Professional Documents
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Signapulse2019spring DL
Signapulse2019spring DL
Pulse of MR
Spring 2019
ISMRM Edition
Volume Twenty-Six
Issue Spotlight
News 9 Development of an MR-only
radiation therapy workflow
In Practice
5 Leading the AI charge 15 Thirty-minute PET/MR exam 27 Transforming the MR imaging
for pediatric cancer patients experience for one of Sweden’s
5 Artful images largest pediatric hospitals
23 Whole-body diffusion for evaluation
5 Global MR market size to grow of metastatic lesions 32 AIR Technology™: a brilliant
improvement in high-quality
5 More comfortable prostate scans imaging and patient comfort
GE Contributors:
Nathalie Aubin Francois Ferrieres Taro Igarashi Troy Lewein Fraser Robb
Marketing Customer Success 3.0T Clinical Leader, MR Global Product Manager, RF Coils, MR
Communications Specialist Allyson L. Jacobsen Marketing Manager, Joleen Rodrigues
Leader, MR Europe Fabien Fortin Global Marketing 3.0T MR Imaging General
Chakib Bereksi-Reguig Product Sales Specialist, Director, Artificial James McMahon Manager, MR Africa
Advanced Applications MR Intelligence and Senior Director, Dimitri Roose
Specialist, MR Amanda Gintoft Analytics Platform Regulatory Affairs, MR Clinical Education
Isabelle Claude-Dufour Senior Communications Martin Janich Jonathan Meyer Specialist, MR
Clinical Leader, MR Manager Cardiac Applications Clinical Leader, MR Glen Sabin
Simon Dezonie Icham Gouadjelia Manager, MR Magnus Olsson Director, Regulatory
Zone Clinical Leader, MR Clinical Applications Yu Kaibara Imaging Modality Affairs, MR
Almos Elekes, PhD Leader, MR Product Marketing Manager, Nordic Region Sheila Washburn
Global Product Axel Hartwig Manager, MR Sabina Prato Digital Product Manager,
Marketing Manager, Segment Leader, MR Customer Success MR Intelligent Scanner
PET/MR, Oncology and Leader
Molecular MR
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News
While certain aspects of healthcare aren’t expected to feel the effects of artificial to grow
intelligence (AI) for some time, radiology is often cited as an area that will first
In January 2019, Technavio released
feel its impact. Dr. Mark Michalski, Executive Director of the MGH & BWH Center
their research report on the Global
for Clinical Data Science, recently weighed in on why he feels radiologists are
MRI Systems Market for the forecast
uniquely positioned to advance AI in an interview for GE Healthcare’s The Pulse
period 2019-2023. This market
news website. In the interview, Michalski stated that the most recent advances
analysis report segments the market
in machine learning—such as deep learning—work very well with image and
by product (closed MR systems and
video data, so radiology and other specialties that use image data (like pathology,
open MR systems) and geography
dermatology, ophthalmology, or radiation oncology and others) have been among
(the Americas, APAC, and EMEA).
the first impacted. Beyond this, radiology has a relatively well-structured set of
data, which is the foundation for building machine intelligence. Michalski also The report stated that the market size
noted that the radiology community already has made significant investments for global MR systems will grow by
in IT and tech infrastructure—it is generally familiar with high tech systems (like almost 1.58 billion USD during 2019-
scanners, integrations with EHRs, etc.), making adoption and integration of 2023, at a Compound Annual Growth
machine learning technologies perhaps easier. Rate of more than 5%. Body imaging
was cited as one of the fastest-growing
applications of MR.
Source: businesswire.com
More comfortable
prostate scans
Imaging the prostate is now a lot less
embarrassing and more comfortable
for patients. The clinicians at the Surp
Pırgiç Armenian Hospital in Istanbul,
Turkey, are using a new imaging
process on their 3.0T SIGNA™ Pioneer
system with Total Digital Imaging
(TDI) that eliminates the use of the
Artful images endorectal coil in MR prostate exams.
Dr. Denis Ducreux, a French radiologist, Professor of Neuroradiology at University The coil can be eliminated because of
of Paris-Sud, and Head of the Diagnostic Neuroradiology Department at Bicêtre the scanner’s dramatically high signal-
Hospital in France, has been creating artistic renderings from MR images for to-noise ratio results. In addition to
15 years. Since 2017, he’s been using the 3.0T SIGNA™ Architect to capture the making the exam more comfortable,
raw MR images. He then processes using BrainAnalyst, a research-use only the new process helps patients get in
neuroimaging software he developed that tracks fibers in the brain. and out of the scanner faster, creating
a boost in productivity.
Dr. Ducreux says all of his artistic images focus on the limbic system because
it is the center of the unconscious. Although he does not use the artistic images University Hospital Quirónsalud
for diagnostic purposes, he says studying the limbic system is critical to research in Madrid is pushing to new limits
to help understand how humans’ emotional processing works. by using Multiparametric Magnetic
Resonance (RMmp), an MR imaging
technique that allows them to non-
invasively study the prostate. This
exam helps detect the volume of a
tumor and can track the progression
SIGNA™ Pulse of MR surveyI of its development, a key element
in properly diagnosing and treating
What’s on your mind? The editors at SIGNA™ Pulse of MR the disease.
want to know. Help us improve the content of our magazine
by taking our survey at: http://tinyurl.com/sps191
fueled ViosWorks How does it work? AIRx™ features a pre-trained neural network model that
leverages deep learning algorithms and anatomy recognition to define the
Many of you have read about correct anatomical landmarks and automate the scanning process for routine
GE Healthcare’s groundbreaking MR to challenging setups. The algorithm automatically aligns the scan prescription
software solution, ViosWorks, that to anatomical references that are based on a database of over 36,000 images
can complete a scan of cardiovascular sourced from clinical studies and reference sites. AIRx™ is built on Edison,
anatomy, function and flow in 10 GE Healthcare’s new artificial intelligence platform.
minutes or less—an astonishing time
savings compared to historical cardiac And speaking of air, GE Healthcare’s AIR Technology™ RF coils received FDA
exam times of one to two hours. What clearance for 3.0T and 1.5T systems in November 2018.‡ The current suite consists
you may not know is how the solution of a 30-channel Anterior Array (AA), a 21-channel large Multi-Purpose (MP) Coil
leveraged video game technology and a 20-channel medium Multi-Purpose (MP) Coil. This industry-first suite of RF
to overcome a major hurdle. In an coils enables freedom in coil positioning and handling during a scan. For example,
article for GE Healthcare’s The Pulse, the AIR Technology™ AA is 60 percent lighter than a conventional, hard-shell AA.
Dr. Albert Hsiao, co-developer of
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
ViosWorks, said that when he first
started adjusting MR scanners to
Read more about AIRx™ on page 37.
capture information for his software,
they captured so much data, the
computers couldn’t process it all into
images doctors could interpret. To
address this hurdle, Dr. Hsiao and
EPI in the mix
Arterys™, a company Hsiao co-founded Anna Falk Delgado, MD, PhD, specialist physician at Karolinska University Hospital,
to specialize in web-based medical Tim Sprenger, PhD, Clinical Scientist, GE Global Research and Stefan Skare, PhD,
imaging analytics powered by AI, Associate Professor and MR physicist at Karolinska Institutet, received the 2018
looked to the technologies behind Athena Prize for shortening the time for an MR exam from one half hour to one
modern 3D video games to distribute minute. Their work focused on developing software that controls the MR system
large amounts of 3D data across many so it could produce images in less time, but still ensure the images contained
graphics processing unit (GPU) cores. enough information for diagnoses. Typically between five and 10 different types
With this approach, Arterys™ was able of MR sequences are needed for an MR exam, and each imaging series may take
to develop a cloud-based system up to seven minutes. Skare however, noted that the EPI imaging method is around
to manage and rapidly process the 100 times faster than other MR imaging methods. Skare asked himself, what if
gigabytes of MR data behind each you used the quick method to take all types of MR images? This led Skare’s team
cardiac image. to develop a method called EPI Mix that allows all images to be captured in
70 seconds instead of 20-30 minutes. The group is now planning further studies
to compare conventional MR imaging and EPI mix.
News
awarded 3.2M grant
In December of 2018, GE Healthcare’s
MR team in Hungary won a $3.2M
grant from EIT Health to work with
customers to streamline the delivery of
radiation therapy (RT). Approximately
one in three people will develop cancer
in their lifetime and about half of these
patients will experience RT. Today’s
RT workflow is quite complex, time-
consuming, costly and stressful for
anxious patients. One of the goals of
the research is to develop and produce
a silent, one-stop, MR-only RT solution,
MR optimizes diagnoses and long-term leveraging the full potential of multi-
parametric MR and deep learning
patient management artificial intelligence.
GE Healthcare was recently featured in USA Today for how MR technology Members of the GE Healthcare
optimizes diagnosis and long-term treatment. The article cited several new team include Florian Wiesinger, PhD,
MR technologies from the company which are making it easier for patients to Principal Investigator, Timo Schirmer,
undergo the scans and doctors to use MR imaging for diagnosing neurological PhD, and Senior Scientist Cristina
diseases and disorders. These technologies include AIRx™, which uses a deep- Cozzin, PhD. Clinical partners for
learning approach to automatically detect and suggest “slices” for neurological clinical development, assessment and
exams and deliver consistent and quantifiable results from scan to scan.‡ Also patient scanning include New Castle
mentioned is Quantib™ Brain software which uses machine learning to identify University (Prof. Hazel McCallum and
where lesions are in a patient’s brain, while color coding new and old lesions Prof. Ross Maxwell) and Erasmus
and measuring brain volume. Medical Center (Prof. Steve Petit and
Prof. Juan Hernandez Tamames).
From a comfort point of view, these technologies are making an impact. “No
Additionally, the team is partnering
matter how the patient’s head is positioned, AIRx™ will place those slices in the same
with the Technical University Munich,
location, reducing variation amongst technologists,” says Heide Harris, Global
King’s College London, Szeged
Product Marketing Director, MR Applications and Visualization for GE Healthcare.
University and SyntheticMR.
Technology advances from GE Healthcare have also increased exam speed.
The EIT Health grant focuses on
Ten years ago an exam took 25-35 minutes but with the latest advances many
healthcare innovation. The organization
exams can be completed in about 10 minutes.
cited GE Healthcare’s great reputation
regarding pseudo CT image conversion,
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
deep learning, silent imaging and
parameter mapping as a key reason
for the award.
Read the full article at:
tiny.cc/sps194
Cube enhancement
In DV28.0, the Cube pulse sequence waveform has been optimized to
reduce slab wrap and echo space. As a result, SNR of Cube improves
greatly with selective RF excitation. For non-selective RF excitation, the
shading is also obviously reduced. In addition, a new image intensity
correction algorithm, SCENIC, has been introduced to improve the
left/right shading on Neuro.
