syngo.via Ask-the-Experts: MR Tissue4D Workflow Job Aid

SIEMENS Healthineers Ask-the-Experts: syngo.via MR Tissue4D Post processing tips and techniques Template Effective Date: 27 MAY2019 | HOOD05162003010284 Template Effective Date: 27 MAY 2019 | HOOD05162003010284 Effective Date: 24 JUL 2020 | HOOD05162003006414 Effective Date: 24 JUL 2020 | HOOD05162003108218 Restricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 SIEMENS Healthineers Table of contents • Overview • syngo.Tissue4D– Routine Case • Background Information: Models • Deep Dive: • Data Requirements • Settings • Steps 2 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Disclaimer SIEMENS Healthineers This presentation and demo was prepared using AF Concentration Curve 0.50 Concentration syngo.via version VB40A. 10.40 0.30 0.20 Most of the features and principles explained p.10 0.00 150 Volume 266.57 cm3 75 225 Time(Sec) 300 during this session also apply for earlier Min / Max: 0.00 /657.00 Mean/SD: 187.94 /93.93 Ktrans 0.296 Kep 0.213 JAUC 0.202 Chi2 0.054 versions. AF AF AF R R MR Tissue4D requires an additional license and Rtrans Rep Ruc might not be available in every country. Please contact your SHS Sales Representative if you have questions regarding licenses. 3 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Overview of MR Tissue4D How do I use syngo.via’s MR Tissue4D in my clinical routine? 4 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 4 Overview SIEMENS Healthineers AF MR Tissue4D* workflow computes 0.50 Concentration Concentration Curve parametric maps, depicting contrast 0.40 0.30 enhancement or permeability from a 0.20 DCE acquisition. R 0.10 0.00 The generated maps can be analyzed on 0 75 150 225 Volume 266.57 cm3 Time(Sec) 300 Min / Max: 0.00 /657.00 dedicated layouts in MR Prostate. Mean/SD: 187.94 /93.93 Ktrans Kep Ve iAUC chi2 0.296 0.213 1.388 0.202 0.054 AF AF AF 0.744 5.94 2.08 R IR R Rtrans Rep * MR Tissue4D requires an additional license and might not be available in all countries. 5 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 syngo.MR Tissue4D – Routine Case SIEMENS Healthineers V 1. Select MR Tissue4D or MR Prostate workflow 2. Motion Correction Verify that the automatic MOCO provided accurate results. Adapt if L necessary. 3. Alignment V Verify the alignment between the morphology and pre-contrast series to the dynamic series. 6 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 syngo.MR Tissue4D – Routine Case SIEMENS Healthineers 4. Processing V • Visually inspect the concentration curve of the model and acquired data. • Verify the used protocol. • Verify that the contrast agent used for this patient is correct, as well as the injected volume and adapt if necessary. • Ensure that the Arrival Time is set correctly at the beginning of the enhancement. 5. Reading in MR Tissue4D Workflow To analyze the maps, click on the Reading Step of MR Tissue4D, where generated maps are displayed side-by-side, fused with the morphological image. 7 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 syngo.MR Tissue4D – Routine Case SIEMENS Healthineers 6. Reading in MR Prostate workflow V • If you are using the MR Prostate workflow to read the maps generated from MR Tissue4D, you can select the layout Morph & Diff & Dyn. • This layout automatically displays the morphology images, the diffusion and the maps, as well as a segment dedicated to the enhancement curve evaluation. 8 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models What is the difference between Qualitative model and Tofts model? 9 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Overview There are two types of maps calculated on MR Tissue4D workflow: • Qualitative model (Qualitative parametric maps) • Wash in • Wash out • Time to peak (TTP) • Arrival Time (AT) • Peak Enhancement Intensity (PEI) • Initial area under the curve (iAUC) • Tofts model (Quantitative parametric maps) • K trans • kep • ve • iAUC • chi2 10 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Overview O MRI Kinetic modeling modeling MRI Signal CA Quantitative intensity Concentration biomarkers (e.g. Ktrans) T1, Relaxivity… AIF... Qualitative maps, e.g. Quantitative maps, e.g. wash in Ktrans 11 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Qualititative The Qualitative model does not use any kinetic modeling, Concentration Curve it only uses an MRI modeling, in order to transform the 0.20 Concentration MRI signal into concentration values of CA. .10 It then displays the concentration curve for each voxel and fits the 3 tangent lines to the curve: • Baseline – time before contrast enhancement. 0.00 < ----- ............ ......... 