temperature) and highly dependent on its cellular environment (Medium). In highly cellular tissues (e.g., tumor tissue), the tortuosity of the extracellular space and cell membrane density limit the apparent diffusion of water molecules. In contrast, cystic and necrotic tissues have fewer barriers to water diffusion and the apparent diffusion is relatively free. Diffusion Weighted Imaging We measure the random motion of water molecules to: • Generate the Diffusion Weighted contrasts • Detect microscopic structural changes of tissues Highly Cellular Tissues 6 Unrestricted © Siemens Healthineers, 2023 Notes 482 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers .. Theory Isotropic Diffusion The diffusion rate appears to be the same when measuring along any axis. Isotropic Diffusion Anisotropic Diffusion Water will diffuse more rapidly in the direction aligned with certain internal structure. It moves slowly in the direction perpendicular to the structure. Anisotropic Diffusion 7 Unrestricted © Siemens Healthineers, 2023 Notes 483 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Theory – Central Nervous System (CNS) Gray Matter Consists of neuronal cell bodies, neuropil (axon terminals, dendrites), glial cells, capillaries. › › dendrites White Matter Main function: information processing. More isotropic diffusion is expected. synapse axon terminal White Matter node of Ranvier Consists mostly of myelinated nerve fibers. myelin sheath Schwann cell Main function: passing the messages between nucleus Schwann cell different areas of gray matter within the CNS. More anisotropic diffusion is expected. microfilament synapse microtubule Axon dendrites Gray Matter 8 Unrestricted © Siemens Healthineers, 2023 Notes 484 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Applications a a MRI Diffusion in Routine Imaging • Early detection and assessment of stroke • Differentiation of new from old infarcted regions • Tumor characterization • Infections (e.g., abscesses) • Evaluation of multiple sclerosis Acute Stoke Primary CNS Lymphoma Advanced Diffusion applications a • Diffusion Tensor Imaging (DTI) • Diffusion Spectrum Imaging (DSI) GBM with Peripheral Edema Abscess with Ventriculitis 9 9 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 485 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Applications Advanced Diffusion Applications • Diffusion Tensor Imaging (DTI) • Diffusion Spectrum Imaging (DSI) MRI Diffusion in Advanced Applications: White Matter • Dissected white matter of the brain • Several fiber bundle directions can be distinguished 10 10 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 486 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Sequences SIEMENS Healthineers ... MR Applications Fundamentals 1 Diffusion Weighted Imaging Sequences 11 Unrestricted © Siemens Healthineers, 2023 Notes 487 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... DWI Sequences Single‐Shot EPI RESOLVE BLADE Diffusion HASTE Diffusion PSIF 12 12 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 488 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers .. Diffusion Encoding Gradients Contrast generated by diffusion weighting gradients. Pair of gradients to de‐phase and afterwards re‐phase 90° 180° all spins. RF If spins are moving during the active gradients along the direction of the gradient, spins can’t be re‐phased G G to their initial phase. GR,P,S • Results in signal loss • The amount of signal loss indicates level and the δ δ probable direction of the motion Δ -d 0 +d Distance To detect microscopic motion of water diffusion in tissues, diffusion encoding gradients must be very strong. 13 Unrestricted © Siemens Healthineers, 2023 Notes 489 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Diffusion Encoding Gradients b‐value Factor that reflects the strength and timing of the 90° 180° gradients used to generate diffusion‐weighted images. RF The higher the b‐value, the stronger the diffusion effects. G G Simplified formula for Monopolar gradients. (i.e., one pair of diffusion encoding gradients). GR,P,S b = γ 2 G2 (∆ − δ/3) s/mm2 δ δ • with γ =42.58MHz/T (gyromagnetic ratio of 1H) Δ -d 0 +d Distance To sense slow moving water molecules and/or smaller diffusion distances, b values must be higher. () ( ) S b =S b0 ·e −b·ADC • • Brain typically b=1000 14 Unrestricted © Siemens Healthineers, 2023 Notes 490 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... Diffusion Encoding Gradients Signal loss corresponds to the applied diffusion gradient ¥2ndwkUU1 AFR Hospital ¥2ndwkUU1 AFK 0001 0001 *2/21/1987, F, 20Y Aera MR E11 +2/21/1987, F. 20Y STUDY 1 HFS 2/20/2017 +4 PH STUDY 1 2/20/2017 directions. 11:25:35 AM 100 IMA 91 / 100 11:26:26 AM 101 IMA 41 /100 • Potential information for understanding the directions of white matter • Single Diffusion Gradient direction measurement is not appropriate in brain → 3 or 4 scan TRACE MF 1.00 10cm MF 1.00 TR 5700.0 TR 5700.0 TC 100.0 TC 100.0 .TA 01:38 TP O. BW 1240.0 SP H27.7. TA 01:38 Diffusion coefficient could be calculated to quantify the p2 DIFFUSION/NONE/ND/NORM L 5.0/1.5: ds BW 1240.0 FOV 234 234"234. p2 DIFFUSION/NONE/ND/NORM A2/PFPIFS Tra Cor(2.2) Sog 4p*384 1 ag(-1.0) A4/PFPFS HE1-4 ep_b0 / 90 HE1-4 "ep_b1000s /90 Diffusion level. . . . . . . . . . . .. . . ... V2ndwk001 AFR Hospital V2ndwk001 12/21/1087, F, 20Y Apra MR E11 HE'S *2/21/1087, F, 20Y STUDY 1 STUDY 1 2/20/2017 + PH 11:26:15 AM 2/20/2017 102 IMA 66 / 100 11:26:21 AM 103 IMA 66 /100 RMP MF 1.00 40cm MF 1.00 TR 5700.0 TE 100.0 TR 5700.0 TA 01:38 TP O TE 100.0 BW 12400 SP H27 .7 TA 01:38 p2 DIFFUSION/NONE/ND/NORM SL 5.011.5 BW 12400 FOY 234*234 p2 DIFFUSION/NONE/ND/NORM A4/PFPIFS 384p+384 1 A4/PFPIFS HE1-4 Tro>Cor(2.2)>Sag(-1.8) ep_b1000p /90 426 HE1-4 184 *ep_b1000r /90 15 15 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 491 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Single‐Shot EPI Diffusion Single‐Shot EPI all of k‐space is acquired after one 90° 180° excitation and one refocusing pulse  Spin‐Echo RF EPI. GS Central Echo is SE Contrast is T2‐weighted. GR All other k‐space lines are Gradient Echoes. GP (i.e., sensitive to susceptibility). • During continuous readout, spins of different MR B0 areas will dephase and will accumulate the Diffusion Encoding wrong phase encoding information  image Gradients distortions • The longer the readout, the more dephasing, the more distortions! • Reduce PE steps (e.g., iPAT, avoid Oversampling, small FoV in PE) and reduce echo spacing! 16 Unrestricted © Siemens Healthineers, 2023 Notes 492 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Single‐Shot EPI Diffusion Single‐Shot EPI all of k‐space is acquired after one 90° 180° excitation and one refocusing pulse  Spin‐Echo RF EPI. GS Central Echo is SE Contrast is T2‐weighted. GR All other k‐space lines are gradient echoes. GP LULL (i.e., sensitive to susceptibility). MR • During continuous readout, spins of different B0 areas will dephase and will accumulate the Diffusion Encoding wrong phase encoding information  image Gradients distortions • The longer the readout, the more dephasing, the more distortions! Echo Spacing • Reduce PE steps (e.g., iPAT, avoid Oversampling, small FoV in PE) and reduce echo spacing! 17 Unrestricted © Siemens Healthineers, 2023 Notes 493 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 RESOLVE Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Multi‐Shot Echo Planar Diffusion Weighted One Readout Segment / Shot per TR Imaging 90° 180° 180° k‐space is segmented in readout direction RF (i.e., only a certain portion of k‐space is acquired after one excitation  one segment per TR). GS • Every segment is a single‐shot EPI, with a much shorter Echo Spacing (i.e., less time for GR dephasing and less distortions) • Segments must match their phase information, GP a navigator echo is acquired with each segment to correct the phases of each MR individual shot Imaging echo Navigator echo 18 Unrestricted © Siemens Healthineers, 2023 Notes 494 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Multi‐Shot Echo Planar Diffusion Weighted One Readout Segment / Shot per TR Imaging 90° 180° 180° k‐space is segmented in readout direction RF (i.e., only a certain portion of k‐space is acquired after one excitation  one segment per TR). GS • Every segment is a single‐shot EPI, with a much shorter Echo Spacing (i.e., less time for GR dephasing and less distortions) • Segments must match their phase information, GP a navigator echo is acquired with each segment to correct the phases of each MR individual shot Imaging echo Navigator echo Echo Spacing 19 Unrestricted © Siemens Healthineers, 2023 Notes 495 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Navigator Echo One Readout Segment / Shot per TR An additional Navigator Echo after a second 90° 180° 180º 180° refocusing pulse covering the central k‐space. RF Corrects non‐linear phase errors which differ GS from shot to shot. GR Due to diffusion weighting preparation a multi‐shot diffusion sequence is susceptible GP for motion induced by CSF pulsation MR The reduction of these phase errors happens Imaging Echo Navigator Echo in 2 steps: Shot‐to‐shot phase variations in DWI Navigator Echo • Phase correction of each shot • Optional reacquisition of shots where phase variation is too large 20 Unrestricted © Siemens Healthineers, 2023 Notes 496 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Navigator Echo 3 5:08 min | Auto @ 2 @ 0.6x0.6x5.0 mm3 1.00 Acquires the phase of the central segment Routine Contrast Resolution Geometry Systen Physio Diff Sequence of k‐space with each segment. Part 1 Part 2 Assistant It analyses, compares and corrects Reacquisition Mode Off accordingly the phase of each individual segment. artifact artifact Optional Reacquisition mode: • Sequence  Part 2 shot 1 shot 2 shot 3 shot 4 shot 5 shot 6 shot 7 b C • If phase variation between shots are too large (e.g., due to CSF pulsation) the corrupted shot is omitted and re‐ acquired • Should be ON in all Neuro studies TA increases up to 20% (i.e., no more shot 1 shot 2 shot 3 shot 4 shot 5 shot 6 shot 7 e • Reacquisition Mode On than 20% of shots are corrected!) 21 21 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 497 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Number of Segments 8 2:35 min 1 Auto @ 2 0.8x0.8x5.0 mm3 0.98 More segments allow: Routine Contrast Resolution Geometry System Physio Diff Sequence • Shorter Echo Spacing and less distortions! Common Acceleration Filter Accel. Mode GRAPPA • Higher Matrix sizes while maintaining a short Echo Spacing Phase Partial Fourier Off Reference Scans EPI/Sep ... Readout Partial Fourier 6/8 Properties Acceleration Factor PE 2 Readout Segments 5 4 • Longer TA because multiple TR for one k‐ Reference Lines PE 75 space/Image • Usually, less SNR because of less averages • With shorter ES, TE can be reduced  Current setting: 6/8 -> Acquired readout segments: 4 increases SNR Available options: 4/8 -> Acquired readout segments: 3 To reduce scan time: Readout Partial Fourier. 5/8 -> Acquired readout segments: 3 6/8 -> Acquired readout segments: 4 7/8 -> Acquired readout segments: 4 Off -> Acquired readout segments: 5 22 Unrestricted © Siemens Healthineers, 2023 Notes 498 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Readout Partial Fourier Certain number of segments are omitted to reduce scan time. Shorter TA, more diffusion directions, more b‐values, more averages, and/or more segments to reduce ES. Half‐Fourier reconstruction via POCS • True reconstruction of k‐space data compared to zero‐filling like in EPI • Maintains Spatial Resolution Current setting: 6/8 -> Acquired readout segments: 4 • Loss of SNR • Works in k‐space, therefore, Available options: 4/8 -> Acquired readout segments: 3 requires Adaptive Coil Combine 5/8 -> Acquired readout segments: 3 6/8 -> Acquired readout segments: 4 7/8 -> Acquired readout segments: 4 Off -> Acquired readout segments: 5 23 Unrestricted © Siemens Healthineers, 2023 Notes 499 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE, b = 1000 s/mm2, 4‐scan trace Standard Readout Partial Fourier = 6/8 Readout Partial Fourier = 5/8 4:36 min 3:23 min 2:24 min 24 24 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 500 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE, b = 1000 s/mm2, 4‐scan trace Standard Readout Partial Fourier = 6/8 Readout Partial Fourier = 5/8 4:31 min 3:16 min 2:38 min 25 25 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 501 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE Readout Partial Fourier Limitations: Sometimes mesh pattern appears when Partial Fourier is used. SMS will make mesh pattern more obvious because of lower SNR  avoid extensive Partial Fourier acquisitions. AFL AFL RAF Conventional SMS=2 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 502 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE versus Single‐Shot EPI Tumor delineation and anatomical correlation. T2 TSE T2 Dark‐Fluid RESOLVE SE‐EPI Single‐Shot b = 1000 s/mm2 b = 1000 s/mm2 27 27 Courtesy of Tongji Hospital, Wuhan, China Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 503 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE versus Single‐Shot EPI 12‐year‐old, medulloblastoma with metastases. SE‐EPI Single‐Shot b‐value = 1000 s/mm2, GRAPPA 2, matrix 160 RESOLVE b‐value = 1000 s/mm2, GRAPPA 2, matrix 224 28 28 Courtesy of Children‘s MRI Centre & RCH, Victorial, Australia Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 504 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE versus Single‐Shot EPI Metal Artifacts. SE‐EPI Single‐Shot RESOLVE b = 50 s/mm2 b = 1000 s/mm2 ADC 29 29 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 505 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... RESOLVE versus Single‐Shot EPI Diagnosis of benign and metastatic vertebral fractures. SE‐EPI Single‐Shot, RESOLVE, GRAPPA 2, FUSED T2 TSE, GRAPPA 2 GRAPPA 2, Matrix 128 Matrix 150 T2 TSE & RESOLVE Matrix 384, TA 1:20 min 30 30 Courtesy of Singapore General Hospital, Singapore. Rumpel et al. (2013). Eur Radiol, 23, 541‐550. Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 506 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Quiet Diffusion Diffusion Weighted Imaging SIEMENS Healthineers ... Quiet Diffusion Readout Segmentation with RESOLVE 90° 180° 180° increased Echo Spacing to minimize acoustic noise. RF • Stretched gradients to minimize the slew rate to a desired level GR • Reduces acoustic noise while maintaining a relative short ES MR • ES should be kept smaller or identical to Single‐Shot EPI to avoid stronger distortions qDWI 90° 180° 180° • Because ES is longer than in RESOLVE, TE and TR become RF longer • Phase Partial Fourier (with Zero‐ GR Filling) to shorten TE (not to mix up with Readout Partial Fourier!) MR 31 Unrestricted © Siemens Healthineers, 2023 Notes 507 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Quiet Diffusion Readout Segmentation with Dot Cockpit - Explorer ? 0 x increased Echo Spacing to minimize Explorer Ò 2:05 min 1| Auto @ 2 0.8×0.8×5.0 mm3 1.00 Browse Import Expo Routine Contrast acoustic noise. Resolution Geometry System Physio Diff Sequence X Common Acceleration Filter • Stretched gradients to minimize SIEMENS Accel. Mode GRAPPA the slew rate to a desired level % a psif Phase Partial Fourier 718 • Reduces acoustic noise while GOBrain maintaining a relative short ES library Reference Scans EPI/Sep ... localizer Acceleration Factor PE Readout Segments = • ES should be kept smaller or T1 identical to Single‐Shot EPI to Reference Lines PE 66 T2 avoid stronger distortions PD+T2 • Because ES is longer than in BD diffusion RESOLVE, TE and TR become perfusion longer BOLD • Phase Partial Fourier (with Zero‐ BLADE SWI Filling) to shorten TE (not to mix flow qdwi_4scan_trace_tra_p2 02:05 up with Readout Partial Fourier!) multi-echo qdwi_4scan_trace_tra_s2_p2 01:25 QUIET 32 Unrestricted © Siemens Healthineers, 2023 Notes 508 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... Quiet Diffusion Because of the prolonged Echo Spacing, image distortions become STUDY1 STUDY 1 HFS stronger compared to RESOLVE 31:30:48 AM 3/21/2016 11:32:36 AM (preferred ES in qDWI ≤ 1ms). Because of Phase Partial Fourier with Zero Filling, image blurring RHP RHP increases. The IQ of qDWI is more comparable AF 1.00 MF 1.00 to a Single‐Shot EPI. |TR 6700.0 TR 5800.0 TA 01:55 TP O SP F33.5 ITA 02:03 DVV 104U.U SL 4.0/1.2| SPF33.5 p2 DIFFUSION/TRACEWIND/NORM PW 700.0 FoV 220*2201 p2 DIFFUSION/TRACEWIND/NORM SL 4.0/1.2 FoV 220*220 A3/PFP/FS 384p*384 1 Tra>Sag(-1.5)>Cor(-1.5) A1/PFP/FS 160p*160 Tra>Sag(-1.5)>Cor(-1.5) *ep_b1000t / 90 W 450 1791 *qD_b1000t / 180 W 1218 33 33 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 509 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BLADE Diffusion Weighted Imaging SIEMENS c Healthineers ... BLADE Diffusion b a BLADE Diffusion Multi‐shot imaging with BLADE trajectory and reduced sensitivity to B0 inhomogeneities is based on: • TSE (EPI factor = 1) 90° 180° 90° (x+180)/2° x° TGSE (EPI factor > 1) a b c • RF/MR Spin motion during diffusion gradients leads EPI factor = 3 to spatially varying/unknown phase accruals (→ CPMG condi on violated). ti Gx Phase insensitive preparation restores CPMG condition. Gy Excitation and Phase insensitive Readout diffusion preparation preparation 34 Unrestricted © Siemens Healthineers, 2023 Notes 510 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... BLADE Diffusion Properties SIEMENS SIEMENS >> head > library > BLADE SIEMENS my head > library > diffusion _T1w ZOOMit - diffusion_ XA50A - CD head t1_blade_dark-fluid_sag_p2 04:01 temporal lobe Standalone BLADE diffusion sequence. [ head Brain Assist 11_blade_dark-fluid_tra 03:59 > Brain Assist ep2d_diff_cor_ZOOMit 02:36 Brain Autopilot Brain Autopilot clinical libraries t1_blade_dark-fluid_cor_p2 03:49 > clinical libraries HASTE - diffusion_ XA51A advanced applications libraries _T2w- advanced applications libraries t2_haste_diff_cor_p2 GOBrain GOBrain 04:27 Standalone BLADE sequence includes: library 12_blade_tra_p2 01:50 library BLADE - diffusion localizer E localizer 03:02 ET1 • Fast BLADE mode (FAST_TSE based t2_blade_dark-fluid_tra_p2 blade_diff_tra_144_p2 E T2 t2_blade_cor_p2 04:02 T2 BLADE equivalent) blade_diff_tra_160_p252 03:06 E PD+T2 E PD+T2 # 3D blade diff cor 144_p2 3mm 03:29 • BLADE Diffusion El diffusion E diffusion E perfusion E BOLD Routine Contrast Resolution Sequence E BLADE Geometry System Diff Inline Part 1 Part 2 Assistant Introduction v Acoustic noise reduction Of Fast Mode Motion Correction Off 35 Unrestricted © Siemens Healthineers, 2023 Notes 511 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... BLADE Diffusion Properties Routine Contrast Resolution Ge ommon Acceleration Filter Only BLADE trajectory is available Separate PAT • Acceleration mode SMS reference scan for fast • SMS is supported (TSE/Separate reference scan) acquisition and SMS • The reordering is matched Reference Scans TSE/Sep ... (centric/linear for short/long TE) Acceleration Factor PE Reference Lines PE 64 • EPI factor can be changed (only BLADE diffusion) SMS Factor 2 Routine Contrast Resolution Geometry System Physio Diff Inline Sequence Part 1 Part 2 Assistant TGSE (EPI factor > Routine Contrast Resolution Geometry System Physio Diff Inline Sequence FOV Shift Factor Sequence Name tgBAES 1) Bandwidth 504 Hz/Px Diffusion Mode None Echo Spacing 17.1 ms Scan Assistant None Routine Contrast Resolution Geometry System Physio Diff Inline Sequence <3-Scan Trace> Part 1 Part 2 Assistant Switching <4-Scan Trace> ? Your last change Sequence Nam SeBA Bandwidth 504 + Hz/Px diffusion Diffusion Mode 4-Scan Trace - None Echo Spacing 8.76 0 ms TSE (EPI factor = 1) urbo Factor 11 + mode will adapt the following parameters: TE <3D Diagonal> 70.00 48.00 ms Reordering Centric - Linear RF Pulse Type Normal EPI Factor Turbo Factor 11 EPI Factor 5 9 5 1 Ramp Sampling On Off Gradient Mode Fast EPI Factor > 1 for OK Undo Flow Compensation None fast acquisition Reordering Centric EPI Factor 1 9 and SAR reduction TGSE only for BLADE Diffusion Centric Reordering for Short TE 36 Unrestricted © Siemens Healthineers, 2023 Notes 512 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... BLADE Diffusion – Parameter Hints RF Pulse Type. BLADE - Diffusion_ EssCourseMaterial EssCourseMaterial *1/1/1 989. M. 33Y MAGNETOM Vida *1/1/1999, M. 33Y EssCourseMaterial MAGNETOM Vida *1/1/1 989. M. 33Y 10/18/2022 10/18/2022 10/18/2022 • Fast: non‐SMS blade_diff_tra_160_p2_4mm 03:50 Blade_diff_tra_160_p244m blade_dit_tra_160_p2_4 blade_dif_tra_160 1 1 LatestB-Value_01 labestB-Vale_02 Latest STUDY ID 2c7b884 938 STUDYID 247b8840-93c STUDY ID 2c7b8846 Normal: SMS 14 IMA1 FRM 15/27 14 IMA2 FRM 15/27 15 IMA1 FRM 15727 • blade_diff_tra_160_p2s2_4mm 2 02:52 RAS 20 SL SL SPC SP HB.5 SPC 52 FOV 220 220 FOV 220"220 SPC TR 5500.0 160 160 160"160 blade_diff_cor_192_p2_3mm TR 5500.0 TR 5500.0 For Short TE. 3 05:27 TE 44.0 Cor(-9)>Sap(1) TE 44.0 Cor(.9).Sag(1) TE 44.0 TA 03:50 W D2 MAONDIFFITRACEWIN c 454 TA 03:50 W TA 03:50 P2 MAON/DIFFITRACEW 92 MAOINDIFFIADCINO • 4‐Scan Trace Monopolar diffusion (no EC effects expected) EssCourseMaterial EssCourseMaterial *1/1/1989, M, 33Y MAGNETOM Vida *1/1/1989, M. 33Y MAGNETOM VISA -1/1/1 989. 4.33 • 10/18/2022 10/18/2022 blade_diff_tra_160_p2;224mm blade_dit_tra_160_p252_4mm STUDY IO 26 76 2 EstestB-Value_01 labeste-Value_02 STUDY ID 2c76084+-9730-40 STUDYIO 2c7bE-14e-93c0-45 16 IMA 1 FRM 15/28 16 IMA 2 FRM 15/28 Bandwidth may be reduced (~500‐600 Hz) to gain SNR. 20 SP H3.9 SL OV 220-220 SPC 160.160 (9)> Sag(1) W 392 TE 45.0 Turbo Factor ~11‐15, EPI factor ~3‐5. 92 82 MAGNDIFFITRACEWINORMOIS20 D2 82 MAGINDIFF/TRACEVONORMIDIS C 186 TA 02:52 D2 $2 MAGNDIFFIDCA EssCourseMaterial EssCourseMaterial EssCourseMaterial *1/1/1 989, M, 33Y MAGNETOM Vida *1/1/1989, M. 33Y ONETOM Vida *1/1/1 989. M. 33) 10/18/2022 10/18/2022 10/18/2022 b‐value Averages = 1‐2; use BLADE coverage to gain SNR. Blade_dif_cor_192_ blade_dit_cor_192_p2 blade_diff_cor_192 latestB-Value_01 1a5estD-Vake_02 Latest STUDY ID 2c76884 STUDYID 2<7b6940-93 STUDY ID 2c76886 3 18 IMA 1 FRM 5/13 18 IMA 2 FRM 5/13 19 IMA1 FRM 5/13 RHA A 2D A 20 A SL SL 3.0 SP P8.4 SL 3.0 Fast BLADE to increase SNR. SPC SP P8.4 FoV 220-220 SPC 3.6 9E FoV 220-220 SPC 3.6 SP P8.4 FoV 220*220 192 192 192-192 192º192 Sag(1)>Tra(1) Sag(1).Tract) ap(1)>Tra(1) 976 TE 48.0 TA 05:27 W 392 TE 48.0 454 186 TA DS:27 p2 MAGN/DIF D2 MAGNDIFFIADCAN Phase Oversampling = 100% for Coronal imaging. 