MR_Syngo MR VE11 LiverLab脂肪定量的临床应用

SIEMENS Quality ID : HOOD0516200309676 Healthineers Effective date: 2020-03-20 MR Syngo LiverLab 脂肪定量的临床应用 https://www.siemens.com/pepconnect 西门子医疗系统有限公司 云端医学教育平台 The animation of the dot pulse can be optionally switched off on the master layout. Frei verwendbar Go to View > Slide Master 1 Unrestricted © Siemens Healthcare GmbH, 2019 After that go to Animations > Animations Pane. LiverLab简述 SIEMENS Healthineers LiverLab是西门子公司推出的肝脏分析软件包，包括多回波（Multi-echo）Dixon技术 和肝脏单体素波谱成像HISTO，序列自动勾画肝脏轮廓以及分析肝脏脂肪及铁含量，可以 定量化评估肝脏病变程度，对弥漫性或局灶性肝脏疾病均能进行直观、准确的定量。 STUDY 1 Liver Evaluation HFS STUDY 2100.0 TE = 12 ms MR E1 20 IMA 1 /2 voxels mean fit error 37 IMA 3 /43.0. ROI 34 1.9% Segmentation Volume 63167 3.0% 50.0 ROI Segmentation 25.0 0.0. Chem. Shift(ppm 0% Fat signal fraction 60% -4 7 S.I. (a.u.) -0.0 19.4 14.1 mean std 100.0. ROI 13.3% 3.9% Segmentation Volume 14.0% 9.5% 75.0 ROI Segmentation 50.0. 25.0 Os^-1 R2* 400s^-1 mean std 0.0 TE (ms) ROI 50.1s^-1 11.2s^-1 0.0 25.0 50.0 75.0 100.0 MF 1.00 Segmentation Volume 53.6s^-1 19.0s^-1 2 Unrestricted © Siemens Healthcare GmbH, 2019 双回波e-Dixon肝脏分割及预评估 SIEMENS Healthineers Dual-Ratio Metabolite Discrimination  E-dixon 基于双回波的vibe-dixon，单次屏气得到 Iron Discriminator Fat Discriminator in/oppo图像； 0.5- 0.4 DO 0.3 基于dixon-W自动勾画肝脏轮廓，统计轮廓内体素的 0.2 0.1 0.1 in/oppo以及F/W； 0.05 0.04 F/W ratio 0.05 Normal Threshold 0.03 0.04 - 根据统计结果自动提示是否使用q-dixon及Histo高级评 0.02 0.03 - o Steatosis Hepatis · Hepatic Iron Deposition 0.02 Combined Disease Normal Parenchyma 0.8 0.9 1 1.1 1.2 估； 0.01 0.1 0.2 0.3 0.4 0.5 2 3 4 5 10 in/opp ratio 敏感性96.7% 3 Unrestricted © Siemens Healthcare GmbH, 2019 多回波（Multi-echo）q-Dixon计算脂肪定量及T2* SIEMENS Healthineers Signal IF+WIexp(-t/T2*)  基于6个回波时间的Vibe序列； in phase 应用高级校正算法dixon重建； 使用T2*校正得到脂肪分数及有效R2*值 IF-WIexp(-t/T2*) apposed phase 0 2.3 4.6 6.9 …. TE [ms] 4 Unrestricted © Siemens Healthcare GmbH, 2019 肝脏波谱成像HISTO计算脂肪定量及T2 SIEMENS Healthineers T2 decay water TE-72 mm  使用多TE的单体素波谱扫描计算每个TE时刻 TE:48 ma' TE -30 . 水脂峰下面积，利用T2校正推算出TE=0时刻 E-24 m TE : 12 m T2 decay fat 水脂峰下面积，进而计算脂肪定量及T2； 7.50 2.50 0 -2.50 -7.50 Frequency (ppm) fit to equil. W level F  Fat fraction: FP=area of fat peak/(fat peak+water peak) 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 -1.0 Chemical Shift (ppm) 5 Unrestricted © Siemens Healthcare GmbH, 2019 LiverLab工作流程 SIEMENS Healthineers Liverlab E-dixon volume & Fat /iron segmentation deposition Q-dixon/Histo Inline report EXPLORER PROGRAM EDITOR Browse Import Export SIEMENS SIEMENS >> abdomen >> Abdomen Dot Engine >> Abdomen Dot Engine Liver Eval CB Edit Q yes head contrast agent c-spine with contrast agent t-spine 11 vibe e-dixon tra bh_pre 00:13 11_vibe_e-dixon_tra_t I-spine 3 ¢ ABLE whole-spine  第一步：两点法E-Dixon 评价是否存在可疑脂肪或者铁沉 › TimCT whole-spine Check precontrast 1 Generic Views neck soft tissue thorax Prepare injector heart 积； breast Care Bolus 01:16 abdomen 3 Care Bolus Abdomen Dot Engine 11 vibe dixon tra bh arterial 00: 13 Abdomen Dot Engine Liver Eval CB 3 ABLE Abdomen Dot Engine CB 11_vibe_dixon tra bh venous 00:13  第二步：使用多回波Dixon法进行成像，肝脏自动分割并 Abdomen Dot Engine TB 3 ABLE clinical libraries 12 haste cor thick slab bh 00:05 library library_Dot Generic Views 自动生成全肝及ROI局部的脂肪及铁含量信息，并以脂肪 pelvis female 12 trufi tra bh 00:19 pelvis male .