0 150 225 Time (Sec) Show iAUC • Wash in-phase – enhancement in the tissue due Finding Legend W-In W-Out AT PEI TTP P1 0.57 -0.02 0.6 0.15 0.25 0.13 to contrast agent arrival. • Wash-out – end of wash-in until the end of the curve. 12 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Qualititative • Qualitative model Concentration Curve Arrival Time (AT) - point in time when contrast Concentration • 0.20 enhancement starts. O TTP • Wash in - slope of the fitted line between AT and end of PEI wash-in. AT • Wash out- slope of the fitted line between start of wash- 0.10 out and end of measurement. • Time to peak (TTP) - time from arrival time to end of wash-in. 0.00- Peak Enhancement Intensity (PEI) - value of concentration 75 150 225 300 • Time(Sec) when the contrast enhancement reaches the highest concentration. W-Ir W-Out TTP AT PEI ¡AUC 0.206 0.006 0.781 0.624 0.187 0.118 • Initial area under the curve (iAUC) - initial area under curve in 60 sec. 13 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Overview O MRI Kinetic modeling modeling MRI Signal CA Quantitative intensity Concentration biomarkers T1, Relaxivity… (e.g. K trans) AIF… Quantitative maps, e.g. Ktrans 14 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts • Tofts model (Quantitative parametric maps) AF • K trans – transfer constant of contrast agent (CA) between blood plasma and extravascular extracelular Space (EES). • Kep – reflux constant, depicting the transfer rate of CA returning to blood vessels. R • Ve – fractional volume of EES. • iAUC – initial Area under the curve (60 sec). • chi2 – degree of error of the fit. 15 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts MR Tissue4D workflow uses the standard Tofts model, which is a one compartment kinetic model, corresponding to the Bolus injection EES. extra- blood Extravascular cellular Plasma Extracellular space Cp(t) Ktrans Space (EES) The standard Tofts model assumes that the contrast agent (whole Ce(t) Ve body) Vp leaves the vessel and is equally dispersed on the EES with Renal Tissue C.(t) minimum redistribution to the vascular space. excretion .... After reaching an equilibrium, the CA is transferred back into the blood plasma and excreted, via the urinary tract. Source: Tofts, PS. MAGNETOM Flash ・ 3/2010 16 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Model Fit Bolus 0.15 injection Ktm=0.30 min- Ktm=0. 10 min -1 tram=0.03 min -11 blood 0.10 extra- Extravascular cellular Plasma Extracellular space Cp (t ) Ktrans Space (EES) (whole Ce(t] Ve Ct (mM) 0.05 body) Vp 0.25 Renal Tissue C(t) 0.00 0 2 0.20 4 6 V = 40 % excretion time / min - V = 20 % 0.15 V = 10 % Source: Tofts, PS. MAGNETOM Flash ・ 3/2010 0.10 Ct (mM) 0.05 Equation 1 (standard Tofts model): 0.00 2 4 8 10 SC (z)e (KTON /V.XI-T) dT time / min C,(t) = Ktrans [ Source: Tofts, PS. MAGNETOM Flash ・ 3/2010 0 17 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Model Fit Bolus During a model fit, the system uses known injection parameters like the concentration of CA in the blood tissue (Ct ), and on blood plasma (Cp ) and it extra- Extravascular estimates the unknown or free values, K . cellular Plasma Extracellular trans and Ve space Cp (t ) Ktrans Space (EES) (whole Ce (t) Ve After giving a value to K trans body) and Ve the resulting , Vp model curve will have a specific shape and height Renal Tissue C(t) that will be compared with the curve of the excretion acquired data. Source: Tofts, PS. MAGNETOM Flash ・ 3/2010 The system will keep estimating different values for the free parameters until it finds the value that Equation 1 (standard Tofts model): results in a curve that is the closest to the measured concentration curve. C,(t) = Ktrans [ SC (z)e (KTON /V.XI-T) dT 0 18 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Model Fit In MR Tissue4D, the model curve is seen Concentration Curve 0.40 Concentration in the straight line, the curve from the acquired data is seen as a dotted line. 0.30 0.20 The chi2 seen on the table, shows the quality of the fit. In other words, how 0.10 close the model curve is to the acquired curve. 0.00 ......... O 75 150 225 Time(Sec) 300 Ktrans Kep Ve iAUC 0.228 0.437 chi2 0.1 0.149 0.07 19 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts Due to the variability of the different kinetic models and implementation of such AF AF AF models 1.2 across different vendors, the absolute value of parameters like the K trans R R R can vary considerably. Other acquisition related factors like AF 0.20 ConcentrationConcentration Curve sequence, temporal resolution, contrast 0.372 12 agent, etc. also have an impact. 0.10 RA R ............ ........ Consequently, absolute K trans values should 0.00 75 150 225 Time(Sec) 300 Kiran be interpreted with great care. 20 Effective Date: 24 JUL 2020 | HOOD05162003108218 © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Unrestricted Models How is the AIF in Tissue4D calculated? 21 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Population Based AIF Subject Based The AIF is calculated from the image for each subject. It usually requires a high temporal resolution of the acquired dynamic sequence. Arterial Input Function (AIF): provides information Population Based about the CA delivery An average AIF has been previously calculated for a certain to the tissue. number of individuals. This averaged AIF is then applied to the acquired data. ... Tissue4D uses Population based AIFs. 22 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Population Based AIF There are 3 different population based AIFs you can choose from in MR Tissue4D: Slow Based on Weimann et al* 1 Intermediate The main difference Using a different AIF between these 3 Based on Parker et al will result in different AIF models is the shape of the AIF quantitative values e.g trans Fast for K . curves. Based on Orton et al ... * See the References at the end of this presentation for full citation 23 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Population Based AIF 0.554 0.754 R 0 Ktrans Ktrans O Slow AIF Intermediate AIF 24 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Models SIEMENS Healthineers Tofts – Population Based AIF Recommendations When Choosing an AIF Choose the AIF that results in a model curve that is the closest to the acquired data (generally this corresponds to the lowest chi2 ). When doing inter- or intra-subject comparisons, you should generally use the same AIF. 25 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Data Requirements Which series do I need for processing? 26 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 2 6 MR Tissue4D Data Requirements SIEMENS Healthineers Overview Measured T1 Pixelwise Constant T1 USER > Prostate > Tissue4D >> Measured T1 USER >> Prostate >> Tissue4D > Pixelwise USER >> Prostate >> Tissue4D >> Constant Morphology_ Morphology Morphology_ t2_tse_tra_p3_336 03:09 t2_tse_tra_p3_336 03:09 t2_tse_tra_p3_336 03:09 T1 mapping . T1 mapping Dynamic B1Map_for_T1mapping 00:08 t1_vibe_tra_flip_2deg 00:53 1 t1_vibe_tra_dyn 04:28 ª T1Map_vibe_tra 00:33 t1_vibe_tra_flip_15deg 00:53 1 t1_twist_tra_dyn 04:02 Dynamic Dynamic_ t1_vibe-twist_dixon_tra_dyn_p4 03:34 t1_vibe_tra_dyn 04:28 t1_vibe_tra_dyn 04:28 t1_twist_tra_dyn t1_grasp-vibe_fs_tra_192 05:02 t1_twist_tra_dyn 04:02 04:02 t1_vibe-twist_dixon_tra_dyn_p4 03:34 t1_vibe-twist_dixon_tra_dyn_p4 03:34 t1_grasp-vibe_fs_tra_192 05:02 t1_grasp-vibe_fs_tra_192 05:02 27 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers Dynamic Series • A dynamic series is mandatory. pelvis male >> library >> dynamic 1 VIBE dynamic • The dynamic series needs to be a Dynamic FLASH 3D variant. inject contrast after 2 measurements • A minimum of 8 slices and 6 phases are required. t1_vibe_tra_p4_dyn 04:44 • The first 5-6 phases need to be scanned without contrast agent TWIST dynamic (preferable) to bring the magnetization to a steady state (dummy scans). inject contrast after 5 measurements t1_twist_tra_p2_dyn 04:12 t1_vibe-twist_dixon_tra_dyn_p4 04:05 28 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers Dynamic Series • Examples for Siemens protocols Concentration Curve Concentration Curve Concentration Concentration 0.20 0.20 (amount of phases): • t1_vibe_tra_dyn (30-35 phases) 0.10 0.10 • t1_twist_tra_dyn (70-80 phases) • t1_vibe-twist_dixon_tra_dyn_p4 (80-100 phases) • t1_vibe-grasp_fs_tra (142-160 phases) 0.00 0.00 0 75 150 225 0 ime(Sec) 300 75 1 50 225 ime(Sec) 300 Ktrans Kep Ve iAUC chi2 Ktrans Kep Ve iAUC chi2 Hint: 0.058 0.304 0.19 0.072 0.016 0.062 0.421 0. 146 0.084 0.04 A dynamic series with non-equidistant phases can be used (available with GRASP) as Tissue4D uses the acquisition time and does not require constant delta time between phases. 