Discovery™ MR750w
PARAMETERS
T2 PROPELLER T2 frFSE MERGE
TR (ms): 9151 15000 1000
TE (ms): 96 96 8
FOV (cm): 22 44.8 24
Slice thickness (mm): 2.8 2.5 2.8
Frequency: 352 640 164
Phase: 512 164 Download the Gold Atlas
dataset at:
NEX: 2.1 1 2
tiny.cc/sps193
Scan time (min): 5:36
To implement an MR-only treatment a model trained with multi-modal Agency, VINNOVA, and associated
planning workflow, the team template materials. The team validated hospitals. The long-term goal of Gentle
together with Spectronic Medical AB the accuracy of the SDA model against Radiotherapy is to create a large-scale
(Helsingborg, Sweden) developed a conventional CT Sim data and found it national world-class platform for cancer
method for generating Hounsfield Units to be highly accurate.1 treatment, including the development
(HU) maps from synthetic CT (sCT) of a fully integrated MR-only workflow
As part of this effort and in
images derived from the MR data. The for radiotherapy. The project has
collaboration with other Swedish
Statistical Decomposition Algorithm also published the Gold Atlas data, a
academic hospitals, Skåne University
(SDA) automatically generates sCT complete dataset of the male pelvic
Hospital participates in Gentle
images from MR imaging data by using region that is a source for training and
Radiotherapy, a national program
automatic tissue classifications and validation of segmentation algorithms
funded by the Swedish Innovation
and methods to convert MR to sCT.2
A B
Figure 1. Comparison of (A) CT and (B) sCT images.
Images copyrighted by Christian Jamtheim Gustafsson, Lund University, reprinted with permission. Thesis: MRI-Only Radiotherapy of Prostate Cancer - Development and evaluation of methods
to assess fiducial marker detection, geometric accuracy and dosimetric integrity ISBN: 978-91-7619-775-2.
Results of a multi-center study techniques, most will not treat the specific distortions for sCT images6 and
validating MR-only prostate planning patient with MR-only imaging. When a dose quality assurance procedure for
using synthetic CT images reported we started this initiative, our goal was sCT using the cone beam CT (CBCT)
minimal differences between CT and to implement MR-only treatment in imaging device on the linear accelerator.7
sCT.3 The MR-Only Prostate External the clinic similarly to conventional,
In MR, T2-weighted spin echo images
Radiotherapy (MR-OPERA) study found CT-based treatments.”
depict gold fiducial markers as a small
that an atlas-based sCT generation
signal void similar to calcifications and
software, MriPlanner (Spectronic A body of research post-biopsy fibrosis. While the use of
Medical), provided dosimetrically To accomplish the goal of MR-only multi-echo gradient echo imaging was
accurate data compared to CT Sim guided radiation therapy planning, shown to be feasible and reliable for
and delivered a robust workflow additional methods and tools were identifying gold fiducial markers5, the
that required only minor changes developed by the Skåne University team also wanted to develop a quality
in the clinical routine.3 The study Hospital team. This includes an assurance method for this process. The
included scanners from two different automatic registration-free method goal is to have an MR-only workflow
manufacturers at two field strengths. for identifying implanted gold fiducial that would not change the radiation
This important study, performed by markers using multi-echo gradient therapy workflow and to avoid the
PhD student Emilia Persson at Skåne echo imaging5, development and introduction of image registration
University Hospital, was a significant evaluation of a technique to quantify errors by using both MR and CT imaging.
step forward in the development of the dosimetric effects of MR system The team addressed this issue using the
an MR-only workflow.
Another research study led by several
leading hospitals in Finland with
contributions from institutions in
Australia, the Netherlands, Denmark
and Skåne University Hospital also
examined the use of an intensity-based
method to generate sCT images from
standard T2-weighted images of the
pelvis. The authors found this method
produced clinically acceptable dose
calculation results across 35 prostate
cancer patients.4 As with MR-OPERA,
this study was conducted on different
MR systems to demonstrate reliability
across scanners and sequences. Figure 3. Onboard kV X-ray images are used to verify the patient position. The fiducial
markers seen in the kV images match very well to the markers seen in the digitally
“In many cases, our research is different reconstructed radiograph generated from the sCT. If the patient does not have fiducial
marker implants, bony structures can be used for position verification.
when it comes to MR-only radiation
therapy,” says Professor Olsson. “While Image courtesy of Gentle Radiotherapy.
Issue Spotlight
University Hospital is not yet using brain imaging to visualize contrast aspects of the MR workflow, we were
SBRT in the MR-only prostate workflow, uptake in the tumors and PROPELLER comfortable treating patients in a
Dr. Gunnlaugsson anticipates the to compensate for motion. Currently, clinical study,” adds Dr. Gunnlaugsson.
development of the MR-only treatment most of the clinical research has been
The team is also working to apply the
platform will enable SBRT treatments on morphological rather than functional
MR-only radiation therapy workflow
in the future. Even for brachytherapy, MR sequences. However, FOCUS, a
to brain cancer, including glioma and
another treatment for prostate DWI sequence, is applied in both the
metastases. For sCT image generation
cancer that involves the placement of prostate and brain using b-values of
in the brain, IDEAL is utilized to provide
radioactive implants directly into the 200 and 800.
water-only, fat-only, out-of-phase
tissue, there is an expectation that an
Other protocol adaptations may occur and in-phase images. This arm of the
MR-only workflow could be beneficial.
for patients who require the use of research project began in Autumn 2018.
“We also aspire to have gynecological vacuum pillows for patient positioning
“We are in the validation process
brachytherapy treatments move to and fixation. “The implication of the
and setting up the workflow to
MR-only and remove the CT imaging,” use of vacuum pillows or other patient
implement the same process in the
adds Gustafsson. “Most of the target immobilization devices is that the
clinic for treatment,” says Minna
delineation today is performed on T2- coil may be placed further from the
Lerner, a research PhD student in
weighted MR imaging, and we are in the patient’s anatomy, which in turn
the department. While much of the
process of optimizing and evaluating decreases SNR,” Gustafsson says.
workflow developed for prostate cancer
the Cube sequences for brachytherapy
Recently, the last patient was enrolled can be applied to brain cancers, there
of the cervix.”
in the Skåne University Hospital are additional considerations that need
T2-weighted images are predominantly study of prostate patients treated to be taken into account.
used for target delineation in the with the MR-only radiation therapy
prostate and, more recently, in the planning process.
brain as well. Skåne University Hospital
A B
the MR-only workflow performs 8. Gustafsson C, Persson E, Gunnlaugsson A, Olsson LE. Using
C-Arm X-ray images from marker insertion to confirm the
equally well if creating an IMRT gold fiducial marker identification in an MRI-only prostate
radiotherapy workflow. J Appl Clin Med Phys. 2018
or VMAT plan.” Nov;19(6):185-192, 2018.
9. Andreasen D, Van Leemput K, Edmund JM. A patch-based
pseudo-CT approach for MRI-only radiotherapy in the pelvis.
Christian Jamtheim Gustafsson Med Phys 2016;43:4742.
The Medical College of Wisconsin (MCW) radiation exposure from CT makes Flex generates both FatSat and non-
is an academic partner of the Children’s PET/MR an attractive alternative, as many FatSat images, while the T1 LAVA is
Hospital of Wisconsin, a top-ranked children will receive multiple imaging acquired in 3D so we can reformat the
pediatric hospital and one of the nation’s exams during their course of treatment.1 data into Coronal and Sagittal views for
busiest. While PET/CT had been utilized image registration with PET.
Additionally, a review article on FDG
for the diagnosis and staging of cancer
PET/MR imaging for malignancies noted Further, the ability to provide concurrent
patients, our facility acquired a SIGNA™
that the additional morphologic and MR with PET in the same setting under
PET/MR in late 2017 and scanned our
functional information provided by one sedation is best for the pediatric
first patients in February 2018. The
MR may help further characterize FDG patient and their parents. The oncologists
PET/MR is clinically utilized for 75% of
uptake in a suspicious lesion.2 Another are also pleased with the information
our oncology cases, primarily sarcoma
study reported that additional findings we are able to provide in a three-
and lymphoma, and 25% for brain
from PET/MR impacted patient clinical minute PET/MR per bed exam, as
cases, including seizures and tumors.
management in nearly 18% of cases.3 demonstrated in the following patient
A 2014 study published in Radiology cases. We are continuing to evaluate
The disadvantage of PET/MR compared
of 20 whole-body PET/CT and PET/MR the efficacy of this short PET/MR
to PET/CT is the longer scan times for
exams in 18 pediatric patients reported exam in the long-term management
MR versus CT. We addressed this issue
that PET/MR demonstrated equivalent of lymphoma and sarcoma, as well
by taking PET as the time-limiting factor
lesion detection rates in pediatric as investigate the use of PET/MR in
and tailoring our MR sequences to fit
oncology cases compared to PET/CT. pheochromocytoma and possible
into the PET acquisition times. Based
The study indicated that MR had a medulloblastoma patients.
on three-minute per bed positions, we
higher sensitivity than PET or PET/CT
acquire a 15-second MRAC to generate With the implementation of PET/MR,
for solid organs and bone lesions and
an AC Map, a 40-second Axial T1 LAVA we have successfully converted PET/CT
in several cases provided additional
Flex sequence for anatomic registration imaging studies for our pediatric cancer
diagnostic information in areas of soft
and then a two-minute Axial T2 frFSE patients to PET/MR.
tissue.1 Further, the lack of ionizing
Flex for pathology survey. The T2 frFSE
Case 1
A 21-year-old Hodgkin’s lymphoma positions, three minutes each bed Tumor is dark on T2-weighted sequence,
patient originally staged with PET/CT. position, for a total scan time of suggesting fibrotic changes or scar
Patient was scanned using PET/MR 21 minutes. tissue. Patient remained PET negative
on the second day of clinical service. at completion of the chemotherapy.
Results: Complete response with
Patient was scanned with seven bed
uptake equivalent to the blood pool.
A B C
D E F
Figure 1. Case 1.
A 21-year-old patient
with Hodgkin’s
lymphoma, restaged
with PET/MR. (A-C)
Initial staging PET/CT;
(D-F) Interim PET/MR;
and (G-I) restaging
G H I
PET/MR.
Issue Spotlight
A 16-year-old female with desmoplastic for breathing/gating kept catching on intensity on both T1 and T2-weighted
small round cell tumor was the first the bore and the scan would abort. sequences and without FDG uptake,
patient to undergo only PET/MR (no We eventually decided to not use most consistent with a complex fluid
PET/CT). Patient had widespread respiratory gating for the study. PET/MR collection (Figure 2).
disease throughout the abdomen, images were acquired two hours after
The diaphragm lesion is well seen on
including a pelvic lesion and soft tissue injection, yet despite the low photon
the T2 FatSat image and the Sagittal
mass coating the diaphragm. The count we were able to acquire good
reformat (Figure 2C, 2D) even with
patient had debulking surgery and was diagnostic-quality images.
the free-breathing sequence and it
referred for restaging. Unfortunately,
Results: A suspicious residual, correlates with abnormally increased
due to her size (200 lbs., 5 feet 4
hyperdense lesion in the pelvis seen on FDG uptake. Findings are consistent
inches and BMI 32) the bellow belt
CT was well characterized on MR, low with residual disease.
A
B
Case 3
A newly diagnosed 13-year-old patient foci next to the spine that correspond Results: Patient had a tumor in the
with Ewing’s sarcoma was referred to with lesions in the deep fascia of left spinal muscle with high-grade FDG
PET/MR to confirm initial diagnosis on a the spinal muscle and the other in a uptake at time of staging. Adjuvant
dedicated MR system. In this case, the paraaortic lymph node. In retrospect, therapy shrunk the primary tumor and
quality of the T2 frFSE Flex sequence those can be seen on the diagnostic two hot spots (Figure 4), leading to
captured on the PET/MR was similar to MR performed five days prior (Figure negative surgical margins.
the dedicated MR. There are two small 3C, 3D).