() Generic Views shoulder 11 vibe_dixon tra_bh_delayed 00:13 elbow . 3 ABLE wrist 11 vibe dixon cor_bh_post 00:14 t1_vibe_dixon_cor_bh 百分数图及R2*/T2*数值显示； hand Generic Views 21 hip Evaluation knee yes ankle Evaluation  第三步：HISTO肝脏波谱成像，获得R2/T2定量结果。 whole body oncology whole body diffusion yes TimCT oncology Evaluation Method › angiography multi-echo Dixon HISTO angiography_ce vibe_q-dixon_tra_bh 00:13 HISTO 00:15 spectroscopy o Liver Quantification adjustments 2 Liver Quantification 3 TimCT Angiography CE 6 Pediatric 16 ch Head Unrestricted © Siemens Healthcare GmbH, 2019 LiverLab工作流程 e-Dixon protocol SIEMENS Healthineers General TA: 0:18 PM: ISO PAT: 4 Voxel size: 1.2x1.2×3.0mm Rel. SNR: 1.00 : fl Original echoes Protocol Parameters Resolution Physio Inline Sequence Water Voice Commands Routine Contrast Geometry System Common Dynamic Execution Fat v Image Management TR 6,80 ms Fat suppr. None In phase Auto Load TE 1 4 2,39 ms Opposed phase V Copy References Water suppr. None  激活报告以及 Preview Fat fraction 打开自动勾画 Debug Protocol TE 1: 2.39 ms Water fraction Debug ExamAddIn TE 2: 4.77 肝脏轮廓选项 ms Dixon V T2ª Dixon evaluation R2* Report Flip angle 10,0 deg Liver segmentation v Inline card Liver registration 7 Unrestricted © Siemens Healthcare GmbH, 2019 e-Dixon Output SIEMENS Healthineers In-phase,opp-phase,F(fat),W(water); 自动进行肝脏轮廓勾画并推荐ROI局部测量； 初步结论： 肝脏体积分割：分割容积**ml/体素数量/体素容积 e-Dixon结论：正常/脂肪肝/铁沉积/合并/不明， Liver Segmentation Dual-Ratio Dixon Discrimination 并给出进一步评估建议； Segmentation Volume: 1608 ml 生成报告页； Number of Voxels: 219571 Result: fat deposition Voxel Volume: 0.007 ml Recommendation: un liver evaluation * 选取的ROI会自动保留在后续评估中 8 Unrestricted © Siemens Healthcare GmbH, 2019 LiverLab工作流程 SIEMENS q-Dixon protocol Healthineers General TA: 0:18 PM: ISO PAT: 4 Voxel size: 1.2x1.2×3.0mm Rel. SNR: 1.00 : fl Protocol Parameters Original echoes Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Water Common Dynamic Execution Image Management TR 15,60 ms Fat suppr. None Fat Auto Load TE 1 2,38 In phase ms Copy References Water suppr. None Opposed phase Preview  激活需要 Debug Protocol TE 1: 2.38 ms 的图像显 Fat fraction Debug ExamAddIn TE 2: 4.76 ms TE 3: 示结果 7.15 ms TE 4: Dixon 9.53 ms Water fraction V TE 5: 11.91 ms Dixon evaluation TE 6: 14.29 ms T2* V Flip angle 4,0 deg R2* V Report 9 Unrestricted © Siemens Healthcare GmbH, 2019 q-Dixon Output SIEMENS Healthineers O O GAM_RATZ_CROMOXX) IOCE'BOS et 0 zleups / sulev yaso W A-592.E-toe PERE W 21.0 sleups I oulev yeso 脂肪分数图（Fat