MR Abdomen Diagnostikum

SIEMENS Healthineers MR – Abdomen Education Plan Diagnostikum Kerstin Schnabl Oktober 2024 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 2 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 3 Motion Management SIEMENS Healthineers ? Wahl der Technik One of the most challenging tasks in Abdominal MRI is the patient motion Strongest motion comes from the patient breathing Motion in head-feet and in anterior-posterior direction Several techniques to manage MIT Kontrastmittel OHNE Kontrastmittel the motion in the body Care Bolus Single and multiple Breath- TOF – Time of Flight Technik Test Bolus PCA – Phasen-Kontrast Technik hold techniques Dynamische Angiographie NATIVE TrueFISP/SPACE Respiratory triggered TWIST Angiographie QISS techniques Breath-hold example: ~3 cm difference in HF direction between end- Free-breathing techniques expiration and end-inspiration. Liver is clearly elastically deformed. Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 4 SIEMENS Healthineers Welche Techniken werden an eurem Standort angewandt Graz ? Schladming Linz Wien Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 5 Restricted © Siemens Healthineers, 2021 Motion Management SIEMENS Healthineers Breathhold Breath-hold can be done in inspiration or expiration: End-Expiration Typically better reproducible Triggered scans do also acquire in end-expiration End-Inspiration More variations between MIT Kontrastmittel OHNE Kontrastmittel separate BHs possible Care Bolus TOF – Time of Flight Technik But typically better tolerated Test Bolus PCA – Phasen-Kontrast Technik from patients Dynamische Angiographie NATIVE TrueFISP/SPACE TWIST Angiographie QISS Separate scans should use the same BH! expiration inspiration Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 6 Motion Management SIEMENS Healthineers Breathhold Multi Breath-hold SIEMENS >> abdomen >> library >> T2 >> 12_haste tra_p2 mbh_384 ? X General @ 1:08 min ; Manual @2 @ 1.0x1.0x5.0 mm = 1.00 Some protocols can be used Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence with multiple breath-holds (e.g. Voice Commands Execution Common AutoAlign Navigator Saturation Tim Planning Suite HASTE, TSE, BLADE, ep2D_diff) Image Management Slice Group FoV Read 380 mm Special option for multiple BHs Auto Load Slices 35 + FoV Phase 81.3 4 % Copy References in the Abdomen: Interleaved in Slice Thickness 5.0 ¢ mm Distance Factor 20 % TR 1600.0 + ms Breath-hold Position Isocenter Multi-Slice Mode Single Shot MIT Kontrastmittel Orientation Transversal OHNE Kontrastmittel Series Interl. in B .- h. Phase Encoding Dir A >> P Concatenations Ascending Care Bolus Descending Test Bolus Phase Oversampling 0 ~ % TOF – Time of Flight Technik Interleaved PCA – Phasen-Kontrast Technik Interl. in B .- h. Dynamische Angiographie NATIVE TrueFISP/SPACE TWIST Angiographie QISS OK Cancel SMART SIM Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 7 Motion Management SIEMENS Healthineers Interleaved in Breathhold Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 8 Motion Management SIEMENS Healthineers Breathhold Multi Breath-hold SIEMENS > abdomen >> library > BLADE >> 12_blade_fs_tra_p3_mbh ? × General @ 1:22 min | Manual @3 @ 1.5x1.5x5.0 mm 1.00 to use automatic voice Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence commands at each Voice Commands Execution Signal Cardiac PACE measurement, make sure that Image Management Resp. Control Breath-hold the Breath-hold option is Auto Load Copy References selected in the "Physio" > "PACE" parameter card The duration of the breath- MIT Kontrastmittel hold is available as a tool tip OHNE Kontrastmittel of the measurement time Care Bolus TOF – Time of Flight Technik Concatenations 3 Test Bolus Select as many concatenations PCA – Phasen-Kontrast Technik Dynamische Angiographie NATIVE TrueFISP/SPACE as necessary to ensure that the TWIST Angiographie QISS patient is comfortable with the duration of the breath-holds OK Cancel Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 9 Motion Management SIEMENS Healthineers Trigger MR acquisitions in the abdomen PACE: can also be triggered to the respiratory cycle Prospective Acquisition CorrEction Triggering can be realized by: Internal trigger using 2D "1D PACE for cardiac exams PACE with a "Liver Dome Scout" or "Phase Scout" =2D PACE for abdominal applications MIT Kontrastmittel OHNE Kontrastmittel Care Bolus External trigger using a · 3D PACE for neuro imaging TOF – Time of Flight Technik Test Bolus PCA – Phasen-Kontrast Technik respiratory belt Dynamische Angiographie NATIVE TrueFISP/SPACE TWIST Angiographie QISS BioMatrix Respiratory Sensor Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 10 Motion Management SIEMENS Healthineers Trigger - PACE test_09_01_2003 17 IMA 1 Head [mm] Scan 6/34 100 Acquisition window Shift: H 3.5 [mm] 80 Accept Accept Trig. period: 4.2 [s] Threshold: 25 [%] 60 window position 40 20 Trigger Position of TT O diaphragm -200 180 120 -80 -40 Time -20 Imaging sequence (block) MIT Kontrastmittel OHNE Kontrastmittel -40 Care Bolus TOF – Time of Flight Technik -60 Navigators Test Bolus PCA – Phasen-Kontrast Technik -80 Dynamische Angiographie NATIVE TrueFISP/SPACE -100 Scout TR TWIST Angiographie Acquisition duration tse_pace / 180 QISS Free breathing OP Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 11 Motion Management SIEMENS Healthineers Trigger - PACE PACE parameter card SIEMENS >> abdomen >> library >> T2 >> 12_tse_fs_tra_p2_trig_448 ? × The acquisition duration is General 3:25 min 4 Manual @ 2 0.9x0.9x5.0 mm ~ 1.00 Protocol Parameters available as a tool tip of the TA Routine Contrast Resolution Geometry Total Measurement Time: 3:25 min Inline Sequence