updates mr imaging - university of...
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UPDATES MR IMAGING
ASSOC PROF DR NORLISAH MOHD RAMLI
DEPT OF BIOMEDICAL IMAGING
UNIVERSITY MALAYA MEDICAL CENTRE
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INTRODUCTION:
• Volumetric acquisition
• Angiography
• Artifacts– Magnetic subsceptibility effects
– Chemical shift artifacts
• Fusion
• Therapeutics
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The problem with MRIDETAILS vs TIME
• High spatial resolution– Slower
– Better resolution
– Needed in: Neuroimaging, all other imaging
• High temporal resolution– Faster
– Loss of resolution
– Needed in: Cardiac imaging, EPI (functional/ tractography), abdominal imaging due to bowel and breathing movements
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• Volumetric Fast Spin Echo acquisition for T2, T2 FLAIR and PD tissue contrasts
• Scan once and reformat the sub‐mm, isotropic dataset into any plane with no loss of resolution and no gaps
• Automated, no‐miss sequence, consistent image quality and shorter exam time
Reformat isotropic dataset into any plane
Volume rendering of
Cube T2 FLAIR
Volume rendering of Cube T2
Scan once – reformat into any plane with the same high resolution
HIGH SPATIAL RESOLUTION-Cube
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Reformatted 3D BRAVO datasets:
fMRI, pediatric anatomyBRAVO 3D volume rendering
3D isotropic sub-mm– reformat to any plane w. same resolution
• Volumetric FSPGR acquisition for superb T1w brain imaging
• Optimized contrast for brain tissue segmentation
• Reformat the sub‐mm, isotropic dataset into any plane with no loss of resolution
• Automated, no‐miss sequence, consistent image quality in short scan time
Volumetric with functional fusion- BRAVO
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DCE T1w imaging
Detail & speed in one scan… without compromise
Delivers the ability to capture high-resolution T1w morphology in a short breath-holdHigh spatial resolution…
For small detail and enhanced reformats
High temporal resolution…
For short breath-holds and multi-phase imaging
Fat-sat For enhanced conspicuity
AutoVoiceFor consistent patient instructions
256x2564mm/-2mm22 sec
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Small bowel imaging
LAVA, 418x288, 3.6mm, 20 sec
Body array with respiratory and bowels movement
Hi-definition… and hi-speed small bowel imaging
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Courtesy of ACI, New YorkAcute myocardial infarctionFGRE Time Course Imaging 2D Myocardial Delayed Enhancement Imaging
Complex exam made simple…powerfully simple
Stress Imaging at 1.5 TTechnical excellence for diagnostic confidence • GE exclusive notched RF pulse creates excellent CNR essential for good
time course studies.
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Courtesy of VA Hospital, Houston
Short Axis 2 chamber 4 chamber
Complex exam made routine…powerfully simple Complex exam made simple…powerfully simple
Functional Imaging at 1.5T FIESTA CINE imaging & Tagging• Robust steady state free precession (SSFP) imaging• Volume shimming provides robust image quality without artifacts• ASSET compatibility reduces breath-hold time
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63 year‐old male with Myocardial Infarction
Courtesy of ACI, New York
Fiesta 1.5TEx10800Ex11044
66 year‐old male with Myocardial Infarction
Complex exam made simple…powerfully simple
Viability Imaging at 1.5T 2D Myocardial Delayed Enhancement (MDE)• Adiabatic inversion recovery for homogenous myocardium suppression
and improved CNR between infarcted and normal myocardium
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Curved Reformat Volume RenderingAxial Images
Complex exam made simple…powerfully simple
Coronary Artery Imaging at 1.5T 3D Fat Suppressed FIESTA with Navigator Echo• Free breathing acquisition with improved navigator echo technique
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Courtesy of UWM, WisconsinCourtesy of VA Hospital, Houston Courtesy of Hartford Hospital, CT
Double Inversion Recovery (DIR) FSE Double Inversion Recovery with Fat Sat Triple Inversion Recovery (TIR)
Complex exam made simple…powerfully simple
Anatomy at 1.5T
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ANGIOGRAPHY
• Limited by slab coverage‐slab artifacts and time of examinations.