37 37 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 513 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... From Single‐Shot EPI to BLADE Diffusion Centric Reordering Linear Reordering EstCourseMaterial 2022.10.18-12:11:13-DST-1.3.12 2.1107.5 99 3 EssCourseMaterial 2022:10.18-12:11:13-DST-1 3.12 2 1107.5.993 EssCourseMaterial TOM Vida ONETOM Vida 2022.10.18-12:11:13-D8T-1.3.12.2 1107.5.99 3 +1/1/1 989. M. 33Y MR XASO *1/1/1999, M, 33Y MR XASO *1/1/1 999, M. 33Y 10/18/2022 HFS 10/18/2022 HF'S -LPH +LPH 10/18/2022 blade_di_tra_160_p2_4mm TRACEW latest@-Value_01 blade_of_tra_160_2_tmm TE62_cermic_TRACE latest9-Value_01 Dade_diff_tra_160_p2_4mm TE71_jmeal_TRACEW latest/B-Value_01 b = 0 40 *** STUDYIO 2:78484e-93c8 15 STUDY ID 2c760846-93€0.25 STUDY ID 2cTb##40-0%<0.75 1:01:03 PM 1:14:32 PM 14 IMA1 FRM 14/27 20 IMA1 FRM 14/27 1:18:38 PM 22 IMA1 FRM 14/27 RAF 1cm SL 40 SPC TP ES TR 5500.0 TP F2 TR 5500.0 SP H1 3 TE 620 SP H1.3 TE 71.0 FoV 220-220 TA03:50 TA 03:50 160"160 BW 651.0 FOV 220-220 BWV 651.0 Con(-9).Sag(1) P2 MAGNOIFFITR 160-160 >Cor[.9)>Sag(1) D2 MAGN/DIFFITR Zoom 3:43 A1FFS Zoom 3.43 W AIFF'S HE1-4 W 396 HE1-4 "blade_60/ 133 396 "Blade_b0/ 132 EstCourseMaterial 2022.10.19-12:11:13-DST-1.3.12 2.1107.5.99 3 EssCourseMaterial ONETOM Vida 2022.10.18-12:11:13-DST-1.3.12.2.1107.5.993 EssCourseMaterial AONETOM Vida "17/1 989, M. 33Y MR XA50 "1/1/1989, M, 33Y 2022.10.19-12:11:13-DST-1.3.12.2.1107.5.99.3 MR XA50 "10/1 989. M. 33Y 10/18/2022 HES .LPH 10/18/2022 HE'S +LPH 10/18/2022 blade_de_tra_160_p2_4mm TRACEW blade_Gift_tra_160_92_4mm_TE67_certic_TRA blade_diff_tra_160_p2_4mm_TE7] [near_TRACEW latest@-Valve_02 latestP-Value_02 latest/B-Value_02 STUDYID 2c728840-93c8-42 1:03:59 PM STUDY ID 2c7b8844-93c8-42 1:17:28 PM STUDY ID 2c7bB840-93<@-42 14 IMA 2 FRM 14/27 20 IMA 2 FRM 14/27 1:21:34 PM 22 IMA 2 FRM 14/27 b = 1000 RAF 3 RAF RAF 1cm 20 Em SL SPO CPC TR 5500.0 TR 5500.0 TR 5500.0 TE 44.0 TP F2 SP H1 3 TE 620 TP F2 SP H1 3 TE 71.0 TA 03:50 FoV 220-220 TA03:50 TA. 03:50 BWY 651.0 160-160 FOV 220-220 DW 651.0 D2 MAGNDIFFITRACEY 160-160 DW 651.0 P2 MAON/DIFFITRACEW Cor(-9).Sag(1) "Cor[.9)-Sag(1) D2 MAONDIFFITRACE Zoom 3:43 Zoom 3.43 HE1-4 W 349 ALFS HEL-4 W 349 AUFS "blade_b10001/139 C "blade_b1 0001/133 162 HE1-4 "Blade_b10001/ 132 TE = 44 ms TE = 62 ms TE = 71 ms 38 38 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 514 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... From Single‐Shot EPI to BLADE Diffusion With SMS available Single‐Shot EPI ZOOMit Diffusion RESOLVE BLADE Diffusion PAT 2, SMS 2 PAT 2 PAT 3 Matrix: 0.7 x 0.7 x 5mm3 Matrix: 0.9 x 0.9 x 5mm3 Matrix: 0.9 x 0.9 x 5mm3 Matrix: 1.4 x 1.4 x 5mm3 Geometric Distortion 39 39 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 515 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 HASTE Diffusion Weighted Imaging SIEMENS Healthineers ... HASTE Diffusion Diffusion contrast with Half Fourier Acquired Single Shot TSE (HASTE) 180 ° … Spin‐Echo‐based sequence, hence not sensitive 90° • to B0 inhomogeneities (i.e., no/less distortions) RF … • Especially suitable for very inhomogeneous areas like IACs for cholesteatomas (high t detection sensitivity). Gx,y,z Gr … Properties: • Only one direction per scan • Only one b‐value per scan Diffusion Encoding gradients • ADC map calculation only offline At 3T: • Intended use is cholesteatoma detection only • Suboptimal image quality/artifacts in other applications 40 Unrestricted © Siemens Healthineers, 2023 Notes 516 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... HASTE Diffusion Diffusion contrast with HASTE. SIEMENS head >> library > diffusion resolve_4scan_trace_tra_p__s__160 02:12 SIEMENS SIEMENS > head >> clinical libraries >> iac t1_tse_r_tra 02:48 ZOOMit - diffusion t1_se_r_sag 03:25 head head Brain Assist _temporal lobe_ t2_tse_dark-fluid tra Brain Assist 03:20 Brain Autopilot ep2d_diff_cor ZOOMit 02:36 Brain Autopilot t2_space_tra_p2_iso 04:19 clinical libraries clinical libraries advanced applications libraries HASTE - diffusion E general Inject contrast agent. GOBrain t2_haste_diff_cor_p2 04:27 E lesion t1_vibe_fs_tra library 03:17 E trauma E localizer BLADE - diffusion E atrophy cholesteatoma E T1 E cortical architecture E T2 blade_diff_tra_144_p2 06:27 E white matter lesions t2_haste_diff_cor_p2 04:27 E PD+T2 blade_diff_tra_160_p2s2 03:06 El pituitary E 3D t2_tse_cor_2mm 03:53 E orbits E diffusion blade diff cor 144_p2 3mm 03:29 E iac t1_tse_r_cor_2mm 04:09 El perfusion advanced applications libraries 41 Unrestricted © Siemens Healthineers, 2023 Notes 517 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... HASTE Diffusion Diffusion Contrast with Half Fourier Acquired 0 4:27 min 1| Auto @ 2 0.6x0.6x3.0 mm3 @ 1.00 Single Shot TSE (HASTE) Routine Contrast Resolution Geometry System Physio Diff Sequence Due to low SNR many averages (default 12) Diffusion Mode 3D Diagonal Diff. Weighted Images are needed. Limited parameters compared to other 3D Diagonal diffusion weighted sequences. b-value Averages Only one b‐value 1000 12 • • Only one Diffusion direction • Only Diffusion Weighted Images • No (inline) ADC 42 Unrestricted © Siemens Healthineers, 2023 Notes 518 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Cholesteatoma Imaging at 1.5T Single‐Shot EPI Diffusion HASTE Diffusion 43 43 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 519 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... Cholesteatoma Imaging at 3T HASTE Diffusion BLADE Diffusion RESOLVE 44 44 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 520 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... PSIF Diffusion Dot Cockpit - Explorer ? 0 x Spin‐Echo based sequence, that is not Explorer Program Editor sensitive to B0 inhomogeneities (i.e., Browse Import Export Edit Simulate no/less distortions). Q Q Reduced susceptibility artifacts (i.e., SIEMENS SIEMENS >> I-spine > library > diffusion • t2_psif_sag_diff_r_69 00:53 less distortions than EPI‐based % Q psif sequences) I-spine [1] O 53 sec 1| Auto @ None @ 1.2x1.2x7.0 mm3 1.00 >L-Spine Dot Engine Routine Contrast Resolution Geometry System Physio Diff Sequence • Alternative EPI‐based DWI at 3T clinical libraries library [1] Diffusion Mode Read (HASTE also available) None localizer Slice • Only one diffusion direction per scan T1 Read No b‐values accessible T2 • PD • The degree of diffusion weighting is 3D defined by the diffusion moment diffusion [1] QUIET (mT/m*ms) WARP Diff. Moment mT/m*ms 69 ¢ • No ADC map calculation 45 Unrestricted © Siemens Healthineers, 2023 Notes 521 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... PSIF Diffusion – Comparison with EPI and HASTE Single‐Shot EPI Diffusion HASTE Diffusion PSIF Diffusion b=500 s/mm2 b=1000 s/mm2 Diff. Moment=69 mT/m*ms 46 46 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 522 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameters SIEMENS Healthineers ... MR Applications Fundamentals 1 Diffusion Weighted Imaging Parameters 47 Unrestricted © Siemens Healthineers, 2023 Notes 523 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Modes Diffusion Parameters SIEMENS Healthineers ... Diffusion Modes Coordinate System [x, y, z] 0 2:49 min 1| Auto @ 2 0.7x0.7x5.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Diff Sequence o- Diffusion Mode 4-Scan Trace Diff. Weighted Images Diff. Directions <1-Scan Trace> 3-Scan Trace Trace Weighted Images Diffusion Scheme 4-Scan Trace Tensor Diff. Weightings FA Maps b-value ADC Maps O 1000 3D Diagonal Exponential ADC Maps Coordinate System [p, r, s] q-Space b-value >= 0 s/mm2 ADC Noise Threshold 40 Dynamic Field Correction Noise Masking Invert Gray Scale Calculated b-value 48 Unrestricted © Siemens Healthineers, 2023 Notes 524 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diffusion Modes Phase r 0 2:49 min 1| Auto @ 2 @ 0.7x0.7x5.0 mm3 1.00 p Contras Resolution Geometry System Diff Sequence • Diffusion vector [p,r,s]= [1,0,0] Routine Physio Diff. Directions=1 V0 Diffusion Mode Diff. Weighted Images • 4-Scan Trace No Trace Weighted Images s <1-Scan Trace> 3-Scan Trace Trace Weighted Images • Diff. Directions Diffusion Scheme 4-Scan Trace Tensor Read r V0 Diff. Weighting A Maps • Diffusion vector [p,r,s]= [0,1,0] p b-value ADC Maps V O • Diff. Directions=1 1000 3D Diagonal Exponential ADC Maps No Trace Weighted Images s • q-Space b-value >= 0 + s/mm2 ADC Noise Threshold 40 Slice r Dynamic Field Correction Noise Masking • Diffusion vector [p,r,s]= [0,0,1] p Invert Gray Scale Calculated b-value • Diff. Directions=1 70 • No Trace Weighted Images sV0 S 49 Unrestricted © Siemens Healthineers, 2023 Notes 525 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diffusion Modes Orthogonal r V1 0 2:49 min 1| Auto @ 2 @ 0.7x0.7x5.0 mm3 1.00 • Diffusion vectors [p,r,s]= [1,0,0], p Routine Contras Resolution Geometry System Physio Diff Sequence [0,1,0], [0,0,1] V0 Diffusion Mode 4-Scan Trace Diff. Weighted Images • Diff. Directions=3 Diff. Directions <1-Scan Trace> s V2 3-Scan Trace Trace Weighted Images Diffusion Scheme 4-Scan Trace Tensor 3D Diagonal Diff. Weightings y V0 A Maps • Diffusion vector [x,y,z]= [1,1,1] b-value ADC Maps V O • Diff. Directions=1 x 1000 3D Diagonal Exponential ADC Maps • No Trace Weighted Images z b-value >> q-Space 0 + s/mm2 • Most efficient gradient ADC Noise Threshold 40 combination allows shortest Dynamic Field Correction Noise Masking possible TE Invert Gray Scale Calculated b-value • Works only for Isotropic Diffusion 50 Unrestricted © Siemens Healthineers, 2023 Notes 526 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diffusion Modes 3‐Scan Trace V0 @ 2:49 min 1| Auto @ 2 @ 0.7x0.7x5.0 mm3 1.00 Diffusion vector [x,y,z] = [1,1,‐ y Routine Contras Resolution Geometry System Physio Diff Sequence • 0.5], [1,‐0.5,1], [‐0.5,1,1] v2 V2 x Diffusion Mode 4-Scan Trace Diff. Weighted Images • Diff. Directions=3 z Diff. Directions <1-Scan Trace> Trace Weighted Images ! ------ V1 V1 3-Scan Trace Diffusion Scheme 4-Scan Trace Tensor 1‐Scan Trace Diff. Weightings A Maps b-value • Like 3‐Scan Trace ADC Maps V 0 • 3 directions but within one 1000 3D Diagonal Exponential ADC Maps acquisition, one after the other q-Space b-value >= 0 + s/mm2 • Diff. Directions=3 ADC Noise Threshold 40 Dynamic Field Correction Noise Masking Invert Gray Scale Calculated b-value 51 Unrestricted © Siemens Healthineers, 2023 Notes 527 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diffusion Modes 4‐Scan Trace V2 y V0 0 2:49 min | Auto @ 2 @ 0.7x0.7x5.0 mm3 1.00 Diffusion vector Routine Contras Resolution Geometry System Physio Diff Sequence • x [x,y,z]=[1,1,‐1], [1,‐1,1], [‐1,1,1], V3 Diffusion Mode 4-Scan Trace V3 Diff. Weighted Images [‐1,‐1,‐1] <1-Scan Trace> z Diff. Directions 3-Scan Trace Trace Weighted Images N • Diff. Directions=4 V1 Diffusion Scheme 4-Scan Trace Tensor • Like 3D Diagonal (i.e., most Diff. Weightings A Maps efficient combination of the b-value ADC Maps V O three physical gradients but 1000 3D Diagonal Exponential ADC Maps with 4 diagonal directions b-value >= q-Space 0 + s/mm2 instead of one) ADC Noise Threshold 40 • Less dependent on diffusion Dynamic Field Correction Noise Masking isotropy Invert Gray Scale Calculated b-value 52 Unrestricted © Siemens Healthineers, 2023 Notes 528 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diffusion Modes – available Inline Results Diffusion mode Diff. Weighted images Trace weighted images ADC+ FA/Tensor 1/3/4‐scan TRACE x x Orthogonal x xx Slice/Read/Phase x x 3D Diagonal x x MDDW/Q‐space* x x xx *Used for DTI/DSI +ADC only accessible if 2 or more b‐values are available. 53 Unrestricted © Siemens Healthineers, 2023 Notes 529 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers' ... Diffusion Scheme Monopolar Monopolar • Pair Diffusion Encoding Gradients with same polarity 180 º • Strong and fast gradients can induce eddy currents which 90 cause local inhomogeneities and local distortions RF AAA • Due to same polarity of gradients eddy currents are adding up  can be retrospectively corrected via G Encoding Decoding Grec gradient gradient Dynamic Field Correction • Monopolar allows shorter TE  increases SNR D Bipolar Bipolar 180 180º • Diffusion encoding gradients spit into components with 90º opposite polarities RF • Positive and negative gradients compensate each other and hence compensate (partly) eddy currents  less Grec G distortions --------- • Longer TE and hence less SNR ------. • Used mainly for Neuro Diffusion 54 54 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 530 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Dynamic Field Correction (DFC) To reduce eddy current related distortion @ 2:49 min / Auto@ 2 0.7x0.7x5.0 mm3 @ 1.00 effects (mainly caused by Monopolar Diffusion Routine Contras Resolution Geometry System Physio Diff Sequence Scheme). Diffusion Mode 4-Scan Trace Diff. Weighted Images Diff. Directions Trace Weighted Images Direct Mode Diffusion Scheme Bipolar Tensor Registration of individual diffusion encoded Diff. Weightings FA Maps images to reference (b=0) image. b-value Averages ADC Maps O 2 1000 5 Exponential ADC Maps Adjustment Mode b-value >= 0 + s/mm2 • Dedicated, additional adjustment scans to ADC Noise Threshold 40 estimate dynamic field errors Dynamic Field Correction Noise Masking • Applicable to low SNR images (high b‐values) Invert Gray Scale Calculated b-value • Much longer additional scan time Note: with DFC the result series might be labeled with “ _MIX”, that means that not every image could be properly corrected. Usually happens if motion is present during scan. 55 Unrestricted © Siemens Healthineers, 2023 Notes 531 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Dynamic Field Correction (DFC) – Direct Mode Reference image Distorted image Corrected image Additional b0 image b = 1000 s/mm2 b = 1000 s/mm2 56 56 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 532 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diff. Weightings @ 2:49 min 1 Auto @ 2 0.7x0.7x5.0 mm3 1.00 Defines the number of individual weightings. Routine Contras Resolution Geometry System Physio Diff Sequence i.e., b‐values (≤16). Diffusion Mode 4-Scan Trace Diff. Weighted Images Typically, 2 weightings. Diff. Directions Trace Weighted Images / Diffusion Scheme Bipolar Tensor b‐value and Averages Diff. Weightings 2 FA Maps Sets the b‐values [s/mm2] used for the b-value Averages ADC Maps V measurement with corresponding number of 2 O 1000 5 Exponential ADC Maps averages. b-value >= 0 + s/mm2 ADC Noise Threshold 40 Variable number of averages for each b‐ Dynamic Field Correction Noise Masking value to optimize SNR & acquisition time. Invert Gray Scale Calculated b-value The more averages the better the SNR and accuracy of ADC calculation. 57 Unrestricted © Siemens Healthineers, 2023 Notes 533 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Diff. Weighted Images @ 2:49 min / Auto @ 2 0.7x0.7x5.0 mm3 @ 1.00 Original diffusion weighted images for each Routine Contras Resolution Geometry System Physio Diff Sequence available diffusion direction. Diffusion Mode 4-Scan Trace Diff. Weighted Images Available for Diffusion Modes: Phase, Read, Diff. Directions 4 - Trace Weighted Images M Slice, Orthogonal, 3D diagonal, MDDW, q‐ Diffusion Scheme Bipolar Tensor space, Free. Diff. Weightings FA Maps b-value Averages ADC Maps V TRACE Weighted Images 2 O 1000 5 Exponential ADC Maps Isotropic Diffusion Weighted image. b-value >= 0 + s/mm2 Average of all individual diffusion directions ADC Noise Threshold 40 and averages for each defined b‐value. Dynamic Field Correction Noise Masking Available for: 1‐Scan Trace, 3‐Scan Trace, 4‐ Invert Gray Scale Calculated b-value Scan Trace, Orthogonal, MDDW, q‐space, Free. 58 Unrestricted © Siemens Healthineers, 2023 Notes 534 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... ADC Maps @ 2:49 min / Auto@ 2 0.7x0.7x5.0 mm3 1.00 Inline calculated Apparent Diffusion Routine Contras Resolution Geometry System Physio Diff Sequence Coefficient maps. Diffusion Mode 4-Scan Trace Diff. Weighted Images Available only if 2 or more Diffusion Diff. Directions 4 - Trace Weighted Images Weightings are used. Diffusion Scheme Bipolar Tensor Diff. Weightings FA Maps Units of ADC: μm2/s b-value Averages ADC Maps M 2 O ( ) ( ) S b =S b0 ⋅e −b⋅ADC → e −b⋅ADC S b 1000 5 Exponential ADC Maps = S b0 b-value >= 0 + s/mm2 → −b⋅ADC=ln (8) S b S b0 ADC Noise Threshold 40 Dynamic Field Correction Noise Masking → ADC= − 1 - (8) b ⋅ln S b Invert Gray Scale Calculated b-value S b0 59 Unrestricted © Siemens Healthineers, 2023 Notes 535 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... ADC Maps Calculated pixel by pixel by linear regression: On a logarithmic scale, the signal decay delivers a straight tilted line whose slope provides the ADC. Slope=ADC S(b) Signal attenuation / ln(S) b b 0 300 600 1000 0 300 600 1000 60 Unrestricted © Siemens Healthineers, 2023 Notes 536 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... ADC Maps and the effect of b‐values on ADC More b‐values can improve accuracy of ADC calculation, however additional b‐value should not be in the middle of the highest and lowest b‐value. ---- - - - --- Signal attenuation / ln(S) Signal attenuation / ln(S) b b - - 0 300 600 1000 0 300 600 1000 61 Unrestricted © Siemens Healthineers, 2023 Notes 537 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers' ... # XA10 Vida # XA10 Vida #XA10 Vida STUDY ID Current STUDY I STUDY ID Current 2:42:06 PM 2:44:28 PM 2:44:28 PM 8 IMA 1 FRM 14/27 8 IMA 2 FRM 14/27 9 IMA 1 FRM 14/27 RFA RFA RFA 10cm nem 10cm 2D 2D 4.0 SL 2D SL 4.0 SL 4.0 SPC 5.2 F SPC 5.2 SPC 5.2 b‐value = 0 s/mm 2 Trace, b‐value = 1000 s/mm2 ADC Map 62 62 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 538 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers' ... Offline ADC Calculation SIEMENS ... O Demo_Brain_Routine, 1 X Healthineers ADC & b-value ? X - 5/22/1969 Zum Beenden des Vollbildmodus |F11 drucken MIR View&GO AHL AHL Series MR View&GO Demo_Brain_Routine, 1 No clinical Demo_Brain_Routine, 1 No clinical Demo_Brain_Routine, No clinical ADC Map Calculation Head MAGNETOM Vida Head MAGNETOM Vida Head Stack 2 x2 Stack sint "5/22/1 969, F. 48Y Add Study Sardine CURRENT MR XA10 "5/22/1969, F. 48Y MAGNETOM Vida MR XA10 "5/22/1 969, F. 48Y MR XA10 HFS CURRENT 11/14/2017 HFS CURRENT Input Series 11/14/2017 HFS 11/14/2017 # - Series Name V resolve_4scan_trace_tra_p2_192_TRACEW 12_tse_tra_512 Latest 11_mprage_sag_p2giso V B-Value_01_0 latest latest 5 IMA 1 FRM 1/27 6 IMA 1 FRM 1/27 7 IMA 1 FRM 1/128 Current Y B-Value_02_1000 MR, 11/14/2017 Favorite Tools TOF, DWI, 3D TR 6000.0 2 t2_tse_cor_p2_512_3mm TP O TR 9000-0 TE 100.0 TE 90.0 TP 0 -TR-2300 0 TA 02:30 SP F83.3 TA 01:48:2 SP F83.3 TE 2.3 TA05:18 SP R59.5 3 t2_tse_cor_p2_512_3mm fs BW 222.0 FOV 220 220 BY 289.0 FOV 213.220 BW 199.0 OV 240.240- 4 [2_tse_tra_512_3mm MAGN/NORM/DIS2D 384-512s 217-320$ 256-256 "(-7)>Sag(2) MAGN/NORM/DIS2D or(-7)>Sag(2) p2 MAGN/NORMIDIS2D Sag>Tra(1) 5 t2_tse_tra_512 HE 1-4 Zoom 0.57 A1/R/F8 Zoom 0.95 HE1-4 612 ALAR Zoom 1.18 1155 W 932 5 tz_tse_tra_512_3mm fs -150201_15/150 552 HE1-4 *tir2d1_17/ 150 259 *M3d1_16ns /8 C 443 t2_tse_dark-fluid_tra Threshold 10 Remove Series 7 t1_mprage_sag_p2_iso AHL 8 > resolve_4scan_trace_tra_p2_19 ... Result Series Name Results ADC_bo_1000_resolve_4scan_trace_tra_p2 Demo_Brain_Routine, 1 No clinicar Demo_Brain_Routine, 1 No clinical Demo_Brain_Routine, 1 resolve 4scan trace tra_p2_1 ... Head UR XA10 Head C *5/22/1 969, F. 48Y NETOM Vida Head *5/22/1969, F. 48Y W MR XA10 *5/2 2/1 969, F. 48Y 19 t1_tse_tra_3mm Computed b-value images CURRENT Favorite Tools CURRENT × 11/14/2017 HFS CURRENT 11/14/2017 10 tof_#13d_tra Enable Computed b-value 3D resolve_4scan trace_tra_ 192_TRACEW resotra Miscan 11 tof_f13d_tra_MIP_SAG b-value 1400 M Auto Preview O latest/B-Value_01 12 tof_f13d_tra_MIP_COR Show in TimeCurve ADC & b. 30 Composel value Combine 8 IMA 1 FRM 1/27 Perform ADC & Computed b-value 13 tof_f13d_tra_MIP_TRA Result Series Name Results CALC_b1400_bo_1000_resolve_4scan_trace RFA 14 t2_space_tra_iso 10 ... : Results Filter_12_tse_tra_512.01 TR 5940.0 TR 5940.0 Resu TE 65.0 SP F83.3 TE 65.0 SP F83.3 10 ... : Results Filter_t2_tse_tra_512.lat ... TA 03:53 TA 03:53 PF58.5 3D Ref. Distance Position Snapshot Print Stack Point Displa ... BW 651.0 oV 220*220 Line BW 651.0 1-76081 RA - p2 MAGN/DIFF/TRACEW/ .. 192*192 (-7)>Sag(2) D2 MAGN/DIFFJADC/NOR. Flip Save as Mosaic Subtracti ... A1/FS Horizontal Series HE1-4 Te_b0 / 180 76_60_1000/180 HE1.3.4 1301r_170/20 Activate wholeiva Wi OK Preview Cancel + Go to Settings to activate Windows. 63 63 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 539 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... B‐Value >= @ 2:49 min 1 Auto 2 0.7x0.7x5.0 mm3 1.00 Only b‐values higher than the specified value Routine Contras Resolution Geometry System Physio Diff Sequence are used for ADC calculation. Diffusion Mode 4-Scan Trace Diff. Weighted Images (e.g., Use b=0 for ADC calculation to Diff. Directions 4 - Trace Weighted Images / eliminate perfusion effects that are dominant Diffusion Scheme Bipolar Tensor at low b‐values). Diff. Weightings 2 FA Maps b-valu Averages ADC Maps V ADC Noise Threshold 2 O 1000 5 Exponential ADC Maps Excludes pixels with an intensity value lower b-value >= 0 + s/mm2 than Noise level from ADC calculation. ADC Noise Threshold 40 (applied on lowest b‐value image). Dynamic Field Correction Noise Masking Invert Gray Scale Calculated b-value Noise Masking Excludes background by creating a threshold mask. 64 Unrestricted © Siemens Healthineers, 2023 Notes 540 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Exponential ADC Maps @ 2:49 min 1 Auto@ 2 0.7x0.7x5.0 mm3 ? 