Voice Commands Acquisition Duration: 1422 ms Execution Signal Cardiac PACE Respiratory Cycles: 5+78 Shows the number of required Image Management Resp. Control Trigger Select Acquisition Window Automatic respiratory cycles (5 cycles for Auto Load Scout Mode Acquisition Window 35 % Copy References Learning phase plus X cycles for imaging phase) Scout Type Phase Scout "Select acquisition window" should Scout TR 284 + ms Position Navigator Automatic Accept Window + 15 % Trigger Pulse be set to "Automatic" for 2D multi- MIT Kontrastmittel Position Accept Window Automatic OHNE Kontrastmittel shot sequences (TSE, BLADE) Concatenations 6 Care Bolus Automatic adjustment of the TOF – Time of Flight Technik Test Bolus Store Profile Images PCA – Phasen-Kontrast Technik Dynamische Angiographie number of concats according to NATIVE TrueFISP/SPACE TWIST Angiographie the respiratory cycle and the QISS selected acquisition window OK Cancel Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 12 Motion Management SIEMENS Healthineers Trigger - PACE PACE parameter card SIEMENS >> abdomen >> library >> T2 >> 12_tse_Is_tra_p2_trig_448 ? × · Set the imaging parameters (e.g. General G 3:25 min Manual 0.9x0.9x5.0 mm 1.00 Protocol Parameters Routine Contrast Resolution Geometry Total Measurement Time: 3:25 min Acquisition Duration: 1422 ms Inline Sequence number of slices per concat, Voice Commands Execution Signal Cardiac PACE Respiratory Cycles: 5+78 Turbo factor) such that the Image Management Resp. Control Trigger Select Acquisition Window Automatic duration of acquisition is equal Auto Load Scout Mode Acquisition Window 35 = % or less than 1/3 of the expected Copy References average respiratory period Scout Type Phase Scout Scout TR 284 = ms Position Navigator Automatic To ensure a robust triggering, Accept Window + 15 € % Trigger Pulse acquisition duration should be MIT Kontrastmittel Position Accept Window Automatic OHNE Kontrastmittel no more than one third of the Concatenations 6 Care Bolus individual breathing period of TOF – Time of Flight Technik Test Bolus Store Profile Images PCA – Phasen-Kontrast Technik the patient Dynamische Angiographie NATIVE TrueFISP/SPACE TWIST Angiographie QISS OK Cancel SMART SIM Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 13 Motion Management SIEMENS Healthineers Trigger - PACE etry System Physio Inline Sequence Liver Dome Scout Select Acquisition Window Automatic SP1 Acquisition Window 35 % BO1 Scout Type Liver Dome Scout SP2 Liver Dome Scout RO Phase Scout MIT Kontrastmittel OHNE Kontrastmittel BO2 Trigger Pulse 1 10 cm Care Bolus TOF – Time of Flight Technik SP3 Test Bolus PCA – Phasen-Kontrast Technik Concatenations Dynamische Angiographie NATIVE TrueFISP/SPACE TWIST Angiographie 6 QISS Store Profile Images v Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 14 Motion Management SIEMENS Healthineers Trigger - PACE etry System Physio Inline Sequence Phase Scout Select Acquisition Window Automatic Soort 98/194 Acquisition Window 35 % BO1 SPI -100 -40 rme Scout Type Phase Scout ACS Position Navigator Liver Dome Scout Phase Scout MIT Kontrastmittel OHNE Kontrastmittel MM Trigger Pulse 1 Care Bolus TOF – Time of Flight Technik Test Bolus PCA – Phasen-Kontrast Technik Concatenations Dynamische Angiographie 6 NATIVE TrueFISP/SPACE TWIST Angiographie QISS Free brear lig Store Profile Images v Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 15 Motion Management SIEMENS Healthineers Trigger – PACE – Phase Scout 101 SCONE 95-194 ACS ACS Automatically positioned in MM 21 7 the Liver -T -21 25% from center to the right of side the body in L-R Free tiezang In middle of the FOV in A-P MIT Kontrastmittel Above the middle of the FOV OHNE Kontrastmittel TOF – Time of Flight Technik Acceptpck in H-F PCA – Phasen-Kontrast Technik -19 ACS NATIVE TrueFISP/SPACE QISS 22 15 Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 16 Motion Management SIEMENS Healthineers Trigger - PACE Liver Dome Scout vs. Phase Scout If navigator positioning is not a problem the "liver dome scout" usually results in shorter scan - Phase scout less reliable than liver-dome scout, but liver-dome scout may be out of FOV Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 17 Motion Management SIEMENS Healthineers Trigger MR acquisitions in the abdomen can also be triggered to the respiratory (4) cycle Triggering can be realized by: (5) Internal trigger using 2D PACE with a "Liver Dome Scout" or (5) "Phase Scout" BioMatrix Respiratory Sensors (with BM Spine or BM Body coils) External trigger using a respiratory belt or cushion Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 18 Motion Management SIEMENS Healthineers Trigger BioMatrix Sensor, H-field Induced RF current how does it work? Lungs Lungs A magnetic loop antenna is Exhaled Phase Q Lexh Inhaled Phase Q Linh Located beneath Pin Pr,ex PinTVP r,inh patient's torso h Reflected energy PT Pr is observed Prinh while breathing Prexh time Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 19 Motion Management SIEMENS Healthineers Trigger - extern MR acquisitions in the abdomen can (3) Respiratory Belt also be triggered to the respiratory cycle Triggering can be realized by: Internal trigger using 2D PACE with a "Liver Dome Scout" or "Phase Scout" BioMatrix Respiratory Sensor External trigger using a respiratory belt or cushion Respiratory Cushion with pressure hose SIEMENS Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 20 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung Ultra-fast pulse sequences (e.g. EPI, TrueFISP) Averaging PAT-Averaging BLADE Radial sampling (-> StarVIBE) Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 21 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung Ultra-fast (single-shot) 2D pulse sequences may acquire images rapidly enough to freeze bulk motion without breath holding or any additional special techniques HASTE, EPI, TrueFISP Example: CINE imaging of the small bowel peristalsis during free breathing Coronal TrueFISP CINE, Slice 1, Coronal TrueFISP CINE, Slice 2, with ~400ms per slice with ~400ms per slice Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 22 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung Averaging Will reduce artifacts and increase signal-to-noise but at TSE, 1 Avg. TSE, 2 Avg. TSE, 4 Avg. expense of increased imaging time With averages, the k-space data is acquired several times assuming the motion pattern will be different during the separate scans With averages, the motion artifacts can be "smeared out" "Long term" averaging to reduce "slow" motion effects Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 23 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung PAT Averaging for TSE Parallel acquisition strategy Free breathing for motion artifact removal (no change in scan time, Less artifacts) Advantages: Effective Averaging makes routine applications more robust No extra time needed for calibration, data sub-sets "calibrate each other" standard reconstruction PAT Averaging Identical scan time if 1 Avg ., iPAT=1 3 Avg ., iPAT=3 PAT factor = # Avg. Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 24 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung BLADE (-> PROPELLER) BLADE continuously acquires low resolution data sets during motion Each BLADE is a "single-shot" TSE acquisition (Turbo factor = 1x blade) The blades are rotated around the center of k- space by a certain angle The process continues until imaging data from the entire k-space circle has been collected The center of k-space, where we are most sensitive to motion effects, is highly oversampled Motion artifacts are "averaged" or "smeared" out, SNR is increased Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 25 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung StarVIBE 3D pulse sequence based on VIBE Contrast is identical to conv. VIBE Cartesian sampling, i.e. phase encoding in partition direction Radial sampling in each partition, i.e. no phase encoding, only readout Stack of stars acquisition Prior to reconstruction re-gridding on Cartesian grid Because of radial trajectory, no iPAT Compatible with Quick FatSat / SPAIR and Dixon KZ Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 26 Motion Management SIEMENS Healthineers Reduktion der Empfindlichkeit auf Bewegung GRASP VIBE*: Golden angle RAdial Sparse Parallel Continuous Radial Scan Free breathing Radial Sampling with golden time angles Sparse sampling and iterative **** * reconstruction (-> Compressed Sensing ) Self-Gating Pre contrast Arterial Portal-venous Delayed - Automatic bolus detection Phases with variable temporal resolution Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 27 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 28 Kontrastmittel SIEMENS Healthineers Relaxivity • Reduktion der T1 und T2 Relaxationszeit • interne Körperstrukturen werden sichtbar R • enthalten paramagnetische Stoffe 10 • Ermöglicht Differenzierung zwischen: 1.00 MF 1.00 • gutartigen und bösartigen Läsionen • verschiedenen bösartigen Läsionen unterschiedlichen Malignitäten von Läsionen Ohne Kontrastmittel Mit Kontrastmittel • Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 29 Kontrastmittel SIEMENS Healthineers Relaxivity Relaxivity T1 effect T2 effect • Reduktion der T1 und T2 Relaxationszeit Describes how the relaxation rates SI of a solution change as a function of with Gd • interne Körperstrukturen werden sichtbar concentration [C]: • enthalten paramagnetische Stoffe without Gd 1/T1observed = 1/T1native + r1 C • Ermöglicht Differenzierung zwischen: 1/T2observed = 1/T2native + r2 C • gutartigen und bösartigen Läsionen verschiedenen bösartigen Läsionen without Gd Relaxivity depends on the • • unterschiedlichen Malignitäten von Läsionen temperature, field strength, and Ohne Kontrastmittel Mit Kontrastmittel substance in which the CA is • Einfache Dosis für Angiographien ausreichend dissolved. with Gd - In clinical use: r1 and r2 for 1.5T in plasma at body temp. (37ºC) Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 30 Kontrastmittel SIEMENS Healthineers Relaxivity Relaxivity Shortening effect on T1 and T2 • Reduktion der T1 und T2 Relaxationszeit Describes how the relaxation rates Example for the Liver: T1 ~ 600 ms, T2 ~ 50 ms, CA is of a solution change as a function of concentrated by 0.1 mmol/l, r1= 5l/(mmol*s), r2= 6l/(mmol*s) • interne Körperstrukturen werden sichtbar concentration [C]: • enthalten paramagnetische Stoffe 1/T1observed = 1/T1native + r1 C T1observed = 1 / (1 / 0.6s + 0.1mmol/l * 5 L/ (mmol ** s)) = (1 / 2,17)s • Ermöglicht Differenzierung zwischen: 1/T2observed = 1/T2native + r2 C = 461 ms >23% reduction • gutartigen und bösartigen Läsionen • verschiedenen bösartigen Läsionen Relaxivity depends on the unterschiedlichen Malignitäten von Läsionen temperature, field strength, and 7 T2observed = 1 / (1 / 0.05s + 0.1mmol/L * 6 L/(mmol*s)) • Ohne Kontrastmittel Mit Kontrastmittel substance in which the CA is = (1 / 20,60)s Einfache Dosis für Angiographien ausreichend = 48.5 ms -> 3% reduction • dissolved. - In clinical use: r1 and r2 for 1.5T in plasma at body temp. (37ºC) Shortening effect depends on the baseline value, the larger the initial value, the stronger the effect (T1>>T2) Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 31 Kontrastmittel SIEMENS Healthineers Relaxivity Relaxivity Shortening effect on T1 between 1.5T and 3.0T • Reduktion der T1 und T2 