29 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers Methods to Derive the Native T1 Values Calculated at the MRI Sent to syngo.via Protocol type: Measured T1 (Tofts model) Arterial Input Calculated in syngo.via MR Tissue4D 3 methods to obtain Function (AIF): the pre- contrast T1 provides information Requires at least 2 pre-contrast series with different flip angles values about the CA delivery Protocol Type: Pixelwise T1 (Tofts model) to the tissue. No Map is Available × Pre-contrast T1 is set as a constant value in MR Tissue4D Protocol type: Assumed T1 (Tofts) or Constant T1 (Qualitative) 30 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers T1 Map • A T1 Map series is mandatory for evaluation with ... >> pelvis male >> library >> dynamic Tofts model, Protocol Type Measured T1. t1_twist_tra_p2_dyn 04:12 • When the T1 Map series is scanned, it results in t1_vibe-twist_dixon_tra_dyn_p4 04:05 three series: body-array + endo Two pre-contrast flip angle series and one T1 Map - series. insert all protocols together into the q ... All three series are needed for Protocol Type - Measured T1. T1 mapping B1Map_for_T1_mapping 00:09 • It is recommended to scan the B1Map series directly 2 before the T1 Map series. T1Map_vibe_tra 00:50 It creates a map of the B1 field and improves the quality 2 of the resulting T1 Map. Hint: The MapIt license is required on the scanner. 31 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers Pre-Contrast Series • A pre-contrast series is mandatory for evaluation with TWIST dynamic (preferable). Tofts model, Protocol Type Pixelwise T1. inject contrast after 5 measurements • The pre-contrast series needs to be a t1_twist_tra_p2_dyn 04:12 Non-contrast FLASH 3D series with different flip angles. t1_vibe-twist_dixon_tra_dyn_p4 04:05 • A minimum are 2 different flip angles are required. T1 mapping for Tissue4D • Examples for Siemens protocols: t1_vibe_tra_flip_2deg 00:55 3 • T1_vibe_tra_flip_2deg 2ª t1_vibe_tra_flip_15deg 00:55 • T1_vibe_tra_flip_15deg 3 32 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers Pre-Contrast Series • The pre-contrast series may only differ in the flip angle. All TWIST dynamic (preferable) other scan parameters (orientation, TR, TE, amount of slices, …) must be the same. inject contrast after 5 measurements t1_twist_tra_p2_dyn 04:12 • From the pre-contrast series the application calculates a T1 map. This map is needed for the conversion of signal t1_vibe-twist_dixon_tra_dyn_p4 04:05 intensities into Gadolinium concentration values. T1 mapping for Tissue4D t1_vibe_tra_flip_2deg 00:55 3 t1 vibe tra_flip_15deg 00:55 3 33 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Data Requirements SIEMENS Healthineers Morphology Series • Morphology series are optional. Series S ... A Any series can be used, one series is sufficient. Series Description • 2 t2_tse_sag_p2_384_h_f A high-resolution T1- or T2-weighted image is useful to 3 t2_tse_cor_p3_320 compare the parametric maps with the anatomy. t2_tse_tra_p3_384 5 ep2d_diff_b50_400_800_tra_p2_TRACEW ep2d_diff_b50_400_800_tra_p2_ADC • The morphology series is registered to the reference phase 7 ep2d_diff_b50_400_800_tra_p2_CALC_BVAL of the dynamic series and can be used to place the Volume 8 t1_tse_tra_3mm of Interest (VOI) for the evaluation. 9 t1_vibe-grasp_fs_tra_dyn_STATIC 10 t1_vibe-grasp_fs_tra_dyn Hint: Even if the VOI is placed on the morphology series, the evaluation is done on the dynamic series. 34 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Settings How do I define the properties in order to get accurate maps? 35 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 3 5 MR Tissue4D Properties SIEMENS Healthineers Data Definition • Define which series should be used as Morphology, Pre- MR Tissue4D Properties ? X Contrast and Dynamic series and their color LUT in the Motion Correction and Alignment step. Data Definition Preprocessing Alignment Processing Parametric Map Morphology Pre-Contrast Dynamic Series Descriptions Series Descriptions Series Descriptions • Define all Series Description strings as detailed as possible. t2_tra PreContrast 11_vibe t2_tse_tra flip t1_twist dyn • An asterisk “*” can be used as wild card for any characters. At least one additional character has to be set. + - + Add + Remove Restore Add Remove Restore Add Remove Restore Lookup Table Lookup Table Lookup Table Hint: Hot Body Hot Body Hot Body The asterisk placeholder is helpful for DIXON series where each phase is stored in a separate series and Restore Restore Restore the user can use shorter strings. Example: ‘t1_vibe*_W’ for ‘t1_vibe-twist_dixon_tra_dyn_p4_TTC=8.8s_W’ OK Cancel 36 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Data Definition • Be sure to define the string in a way, that it cannot be MR Tissue4D Properties ? X mixed up with the dynamic series. Data Definition Preprocessing Alignment Processing Parametric Map • To reduce the pre-processing time add only the series Morphology Pre-Contrast Dynamic Series Descriptions Series Descriptions Series Descriptions description of the series that should be used as t2 tra PreContrast 11_vibe morphology. t2_tse_tra flip t1_twist dyn • Define the correct series description for pre-contrast series if you want to use Protocol Type Pixelwise or Measured T1. + - + - 