Signa Pulse Sp2019-Lr1

™
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
6 Video game tech fueled ViosWorks 37 New deep learning tool

streamlines MR slice prescription
6 Clear the AIR
38 An upgrade that meets the
6 EPI in the mix expectation for higher resolution,
SNR and productivity
7 MR optimizes diagnoses and
long-term patient management 42 Ultra-flexible AIR Technology™
Suite making a difference in the
7 European team technologist’s workflow
awarded 3.2M grant
46 MR Excellence Program is a beacon
8 New software release focuses for optimizing MR imaging workflow
on enhancements and the patient experience
8 Localizing pain with PET/MR 51 Cardiac MR in patients with CIEDs
Publications Team: Editorial Board:

Stephanie Broyhill Heide Harris Allen Song, PhD R. Scott Hinks, PhD
Editor-in-Chief Clinical Editor Director of the Duke Chief Scientist, MR
Marketing Global Product University Brain Imaging Jason Polzin, PhD
Communications Marketing Director, and Analysis Center General Manager,
Leader, Global MR MR Applications and Professor of Radiology, MR Applications and
Anna Brown Visualization Duke University Workflow
Associate Editor Steve Lawson Ersin Bayram, PhD Guillermo Zannoli, PhD
Marketing Operations Clinical Editor Body & Clinical Clinical Marketing
and Brand Management Clinical Marketing Applications Manager, Manager, MR Europe
Director, Global MR Manager, Global MR MR
Mary Beth Massat RocketLawnchair Katrin Herrmann, PhD
Associate Editor Design & Production Former Global Product
Marketing Manager,
MR Applications and
Visualization
gehealthcare.com/mr 2 SIGNA Pulse of MR

Case Studies
56 Body imaging with AIR Technology™
Anterior Array and Posterior Array
60 Neuro imaging with

48-channel Head Coil Tech Trends
64 Diffusion imaging with 80 SIGNA™Works: tuned for productivity
AIR Technology™ Suite and efficient workflows
66 Free-breathing liver imaging using 84 Hyperpolarized gas lung imaging
DISCO with Auto Navigator
87 Edison a common, integrated
69 Free-breathing navigator-echo digital platform for AI
triggered diffusion-weighted imaging in
the evaluation of hepatobiliary disease
74 3D MRCP with HyperSense:

an evaluation of respiratory-triggered
and breath-hold sequences
77 Detecting ischemia-induced cardiac

fibrosis with phase sensitive MDE
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
© 2019 General Electric Company, doing business as GE Healthcare. All rights reserved. The copyright, trademarks, trade names and other intellectual property rights subsisting in or used in connection
with and related to this publication are, the property of GE Healthcare unless otherwise specified. Reproduction in any form is forbidden without prior written permission from GE Healthcare.
LIMITATION OF LIABILITY: The information in this magazine is intended as a general presentation of the content included herein. While every effort is made by the publishers and editorial board to see
that no inaccurate or misleading data, opinion or statements occur, GE cannot accept responsibility for the completeness, currency or accuracy of the information supplied or for any opinion expressed.
Nothing in this magazine should be used to diagnose or treat any disease or condition. Readers are advised to consult a healthcare professional with any questions. Products mentioned in the magazine
may be subject to government regulation and may not be available in all locations. Nothing in this magazine constitutes an offer to sell any product or service.
gesignapulse.com 3 Autumn 2018