A B
C D
Issue Spotlight
A 16-year-old patient with large B cell transplant was planned; however, the Results: Uptake in the right basal
lymphoma who relapsed with lesions patient prognosis is better if they have ganglia corresponds with enhancement
in the brain and underwent salvage complete remission. We proposed on the MR, suggestive of a residual
chemotherapy. Monthly dedicated MR PET/MR to help determine if the lesions lesion. Patient underwent another
imaging demonstrated a continual were scar tissue or viable tumors, and round of chemotherapy prior to stem
decrease of the lesions in the first two whether the patient was in complete cell transplant.
months of therapy that lessened near remission. The PET study was acquired
the end of the treatment. Stem cell concurrently with a dedicated MR study.
A B C D
3/30/18 4/23/18 5/15/18 6/19/18
Figure 5. Case 4. A 16-year-old with large B cell lymphoma, who relapsed with lesions in the brain. MR images acquired with PET/MR.
A B C
A B
C D
A B
C D
a liver, pancreas and small bowel targets for biopsy. 1. Schäfer JF, Gatidis S, Schmidt H, et al. Simultaneous whole-
body PET/MR imaging in comparison to PET/CT in pediatric
transplant at age 2. Patient has oncology: initial results. Radiology. 2014 Oct;273(1):220-31.
Results: There are two foci in the
abdominal pain, fever and vomiting. 2. Kwon HW, Becker AK, Goo JM, Cheon GJ. FDG Whole-Body
abdomen with FDG uptake: one in the PET/MRI in Oncology: a Systematic Review. Nucl Med Mol
Initially, a white blood cell scan using Imaging. 2017 Mar;51(1): 22–31.
right quadrant that correlates with the
nuclear medicine was ordered; however, 3. Catalano OA, Rosen BR, Sahani DV, et al. Clinical impact
small bowel and the other next to the of PET/MR imaging in patients with cancer undergoing
we recommended PET/MR due to its
surgical anastomosis in distal small same-day PET/CT: initial experience in 134 patients—a
higher spatial and contrast resolution. hypothesis-generating exploratory study. Radiology. 2013,
bowel. With the PET/MR exam, we were Dec;269(3):857–69.
We utilized PET/MR to look for foci
able to provide two areas for biopsy.
of infection, inflammation or organ
B C
D E
A
Cancer patients are often referred for signal. Further, utilizing an MR system • Several bilateral swollen axillary
whole-body imaging to evaluate the that has strong magnet homogeneity lymph nodes, predominant in number
presence of secondary or metastatic allows for the acquisition of large and size at the right axillary region
lesions, which can change the course field-of-view (FOV) images and helps
• Lesion located on the proximal
of patient treatment. In our institution, reduce distortions in areas of off-center
metaphysis of the ulna of the left
whole-body diffusion MR is our preferred imaging, such as the extremities. DWI
arm and suspected to be metastatic,
modality for this type of study. STIR with a “3-in-1” technique provides
measuring 13 mm from its long
an excellent compromise between
Diffusion-weighted imaging (DWI) on axis, hyperintense in diffusion,
acquisition time and signal-to-noise
MR has shown excellent sensitivity hyperintense in STIR and gadolinium-
ratio (SNR), allowing acquisition of thin
(82%) and specificity (97%) compared enhanced on post-contrast T1 sequence
slices that may help further enhance
to PET/CT (sensitivity of 72% and
sensitivity of the DWI sequence. • Second suspicious lesion with similar
specificity of 92%) in whole-body
aspect, measuring 9 mm and located
imaging in melanoma metastases.1
Patient history on the distal diaphysis of the radius of
Additionally, DWI MR has been
A 75-year-old female with known the right arm
shown to be the most accurate for
detecting metastases in the bone, melanoma was referred for whole-body • Lesion on the left iliac joint,
liver, subcutaneous and intra- DWI MR for evaluation of suspected measuring 6 mm, hyperintense in
peritoneal sites compared to PET/CT.1 metastatic (secondary) lesions on her diffusion, with no aspects on the
extremities. Post-contrast whole-body MR other sequences
However, non-optimal DWI MR with LAVA Flex was also used to evaluate
acquisitions can produce scintigraphy- areas with suspicious contrast uptake. • Small nodule of 15 mm situated on
like images that may produce false the soft tissues of the right thigh,
positive results. Combining DWI MR at the inferior part located within
MR findings
with an inversion time technique can the posterior muscular compartment,
• Important effusion on the
help overcome this issue by allowing hyperintense in diffusion.
glenohumeral joint of the right
for a better suppression of fat signal, shoulder, to be investigated
which helps suppress background body
A B C D
Figure 1. Whole-body MR imaging with approximately 120 cm coverage. (A-B) Coronal in-phase and water LAVA Flex; 2.5 x 3 x 2.6 mm,
3 stations, 1:45 min.; (C) Coronal STIR, 1.5 x 2.1 x 8 mm, 3 stations, 5:30 min.; and (D) Coronal water LAVA Flex, post contrast, 2.5 x 3 x 2.6 mm,
3 stations, 1:45 min.
A C E
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
A B
Figure 1. Long bone/soft tissue assessment in 10-year-old patient, both legs imaged
simultaneously with AIR Technology™ AA. (A, B) Coronal T2 FSE Flex, 0.9 x 1.2 x 5 mm,
2:54 min.; (B) Water image; (C) Axial T2 FSE Flex (Water), 1.2 x 0.8 x 5 mm, 2:31 min.;
and (D, E) Axial DWI with ADC Map.
are still evaluating MPRAGE, however, It is lightweight—60 percent lighter and see what the impact is on patient
they are obtaining better contrast than conventional, hard-shell coils— comfort and image quality.
between white and gray matter in the and children in pain may not tolerate
In musculoskeletal imaging of the
brain compared to other conventional a heavy coil on their body, Dr. Boström
shoulder and arm, lower extremities or
3D FSPGR sequences. This sequence explains. This includes children who
imaging both legs, Svensson can wrap
would be particularly helpful when had open heart surgery at The Queen
the coil around larger field-of-views
imaging epilepsy patients before and Silvia Children’s Hospital, one of only
(FOVs) and obtain a homogenous signal
after surgery. two pediatric cardiac surgery centers
for good image quality. For example,
in Sweden.
In addition to the new sequences, the patients with multifocal chronic
department received the AIR Technology™ “Fetal imaging is another area where osteomyelitis or muscular dystrophy/
AA and 48-channel Head Coil in early we see an advantage with the AIR myositis will often require imaging of
2019. The AIR Technology™ AA has the Technology™ AA,” adds Svensson. “It both legs simultaneously.
highest channel count and coverage in can be difficult to put a conventional,
“With the AIR Technology™ AA, we can
the industry. hard-shell coil around a pregnant
cover large areas but we also get good
woman’s abdomen and get a good,
“Our initial experience is very good,” says SNR, so we can provide detailed images
homogeneous signal.”
Dr. Boström. “We’ve used the AA for of specific joints with high resolution,”
several exams, such as the abdomen, For women in the late stage of he says.
pelvic, lower extremities, shoulder and pregnancy, lying on their back can be
Positioning these precious patients is
fetal imaging. The main advantages uncomfortable. Svensson wants to try
also easier now with AIR Technology™.
with the AIR Technology™ AA are the imaging them on their side with the AIR
There are many factors that can
flexibility and ease of positioning on Technology™ AA wrapped around them
impact the overall time a child is in
the patient.”
C D E
C D E
A B C D
Figure 5. Neuro imaging with the 48-channel Head Coil in a three-year-old patient. Note the same resolution with less blurring in the MUSE DWI
sequence. (A-B) Traditional single-shot DWI, 1.8 x 1.4 x 3.6 mm, 2 shots, acceleration factor of 2, 1:58 min.; and (C, D) MUSE DWI, 1.8 x 1.4 x 3.6 mm,
2 shots, acceleration factor of 2, 2:16 min.
the MR scanner and any time saved AIR Touch™ even helps when using more asked, these patients preferred the new
in positioning means the sooner the than one coil. Embedded in the SIGNA coil, especially because it was not so
patient can get back to his or her parents. Architect™ table is the Posterior Array heavy and confining on their bodies.
(PA). With small children, Dr. Boström
Another patient-centric feature of “The most important benefit of AIR
and Svensson are using GE’s Flex
AIR Touch™ is that it assists with patient Technology™ is the patient comfort,”
Coil in combination with the PA. They
positioning. It automatically selects says Dr. Boström. “It is lightweight
have seen excellent results using the
the best elements to use and uniquely and can lay on the patient like a
combination of both coils in cardiac
optimizes uniformity, SNR, artifacts blanket. We believe this also impacts
and abdominal exams.
and parallel imaging. patient compliance.”
After using the impressive AIR
Overall, Dr. Boström and Svensson
Technology™ AA for just two months
are impressed with SIGNA™
“AIR Touch™ makes coil selection Svensson and Dr. Boström no longer use
Architect, SIGNA™Works and
the conventional AA. They look forward
much easier and I don’t have especially AIR Technology™.
to receiving the new AIR Technology™
to check what elements are Multi-Purpose (MP) Coil, a smaller “This is a stable MR system with very
activated because the system version of the AIR Technology™ AA. good image quality,” says Svensson.
“We are satisfied with the upgrade
does it. It helps with workflow, There have been a few patients
and our initial experience with AIR
but the most important factor who had MR exams with both
Technology™.”
the conventional coil and the AIR
is that it helps me focus more
Technology™ AA. Svensson says when
on the child.”
Pär-Arne Svensson
Erasmus Medical Center in Rotterdam, imaging artifacts when compared to (MDE) sequence where Dr. Hirsch
Netherlands, is a leading university previous generations of conventional evaluates myocardial viability. With the
medical center in Europe and has coil technology. 2D FIESTA sequence, he is looking at
long been recognized for its adoption cardiac function. However, 2D FIESTA
Recently, several clinicians from
of cutting-edge technologies and sequences have historically been
Erasmus shared their initial impression
advanced medical solutions. For the last problematic at 3.0T.
of AIR Technology™ on the SIGNA™
few years, Erasmus has collaborated
Premier 3.0T MR system, including the “The new SIGNA™ Premier system is
with GE Healthcare to evaluate the
AIR Technology™ Anterior Array (AA), the especially good for late enhancement
introduction of new technologies into
48-channel Head Coil and AIR Touch™. images and also for perfusion,” Dr.
the clinical environment. One of these
Hirsch says. “I was able to see the
is AIR Technology™.
Cardiac imaging anatomy and the function, as well as
AIR Technology™ Coils are designed Alexander Hirsch, MD, cardiologist, differentiate the contrast between the
to fit all patients, allow flexibility in any specializes in non-invasive cardiac blood and the myocardium. Previously
direction and closely wrap around imaging. In cardiac patients, Dr. Hirsch in a 3.0T system, that was a problem,
the patient’s anatomy for greater scans cardiomyopathy and ischemic however, with the SIGNA™ Premier this
visibility of hard-to-scan areas with heart disease patients on SIGNA™ has improved a lot.”
excellent image quality. By conforming Premier. Typically, the 2D FIESTA, first- A key factor in the improved image
to the patient habitus and bringing the pass perfusion and MDE images are quality is AIR Technology™. Dr. Hirsch
coil elements closer to the patient, AIR the most common sequences for these says he gets a more homogeneous
Technology™ improves signal quality and patients.‡‡ Image quality is important, signal and better contrast between the
signal-to-noise ratio (SNR) and reduces particularly in the late enhancement blood and the myocardium.