• Increase SAR.
• Decrease of signal in tortousity or reversal of flow in terms of directions
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Inhance 3D Velocity Inhance 2D Inflow
No compromise Non-Contrast MR Angiography
Non‐contrast MR Angiography•Inhance Application Suite• Non‐contrast MR angiography without compromise
• The first choice for NSF susceptible population
• Utilizing inherent contrast characteristics like flow and relaxation times to delineate vascular anatomy
• Consistency and reliability without contrast injection and reduced cost
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3D VelocityBrain MRA Applications
• Whole brain volumetric 3D acquisition in less than 5 min• Excellent background suppression for cerebral
arteries and veins visualization• T1 weighted contrast from the same acquisition for accurate correlation between vessels and anatomy
3T
3.0T
3.0T
No Miss NCE MRA –whole brain in 3D in less than 5 min
3D rendering with color-coded arterial and venous flow
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3D VelocityInhance 3D Velocity images capture this dural fistula and the network of typical corkscrew shaped supplying vessels in exquisite detail – in one rapid scan
3T
Multiphase TRICKS confirms the AVF and
provides blood filling dynamics information
3D TOF fails to depict the whole convoluted vasculature (sensitive to thru-plane flow only) and the pathology is obscured by some background tissue noise
Courtesy of UW Madison
Inhance 3D Velocity
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• Excellent background suppression with optimized pulse sequence design
• Respiratory Triggering compatible, allowing free breathing renal artery acquisition
Abdominal MRA Applications
3.0T3.0T
Inhance 3D Velocity
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Quick StepQuickest way to do a run off exam with
minimum user input
QuickStep 1st Station with TR = 2.2ms
• No Localizers – Landmark once at ankle• Automatic Skin to Skin coverage • Just select protocol based on patient size & scan• Fluoro Trigger contrast detection• Faster table (30cm/s) to capture arterial phase• Multi-Phase capability at 3rd station• Parallel Imaging (2D ARC) compatible
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Vascular MR TRICKS at 3T
Images Courtesy Edison Imaging.
AVM CALF
Combining high spatial with high temporal resolution at 3T
Bilateral Lower Legs Whole head coverage
For vessel filling dynamics use TRICKS
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AVM Brain Sagittal Sinus Imaging Bilateral Carotid Artery
ASSET accelerated
Vascular MR TRICKS at 3TSingle phase images from TRICKS-XV acquisitions showing superb spatial resolution
For smallest vessel detail use TRICKS
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ARTIFACTS
• Chemical shift artifact
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Consistent quality and uniformity
• Break‐through water‐fat separation technique
• One scan, four contrasts- Water Only
- Fat Only
- In Phase
- Out of Phase
IDEAL
No-fail water-fat separation…one scan , four contrasts
Fat In Phase Out of PhaseWater
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Water In Phase
Out of Phase Fat
Arterial
Portal
Angiomyolipoma
LAVA-Flex DCE T1w imaging
Scan ONCE... characterize tissue with multiple contrasts
Delivers the ability to generate up to 4 contrasts in one scan enabling the ability to characterize tissue with one scan1 scan… 4 contrasts…Tissue Characterization
Water, fat, in-phase, and out-of-phase that enable tissue characterization and problem solving
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LAVA-Flex DCE T1w imaging
320x192, 4mm/-2mm, 20 sec
Water-only… no fatHomogeneous fat suppression that succeeds where traditional fat sat may fail
1 scan… 4 contrasts…including…
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ARTIFACTS
• Susceptibility artifacts– Usually occurs near interfaces
of substance of different magnetic susceptibility
– Can be useful clinically and therefore use in gradient echo or sequence with long TE
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• Clearly delineate microbleeds & small veins• Visualize large vascular structures• Assess iron and calcium in the tissue
SUSCEPTIBILITY WEIGHTED IMAGING
Courtesy of LMU, Muenchen, GermanyMore SNR, More Contrast, Faster Scans
Microbleeds show much better on SWAN image (L) compared to GRE (R).