Relaxationszeit Describes how the relaxation rates Example for the Liver: T11,5T~600 ms, T13T~800 ms, CA is con- of a solution change as a function of centrated by 0.1 mmol/L, r11.5T= 5l/(mmol*s), [13]= 4.8l/(mmol*s) • interne Körperstrukturen werden sichtbar concentration [C]: enthalten paramagnetische Stoffe 1/T1observed = 1/T1native + r1-C T1observed = 1 / (1 / 0.6s + 0.1mmol/L * 5 l/(mmol ** s)) • = (1 / 2,17)s 1.5T • Ermöglicht Differenzierung zwischen: 1/T2observed = 1/T2native + r2*C = 461 ms >23% reduction • gutartigen und bösartigen Läsionen Relaxivity depends on the • verschiedenen bösartigen Läsionen • unterschiedlichen Malignitäten von Läsionen temperature, field strength, and T1observed = 1 / (1 / 0.8s + 0.1mmol/L * 4.8 L/(mmol*s)) Ohne Kontrastmittel Mit Kontrastmittel substance in which the CA is = (1 / 1,73)s 3.0₸ • Einfache Dosis für Angiographien ausreichend dissolved. = 578 ms > 28% reduction -> In clinical use: r1 and r2 for 1.5T in plasma at body temp. (37ºC) Shortening effect is higher at 3T even that the relaxivity of the CAs is slightly reduced. Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 32 Kontrastmittel SIEMENS Healthineers Relaxivity The dose efficacy principle is not After a certain concentration • Linear Reduktion der T1 und T2 Relaxationszeit 1,2 the T2 effect is dominant In routine MR imaging, the mild interne Körperstrukturen werden sichtbar 1,0 • T2-shortening effects of low T1-effect doses of Gd are usually enhances SI • enthalten paramagnetische Stoffe 0,8 overwhelmed by the more dominant T1-shortening effects • Ermöglicht Differenzierung zwischen: 0,6 T2 Relaxivity gutartigen und bösartigen Läsionen However, as the concentration T1 Relaxivity • • verschiedenen bösartigen Läsionen 0,4 T1/T2 of Gd increases, signal intensity • unterschiedlichen Malignitäten von Läsionen will eventually begin to fall Ohne Kontrastmittel Mit Kontrastmittel The Gd concentration beyond Einfache Dosis für Angiographien ausreichend 0,2 • which signal falls depends on T2-effect the particular tissue and pulse reduces SI O 0,0001 0,001 0,01 0,1 1,0 10 100 1000 sequence parameters selected concentration [mM] Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 33 Kontrastmittel SIEMENS Healthineers schematic transversal T1-w schematic transversal T2-w Image of the bladder post CA Image of the bladder post CA SI Courtesy of SeungTae Woo, Ph.D.; JooHyun Kim Ph.D.; Bayer Health ( > Too high concentrations will cause signal loss! CA conc. CA conc. Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 34 Kontrastmittel SIEMENS Healthineers Pharmakokinetik Brand Name • Reduktion der T1 und T2 Relaxationszeit Most of the MR contrast agents follow a Protein- Elimination Elimination two compartment profile with: binding Half-Life [hr] • interne Körperstrukturen werden sichtbar no 1.6 Early vascular phase (> first-pass) Magnevist Kidney enthalten paramagnetische Stoffe Gadovist no Kidney 1.8 • Diffusion from the vascular space into the ProHance no Kidney 1.6 extravascular extracellular space (EES) • Ermöglicht Differenzierung zwischen: MultiHance <5% Kidney (>96%), gutartigen und bösartigen Läsionen 1.6 • After 2.5 to 5 minutes balanced Liver (<4%) • verschiedenen bösartigen Läsionen concentration between intravascular and unterschiedlichen Malignitäten von Läsionen Dotarem no Kidney 1.6 • extravascular space *,** Ohne Kontrastmittel Omniscan no Kidney Mit Kontrastmittel 1.3 Elimination via renal excretion with passive OptiMARK no Kidney 1.7 glomerular filtration (for some CAS, elimination partly via the liver) Primovist / <15% Kidney (~50%), 0.9 Eovist Liver (~50%) Excretion after 24 h > 95% ** Ablavar >85% Kidney (>91%) 16.3 Liver (<9%) "not valid for the brain with intact blood-brain-barrier, different for Ablavar due to protein binding Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 35 Kontrastmittel SIEMENS Healthineers Pharmakokinetik • Reduktion der T1 und T2 Relaxationszeit Intravenous MR contrast agents can be The two currently commercial available HSA divided into extracellular (ECA) and are: • interne Körperstrukturen werden sichtbar hepatocyte-specific agents (HSA) Primovist / Eovist (gadoxetic acid, Bayer • enthalten paramagnetische Stoffe ECA equilibrate with the extracellular Health-Care Pharmaceuticals) fluid space after intravenous injection and MultiHance (gadobenate dimeglumine, • Ermöglicht Differenzierung zwischen: are excreted by glomerular filtration gutartigen und bösartigen Läsionen Bracco) • HSA show some degree of biliary • verschiedenen bösartigen Läsionen excretion, allowing a late hepatobiliary With Primovist / Eovist, 50% of the dose is unterschiedlichen Malignitäten von Läsionen phase acquisition taken up by hepatocytes and is eliminated by • Ohne Kontrastmittel Mit Kontrastmittel biliary excretion, compared to 3%-5% with Due to the action of known cellular MultiHance membrane transporters, only normal functioning hepatocytes take up HSA and > Hepatobiliary phase images are acquired 20- excrete them to the biliary tree 40 min after Primovist / Eovist injection, compared to 1.5-3 h after MultiHance injection. Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 36 Kontrastmittel SIEMENS Healthineers Leberspezifische Kontrastmittel • Reduktion der T1 und T2 Relaxationszeit Pitfall with Primovist/Eovist: Pre phase Arterial phase Portal Venous Delayed phase phase "Pseudo-washout" • interne Körperstrukturen werden sichtbar · Hemangiomas are described • enthalten paramagnetische Stoffe as hyper-vascular lesions with centripetal fill-in, sustained in • Ermöglicht Differenzierung zwischen: late dynamic post contrast • phases gutartigen und bösartigen Läsionen • verschiedenen bösartigen Läsionen With Primovist / Eovist, the • unterschiedlichen Malignitäten von Läsionen accumulation of contrast can Dynamic Liver Scan with Primovist/Eovist Ohne Kontrastmittel Hepatobiliary Mit Kontrastmittel phase be masked by the intense hepatic parenchymal enhancement, giving the "illusion" of washout of the hemangioma Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 37 Kontrastmittel SIEMENS Healthineers Leberspezifische Kontrastmittel • Reduktion der T1 und T2 Relaxationszeit Transient severe motion (TSM) Respiratory Motion Artifact with Primovist/Eovist (?) interne Körperstrukturen werden sichtbar Affecting Hepatic Arterial • · Transient arterial phase Phase Imaging with Gadoxetate Radiology • enthalten paramagnetische Stoffe respiratory motion-related artifact Disodium: Examination Recovery with a Multiple Arterial Phase • Ermöglicht Differenzierung zwischen: - "Recent work suggested that the Acquisiti Clinical Imaging 41 (2017) 23-27 gutartigen und bösartigen Läsionen Contents lists available at ScienceDirect image quality of the arterial phase • Jason A. Pietryga, MD • verschiedenen bösartigen Läsionen Clinical Imaging Lauren M. B. Burke, MD Purpose: in gadoxetate-enhanced liver MR Daniele Marin, MD unterschiedlichen Malignitäten von Läsionen Tracy A. Jaffe, MD ELSEVIER journal homepage: http://www.clinicalimaging.org • is more commonly deteriorated by Mustafa R. Bashir, MD Original Article Ohne Kontrastmittel Mit Kontrastmittel the TSM phenomenon than other Transient arterial phase respiratory motion-related artifact in MR imaging of the liver: an analysis of four different gadolinium-based CrossMark gadolinium-based contrast contrast agents *, xx Mansi R. Shah 1, Milana Flusberg *1, Viktoriya Paroder 1, Alla M. Rozenblit 1, Victoria Chernyak 1 agents" Department of Radiology, Montefiore Medical Center, 111 E 210th St. Bronx, NY. 10467 ARTICLE INFO ABSTRACT Article history: Purpose: The purpose was to compare hepatic arterial phase (HAP) respiratory motion artifact (RMA) between · The cause of this phenomenon Received 6 June 2016 gadoxetate. gadobutrol, gadopentetate, and gadobenate. Received in revised form 30 August 2016 Materials/methods: Two hundred cases of each gadolinium agent were included. RMA was assigned using Accepted 8 September 2016 5-point Likert scale (1=no motion, 5=extreme motion) on precontrast and HAP, RMA increase (increase 21 on remains unclear Keywords: HAP from precontrast) was the outcome in logistic regression. Respiratory motion artifact Results: Odds of RMA increase for gadoxetate were 5,5 (P<001), 3.6 (P= 034), and 9.5 (P<001) times higher Gadoxetate than gadobutrol, gadopentetate, and gadobenate, respectively. Gadolinium volume and dose were not indepen- Hepatic arterial phase dent predictors of RMA increase. Transient respiratory motion Conclusion: Gadoxetate has increased odds of RMA compared with other gadolinium agents: tight contrast bolus is not a contributor. Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 38 Kontrastmittel Hepatobiliary phase SIEMENS Healthineers Leberspezifische Kontrastmittel Protocol suggestions with Primovist / Eovist: Hepatobiliary phase To shorten the total Acquired ~20 minutes after injection of Primovist / Eovist or ~90 to 180 minutes after acquisition time it is injection of MultiHance recommended to run the dynamic workflow Hepatobiliary phase has the following at the beginning characteristics: followed by T2 and DWI Liver parenchyma is enhanced MRCP should be Liver arteries, portal vein and central veins Ohne Kontrastmittel performed prior to are hypo-intense contrast injection since Hepatocyte containing lesions are T2 time in bile ducts are enhanced (e.g. FNH, early HCC) shortened (biliary Lesions of other origin (i.e. metastasis) are excretion) hypo-intense Biliary tracts are enhanced 39 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 40 SIEMENS Healthineers Sequenztechniken RO 0 0 0 0 0 0 0 0 0 Centric 0 0 0 0 10 0 0 0 0 0 0 0 0 O O TI fill time O O 0 O O O 0 0 0 O 0 0 center of k-space O O O O O O 0 O O O O 0 0 O 0 0 O 0 0 0 Linear O O 0 O O 0 0 O O 0 O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O 0 0 0 SMART SIM PEZ 0 0 10 O 10 0 10 0 O 0 PEy 20-30% faster a, P2 a, 01 2 RF - 22 Gs QS GR DR GP PP MR opp-phase in-phase Echo Echo Kz 41 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 42 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte 25% of the blood supply of the liver is provided by oxygenated arterial blood from the common hepatic artery 75% (>1l/min) of the blood supply comes from the portal vein Consists of resorbed nutrients, metabolites, and hormones coming from the stomach, small O bowel, spleen and pancreas, respectively Arterial and portal vein blood compartments are mixed in the liver sinusoids, the capillary system of the liver Uptake, conversion and storage of oxygen, nutrients and waste products, elimination of metabolites Blood flows through and empties into the central vein 43 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase 44 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Pre contrast phase Pre contrast phase Should be acquired with same acquisition parameters as post-contrast imaging Used to determine intrinsic T1 intensity of observations relative to reference tissue such as liver and to gauge enhancement on post-contrast images Pre-contrast T1 water images are extremely important in lesion characterization Pre-contrast images may be subtracted from post-contrast images For observations that are hyper-intense pre-contrast, subtractions may help in the assessment of arterial phase enhancement 45 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Early Arterial phase Late Arterial phase Arterial