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
“Because of the specialized nature of was typically preferred for CMR, he and Section Chief of Musculoskeletal
our facility, with referrals from all over worked with Dr. Hirsch to evaluate CMR Radiology at Erasmus Medical Center.
the Netherlands, it is important to exams on the SIGNA™ Premier 3.0T MR He dedicates half his time to research
have the latest technology,” he says. system with AIR Technology™. and working with MR physicists and
“With the new GE SIGNA™ Premier and PhD students to improve technologies
“The AIR Technology™ AA is brilliant and
AIR Technology™, we can provide high- and apply MR imaging in population
it’s an improvement for the patient. It
quality care for our patients.” health studies.
is very easy to handle, very lightweight
“The new AIR Technology™ AA has a and the quality is very good for cardiac “SIGNA™ Premier offers advantages in
major advantage in that it helps provide imaging, especially on the SIGNA™ musculoskeletal imaging because of its
high image quality,” Dr. Hirsch adds. Premier system,” Bakker says. higher gradient performance, especially
Plus, with SIGNA™ Premier he has been when it is used with the AIR Technology™
“AIR Technology™ is very flexible, you can
able to achieve high SNR, which is Coil,” Professor Oei says.
put it around the chest or stomach but
very important for the sequences he
also use it around the knee or shoulders,” According to Professor Oei,
is using. Dr. Hirsch also expects to see
Bakker says. “With other coils that are musculoskeletal (MSK) MR imaging
improvements in 4D Flow (ViosWorks),
more rigid, this is not possible.” tends to suffer from artifacts and
as well as the new 3D MDE sequence.
movement more than in other body
In pediatric imaging, the AIR Technology™
“When we started working with SIGNA™ parts. Often, there are difficulties
Coils fit almost like a blanket on the
Premier, I was pleasantly surprised to with positioning patients due to their
child, he adds.
see the image quality, especially for the injury or ailment, as well as using the
2D FIESTA sequence,” he says. right coil. While coil selection is not
MSK imaging
as problematic in the knee or ankle,
Brendan Bakker, MR radiographer, has Edwin Oei, MD, PhD, is an Associate
it can be more difficult when imaging
developed cardiac MR (CMR) protocols Professor of Musculoskeletal Imaging
the shoulder, wrists or ribs.
at Erasmus with Dr. Hirsch. While 1.5T
A B C
Figure 2. AIR Technology™ Suite is flexible and assists with patient positioning in areas where coil selection may be more difficult, such as the
wrist. (A) Coronal 3D MERGE; (B) Coronal PD FatSat; and (C) Coronal T2 Flex.
Premier,” Ramman explains. “With AIR He also discovered that the HyperBand AA lays on the patient’s chest, it is
Technology™ and AIR Touch™, we don’t capability on SIGNA™ Premier enables as close to the body as possible. This
need to do any calibration as it is done the possibility to simultaneously scan enables a high SNR.
automatically. This makes a difference several slices, accelerating acquisition
Another advantage is in pediatric
in our daily routine because it takes less with the potential to shorten scan
imaging. Professor Tamames says a
time to position a patient.” times when using DWI. With the
baby can be wrapped in the coil, which
parallel transmission, he can tailor
makes them more comfortable and
A remarkable advance the RF for specific tissues in a more
enables the coil to get closer to
Juan Hernandez Tamames, PhD, appropriate way.
the anatomy.
Associate Professor (MR) and Head of “Compressed sensing is another
the MR Physics group in the radiology “In general, AIR Technology™ is more
remarkable advance on SIGNA™
department at Erasmus, facilitates convenient and it can fit almost
Premier,” Professor Tamames adds.
the introduction of new technology any sized anatomy,” adds Professor
“When used with AIR Technology™,
in MR imaging for both clinical and Tamames.
which improves signal due to the closer
research purposes. proximity to the patient anatomy and Professor Tamames is interested in
“SIGNA Premier incorporates several
™ tissue, we can increase the acceleration testing the AIR Technology™ AA with
new approaches and breakthroughs with compressed sensing and parallel a conventional head coil and also with
in technology,” Professor Tamames imaging to reduce scan times.” the 48-channel Head Coil.
says. “For example, the AIR Technology™ For example, since the lungs are filled “With 48-channels we can accelerate
Coils are one of the most remarkable with air, it is often difficult to obtain more because we have a really good,
innovations I’ve seen because they good SNR. Because the AIR Technology™ high-quality signal,” Professor Tamames
increase SNR.”
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
“We are now using PROPELLER MB for “Sometimes we needed different WW/ Using HyperCube with the AIR
all abdominal cases, such as pelvis, WL adjustments so we could clearly Technology™ AA in prostate imaging,
liver and pancreas,” he says. “There see the anatomy between the center Professor Hori can perform thin-slice
is also the additional big advantage and the edge of the FOV to make a imaging. He acquires 1-2 mm slice 3D
of motion correction without any diagnosis. Now, we no longer need to images with HyperCube and obtains
critical disadvantage.” make this change in most patients,” good quality compared to conventional
he says (Figure 3). 2D 5 mm Axial imaging. The advantage
For example, he obtained good contrast
is that the thin slices provide him with
of the endometrium and junctional Professor Hori evaluated the AIR
a better understanding of capsular
zone in a patient without motion artifact. Technology™ AA and a conventional
invasion, which can impact patient
In the upper abdomen, he acquired AA in a patient exam. He discovered
management and treatment options
good images that were also not that with the latest uniform correction
(Figures 4 and 5).
compromised due to motion (Figure 2). application, reFINE, he could acquire
higher image quality and better uniformity Multi-plexed Sensitivity Encoding
It’s not just the coil that is leading to
in many clinical cases and contrasts. (MUSE) DWI is another impressive
excellent imaging results at Osaka
application, especially in the prostate.
University. Professor Hori found the “Also, I found the AIR Technology™ AA
It provides both high SNR and high
combination of the SIGNA™ Architect, provides better signal penetration, so
spatial resolution.
advanced sequences and AIR Technology™ image quality and SNR are better than
together deliver robust imaging with a conventional coil, especially in large
excellent image uniformity. patients,” he adds.
C D E
Figure 3. Patient with an adrenal mass. (A) Axial T2w SSFSE, 1.1 x 1.8 x 5 mm, 18 sec.; (B) Axial DW-EPI, 2.8 x 2.8 x 5 mm, 3:49 min. (RTr);
(C-E) Coronal LAVA Flex, 1.4 x 1.6 x 3 mm, 16 sec.; (C) water, (D) in-phase and (E) out-of-phase.
A B C
Figure 4. Prostate cancer patient (A) Axial T2w PROPELLER MB, 0.6 x 0.7 x 4 mm, 3:25 min; (B) EPI DWI b1000, 2.3 x 2.3 x 4 mm, 2:08 min.;
and (C) FOCUS DWI, b1000, 1.5 x 1.5 x 4 mm, 4:10 min.
“Currently, we acquire both conventional In MRCP imaging, HyperSense is Looking forward, Professor Hori wants
EPI DWI for the whole pelvis and shortening scan times by 30 percent at to evaluate the use of AIR Technology™
FOCUS DWI for targeted small FOV Osaka University. He has also increased in exams that require wide scan
with high resolution,” Professor Hori matrix size, from 512 x 320 to 512 x 416. coverage, from the upper to the lower
explains. “However, MUSE can provide With this protocol, he can more clearly abdomen. This coil has the highest
high-quality imaging in both larger and see the small intrahepatic bile duct channel count and coverage in the
smaller FOV for the prostate,” (Figure 6). with less motion due to the shortened industry today.
scan time (Figure 7).
“With the AIR Technology™ AA, 65 cm
wide coverage might be very beneficial
for these types of studies,” he adds.
A B C D
A B
C D E
Figure 4. Patient weighed over 200 lbs. (120 kg). Abdominal kidney exam using the AIR Technology AA required a wide FOV, however,
™
highly uniform images were acquired. (A) Axial T2w PROPELLER MB, 0.8 x 0.8 x 5 mm, ASSET 4.0, 5:39 min.; (B-D) Axial LAVA Flex; (B) water;
(C) in-phase; (D) out-of-phase: 1.6 x 1.6 x 4 mm, 14 sec.; and (E) Coronal DWI b900, 3.1 x 1.6 x 5 mm, ASSET 4.0, 4:20 min.
“We already use MAGiC in clinical angiography exam in six minutes— productivity platform with SIGNA™
routine neuro examinations to acquire something that previously took Architect. Naka loves the improvements
excellent T1 contrast, which by principle approximately 20 minutes (Figure 3). in DWI, especially MUlti-plexed
is difficult to obtain at 3.0T,” Naka says. Sensitivity Encoding technique (MUSE)
He has noticed that patients are more
“However, with the 48-channel Head and PROGRES.
relaxed with the AIR Technology™ AA
Coil, we can reduce the scan time from
than with conventional coils. Even “The most impressive application is
six to three minutes because of the
large-sized patients weighing over MUSE, a multi-shot DWI that allows us
higher SNR,” (Figure 2).
200 lbs. can fit comfortably inside the to achieve quite high spatial resolution
Plus, the 48-channel Head Coil allows MR, with space between the coil and compared to conventional DWI,” he
Naka to use a higher HyperSense the bore (Figure 4). explains. “I find that MUSE DWI provides
factor because of the high SNR and us completely different image quality
Kawasaki Saiwai Hospital also installed
spatial resolution. As a result, he can versus the conventional sequence.”
the latest version of the SIGNA™Works
now acquire a high-resolution MR
A B C
In particular, the improvement in MUSE DWI will have an advantage in From streamlined patient positioning
female pelvis imaging is notable. MUSE detecting small lesions in the pancreas.” to greater patient comfort, Naka sees
DWI clearly depicts details of cervix and the difference that AIR Technology™
After investigating several sequences,
endometrial lesions when Naka sets has on the patient experience. For his
Naka and his colleagues found
the acquisition plane (slices) along the department, the ability to use higher
PROGRES provided the best DWI image
uterine axis (Figure 5). acceleration factors and save time in
with the least distortion. Susceptibility
patient set-up will positively impact the
“We could see almost no distortion even artifacts around the eye and inner ear
technologist’s workflow, further improving
in the Sagittal plane and there was less were decreased with no major impact
staff satisfaction. And, with the new
artifact from rectal gas,” explains Naka. on scan time when using PROGRES. As
sequences available in SIGNA™Works, he
“Surprisingly, when we fuse MUSE DWI a result, PROGRES is being frequently
and his team can deliver the excellent
with T2-weighted images, we could used for neuro DWI at Kawasaki Saiwai
image quality clinicians need for a more
not find misregistration caused by Hospital (Figure 6).
confident diagnosis.
distortion. So, we think high-resolution
In Practice
implemented at Kirchberg Hospital MR Excellent Program Leader at project, Kirchberg Hospital has
to help harmonize protocols across Kirchberg Hospital, agrees with Sana’s purchased the MR Excellence solution
the same clinical indication, optimize assessment that a key first step is and Debelle is excited at the prospect
scheduling times and monitor MR to customize the dashboards to the of implementing it.
utilization and performance. department and facility.