MR is elevating radiology
and patient care
Welcome to the 2019 Spring Edition of AI may also assist in our ability to
SIGNA™ Pulse of MR. As the inaugural detect diseases at an early stage when
Guest Editor, I am honored and excited treatments may be most effective.
to share some of my thoughts with you. Importantly, together AI and ML bring In addition to these developments at
I hope that you will enjoy reading the many the latest technologies to all corners the forefront, it is worth noting that
clinical and technical advancements of the world. GE is also making a concerted effort to
highlighted in this issue; several are extend its cutting-edge technologies
Articles in this issue are partial
made possible by the collective effort across the product portfolio, making
reflections of this exciting evolution.
of GE Healthcare’s academic partners them accessible to all. For example,
On the expanding roles of MR, for
that further elevate radiology. the industry-first AIR Technology™‡
example, we see how the development
that has demonstrated its superiority
The past decade has truly been an of an MR-only planning workflow at
on the top-of-the-line SIGNA™ Premier
exhilarating period with multiple Skåne University Hospital, Sweden,
platform has been migrated to the
advances converging, fueled by is changing our way of performing
SIGNA™ Architect platform (see articles
technological innovations. We’ve radiation therapy; we see that the
featuring The Queen Silvia Children’s
seen the extension of MR as a mostly use of PET/MR at the Medical College
Hospital, Osaka University Hospital
diagnostic tool into the realm of therapy of Wisconsin and Children’s Hospital
and Kawasaki Saiwai Hospital), thus
and preventive healthcare. Indeed, of Wisconsin is facilitating pediatric
benefiting a wider population.
the field of MR, whether in the clinic or cancer staging and restaging; and we
research center, has been technology see that whole-body diffusion MR at Using somewhat fitting jargon, I feel
driven. There is a constant thirst for PRIISM, EHP Kara in Algeria allows that this issue is a “HyperSense”
higher field strengths, stronger gradient metastatic lesion detection. The sampling of all the MR advances
power, more RF channels and faster never-ending technological innovations happening at GE, from which you can
imaging speeds, leading to more continue to remove traditional hopefully reconstruct and infer a more
efficient and precise ways of gathering obstacles and open new avenues. For complete image of GE MR today. From
knowledge. While these front-end example, the integration of HyperSense high-power gradient systems, the
innovations in image acquisition are acquisition for accelerated scanning transformative and comfortable AIR
continuing, there is a recent revolution and next-generation body navigators Technology™ Suite, innovative pulse
in data sciences encompassing the are making free-breathing MR a reality sequences, to new applications in the
full span of an MR workflow. With the for body applications (see case study brain and body; from disease diagnosis,
emergence of artificial intelligence (AI) from Medipole de Savoie). The adoption to therapy and monitoring patients
and machine learning (ML) algorithms, of high-channel count arrays, increased with chronic disease; from leading MR
we may exact, analyze and share much gradient performance and fast imaging centers to rural corners of the world,
richer and more detailed information techniques now offer unprecedented GE MR is bringing great things to, and
than previously possible. For example, and exquisite details of the human elevating the quality of, life.
AI and ML embedded on the MR scanner brain (see 48-channel Head Coil case
may help enhance consistency in image study from RNR). The infusion of AI and
acquisition and raise the probability for deep learning algorithms are helping
great results. Other advances may help to automate workflow (see article
increase the amount of information on AIRx™‡ at Fairfax Radiological Allen Song, PhD,
available to us for disease diagnosis and Consultants) and making the MR Director of the Duke University
for guiding therapeutic interventions. images more informative and accessible. Brain Imaging and Analysis Center
and Professor of Radiology at
Duke University, Durham, NC
‡Not licensed in accordance with Canadian law. Not available for sale in Canada. Not CE marked. Not available for sale in all regions.

Leading the AI charge Global MR market size
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
gesignapulse.com 5 Spring 2019

Clear the AIR
GE Healthcare’s AIRx™‡ technology was
cleared by the FDA in January 2019. This
AI-based, automated workflow tool for brain
scanning is designed to increase consistency
and productivity by providing automated slice
prescriptions to help reduce previously redundant,
manual steps. AIRx™ is intended to produce images that
have less variability between technologists and between
scans to help lower the chances for retakes due to incorrect
Video game tech slice placement.
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
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.
SIGNA Pulse of MR – digital library

View this issue and those from the past at: www.gesignapulse.com

European team
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,
deep learning, silent imaging and
parameter mapping as a key reason
for the award.
Read the full article at:
tiny.cc/sps194
To learn more about

the grant, visit:
https://www.eithealth.eu/.

New software release focuses on enhancements
Consistent, excellent image quality is not only one of the top
needs from MR customers but also the bread-and-butter of the MR Cube T2 LSpine (Selective Excitation)
modality. Therefore, GE Healthcare MR never stops looking at existing
Before DV28.0
applications and analyzing what can be done to further improve them.
According to Wei Sun, Engineering Manager for MR Pulse Sequence/
Applications Development at GE Healthcare, MR users will be thrilled
with some of the enhancements the new DV28.0 software release
will bring.
DV28.0, available mid-2019, will launch on the 3.0T product line first
including SIGNA™ Premier, SIGNA™ Architect and SIGNA™ Pioneer, and
will then integrate into our 1.5T products. It will feature enhancements
to Cube, Cube T2 FLAIR, FSE T2 FLAIR, PROPELLER, LAVA, 3D FIESTA
and other applications. The enhancements produce images with less
wrap-around artifacts, darker backgrounds and higher contrast and In DV28.0 (Slab wrap reduction)
SNR than prior generations.
The before and after DV28 images demonstrate remarkable
improvements as illustrated in updates to Cube.
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.
Localizing pain with PET/MR