Developmental venous anomaly (DVM) clearly visible on SWAN (L) but not GRE (R).
“Good susceptibility weighting without susceptibiliy artifacts. It’s fast, easy and provides excellent image quality.”L. Tanenbaum, MD @ Mount Sinai, NY
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FUSION: Fusion of ADC/Diffusion, perfusion , CSI and anatomic map will assist in lesion detection
NEIeADC
Cr.+Cho.Citrate
FSE 4:20, 320x256 x 4mm
LAVA3 sec/phase 40 time points
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EchoPlus body diffusion FRFSE T2
DWI192x224B-value 40024 sec
Extend clinical utility with anatomical and functional imaging
192x224B-value 40024 sec
eADC overlay
LAVA-Flex
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MR-TouchAn extension of the age old
technique of diagnosing from touching
Shear waves generated in the tissue by an external acoustic driverImaging performed with multi-phase GRE with a modified cyclic Motion- Encoding Gradient (MEG)MEG gradient is synchronized with the external acoustic driverInversion algorithm generates wave images and stiffness map (Elastogram)
Wave Image Elastograms
Two subjects with differing relative stiffness
Active driver – sound waves
Passive driver –shear waves
Extend clinical utility with a new touch in MR imaging
Soft Hard Hard
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THERAPEUTICS
• MR guided focused ultrasound
• 4 role of MRI– Diagnostic tool
– Planning tool
– Monitoring tool
– Assessment tool
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Focused Ultrasound (FUS)
•The ExAblate 2000 system is a device that can target and ablate tissue without requiring surgical incision
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How Focused Ultrasound Works (con’t)
•Similar to how a magnifying glass focuses light energy, ultrasound can be focused on a specific point
TransducerEnergy
pass zone
Treated spot
Tumor
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Physiology of Thermal Therapy•Coagulated regions seen in macro pathology image
•Histology analysis shows a sharp demarcation between treated and non treated regionsMRgFUS treated liver (pig)
0.1 mm
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MRI• Magnetic Resonance Imaging (MRI) is a method used
to visualize the inside of living organisms.
• MRI uses non-ionizing, radio frequency signals to acquire images. MRI is best suited for soft (non-calcified) tissues.
• Medical MRI relies on the relaxation properties of excited hydrogen nuclei in water and fat.
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MR Imaging Anatomy
Breast
Tumor
Ribs Nerves
Pubic bone
Bladder
Fibroid
Uterus
T2W pelvic MR image
T1W+C breast MR image
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MR Guidance•Visualization of treatment plan before energy is delivered, identifies:
Surgical clips
Scar
Bowel
Nerves
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sonicating cooling
•Provides real‐time feedback during treatment, showing regions that have met thermal dose requirements
MR Thermometry
+ +++
+ +++
Perpendicular to beam path
Parallel to beam path
Temperature graph
6 sec 12 sec 18 sec 24 sec
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MRgFUS In Treatment Of Uterine Fibroids: Early UMMC Experience
• Abdullah BJJ, *Subramaniam RV, Mohd Ramli N, Yaakup NA, Vijayananthan, *Omar SW, +Wragg P, Wui Ai Leng, Lee Chin Chew
• Department of Biomedical Imaging & *Dept of Obstetrics & Gynaecology University of Malaya, Kuala Lumpur, Malaysia and +Insightec USA
•Introduced MRgFUS in UMMC in Feb. 2009•Treatment planning is done by radiographers
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Results
% of fibroids treated (19)
• Range 22‐100%
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CONCLUSION
• Recent advance in MRI has improve temporal and spatial resolution.
• In future this will create a TRUE merging of functional and anatomical imaging
• MRI also has an increasing role as a tool in therapeutics.