“You want consistency between the The pilot project
analytics and what is happening in Several key areas were targeted for the
“When you discover the Imaging the clinical routine,” Debelle says. pilot evaluation project using Imaging
Insights dashboards, it is “Depending on your goals, the KPI Insights dashboards at Kirchberg
indicators can be very different.” Hospital: scheduling, protocol
similar to when you discover standardization, clinical excellence
the dashboard of your new car Since Kirchberg Hospital was involved and patient experience.
in the test and pilot phase in the
for the first time. Very quickly,
development of MR Excellence, there
you become familiar with it and was a lot of communication and
“Without hesitation, MR
can configure the dashboards feedback with GE, including a team
of digital experts. The collaboration Excellence improved scheduling
to make them more useful and
between GE digital experts and the for MR exams. Thanks to the
comprehensive to your facility
data team at Kirchberg Hospital was dashboard analytics, we were
and your specific clinical or a main factor for the project’s success.
able to quickly compare the
operational needs.” Working with GE’s digital experts as schedule duration to the actual
a part of the MR Excellence Program
Paolo Sana also helped Debelle tailor the indicators
exam time. We then adjusted
to the hospital’s specific goals. She our exam scheduled slots so
Sana credits the development of a data refers to this collaboration and guidance they fit with reality. As a result,
team at Kirchberg Hospital during the as the hospital’s GPS, helping to sort
we had an 11 percent increase
DoseWatch evaluation and the inclusion out the tremendous volume of data
of the staff that uses the SIGNA™ Artist that can be pulled from the Imaging in the volume of knee exams in
each day for the success of the program. Insights dashboards. just a few weeks, for example.”
It is that teamwork and the feedback “Do not underestimate the importance
that helped drive decisions. of the data team,” adds Sana. “They Paolo Sana
“We need the input of people from the are really the pillars of the project and
field, who are most able to compare should be the first thing put in place
the data to their experiences so that before starting this type of project.”
the analysis and decisions fit with the
clinical reality,” he adds.
Figure 2. A comparison of the most common MR exams (distribution) with the average exam duration.
Study description System # exams Status % difference Scheduled slot Total appointment Setup time Exam duration Setup time after
(min.) time (min.) before exam P75 (min.) exam (min.)
Cerebral MR
Cardiac MR with stress test
Cardiac MR
Prostate MR
Liver MR
MR of the left knee
MR of the right knee
MR of the lumbar spine
MR of the right shoulder
Figure 3. A comparison of the scheduled versus actual exam slots led to a reduction in appointment times for several common MR exams.
dashboard, the MR Excellence Program care we can deliver and further benefit
Using the Imaging Insights enables her and her team to find new the patient experience. Patients are
dashboard, Debelle was able ways to improve workflow, scheduling, more aware today of how their care
clinical excellence and the patient is delivered, from waiting times to the
to analyze protocol variations
experience. caregiver’s empathy.”
by exam type. She could also
“Participating in the pilot evaluation of With the explosion in imaging
see which protocols were the MR Excellence Program has allowed utilization over the last two decades
most often utilized. Based on me to discover a new, important facet coupled with the emergence of
this analysis, the department of my job that is very closely tied to information technology (IT) and
the MR exam,” says Debelle. “This data digitization in healthcare, patients may
decreased the number of
allows us to find areas of improvement feel disconnected from their caregivers
protocols on the SIGNA™ Artist in the planning and workflow that really and the care process. MR Excellence
by 47 percent (Figure 6). enable a team approach to embrace provides an opportunity to utilize data
and implement change.” and IT to identify areas of improvement
in the entire imaging workflow.
A key facet of the program was to
“Every protocol is now optimized for
create buy-in from the staff at all levels.
image quality and acquisition time and
Sana and Debelle shared the goals
dedicated to the particular indication,” “The MR Excellence Program and
with the MR team, specifically how
Debelle says. As an example, the
department had 11 protocols for a
the data could help improve patient the Imaging Insights dashboards
management and workflow and create are like a lighthouse that
head exam prior to the MR Excellence
a more efficient and productive working
Program; after implementing the MR
environment.
delivers a live view of the MR
Excellence Program, the hospital has
imaging department, so we can
six protocols for head exams. “We wanted the MR team to see the
data and dashboard as a tool that improve performance, optimize
An improved imaging experience facilitates our daily work and allows system utilization and reduce
The MR Excellence Program allows the caregiver to spend more time variability, all which impact the
Debelle to be more aware of the many with the patient,” says Sana. “The
patient experience.”
factors that can influence patient entire digitization of the hospital in
workflow. Through the Imaging Insights general is to enhance the quality of
Paolo Sana
a regular rate, and can greatly improve artifacts can be removed, albeit with between blood and myocardium can be
MR image quality compared to an a reduction of blood-to-myocardium improved if acquired post-contrast.
irregular heart rate. contrast-to-noise ratio (CNR). Acquiring
For late gadolinium enhanced (LGE)/
the short- and long-axis Fast SPGR
Patient positioning in the MR scanner myocardial delayed enhancement
Cine images following contrast agent
is similar to exams in patients without (MDE) imaging, an inversion pulse with
administration can improve CNR, and
devices. The patient is connected an appropriate TI is used to suppress
has the additional benefit of decreasing
to a patient monitoring system, so signal from normal myocardium,
total exam time (since there is normally
that the patient’s ECG and pulse highlighting signal from infarcted
10 minutes of waiting following contrast
oximetry information can be monitored myocardium. With conventional MDE
agent administration).‡ Figure 2 shows
throughout the exam. In addition, we imaging, B0 inhomogeneity could cause
a typical image acquired with FIESTA
attempt to have the patient place their incomplete inversion and artifactual
(2A) and post-contrast Fast SPGR Cine
arms over their head, as this can move high signal in normal myocardium could
(2B) in a patient with an ICD.
the device away from the imaging field- be mistaken for infarction. A new wide-
of-view (FOV) and reduce the amount Using thinner slices to reduce bandwidth adiabatic inversion pulse for
of main magnetic field (B0) modulation through-slice dephasing can also help MDE (standard in GE’s DV26.0 software)
near the imaging FOV. reduce artifact. In Figure 3A, a more allows suppression of myocardial signal
conventional 8 mm thick/0 mm gap without artifactual high signal (see
FIESTA imaging sequences can contain
slice was used with Axial post-contrast clinical cases). When combined with
banding artifacts due to B0 field
Fast SPGR Cine; in Figure 3B, a slice at the Phase-Sensitive Inversion Recovery
modulations; the artifacts can be
the same location with 4 mm thickness (PSIR) option, high image quality can be
particularly troubling due to the
and 4 mm spacing to maintain coverage achieved (Figure 4). We do not use the
intense B0 modulation caused by
with fewer artifacts was utilized. single-shot MDE sequence (SS MDE) at
the CIED. These artifacts are usually
Disadvantages include increased 1.5T for these patients, since this uses a
more severe with ICDs compared to
TE with reduced slice thickness and FIESTA readout combined with parallel
pacemakers. By using a Fast SPGR
reduced SNR, although the CNR imaging; the combination is prone to
Cine imaging sequence, the banding
artifactual high late enhancing signal.
‡Drug products should be used in accordance with their approved labeling.
Gadolinium-based contrast agents have not been approved for cardiac use in all regions.
Figure 4. Comparison of
(A, C) original inversion vs
(B, D) higher broadband
inversion, using the
PSIR option. Note the
improved image quality
when improved broadband
C D
inversion was utilized.
We image all MR-Conditional CIED Currently, all patients with MR- Recently, GE introduced lightweight
patients at 1.5T, with SAR and dB/dT Conditional CEIDs are scanned on AIR Technology™ Coils. While we have
set to Normal Operating Mode, which a wide bore 1.5T MR system in our not had an opportunity to use the AIR
has a whole body SAR limit of 2.0 W/kg. facility, assuming specifications for Technology™ Coils for imaging patients
Recent versions of GE software include field strength and maximum spatial with CIEDs, our current experience
a Low SAR mode, allowing the user gradients of the static field in the MR- for cardiac imaging on our 3.0T SIGNA™
to specify even lower limits for SAR Conditional device labeling can be met. Premier systems demonstrate excellent
or B1+RMS. Most MR-Conditional CIEDs We find the wider bore is particularly image quality. We anticipate improved
specify 2.0 W/kg for SAR at 1.5T; helpful when imaging patients who patient comfort for these exams, which
however, those that are MR-Conditional cannot easily hold their arms above may facilitate improved compliance for
at 3.0T can have lower limits. For example, their head. Additionally, employing arms-above-head positioning.
the Medtronic Advisa DR/SR MRI rapid sequences may reduce scan
pacemakers specify maximum times and enhance patient comfort and
B1+RMS=2.8μT for thoracic imaging, which compliance; however, our institution
can be easily set in Low SAR mode. The has not yet evaluated rapid sequences
availability of 3.0T imaging combined for CMR imaging in patients with MR-
with low SAR mode is expected to be Conditional devices.
important if the scan is clinically indicated
for 3.0T (e.g., PET/MR) or for institutions
without access to a 1.5T system.
Optima™ MR450w
PARAMETERS
Sagittal short axis Axial long axis Sagittal Coronal and Axial
Fast SPGR Cine Fast SPGR Cine short axis PS MDE long axis PS MDE
TR (ms): 6.3 6.3 8.2 7.9
TE (ms): 2.6 2.6 3.9 3.8
FOV (cm): 38 x 38 38 x 29.3 38 x 26.6 38 x 30.4
Slice thickness 6 6 6 5
(mm):
Frequency: 256 256 224 200
Phase: 160 160 192 192
NEX: 1 1 1 1
Scan time (min): 1:30 (12 slices) 0:25 (sec.) (3 slices) 1:48 (12 slices) 0:42 (sec.) (4 slices)
A B C
D E F
Figure 5. (A) Short axis Fast SPGR Cine; (B) long axis Fast SPGR Cine; (C) short axis MDE (arrow); (D-F) long axis MDE.
In Practice
Patient with a history of ventricular tachycardia with possible
left ventricular thrombus. MR shows enlarged left ventricle,
with global hypokinesis with dyskinesis in the apical anterior
wall and true apex. Thrombus is seen in the apex, with a
thin rim of increased enhancement at the edges of the
thrombus. There is subendocardial to transmural enhancement
in the apex.
Optima™ MR450w
PARAMETERS
Coronal short axis Axial long axis Long axis
Fast SPGR Cine Fast SPGR Cine PS MDE
TR (ms): 5.3 5.3 5.9
TE (ms): 2.4 2.4 2.8
FOV (cm): 40 40 40
Slice thickness (mm): 6 6 6
Frequency: 192 192 192
Phase: 160 160 192
NEX: 1 1 1
Scan time (min): 1:21 (12 slices) 0:20 (sec.) (3 slices) 0:49 (sec.) (3 slices)
A B
Fetal imaging
By Manuel Recio Rodríguez, MD, Associate Chief of Diagnostic Imaging Department
With the AIR Technology™‡ Anterior Array (AA), we can achieve good signal penetration for fetal imaging.
This enables us to obtain high-quality images of the fetal brain with short acquisition times using T2 and
DWI sequences.
A B C D
Figure 1. AIR Technology AA provides excellent signal penetration for high-quality images. (A) Sagittal T2 SSFSE; (B) Coronal T2 SSFSE;
™
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
Case Studies
By Vicente Martinez de Vega, MD, Chief of Diagnostic Imaging Department
Abdominal imaging with the AIR Technology™ Coils is better than we expected, particularly the coverage,
signal homogeneity, high spatial resolution and scanning speed. We were also able to achieve short
acquisition times and homogenous fat suppression. In this particular case, a thickening of the terminal
ileum can be noticed in a very short segment, which is consistent with Crohn’s disease.