1.00 Calculated Trace‐weighted contrast to Routine Contras Resolution Geometry System Physio Diff Sequence exclude T2 shine‐through effects. Diffusion Mode 4-Scan Trace Diff. Weighted Images Diff. Directions 4 - Trace Weighted Images / Structures with long T2 (e.g., water‐rich Diffusion Scheme Bipolar Tensor objects like cysts) show high signal even in Diff. Weightings FA Maps high b‐value images. b-valu Averages ADC Maps 2 O • Could mimic diffusion restriction 1000 5 Exponential ADC Maps • Every b‐value image is divided by the b-value >= 0 + s/mm2 lowest b‐value image ADC Noise Threshold 40 S(b) Normalized S(b) Dynamic Field Correction Noise Masking Invert Gray Scale Calculated b-value b b 0 300 600 1000 0 300 600 1000 65 Unrestricted © Siemens Healthineers, 2023 Notes 541 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameters SIEMENS Healthineers ... Calculated b‐value @ 2:49 min 1 Auto@ 2 0.7x0.7x5.0 mm3 ? 1.00 Calculates a Trace‐weighted Image with Routine Contras Resolution Geometry System Physio Diff Sequence specified higher b‐value, Diffusion Mode 4-Scan Trace Diff. Weighted Images Calculation is based on ADC. (i.e., ADC is Diff. Directions 4 - Trace Weighted Images / used to calculate higher b‐values) Diffusion Scheme Bipolar Tensor • Won’t add additional information but Diff. Weightings FA Maps can increase contrast between tissues b-value Averages ADC Maps V Frequently used in Prostate imaging 2 O • 1000 5 Exponential ADC Maps • May be beneficial since measured high b-value >= 0 + s/mm2 b‐values suffer from low SNR ADC Noise Threshold 40 Dynamic Field Correction Noise Masking S(b) Invert Gray Scale Calculated b-value v 1400 + s/mm2 1400 Calculated b-value 5000 s/mm2 b 0 300 600 1000 1400 66 Unrestricted © Siemens Healthineers, 2023 Notes 542 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Options SIEMENS Healthineers ... MR Applications Fundamentals 1 Diffusion Weighted Imaging Options 67 Unrestricted © Siemens Healthineers, 2023 Notes 543 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SMS Diffusion Weighted Imaging SIEMENS Healthineers ... Simultaneous Multi‐Slice Example: SMS 3, iPAT 2 Multiple slices excited Blipped CAIPIRINHA Slice GRAPPA based Conventional Inplane simultaneously applied during Echo Train unaliasing GRAPPA 68 68 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 544 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Simultaneous Multi‐Slice SMS in DWI 0 1:24 min 1| Auto @ 4 1.3x1.3x5.0 mm3 1.00 Frequently used for DWI. Routine Contrast Resolution Geometry System Physio Diff Sequence Common Acceleration Filter Used to reduce TR to: Acceleration mode SMS Advanced Reconstruction Off • Shorten TA Phase Partial Fourier 6/8 • Increase number of Averages • Increase SNR Reference Scans EPI/Sep ... • Increase number of slices within same time Acceleration Factor PE 2 - • Compromise between Time, SNR, Slices Reference Lines PE 42 SMS Factor Applicable to Single‐Shot EPI, RESOLVE, BLADE and Quiet DWI. SMS Factor 2 69 Unrestricted © Siemens Healthineers, 2023 Notes 545 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... Simultaneous Multi‐Slice H/N20 @ Avantofit H/N20 @ Skyra 15.07 21-09:09:40-DST-1.3.12. AHL MRC33/DEC239CF247598/90CO2F/ AHL MRC33/DEC239CF247583/30 CO2F. *8/26/1964, 0, 51Y *8/26/1964, 0, 51Y *3/20/1 965, F, 50Y MRE11 15.07.21-09:09:40-DST-1.3.12 ... *3/20/1965, F, 50Y STUDY 1 STUDY 1 8/26/2015 8/26/2015 STUDY 1 7/21/2015 STUDY 1 2:25:39 PM 7/21/2015 21 IMA 59 / 80 2:19:15 PM 15 IMA 59 / 80 9:15:05 AM 7 IMA 40 / 56 9:12:51 AM 5 IMA 40 / 56 RFP RFP RHA LALU T 5cm MF 1.00 10cm MF 1.00 MF 1.00 MF 1.00 LL 10c TR 5600.0 TE 75.0 TR 3000.0 TR 3200.0 TA 02:10 TP O TE 75.0 TR 5200.0 DIR TE 80.0 SP H2.6 TA 01:16 TP TE 80,0 TP O BW 1240.0 SL 2.5/0.75 BW 1240.0 SP H2 TA 01:30 SP H12.1 TA 01:01 p2 s2 DIFFUSION/TRACEWIND/NORM SL 2.5/0 ; BWV 1040.0 BW 1040.0 p2 DIFFUSION/TRACEWIND/NORM FoV 230*230 FoV 230*2: P2 DIFFUSION/TRACEWIND/NORM SL 4.0/1.2 FoV 220*220 p2 s2 DIFFUSION/TRACEWIND/NORM A4/PFP/FS 384p*384 1 Tra>Sag(1.5)>Cor(1.3) A4/PFP/FS 384p*384 Fo33220-220 HE1-4 HE1-4;NE1,2 Tra>Sag(1.5)>Cor(12 1. A3/PFP/FS 384p*384 1 Tra>Cor(-14.6)>Sag(-2.4) A3/PFP/FS *ep_b1000t / 90 314 *ep_b1000t / 90 SHE1-4 22tep_b1000t / 90 15' no SMS W 394 HE1-4 174 *ep_b1000t / 90 SMS 2 Tra>Cor(-14.6)- Sagt.2 iPAT 2, SMS 1 iPAT 2, SMS 2 iPAT 2, SMS 1 iPAT 2, SMS 2 TA 2:10 TA 1:16 TA 1:30 TA 1:01 70 70 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 546 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Simultaneous Multi‐Slice – Diffusion Distortions In‐plane geometric distortions are not No iPAT , SMS 4 influenced by SMS, since the readout is not affected by SMS. Inplane distortions can be reduced by increasing the PAT factor. Through‐plane distortions might slightly iPAT 2, SMS 2 increase with SMS due to slightly different RF pulse bandwidth and slice select gradient profiles (VERSE pulses). iPAT 2, SMS 2 iPAT 2, no SMS 71 71 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 547 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Simultaneous Multi‐Slice Diffusion Scheme with SMS @ 1:50 min Auto @ 4 0.7x0.7x5.0 mm3 1.00 During the application of a gradient, the magnetic Routine Contrast Resolution Geometry System Physio Diff Sequence field will have a nonlinear spatial dependency, Common Acceleration Filter known as Maxwell field. Scan Assistant ? X tion Off burier 6/8 This is an additional dependency in an orthogonal ? Your last change direction to the nominal gradient caused by the Acceleration mode GRAPPA - SMS laws of electromagnetism. Acce will adapt the following parameters: Diffusion Scheme Bipolar Monopolar • Especially relevant for Bipolar Diffusion Slices 25 26 Encoding scheme TE 105.00 96.00 ms Optimization Min. TE None • SNR drop in off‐center slices with high b‐values Effect inversely proportional to the field OK Undo • strength Effect corrected by Maxwell correction Maxwell correction is slice‐specific and is not applicable with SMS  Monopolar scheme @1.5T. 72 Unrestricted © Siemens Healthineers, 2023 Notes 548 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Simultaneous Multi‐Slice Slice Aliasing Fat Ghost Simultaneously excited slices cannot Greater chemical shift/different slice profile be unfolded completely. for fat spins and water spins due to SMS pulses. m220150723 F1427 AvantoFit More likely to occur at 1.5T with 15.07 23-10:13:41-DST-1.3.12 .... "7/23/1974, M. 41Y STUDY 1 7/23/2015 11:03:08 AM HN16/20 and in b0 images. 52 IMA 1 /20 Incomplete Fat Saturation. Counter‐measures: Can occur also for non‐SMS protocols. • Use Neck coil elements • Increase distance between Slice Counter‐measures: bands (e.g., increase slice count) TR 3000.0 TE 91 0 • Use Low SAR pulses TA 01:08 BW 1240.0 p2 $2 DIFFUSIONCAD • Increase FoV A4/PFPFS Re‐run Shim/Frequency Adjustments HE1-4 • "ep_b0_1000/90 Puzes 2,4 73 73 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 549 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers' ... Simultaneous Multi‐Slice SMS enables a reduced TR. TR 6400 ms TR 3200 ms • Changing TR affects SNR and CNR. • The theoretical minimum TR might not be reached for all clinical protocols 0.9 MF 1.00 MF 1.00 0.8 TR 6400.0 TE 98.0 DIR TR 3200.0 TA 01:30 TP OTE 98.0 BW 1040.0 SP H53.4 TA 48 00 p2 s2 DIFFUSION/TRACEW/ND/NORM SL 4 0/8 0 BW 1040.0 FoV 220 220 P2 s2 DIFFUSION/TRACEW/ND/NORM 0.7 A3/PFP/FS 384p 384 1 HE1-4 Resize: 4X Orig: 384 x 384 Tra>Cor(-12.1)>Sag(-2.9) A3/PFP/FS "ep_b0 / 90 52. TR 6400 251 HE1-4 585 "ep_b0 / 90 Resize: 4X Orig: 384 x 384 $2. TR 3200 AHR 0.6 grey matter mz20151014_FH333_VE11C_Sk ... 15.10.14-13:06:49-DST-1.3.12.2.1 ... MRC33/DEC239CF24759B/90002F/ mz20151014_FH333_VE11C_Sk ... "3/25/1958, M, 57Y Skyra 15.10.14-13:06:49-DST-1.3.12.2.1 .... white matter TR 2400 ms MR E11 .3/25/1958, M, 57Y STUDY 1 HES STUDY 1 +LPH TR 1600 ms 10/14/2015 10/14/2015 1:18:44 PM 14 IMA 8 / 1 L 1:19:16 PM 16 IMA 8 / 1 CSF M(t)/M 0.4 0.3 0.2 0. 7 O 1000 3000 4000 TR 2400.0 SMS 2, 3‐scan trace images, Skyra pTx, 3T, H/N20 5000 7000 TE 98.0 DVR IR 1600.0 TA 38.00 TP O TE 98.0 BW 1040.0 SP H53.4 TA 28.00 p2 $2 DIFFUSION/TRACEW/ND/NORM SL 4.0/8.0 BW 1040.0 TR FoV 220-220 p2 s2 DIFFUSION/TRACEW/ND/NORM A3/PFP/FS 384p 3841 HE1-4 ep_b0 / 90 Resize: 4X Orig: 384 x 384 Tra>Cor(-12.1)>Sag(-2.9) A3/PFP/FS $2, TR 2400 907 HE1-4 426 ep_b0 / 90 Resize: 4X Orig: 384 x 384 $2, TR 1600 74 74 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 550 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Phase Correction for EPI Diffusion Diffusion Weighted Imaging SIEMENS Healthineers ... Phase Correction for EPI Diffusion Correct for timing inconsistencies. 8 2:12 min 4 Auto @ 2 0.6x0.6x4.0 mm3 1.00 EPI Diffusion supports internal and external Routine Contras Resolution Geometry System Physio Diff Sequence phase correction modes. Part 1 Part 2 Introduction External Phase Correction is useful for applications with challenging FatSat such as abdominal/breast imaging. Phase Correction External Side effects: Interna External • TE can be reduced in many cases • TA slightly increases as one additional repetition is needed 75 Unrestricted © Siemens Healthineers, 2023 Notes 551 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Phase Correction for EPI Diffusion Internal Phase Correction Within each EPI scan (i.e., for each 90° 180° RF b‐value, diffusion direction, average). GS Phase Correction measured at GR different TE than the actual scans. GP TE is slightly prolonged to incorporate internal phase MR correction. 76 Unrestricted © Siemens Healthineers, 2023 Notes 552 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Phase Correction for EPI Diffusion External Phase Correction Performed prior to measurement 90° 180° RF in a separate scan at the same TE as the actual scans (where fat and water become in‐phase). GS WWWW GR Since no internal Phase Correction is needed, the TE can be slightly GP reduced. MR One addition TR is needed for Phase Correction. 77 Unrestricted © Siemens Healthineers, 2023 Notes 553 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Weighted Imaging SIEMENS Healthineers ... Intra Voxel Incoherent Motion (IVIM) Diffusion imaging at low b‐values. 6:03 min 1| Auto @ 2 @ 1.4x1.4x5.0 mm3 1.00 All diffusion sequences offer small b‐values Routine Contras Resolution Geometry System Physio Diff Sequence for monopolar diffusion. Diffusion Mode 4-Scan Trace Diff. Weighted Images Diff. Directions Trace Weighted Images b‐values between 10 and 40 depend on the Diffusion Scheme Monopolar Tensor protocol. Diff. Weightings FA Maps • Spoiling moment of the applied diffusion b-valu Averages ADC Maps v gradients must be large enough to O 11 10 1 Exponential ADC Maps suppress all FID signal from the refocusing 20 1 b-value >= 0 s/mm2 pulse 30 1 40 1 ADC Noise Threshold 10 • Depends on FoV, slice thickness and Dynamic Field Correction M ... Noise Masking resolution Invert Gray Scale Calculated b-value b-value 2 10 IMPORTANT: NO dedicated post‐processing 10000 s/mm2 for IVIM provided! 78 Unrestricted © Siemens Healthineers, 2023 Notes 554 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging (DTI) SIEMENS Healthineers Diffusion Tensor Imaging (DTI) MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 555 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Diffusion Tensor Imaging (DTI) • Theory • Parameters • Applications • Result Series 2 Unrestricted © Siemens Healthineers, 2023 Notes 556 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Explain Diffusion Tensor Imaging theory • Recognize the DTI parameters • Recall the DTI applications • List the types of DTI result series 3 Unrestricted © Siemens Healthineers, 2023 Notes 557 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... The information presented in the Diffusion Tensor Imaging presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. Competition product descriptions, comparison and specifications contained in this document are based on interpretation of available data at the time this material was being prepared [include date] and may require independent verification. Specifications have been obtained from competition brochures, websites, and other independent published sources. A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents. 4 Unrestricted © Siemens Healthineers, 2023 Notes 558 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 SIEMENS Healthineers ... MR Applications Fundamentals 1 Diffusion Tensor Imaging (DTI) 5 Unrestricted © Siemens Healthineers, 2023 Notes 559 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging SIEMENS Healthineers ... Diffusion Mode Coordinate system [p, r, s] @ 1:16 min : Auto @ 2 @ 1.5x1.5x5.0 mm3 1.00 Phase/Read/Slice Routine Contrast Resolution Geometry System Physio Diff Sequence • Diffusion Mode MDDW Diff. Weighted Images v • Orthogonal • 3D Diagonal Diff. Directions <1-Scan Trace> <3-Scan Trace> Trace Weighted Images Diffusion Scheme 4-Scan Trace Tensor • 1/3/4 scan TRACE Diff. Weightings FA Maps • MDDW b-value ADC Maps • Q‐space 0 800 <3D Diagonal> Exponential ADC Maps • FREE MDDW q-Space Free ADC Noise Threshold 40 Dynamic Field Correction V Noise Masking Invert Gray Scale Calculated b-value Coordinate system [x, y, z] 6 Unrestricted © Siemens Healthineers, 2023 Notes 560 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging SIEMENS Healthineers ... Diffusion Mode – MDDW 1:16 min : Auto@ 2 @ 1.5x1.5x5.0 mm3 1.00 • Diffusion vectors in [x,y,z] Routine Contrast Resolution Geometry System Physio Diff Sequence Only direction number 6, 12, and 20 vector information Diffusion Mode MDDW Diff. Weighted Images • Diff. Directions <1-Scan Trace> are available in user manual <3-Scan Trace> Trace Weighted Images Diff. Directions = 6,10,12,20,30,64,256 Diffusion Scheme 4-Scan Trace Tensor • Diff. Weightings FA Maps MDDW 6 directions Direction vectors in the magnet coordi- b-value nate system ADC Maps v 0 800 <3D Diagonal> Exponential ADC Maps[] 1 (1.0, 0.0, 1.0) MDDW 2 (-1.0, 0.0, 1.0) q-Space Free ADC Noise Threshold 3 (0.0, 1.0, 1.0) Dynamic Field Correction Noise Masking Invert Gray Scale Calculated b-value [] 4 (0.0, 1.0, - 1.0) 5 (1.0, 1.0, 0.0) 6 (-1.0, 1.0, 0.0) Vector info in manual* 7 * Neuro MR Operator Manual Unrestricted © Siemens Healthineers, 2023 Notes 561 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion in MDDW Mode SIEMENS Healthineers ... DTI Results DTI MDDW DTI of Brain and Spine with RESOLVE MAGNETOM Prisma • Shows high anatomical accuracy • RESOLVE, b0 and b600 • MDDW6 • GRAPPA2 • Matrix 180*300, • TA 20:24 min 8 8 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 562 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion in MDDW Mode SIEMENS Healthineers ... DTI Results A High resolution DWI and DTI depicting structural CNS connectivity in the most challenging areas (MAGNETOM Prisma) 9 9 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 563 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion in MDDW Mode SIEMENS Healthineers ... DTI Results RESOLVE DTI • b=1000 • ADC • Color FA • MDDW 20 directions • 1.5 mm • Matrix 220 • FoV 220 • iPAT2 • MAGNETOM Prisma 10 10 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 564 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging SIEMENS Healthineers ... Algorithm and Limitations DTI Algorithm is based on the ellipsoid model and Diffusion in single oriented tissue calculates the eigenvectors with the corresponding eigenvalues (e1, e2, e3). E1 Always e1≥ e2≥ e3 E2 • E1 E2 DTI Limitations E3 E3 • DTI can only resolve a single fiber orientation within each imaging voxel due to the constraints of the tensor model • It cannot resolve fibers crossing, bending, or twisting Diffusion in double Oriented Tissue: not possible to within an individual voxel decompose the crossing fibers E2 E1 E3 11 Unrestricted © Siemens Healthineers, 2023 Notes 565 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging SIEMENS Healthineers .. Data acquisition requirements In order to solve the fiber crossing problems, other post‐processing algorithm is needed 1.0 ***** ***** ***** Some requirements in data acquisition: ******* XXXXXXX xxxxx 1. Q‐ball Imaging (QBI) 0.5 7 XXXXXXXX • 2 b‐values (0‐3000 s/mm2) • ≥ 100 directions 0.0 XXXXXXXAYR,! y-axis -XxXXXX • We can use MDDW mode ***** XXXX XXXXXXX xxxx* 0.5 1.0 XXXXX Diffusion Spectrum Imaging (DSI) -0.5 2. +.0 x-axis • ≥ 100 q‐space coordinates • Highest b‐value up to 10000 s/mm2 • Available in Q‐Space mode Q‐ball Imaging Diffusion Spectrum Imaging 12 Unrestricted © Siemens Healthineers, 2023 Notes 566 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameter Card SIEMENS Healthineers' ... Diffusion Mode 8 28:57 min 1; Auto @ 2 1.4x1.4x5.0 mm3 1.00 Q‐Space: sampling the Diffusion space (q‐space) with Routine Contrast Resolution Geometry System Physio Diff Sequence Diff. Weighted Images high resolution. Diffusion Mode q-Space Trace Weighted Images • q‐Space weightings is the number of non‐zero q‐Space Diffusion Scheme Bipolar Tensor V coordinates sampled along each spatial dimension q-Space Weightings FA Maps • Often used in Diffusion Spectrum Imaging q-Space max. b-value 10000 - s/mm2 ADC Maps V • Possible for DTI reconstruction (e.g., Neuro3D) q-Space Coverage Half Exponential ADC Maps[] Half ADC Noise Threshold 40 Dynamic Field Correction M ... Noise Masking Invert Gray Scale Calculated b-value 13 13 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 567 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Card SIEMENS Healthineers .. Q‐Space Define the max‐b value (q‐space boundary). qy @ 28:57 min Auto @ 2 1.4x1.4x5.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Diff Sequence Diffusion Mode q-Space Diff. Weighted Images V Trace Weighted Images v --- Diffusion Scheme Bipolar Tensor M 0 q-Space Weightings A Maps V qx q-Space max. b-value 10000 + s/mm2 ADC Maps V q-Space Coverage Half Exponential ADC Maps[] Half Full ADC Noise Threshold 40 Dynamic Field Correction Noise Masking qz Invert Gray Scale Calculated b-value b = γ² G² δ² (Δ−δ/3) q = 1/(2π) γ G δ 14 Unrestricted © Siemens Healthineers, 2023 Notes 568 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Card SIEMENS Healthineers ... Q‐Space Define the number of q‐space weightings. qy 1 2 3 4 5 Q‐space coverage in Full. 5 @ 28:57 min | Auto @ 2 @ 1.4x1.4x5.0 mm3 1.00 4 Routine Contrast Resolution Geometry System Physio Diff Sequence 3 Diffusion Mode q-Space Diff. Weighted Images M 2 Trace Weighted Images v Diffusion Scheme Bipolar 1 Tensor M q-Space Weightings A Maps V 0 qx q-Space max. b-value 10000 - s/mm2 ADC Maps V q-Space Coverage Half Exponential ADC Maps[] Half Full ADC Noise Threshold 40 Dynamic Field Correction V ... Noise Masking Invert Gray Scale Calculated b-value b = γ² G² δ² (Δ−δ/3) q = 1/(2π) γ G δ 15 Unrestricted © Siemens Healthineers, 2023 Notes 569 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Card SIEMENS Healthineers ... Q‐Space Q‐space coverage in Half. qy 1 2 3 4 5 5 @ 28:57 min | Auto @ 2 @ 1.4x1.4x5.0 mm3 1.00 4 Routine Contrast Resolution Geometry System Physio Diff Sequence 3 Diffusion Mode q-Space Diff. Weighted Images M 2 Trace Weighted Images v Diffusion Scheme Bipolar Tensor M 1 q-Space Weightings A Maps V 0 q-Space max. b-value 10000 - s/mm2 ADC Maps V qx q-Space Coverage Half Exponential ADC Maps[] Half Full ADC Noise Threshold 40 Dynamic Field Correction V ... Noise Masking Invert Gray Scale Calculated b-value b = γ² G² δ² (Δ−δ/3) q = 1/(2π) γ G δ 16 Unrestricted © Siemens Healthineers, 2023 Notes 570 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion in Q‐Space Mode SIEMENS Healthineers ... The Q‐space acquisition is evaluated as DTI during the postprocessing with the MR Neuro3D Application. MR Neuro3D does not support DSI evaluation MAGNETOM Prisma • Isotropic Resolution ‐ 2.5mm • 32‐Channel Head Coil • iPAT2 Full q5 Sampling: • 515 coordinates • Bipolar diffusion encoding • Maximum b‐value: 5000s/mm2 • TE 83ms, TR 5100ms 17 17 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 571 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion in Q‐Space Mode SIEMENS Healthineers ... Diffusion Spectrum Imaging • Ultra‐high intra‐voxel sensitivity • Up to 514 diffusion directions DSI, b‐max=5000, TE=80, TR=8200 514 directions, 2mm iso, iPAT2 DSI Results* 18 18 * Coil: Head/Neck 64, post‐processing courtesy of TrackVis Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 572 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion in Q‐Space Mode SIEMENS Healthineers ... The Q‐space dataset can be loaded into MR Neuro3D to obtain DTI results (i.e., depends on the ellipsoid model). E,FA 60,1610]/FA [0 ,- ] t OFF/FM OFF/Clus OFF 19 19 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 573 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Parameter Card SIEMENS Healthineers ... Diffusion Mode @ 3:44 min 1 Auto @ 2 @ 1.4x1.4x5.0 mm ~ 1.00 Free: users can define their own diffusion Routine Contrast Resolution Geometry System Physio Diff Sequence gradient file (.dvs) and use for the scan. Diffusion Mode Free Diff. Weighted Images VD software and before works only with Diff. Directions Trace Weighted Images • IDEA license Diffusion Scheme Moropolar ensor v Diff. Weightings 2 2 • VE and after works with the standard FA Maps V Value Averages system licenses ADC Maps 10 O 2000 4 Exponential ADC Maps Diffusion vector files save in K:\CustomerSeq\DiffusionVectorSets ADC Noise Thishold 40 Diffusion vector set - Import/Export ? X ng Use Import to load an external *. dvs file. Import ... Use Export to save the loaded vector set to a *. dvs file. Export ... Close 20 Unrestricted © Siemens Healthineers, 2023 Notes 574 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging (DTI) SIEMENS Healthineers ... Applications Tumor: DTI correlated with some other images. RA T1 MPRAGE Post Gd relCBV Diffusion Tensor Imaging (DTI) Images 21 21 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 575 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Diffusion Tensor Imaging (DTI) SIEMENS Healthineers ... Applications Different damage levels to the left arcuate fasciculus (AF)1 Type A Type C R R Tractography showing arcuate fasciculus2 Broca’s Area Left AF – Severely Damaged AF ‐ preserved around the lesion Type B R AF ‐ is disrupted Wernicke’s Area Ref: 1. Tae WS et al., J Clin Neurol 2018;14(2):129‐140 22 22 2. Yeh FC et al., NeuroImage (2018), 178, 57‐68 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 576 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Result Series SIEMENS Healthineers ... Diffusion Weighted Images Each diffusion vector and average is saved individually. 