phase Is the hepatic arterial phase Is a post-contrast injection time-range with the following characteristics: Hepatic artery and branches are fully enhanced Hepatic veins are not enhanced Sub classification in early and late arterial phase Early arterial phase: portal vein is not enhanced Late arterial phase: portal vein is enhanced 46 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte (Late) Arterial phase Late Arterial phase Typically, due to the limited time resolution we only measure the late arterial phase Most diagnostic information can be derived from the Late hepatic arterial phase, also called hepatic-arterial dominant phase The late hepatic arterial phase is strongly preferred for HCC diagnosis and staging The degree of enhancement in HCC is usually higher in the late than in the early hepatic arterial phase. Some HCCs may show hyper-enhancement only in the late hepatic arterial phase 47 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Portal Venous phase Portal venous phase Post-contrast injection time-range in which images have the following characteristics: Portal veins are fully and maximally enhanced Hepatic veins are enhanced Liver parenchyma usually is at peak enhancement Maximizes contrast between hypo- vascular lesions and the background liver, and can be used to evaluate the contrast washout pattern 48 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Delayed phase Delayed Phase Post-contrast acquired after portal venous phase with the following characteristics: Portal and hepatic veins are enhanced but less than in portal venous phase Liver parenchyma is enhanced but usually less than in portal venous phase Delayed phase usually should be acquired after around 3-5 minutes If used with hepatocyte-specific CAs usually referred to as transitional phase Helps to evaluate persistent enhancement in hemangiomas, washout in HCC, or delayed enhancement of fibrotic tissue or tumors 49 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase 2.50 2.00 -Artery 1.50 -* Portal Vein Vein 1.00 -Tissue 0.50 0.00 O 20 40 60 80 100 120 140 160 180 200 50 Dynamik SIEMENS Healthineers Physiologische und pathophysiologische Aspekte Focal Nodular Hepatocellular Hepatocellular Intrahepatic malignant Hemangioma Hyperplasia (FHN) Adenomas (HCA) Cyst Abscess Carcinoma (HCC) Cholangiocarcinoma (IHC) Metastasis FS T2 T1 GRE IP T1 GRE OP ........................................... FS T1 GRE AP O ...... FS T1 GRE PVP FS T1 GRE DP FS T1 GRE HBP Primovist - Hepato Biliari Phase SHS CS EDU APT AN1 3 51 1 from: Matos et al.; WJH, 2015; 7(16): 1987-2008 Dynamik SIEMENS Healthineers Timing der Phasen Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase Before Contrast Because of the temporal Center of k-space Center of k-space ~30 Center of k-space ~180 agent injection resolution usually no ~25 to 35 seconds seconds after center of seconds after center of early arterial phase is after contrast k-space of the arterial k-space of portal acquired. Most important injection. phase, i.e. ~60 to 65 venous phase (i.e. ~240 phase in liver dynamics is seconds after contrast to 245 seconds after the Late arterial phase! injection. contrast injection). 52 Dynamik SIEMENS Healthineers Timing der Phasen Pre phase Late Arterial phase Portal Venous phase Delayed phase Injection B VIBE B B VIBE B B VIBE H H H H B B VIBE B (~15 sec.) H (~15 sec.) (~15 sec.) H H (~15 sec.) H ~25-35 sec.+ ~30 sec. ~180 sec. 53 Dynamik SIEMENS Healthineers Timing der Phasen Most crucial phase for planning is the Different approached for timing: arterial phase Fixed timing is easy to apply, but does not take physiologic Timing must optimally catch the (Late) variations of the patient into account. Moreover, different "optimal" timings can be found in Literature arterial phase, where: Test Bolus and CARE Bolus take physiologic variations into the hepatic artery and branches are fully account, but still use a fixed time delay between Bolus enhanced detection and acquisition of the arterial phase the portal vein is enhanced This may also slightly vary depending on the patient situation (e.g. heart rate, cardiac output) Liver parenchyma is partly enhanced (<30%) Could be overcome by detection of the bolus more close to The hepatic veins are not enhanced the organ (e.g. at the celiac trunk), but requires more timing Different techniques for planning adaptions of the sequence (BH command, TTC) Optimal timing may still vary with different pathologies in Fixed timing the liver, e.g. fibrosis, cirrhosis Test bolus timing CARE Bolus timing 54 Dynamik SIEMENS Healthineers Timing der Phasen – multiarterielle Phasen Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase early mid Late A A A 55 Dynamik SIEMENS Healthineers Timing der Phasen – multiarterielle Phasen Parallel imaging with CAIPIRINHA View-sharing > TWIST How can that be applied TWIST view sharing scheme to the VIBE sequence? A B1 B2 B3 High temporal k-space A=central region B-region = periphery resolution for multiple time B1 B2 A B3 A B1 A B2 A B3 A measurements through measured: view-sharing reconstructed: M1 M2 M3 M4 M5 ... with TWIST Coils High PAT factors with = acquired not acquired CAIPIRINHA Fat water separation F/W separation with Dixon TE1 TE2 with Dixon RF RO ADC 56 Dynamik SIEMENS Healthineers Timing der Phasen – multiarterielle Phasen GRASP VIBE*: Conventional Golden angle RAdial Sparse Contrast Parallel Pre- contrast Arterial- Venous- Delayed- Free breathing phase phase phase Radial Sampling with golden scan scan scan scan angles ~ 30s Sparse sampling and iterative ~ 60s reconstruction (-> Compressed Sensing ) GRASP-VIBE Self-Gating Automatic bolus detection Continuous Radial Scan Phases with variable temporal