15 Add + Remove Restore Add Remove Restore Add Remove Restore Lookup Table Lookup Table Lookup Table Hot Body Hot Body Hot Body Hint: Restore Restore Restore Do not define the Series Description of the T1 Map under Pre-Contrast. It is entered in the Processing tab. OK Cancel 37 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Data Definition • The dynamic series are mandatory. MR Tissue4D Properties ? X You must define a correct series description for the system Data Definition Preprocessing Alignment Processing Parametric Map • to identify the dynamic acquisition. Morphology Pre-Contrast Dynamic Series Descriptions Series Descriptions Series Descriptions t2_tra PreContrast t1_vibe • If the correct series are not identified, a message will be t2_tse_tra flip t1_twist dyn displayed: ‘No valid dynamic series is available in the application!’ + - + - Add + Remove Restore Add Remove Restore Add Remove Restore Lookup Table Lookup Table Lookup Table Hot Body Hot Body Hot Body Restore Restore Restore OK Cancel 38 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Data Definition Selection Rules for Multiple Dynamic Series: MR Tissue4D Properties ? X 1. Use the series with the string matching 100%. Data Definition Preprocessing Alignment Processing Parametric Map If no string matches Morphology Pre-Contrast Dynamic Series Descriptions Series Descriptions Series Descriptions 100% t2 tra PreContrast t1_vibe t2_tse_tra flip t1_twist dyn 2. Use the series with the maximum matching string. + - + - + If rule 1+2 apply to Add Remove Restore Add Remove Restore Add Remove Restore more than 1 series Lookup Table Lookup Table Lookup Table Hot Body Hot Body Hot Body 3. Use the series with the latest acquisition time. Restore Restore Restore If rule 1-3 apply to more than 1 series 4. The application will select in a non-deterministic manner. OK Cancel 39 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Preprocessing • Define if morphology and pre-contrast series must be MR Tissue4D Properties ? X elastically registered on the dynamic series and define if motion correction must be applied on the dynamic phases. Data Definition Preprocessing Alignment Processing Parametric Map Registration • For a standard prostate examination, the unregistered Restore Morphology on Dynamic Elastic morphology images are fully functional. As morphology Pre-Contrast on Dynamic Elastic images are not used for any model calculation, motion Dynamic Motion Correction does not affect the correctness of the model output. Pharmacokinetic Model Model Qualitative • It is recommended to perform registration for “Pre- Contrast on Dynamic” and motion correction within the Volume of Interest Restore dynamic phases. Type Ellipsoid Center x 50 Diameter x 50 % y 50 9 y 50 % Z 50 % Z 50 % OK Cancel 40 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Preprocessing • Define, which model you want to use for the creation of MR Tissue4D Properties ? X the parametric maps: Data Definition Preprocessing Alignment Processing Parametric Map • Qualitative model Registration Restore • Wash in Morphology on Dynamic Elastic • Wash out Pre-Contrast on Dynamic Elastic Time to peak (TTP) Dynamic Motion Correction • Arrival Time (AT) Pharmacokinetic Model • • Peak Enhancement Intensity (PEI) Model Qualitative • Initial area under the curve (iAUC) Volume of Interest Restore • Tofts model Type Ellipsoid • K trans Center x 50 Diameter x 50 % y 50 9 y 50 % • kep Z 50 % Z 50 % • ve • iAUC OK Cancel • chi2 41 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Preprocessing • Define the shape, size and position of the VOI. MR Tissue4D Properties ? X Preprocessing • If the Diameter/Dimension values for the VOI are set to Data Definition Alignment Processing Parametric Map ‘0’, no preprocessing will be performed at all. Registration 1 Restore Morphology on Dynamic Elastic Pre-Contrast on Dynamic Elastic Dynamic Motion Correction Pharmacokinetic Model Model Qualitative Hint: To disable the preprocessing, set ‘0’ for the Volume of Interest Restore Diameter/Dimension values. Type Ellipsoid Center x % Diameter x 50 % 50 % y 50 % Z 50 % Z 50 % OK Cancel 42 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Processing • Define a default contrast agent. MR Tissue4D Properties ? X Data Definition Processing • The values defined for the contrast agent are part of the Preprocessing Alignment Parametric Map user configuration. Contrast Agent Field Strength 0.0 ¢ To 0.0 + + Restore Magnevist(Default) Gadovist The user can add any value according to scientific Prohance 0 - 17 • Multihance Relaxivity 4 I/mmol/s publications or individual research activities. Dotarem Omniscan