5 - ep2d_diff_mddw_20_p2 AHR - B-Value_01 [bo) Demo_Fusion, Brain Anlage Demo_Fusion, Brain Anlag Head Head Volume 01 *1/1/1961, M, 58Y MAGNE *1/1/1961, M, 58Y MAGNE CURRENT CURRENT Volume_02 10/28/2019 10/28/2019 Series Volume_03 ep2d_diff_mddw ep2d_diff_mddw Value_0 Volume_05 " Value_02 Volume_05 Series Number Series Description Volume_04 4D 0 4D 0 Volume_05 STUDY ID d034cd58-ece7-4f STUDY ID d034cd58 1 AAhead_scout 9:54:39 AM 9:50:48 AM Volume_06 6 IMA 65 FRM 12/25 6 IMA 6 FRM 12/25 2 AAhead_scout_MPR_sag Volume 07 RFP RFP 3 AAhead_scout_MPR_cor Volume_08 4 AAhead_scout_MPR_tra SPC 6.5 5.0 SPORE 5.0 Volume_09 99 PhoenixZIPReport Volume_10 TR 3900.0 TR 3900.0 5 t1 mprage sag_p2 iso TE 84.0 TE 84.0 Volume_11 TA 04:54 Fo TA 04:54 6 ep2d_diff_mddw_20_p2 BW 1395.0 BW 1395.0 Volume_12 p2 MAGN/DIFF/NORMIND Tra>Cor(-1 p2 MAGN/DIFF/NORI Tra>Cor(-1 ep2d_diff_mddw_20_p2_ADC A1/PFP/FS A1/PFP/FS B-Value_02 [b1000] ep2d_diff_mddw_20_p2_TRACEW *ep_b0/90 *ep_b1000#5 / 90 Volume_01 CO 9 ep2d_diff_mddw_20_p2_FA Volume_02 10 ep2d_diff_mddw_20_p2_ColFA Volume_03 11 ep2d_diff_mddw_20_p2_TENSOR b=0 b=1000, DWI Volume_04 12 ep2d_diff_mddw_20_p2_TENSOR_BO Volume_05 Volume_06 Volume_07 23 23 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 577 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Result Series SIEMENS Healthineers' ... ADC Maps: ADC= 1 AHR 3 (e1 +e2 +e3 ) AHR Demo_Fusion, Brain Anlagenzentrum Head Demo_Fusion, Brain Anlagenzentrum *1/1/1961, M, 58Y MAGNETOM Sola Head MR XA20 MAGNETOM Sola CURRENT *1/1/1961, M, 58Y HFS MR XA20 −b·ADC 10/28/2019 CURRENT HFS TRACEW: S b =S0 +LPH ·e 10/28/2019 ep2d_diff_mddw_20_p2 ADC latest ep2d_diff_mddw_20_p2_TRACEW latest # XA11 Sola Series STUDY ID d034cd58 # XA11 Sola 9:50:27 AM STUDY ID d034cd58-ece7-4f 7 IMA 1 FRM 13/25 9:50:27 AM 8 IMA 1 FRM 13/25 Series Number Series Description RFP 1 cm AAhead_scout E RFP 1 cm 2D AAhead_scout_MPR_sag F SL 5.0 SPC 6.5 F AAhead_scout_MPR_cor D/R DIR AAhead_scout_MPR_tra TR 3900.0 TE 84.0 TP O SP H29.3 TR 3900.0 TP 0 TA 04:54 TE 84.0 SP H29.3 WN 99 PhoenixZIPReport BW 1395.0 FoV 230*230 MAG S p2 MAGN/DIFF/ADC/NORM/ 128p*128 TA 04:54 Tra>Cor(-13)>Sag(1) BW 1395.0 FoV 230*230 128p*128 5 t1_mprage_sag_p2_iso A1/PFP/FS Zoom 4.29 p2 MAGN/DIFF/TRACEW/NORMIND or(-13)>Sag(1) 2699 Zoom 4.29 ep2d_diff_mddw_20_p2 HE1-4;NE2 W A1/PFP/FS *ep_b0_1000 /90 C 1246 HE1-4;NE2 W +ep_b1000t / 90 C 361 154 ep2d_diff_mddw_20_p2_ADC ep2d_diff_mddw_20_p2_TRACEW ep2d_diff_mddw_20_p2_FA 10 ep2d_diff_mddw_20_p2_ColFA 11 ep2d_diff_mddw_20_p2_TENSOR ADC Map B=1000; TRACE‐weighted 12 ep2d_diff_mddw_20_p2_TENSOR_BO 24 24 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 578 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Result Series SIEMENS Healthineers ... Grayscale Fractional Anisotropy (FA) Map Color FA Map Demo_Fusion, Brain Anlagenzentrum Demo_Fusion, Brain Anlagenzentrum Head Head *1/1/1961, M, 58Y MAGNETOM Sola *1/1/1961, M, 58Y MAGNETOM Sola MR XA20 MR XA20 CURRENT HFS CURRENT HFS 10/28/2019 +LPH 10/28/2019 +LPH ep2d_diff_mddw_20_p2_FA ep2d_diff_mddw_20_p2_ColFA Series latest latest # XA11 Sola Series Number # XA11 Sola Series Description STUDY ID d034cd58-ece7-4f STUDY ID d034cd58-ece7-4f 9:50:27 AM 9:50:27 AM AAhead_scout 9 IMA 1 FRM 13/25 10 IMA 1 FRM 13/25 AAhead_scout_MPR_sag RFP RFP 1 cm AAhead_scout_MPR_cor 20 AAhead_scout_MPR_tra SPC 6.5 SPC 6.5 5.0 T 99 PhoenixZIPReport TR 3900.0 D/R TP O TR 3900.0 5 t1_mprage_sag_p2_iso TE 84.0 SP H29.3 TE 84.0 TA 04:54 BW 1395.0 FoV 230*230 TA 04:54 6 ep2d_diff_mddw_20_p2 FOV 230*230 BW 1395.0 p2 MAGN/DIFF/FA/NORMIND 128p*128 Tra>Cor(-13)>Sag(1) p2 MAGN/DIFF/FA/NORMIND ep2d_diff_mddw_20_p2_ADC Tra>Cor(-13)>Sag(1) A1/PFP/FS ep2d diff mddw 20_p2 TRACEW HE1-4;NE2 W 1000 A1/PFP/FS *ep_b0_1000 / 90 C 500 HE1-4;NE2 *ep_b0_1000 / 90 9 ep2d_diff_mddw_20_p2_FA O 10 ep2d_diff_mddw_20_p2_ColFA ep2d_diff_mddw_20_p2_TENSOR 12 ep2d_diff_mddw_20_p2_TENSOR_BO FA Map Color FA 25 25 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 579 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Result Series SIEMENS Healthineers' ... TENSOR: use for MR Neuro3D, but not visible in View&GO. HAR MRN_fMRI_DTI_Zoomlt Anlagenzentrum TENSOR_B0: use for offline TENSOR calculation. 1234 *03.11.1942, M. 71Y Prisma MR D13D CURRENT HFS 07.02.2014 LPH Mi_mprage_sag_p2 latest -- >Current.MR_FUSION_STRUCTURE Series STUDY ID 1 Series Number Series Description AAhead_scout 2 AAhead_scout_MPR_sag 3 AAhead_scout_MPR_cor 4 AAhead_scout_MPR_tra 5cm 99 PhoenixZIPReport 5 t1_mprage_sag_p2_iso TI 900.0 6 ep2d_diff_mddw_20_p2 TR 2300,0 TE 3,0 7 ep2d_diff_mddw_20_p2_ADC BW 240,0 8 ep2d_diff_mddw_20_p2_TRACEW VRT : p2 MIND/NORM TP 0 SP A21,1 9 ep2d_diff_mddw_20_p2_FA A1/IR 248*256 10 ep2d_diff_mddw_20_p2_ColFA HC1-7 *tf13d1_16ns / 9 Cor-Sag(18)>Tra( 6) 11 ep2d_diff_mddw_20_p2_TENSOR 12 Image quality: high ep2d_diff_mddw_20_p2_TENSOR_BO 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 580 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Arterial Spin Labeling (ASL) SIEMENS Healthineers Arterial Spin Labeling (ASL) MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 581 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... Arterial Spin Labeling (ASL) • ASL 2D • Pulsed ASL (PASL) 2D • Pseudo‐Continuous ASL (PCASL) 2D • ASL 3D • Pulsed ASL (PASL) 3D • Pseudo‐Continuous ASL (PCASL) 3D 2 Unrestricted © Siemens Healthineers, 2023 Notes 582 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Recall the principles of Arterial Spin Labeling • State the differences and applications between ASL 2D, Pulsed ASL (PASL) 2D, and Pseudo‐ Continuous ASL (PCASL) 2D • State the differences and applications between ASL 3D, Pulsed ASL (PASL) 3D, and Pseudo‐ Continuous ASL (PCASL) 3D 3 Unrestricted © Siemens Healthineers, 2023 Notes 583 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Introduction SIEMENS Healthineers ... MR Applications Fundamentals 1 Arterial Spin Labeling (ASL) Introduction 4 Unrestricted © Siemens Healthineers, 2023 Notes 584 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Arterial Spin Labeling (ASL) SIEMENS Healthineers ... Introduction Arterial Spin Labeling is a method for measuring (cerebral) T1 relaxation perfusion without exogeneous contrast agent administration. Arterial blood water is used as an endogenous tracer by magnetic labeling instead • The longitudinal magnetization of arterial blood water must be manipulated (labeling) so that it differs from the tissue magnetization. • The difference between images with and without labeling can be used to calculate perfusion. • The magnetic labeling decays with T1. arterial spin labeling Key parameters for ASL quantification • T1 relaxation times of blood and tissue • Labeling efficiency • Arterial transit time 5 MReadings: Neurology: Arterial Spin Labeled Perfusion MRI; John A. Detre, M.D Unrestricted © Siemens Healthineers, 2023 Notes 585 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Arterial Spin Labeling (ASL) SIEMENS Healthineers ... Introduction Labeling conditions: Perfusion measurements are based on: • Labeled or tag images and • Unlabeled control images With identical static tissue signals, but different magnetization of the inflowing blood. = – Perfusion‐weighting: (multiple averages) Subtraction of the labeled/tagged images from the control images. Control Image Label/Tag Perfusion‐weighted • Eliminates static tissue signal Image Image • The remaining signal is a relative measure of perfusion 6 6 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 586 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Arterial Spin Labeling (ASL) SIEMENS Healthineers .. Introduction SNR • Multiple tag‐control image pairs are acquired and averaged for the generation of perfusion maps • Additional saturation pulses are applied to reduce static tissue signal • Higher channel coils are beneficial to increase the SNR ASL benefits from high field strength due to: • Intrinsically higher SNR Mz • Longer T1 relaxation times (slower decay of labeled M0 short T1 information) ΔMz long T1 time 7 Unrestricted © Siemens Healthineers, 2023 Notes 587 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers ... MR Applications Fundamentals 1 Arterial Spin Labeling (ASL) 2D 8 Unrestricted © Siemens Healthineers, 2023 Notes 588 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers ... Principle Acquisition of two images: • One with labeled information • One without labeled information AAAAAA wait Subtraction of the images. The difference (ΔMz) is proportional to the perfusion level of the tissue. Label/Tag Image acquisition Mz Control – Label/Tag  CBF M0 ΔMz 444144 111144/ wait 4444 time Control Image acquisition 9 Unrestricted © Siemens Healthineers, 2023 Notes 589 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers ... Principle Pre‐saturation • The signal difference between tag and control images is very small Imaging Slices • Background signal suppression is required to improve the perfusion‐weighted signal (i.e., the contrast between tag and control signal) • A pre‐saturation pulse is applied to suppress the static Pre‐saturation tissue signal Inversion Inversion pulses are applied to label/tag arterial blood water spins. Imaging Images are acquired with an EPI sequence (epfid) after a waiting time (Inversion Time). Inversion 10 Unrestricted © Siemens Healthineers, 2023 Notes 590 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers ... Motion Correction and control PACE 3D Part 1 Part 2 System Physio Perf • Prospective motion correction Sequence Name epfid Sequence File Name: • Implemented in the sequence ep2d_asl ep2d_asl Sequence Variant: epfid2d1_64 Motion Correction v Motion Correction > perfusion >> asl_2d_tra ? > 3 3:42 min Auto @ None 4.0x4.0x8.0 mm3 1.00 • Retrospective motion correction Routine Contrast Resolution Geometry System Physio Perf Sequence Common Dynamic ASL Quality Check Perfusion Mode PICORE Q2T Bolus Duration 700.00 + ms • On: images with excessive motion are rejected before map calculation Inversion Time 1800.00 + ms • Off: results without any image rejections Quality check On • On‐Extended: both results are generated Flow Limit 100.00 + cm/s 11 Unrestricted © Siemens Healthineers, 2023 Notes 591 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers ... Motion Correction and control • Head movement during scan • Quality‐Check = On‐Extended • Perfusion‐weighted images PACE 3D, Motion Correction PACE 3D, Motion Correction Quality Check = Off Quality Check = On 12 12 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 592 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers ... Result Series • Original images 15 asl_2d_tra_PCASL • MoCo series 16 MoCoSeries • Perfusion‐weighted image 18 Perfusion_Weighted • relCBF map 19 relCBF Perfusion‐weighted image relCBF map Neurokurs i Erlangen Neurokurs Uni Erlang 1 MAGN 1 *11/5/1957, F, 63Y *11/5/1957, F, 63Y CURRENT CURRENT 11/5/2020 11/5/2020 asl_2d_tra_PCASL MoCoSeries_1 Idtesum ase_06 of 43 latest/Phase_06 of 43 0017-44 4D 0 1 4458fc51-6017-44 STUDY ID 4458fc51-6017-44 3:38:58 PM 15 IMA 6 FRM 7/12 16 IMA 6 FRM 7/12 RFA RFA SL 6.0 SL 6.0 SPC 7.5 SPC 7.5 TI 1800.0 TI 1800.0 TR 4800.0 TR 4800.0 RMIMOCOIT_TEST/DIS2D TE 12.0 TE 12.0 TA 03:28 TA 03:28 BW 2367.0 BW 2367.0 MAGN/ASU'NORM/DIS2D Tra > Com MAGN/ASURESAMP/NORM/MOCO/DIS2D Tra>Cor A1/PFP/SAT1/FS A1/PFP/SAT1/FS Permision Weighted ima B (PEASL) KEIC BF (PEASL HE1-4 HE1-4 *epfid2d1_64 / 90 *epfid2d1_64/ 90 lotion: 0.12 ,- 0.01 ,- 0.28 ,- 0.02 ,- 0.12.0.07 Comment: Original images Motion‐Corrected images labeling technique 13 13 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 593 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 2D SIEMENS Healthineers' ... Clinical Example Diffusion, b0, b1000, ADC map ASL 2D 3D FLASH TOF T2 TSE T2 Dark Fluid 14 14 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 594 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pulsed ASL 2D SIEMENS Healthineers ... MR Applications Fundamentals 1 Pulsed ASL 2D 15 Unrestricted © Siemens Healthineers, 2023 Notes 595 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pulsed ASL 2D SIEMENS Healthineers ... A wide inversion slab is positioned proximally to cover arterial vessels and applied once for each tag image. Routine Contrast Resolution Geometry Common Dynamic ASL Perfusion Mode PICORE Q2T Inversion: a short inversion wwww pulse for a thick region. wwww www Label/Tag Control 16 16 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 596 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pulsed ASL 2D SIEMENS Healthineers ... Measurement planning HAR brain 2 IMA 1 FRM 3/5 perfusion >> asl_2d_tra X @ 3:42 min 4 Auto @ None 4.0x4.0x8.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Perf Sequence Common AutoAlign Saturation im Planning Suite ARF Saturation Region Special Saturation Parallel Gap 18.80 - mm 5cm Thickness 100.00 - m TP O SPR3.1/ FoV 259*259 IMPR/RESAMP/NORM DIS3D Sag>Cor(10)>Tra(1) AAhead_scout_MPR_sag 717 330/ Not for diagnostic use 17 17 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 597 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pulsed ASL 2D SIEMENS Healthineers ... Parameters Bolus Duration defines the length of the perfusion >> asl_2d_tra ? bolus. 3:42 min Auto @ None @ 4.0x4.0x8.0 mm3 1.00 The bolus of blood delivered to the tissue Routine Contrast Resolution Geometry System Physio Perf Sequence • of interest is controlled via periodic Common Dynamic | ASL saturation pulses. Perfusion Mode PICORE Q2T Bolus Duration 700.00 ms • Periodic saturation pulses terminate the bolus at a predefined time interval Inversion Time 1800.00 + ms resulting in an accurate definition of the Quality check On bolus. Inversion Time specifies the inflow time. Coupling bolus termination with long inflow times allows the labeled bolus to reach the Flow Limit 100.00 + cm/s tissue phase of the vascular tree and improves the perfusion‐weighting. 18 Unrestricted © Siemens Healthineers, 2023 Notes 598 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pulsed ASL 2D SIEMENS Healthineers ... Sequence diagram (simplified) Pre‐saturation ? 90° 180° Auto @ None 4.0x4.0x8.0 mm3 . 1.00 90° Fat Sat 90° … ystem Physio Perf Sequence RF Bolus Duration 700.00 + ms Bolus Duration EPI acquisition time Gr Inversion Time Inversion Time 1800.00 + ms … Gp Gs Flow Limit 100.00 + cm/s 19 Unrestricted © Siemens Healthineers, 2023 Notes 599 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo-Continuous ASL 2D SIEMENS Healthineers ... MR Applications Fundamentals 1 Pseudo‐Continuous ASL 2D 20 Unrestricted © Siemens Healthineers, 2023 Notes 600 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo‐Continuous ASL 2D SIEMENS Healthineers ... Why Pseudo? Continuous RF transmission • Generation of a steady stream of labeled/tagged arterial spins flowing through the labeling plane • Continuous RF transmission is not feasible with conventional hardware (not available in product) Application of a long train of very short RF pulses instead (mimicking a continuous RF effect) → Pseudo‐continuous RF transmission RF … Continuous ASL Not available in product Label/Tag Control 21 21 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 601 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo‐Continuous ASL 2D SIEMENS Healthineers ... Pseudo‐Continuous ASL Application of a long train of very short RF pulses generates a steady stream of labeled/tagged arterial spins flowing through the labeling plane. Advantages over pulsed ASL • Higher perfusion signal/time (SNR) • Less transit time dependency • More perfusion homogeneity RF AAAA wwwY MM … Label/Tag Control 22 22 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 602 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo‐Continuous ASL 2D SIEMENS Healthineers' ... Measurement planning Guidance Parameters /1 28 2M.1/1 Position labeling plane above the brain brain carotid artery bifurcation and below the V3 segment as shown 2 IMA 1 FRM 3/5 MA.1-ERM 10/1.9. in the example. - - ARF RPF 5cm 10cm > perfusion >> asl_2d_tra ? x TP O SP R3.1 SP P4.6 @ 3:38 min 4 Auto @ None @4.0x4.0x6.0 mm 1.00 FoV 259*259 FoV 301*301 ... JMPR/RESAMP/NORM/DIS3D Sag>Cor(10)>Tra(-1) MAGN/ANGIO/ADD or>Sag(-8)>Tra(1) Routine Contrast Resolution Geometry System Physio Perf Sequence AAhead_scout_MPR_sag W 717 503 C 330 MIP Range W Not for diagnostic use Not for diagnostic use C 196 Common AutoAlign Saturation Tim Planning Suite - Saturation Region Special Saturation Parallel F Gap 35.00 - mm 23 23 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 603 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo‐Continuous ASL 2D SIEMENS Healthineers ... Parameters Labeling Duration is the duration of applying labeling on >> asl_2d_tra ? X pulses. @ 3:38 min / Auto @ None 4.0x4.0x6.0 mm3 1.00 Postlabeling Delay is used to define the inflow time Contrast Resolution Geometry System Physio Perf Sequence (like the inversion time in PASL 2D) Dynamic ASL Perfusion Mode PCASL Labeling Duration 1800 m Presaturation Postlabeling Delay 1800 + ms 90° Labeling pulses Fat sat 90° … RF time Labeling Postlabeling EPI acquisition Gr Duration Delay … Flow Limit 100.00 + cm/s Gp Gs 24 Unrestricted © Siemens Healthineers, 2023 Notes 604 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PASL & PCASL 2D SIEMENS Healthineers ... Protocols PASL PCASL • Lower resolution • Higher resolution • More measurement numbers • Less measurement numbers • Shorter TR possible • Longer TR perfusion >> asl_2d_tra ? > perfusion >> asl_2d_tra ? X 33:42 min Auto @ Non @ 4.0x4.0x8.0 mm3 1.00 3:38 min Auto @ None @ 4.0x4.0x6.0 mm 1.00 Routine Contrast Resolution Geometry System Physio Sequence Routine Contrast Resolution System Physio Perf Sequence Common Dynamic ASL Common Dynamic ASL Dynamic Mode Standard Measurements 91 Dynamic Mode Standard Measurements 45 Routine Contrast Resolution Geometry System Physio Perf equence Routine Contrast Resolution Geometr System Physio Perf Sequence Slice Group 1 FOV Read 256 - mm Slice Group 1 FoV Read 256 - mm Slices 9 - FoV Phase 100.0 % Slices 12 + FOV Phase 100.0 % Slice Thickness 8.0 4 mm Slice Thickness 6.0 mm Distance Factor 25 TR 2400.0 - ms Distance Factor 25 + TR 4800.0 + ms Position Isocenter TE 12.00 ¢ m ms Position Isocenter TE 11.00+ Note: an odd measurement number as the first image is the M0 reference 25 Unrestricted © Siemens Healthineers, 2023 Notes 605 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PASL versus PCASL 2D SIEMENS Healthineers ... Perfusion Weighted Images PASL PCASL 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 606 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D, PASL 3D & Pseudo-Continuous ASL 3D SIEMENS Healthineers ... MR Applications Fundamentals 1 ASL 3D, Pulsed ASL 3D,& Pseudo‐Continuous ASL 3D 27 Unrestricted © Siemens Healthineers, 2023 Notes 607 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D ASL 3D SIEMENS Healthineers ... Pre‐saturation is used to suppress the background signal and to enhance the perfusion contrast. Background Suppression • Background signal is further reduced with an additional background suppression • It is optimized for gray matter and white matter suppression Imaging • A 3D TGSE sequence is used for image acquisition • It provides higher SNR and more uniform contrast across slices PW Image MAGNETOM Aera PW Imaged MAGNETOM Skyra 2x2x2 mm voxel size 2x2x2 mm voxel size 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 608 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pulsed ASL (PASL) 3D SIEMENS Healthineers ... FAIR FAIR is a different labeling technique that is used in PASL 3D rather than in PASL 2D. Routine Contrast Resolution Common Dynamic ASL The Tag and control images are acquired as follows: Perfusion Mode FAIR Q2T Tag Non-Selective Non‐selective inversion Inversion Slab selective inversion Control Slab selective inversion limited to the wwwwwwww WWWMMMMMMMM imaging volume wwwwwwwww. WWWwwwMMMMM wwwwwwwww. -> Proximal arterial blood spins wwwwwwww wwwwwwwwwwww excluded from inversion wwwwwwwww. -> Inflow of fully relaxed signal wwwwwwwww Label/Tag Control 29 29 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 609 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 PASL 3D Pulsed ASL (PASL) 3D SIEMENS Healthineers ... Measurement planning Parameters • brain Bolus Duration • Inversion Time 2 IMA 1 FRM.3/5._ • Inversion Array Size: number of inversion times used for measurements EMENS > head >> library >> perfusion >> asl_3d_tra fast ? X Ö 2:15 min Auto @ None @ 2.0x2.0x5.5 mm3 1.00 Contrast Resolution Geometry System Physio Inline Sequence Dynamic ASL ARF Perfusion Mode FAIR Q2T Bolus Duration 700.00 + ms Suppression Gray-White Inversion Time 1990.00 - ms L TP O SP R3.1 FoV 259*259 IMPR/RESAMP/NORM/DIS3D Sag>Cor(10)>Tra(-1) AAhead_scout_MPR_sag 717 330 Inversion Array Size Not for diagnostic use 30 30 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 610 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo‐Continuous ASL (PCASL) 3D SIEMENS Healthineers ... The same labeling technique is used in PASL 3D as in PCASL 2D. However, a 3D TGSE image acquisition is used. Routine Contrast Resolution Common Dynamic ASL Perfusion Mode PCASL RF AAAA … Label/Tag Control 31 31 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 611 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Pseudo‐Continuous ASL (PCASL) 3D SIEMENS Healthineers ... Measurement planning Parameters • Labeling Duration • Postlabeling Delay • Delay/Inversion Array Size: number of postlabeling delays/inversion times used for measurements Parameters » SIEMENS > head >> library >> perfusion >> pcasl_3d_singleTI ? > 0 4:35 min | Auto @ 2 @ 1.7x1.7x4.0 