fraction） R2* map 水分数图（Water fraction） T2* map test_21.05.2014 Hospital 111 test_21.05.2014 test_21.05.2014 111 *2/18/1942, M, 72Y, Aera MR E11 Hospital 111 *2/18/1942, M, 72Y 2/18/1942, M, 72Y Liver Evaluation STUDY 1 Segmentation Volume Aera STUDY 1 MR E11 STUDY 1 5/21/2014 voxels mean fit error 11:47:05 AM 14 IMA 1 /2 ROI 40 1.1% 14 IMA 2 / 2 x1000 16 IMA 24 / 60 Segmentation Volume 58064 2.3% 17  坐标图方 Segmentation ROI  Inline生成ROI 13 19 及整个肝脏 式显示整  Goodness of voxels fit：评估分数 0% Fat signal percentage 60% % O mean std ROI 9.7% 0.0 25.0 50.0 75.0 100.0 个肝脏内 1 .2% Fat signal percentage Segmentation Volume 9.4% 7.9% x1000 脂肪及 值的准确程度 ROI Segmentation  脂肪及 30 100m R2*含量 （good <5%） 22 OS^-1 R2 * H FIJI R2*mean值 15 voxels R2 400s^-1 7 TP F7 mean std SP H15.7 SA 的相对体 ₩ 1080.0 SL 3.5i ROI 37.58^-1 3.8s^-1 及标准差 FoV 371*450 O MF 1.00 Segmentation Volume 37.85^-1 13.25^-1 208*320 | 512'512 MF 1.00 0.0 100.0 200.0 300.0 400.0 p4 p4 SC R2* 024*1024 BO1-3;SP2-4 Tra vibe_q-dixon_tra_bh_Report 素分布 f13d6 /6 5 vibe_q-dixon_tra_bh_Report W Gray value 1 equals 0.1% 708 307 10 Unrestricted © Siemens Healthcare GmbH, 2019 手动测量ROI内脂肪含量及R2*值 SIEMENS Healthineers Patiert Applications Transfer Edit View Image Tools Evaluation System Options Help VE11A training VEMAt Nning VE11A training '5/10/1951.F. 53Y VE11A training "5/2011 961, F. 53Y VRE11 STUDY 1/14.2015 +LPH HES E11A training Exam 4-01:52 PM 20 MA. 40172 23 Wx 40(72 Patient Browser Patient Applications Transfer Edit View Filter Evaluation Sort Options Help Viewing ? [26] vibe_q-dixon_tra_bh_F Filming [27] vibe_q-dixon_tra_bh_Report EP H-223.1 TA 190 EN DIRCKINDOF AT_FTLACTION SL 39 FOV 368'460 PA DECORUNO SL 202-3201 202-320 1 DO1-3:3P1-3 A [28] vibe_q-dixon_tra_bh_FP with contrast Tra Gay value 1 equis 0.1% with corteset 4306 74 Gray value 1 catuNs 0.1% YEHA training Tools | Image | View [29] vibe_q-dixon_tra_bh_GoodnessOfFit STUDY 1 1/14/2015 3D 4:01:52 PM Local Database VE 11A training abdomen Abdomer [30] vibe_q-dixon_tra_bh_R2s_Eff 30 MA: 40×72 Scheduler [31] vibe_q-dixon_tra_bh_T2s_Eff Ficomises à DVD-ROM [32] vibe_q-dixon tra bh WP DVD-R [33] HISTO Patient Eval Exam [34] HISTO_reports [35] vibe_q-dixon tra bh W TA 19.05 TP HOS HW 1032.0 SP 123.1 [36] vibe_q-dixon_tra_bh_F 54 DOIDNINDRZ-STAR MAP rov 360'400 A1 20243201 Tra [37] vibe_q-dixon_tra_bh_Report X 1/19/2015 8:39:02 AM [38] vibe_q-dixon_tra_bh_FP Patient name VE11A training  放置ROI Date of birth:5/20/1961 Patient ID VE 11A training Study description abdomen Abdomen Dot Engine Study dato 1/14/2015 Modality MR  Fat Fraction[%]=Mean 值/10 72 71 70 69 68 67 66 65 64 63 F85.4 F81.9 R2*[1/s]=Mean 值 F88.9 F78.4 F74.9 F714 F67.9 F64.4 F60.9 F57.4   Goodness of Fit[%]=Mean值/10 62 F53.9 61 60 :59 58 F39.9 57 56 55 54 F43.4 F36.4 F32.9 F25.9 53 F22.4 11 F50.4 F46.9 F29.4 Current Filter. Off Unrestricted © Siemens Healthcare GmbH, 2019 LiverLab工作流程 