Molarity 0.5 mmol/ml Ontimark + Dose 0.1 mmol/kg Add Remove Set As Default Protocol . Qualitative Tofts Hint: Assumed T1 2000 ms Always inject the dose defined in the properties. Threshold 20 Restore If you want to apply different doses of the same contrast agent, create a new entry. OK Cancel 43 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers How Does syngo.via Determine the Contrast Agent Settings? Determine Determine Match Magnetic Field Strength Contrast Agent Magnetic Field Strength With Read from DICOM header. Read from DICOM header. Contrast Agent Compare with list in properties. and determine Exact match = select matching. Relaxivity No match = select default. Determine Determine Determine Molarity and Dose Patient Weight Contrast Volume Read from properties for Read from DICOM header. Read from DICOM header. selected contrast agent. If not available, calculate volume using Dose, Molarity and Patient Dose = (Volume * Molarity) / Patient Weight Weight. 44 44 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Processing • The threshold filters out low signal intensity and therefore MR Tissue4D Properties ? X noise is reduced. Data Definition Preprocessing Alignment Processing Parametric Map • It applies to the pixel values of the dynamic images and all Contrast Agent Restore models and protocol types. Magnevist(Default) Field Strength 0.0 To 0.0 + Gadovist Prohance 0 - 1 T Multihance Relaxivity I/mmol/s • The value can and should be configured site-specific if the Dotarem Omniscan Molarity 0.5 mmol/ml default value is not appropriate. Ontimark Dose 0.1 mmol/kg Add Remove Set As Default Protocol Qualitative Tofts Assumed T1 2000 ms Threshold 20 Restore OK Cancel 45 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Processing Protocol: Qualitative MR Tissue4D Properties ? X Data Definition Preprocessing Processing • Assumed T1 Alignment Parametric Map Define an appropriate native T1 value depending on Contrast Agent 15 Restore Magnevist(Default) Field Strength TO 0.0 + + the organ and the field strength. Gadovist Prohance 0 - 1T Multihance Relaxivity I/mmol/s Dotarem Omniscan Molarity 0.5 mmol/ml Ontimark Dose 0.1 mmol/kg Protocol: Tofts Protocol Qualitative . Tofts Add Remove Set As Default Protocol Type Measured T1 Protocol . Qualitative Tofts Measured T1 Series Description T1_image • Assumed T1 2000 ms Threshold 20 Define the Series Description of the T1 Map Threshold 20 Restore Recommended setting. Protocol Qualitative . Tofts Protocol Type Pixelwise T1 • Pixelwise T1 Threshold 20 OK Cancel Recommended, if Measured T1 not possible 46 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Processing MR Tissue4D Properties ? X Alignment Processing Data Definition Preprocessing Alignment Processing Parametric Map Recalculation is required Contrast Agent Magnevist(Default) Field Strength 0.0 ¢ To 0.0¢ + Restore Model Tofts Gadovist Prohance 0 - 1 T AIF Intermediate Multihance Relaxivity 4 I/mmol/s Dotarem Contrast Agent Dotarem Omniscan Molarity 0.5 mmol/ml Settings Ontimark Protocol Pixelwise T1 mmol/kg + Dose 0.1 Add Remove Set As LL Arrival Qualitative Tofts Time 36.62 sec Calculate Protocol Maps Assumed T1 2000 ms Threshold 20 Restore Hint: If a T1 map is not available (for measured T1) or not calculated (for pixelwise T1) the Tofts model in some occasions might default to a Constant T1 mode, using OK Cancel the Assumed T1 value or Qualitative mode. 47 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Properties SIEMENS Healthineers Different Body Parts ALH • MR Tissue4D can be used in different body parts. 0.196 • The settings of the workflow, including model calculation must be verified and likely adapted to each specific body part. RAH Hint: If you regularly use MR Tissue4D for different body parts, you Ktrans can copy the factory workflow and adapt its default settings to best match the acquisition for a different body part. 48 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Steps Which workflow steps are available and what should I do in each of these steps? 49 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 4 9 MR Tissue4D Workflow Steps SIEMENS Healthineers Motion Correction • In the Motion Correction step you should check the dynamic phases for motion artifacts that may have a MR Tissue4D negative impact on the MR Tissue4D analysis. MR Tissue4D Analysis Os • You can toggle between motion corrected and non motion corrected images and navigate through the phases. 