resolution timo 57 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 58 Fett- und Eisenquantifizierung SIEMENS Healthineers Pathologie Cascade of Liver disease Cx (Liver failure) Steatosis and Hemochromatosis HCC are the earliest stages in the cascade of Liver disease and Cirrhosis Liver failure Inflammation / Necrosis Measuring the Fat and Iron content of the Liver is of high Fibrosis interest and diagnostic value Steatosis Haemochromatosis 59 Fett- und Eisenquantifizierung SIEMENS Healthineers Pathologie - Steatose Healthy Liver Fatty Liver Fatty Liver disease is one of the most common cause of chronic liver disease Leads to transplantation, HCC, and/or liver-related death Steatosis > accumulation of fat- containing vacuoles within hepatocytes Gold standard for Diagnosis is biopsy, but is invasive, suffers from sampling errors and is not appropriate for screening Need for a non-invasive method for detection and quantification of liver fat! 60 Fett- und Eisenquantifizierung SIEMENS Healthineers Due to different chemical environment, water water and fat have different resonance [H20] frequencies: - Chemical shift fat Effects on fat-water admixtures: [CH2] .................................................. "First-kind": fat-water misregistration in readout direction .......................................................................................... "Second-kind": phase interference effect 1.3 4.7 resonance or "Ink artifact" in GRE based sequences 3.4 ppm frequency [ppm] .............. ................ 61 Fett- und Eisenquantifizierung SIEMENS Healthineers S IF+W| exp (-t/T2*) In gradient echo imaging, the In phase - IF- WI exp (-t/T2*) - Resulting signal of a voxel containing fat & water different resonance frequencies of fat and water cause periodic phase In phase interferences Signal oscillations depending Opposed phase on TE If water and fat are "in-phase", Opposed; phase; their signals add constructively TE ms If water and fat are "opposed- phase", they cancel out each other Tissue 1, mainly water Tissue 2, mainly "Ink artefact" -> signal void in fat voxels containing equal amounts of water and fat 62 Fett- und Eisenquantifizierung SIEMENS Healthineers Dual Echo Dixon Using Dual-Echo GRE sequence, the fat percentage could be estimated: opposed-phase in-phase In = W + F, Out = W - F F = In -Out W = In+Out 2 2 BUT: Min/ivax: 191 /236 Min/Max: 155 /195 1 Mean/SD: 213.1 /10.4 1 Mean/SD: 174.9/9 1 Area: 3.32 sq.cm 1 Area: 3.32 sq.cm T2* relaxation effects between 1 Pixel: 172 1 Pixel: 172 opp- & in-phase echoes are not taken into account! Calculation is done on magnitude The opposed-phase echo has a higher SI (213 vs. 175) because of images -> fat-dominant voxels an increased iron content and, therefore, very short T2* relaxation cannot be distinguished from time! -> As a result, the fat percentage would be negative! water-dominant voxels 63 Fett- und Eisenquantifizierung SIEMENS Healthineers Multi Echo Dixon [LiverLAB] Based on multi-echo (3-12, S IF+W| exp (-t/T2*) In phase - IF- WI exp (-t/T2*) typ. 6 echoes) gradient echo - Resulting signal of a voxel containing fat & water sequence (VIBE) using hybrid multi-step adaptive In phase fitting and advanced Opposed phase correction algorithm Adv. Dixon reconstruction Opposed; phase; TE ms Fat fraction (fat signal percentage) and effective R2* Following assumptions are done: are reconstructed with single effective transverse relaxation value for all corrections for T2* effects spectral fat (F) components and water (W) . Low flip angle excitation (4º) to minimize T1 effects 64 Fett- und Eisenquantifizierung SIEMENS Healthineers Multi Echo Dixon [LiverLAB] Required settings: SIEMENS >> abdomen >> library >> 3D >> vibe_q-dixon_tra_p4_bh ? X General ¿ 12 sec Manual @ 1.4x1.4x3.5 mm 1.00 Dixon (dual-echo): Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Execution Common Dynamic Water Image Management SIEMENS >> abdomen > library > 3D >> vibe_q-dixon_tra_p4_bh ? X Auto Load General 8 12 sec Manual 04 @ 1.4x1.4x3.5 mm @ 1.00 Fat Copy References Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands (In-phase) Dynamic Liver Subtraction MIP Soft Tissue Composing Mapit Execution Image Management Liver Registration Dixon Evaluation · (Opposed-phase) Auto Load Liver Segmentation Fat Fraction Copy References Save Original Images V Water Fraction Y Dixon evaluation: T2* Fat fraction R2* Report v (Water fraction) (T2* (effective)) R2* (effective) Report OK Cancel 65 Fett- und Eisenquantifizierung SIEMENS Healthineers HISTO [LiverLAB] HISTO sequence High-Speed T2-corrected multiecho acquisition at 1H MR Spectroscopy single voxel spectroscopy TE TR TE, TR2 TES TR 5 timing-optimized concatenated TE, 12 TM TE, 12 TE, /2 TM TE, 12 TE3 /2 TM TES /2 STEAM modules (Stimulated Echo RF Acquisition Mode) x Gy Spoil Gradient- Two protocols available: Gz moderate iron load: Pineda N. et al. [6] TE = 12, 24, 36, 48, 72 ms high iron load: TE :72 TB TE = 12, 15, 18, 21, 24 ms TE.48 mg TR = 3000ms (optimal relax. & TA) TE-35 ms 1024 points at BW = 1200 Hz/Pix TE : 24 ms Voxel 3 x 3 x 3 cm TE - 12 m 7.50 5 2.50 2.50 -5 -7.50 O Frequency (ppm) 66 Fett- und Eisenquantifizierung SIEMENS Healthineers HISTO [LiverLAB] Planning of HISTO Guidance for HISTO evaluation HISTO is a spectroscopy Ö 15 sec | Manual 30 x30 x30 mm @ 1.00 technique, therefore, does not Guidance Parameters allow to plan on distortion corrected images! For adequate planning in N4 software, select one 3D series O (e.g. e-dixon water with segmentation), apply „Undo Distortion Correction", load ND series into 3D Card and calculate sagittal and Check voxel position and adapt if necessary. coronal MPRs for planning 67 Fett- und Eisenquantifizierung SIEMENS Healthineers HISTO [LiverLAB] Output: test 21.05.2014 Hospt test 21.05.2014 Hospital test_21.05.2014 Hospital 111 Aera 111 111 "2/18/1942, M, 72YHISTO MR E11 2/18/1913 :24) TE = 12 ms Aera *2/18/1942, M, 72Y Aera STUDY 1 S STUDY 1 MR E11 STUDY 1 MR E11 21 IMA 1/3 21 IMA 2/3 Voxel 21 IMA 3 75.0 Fat percentage (%) 10.79 % (C195: 9.61 to 11.96) 50.0 R2 water 30.15 s-1 (rsq = 1.00) Water Sig. Lipid Sig Lipid Percont 25.0 T2 Corrected 1.66e+07 0% Fat signal percentage 60% 1.37e+08 10.79 TE = 12 9.76e+07 1.45e+07 12.91 value rsq. ft TE = 24 6.66e+07 9.49e+06 12.47 Voxel 10,8% 0.0- Chem. Shift(ppm) 0.97 TE = 36 4.60e+07 7.43e+06 13.91 -0.0 9. 