mm3 1.00 /1 28 2M.141 - Position labeling plane above the carotid artery bifurcation and Line Contrast Resolution Geometry System Physio Inline Sequence below the V3 segment as shown in the example. on Dynamic ASL Perfusion Mode PCASL Labeling Duration 1800 + ms Dynamic ASL Perfusion Mode PCASL lite .... Postlabeling Delay 1800 + ms Max. Labeling Duration 1800 % ms Suppression Gray-White .... Inversion Time 1 nversion Array Size 16 Delay Array Size 1 + 32 32 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 612 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D: PASL versus PCASL SIEMENS Healthineers ... relCBF Maps @ 1.5T PASL_3D_tra_fast PCASL_3D_singleTI SL 5.5 mm; BD 700 ms, TI 1990 ms SL 3.5 mm; LD 1800 ms, PLD 1800 ms 33 33 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 613 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... Bolus Arrival Time (BAT) Bolus arrival time describes the transit time of blood from the labeling plane (or superior labeling slab in PASL) to the target tissue (imaging slice/voxel). • BAT modeling requires multiple inversion times Imaging • Available from XA31: BAT maps are automatically calculated Slice for multi‐TI data (Delay/Inversion Array Size > 1) @ 6:06 min Auto @ None @ 2.0x2.0x5.5 mm3 @ 1.00 Contrast Resolution Geometry System Physio Sequence Dynamic ASL Perfusion Mode FAIR Q2T Bolus Duration 700.00 ms Bolus Suppression Gray-White Inversion Time 1 1990.00 m Arrival @ 4:59 min & Auto Time Contrast Resolution Geometry Syste Dynamic ASL Perfusion Mode PCASL Max. Labelin nversion Array Size Suppression Gray-White .... Inversion Time 1 4 800 The parameter defines the time between the start of the labeling duration and the start of the image acquisition. TI = LD + PLD. LD / PLD / TI = 800 / 0 / 800 ms nversion Array Size 16 + Labeling/Tagging 34 Unrestricted © Siemens Healthineers, 2023 Notes 614 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... iPAT & TGSE Setup iPAT is available for ASL 3D • Compatible with PASL 3D and PCASL 3D • Applicable in‐plane (recommended) and in slice direction (not recommended) • UI solvers for: # of slices, iPAT Factors, Partial Fourier, EPI Factor & Turbo Factor TGSE protocol modification (rules of thumb) • EPI Factor x Echo Spacing < 15 ms • Turbo Factor x TE < 300 ms _MNO) > SIEMENS > head > library > perfusion > pcasl Perfusion Mode: None • Available from XA31 Routine Contrast Resolution Geometr • Acquisition without ASL preparation Common Dynamic ASL (i.e., w/o labeling and w/o background suppression) Result: PDw image (M0) Perfusion Mode None • 35 Unrestricted © Siemens Healthineers, 2023 Notes 615 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... Background Suppression ≥ XA31 • Improved background signal suppression was implemented in ASL 3D • Additional suppression mode was added Gray‐White‐Strong for increased signal suppression • The suppression mode can be changed in the ASL parameter card • Recommended application (default setup) • Gray‐White is used for PASL 3D • Gray‐White‐Strong is used for PCASL 3D Routine Contrast Resolution Geometry Common Dynamic ASL Perfusion Mode FAIR Q2T Suppression Gray-White Gray-White Gray-White-Strong 36 Unrestricted © Siemens Healthineers, 2023 Notes 616 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D: SIEMENS Healthineers .. M0 reference ≥ XA31 1.5T XQ (Sola-XQ_64Rx) > SIEMENS > head >> library >> perfusion >> asl_3d_tra_fast ? X General 2:25 min : Auto @ None @ 2.0x2.0x5.5 mm3 1.00 An M0 reference image is acquired as the Protocol Parameters Routine Contrast Resolution Geometry System Physio • Inline Sequence Voice Commands first image in addition to the specified Common Dynamic ASL Execution Image Management Perfusion Mode FAIR Q2T Bolus Duration 700.00 + ms measurements Auto Load Copy References ASL 3D: counting in pairs Suppression Gray-White Inversion Time 1990.00 ms • SIEMENS >> head >> library >> perfusion >> asl_3d_tra_fast ? X • Example: measurements = 8; sets up a 2:25 min 4 Auto @ None @ 2.0x2.0x5.5 mm3 1.00 measurement of one M0 reference image Routine Contrast Resolution Geometry System Physio Inline Sequence Common ASL followed by eight tag‐control‐pairs, nversion Array Size Dynamic Mode Standard Measurements 2 + 1 + (i.e., total of 17 measurements) 1.5T XQ (Sola-XQ_64Rx) > SIEMENS > head >> library >> perfusion >> pcasl_3d_singleTI ? x General 4:35 min Auto @ 2 @ 1.8x1.8x3.5 mm3 1.00 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Common Dynamic ASL Image Management Perfusion Mode PCASL Labeling Duration 1800 + ms Auto Load Copy References Preview Suppression Gray-White -... Postlabeling Delay 1800 ms IEMENS >> head >> library > perfusion >> pcasl_3d_singleTI ? X @ 4:35 min Auto @ 2 @ 1.8x1.8x3.5 mm3 1.00 Routine Contrast Resolution Geometry System Physio Inline Sequence Common Dynamic ASL Delay Array Size Dynamic Mode Standard Measurements 1 4 37 Unrestricted © Siemens Healthineers, 2023 Notes 617 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... Result Series Single‐TI Original images Perfusion‐weighted image • Original images (M0‐Label‐Control‐Label‐ AdvNeuro_ASL Uni Erlangen Radiologie AdvNeuro_ASL Und Erlangen Radiologie AdvNeuro_ASL MAONETOM Sola AdvNeuro_ASL Control‐…) "12/18/1964, M. 57Y MAGNETOM SOIR MR XA51 "1 2/1 8/1 964, M. 5TY 39 pcasl_3d_singleTI 9/1/2022 HE'S 9/1/2022 pcast_3d_mutTi +LPH Perfusion_Weighted_2 Perfusion‐weighted image labesoPhase_01 of 3) ladestPhase_12 of 792 • AD 40 Perfusion_Weighted STUDY ID 11944e29-37b1-41 STUDY ID 11144e29-27b1-4 3:33:20 PM 3:38:04 PM 26 IMA 1 FRM 15/24 27 IMA 12 FRM 15/24 • relCBF map 41 relCBF 1cm TI 2900.0 Multi‐TI R 4360.0 TE 20.4 TP O TR 4360.0 SP F2.6 TE 20.4 TA 05 3 DW 2441.0 FOV 240"240 TA04.66 BWV 2441.0 Original images p2 MAGNIASLINORUND 124.1281 Con(-14)>Sap(1) p2 MAGNIASU/SUB NORWT_TESTA • A1/SATIFS Zoom 4 29 AT/SATI/FS HE1-4 W 13705 C 6917 HE1-4 Jase301_930/ 180 "Ipse331_930/ 180 (M0‐LabelTI1‐ControlTI1‐LabelTI2‐ControlTI2‐…) relCBF map BAT • Perfusion‐weighted images 42 pcasl_3d_multiT AdvNeuro_ASL Uni Erlangen Radiologie AdvNeuro ASL Thu Erlangen Radiologia AdvNeuro_ASL "12/18/1964, M. 57Y MAGNETOM Sola AdvNeuro_ASL MR XA51 1 2/1 8/1 964. M. STY (PWTI1‐PWTI2‐…) 43 Perfusion_Weighted 9/1/2022 HES 9/1/2022 reICBF 2 .LPH BAT Isbest Latest • relCBF map 44 relCBF STUDYIO 11144829 STE STUDY ID 11144e29-37b1-41 28 1MA 1 FRM 15/24 3:38:04 PM 29 IMA 1 FRM 15/24 • BAT (bolus arrival time) 45 BAT RAF 1 cm or E TR 4360.0 TR 4360 0 TE 20.4 TP O Sap(1) 02 MAGNASL BATINT 1 24-1 28 1 Tra>Cor(-14)"Sag(1) • Original images without M0 image A16/8AT1/FS Zoom 4.29 A1 6/SATIFS Zoom 4 29 HE1-4 W 1500 750 ME1-4 "gse301_930/180 "1980301_930/ 160 0 1143 • Perfusion‐weighted image(s) Labeling technique in comment 38 38 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 618 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... Clinical Example Perfusion Evaluation TSE T2 T1 TSE PC ASL 3D DSC perfusion, relCBF and relCBV DWI, b1000 and ADC 39 39 Courtesy of: Sir Charles Gardiner Hospital, Perth, Australia Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 619 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... Clinical Example Proximal Vessel Stenosis A DSC relCBF B ASL relCBF C DSC delay D TOF 40 40 Haller S et. al, Radiology.2016 Nov;281(2):337‐356. https://doi.org/10.1148/radiol.2016150789 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 620 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 ASL 3D SIEMENS Healthineers ... Clinical Example Dementia A Normal aging B Alzheimer's dementia G Fronto-temporal dementia 2000 60 50 40 30 20 OL Bq/ml ml/100g FDG /min ASL 41 41 Haller S et. al, Radiology.2016 Nov;281(2):337‐356. https://doi.org/10.1148/radiol.2016150789 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 621 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Day 4 SIEMENS Healthineers DSC Perfusion MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 622 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... DSC Perfusion • DSC Perfusion overview • Parameter Card • Perfusion Maps 2 Unrestricted © Siemens Healthineers, 2023 Notes 623 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Recall the principles and applications of DSC Perfusion • Identify the parameters on the DSC Perfusion card • Describe the features and applications for the various Perfusion Maps 3 Unrestricted © Siemens Healthineers, 2023 Notes 624 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... Contrast Disclaimer: A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents. Practice of Medicine: The information presented in this DSC Perfusion presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. 4 Unrestricted © Siemens Healthineers, 2023 Notes 625 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Dynamic Susceptibility Contrast (DSC) SIEMENS Healthineers ... MR Applications Fundamentals 1 Dynamic Susceptibility Contrast (DSC) Perfusion 5 Unrestricted © Siemens Healthineers, 2023 Notes 626 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Dynamic Susceptibility Contrast (DSC) Perfusion SIEMENS Healthineers ... Dynamic • Dynamic measurements ~ 60 measurements • To observe the signal drop during the first pass of the contrast media Susceptibility Contrast • FID sequence uses a Single‐Shot EPI Readout • T2* weighted images Contrast Agent (Gd) Bolus Negative enhancement in signal intensity of perfused brain tissue. 6 6 MReadings: Neurology: Arterial Spin Labeled Perfusion MRI; John A. Detre, M.D Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 627 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DSC Perfusion SIEMENS Healthineers ... Applications Tumor usually takes the results from a relCBV map. Note: a T1 correction is needed in case of Blood Brain Barrier (BBB) disruption. Automatic T1 correction: relCBVCorr map. relCBV map 7 7 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 628 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DSC Perfusion SIEMENS Healthineers ... Bolus Injection Suggestions Power injector is used to infuse intravenous contrast media. It is not recommended to perform a manual injection. Contrast agent dose in cc/kg and rate in cc/s: • Dose in ml and rate of injection is at the Radiologist discretion • Consider size/gauge of the catheter used for the injection • Check IV to ensure no resistance to flow 20cc saline flush following contrast injection The same injection rate used for the contrast injection should be used for the saline flush. Reference: MAGNETOM FLASH – 1/2012 Brain perfusion; How & Why; Nader Binesh, Ph.D.1; Marcel M. Maya, M.D.1; Helmuth 8 Schultze‐Haakh, Ph.D.2; Franklin G. Moser, M.D Unrestricted © Siemens Healthineers, 2023 Notes 629 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 DSC Perfusion SIEMENS Healthineers ... Scan 1. Start the Scan. Intensity 2. Wait ~ 10 seconds, establish a baseline for a more accurate perfusion evaluation. 3. Start the bolus injection • Follow the Radiologist direction for dose (ml) and rate of injection time 9 9 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 630 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Parameter Card SIEMENS Healthineers ... MR Applications Fundamentals 1 Perfusion Parameter Card 10 Unrestricted © Siemens Healthineers, 2023 Notes 631 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion SIEMENS Healthineers ... Parameter Card Motion Correction – Advanced Retrospective » perfusion » ep2d_perf_p2 ? X Technique (ART) Ö 1:42 min Auto @ 2 1.7x1.7x4.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Perf The datasets are acquired and Sequence • retrospectively realigned in 3D using k‐space GBP V interpolation PBPV Motion Correction V TTP • Rigid body model motion correction relCBV • Removes patient motion artifacts Ability to cope with strong signal drops as relCBF • observed in DSC EPI Bolus tracking reIMTT Spatial Filter acquisitions relCBVCorr Filter Width 1.0 + mm Measurements 60 Translation Rotation 11 Unrestricted © Siemens Healthineers, 2023 Notes 632 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion SIEMENS Healthineers' ... Parameter Card Motion Correction – Advanced Retrospective AHL AHL Technique (ART) Demo_BOLD Mosaic Anlagenzentrum Demo_BOLD Mosaic Anlagenzentrum Brain *1/1/1961, M, 58Y MAGNETOM Sola Brain MR XA20 *1/1/1961, M, 58Y MAGNETOM Sola • First dynamic image is a reference MR XA20 CURRENT HFS CURRENT HFS The motion corrected information is displayed 10/28/2019 +LPH 10/28/2019 +LPH • MoCoSeries MoCoSeries as comments in each dynamic image 01 of 90 latest Phase_02 of 90 4D 0 4D 0 The first three values show the translation in # XA20 Sola # XA20 Sola • STUDY ID Sola STUDY ID Sola 9:38:32 AM 9:38:34 AM the X, Y, Z direction (in mm) 8 IMA 1 FRM 18/36 8 IMA 2 FRM 18/36 • The following three values show the rotation RAF RAF about the X, Y, Z axis (in degrees) 1 cm cm 2D SL SPC 3.8 F 2. 3.0 F TR 2000.0 D TP O TR 2000.0 TE 50.0 TP 0 TA 03:13 SP H27.8 TE 50.0 TA 03:13 SP H27.8 BW 1796.0 FoV 192*192 BW 1796.0 FoV 192*192 p2 s2 MAGN/FMRI/RESAMI /MOCO DIS2D 96*96 96*96 Tra>Cor(-13)>Sag(1) p2 s2 MAGN/FMRI/RESAMP/MOCO/DIS2D Tra>Cor(-13)>Sag(1) A1/FS Zoom 4.48 A1/FS Zoom 4.48 HE1-4 1036 HE1-4 W 1033 *epfid2d1_96 / 84 521 *epfid2d1_96 ( 84 C 515 Reference volume for motion correction. Motion: 0.03,0.02.0.28,0.02 ,- 0.11.0.01 12 12 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 633 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion SIEMENS Healthineers .. Parameter Card Measurements defines the number of dynamic perfusion > ep2d_perf_p2 ? measurements to be scanned. Ö 1:42 min / Auto @ 2 1.7x 1.7x4.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Perf Sequence Spatial Filter is applied in the image domain. GBP V It activates a low pass filter for smoothing images PBP Motion Correction (Gaussian filter). TTP relCBV • Increase SNR Reduce the spatial resolution relCBF • reIMTT Spatial Filter M Filter Width defines the Filter strength. relCBVCorr Filter Width 1.0 - mm Measurements 60 13 Unrestricted © Siemens Healthineers, 2023 Notes 634 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... MR Applications Fundamentals 1 Perfusion Maps 14 Unrestricted © Siemens Healthineers, 2023 Notes 635 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... Global Bolus Plot (GBP) Global Time Intensity Curve ≥15 measurements >> perfusion > ep2d_perf_p2 ? 1:42 min 1 Auto @ 2 1.7x1.7x4.0 mm3 1.00 Used to assess bolus passage that occurred over Routine Contrast Resolution Geometry System Physio Perf Sequence time. GBP It displays the time course of average signal in a PBPV MRN_DCEDSC_01 Uni Erlangen Radiologie central slice. TTP 12345 Ref.: ST Hochschulambulanz "12/11/1958. F. 58Y Skyra_fit CURRENT MR E11 reICBV 3/27/2017 Percent +LPH GBP_ep2d_perf_p2 100 Used to validate the passing of the bolus. relCBF latest It is used to monitor time course of contrast reIMTT 2:16:11 PM 73 IMA 1 uptake by (mainly) normal tissue for quality relCBVCorr assurance purposes. Signal is plotted as a percentage of the Measurements 60 S maximum value across all time points. Meas O 15 30 45 60 If a dip in curve is not seen (<20%) → Results will GBPIND sec 28"1 28 be poor HE1-4 0.0 23.6 47 2 70.8 94.4 15 Unrestricted © Siemens Healthineers, 2023 Notes 636 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... Percentage of Baseline at Peak (PBP) Pixel values in the map show the minimum >> perfusion »> ep2d_perf_p2 ? (peak) signal as a percentage from that 1:42 min 1 Auto @ 2 1.7x1.7x4.0 mm3 1.00 of baseline. How much signal drops at the Routine Contrast Resolution Geometry System Physio Perf Sequence peak. ( ≥15 measurements). GBP PBPV MRN_Stroke This Baseline value is the average of number TTP V 1006804566 *6/2/1949, M, 58Y of measurement 6‐10. reICBV CURRENT relCBF PBP_Perfus, planen wie dif latest Pixel Scaling: reIMTT # 0003973886 STUDY ID 0003973886 11:56:58 AM Min /Max: 868.00 /986.00 Mean/SD: 931.54 /34.74 The PBP value of 100% has a signal intensity relCBVCorr 1055 IMA 1 FRM 13/25 Area: 0 40 cm2 of 1000. RFA 1cm 5.0 SPC 6.0 Measurements 60 TR 2610.0 3:00 /584.00 TE 40,0 PO TA 00.08 260 62 /139.95 SP FO.9 BW 1565.0 oV 230*230 MAGN/PERFISCM 128p*128 Tra>Cor(-32)>Sag(4) A1/FS Zoom 4.29 HE 1378 epfid2d1_128 /90 689 16 Unrestricted © Siemens Healthineers, 2023 Notes 637 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... Time to Peak (TTP) The pixel intensity value in the image shows perfusion > ep2d_perf_p2 ? the time when the dynamic signal reaches Ö 1:42 min / Auto @ 2 1.7x1.7x4.0 mm3 1.00 the peak (≥15 measurements). Routine Contrast Resolution Geometry System Physio Perf Sequence GBP The brighter an area in the grayscale image, PBP V TTP MRN_Stroke Neuroradiologie Erlangen the more time expired until the signal peak 1006804566 Ref.: NL Notfallaufnahme Sonata CUR CURRENT MR XA30 was reached. elCBV 10/25/2007 HES High values correspond to long time delays, relCBF TTP_Perfus. planen wie diff latest Min / Max: 26.08 s/28.70 s # 0003973886 Mean/SD: 26.24 s/0.66 s reIMTT STUDY ID 000397 3886 Area: 0.56 cm2 and the results are displayed in seconds. 11:56:51 AM 1015 IMA 1 FRM 13/25 relCBVCorr Pixel values show the time point of the signal RFA SL Min 1cm minimum as a fraction of the time taken to SPC 6. Mear F acquire the entire time series of Measurements 60 TR 2610.0 TE 40.0 TP O SP F0.9 measurements. TA 00.08 BW 1565.0 FoV 230*230 MAGN/PERFITTP 128p*128 Tra>Cor(-32)>Sag(4) A1/FS Zoom 4.29 HE epfid2d1_128 / 90 Contrast agent 10.00m 17 Unrestricted © Siemens Healthineers, 2023 Notes 638 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... Arterial Input Function (AIF) AIF has the necessary information to > perfusion > ep2d_perf_p2 ? X @ 1:42 min / Auto 2 @ 1.7x1.7x4.0 mm3 1.00 calculate the perfusion maps rCBV, rCBF, Routine Contrast Resolution Geometry System Physio Perf Sequence GBP and rMTT. PBP Motion Correction TTP relCBV AIF is the reference used to see the reICBF arterial input of the contrast medium. reIMTT Spatial Filter relCBVCorr Global AIF Measurements 60 ¢ • Only available in MR Neurology Arterial Input Function (AIR Perfusion Maps MRN_Stroke Workflow 1006804566 +6/2M949, M, 58Y CURRENT Global AIF Local AUF 10/25/2007 • Manual selection of AIF Perfus. planen wie diff.Il VTTP PBP latest/Phase_12 # 0003973886 relCBF reIMTT STUDY ID 0003973886 11:57:21 AM relCBV relCBVCo 19 IMA 283 Local AIF RFA SL 5.0 • Available in Inline Perfusion card and ASIST Perfusion SPC 6.0 Delay Correction TR 2610.0 MR Neurology Workflow TE 40.0 TA 00.08 BW 1565.0 MIND A1/F'S • Automatic selection of AIF HE *epfid2d1_128/90 Gadovist 10 ml 10 00ml Select Al Clear All Start Close 18 18 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 639 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers' ... Global AIF We use one reference ROI to determine the incoming MRN_Stroke 1006804566 flow of contrast agent for whole brain. *6/2/1949, M. 58Y CURRENT 10/25/2007 Perfus, planen wie diff.!! latest/Phase_12 #000397 3886 STUDY ID 0003973886 The ROI is 5x5 pixels. 