1 Motion Correction • In the upper part of the layout, fused images are displayed Blending 0 100% where you can compare the reference phase to any available phase to evaluate motion. Set As Toggle Exclude Exclude Referen. Images Phase Rest All • Phases affected by motion can be excluded. Alignment • A new motion corrected series can be created by using Processing “Set As Reference”. Reading Viewing 50 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Workflow Steps SIEMENS Healthineers Alignment • In the Alignment step you can check the quality of the MR Tissue4D alignment of the morphology series and the pre-contrast series on the dynamic. Motion Correction Alignment • Toggle between registered and unregistered images and switch between different series using the drop down Morphology To Dynamic Morphology t2_tse_tra_01.5x01.5 ... menu. Blending 100% • A new registered series can be created by using the “Align” O Align Toggle buttons. Images Pre-contrast To Dynamic Hint: Flip Angle 10 When creating registered series manually, the alignment needs to Blending be done for each pre-contrast / Flip Angle series separately, by 0 100% selecting them from the drop down menu and clicking on ‘’Align’’. Align Toggle Images Processing 51 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Workflow Steps SIEMENS Healthineers Processing • In the Processing step it is recommended AF to verify the factors that have a direct Concentration Curve centratio 0.40 Col impact on the maps. 0.30 • Verify that the VOI is correctly adapted to the desired pathological area. You should 0.20 avoid including the bladder and large R vessels. D.10 0.00 • The interactive slider/bar on the graph Volume 168.66 cm3 75 150 225 Time(Sec) 300 ................. represents the end of the arrival time and Min / Max: 0.00 /593.00 Mean/SD: 182.95 /85.71 Ktrans Kep Ve iAUC chi2 beginning of contrast enhancement. 0.13 0.27 0.481 0.149 0.029 • Verify that the slider seen on the graph is positioned at the beginning of the curve enhancement and adapt if necessary. 52 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 MR Tissue4D Workflow Steps SIEMENS Healthineers Processing Concentration Curve Concentration Curve 0.40 Concentration 0.20 Concentration 0.30 0.20 0.10 0.10 Volume 1233.76 cm3 Min / Max: 0.00 /665.00 Volume 168.66 cm3 Mean/SD: 190.04 /108.90 Min / Max: 0.00 /593.00 Mean/SD: 182.95 /85.71 0.00 0.00 0 75 150 225 Time(Sec) 300 75 150 225 Time(Sec) 300 O Ktrans Kep Ve ¡AUC chi2 Ktrans Kep Ve iAUC chi2 0.13 0.27 0.481 0.149 0.029 0.083 0.385 0.216 0.05 0.013 Note the difference in maximum concentration on the graph, when the bladder is excluded from the VOI, as seen on the left image. Also take note of how AT slider is not correctly set in in the image on the right. You can reposition it by dragging the slider to the beginning of enhancement of the curve. 53 Effective Date: 24 JUL 2020 | HOOD05162003108218 © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 Unrestricted MR Tissue4D Workflow Steps SIEMENS Healthineers Processing Alignment • In the Processing step you should check the model being Processing used. Recalculation is required • If the Tofts model is used, check the chi2 in the table and perform a visual inspection of the model curve. Model Tofts AIF Intermediate • Adapt the AIF, if necessary. Contrast Agent Dotarem • Double check that the CA is set correctly and was not MR Tissue4D Processing Settings Settings ? X Pixelwise T1 changed at the acquisition. Contrast Agent Magnevist Field Strength 3T Gadovist Relaxivity 4.1 /mmol/s Prohance Calculate • Click on settings to verify the volume of CA used. Multihance Molarity 0.5 mmol/ml Dotarem Maps Omniscan Dose 0.09036145 mmol/kg Optimark Volume 15 ml • Click on ‘’Calculate Maps’’ if any changes were performed. Protocol Qualitative . Tofts Protocol Type Pixelwise T1 Threshold 20 OK Cancel 54 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Summary SIEMENS Healthineers In the table below, you can see a summary of the parameters that you can control and that impact the parametric maps. Assumed Pixelwise Measured Volume Type of Population AT VOI Threshold Patient Field (constant) T1 T1 of CA CA* based AIF weight strength T1 Protocol type Contrast Agent Processing Tofts model V V V Qualitative V X X V × * Different CA e.g. Gadovist, Dotarem etc. 55 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 List of Abbreviations SIEMENS Healthineers CA – Contrast Agent FOV – Field of View AIF – Arterial Input Function EES – Extracellular extravascular space AT – Arrival Time VOI – Volume of Interest TP – Time Point(s) 56 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Literary review SIEMENS Healthineers To learn more you can consult the following articles: 1. Tofts, P.F., T1-weighted DCE Imaging Concepts: Modelling, Acquisition and Analysis. MAGNETOM Flash · 3/2010. 