A D
B C E
Figure 2. AIR Technology AA and PA Coils for abdominal imaging deliver better than expected coverage, signal homogeneity, high spatial
™
resolution and homogeneous fat suppression. A thickening of the terminal ileum (red arrows) is consistent with Crohn’s disease. (A) Axial T2
SSFSE; (B) Axial DWI b1000; (C) Coronal T2 SSFSE; (D) Axial T2 SSFSE FatSat; and (E) Axial T1 LAVA ASPIR.
Case Studies
By Manuel Recio Rodríguez, MD, Associate Chief of Diagnostic Imaging Department
Prostate MR is growing in use and referrals in our institution. However, in order to clearly depict the cancer to determine
the extent of disease, it is necessary to obtain T2 sequences with high spatial resolution. Also, T2 Cube images can be
used to merge with ultrasound to assist in performing targeted biopsies. In this particular case, a lesion with high
signal in the T2-weighted sequence in the central prostate can be seen. There is no enhancement in the dynamic
sequence and restricted diffusion is consistent with a prostate abscess. Dynamic acquisition with DISCO LAVA
provides high spatial and temporal resolution (4.5 seconds per phase) and the diffusion imaging is very high quality.
A B
When scanning with the new for multiple sclerosis as well as carotid By combining the advantage of extra
48-channel Head Coil on the SIGNA™ MRA studies. SNR with high ARC factors and new
Pioneer 3.0T MR system, routine neuro acceleration techniques, such as
The 48-channel Head Coil has an
acquisitions show significantly higher HyperSense and HyperBand, we are
adaptable design with an additional
signal-to-noise ratio (SNR) compared to able to decrease significantly our total
3 cm expansion to gain more room for
prior acquisitions with the conventional examination time for neuro protocols
very large-sized heads and necks. It
Head Neck Unit (HNU) coil. by 25% while maintaining or even
also helps reduce the patient feeling
increasing image quality and spatial
With the embedded AIR Technology™ confined or having their nose in contact
resolution.
element design, we can observe a very with the front of the coil. The coil is
homogenous signal distribution over compatible with the comfort tilt device, The 48-channel Head Coil is a real asset
the whole field-of-view without any which is very important when scanning for us as a neuroradiological institute
signal drop in the center of the brain. elderly patients suffering from kyphosis and it further extends the clinical
In our experience, we know this is not because it helps them lie comfortably benefits of a powerful 3.0T MR system
the case for every dedicated neuro coil on the table. It is essential for our such as the SIGNA™ Pioneer.
available on the market. dementia protocols that the patient
not move during scanning due to
Additionally, the coverage of the coil in
discomfort.
the z-direction gives us the versatility to
easily scan the brain and cervical spine
A B C
Figure 2. Patient with multiple
sclerosis. Higher SNR with the
48-channel Head Coil enables
better gray matter delineation
(green arrows) and enhanced
lesion depiction (red arrows).
(A-C) 48-channel Head Coil,
Sagittal Cube FLAIR HyperSense,
1 x 1.1 x 1.2 mm, 3:30 min.; and
(D-F) conventional HNU, Sagittal
Cube FLAIR HyperSense,
D E F
1 x 1.1 x 1.2 mm, 3:45 min.
A C
Figure 6. Standard brain and orbits protocols acquired with the 48-channel Head Coil.
(A) TOF with HyperSense, 0.7 x 0.7 x 1 mm, 3:21 min.; with (C) Sagittal and (D) Coronal
reformats; and (B) Axial T2 HyperCube with Flex and HyperSense, 3:53 min.
Case 1
A 59-year-old female with loss of consciousness. Prior history includes gall bladder stone and cholecystitis.
MR findings
Patient has multiple infarction. Micro infarction was not clearly visualized in conventional DWI sequence.
However, MUSE enabled high-resolution DWI that enabled depiction of micro infarction in the gray matter.
59-year-old female.
Coil: 48-channel Head Coil
Parameters:
DWI, b1000: 0.9 x 1.9 x 5 mm
MUSE, b1000: 0.8 x 0.9 x 5 mm
A B C
D E F
Figure 1. With the improvement in resolution using MUSE, there is clear depiction of the infarct in the gray matter compared to the
conventional sequence. (A-C) Conventional DWI, b1000; (D-F) MUSE, b1000.
Case Studies
A 46-year-old male presenting with fever of unknown origin and suspected infection after aortic stent
replacement surgery.
MR findings
T2 SSFSE and T2 STIR PROPELLER MB confirmed abscess formation in the left upper lung lobe without
having to reposition the coil. High signal DWI confirmed location. Whole-body Coronal DWI was acquired
in two stations. The AIR Technology™‡ Anterior Array (AA) allows higher parallel imaging factors, enabling
low-distortion DWI even in cases with a large field-of-view.
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.
46-year-old male.
Coil: AIR Technology™ AA
Parameters:
T2 STIR 1.6 x 1.6 x 5 mm
PROPELLER MB: ARC factor of 3
3:49 min.
T2-weighted 1.3 x 2.1 x 5 mm
SSFSE: 1:10 min.
C D E
MR imaging is routinely used for of their liver disease and side effects option for patients who cannot hold
non-invasively evaluating the liver. of cancer treatments. This inability to their breath, even though they have
Improvements in both diffusion-weighted hold their breath for approximately a regular, stable breathing pattern,
sequences and hepatocyte-specific 15 seconds can impact image quality capturing high quality images without
contrast agents have improved and in some cases render the MR study a breath-hold. Auto Navigator is a
the detection of both primary and insufficient for radiologist diagnosis free-breathing technique that combats
secondary (metastatic) lesions. and evaluation of patient treatment. respiratory motion and includes an
automatic tracker placement for
However, many patients are unable to Recent advances in MR imaging
enhanced workflow. More importantly,
perform breath-holds due to the extent sequences offer a free-breathing
it is compatible with all the typical
sequences used for liver imaging,
including T2 PROPELLER MB, FSE and
SIGNA™ Artist DWI, as well as the critical dynamic T1
sequences, such as LAVA, LAVA Flex
PARAMETERS
and DISCO.
Axial DWI Axial Axial DISCO Flex
LAVA Flex, LAVA Flex, DCE The navigator tracker is automatically
breath-hold Navigated placed over the right hemidiaphragm
TR (ms): 5217 6.2 6.2 6.4 and synchronizes with the patient’s
TE (ms): 71.7 3.1 3.1 3.1 breathing pattern to reduce respiratory
ghosting artifacts. Acceptance window
FOV (cm): 44 42 42 42
and threshold levels can be adjusted
Slice thickness 5 / 0.5 4.4 4.4 4.4 during the acquisition, which helps
(mm):
eliminate failures due to changes in the
Frequency: 112 320 320 320 patient’s respiratory cycle, especially as
Phase: 128 224 224 224 the patient begins to relax in the MR bore.
NEX: b50 = 4; 1 1 1 Combining Auto Navigator with DISCO
b1000 = 12
delivers excellent image quality with a
Zip: 2 2 2 free-breathing, dynamic scan without
Scan time 3:18 0:15 (sec.) 0:45 (sec.) 5:34 sacrificing resolution.
(min):
Options/other: b50, b1000 6 phases Patient history
RTr with view shared A 70-year-old man was referred to
ADC map (14 sec/phase)
+ 6 phases MR for evaluation of hepatocellular
delayed non- carcinoma (HCC) after surgery, targeted
view shared therapy and biliary duct prosthesis.
k-space
(40 sec/phase)
A B
Discussion high-resolution images (2.2 mm, 320 x 224 resolution allowing contrast
Without the availability of the Auto matrix, two arterial phases, three venous enhancement analysis on arterial,
Navigator free-breathing protocol, phases and late enhancement to 5 portal and late phases. DISCO Flex
the exam quality would have been minutes). Additionally, TDI enabled high is easy to use and minimizes the
insufficient for the radiologist to evaluate signal and high-resolution imaging so technologist’s concern regarding
patient treatment and detect the we could acquire DWI with a b-value of enhancement timing. The addition of
new lesions due to the patient’s poor 1000, 5 mm slice thickness and good SNR. Auto Navigator and respiratory trigger
breathing pattern and inability to hold offer a comprehensive free-breathing
DISCO with Auto Navigator delivers
their breath. DISCO with Auto Navigator protocol that provides images without
simplicity of prescription, high
allowed the radiologist to examine breathing artifacts for high-quality
spatial resolution and good temporal
hepatic contrast enhancement with abdominal imaging.
Introduction options, accurate identification and (CNR) and a reliance on the patient’s
Increasing demands are made upon characterization of hepatobiliary ability to breath-hold for adequate
MR in the workup of patients with lesions is critical. Patients listed for periods of time.3 In addition, signal loss
hepatobiliary disease. This is especially transplantation for chronic liver disease, secondary to susceptibility artifact
true in the evaluation of those with including those with cholangiopathies, and motion is more pronounced, in
cholangiopathies in which high-quality require optimal imaging because the particular within the left liver where
imaging is critical for the initial disease identification of a malignancy may cardiac pulsation often markedly
diagnosis and also in surveillance ultimately preclude transplantation. compromises image quality.3
imaging for the development of Of proven importance is diffusion-
Navigator-echo triggered DWI can
malignancy. In addition, there has been weighted imaging (DWI) due to its
track diaphragmatic motion during
continued expansion of treatment sensitivity for detecting lesions and, in
free-breathing and subsequently
options available to patients with some cases, its utility in characterizing
trigger data acquisition in quiescent
primary and secondary hepatic them.1 Furthermore, in patients unable
periods of the respiratory cycle.3 Given
malignancies previously considered to undergo contrast-enhanced MR
the importance of this sequence, this
untreatable. Surgical resection imaging due to renal dysfunction,
technique has superseded breath-
and locoregional therapies such as DWI is of even greater importance for
hold DWI at our institution and has
radiofrequency ablation, transarterial lesion detection.
resulted in increased confidence in
embolization/chemoembolization
Several techniques exist for DWI lesion detection and repeatability. The
(TAE/TACE), radioembolization, hepatic-
evaluation of the liver, including breath- method is particularly applicable within
arterial infusion pump-delivered therapy
hold, free-breathing, respiratory and the left liver to mitigate the effects of
and external beam radiotherapy
navigator-echo triggered acquisitions.2 cardiac motion and within the most
are all currently available treatment
While breath-hold DWI has the superior segments on the right where
strategies. While traditionally colorectal
advantage of speed of acquisition, the proximity of lung parenchyma
metastases have been targeted
disadvantages include inferior often results in image degradation.
for therapy, other tumor types are
signal-to-noise ratio (SNR), which The resultant high resolution and
increasingly being considered for
is particularly pronounced at high relative insensitivity to motion artifact
more aggressive intervention.
b-values and necessitates thicker has also, on occasion, led to the
Given the high cost and potential of slice partitions and reduced spatial detection of extrahepatic disease that
associated toxicity to normal tissues resolution. This results in inferior would otherwise almost certainly go
and organs of many cancer treatment lesion-to-liver contrast-to-noise ratios undetected with MR.