11:57:21 AM 19 IMA 283 The pixels selected as AIF are determined by the users. Correre MR _TOF cm SPC 6.0 TR 2610.0 TE 40.0 TP O Offline Calculation results of relCBV, relCBF, and TA 00 08 SP H29.1 BW 1565.0 FoV 230*230 MIND 128p*128 Cor(-32)>Sag(4) A1IFS Zoom 4.29 HE 909 relMTT maps are generated. *epfid2d1_128 Gadovist 10 ml 10.00ml .No . of Timepoints rfusion Maps Delay Correction might minimize the bolus delay and Global AIF Local AIF dispersion between the artery and the tissue of ¥ TIP V PBP ¥ relCBF ¥ reIMTT interest by using block‐circulant deconvolution ¥ relCBV relCBVCorrected technique instead of a Stochastic Singular Value Decomposition (sSVD). ASIST Perfusion Delay Correction Select Al Clear All Start Close 19 19 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 640 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers' ... Local AIF The Reference Volume for determining the MRN_Stroke 1006804566 income flow of contrast agent is around every *6/2/1949, M. 58Y CURRENT 10/25/2007 3cm voxel. Perfus, planen wie diff.il 3cm latest/Phase_12 # 0003973886 STUDY ID 0003973886 The reference volume is 3cm x 3cm x 3cm 11:57:21 AM • 19 IMA 283 RFA • Every voxel has its own AIF, it can avoid the 20 3cm SL 5.0 SPC 6.0 manual selection of AIF to reduce the bias from voxel TR 2610.0 TE 40.0 TP O TA 00.08 SP H29.1 individuals BW 1565.0 FoV 230*230 MIND 120p*128 or(-32)>Sag(4) A1/FS Zoom 4.29 HE 909 epfid2d1_128/ 90 432 Offline and Inline Calculation results of relCBV, Gadovist 10 ml 1000ml Arterial Input Function (AUF) Perfusion Maps relCBF, and relMTT maps are generated. Global AIF Local AIF V TTP PBP relCBF ¥ reIMTT It minimizes the bolus delay and dispersion relCBV relCBVCorrected between the artery and the tissue of interest. ASIST Perfusion Delay Correction This method reduces artifacts due to arterial flow differences between different regions/slices. Select All Clear All Start Close 20 20 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 641 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... relative Cerebral Blood Flow (relCBF) Inline relative CBF map reconstruction is y > perfusion » ep2d_perf_p2 ? x based on the local AIF method when enabled @ 1:42 min / Auto @ 2 @ 1.7x1.7x4.0 mm3 1.00 in the Perfusion card. Routine Contrast Resolution Geometry System Physio Perf Sequence GBP V Arbitrary Units. PBP V AH TTP V MRN_Stroke Neuroradiologie Erlangen 1006804566 Ref.: NL Notfallaufnahme *6/2/1949, M, 58Y Sonata relCBV CURRENT MR XA30 10/25/2007 HFS +LPH relCBF V RELCBF_LOCAL_Perfus. pla latest # 0003973886 reIMTT V STUDY ID 0003973886 11:56:51 AM 1014 IMA 1 FRM 13/25 relCBVCorr M RFA 1 cm SL 5.0 SPC 6.0 Measurements 60 TR 2610.0 TE 40.0 TP O TA 00.08 SP F0.9 BWV 1565.0 FoV 230*230 MAGN/PERF/RCBF 128p*128 or(-32)>Sag(4) A1/FS Zoom 4.29 HE 612 *epfid2d1_128/90 306 Local AIF Contrast agent 10.00ml 21 21 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 642 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... relative Cerebral Blood Volume (relCBV) Inline relative CBV map reconstruction is y > perfusion > ep2d_perf_p2 ? x based on the local AIF method when enabled @ 1:42 min / Auto @ 2 @ 1.7x1.7x4.0 mm3 1.00 in the Perfusion card. Routine Contrast Resolution Geometry System Physio Perf Sequence GBP V Arbitrary Units. PBP V TTP V MRN_Stroke Neuroradiologie Erlangen 1006804566 Ref: NL Notfallaufnahme *6/2/1949, M, 58Y Sonata CURRENT MR XA30 relCBV V 10/25/2007 HFS +LPH RELCBV_LOCAL_Perfus. planen wie diff !! relCBF V latest # 0003973886 reIMTT V STUDY ID 000397 3886 11:56:51 AM 1013 IMA 1 FRM 13/25 relCBVCorr RFA SPC 6.0 5.0 Measurements TR 2610.0 TE 40.0 TP O TA 00.08 SP FO.9 BW 1565.0 FoV 230*230 MAGN/PERF/RCBV 128p*128 Tra>Cor(-32)>Sag(4) A1/FS Zoom 4.29 HE 709 epfid2d1_128 / 90 354 Local AIF Contrast agent 10.00ml 22 22 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 643 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... relative Mean Transit Time (relMTT) Inline relative MTT map reconstruction is y > perfusion > ep2d_perf_p2 ? x based on the local AIF method when enabled @ 1:42 min 4 Auto @ 2 @ 1.7x1.7x4.0 mm3 1.00 in the Perfusion card. Routine Contrast Resolution Geometry System Physio Perf Sequence GBP V Arbitrary Units. PBP V TTP V MRN_Stroke Neuroradiologie Erlangen 1006804566 Ref: NL Notfallaufnahme *6/2/1949, M. 58Y Sonata CURRENT MR XA.30 relCBV 10/25/2007 HFS +LPH RELMTT_LOCAL_Perfus. pla relCBF latest # 0003973886 reIMTT V STUDY ID 000397388 11:56:51 AM 1016 IMA 1 FRM 13/25 relCBVCorr M RFA 1cm SPC 6.0 Measurements 60 TR 2610.0 TE 40.0 TP 0 TA 00.08 SP F0.9 BWV 1565.0 FoV 230*230 MAGN/PERF/MTT 128p*128 Tra>Cor(-32)>Sag(4) A1/FS Zoom 4.29 HE W 580 *epfid2d1_128/90 C 290 LocalAIF. Contrast agent 10.00mi 23 23 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 644 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Perfusion Maps SIEMENS Healthineers ... T1 Corrected relCBV (relCBVCorr) Inline T1 corrected relative CBV map y > perfusion » ep2d_perf_p2 ? x reconstruction. In cases of BBB break‐down @ 1:42 min 4 Auto @ 2 @ 1.7x1.7x4.0 mm3 1.00 the extravasation of contrast agents yields T1 Routine Contrast Resolution Geometry System Physio Perf Sequence effects and therefore misestimation of the GBP V relCBV. PBP V MRN_Stroke .Neuroradiologie Erlangen TTP V 1006804566 Ref.: NL Notfallaufnahme "6/2/1949, M, 58Y Sonata CURRENT MR XA30 Only available for the Local AIF method. relCBV 10/25/2007 HFS +LPH RELCCBV_LOCAL_Perfu relCBF latest # 0003973886 Arbitrary Units. reIMTT v STUDY ID 0003973886 11:56:51 AM 1032 IMA 1 FRM 13/25 Total Leakage-Contaminated relCBVCorr Relaxation Rate RFA 1cm 3-1 K, = 1; K = 0; KOP = 0 (WBA) K = 1; K, = 0.05; KeP = 0 (BW-mod SPCEn 5.0 2- K = 1; K5 = 0.05; Kep = 0.002 K, = 1; K, = 0.05; KOP = 0.005 1- - K, = 1; K, = 0.05; KeP = 0.1 Measurements 60 TR 2610.0 TE 40.0 TP O TA 00.08 SP FO.9 FoV 230*230 O 20 BW 1565.0 MAGN/PERF/RCBV 128p*128 50 100 150 Tra>Cor(-32)>Sag(4) -1- A1/FS Zoom 4.29 AR2"(t) [sec-1] Correction HE 1431 repfid2d1_128 / 90 715 -2 A BBB Broken Local'AIF: relCBVCom Contrast agent 10.00m 24 24 Ref: Leu K et al., AJNR 2016, 37 (8) 1440‐1446 DOI: https://doi.org/10.3174/ajnr.A4759 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 645 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers BOLD/fMRI MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 646 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... BOLD/fMRI • Theory • Stimulation • Paradigms • Protocols • Parameter card • MR Neuro3D postprocessing 2 Unrestricted © Siemens Healthineers, 2023 Notes 647 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Explain BOLD/fMRI theory • List the different types of BOLD stimulation • Recall the different BOLD paradigms • Identify the BOLD protocols • Recognize the BOLD parameters • Describe how to postprocess BOLD data in MR Neuro3D 3 Unrestricted © Siemens Healthineers, 2023 Notes 648 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... The information presented in the BOLD/fMRI presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. Competition product descriptions, comparison and specifications contained in this document are based on interpretation of available data at the time this material was being prepared [include date] and may require independent verification. Specifications have been obtained from competition brochures, websites, and other independent published sources. 4 Unrestricted © Siemens Healthineers, 2023 Notes 649 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Theory SIEMENS Healthineers ... MR Applications Fundamentals 1 BOLD/fMRI Theory 5 Unrestricted © Siemens Healthineers, 2023 Notes 650 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Theory Functional MRI is a technique used to measure the brain activity by detecting some changes in the brain tissue. (e.g., blood flow, oxygenation levels) BOLD (Blood Oxygen Level Dependent) Contrast The activated regions have changes in blood the oxygen concentration. Use EPI sequences to record the changes: • T2* contrast images • An increase of deoxyhemoglobin introduces more local field inhomogeneities and leads to more signal loss in the images • The activated regions would have higher signal due to the over‐compensation 6 6 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 651 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Theory BOLD/fMRI signal response Brain areas activated by a specific task utilize more 3% peak oxygen. • Initially, this activity decreases the levels of 2% oxyhemoglobin → decrease in signal intensity • Within seconds, however, the brain microvasculature responds to this local oxygen depletion by increasing 1% the flow of oxygen‐rich blood to the active area, flushing away the deoxyhemoglobin (increase in signal 0% BOLD Response intensity) initial dip post stimulus undershoot Hemodynamic Response Function (HRF) is the model -1% 0 describing the BOLD signal response after a brief 10 15 20 25 Time (sec) stimulation. stimulus Signal response after an impulse stimulation 7 Unrestricted © Siemens Healthineers, 2023 Notes 652 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers' ... Theory Activation Maps on Motor Cortex Activation Maps on Visual Cortex HPR 40.95 RA 4.00 -4.00 .40 95 8 8 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 653 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Stimulation SIEMENS Healthineers ... MR Applications Fundamentals 1 BOLD/fMRI Stimulation 9 Unrestricted © Siemens Healthineers, 2023 Notes 654 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Stimulation The stimulation is applied during the measurement to record the signal response. Goggles The stimulation could be: 1. Motor Stimulation, the patient performs a motor task (e.g., finger tapping). Headphones 2. Sensory stimulation (e.g., visual, or acoustic stimulation) 3. Cognitive stimulation, during the Running session ... Volume measurement, the patient is involved in Response Grips Press enter to abort 1 of 70 handling a cognitive task Note: Equipment may be needed to provide the external stimuli and synchronize with the MR scanner. Synchronization Box 10 Unrestricted © Siemens Healthineers, 2023 Notes 655 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Stimulation Devices NordicNeuroLab: Inroom viewing device 40‐inch 4K UHD Presentation of Visual Stimulus Patient Comfort O 11 Unrestricted © Siemens Healthineers, 2023 Notes 656 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Stimulation Devices With Integrated Eye‐ NordicNeuroLab: Visual system Presentation of Visual Stimulus Tracking Camera 12 Unrestricted © Siemens Healthineers, 2023 Notes 657 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Stimulation Devices NordicNeuroLab: Audio system Presentation of Visual Stimulus Communication Console 13 Unrestricted © Siemens Healthineers, 2023 Notes 658 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD/fMRI SIEMENS Healthineers ... Stimulation Devices NordicNeuroLab: Response Group Response Grips and Interface 14 Unrestricted © Siemens Healthineers, 2023 Notes 659 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Paradigms SIEMENS Healthineers ... A paradigm is a temporal allocation of stimuli to acquire After the measurement, we compare the signal response BOLD responses from the subject. pixel‐by‐pixel with the paradigm design. The stimulation is repeated several times within the • If the signal response is like the paradigm, then the area paradigm. is involved in the stimulus The paradigm should always contain a baseline (rest Stimulus Stimulus Stimulus phase) and at least one stimulus (active phase). Baseline Baseline Baseline Baseline Stimulus Stimulus Stimulus Baseline Baseline Baseline Baseline • If the signal response shows little relation to the paradigm, then the area is not related to the stimulus Stimulus Stimulus Stimulus Baseline Baseline Baseline Baseline MATWIM 15 Unrestricted © Siemens Healthineers, 2023 Notes 660 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Paradigms SIEMENS Healthineers ... Example of the paradigm: Finger tapping Can we run multiple‐task stimulation in one fMRI experiment? Yes, but it not recommended. Active: Finger tapping Finger tapping Finger tapping In this design we could have a pure baseline for all Baseline: stimulation tasks. Do nothing Do nothing Do nothing Do nothing Example of the measurement setup: Right hand Right hand Left hand Left hand • EP_FID sequence (T2* contrast) Baseline Baseline Baseline • TR=3000ms 10 meas. 10 meas. 10 meas. 10 meas. 10 meas. • Baseline = 30sec (10 measurements) Active = 30sec (10 measurements) 10 meas. 10 meas. • • Total 70 measurements: 10B‐10A‐10B‐10A‐10B‐10A‐10B 16 Unrestricted © Siemens Healthineers, 2023 Notes 661 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Paradigms SIEMENS Healthineers ... Why are there different colors in the activation maps? HPR Stimulus Stimulus Stimulus Positive 40.95 Baseline Baseline Baseline Baseline Correlation 4.00 -4.00 Negative Correlation -40.95 time 17 Unrestricted © Siemens Healthineers, 2023 Notes 662 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Protocols BOLD Protocols SIEMENS Healthineers ... ep2d_fid_basic_bold_p2 ep2d_fid_basic_bold_p2 02:58 Fundamental sequence for running fMRI. V: means you can enable the parameter. No inline calculated fMRI results are ep2d_bold_moco_p2 03:11 Cannot use in the default protocol setup. available. ep2d_pace_moco_p2 03:11 *: means PACE3D is coded in the sequence. ep2d_bold_moco_p2 ep2d_pace_moco_filter_p2 03:11 Cannot be turned off in the parameter card. Retrospective motion correction is enabled. SMS - BOLD BOLD card is available for inline calculation. ep2d_bold_moco_p2_52 03:11 Basic PACE Sequence 3D* MoCo BOLD card SMS ep2d_pace_moco_p2 PACE 3D (prospective motion correction) & ep2d_fid_basic_bold_p2 ep2d_fid (V) retrospective motion correction is enabled. ep2d_bold_moco_p2 ep2d_bold V V (V) Inline calculation available. ep2d_pace_moco_p2 ep2d_pace V V V ep2d_pace_moco_filter_p2 ep2d_pace_moco_filter_p2 ep2d_pace V V V Additionally enabled spatial filter. ep2d_bold_moco_p2_s2 ep2d_bold V V V 18 Unrestricted © Siemens Healthineers, 2023 Notes 663 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD Protocols SIEMENS Healthineers ... ep2d_fid_basic_bold_p2 No BOLD card available (controlled by licenses) ep2d_bold or ep2d_pace BOLD > ep2d_fid_basic_bold_p2 ? X BOLD > ep2d_pace_moco_p2 ? x 3 2:58 min 1| Auto @ 2 3.0x3.0x4.0 mm3 1.00 Ö 3:11 min Auto @ 2 2.0x2.0x3.0 mm3 1.00 Routine Resolution Geometry System Physio Perf Sequence Routine Contrast Resolution Geometry System Physio BOLD Sequence GBP GLM Statistics Motion Correction PBP Motion Correction TTP Ignore Meas. at Start Spatial Filter relCBV Ignore After Transition relCBF Model Transition States Measurements 60 reIMTT Spatial Filter Temp. Highpass Filter Delay in TR 0.00 + ms relCBVCorr Threshold 4.00 ¢ Paradigm Size 20 Meas[1] Baseline Measurements 60+ Meas[2] Baseline Meas[3] Baseline 19 Unrestricted © Siemens Healthineers, 2023 Notes 664 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD Protocols SIEMENS Healthineers ... With Simultaneous Multi‐Slice (SMS) Benefits of using SMS in BOLD fMRI. BOLD contrast vs. Flip angle • Increased temporal resolution with the same TA The flip angle must be adjusted to the Ernst angle for • Increased number of slices and resolution with the maximal SNR when using short TR: same TA θE=cos−1 −TR/T1 • e • Reduce TA while maintaining statistical power Example at 3T: • Assume T1_GM~1500ms, T1_WM~800ms, T1_ave~1000ms 1 > BOLD > ep2d_bold_moco_p2_s2 • TR=1.5sec → θE~77 Routine Contrast Resolution • TR=1.0sec → θE~68 Common Dynamic • TR=0.5sec → θE~53 TR 1500.0 ms TE 30.00 m MTC lip Angle 70 % deg 20 Unrestricted © Siemens Healthineers, 2023 Notes 665 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD Protocols SIEMENS Healthineers ... With SMS SMS BOLD: SMS Factors and Coils Head/Neck 64 Head 32 Head/Neck 20 Head/Neck 16 • iPAT 2, SMS 2 • Diffusion iPAT 2, SMS 3 iPAT 2, SMS 3 might work (no iPAT 2, SMS 2 iPAT 2, SMS 2 product protocols) • • iPAT 2, SMS 3 iPAT 2, SMS 3 • SMS ~6 w/o iPAT • iPAT 2, SMS 4 BOLD SMS 6‐8 w/o iPAT for might work (no • iPAT 2, SMS 2 iPAT 2, SMS 2 research purposes (no product product protocols) protocols) 21 Unrestricted © Siemens Healthineers, 2023 Notes 666 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD Protocols SIEMENS Healthineers' ... With SMS BOLD with HN16 @ Skyra 24 iPAT 2 40.95 0225 3918. 12. SMS 2, iPAT 2 SMS 4, no iPAT Alternating finger tapping d, Fused , MPR Manipulated, Fused , MPR Manipulated, Fused, MPR (baseline) and tongue movement (activation). 6.00 -6.00 Three scenarios: • iPAT 2 • SMS 2, iPAT 2 • SMS 4, no iPAT -40.95-)FM OFFICIus 20 Anot W 845 C 391 Anat,Act Anat [50 ,- ]FM OFF/Clus 20 Anst W 845 C 391 Anat, Act Anat [50 ,- ]/FM OFF/Clus 20 Anat W 845 C 391 mz20150225_FH334_SMS2 mz20150225_FH334_SMS2 15.02.25-16:12:15-STD-1.3.12 .... Hospital #1/1 /1 981 Skyra |15.02.25-16:12:15-STD-1.3.12 .. Hospital mz20150225_FH334_SMS2 MR E11| M1/1/1 981 Skyra MR E11 15.02.25-16:12:15-STD-1.3.12 .... HFS 1/1/1 981 HES Flip Angles adjusted. STUDY 1 Mean STUDY 1 1071.81 Mean STUDY 1 1268.71 817.95 Mean 163.39 381.53 1058.06 991.24. Nearly identical acquisition time 952.73 800.95 Mr 631.80 Number of volumes: 60 → 120 → 847.40 [ ........... rrrrrrr M aquisition Number O 10 20 30 40 50 60 70 80 90 100 110 120 Image Acquisition Number 0 10 20 30 40 50 60 70 80 901001 1 01 201 301 401 501 601 701 801 902001 022030240 Image Acquisition Number 240. 60 measurements 120 measurements 240 measurements 22 22 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 667 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD Protocol SIEMENS Healthineers ... Fieldmap gre_field_mapping SIEMENS > head >> library >> BOLD MR. 6/12/2019 NNL NeuroNNL • Includes a measurement of the main magnetic BOLD AAhead_scout field (B0 field) 2 AAhead_scout_MPR_sag • It marks areas (purple mask) where the gre_field_mapping 00:54 3 AAhead_scout_MPR_cor allocation of functional information with ep2d_fid_basic_bold_p2 02:58 4 AAhead_scout_MPR_tra respect to the anatomy must be checked 5 t1_mprage_sag_p2_iso 16 • The coverage of the field map protocol must be ep2d_bold_moco_p2 03:11 gre_field_mapping 17 ep2d_pace_moco_filter_p2_Ri ... always equal to or larger than the coverage of AFL 8 MoCoSeries the fMRI BOLD protocol Tmri 2019.06.12-08.57.07-DST-1.3.12.2.1107.5.99.3 10 Desig *6/1 8/1 995, M, 23Y CURRENT 6/12/2019 11 EvaSeries_GLM gre_field_mapping latest 12 >Mean_&_t-Maps STUDY ID SJeaba5a-60€6-42 RAF TR 400.0 TE 7 4 TA 50 4 BW 601.0 PHASE DIS2D A1 HE1-4 *fm2d2r/60 23 Unrestricted © Siemens Healthineers, 2023 Notes 668 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD Protocols SIEMENS Healthineers ... ep2D PACE MoCo ep2d_pace_moco… (original protocol name) MR. 6/12/2019 Original acquired images. NNL NeuroNNL 7 - ep2d_pace_moco_filter_p2_Ri .. Phase_01 1 AAhead_scout Phase_02 2 AAhead_scout_MPR_sag MoCoSeries Phase_03 3 AAhead_scout_MPR_cor Images after retrospective motion correction and Phase_04 4 AAhead_scout_MPR_tra Phase_05 for applying spatial filter. 5 t1_mprage_sag_p2_iso Phase_06 6 gre_field_mapping Phase_07 Design 7 > ep2d_pace_moco_filter_p2_Ri ... Phase_08 Protocol is setup under BOLD card when GLM 8 MoCoSeries Phase_09 statistics is enabled. 10 Design Phase_10 11 EvaSeries_GLM Phase_11 12 Mean_&_t-Maps Phase_12 EvaSeries_GLM Phase_13 Pixel‐by‐pixel t‐value results. Phase_14 Mean_&_t‐Maps EPI images overlaid with the t‐map (|t|> threshold). 24 Unrestricted © Siemens Healthineers, 2023 Notes 669 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD SIEMENS Healthineers ... Result Series ep2d_pace_moco (Original Protocol Name) MoCo Series AFL AFL fmri Siemens Healthineers 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 fmri Siemens Healthineers *6/18/1995, M, 23Y MAGNETOM Vida 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 MR XA20 MAGNETOM Vida CURRENT *6/18/1995, M, 23Y HFS MR XA20 +LPH CURRENT 6/12/2019 ep2d_pace_moco_filter_p2_Right latest/Phase_06 of 90 MoCoSeries 4D 0 latest/Phase_06 of 90 STUDY ID 5dea6a5a-68c6-42 4D 0 9:18:12 AM STUDY ID 5dea6a5a-68c6-42 7 IMA 6 FRM 19/40 9:18:12AM 8 IMA 6 FRM 19/40 RAF 1cm RAF SL SPC 3.0 F 2D 1cm SL 3.0 SPC 3.0 TR 3000.0 TE 30.0 TP H29 TR TR 3000.0 TP H29 TA 04:39 SP H22.9 FoV 192*192 TE 30.0 SP H22.9 BW 1970.0 94*94 TA 04:39 p2 MAGN/FMRI/DIS2D Tra>Cor(4)>Sag(1) BW 1970.0 FOV 192*192 94*94 A1/FS Zoom 5.84 p2 MAGN/FMRI/RESAMP/FIL/MOCO/DIS2D Tra>Cor(4)>Sag(1) HE1-4 W 1564 A1/FS Zoom S om 6 84 *epfid2d1_94 / 90 C 810 HE1-4 *epfid2d1_94 / 90 Motion: 0.02 ,- 0.00,0.06 ,- 0.01 ,- 0.08 ,- 0.00 .......................... 25 25 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 670 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD SIEMENS Healthineers ... Result Series Design EvaSeries GLM ........... AFL fmri Siemens Healthineers fmri Siemens Healthineers 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 *6/18/1995, M, 23Y MAGNETOM Vida 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 *6/18/1995, M, 23Y MAGNETOM Vida MR XA20 CURRENT CURRENT HFS STUDY 6/12/2019 6/12/2019 +LPH Design EvaSeries_GLM latest latest 6/1 2/2019 STUDY ID 5dea6a5a-68c6-42 9:22:26 AM 9:17:57 AM 10 IMA 1 FRM 100 11 IMA 1 FRM 19/40 RAF 2D 1 cm SPC 37 5.0 F TR 3000.0 TP H29 SP H22.9 TA04:39 BW 1970.0 FoV 192*192 p2 MAGN/FMRI/T_TEST/FIL/MOCO/GLM/DIS2D 94*94 Tra>Cor(4)>Sag(1) A1/FS Zoom 5.84 HE1-4 1009 *epfid2d1_94/ 90 2281 nE Used meas. | Paradigm | Design Matrix O- t-Map 26 26 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 671 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 BOLD SIEMENS Healthineers ... Result Series 12 - Mean_&_t-Maps Mean_&_t‐Maps Volume_01 Volume_02 Volume_03 AFL AFL AFL fmri Sieme Siemens Healthineers fmri Siemens Healthineers 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 MAGNETOM Vida 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 fmri Siemens Healthineers *6/18/1995, M, 23Y *6/18/1995, M, 23Y MAGNETOM Vida 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 MR XA20 MR XA20 *6/1 8/1 995, M, 23Y MAGNETOM Vida CURRENT HFS CURRENT HFS 6/12/2019 HFS +LPH 6/12/2019 CURRENT MR XA20 +LPH 6/12/2019 +LPH Mean_&_t-Maps latest/Volume_01 Mean_&_t-Maps latest Volume_02 Mean_&_t-Maps latest/Volume_03 4D >>> STUDY ID 5deaba5a-68c6-42 STUDY ID 5deaba5a-68c6-42 STUDY ID 5dea6a5a-68c6-42 12 IMA 1 FRM 19/40 12 IMA 2 FRM 19/40 9:17:57 AM 12 IMA 3 FRM 19/40 RAF RAF RAF SPC 30 3.0 spcan 3.0 F SPC 3.0 3.0 F TR 3000.0 TP H29 TR 3000.0 TR 3000.0 TE 30.0 TP H29 SP H22.9 TE 30.0 SP H22.9 TE 30.0 TP H29 TA 04:39 FoV 192*192 TA 04:39 SP H22.9 BW 1970.0 BW 1970.0 FOV 192*192 TA 04:39 BW 1970.0 FoV 192*192 p2 MAGN/FMRI/MEAN/FIL/MOCO/DIS2D 94*94 Tra>Cor(4)>Sag(1) p2 MAGN/FMRI/MEAN/FIL/MOCO/DIS2D 94*94 Tra>Cor(4)>Sag(1) p2 MAGN/FMRI/MEAN/FIL/MOCO/DIS2D 94*94 Cor(4)>Sag(1) A1/FS Zoom 5.84 Zoom 5.84 Zoom 5.84 HE1-4 W 4096 A1/FS A1/FS 2048 HE1-4 4096 C 2048 HE1-4 W 4096 *epfid2d1_94 / 90 *epfid2d1_94 / 90 *epfid2d1_94 / 90 C 2048 Merged Image: t- 4:00 Merged Image: [t]>4.00 27 27 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 672 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards Parameter Cards SIEMENS Healthineers ... The setup under BOLD card is used to calculate the inline » BOLD » ep2d_pace_moco_p2 ? X 8 3:11 min | Auto @ 2 2.0x2.0x3.0 mm3 1.00 fMRI results. Routine Contrast Resolution Geometr System Physio BOLD Sequence GLM Statistics Motion Correction V The paradigm size and the measurement states should be the same as the experiment design of the patient scan. Ignore Meas. at Start Spatial Filter The measurement number of one baseline period and Ignore After Transition • one active period is the paradigm size Model Transition States V Measurements 60 Meas[1] to Meas[10] = Baseline Temp. Highpass Filter Delay in TR 0.00 ms • Threshold 4.00 ¢ • Meas[11] to Meas[20] = Active Paradigm Size Meas[1] Baseline Meas[2] Baseline Active Active Active Active Meas[3] Baseline Baseline Baseline Baseline Baseline 10 meas 10 meas 10 meas 10 meas 10 meas 10 meas 10 meas 10 meas → Total 60 meas 28 Unrestricted © Siemens Healthineers, 2023 Notes 673 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... GLM Statistics is either On or Off. > BOLD > ep2d_pace_moco_p2 ? > @ 3:11 min 1| Auto @ 2 2.0x2.0x3.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio BOLD ON: the General Linear Model is applied, and the Sequence GLM Statistics Motion Correction v t‐maps are calculated. • Ignore meas. at start: enabled Ignore Meas. at Start GLM Statistics • Ignore after transition: enabled Ignore After Transition • Model transition states: enabled Model Transition States Ignore Meas. at Start • Temp. highpass filter: enabled Temp. Highpass Filter • Threshold: enabled Threshold Ignore After Transition 4.00 Paradigm Size 20 ¢ Model Transition States OFF: the images are saved without evaluation. Meas[1] Baseline Temp. Highpass Filter • Ignore meas. at start: disabled Meas[2] Baseline Meas[3] Baseline Threshold 4.00 • Ignore after transition: disabled Model transition states: disabled Paradigm Size 20 • Temp. highpass filter: disabled Meas[1] Baseline • Meas[2] Baseline • Threshold: disabled Meas[3] Baseline 29 Unrestricted © Siemens Healthineers, 2023 Notes 674 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... Ignore Meas. at Start Ignore Meas. at Start. determines the number of >> BOLD > ep2d_pace_moco_p2 measurements that are ignored at the beginning 3:11 min 1| Auto @ 2 2.0x2.0x3.