2. Orton MR, d'Arcy JA, Walker-Samuel S, Hawkes DJ, Atkinson D, Collins DJ, Leach MO. Phys Med Biol. 2008 Mar 7;53(5):1225-39. Computationally efficient vascular input function models for quantitative kinetic modelling using DCE-MRI. 3. 3. Parker GJ, Roberts C, Macdonald A, Buonaccorsi GA, Cheung S, Buckley DL, Jackson A, Watson Y, Davies K, Jayson GC. Magn Reson Med. 2006 Nov;56(5):993-1000. Experimentally-derived functional form for a population-averaged hightemporal-resolution arterial input function for dynamic contrast-enhanced MRI. 4. 3. Weinmann H, Laniado M, Mutzel W. Physiol Chem Phys Med NMR. 1984 ;6(2):167-72. Pharmacokinetics of GdDTPA/dimeglumine after intravenous injection into healthy volunteers. 5. Rohrer, M, Bauer H, Mintorovitch J, Requart M, Weinmann HJ Invest Radiol 2005; 40: 715-724 Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. 57 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Acknowledgments SIEMENS Healthineers Image data courtesy of: Benson Radiology City West, Australia. 58 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Q&A MR Tissue4D • Biological Meaning of K trans • Standard Tofts and Extended Tofts Models • Population Based AIF and Subject Based AIF 59 Effective Date: 24 JUL 2020 | HOOD05162003108218 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Unrestricted © Siemens Healthineers, 2021 5 9 Tofts Model SIEMENS Healthineers What is the Biological Meaning of K trans? The biological meaning of K trans varies, depending on AF physiology of the tissue. On healthy tissue the leakage of CA into EES space is small, hence K trans reflects the permeability surface area product. In the particular vasculature of tumors, the capillaries walls R are very leaky and highly permeable. In this case, K trans is more reflective of the flow or perfusion of contrast agent. 60 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 What is the Difference Between Standard Tofts and Extended SIEMENS Healthineers Tofts Models? The extended Tofts model uses an extra compartment for the vascular space (vp) while the standard Tofts model considers the contribution of the vascular space to be small and thus it‘s ignored. We know that biologically in high vascularized regions like tumors the vascular space can provide a non-negligible contribution. However, the fitting process for this more complex model (that models 3 free parameters instead of 2 like the standard tofts) is also more complex and studies have found it to be less robust and reproducible. One studies e.g. found that the same patient scanned at different days under the same conditions had different results when using the extended TOFTS, while the standard tofts provided more reproducible results. In a clinical setting, it is extremely important have reproducible results. E.g. if you see changes after therapy, you need to be absolutely sure that the differences observed are due to changes in the biology of the tissue and not due to the fitting process. The standard Tofts is considered to provide better results in a clinical setting and is the model used in Tisue4D. Frontier our research does have the extended tofts model, as well as a dual input model, for liver examinations. 61 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Why use a Population Based AIF and not a Subject Based AIF? SIEMENS Healthineers One of the main constraints in using a subject based AIF calculated for each patient is that it requires a very high temporal resolution. This is the case for DSC scanning and is used in MR Neurology e.g. However, at DCE in a clinical setting usually a temporal resolution of about 5-8 sec is used. At this sort of temporal resolution it is not recommended to use a subjected based AIF. This is mainly because we cannot be sure to capture the correct peak and amplitude of the curve at such temporal resolutions. Another issue with body DCE is that the images area might not contain a vessel from which we can measure the input function, which would render the calculation of quantitative maps impossible. On the other hand, several publications have demonstrated that using a subject based AIF does not consistently provide more accurate results. Taking all these considerations into account the usage of populations based AIF is considered by our scientists to be the best approach for a clinical package like Tissue4D. 62 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021 Disclaimer SIEMENS Healthineers Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2021 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens.com/healthineers 63 Effective Date: 24 JUL 2020 | HOOD05162003108218 Unrestricted © Siemens Healthineers, 2021