C D E
Case Studies
Unenhanced LAVA Flex T1-weighted In addition, a small hyperintense
imaging demonstrated a tiny focus was visible within the right
hyperintense lesion within segment 5, lung base, which in retrospect was
of high signal on DWI but indeterminate present three months prior, although
Apparent Diffusion Coefficient (ADC) less conspicuous (Figure 2). On repeat
findings due to image artifact (Figure 1). review of the previous CT imaging
Due to its small size and indeterminate performed at the same time as the
nature, early interval imaging was advised, original MR study, a tiny nodule was
although initial findings were concerning, visible at this location, raising concern
given the known innate T1 hyperintensity for pulmonary metastasis. Restaging CT
of melanoma metastases. imaging of the chest was advised, which
confirmed an enlarging lung nodule
At follow-up, the patient’s inability
consistent with metastatic disease.
to breath-hold for some sequences
Patient management subsequently
resulted in suboptimal T1-weighted
changed significantly to immunotherapy
image quality but confirmed a
with avoidance of unnecessary surgery
persistent tiny hyperintense lesion, now
or locoregional therapy.
with unequivocal restricted diffusion
A B C
D E F
Figure 4. (A, D) MAGiC DWI b1000 images demonstrating a ring of restricted diffusion within the inferior common bile duct immediately
upstream of the stricture shown in Figure 3B. (B, E) Axial T2w PROPELLER images fused with (C, F) false color DWI images demonstrate
correlation with subtle irregular mural thickening and T2 hyperintensity at the level of the stricture (arrows). (C) Subtle diffusion
restriction was also present within the regions of fibrosis (asterisk).
*
Figure 5. Axial endoscopic ultrasound image
at/immediately below the abnormal mural
P SMV
thickening seen in Figure 4. (P) = pancreas,
(SMV) = superior mesenteric vein. A core
biopsy needle (arrow) can be seen entering
luminal soft tissue (asterisk).
Image courtesy of Dr. N. Carroll, Consultant Radiologist,
Cambridge University Hospitals.
A B
A B
In cardiac patients, particularly those A strong saturation of healthy The introduction of a phase sensitive
who have a history of ischemia, myocardium signal on MDE sequences MDE (PS MDE) sequence now allows
determining myocardial viability is allows for a better delineation and for better suppression of healthy
critical for planning the patient care assessment of ischemic induced cardiac myocardium signal even with non-
pathway as it allows us to identify fibrosis. However, the most optimal optimal TI values. Additionally, we can
patients who would not benefit from inversion time value (TI) is needed for avoid rescanning patients in cases of
angioplasty. Myocardial delayed acquiring a reliable and clinically useful poorly suppressed healthy myocardium
enhancement (MDE) sequences are MDE study. Cine IR allows us to obtain signal due to incorrect TI value selection
typically employed for these studies. this value even though the TI time by only evaluating the PS MDE sequence
continually changes as the contrast (see Figure 1).
washes out.‡
SIGNA™ Explorer
PARAMETERS
FIESTA FIESTA FIESTA FIESTA Tagging Perfusion, 2D MDE 2D MDE 4 2D MDE PS MDE
Gated Gated Gated Gated SA multi SA chambers LA SA
Cine SA Cine LA Cine 4 Cine planes
chambers LVOT in SA + 4
chambers
TR (ms): 4.3 4.3 4.1 4.3 5 3.3 4.9 4.8 4.7 7.6
TE (ms): 1.9 1.9 1.8 1.9 2.3 1.6 1.4 1.4 1.3 3.5
FOV (cm): 38 38 38 38 40 x 28 38 x 34.2 40 x 36 40 x 36 40 x 36 38 x 34.2
Slice 8 8 8 8 8 10 9 9 9 9
thickness
(mm):
Frequency: 224 224 224 224 256 128 224 224 224 200
Phase: 224 224 224 224 192 96 160 160 160 192
NEX: 1 1 1 1 1 0.75 3 3 3 1
Scan time 1:15 1:17 1:09 0:19 1:49 1:04 2:06 1:59 2:11 2:00
(min): (sec.)
Options / After After 25
other: 8 min. of min. of
contrast contrast
bolus bolus
‡Drug products should be used in accordance with their approved labeling. Gadolinium-based contrast agents have not been approved for cardiac use in all regions.
A B C
Figure 2. Myocardial viability study. (A, B with color map) 2D PS MDE SA, 1:59 min.; and (C) 2D MDE 4 chambers, 2 min. Yellow arrows indicate
ischemia-induced fibrosis.
A B C D
Figure 4. (A) Perfusion FGRE TC SA, 1:04 min.; (B) PS MDE SA with color map, 2 min.; and (C, D with color map) 2D MDE 4 chambers, 1:59 min.
Red arrows show the sub-endocardial no-reflow phenomenon on the inferoseptal region of the apex.
PS MDE provides very good contrast Cardiac MR (CMR) brings a new level of clinical confidence due to excellent
and good delineation of fibrosis, detail and depth to our diagnosis and imaging capabilities that assists us
especially in cases where determining management of coronary disease. In in myocardium viability studies as
the optimal TI value is complicated. We particular, it supports management well as diagnosing difficult-to-detect
now have an alternative with PS MDE of hypertrophic cardiomyopathy conditions, such as myocarditis and
that appears to be as efficient as the patients and post-operative follow-up arrhythmogenic right ventricular
traditional MDE sequence. in Tetralogy of Fallot cases. With CMR dysplasia. CMR on the SIGNA™ Explorer
and an advanced 1.5T MR system such adds real value to patient care.
as SIGNA™ Explorer, we have higher
Acceleration techniques having to scan the entire FOV or use synthetically calculating and providing
HyperWorks is a collection of no-phase wrap. It lowers scan time multiple and higher b-values. In fact,
advanced acceleration techniques without SNR loss, eliminates time- it provides higher b-values than what
that deliver fast scanning—up to 8 consuming parameters and enables can be acquired and improves image
times faster—with excellent image better image quality. For large FOV sharpness and SNR with shorter TEs.
quality. Designed to speed up scanning robust fat suppression, HyperCube It is compatible with all diffusion
to reduce the potential for motion can be combined with Flex. directions and coils.
artifacts and, therefore, repeat exams,
ARC is auto-calibrating, which means
HyperWorks includes HyperSense, Volumetric MR
that it requires no coil sensitivity map
HyperBand and HyperCube. Cube, a volumetric FSE-based
and is therefore less sensitive to motion
• HyperSense is a compressed artifacts that would occur between the sequence, allows an image captured
sensing acceleration technique calibration and accelerated scan. It can in one plane to be reformatted to any
based on sparse data sampling and be used with tight FOVs that are smaller other scan plane, potentially eliminating
iterative reconstruction, enabling than the anatomy being imaged and the need for additional multi-planar 2D
faster imaging without the penalties thus allow high-resolution imaging. FSE acquisitions. Compatible with both
commonly found with conventional free-breathing and respiratory-
parallel imaging. It uses a triggered sequences to reduce motion
Synthetic MR
mathematical approach to identify artifacts, Cube also decreases flow
MAGiC is a multi-delay, multi-echo
and calculate data into an image artifacts in the spine, ortho and brain
FSE sequence that generates images
versus scanning to collect all the applications. Since Cube modulates
of any TR, TE and TI after a single
data needed for that image. It can the RF pulse, there is reduced blurring,
scan has been acquired, even after
be used for 88 percent of all clinical commonly associated with long Echo
the patient is gone. It automatically
procedures and is compatible with Train Length sequences. It can also be
outputs eight contrasts—T1, T2, PD,
Cube and TOF sequences. utilized with ARC and/or HyperSense
T1 FLAIR, T2 FLAIR‡, STIR, DIR and
to further reduce scan time, making 3D
• HyperBand, compatible with DWI PSIR—in approximately 5 minutes of
acquisitions consistently attainable.
and diffusion tensor imaging (DTI) scan time. In addition, MAGiC provides
and ARC, speeds up scan time by quantitative parametric maps, including Flex for Cube and FSE Flex use
exciting and acquiring multiple T1, T2, R1, R2 and PD. MAGiC can a 2-point Dixon technique for
slices simultaneously to shorten provide more diagnostic information homogeneous FatSat with water, fat,
acquisition time. HyperBand also without adding scan time even after in-phase and out-of-phase images
allows the ability to acquire thinner the patient has left. in a single scan. With Cube Flex,
slices in the same scan time for DWI the technologist can scan once and
MAGiC DWI is a synthetic DWI
or acquire more diffusion tensor then reformat to any plane with high
sequence that calculates multiple
directions on DTI. sub-millimeter resolution. FSE Flex
b-values from a single DWI scan. In
acquires multiple contrasts in a single
• HyperCube accelerates small field- DWI, increasing the b-value decreases
scan, reducing the need for multiple
of-view (FOV) 3D volumetric imaging SNR and increasing the number of
acquisitions, which is particularly useful
for more detail in less time without b-values increases scan time. MAGiC
for post-contrast spine or MSK imaging.
DWI address both of these issues by
‡It is recommended to acquire conventional T2 FLAIR images in addition to MAGiC.
B C
Figure 3. DISCO with Auto Navigator enables a free-breathing dynamic DCE liver exam with high resolution. (A) Axial T2 SSFSE 352 x 224, 4 mm
slice, scan time of 40 sec.; (B) Coronal T2 SSFSE, 320 x 224, 4 mm slice, scan time of 33 sec.; and (C) Coronal Turbo LAVA, 320 x 192, 3 mm slice,
scan time of 19 sec.
Images courtesy of Seirei Hamamatsu Hospital, Japan.
ViosWorks delivers a comprehensive More recently, PROPELLER Multi-shot The navigator tracker is automatically
cardiac anatomy, function and flow Blade (MB) advancements combine placed over the right hemidiaphragm
in a free-breathing, eight-minute multiple blades together to achieve and synchronizes with the patient’s
scan. It provides visualization and shorter TEs and improved motion breathing pattern to minimize
quantification of 4D flow, tools to assess correction. It allows for true T1 and PD respiratory ghosting artifacts. Real-time
and quantify complex hemodynamics in contrast imaging. Both PROPELLER and adjustment allows threshold levels
cardiovascular disease, and increases PROPELLER MB are compatible with and acceptance window to be adjusted
productivity and patient comfort by Auto Navigator. during the acquisition, eliminating
acquiring one 3D volume over the chest. failures due to changes in the patient’s
PROMO (PROspective MOtion
When used with HyperKat, ViosWorks respiratory pattern. Auto Navigator
correction) delivers prospective motion
reduces the number of slices needed. can gate or trigger the patient’s
correction for 3D brain imaging when
Cloud-based post-processing powered respiratory cycle.
combined with Cube T2, Cube FLAIR
by Arterys™ also allows image analysis
and Cube DIR. Motion is measured
from anywhere using an internet browser. High susceptibility
in real time by acquiring three-plane
spiral Auto Navigator with a motion MAVRIC SL is designed to greatly
Motion tracking algorithm. A mask is applied reduce artifacts caused by the presence
PROPELLER is a multi-shot approach to navigators to remove non-rigidly of MR-Conditional metal implants,
that preserves tissue contrast moving tissue from motion estimates. substantially reducing susceptibility
regardless of weighting while also Six rigid motion parameters are artifacts and significantly improving
reducing motion artifacts and produced in real time by the PROMO visualization of bone and soft tissue.
providing a more signal rich image. tracking algorithm to prospectively It provides the potential to visualize
Rather than filling k-space line-by-line, correct for a patient’s motion during arthroscopic complications, fluid near
PROPELLER fills it with an arrangement the scan. an implant and adverse local tissue
of “blades” that are rotated in k-space reaction. MAVRIC SL acquires several
at incremental angles, resulting in an Auto Navigator, a free-breathing 3D FSE images at multiple spectral
oversampling of the center of k-space approach, combats respiratory motion offsets that are combined into a single
for a more signal-rich image. It delivers for body, cardiac and chest imaging 3D composite data set to remove
motion-artifact-reduced diagnostic with automatic tracker placement. distortions commonly caused by
images that are not impacted by It is compatible with all critical body MR-Conditional metal implants. It also
respiration and peristalsis, potentially imaging sequences, such as diffusion, has a T1-weighting capability for pre-
decreases the number of repeat scans PROPELLER, T2 MRCP and dynamic T1 and post-contrast enhancement.
and enables sedation-free scanning. imaging (LAVA, LAVA Flex and DISCO).