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio Sequence of the experiment. (i.e., more dummy scans). GLM Statistics V Motion Correction • To avoid interferences caused by the experimental response at the beginning of the Ignore Meas. at Start 0 + Spatial Filter measurement Ignore After Transition • The paradigm would be shifted Model Transition States Measurements 60 ¢ Temp. Highpass Filter Delay in TR 0.00 ms Example: Ignore Meas. at Start=2 Threshold 4.00 Paradigm Size 20 Meas[1] Baseline Meas[2] Baseline Meas[3] Baseline 30 Unrestricted © Siemens Healthineers, 2023 Notes 675 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... Ignore After Transition determines the number of Example: Ignore After Transition = 2 measurements to be ignored whenever the state changes. Baseline Stimulus • Often used when Model Transition States=OFF X Model Transition States > BOLD » ep2d_pace_moco_p2 ? x • The hemodynamic response of the brain is used for 8 3:11 min1; Auto @ 2 @ 2.0x2.0x3.0 mm3 1.00 Routine Contrast Resolution Geometry System Physio BOLD Sequence calculation GLM Statistics Motion Correction • The paradigm would be convolved with the HRF to obtain a reasonable model of the activity‐time course Ignore Meas. at Start Spatial Filter Ignore After Transition 0 + Model Transition States V Measurements 60 Paradigm Paradigm ∗ HRF Temp. Highpass Filter Delay in TR 0.00 - ms Threshold 4.00 Acquired signal Paradigm Size 20 Meas[1] Baseline Meas[2] Baseline Meas[3] Baseline 31 Unrestricted © Siemens Healthineers, 2023 Notes 676 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... Temp. Highpass Filter > BOLD > ep2d_pace_moco_p2 ? x 3 3:11 min 1| Auto @ 2 2.0x2.0x3.0 mm3 1.00 • Determining whether amplitude fluctuations can Routine Contrast Resolution Geometry System Physio BOLD Sequence be eliminated over time via a high‐pass filter GLM Statistics Motion Correction • The limit frequency is determined automatically Ignore Meas. at Start 0 + Spatial Filter Threshold Ignore After Transition • The fMRI results (t‐maps) are calculated pixel‐by‐ Model Transition States Measurements 60 pixel and saved in EvaSeries_GLM Temp. Highpass Filter M Delay in TR 0.00 - ms • Only the pixel t‐values exceed the Threshold Threshold 4.00 ¢ would be displayed on the overlay images Paradigm Size 20 (Mean&t‐maps) Meas[1] Baseline Meas[2] Baseline Meas[3] Baseline 32 Unrestricted © Siemens Healthineers, 2023 Notes 677 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... The setup under the BOLD card is saved in the Series Design. Series × fmri Siemens Healthineers 2019.06.12-08:57:07-DST-1.3.12.2.1107.5.99.3 Add Study Send and *6/18/1995, M, 23Y MAGNETOM Vida CURRENT STUDY 6/12/2019 Series Name Design latest Current 6/1 2/2019 MR. 6/12/2019 9:22:26 AM NNL NeuroNNL 10 IMA 1 FRM 101 AAhead scout AAhead_scout_MPR_sag AAhead_scout_MPR_cor 4 AAhead_scout_MPR_tra 5 t1_mprage_sag_p2_iso 6 gre_field_mapping 7 >ep2d_pace_moco_filter_p2_Ri ... 8 MoCoSeries SL 90*180 10 Design 2000 1000 11 EvaSeries_GLM Acquired images Paradigm 12 Mean_&_t-Maps used for analysis Used meas. | Paradigm | Design Matrix 13 ep2d_pace_moco_filter_p2_LvsR 33 Unrestricted © Siemens Healthineers, 2023 Notes 678 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... Motion Correction > BOLD >> ep2d_pace_moco_p2 ? > @ 3:11 min 1| Auto @ 2 2.0x2.0x3.0 mm3 1.00 ART ‐ Advanced Retrospective Technique. Routine Contrast Resolution Geometry System Physio BOLD Sequence • Datasets are acquired and retrospectively realigned GLM Statistics Motion Correction in 3D using k‐space interpolation • Rigid body model motion correction Ignore Meas. at Start Spatial Filter • Removes patient motion artifacts Ignore After Transition Filter Width 3.0 mm • Independently, prospective motion correction would Model Transition States Measurements 60 be performed automatically via the ep2d_pace Temp. Highpass Filter Delay in TR 0.00 - ms protocol Threshold 4.00 Paradigm Size 20 Meas[1] Baseline Spatial Filter is a low pass filter that is activated to Meas[2] Baseline smooth the images. Meas[3] Baseline 3.0 Increase SNR, but reduce the spatial resolution Filter Width 0.1 20.0 mm • • High filter width → stronger filter • Filter is applied to image domain • The filtered images saved in MoCoSeries 34 Unrestricted © Siemens Healthineers, 2023 Notes 679 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Parameter Cards SIEMENS Healthineers ... Delay in TR is a delay time between two subsequent > BOLD > ep2d_pace_moco_p2 ? 3 3:11 min 1| Auto @ 2 2.0x2.0x3.0 mm3 1.00 measurements. Routine Contrast Resolution Geometr System Physio BOLD Sequence • Used mainly when giving voice commands GLM Statistics Motion Correction v • The idea is to have a silent period to give the order to the patient Ignore Meas. at Start Spatial Filter V • It is played out for each measurement (not only in Ignore After Transition Filter Width 3.0 - mm the transitions) Model Transition States Measurements 60 The maximum Delay in TR depends on the TR of the Temp. Highpass Filter Delay in TR 0.00 - ms • protocol Threshold 4.00 Paradigm Size 20 Meas[1] Baseline Meas[2] Baseline Meas[3] Baseline 3.0 Filter Width 0.1 20.0 mm 35 Unrestricted © Siemens Healthineers, 2023 Notes 680 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Neuro 3D MR Neuro 3D SIEMENS Healthineers ... How to open Open the MR Neuro 3D card from the Patient Browser ‐or‐ Configure an Interaction Step with the Advanced Application Add‐in and insert into the program. Then the assigned workflow would open automatically. ep2d_bold_moco_p2_s2 03:11 Advanced Application Auto Start Workflow Advanced Application Guidance Assign and Auto Start Workflow Queue GSP Name of Workflow / Application MR Neuro 3D Automatically open workflow in background 36 Unrestricted © Siemens Healthineers, 2023 Notes 681 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Neuro 3D SIEMENS Healthineers' ... Display Results HRP To display fMRI Function result in MR Neuro 3D, anatomy (e.g., T1 MPRAGE), fieldmap and EvaSeries should be , 23Y loaded. _p2_iso MR Neuro 3D CH 12 > Mean & t-Maps OSESION STRUCTURE 09617-863d-42 MR Neuro 3D Reading 11 EvaSeries_GLM Alignment 10 Design Image Selection 8 I MoCoSeries fMRI 7 ep2d_pace moco_p2 left h. Function 6 gre_field_mapping [29] ep2d_pace_moco_p2 word genera .. 5 11_mprage_sag_p2_iso [23] ep2d_bold_moco_s2_antonim [17] ep2d_bold_moco_s2_sentence-co [11] ep2d_pace_moco_p2 left hand O Primary Individual Uniform Highlight Secondary /NORM/DIS2D Cor mage quality: high 37 37 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 682 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Neuro 3D SIEMENS Healthineers ... Display Results To display fMRI time course result in MR Neuro 3D, HAR fMRI_NNL Siemens Healthineers *10/29/1996, F, 23Y FMRI_NNL Siemens Healthinc anatomy (e.g. T1 MPRAGE), MoCoSeries (suggested) and CURRENT MAGNETOM Vida 10/29/2019 10/29/1996, F. 23Y MAGNETOM V CURRENT EvaSeries would be loaded 5 IMAn a. FRM.n.a. 10/29/2019 RFA MoCoSeries VON atest/Phase_01 of 90 STUDY ID c2e096f7-863d- MR Neuro 3D 3 IMAn.a. FRM n.a. CH MR, 10/29/2019 11 900.0 TR 2300.0 (18)>Sag RFA + head library TE 2.3 MR Neuro 3D Reading MPR FUSION : p2 MAGN/NORM/DIS2D 12 > Mean_& t-Maps IR 3000.0 Alignment HAR TE 30.0 fMRI_NNL Siemens Healthineers BW 1970.0 11 EvaSeries_GLM 10/29/1996, F. 23Y MPR THICK : p2 MAGN/FMRVRESAMP/FIL/MOCO/DIS2D Image Selection CURRENT MAGNETOM Vida A1/FS Cor > Tra( - 15 )> 10 10/29/2019 Design did5 94 / 90 t1_mprage_sag_p2_is fMRI 5 IMA ~1 FRM ~53- Reference volume for motion correction. Tractography 8 MoCoSeries Diffusion Evaluation 7 ep2d_pace_moco_p2 left h .. T1 900.0 TR 2300.0 Tra(-7)>Cor(-2) TE 2.3 Time Course Evaluation gre_field_mapping MPR FUSION : p2 MAGN/NORM/DIS? 5 Function t1_mprage_sag_p2_iso [11] ep2d_pace_moco_p2 left hand fMRI_NNL Siemens Healthincer *10/29/1996, F, 23Y yep2d_pace_moco_p2 left hand MAGNETOM Vida CURRENT -VOM 10/29/2019 [11] ep2d_pace_moco_p2 left hand t1_mprage_sagup?_isn 5 IMAn.a. FRM n.a. ep2d_pace_moco_p2 left hand RFA SP P19.0 256 256 Cor>Tra(-17)>Sag(4) MPR FUSION : P2 MAGNING W 706 314 38 38 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 683 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers MR Spectroscopy MR Applications Fundamentals 1 syngo MR XA51 Unrestricted © Siemens Healthineers, 2023 Notes 684 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Agenda SIEMENS Healthineers ... MR Spectroscopy • Spectroscopy Overview • Brain Metabolites • Sequences • Workflow • Clinical Image Examples 2 Unrestricted © Siemens Healthineers, 2023 Notes 685 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Objectives SIEMENS Healthineers ... At this end of this module, you should be able to: • Recall the Brain Metabolites • Identify MR Spectroscopy (MRS) sequences (PRESS versus STEAM and SVS versus CSI) • Summarize the MRS Workflow • Recall the clinical uses for MRS 3 Unrestricted © Siemens Healthineers, 2023 Notes 686 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Disclaimers SIEMENS Healthineers ... The information presented in the MR Spectroscopy presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard. MR scanning has not been established as safe for imaging fetuses and infants less than two years of age. The responsible physician must evaluate the benefits of the MR examination compared to those of other imaging procedures. 4 Unrestricted © Siemens Healthineers, 2023 Notes 687 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Overview SIEMENS Healthineers ... MR Applications Fundamentals 1 MR Spectroscopy Overview 5 Unrestricted © Siemens Healthineers, 2023 Notes 688 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Potential benefits from spectroscopy include: H • It could reflect metabolic states of various tissues MRN_Spectro_00 Radic 1 • It might show metabolic changes resulting from disease *12/8/1983, M, 19Y syngo • It might be possible to monitor the effect of therapy CURRENT csi_se_30 NAA • It could follow metabolic pathways in biochemical latest/csi_se_30/Spectrum -- > Spectro1 .Spectrum.1- research # 1 STUDY 1 1.4 11/13/2003 3:32:38 PM 1.2 Note: In MR imaging, usually we only see Water and Fat. Series 15 1.0 4.96 R 6.1 Gln 0.8 I: 10.16 Cr2 mins 4.85 I: 7.72 Cho Glu I: 4.23 Real Par 0.6 13.75 0.4 - 0.2 TR 1500 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 TE 30 NA 4 Chemical shift [ppm] TA 07:12 HE1-4_c_4 csi_se/90 : Integral 6 Unrestricted © Siemens Healthineers, 2023 Notes 689 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Signal Source Several different nuclei could be the signal source Nucleus Spin Quantum f0 @1.5T Natural abundance Relative* number I (MHz) (%) Sensitivity S(%) S∝ γ 3 I(I+1) 1H 1/2 63,8 99,98 100,00 3He 1/2 48,6 0,01 5,8x10‐5 7Li 3/2 24,8 92,6 27,00 13C 1/2 16,0 1,10 0,017 17O (3T) 3/2 8,6 0,04 0,001 19F 1/2 59,9 100,00 83,00 23Na 3/2 16,9 100,00 9,30 31P 1/2 25,9 100,00 6,60 129Xe 1/2 17,7 26,4 0,56 7 * Product of natural abundance and NMR‐sensitivity Unrestricted © Siemens Healthineers, 2023 Notes 690 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Chemical Shift Under an external magnetic field (B0), the resonance frequency is ω0=γ∙B0. The resonance frequency is proportional to the locally experienced magnetic field (Bloc) of the nuclei Fat (triglyceride) (e.g., protons) • The chemical structures of water and fat are different • The protons of water and fat would experience different field strengths → Different resonance frequency → Chemical shift 8- 1 6+ MRS is an extreme case of chemical shift. H Water: H2O . . 6- H Red: Oxygen Grey: Carbon White: Proton 8 Image Ref: https://en.wikipedia.org/wiki/Fat, https://en.wikipedia.org/wiki/Water Unrestricted © Siemens Healthineers, 2023 Notes 691 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Chemical Shift The environment of the protons is affected by the neighboring atoms. O Benzyl Acetate Bloc= B0(1‐σ), σ: magnetic shielding Different metabolites have their own patterns in the spectroscopy (like the fingerprinting). 5 H 2 3 | C – H – H | electronic | H cloud C – – | H B0 applied B induced Bloc 9 00 - HSP-06-163 N - ppm 9 Unrestricted © Siemens Healthineers, 2023 Notes 692 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers .. Chemical Shift The chemical shift can be displayed in Hz (absolute unit) or ppm (relative unit). Water ppm (parts per million) is independent from the external magnetic field strength 10 • Fat‐water chemical shift is 3.4ppm, • 1.5T = 220 Hz • 3T = 440 Hz 5 The Spectral Axis uses TMS (tetramethylsilane) as Metabolites the reference at (0 ppm) Water is at 4.7ppm (37⁰C) • O ppm 1H Spectrum 10 Unrestricted © Siemens Healthineers, 2023 Notes 693 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Chemical Shift J‐coupling (spin‐spin coupling or scalar coupling) Without Coupling Is the splitting of single resonance lines due to interaction of neighboring nuclear spins. Hb | Ha Hb Ca – Cb – – | With Coupling Ha J J .......... .................. . Ha Hb 11 Unrestricted © Siemens Healthineers, 2023 Notes 694 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Concentration Concentration of metabolites of interest in vivo Water 1‐10 mM. 1: 4.56E+05 ~ TTTTT 50000 Concentration of water in vivo: 55.6 M: 45000 ~ 70% is MR‐visible in 1H spectra ‐> ~ 40 M. 40000 E 35000 Signal of metabolites ~ 1/10000 Signal of H2O. 3 30000 It is necessary to suppress strong water signal. 25000 Magnitude Longer measurement times for signal 20000 accumulation and better SNR. 15000 10000 5000 cetate Lac 779.78 1: 169.14 T 6 5 Chemical shift [ppm] 12 Unrestricted © Siemens Healthineers, 2023 Notes 695 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Water Suppression WET (Water suppression Enhanced through T1 effects) with three frequency selective saturation pulses and with MRS Phantom Scan optimized flip angles (ΔB1 and ΔT1 insensitive). with Water Suppression without Water Suppression si_se_135 Mister ? X Acetate 4.56E+05 8 7:12 min : Auto @ 10.0x 10.0x 15.0 mm3 1.00 140 50000 Contrast Resolution Geometry System Sequence 120 45000 100 - 40000 TR 1500.0 ms Water Suppression Water Satur ... 4E+03 35000 TE ms Water Suppr. BW 35 Hz 80 Water 38000 542 56 28000 Spectral Suppr. None 20000 Magnitude 40 15000 Angle 90 - deg 20 10000 5000 Acetate Scans erages 4 - ... Chemical shift [ppm] Chemical shift [ppm] 13 Unrestricted © Siemens Healthineers, 2023 Notes 696 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Field Homogeneity We need a very homogeneous field for the spectroscopy measurement. 0,9 If the field is inhomogeneous, the T2* becomes shorter, and it leads to a broader spectral linewidth. 0,4 • Δ1/2 = 1/(πT2*), where 1/T2* = 1/T2 + ½ γΔB0 • ΔB0: inhomogeneities from the main field and due to magnetic susceptibility differences Time ‐Domain 0 5 10 15 20 25 -0,1 • Shimming is very important!! 1 Frequency‐Domain 0 -60 0 60 Red curve: more inhomogeneities 14 Unrestricted © Siemens Healthineers, 2023 Notes 697 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Metabolites in the Brain SIEMENS Healthineers ... MR Applications Fundamentals 1 Metabolites in the Brain 15 Unrestricted © Siemens Healthineers, 2023 Notes 698 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy (MRS) SIEMENS Healthineers ... Metabolites in Brain Introducing ... The Chemicals in Your BRAIN 3, M, 19Y syngo 15.73 NAA se_30/Spectrum ro1 .Spectrum.1- We're nerve 1.4 Cells. We send messages telling 1.2 We are energy the body what We are cells. We make to do. the mess- 1.0 Cr1 engers that 4.96 energy for all carry instruc. 19 Gln the other cells. tions to all 0.8 I: 10.16 the cells. Cr2 mins Glu 1: 4.85 I: 7.72 Cho I: 4.23 I: 13.75 Real Part 0.6 We are astrocytes . 0.4 Our job is to "Coach" the cells. 0.2 4.0 3.5 3.0 2.5 2.0 1.5 0.5 Chemical shift [ppm] Integral 16 Unrestricted © Siemens Healthineers, 2023 Notes 699 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MRS Metabolites in the Brain SIEMENS Healthineers ... NAA (N‐Acetylaspartate) About 10mM in healthy brain. H MRN_Spectro_00 Concentration varies between Gray Matter *12/8/1983, M, 19Y (GM) and White Matter (WM). CURRENT latest/csi_se_30/Spectrum -- > Spectro1 .Spectrum.1- Mainly in neurons (neuronal marker). # 1 STUDY 1 1.4 11/1 3/2003 3:32:38 PM 1.2 - Reduced concentration in tumors, stroke, Series 15 1.0 Cr1 multiple sclerosis (MS). 4.96 R 0.8 Cr2 mins Real Part : 4 85 : 7.72 , 2 1: 420 Singlet @ 2.0ppm (CH3) 0.6 • • Doublet of the doublet @ 2.5ppm (CH2) 0.4 0.2 • Doublet of the doublet @ 2.7ppm (CH2) • Doublet of the doublet @ 4.4ppm (CH) TR 1500 4.0 3.5 TE 30 3.0 2.5 2.0 1.5 1.0 0.5 • Doublet @ 7.8ppm (NH) NA 4 Chemical shift [ppm] TA 07:12 HE1-4_c_4 csi_se/90 I: Integral 17 Unrestricted © Siemens Healthineers, 2023 Notes 700 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MRS Metabolites in the Brain SIEMENS Healthineers ... Creatine About 3 to 8 mM in the brain. MRN_Spectro_00 Related to energy metabolism: *12/8/1983, M, 19Y phosphocreatine is used in the re‐ CURRENT csi_se_30 NAA synthesis of ATP from ADP. latest/csi_se_30/Spectrum 15.73 -- > Spectro1 .Spectrum.1- # 1 STUDY 1 1.4 Singlet @ 3.0ppm (CH3) 11/1 3/2003 • 3:32:38 PM 1.2 Singlet @ 3.9ppm (CH2) Series 15 Creatine • 1.0 • Singlet @ 6.6ppm (NH) R 0.8 Cr2 : 4.85 " Real Part 0.6 0.4 0.2 TR 1500 3.5 2.5 2.0 TE 30 4.0 1.5 Phosphocreatine 3.0 NA 4 Chemical shift [ppm] TA 07:12 HE1-4_c_4 csi_se/90 : Integral 18 Unrestricted © Siemens Healthineers, 2023 Notes 701 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MRS Metabolites in the Brain SIEMENS Healthineers ... Choline About 1 to 2 mM, but with 3 methyl groups. (i.e., totally with 9 protons → MRN_Spectro_00 high spectral peak). *12/8/1983, M, 19Y CURRENT NAA csi_se_30 Existing in cell membranes. latest/csi_se_30/Spectrum 15.73 -- > Spectro1 .Spectrum.1- # 1 STUDY 1 1.4 Related to membrane synthesis and 11/1 3/2003 3:32:38 PM 1.2 degradation. Series 15 1.0 R 0.8 The concentration increases in tumors, Cr2 Real Part ischemia and MS. 0.6 0.4 • Singlet @ 3.2ppm (CH3) 0.2 • Triplet @ 3.5ppm (CH2) TR 1500 1.0 4.0 0.5 Triplet @ 4.1ppm (CH2) TE 30 3.0 2.5 2.0 1.5 • NA 4 Chemical shift [ppm] TA 07:12 HE1-4_c_4 csi_se/90 : Integral 19 Unrestricted © Siemens Healthineers, 2023 Notes 702 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MRS Metabolites in the Brain SIEMENS Healthineers ... Myo‐Inositol (mI or Ins) About 3 to 8 mM in brain. MRN_Spectro_00 It marks glia cells in brain tissue. *12/8/1 983, M, 19Y CURRENT Regarded as an astrocyte marker, the csi_se_30 latest/csi_se_30/Spectrum -- > Spectro1 .Spectrum.1- concentration is elevated in dementia # 1 STUDY 1 1.4 patients. 11/1 3/2003 3:32:38 PM 1.2 - Series 15 1.0 Observable with short TE acquisition. 1: 4.96 R 0.8 Cr2 mins : 4.85 1 7.72 11 4.23 Real Part • Doublet of the doublet @ 3.6ppm (CH) 0.6 0.4 • Triplet @ 3.2ppm (CH) • Doublet of the doublet @ 3.5ppm (CH) 0.2 • Triplet @ 4.05ppm (CH) TR 1500 2.0 0.5 TE 30 4.0 3.5 3.0 2.5 NA 4 Chemical shift [ppm] TA 07:12 HE1-4_c_4 csi_se/90 I: Integral 20 Unrestricted © Siemens Healthineers, 2023 Notes 703 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MRS Metabolites in the Brain SIEMENS Healthineers ... Lactate The end‐product of the anaerobic glycolytic cycle. Normal concentration about 1mM, so it is usually not seen in normal brain. MRN_Spectro_00 • Doublet @ 1.3ppm (CH3) *12/8/1983, M, 19Y • qu @ 4.12ppm (CH) £ 4 :26 latest/csi_se_135_1/Spectrum -- > Spectro1 .Spectrum.13 # 1 0.40 The concentration increased in tumors, necrosis, STUDY 1 11/1 3/2003 3:22:37 PM 0.35 under hypoxia. Series 14 0.30 0.25 R 0.20 Overlap with strong lipid signals, (e.g., tumors) 0.15 Real Part 0.10 0.05 Lipid 0.00 • Peak between 1.2‐1.4ppm, overlap with lactate -0.05 • Mobile lipid could be found in (e.g., glioblastoma, TE 1500 3.0 2.5 2.0 1.5 NA 4 metastases, lymphomas, abscesses, cerebral TA 07:12 Chemical shift [ppm] HE1-4_c_4 infarction and so on). csi_se/90 Integral 21 Unrestricted © Siemens Healthineers, 2023 Notes 704 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Sequences SIEMENS Healthineers ... MR Applications Fundamentals 1 Sequences 22 Unrestricted © Siemens Healthineers, 2023 Notes 705 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Spectral Data Acquisition SIEMENS Healthineers ... FID: Free induction decay Single Voxel Spectroscopy (SVS) The simplest spectroscopic experiment. Selection of a volume of interest (VoI) by slice Signal collected from the entire part of the object seen by selective pulses. the coil. Chemical shift imaging (CSI) TU Spatial encoding over a FoV/VoI by phase encoding (in 2D or 3D). HAMAMMA == - -- Bo Mo = M2 Excitation Pulse: green Transverse Magnetization: red 23 Unrestricted © Siemens Healthineers, 2023 Notes 706 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Single Voxel Spectrosocpy (SVS) SIEMENS Healthineers ... Clinically there are two (2) prominent techniques due to the localization in a single experiment. PRESS: Point RESolved Spectroscopy. Siemens: ‘Spin‐Echo’: svs_se. STEAM: STimulated Echo Acquisition Mode. Siemens: ‘STEAM’: svs_st. Gx (RF‐pulse #1) Gy (RF‐pulse #2) Gz (RF‐pulse #3) Slice selected Bar selected Voxel selected PRESS 90° 180° 180° STEAM 90° 90° 90° Orientation cor sag tra 24 Unrestricted © Siemens Healthineers, 2023 Notes 707 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Single Voxel Spectrosocpy (SVS) SIEMENS Healthineers ... PRESS t1 t1 t2 t2 90° 180° 180° RF Gx Gy Gz 25 Ref: R.E. Gordon, R.J. Ordidge, Proc. SMRM, 1984, p.272..P.A. Bottomley, Ann. N.Y.Acad.Sci. 508, 333(1987). Unrestricted © Siemens Healthineers, 2023 Notes 708 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Single Voxel Spectrosocpy (SVS) SIEMENS Healthineers ... STEAM TE/2 TM TE/2 90° 90° 90° RF Gx Gy Gz VEST ("volume excitation using stimulated echoes"): J. Granot, JMR 70, 488(1986). VOSY ("volume selective spectroscopy"): R. Kimmich, D. Hoepfel, JMR 72, 379(1987). 