SIEMENS HISTO protocol Healthineers General TA: 0:15 PM: REF Vol: 30 x30 x30 mm Rel. SNR: 1.00 : histo Protocol Parameters Routine Contrast Resolution Geometry Voice Commands System Sequence Position Isocenter  Steam序列，使用5个回波时间； ... Execution Image Management Orientation Transversal  序列库中有两组序列供选用： Auto Load Rotation 0 deg  常规序列：TE=12，24，36，48， Copy References Vol R >> L 30 mm TR 3000 ms Preview Vol A >> P 30 mm TE 1 4 12 ms 72ms Vol F >> H 30 mm Averag TE 1: 12 ms  重度铁沉积：TE=12，15，18， TE 2 24 ms TE 3: 36 ms Fil TE 4: 48 21，24ms ms TE 5 72 ms Coil elements BO1,2;S ... 12 Unrestricted © Siemens Healthcare GmbH, 2019 SIEMENS Healthineers Histo Output test_21.05.2014 Hospital test_21.05.2014 Hospital test_21.05.2014 111 Aera 111 Hospital "2/18/1942, M. 72Y MR E11 *2/18/1942. TE = 12 ms Aera *2/18/1942, M, 72Y 111 Aera STUDY 1 HISTO HFS STUDY 1 MR E11 STUDY 1 MR E11 21 MA 1/3 Voxel 21 IMA 3 75.0 water 21 IMA 2 / 3 Fat percentage (%) 10.79 % (C195: 9.61 to 11.96) 50.0- R2 water 30.15 s-1 (rsq = 1.00) fat Fat signal percentage 25.0 . Water Sig. Lipid Sig. Lipid Percent 0% 60% T2 Corrected 1.37e+08 1.66e+07 10.79 TE = 12 9.76e+07 1.45e+07 12.91 value rsq. fit 0.0 Voxel 10,8% 0.97 Chem. Shift(ppm TE = 24 6.66e+07 9.49e+06 12.47 TE = 36 4.60e+07 7.43e+06 13.91 S.I.ta.u.) -0.0 9.4 14.1 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 .00 0.97 105-1 R2 water 305-1 355-1 455-1 603-1 50.0 value rsq. fit Voxel 30.1$-1 1.00 25.0 0.0 TE (ms) 0.0 25.0 50.0 75.0 100.0 MF 1.00 MF 1.00 512'512 1024*1024 MF 1.00 HISTO_reports Colorbar_Report HISTO_reports Fat_Percentage_Results_2 SC 1024*1024 HISTO_reports Fat_Percentage_Results_1  Report包含脂肪含量百分比  坐标图显示最短TE波谱及水脂  脂肪百分比/R2 water/R-Square fit及 及R2 water平均值 曲线 每个回波对应的具体数值 13 Unrestricted © Siemens Healthcare GmbH, 2019 LiverLab的临床应用 SIEMENS Healthineers Liverlab的临床应用越来越广泛，除了能应用于肝脏脂肪定量外，还能用于其它很多方面。 比如，在R2*图像上可测得肝脏铁含量，可对肝铁过载者进行早期诊断和治疗干预。脂肪定量 亦可帮助鉴别脂肪含量不丰富的肾血管平滑肌脂肪瘤和肾脏恶性肿瘤。椎体骨髓脂肪定量方面 也具有重大意义，椎体骨髓脂肪化与骨质疏松、椎间盘退化有密切相关性。白血病、多发性骨 髓瘤等血液系统恶性肿瘤侵犯骨髓时，骨髓内肿瘤细胞侵占脂肪组织空间，导致骨髓脂肪含量 下降。因此，骨髓脂肪定量有助于病情和疗效评估。骨质疏松症患者骨密度降低，骨含量低和 骨髓脂肪含量较高，骨折风险增加，因此骨髓脂肪定量也有助于骨质疏松程度和骨折风险评估。 除此之外，LiverLab利用HISTO与多回波Dixon技术联合定量的使用，在针对某些脑部、关节以 及肺部的铁沉积病变上也有大的应用价值，特别是在对一些遗传性血色病的诊断评估上，相信 LiverLab技术伴随着临床的需求也会有更加广泛的应用空间。 14 Unrestricted © Siemens Healthcare GmbH, 2019 Disclaimer SIEMENS Healthineers 请注意，该资料仅供学习使用！ 为了正确使用软件或硬件，请务必使用由西门子医疗发行的《操作手册》或《使用说明》（以下统称为《操作手册》）。本材料仅学习参考使用，不能代替《操作手册》。 本培训中使用的材料可能未及时更新，并不一定反映软件和硬件最新版本。 操作手册应作为您的主要参考资料，特别是在涉及警告和注意事项之类的安全信息时。 注意：本资料中显示的某些功能为可选项，可能未包含在您的系统中。 某些产品，与产品相关的声明或者功能（以下统称为“功能”），可能尚未在您的国家/地区进行商业销售。 受监管要求所限，我们并不能保证所述功能将来能够向特定国家/ 地区提供。请联系当地的西门子医疗销售代表获取最新信息。 未经书面授权，不得复制、传播、分发该资料及其相关内容，违者将承担相关责任。 所有患者的姓名和数据、参数和配置相关的名称均为虚构，仅作示例使用。 所有权利，包括专利权或产品的注册、设计的权利，均予保留。 版权所有 © 西门子医疗系统有限公司 ………………………………………………………… Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens.com/healthineers 15 Unrestricted © Siemens Healthcare GmbH, 2019