D E F
Figure 4. MUSE allows for advanced diffusion with reduced distortion and increased resolution. (A-C) SS diffusion, 2 x 2 x 3 mm. (D-F) 16-shot
MUSE, 0.75 x 0.75 x 3 mm.
Images courtesy of Duke University, North Carolina, USA.
FOCUS DWI, an EPI diffusion technique, MUSE (MUltiplexed Sensitivity PROGRES, which includes Distortion
enables smaller FOV imaging of Encoding) reduces blurring and Correction, addresses distortion in
anatomy for constrained, undistorted susceptibility induced distortions diffusion scans that typically arise from
single-shot diffusion imaging. This 2D compared to conventional parallel B0 inhomogeneity and the EPI readout
spatially-selective RF excitation method imaging techniques while pushing but can also occur less frequently
for DW-EPI and DTI is designed to the boundaries of spatial resolution from motion and gradient-related
reduce FOV in-phase encode direction for DWI/DTI imaging. Traditionally, imperfections such as eddy currents.
within the imaging plane to reduce higher resolution DWI/DTI imaging This technique uses a “reverse polarity”
geometric distortion and eliminate was challenged because of imaging acquisition and automated advanced
phase wrap artifacts. By using a small artifacts. The longer readout length processing to eliminate sources of
FOV, FOCUS DWI increases image and echo spacing lead to blurring and distortion. It is most effective when
sharpness and resolution, and delivers susceptibility artifacts. MUSE improves SNR is high and provides the best high-
less blurring and distortion in high DWI and DTI image quality by acquiring resolution distortion reduction when
susceptibility areas. It is ideal for use phase-segmented DW-EPI and allowing combined with MUSE.
in the spine, prostate, gynecologic, higher resolution diffusion imaging in
brain and pancreas imaging and can large matrix sizes, up to 512 x 512. It Reference
1. Andre JB, Bresnahan BW, Mossa-Basha M, et al. Toward
be used with 1.5T and 3.0T systems. provides submillimeter in-plane image Quantifying the Prevalence, Severity, and Cost Associated
resolution and can be combined with in- With Patient Motion During Clinical MR Examinations. J Am
Coll Radiol. 2015 Jul;12(7):689-95.
and through-plane image acceleration
techniques for enhanced speed and
coverage. MUSE is particularly beneficial
in anatomical areas that are vulnerable
to susceptibility artifacts, such as the
brain and prostate.
hyperpolarized gas MR imaging “The ability to rapidly switch the scanner most sensitive method for detecting
with a homogeneous field. To to image one nucleus and then the abnormalities. The technique also
accomplish this, they developed a next to obtain functional and structural provides detailed regional information
flexible 32-channel receive array‡ to information together from the same coil on physiological impairment and
use with an asymmetric birdcage is very interesting methodologically,” he disease severity, as well as longitudinal
transmit coil‡, which enables high says. “In one project, we have worked changes in lung function.7
SNR in an accelerated acquisition. The closely with GE on ways for rapidly
“This study demonstrated the ability to
asymmetric birdcage was shown to switching the scanner coils between
follow a given patient and assess their
provide a homogeneous flip angle over different nuclear frequencies using
lung function over time, something
the large FOV needed to image the micro-electro-mechanical switches.”4
that cannot be obtained by pulmonary
entire lung, while the flexible receive
Since the xenon is inhaled, it also goes function tests,” explains Professor Wild.
array allowed it to be placed close
into the blood. With the long relaxation
to the patient’s chest to enable high Another study examined the use of
time of xenon, Professor Wild and his
acceleration factors. The reduction hyperpolarized 129Xe MR imaging in
colleagues have imaged it in other organs.
in scan time provided by the use of 18 patients with idiopathic pulmonary
parallel imaging allowed shorter patient “We’ve picked up dissolved xenon in the fibrosis (IPF). Professor Wild and
breath-holds.2 brain and kidneys, so we can monitor co-authors concluded that this
cerebral perfusion and kidney perfusion technique may be sensitive to short-
In collaboration with GE Healthcare,
with this technique,” he adds.5,6 term changes in interstitial gas
Professor Wild and his team at Sheffield
diffusion in patients with IPF. This is
also developed a dedicated 1H receiver
Evidence-based studies important because prognosticating
array‡ that could improve the SNR that
In a published clinical study of 19 IPF remains challenging due to the
captures both function and structure
pediatric patients with clinically stable absence of sensitive biomarkers.
for use in same-breath acquisition
mild cystic fibrosis, hyperpolarized gas Existing pulmonary function tests,
with hyperpolarized gas 3He or 129Xe
ventilation MR was found to be the such as forced vital capacity (FVC)
without having to move the patient
and diffusing capacity of the lungs for
or switch coils.3
C D E
carbon monoxide (DLCO) are insensitive In addition, Professor Wild also 6. Rao MR, Stewart NJ, Griffiths PD, Norquay G, Wild JM.
Imaging Human Brain Perfusion with Inhaled Hyperpolarized
to longitudinal physiological changes believes the technique could be used 129
Xe MR Imaging. Radiology. 2018 Feb;286(2):659-665.
that can help a clinician assess disease by pharmaceutical companies in early 7. Marshall H, Horsley A, Taylor CJ, et al. Detection of early
subclinical lung disease in children with cystic fibrosis by
progression and treatment response.8 drug design trials for new therapies to lung ventilation imaging with hyperpolarised gas MRI.
treat asthma, COPD and interstitial Thorax. 2017 Aug;72(8):760-762.
In 20 adult asthma patients treated 8. Weatherley ND, Stewart NJ, Chan HF, et al. Hyperpolarised
lung disease.
with a bronchodilating agent, two sets xenon magnetic resonance spectroscopy for the longitudinal
assessment of changes in gas diffusion in IPF. Thorax. 2018
of baseline images using hyperpolarized He adds, “The ability to monitor change Nov 2. pii: thoraxjnl-2018-211851.
gas ventilation MR were captured before existing lung function testing is 9. Horn FC, Marshall H, Collier GJ, et al. Regional Ventilation
Changes in the Lung: Treatment Response Mapping by Using
prior to treatment and one set after where this technology is really making Hyperpolarized Gas MR Imaging as a Quantitative Biomarker.
treatment. Treatment response a difference in respiratory disease.” Radiology. 2017 Sep;284(3):854-861.
techniques and providing sensitive 2. Deppe MH, Parra-Robles J, Marshall H, Lanz T, Wild JM. A
Flexible 32-channel Receive Array Combined With a
outcome measures that cannot be Homogeneous Transmit Coil for Human Lung Imaging
With Hyperpolarized 3He at 1.5 T. Magn Reson Med.
obtained with pulmonary function tests.9 2011 Dec;66(6):1788-97.
3. Rao M, Robb F, Wild JM. Dedicated Receiver Array Coil
“Using the hyperpolarized gas lung MR for 1H Lung Imaging with Same-Breath Acquisition of
technique, we could assess treatment Hyperpolarized 3He and 129Xe Gas. Magn Reson Med.
2015 July;74(1):291-299.
response and monitor how specific
4. Maunder A, Rao M, Robb F, Wild JM. Comparison of MEMS
parts of the lung responded to the switches and PIN diodes for switched dual tuned RF coils.
inhaled therapy,” Professor Wild says. Magn Reson Med. 2018 Oct;80(4):1746-1753.
5. Rao MR, Norquay G, Stewart NJ, Hoggard N, Griffiths PD,
“We have a methodology that is safe, Wild JM. Assessment of brain perfusion using hyperpolarized
repeatable and robust with added 129
Xe MRI in a subject with established stroke. J Magn Reson
Imaging. 2019 Feb 18. doi: 10.1002/jmri.26686.
sensitivity to the early signs of lung
disease and small changes in response
to therapy.”
Tech Trends
digital platform for AI
GE Healthcare’s vision for precision This advanced intelligence platform is • cmr42 analysis, a DL-based contour
health is to enable the right outcome, the foundation for building applications detection for comprehensive cardiac
for the right patient, delivered at and devices that will help radiologists get MR analysis on the AW or AW Server.
precisely the right point of care. Edison faster access to better clinical insights,
• Quantib Brain, an automatic
is GE’s intelligence offering comprised workflow improvements and the latest
labeling, visualization and volumetric
of applications and smart devices built innovations. Edison is comprised of
quantification of brain structures
to help enable this vision. applications (Edison Applications),
that uses ML-based automatic
devices (Edison Smart Devices) and
GE has been investing in digital and segmentation of brain tissues and
developer services (Edison Platform).
artificial intelligence for many years. white matter hyperintensities.
Edison is part of GE’s $1 billion and Edison Applications are a set of
• Liver AI, powered by Arterys™, a DL-
growing Digital portfolio and will serve applications developed by GE and
powered volumetric segmentation and
as a “digital thread” for its existing clinical partners that deliver analytics
longitudinal tracking of liver lesions
artificial intelligence partnerships and artificial intelligence across
according to LI-RADS® scoring.
and products. GE devices. These applications derive
intelligence from data and content, An example of Edison Intelligent
Edison provides one common platform
providing healthcare providers with Applications is AIRx™‡, GE’s intelligent
to build both descriptive (business
actionable insights to enhance and MR slice prescription designed to help
intelligence) and prescriptive (artificial
augment their clinical, financial and technologists determine the best
intelligence) applications. The platform
operational decision-making. position for the slices. AIRx™ rapidly
is a holistic and integrated digital
identifies anatomical landmarks and
platform for healthcare, combining In MR, these applications include:
helps deliver consistent and accurate
globally diverse data sets from across
• Intelligent SAR management, scans regardless of patient position,
modalities, vendors, healthcare
developed with a machine learning time between scans or technologist.
networks and life sciences settings.
(ML) algorithm for fast and accurate
Edison enables continuous innovation GE’s strategy for Intelligent MR is to
SAR estimates
to GE’s installed base, a common use patient-adaptive technologies
platform that will enable multimodality • ViosWorks, powered by Arterys™, a and applied intelligence – artificial
orchestration of data, giving clinicians comprehensive cardiac MR analysis intelligence and analytics – to enable
access to insights for each individual accelerated by AI, including 4D precision diagnostics and ensure that
patient using all relevant data sources, Flow, with deep learning (DL) based the right actions are taken at the right
and a modern software architecture automated segmentation. ViosWorks time for each and every patient.
that accelerates the development of leverage the learning analytic power
advanced intelligent applications of the cloud. ‡Not licensed in accordance with Canadian law. Not available
for sale in Canada. Not CE marked. Not available for sale in
all regions.
that resonate
brand philosophy, the SIGNA™ Masters program
encapsulates the spirit of innovation, serving as an
exclusive community of MR experts coming together
to share best practices, conventional wisdom and
industry insights. It’s this strength in numbers that
helps us continue to lead the charge in MR.
www.gehealthcare.com/signamasters
PET/MR Summit
June 26-27
Los Angeles, US
Neuro Summit
Dates TBD
USA
Americas Summit
September 8-10
Miami, US
MR-0512-04.19-EN-US
JB66236XX