26 STEAM ("stimulated echo acquisition mode"): J. Frahm et al., JMR 72,502(1987). Unrestricted © Siemens Healthineers, 2023 Notes 709 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Single Voxel Spectrosocpy (SVS) SIEMENS Healthineers ... PRESS versus STEAM SNR/(Meas.Time): Spin‐Echo = 2 * STEAM. SVS – VoI = 2 x 2 x 2 cc, TA = 3:12 min Shortest TE’s: STEAM NAA 1: 287.62 NAA : 109.94 • PRESS product: min TE: 30 ms 8 Cr1 STEAM product: min TE: 20 ms, min. TM: I: 122.74 • Cho 5 - 10 ms 122.03 Cr1 6 I: 57.03 mins Cho Less sensitivity to spin motion (diffusion): 1: 182.08 I: 43.83 mins PRESS. : 57.44 Real Part Real Part Less demands on RF: STEAM. Less sensitivity to B1‐misadjustment: STEAM. 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 Chemical shift [ppm] Chemical shift [ppm] PRESS TR/TE=1500/30ms STEAM TR/TE=1500/20ms 27 Unrestricted © Siemens Healthineers, 2023 Notes 710 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Chemical Shift Imaging (CSI) SIEMENS Healthineers ... Spectroscopic Imaging (SI). Spatial encoding by phase encoding of (1), 2, or 3 dimensions (1D‐, 2D‐, 3D‐CSI). Reconstruction of ND‐CSI datasets by (n+1)D‐FFT. 2D CSI HIPR 3D CSI Notfor diagnostic us 28 28 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 711 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Chemical Shift Imaging (CSI) SIEMENS Healthineers ... PRESS 2D‐PRESS‐CSI 3D‐PRESS‐CSI 90° 180° 180° Acquisition 90° 180° 180° Acquisition RF RF Gx Gx Gy Gy Gz Gz 29 Note: the STEAM CSI acquisition is also available in the protocol tree Unrestricted © Siemens Healthineers, 2023 Notes 712 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Chemical Shift Imaging (CSI) SIEMENS Healthineers ... Display of Results I(NAA)/ I(Cr1) I(Cho)/I(Cr1) 2:42 15.57 % 8.74 % MRN_Spectro_00 Radiolos Spectro_00 Radiol RN_Spectro_00 I(Cho) Radiolos *12/8/1 983, M, 19Y syngo MP/1983, M, 19Y syngo I 2/8/1983, M, 19Y syngo MF CURRENT IRENT csi_se_135 5.53 e_tra_512_pat2 JRRENT latest/csi_se_135/Spectrum t tse_tra_512_pat2 -- > Spectro1 .Spectrum.11 Spectro1.Reflmage.1 est #1 0.5 > Spectro1 .Metabolitelmage.1 STUDY 1 DY 1 11/1 3/2003 3/2003 TUDY 1 3:22:37 PM 00 PM /1 3/2003 Series 14 0.4 es 3 05:00 PM1.27 eries 3 0.3 NAA 3.02 PR 3.07 PC 3.3 > H47.6 . 10 TR 1500 4.0 3.5 3.0 2.5 0.5 500 a 0.52 PR THICK TE 135 ₹ 3500 NA 4 Chemical shift [ppm) : 102 TA 07:12 HE1-4_c_4 PCA A 1 csi_se/90 : Integral 2011_13/150 E1-4 se2d1_13/150 Voxel 122 Voxel 122 Voxel 12 Single Spectra of a Single Voxel Spectral Maps Metabolite Images 30 30 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 713 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Chemical Shift Imaging (CSI) SIEMENS Healthineers ... Pros and Cons Advantages Disadvantages • Acquisition of multiple voxels • Longer acquisition times • Metabolite images • Larger VOI → more difficult and less optimal shimming • Many voxels within the same dataset • Voxel bleeding • Nice overview of the distribution of the metabolic • Large datasets concentration 31 Unrestricted © Siemens Healthineers, 2023 Notes 714 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Chemical Shift Imaging (CSI) SIEMENS Healthineers ... Phase Encoding To reduce the scan time, different phase encoding options could be applied in the parameter card. Resolution Geometry System Sequence mm Hamming V ... mm Dimension 2D mm Phase Encoding Weighted Full Elliptical Weighted 32 Unrestricted © Siemens Healthineers, 2023 Notes 715 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Chemical Shift Imaging (CSI) SIEMENS Healthineers ... Phase Encoding Phase Encoding Weighted mode is used to reduce the Hamming filter is used to reduce the signal scan time. contamination from the adjacent voxels. Resolution Geometry System Sequence Phase Encoding S/N TA (2D:16x16) TA (3D:8x8x8) Full 1,0 26mins 51mins mm Hamming Elliptical 1,0 15mins (58%) 20mins (39%) mm Dimension 2D Weighted 1,0 7mins (28%) 8mins (16%) mm Phase Encoding Weighted Phantom‐Measurement – TR = 1.5 s, NA = 4 33 Unrestricted © Siemens Healthineers, 2023 Notes 716 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy Sequence SIEMENS Healthineers ... Parameter Ranges No Localization. Chemical Shift Imaging (CSI) Hybrid 2D/3D CSI. FID sequence: TE: 0.35 ms; TR: 0.3 ‐ 10 s. Parameters (TE/TR): Spin‐Echo: TE: 30 ‐ 300 ms; TR: 0.5 ‐ 10 s STEAM: TE: 20 ‐ 300 ms; TR: 0.5 ‐ 10 s Single Voxel Spectroscopy (SVS) sLASER: TE: 40 ‐ 300 ms Parameters (TE/TR): Spin‐Echo: TE: 30 ‐ 1500 ms; TR: 0.5 ‐ 10 s Field‐of‐View (FoV): STEAM: TE: 20 ‐ 300 ms; TR: 0.5 ‐ 10 s STEAM: FoV ≥80 mm Spin Echo: FoV ≥55 mm Voxel Dimensions: Spin‐Echo: 5 ‐ 40 mm (min. volume: 0.5 cc) Voxel Size: ≥2.5 x 2.5 x 5 mm3 STEAM: 10 ‐ 40 mm 34 Unrestricted © Siemens Healthineers, 2023 Notes 717 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Spectral Quality Some parameters may affect the MRS quality. NA=8 NA=64 NA=256 Typical values Temporal Spatial Parameter SNR Resolution Resolution TE↑ 20‐300ms ↓ ‐‐ ‐‐ TR↑ 1‐5s ↑ ↓ ‐‐ NA↑ 96‐256 (SVS) 1‐8 (CSI) ↑ ↓ 2 cm3 4 cm3 8 cm3 ‐‐ Voxel size↑ 1‐16 cm3 ↑ ↓ ‐‐ 3.0 2.5 2.0 1.5 4. 4.0 3.5 3.0 2.5 2.0 1.5 1.0 9.5 4.0 3.5 3.0 2.5 2.0 4.5 1 .0 9 . 5 0 . 35 Unrestricted © Siemens Healthineers, 2023 Notes 718 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Workflow SIEMENS Healthineers ... MR Applications Fundamentals 1 Workflow 36 Unrestricted © Siemens Healthineers, 2023 Notes 719 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Localizer SIEMENS >spectroscopy > head_1H >> svs localizer • The VOI should be at (or close to) Isocenter 00:09 • Redefine the Isocenter after the first localizer. center on brain abdomen Table Positioning Strategy • Note: table position should be in LOC‐Mode pelvis female localizer_5@center 00:40 pelvis male t1_mprage_sag_p2 03:14 tmj High Resolution images for planning shoulder svs_se_30 03:20 elbow Spectrosconv • 3D imaging + inline MPR (e.g., in brain) wrist Auto Start MR Spectro Advanced Application 2D images in transverse, sagittal, coronal views (e.g., prostate) hand • svs_se_135 04:56 hip Spectroscopy knee Svs_se_270 07:00 Spectral Sequences ankle Spectroscopy foot svs_st_20 06:32 • SVS, or 2D‐, 3D‐CSI measurements whole body oncology Spectroscopy SVS_st_135 06:32 • PRESS or STEAM in different echo times whole body diffusion Spectroscopy peripheral angiography SVS_st_270 06:32 spectroscopy Spectroscopy Assign an advanced workflow (MR Spectro) to open the data. head_1H SVS csi breast_1H prostate_1H qa_1H 37 Unrestricted © Siemens Healthineers, 2023 Notes 720 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow The planning of MRS is ONLY allowed on non‐distortion corrected images. SIEMENS >> spectroscopy >> head_1H >> svs localizer 00:09 Numaris X software, only distortion corrected images are allowed in GSP. center on brain abdomen O Table Positioning Strategy pelvis female localizer_5@center 00:40 There is a special Add‐in for the spectral steps to switch GSP from pelvis male t1_mprage_sag_p2 03:14 tmj Distortion Correction Mode to Non‐Distortion Mode. shoulder SVs_se_30 elbow Spectroscopy wrist Auto Start MR Spectro Advanced Application hand SVS_se_135 04:56 hip Spectroscopy knee Svs_se_270 07:00 ankle Spectroscopy foot svs_st_20 06:32 whole body oncology Spectroscopy SVS_st_135 06:32 whole body diffusion O Spectroscopy peripheral angiography SVS_st_270 06:32 spectroscopy Spectroscopy head_1H SVS csi breast_1H prostate_1H qa_1H 38 Unrestricted © Siemens Healthineers, 2023 Notes 721 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Spectroscopy Add‐in provides all 3 orientations head_1H >> svs > svs_se_30 ? > 3:20 min ; Auto @ 20x20x20 mm3 1.00 (sagittal, coronal, transverse) from the same table Spectroscopy Parameters position in a Non‐Distortion format for planning Spectro steps. Spectroscopy steps can only be planned on non-distortion corrected images. Please do the following steps for examination planning: . drag all series needed for planning into GSP Missing orientations are: . preselect the region of spectroscopy examination by placing a ROI on one series . press "Convert images" to generate non-distortion corrected images for planning • Searched in previous steps . the converted images will be automatically loaded into the GSP . plan your spectroscopy examination • Generated via MPR calculation For multiple spectroscopy measurements with the same position and voxel size, please use "Copy Parameter" with "Measurement Parameters" or "Everything" after conversion of the images. • Hint: enable inline MPR in 3D imaging protocols, head_1H >> svs > t1_mprage_sag_p2 X then all orientations are available before the 0 3:14 min 1; Auto @ 2 1.0x1.0x1.0 mm3 1.00 spectral measurements Routine Contrast Resolution Geometry System Physio Inline Sequence Subtraction Cardiac MIP Composing| Maplt Images from wrong table position are exchanged. MIP Sag Save Original Images MIP Cor MPR Sag V MIP Tra MPR Cor MIP Time MPR Tra V Radial MIP No. of Slices 220 ¢ 39 Unrestricted © Siemens Healthineers, 2023 Notes 722 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers' ... Workflow Planning Spectroscopy 020.10.16-15:37:14-DST-1.3.12.2.1107.5.99.3 5 IMA 1 FRM 69/192 020.10.16-15:37 7 MAT FRMG 2020.10.16-15:37:14-DST-1.3.12.2.1107.5.99.3 1. Open Spectroscopy step. 8 IMA 1 FRM 153/180 2. Place planning images in GSP. 3. Select Region‐of‐interest (ROI) in one GSP element by placing ROI (not a real spectroscopy object yet). ALF RFA RFA 3WILL 4. Press Convert images. F • Non‐Distorted (ND) images are generated TP H49 TP H49 SP R27.9 BPA24 2 SP H63.7 V 250*250 FoV 250*192 • Spectro object is visible know and is placed at 7)>Cor(-3) P/NORM/FM3 2 a>Sag(7)>Cor(4) 996 1122 Not for diagnostic use 11_mprage_sag merape.sag 62 150 HPRETTO 476 3. Not for diagnostic use 542 position of ROI @ 2:50 min " Auto @ 20x20x20 mm' 1.00 5. Perform the patient‐specific planning and place the pectroscopy Parameters voxel or VOI. Spectroscopy steps can only be planned on non-distortion corrected images. Please do the following steps for examination planning: drag all series needed for planning into GSP preselect the region of spectroscopy examination by placing a ROI on one series press "Convert images" to generate non-distortion corrected images for planning the converted images will be automatically loaded into the GSP plan your spectroscopy examination For multiple spectroscopy measurements with the same position and voxel size, please use "Copy Parameter" with "Measurement Parameters" or "Everything" after conversion of the images. Convert images 40 40 Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 723 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Working in ISO‐Mode Working in LOC‐Mode, in general, same table position will ISO‐Mode, in general, table will move to Isocenter for be used for all steps in queue. each protocol individually (if protocols have different center slice position). This is also valid for Spectroscopy steps. For Spectro, the table position of the planning image Note: This is the preferred mode for Spectro → Whole (where ROI was placed) will be written into workflow and it can be configured in LOC‐Mode in Spectroscopy protocol (previous REF‐Mode). MyExam Cockpit. Note: In ISO‐Mode it is often the case that different protocols in the queue have different table position. These will be unloaded by the AddIn and will not be converted to Non‐Distortion images. 41 Unrestricted © Siemens Healthineers, 2023 Notes 724 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Advanced Application Add‐in ... >> spectroscopy > head_1H >> svs localizer 00:09 Configure programs in the MyExam Cockpit so center on brain that an Advanced Application can be started Table Positioning Strategy in the background (e.g., MR Spectro). localizer_5@center 00:40 t1_mprage_sag_p2 03:14 This is an interaction with an Advanced svs_se_30 03:20 Spectroscopy Application add‐in. Auto Start MR Snertro Advanced Application SVs_se_135 04:56 Spectroscopy After reconstruction of all series and images SVs_se_270 07:00 prior to this step, the Workflow Application Spectroscopy SVS_st_20 06:32 will be assigned and start processing. Spectroscopy SVS_st_135 myExam Add-In Configurator SVS_st_270 Hint: you must enter the exact name of the workflow you wish to assign. Auto Start Workflow Guidance Assign and Auto Start Workflow Queue GSP Name of Workflow / Application i MR Spectro Automatically open workflow in background 42 Unrestricted © Siemens Healthineers, 2023 Notes 725 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow CSI planning AHL Select the reference image in the GSP segment and Copy Image Position. mrs 16 Clear All Segments -8 IMA 4 F + Shift to Image print Metabolite and Spectral Maps can be displayed on the reference image. Group Graphics Jy Perpendicular Orthogonal Align Parallel RFA Align Fov Lo Copy Image Position Find Localizer 5cm Repeat Step Repeat & Open Step TR.H49 SP H43.5 Copy Parameters Tra FoV 208*230 .. /NAVAIURESAMP/NORM. t2_tse_tra_p2_$2/3mm_^ NC Create Snapshot use 43 Unrestricted © Siemens Healthineers, 2023 Notes 726 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Manual Adjustment is only necessary if the FWHM Manual Adjustments are started under the System> value is too large*. Adjustments parameter card. 1.5T: 3T: Neuro SVS <13Hz Neuro SVS <20Hz @ 3:20 min 1| Auto @ 20x20x20 mm3 1.00 • • Neuro CSI 15Hz Physio Inline Sequence • • Neuro CSI 25Hz Routine Contrast Resolution System • Prostate 20Hz Prostate and Breast 30Hz Coils Miscellaneous Adjustments Adjust Volume Tx/Rx • Breast 25Hz Adjustment Strategy Standard Adjustment Tolerance Auto (Maxi ... • Confirm Frequency Adjustment BO Shim Brain Adjust with Body Coil Confirm Frequency When Chang ... Assume Silicone FWHM H21 107 Adj. Water Suppr. Manual Adjustments Mag 63,655 55 63,660.662 Coil Combined ADC- Frequency (sys) 63658113 [Hz] Frequency (temp) 63658113 [H2] Apply 44 Unrestricted © Siemens Healthineers, 2023 Notes 727 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Manual adjustment: Interactive Shim Manual Adjustments Display of FWHM (of the spectral Frequency No Amplitude [ Int [P] T2* [ms] FWHM [Hz] Tendency Transmitter 450.0 8,678 magnitude), tentative T2* and tendency. 3D Shim 450.0 8,854 11.9 Inter. Shim 131 4 450.0 8,801 122 132 450.0 8,781 Water Supp. 133 450.0 8,702 ggggg Best Shim: longest T2* and smallest FWHM. Show O 450.0 8,869 51 119 Use Load Best to use the best results. Coil Combined ADC - Uncomb. On Amplitude M [Max| 178 Receiver Gain High Measure [ms] Physio Triggering Off Stop 512 Increment Min Max Temporary System 1st Order Shim A00 [Hz] 63658404 63658408 A11 [HT/m] 48.11 48.11 Apply B11 [HT/m] -716.44 -719.76 /Max| 8,488 A10 [UT/m] -952.05 -952.05 FWHM [Hz] 12.1 A20 [HT/m2] 210.00 210.00 Load Tune-Up A21 [HT/m2] -111.48 -111.48 B21 [HT/m2] -158.05 -158.05 Load System mag 63,657,904 A22 [HT/m2] 295.56 295.56 Load Best B22 [HT/m2] 0.84 0.84 2nd Order Shim Reset Best Reset 45 Unrestricted © Siemens Healthineers, 2023 Notes 728 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Workflow Hints and tips • Protocol conversion and Phoenix of Spectroscopy • Auto Start MR Spectroscopy should be after the first steps automatically include the AddIn to the step spectroscopy protocol, if several spectroscopy (AddIn has a standard guidance text included) measurements should be performed • If images are unloaded from AddIn  check table • Images with DisCor 3D cannot be reverted  not position! (it is easier to work in LOC‐Mode) useable for planning • All ND images (with same table position!) can use • AddIn is not needed for FID‐Sequence since no planning drag&drop to GSP after AddIn conversion step is done here • AddIn is converting images for every step again! • Scroll Nearest functionality doesn‘t exist anymore, but (Only exception: if you copy a step in the queue, spectroscopy Addin selects the nearest images information about planning images will be kept) • loc@center – protocols means new localizer images are measured at the predefined table position 46 Unrestricted © Siemens Healthineers, 2023 Notes 729 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Clinical Image Examples SIEMENS Healthineers ... MR Applications Fundamentals 1 Clinical Image Examples 47 Unrestricted © Siemens Healthineers, 2023 Notes 730 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Variations of 1H MRS in Brain Metabolites Diseases SIEMENS Healthineers ... Stroke NAA↓ Cr↓ Ins↓ Lac↑↑ Glial tumors NAA↓ Cr↓ Cho↑ Lac↑ Lipids↑ (not always) Meningiomas NAA↓ Cr↓↓ Cho↑ Ala↑ Asp↑ Necrosis NAA↓↓ Cr↓↓ Cho↓↓ ↓ ↓ ↓ HIV and related diseases NAA↓ Cr↓ ? Cho↑ Lac↑ MS NAA↓ Cho↑ Lac↑? (active plaques) Lipids↑ Alzheimer's NAA↓ Cho↑ Ins↑ Epilepsy NAA↓ Cho↑ Hepatic encephalopathy Cho↓ Ins↓ Glx↑ Hypoxia NAA↓ Cr↓ Cho↑ (chronic hypoxia) Ins↑ Lac↑ Glx↑ (recovered hypoxia) Anoxia NAA↓ Lac↑ Brain abscess Absence of NAA, Cho, Cr Ace↑ Lac↑ Suc↑ AA↑ Lipids↑ Diabetes Mellitus NAA↓ Cho↑ Ins↑ Glc↑ 48 Ref: N. Salibi, M. Brown – Clinical MR Spectroscopy (Wiley‐Liss) Unrestricted © Siemens Healthineers, 2023 Notes 731 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers' ... Clinical Image Examples Acute Stroke Age Stroke, Harmony St Pierre Otigiles Harmony STUDYRUSTY I : begral 18.55:21 20 - @301 10- O0 - TI 23000 TE 11150 TA 01:21'2 BUY 1300 SP ATE FOU 10 ppm 334ª512 or-Tra(-10.7)>Sag (2.3) 291_21 / 190 SVS – Spin‐Echo, TR 1500ms, TE 135 ms, volume 8ml, TA 5 min 49 49 Courtesy of Ch. Van Ruyssevelt, MD, Klinik St. Pierre, Ottignies, Belgium Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 732 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Clinical Image Examples NAAR Glioma – Abnormality in the pons? 0.4 - 0.3 - 0.2 - 6.737 PRESS SVS VoI = 3 cc TE= 135 ms, TA= 6:24 min Spin‐Echo Post CE Dark‐Fluid TIRM – Post CE 0.0 - Tumor Spectrum Biopsy: pontine glioma 50 50 Courtesy of M. Shapiro M.D., Neurological Imaging Institute, Florida, USA Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 733 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Clinical Image Examples Astrocytoma III. arrozytom Il, prae/post Hyperther SIPSP STUDY zozylom Ill, prac/post Hyperther 0808 2 3/1969, 1, 35 Chol NAA 2D CSI PRESS Dataset: 7.18 • Voxel= 1ml nom. ERFA • TR/TE= 1500/135ms • TA= 4:45min 0.00 ........ Metabolite Map osi se / 90 .............. TR 1500 / TE 135 csi_se / 90 NA 6 / TA 4:45 Ser 5 VOX AP LR :TR 1500 / TE 135 SIZE 10 10 10 :NA 6 / TA 4:45 .......................... Overview of the metabolite concentration distribution. Astrozytom III, prae/post Hyperthermie 892-04 *2/3/1969, M. 35Y : Integral Symphony MR 2002B 892-04 Astrozytom III, prae/post Hyperther *2/3/1 969, M, 35Y STUDY 2 5/1 0/2004 User defined metabolite ratio can be generated Che 49 2:31:52 PM STUDY 2 50-0/2004 2:09:43 PM 2 IMA 12 /19 (e.g. Cho/NAA). -0.2 SPH13.2 SL.6.0 FOY 176*2301 2301512s T(-4.0)-Sag(3:0) FAISPOATE,135 W 1012 428 51 51 Courtesy of M. Busch et al., Groenemeyer Institute for Microtherapy, Bochum, D Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 734 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers' ... Clinical Image Examples Medulloblastoma (in 1yr old child). Medulablastoma 11.05.2001:14PM 3D CSI PRESS Dataset • Weighted phase encoding • TR/TE= 1410/135ms • Voxel= 1.3ml • TA= 8:14min 152 tuMedulloblastorna 83637066 NAA / Cho | *11.05.2001: 14PM 1.46 1.56 1.44 1.38 0,90 1.05 1.56 1.49 1.47 1.74 1.00 1.26 1.01 102 1.20 1.74 1.04 0.42 0.71 1.62 0.85 0 42 0.20 0.21 1.27 0.79 0.13 0.57 1.02 0.73 SeVS. Raw 52 52 Courtesy of Prof. van Hecke, University of Leuven, Belgium Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 735 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Clinical Image Examples Medulloblastoma (in 1yr old child). Scarpelo stoma SO MR 20028 SVS PRESS Data • Voxel= 4.1 ml 1.0 - • NA= 196 • TR/TE= 1600/270 ms • TA= 5:14 min svs_se / 90 TR 1600 / TE 270 NA 196 / TA 5:14 Medullablastoma 83637066 *11.05.2001;14M STUDY RIS 2101758 24.07.2002 11:08:00 7 IMA 4 / 5 Metabolite Pos. /ppm Integral Ratio 0.71 cho 3.25 9.30 1.00 282 5/180 Ser 7 53 53 Courtesy of Prof. van Hecke, University of Leuven, Belgium Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 736 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Clinical Image Examples ‐ Prostate 1H MR Spectroscopy Control Spectra Tumor Spectra Cit Cho Cho Cit ............................ Cit Cho Cho Cit Cit Cho Cho O Cit O 54 54 Courtesy of A. Heerschap, T. Scheenen, D. Klomp et al., University Hospital Nijmegen, St. Radboud, NL Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 737 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 MR Spectroscopy SIEMENS Healthineers ... Clinical Image Examples – Breast 1H MR Spectroscopy Measuring the Choline Signal with syngo GRACE. breast MRS. 4.Zyklus, Ffm, P.Gira MR4 UniFFM Inst Diag /Interv Rad Sonata breast MRS, 4.Zyklus, Ffm, R.G. MR4 UniFFM Inst Diag Intery Rad A0415487 breast MRS. 4.Zy MR 2002B 19.12.1960, F, 43Y Sonata #1409635 ' 18.08.2004 MR 2002B IMA & STUDY 2 13:59:21 HFP : 17.8 STUDY 2 +LPH 18.08.2004 2 IMA 28 / 60 1.0 - 0.5_ R ........ Preast MRS. 4.Zy ... " A IMA 10 ........ 0.0 10cm MF 1.00 ........................ -0.5 - .......... E1.5 ppm 52.6 3.5 3.0 2.5 MIND ......................................................................................... 422p.6403 A1/FS BRL;BRR fl3d1 /12 Ser 55 55 Courtesy: Univ. Frankfurt Unrestricted © Siemens Healthineers, 2023 Unrestricted © Siemens Healthineers, 2023 Notes 738 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 Please complete your assessment and print SIEMENS Healthineers ... your certificate after the completion of your course. 1. Log into https://pep.siemens‐info.com/activity 2. Under the My Events section, select the card for the course you just completed. 3. Select Launch to start the final assessment. 4. Upon successful completion, close the assessment window to return to the event page. 5. Select View Certificate option to complete the survey and print or save your certificate. 16 Unrestricted © Siemens Healthineers, 2023 Notes 739 MR Applications Fundamentals Part 1- STEP Week 2 | syngo MR XA51 On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. 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