14 TE = 48 3.14e+07 5.63e+06 15.22 Voxel 100.0 TE = 72 1.60e+07 4.00e+06 19.98 R2 (S-1) 30.15 20.89 75.0 R-square fit 1.00 0.97 10:-1 R2 water 30%-1 35:-1 455-1 60:-1 50.0 value reg. fit Voxel 30.15-1 1.00 25.0 0.0 TT TT TT TTT TTT T ] TE (ms) 0.0 25.0 50.0 75.0 100.0 MF 1.00 MF 1.00 MF 1.00 512'512 1024.1024 1024*1024 HSTO_reports Colorbar_Report HISTO_reports Fat_Percentage_Results_2 SC HISTO_reports Fat_Percentage_Results_1 NE Report containing average fat fraction Spectra for shortest echo time (TE=12 Table with 'Fat fraction' and 'R2 water', and 'R2 water' within voxel ms) and fitted curves for fat and water the quality of fit and the individual as text and color bar signal (for quality control) echo values for water and Lipid signals 68 Fett- und Eisenquantifizierung SIEMENS Healthineers LiverLAB Voxel ROI test 21.05.2014 Hospital test 21.05.2014 Hospital 111 Aera 111 Aera 2/18/1942, M. 72YHISTO MR E11 *2/18/1942, M, 72Y MR E11 STUDY 1 HES STUDY 1 Liver Evaluation HFS voxels mean fit error 21 MA 1/3 Voxel 14 IMA 1 /2 ROI 40 1.1% Segmentation Volume 58064 2.3% Segmentation ROI A 0% Fat signal percentage 60% value rsq. ft Voxel 10.8% 0.97 0% Fat signal percentage 60% Voxcel mean std ROI 9.7% 1.2% Segmentation Volume 9.4% 7.9% ROI Segmentation 103-1 R2 water 30%-1 455-1 60:-1 value rsq. fit Voxel 30.15-1 1.00 Os^-1 R2* 400s^-1 mean std ROI 37.55^-1 3.85^-1 MF 1.00 512'512 MF 1.00 Segmentation Volwine 37.85^-1 13.25^-1 512*512 HSTO_reports Colorbar_Report p4 vibe_q-dixon_ra ph_Report remember: R2 water < effective R2* 69 Fett- und Eisenquantifizierung SIEMENS Healthineers MR Quantif UNIVERSITÉ DE RENNES 1 MRQuantif imagemed.univ-rennes1.fr/en/mrquantif/about#mrquantif_collapse Informations Main MRI parameters Overview Coil Body (autoselection off) Sequence GRE Options No fat saturation Users TR (msec) 120 (to reduce T1 contrast) TE (msec) multiple of 1.2 MRI protocols FA (0) 20 (to reduce T1 contrast) Bandwith Adapt it to get the correct TEs N excitations 1 Download Plane Axial N slices Max allowed (could depend on the number of TEs ... ) ? User guide Thickness 7 or 8 mm Gap Could be large (10mm) if you have a small number of slice Matrix Asymetric to reduce acquisition time, ex: 128x116 PACS integration Phase Anterior-Posterior FOV (cm) 40 Aq. time (sec) about 15 * Mode serveur Translation Important ! The body coil is the coil integrated in the wall of the tunnel and not the multi-channels coil placed manually around the patient. Validation 70 Agenda SIEMENS Healthineers No patient registered Body 18 Spine 48 R8 • Motion Management Breath-hold Trigger Reduktion der Empfindlichkeit auf Bewegung • Kontrastmittel Relaxivity • Sequenztechniken HASTE • Fett- u. Eisenquantifizierung TSE Zwei-Punkt DIXON VIBE Multiecho DIXON DIFF Spektroskopie (HISTO) TWIST VIBE MR Quantif GRASP VIBE • Software Unterstützung • Dynamik Abdomen DOT Engine Klinischer Hintergrund Physiologische und pathophysiologische Aspekte Timing Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 71 Software Unterstützung SIEMENS Healthineers MyExamAssist Abdomen/ Abdomen DOTEngine Select a suitable examination strategy General Parameters Breath-Hold Parameters Exam Strategy Breath-hold Breath-Hold Capability 20 + S Activate automatic functionalities Protocol Adaptation BH + AutoCoverage Auto Breath-Hold Commands English (United ... Auto Bolus Detection v Pause Between Breath-Holds 10 + s Adapt breath-hold capability to patient's Auto ROI v need Liver evaluation yes contrast agent with contrast agent Evaluation Method HISTO Decide if contrast will be given or not The pending protocols in the measurement queue will be updated on selection 72 Software Unterstützung SIEMENS Healthineers MyExamAssist Abdomen/ Abdomen DOTEngine None No automatic adaptations General Parameters Breath-Hold Parameters Auto Coverage Automatic FOV-read, FOV-phase, slice coverage Exam Strategy Breath-hold Breath-Hold Capability 20 + s & initial positioning based on localiser data Protocol Adaptation BH + AutoCoverage Auto Breath-Hold Commands v. English (United ... Auto Bolus Detection None AutoCoverage Pause Between Breath-Holds 10 + s BH + Auto Coverage Auto ROI BH + AutoCoverage Automatic FOV-read, FOV-phase, slice coverage Liver evaluation yes & initial positioning based on localiser data contrast agent with contrast agent · Automatic protocol adaption to patients breath- Evaluation Method HISTO hold capability Auto Bolus Detection Automatic detection of the contrast bolus arrival in the region of interest & start of the arterial phase measurement 73 Software Unterstützung SIEMENS Healthineers MyExamAssist Abdomen/ Abdomen DOTEngine – Add-ins Abdomen Assist Abdomen Patient View SMART SIM Care Bolus Onco Auto Coverage Scout Auto Timing Abdomen Bolus Timing ABLE Auto Coverage 74 SIEMENS Healthineers Siemens Healthcare Diagnostics GmbH Kerstin Schnabl, BSc.MSc. SHS EMEA CEET AUT CS APP CT&MR kerstin.schnabl@siemens-healthineers.com Siemens Healthcare Diagnostics GmbH Siemensstraße 90 1210 Wien, Austria Kerstin Schnabl, BSc.MSc. | SHS AUT CS APP 75