The number of people who suffer Two recent studies led by Dr. Biswal chronic knee pain was resolved by
from pain is striking. The Institute of highlight the use of PET/MR in localizing removal of an intraarticular synovial
Medicine (IOM) reports that over 100 pain. In the first study using the lipoma, which had shown increased
million adults in the US have chronic SIGNA™ PET/MR, Dr. Biswal studied the uptake of the novel, Sigma-1 receptor
pain, while worldwide, 1.5 billion feasibility of using an 18F-FDG PET/MR specific radioligand 18F-FTC-146 on
individuals suffer from pain related to approach for improved diagnosis of simultaneous PET/MR. It was noted
cancer treatment and other conditions. chronic sciatica. In the study of nine that the patient had previously
As doctors and patients look for ways patients with chronic sciatica and five undergone a variety of unsuccessful
to address pain beyond the use of healthy control volunteers, significantly orthopedic surgeries and denervating
prescription medications, the work of increased 18F-FDG uptake was observed interventions. The study illustrated the
Dr. Sandip Biswal, Associate Professor in detected lesions in all patients and promising application of 18F-FTC-146
of Radiology (Musculoskeletal Imaging) was correlated with pain symptoms. PET/MR as an improvement over MR
at the Stanford University Medical 18
F-FDG-avid lesions not only were alone as an imaging modality for
Center, becomes all the more pertinent. found in impinged spinal nerves but detecting pain generators.
also were associated with non-spinal
Dr. Biswal and his team have been Further studies to validate using
causes of pain, such as facet joint
developing clinical imaging methods PET/MR to localize pain could
degeneration, pars defect or presumed
to objectively pinpoint the site of potentially facilitate, among other
scar neuroma.
pain generation using novel agents things, more intelligent management
that specifically seek out molecular The second study focused on of chronic pain.
and cellular pain markers to highlight localizing knee pain in a 50-year-old
hypersensitive pain-sensing nerves. patient. In the study, the patient’s

Issue Spotlight
Adalsteinn Gunnlaugsson,
Lars E. Olsson, PhD MD, PhD
Skåne University Hospital Skåne University Hospital
Lund, Sweden Lund, Sweden
Development of an MR-only radiation

therapy workflow
Skåne University Hospital developed a new workflow for MR-only
radiation therapy treatments to improve accuracy of treatments and
enable further increases in radiation dose to specific areas with more
precision. The goal was to have an MR-only workflow that would avoid
the introduction of image registration errors by using both MR and CT
imaging. This work has been validated through numerous research
studies conducted by Skåne University Hospital.
CT has historically been utilized as the By 2015, a team led by Lars E. Olsson, Unfortunately, the alignment will not be
primary imaging modality for tumor PhD, Professor of Medical Radiation perfect, which leads to additional safety
definition and dose calculation in Physics at Lund University and a margins around the target that results
radiation therapy treatment planning. physicist at Skåne University Hospital, in a higher radiation dose to healthy,
However, MR provides better soft tissue and Adalsteinn Gunnlaugsson, MD, PhD, non-cancerous tissues.
contrast and resolution than CT and a Senior Consultant in the Department
“This is a major source of error when
has been explored as an alternative for of Oncology at Skåne University
working with two different imaging
tumor definition and targeting. Hospital, began researching the use of
datasets,” says Professor Olsson.
MR-only radiation therapy planning in
Skåne University Hospital in Lund,
prostate cancer patients.
Sweden, is a pioneer in the use of MR
for radiation therapy planning. The “With MR, we are able to see the “By eliminating the CT, we can
radiation therapy department at details of what we irradiate,” says
reduce and save resources.
Skåne University Hospital installed a Dr. Gunnlaugsson. “This will better
Discovery™ MR750w, a 3.0T wide bore allow us to increase the dose to the Since we don’t have to add the
scanner, in 2013 to complement its two tumor and spare normal tissues.” extra margin, we can actually
CT systems used for simulation. Eleven reduce the dose to surrounding
Even when using MR imaging to
linear accelerators are used at Skåne
University Hospital to treat between
plan and direct cancer therapy, a CT healthy tissue. This is the
examination is still acquired for dose
6,000-7,000 cancer patients each year. reason why we want to develop
calculations in the treatment planning
Ten radiation oncologists, 22 radiation
system. However, the MR and CT an MR-only workflow.”
therapy physicists, one dedicated
need to be aligned as accurately as
MR physicist and a large group of Professor Lars E. Olsson
possible, since they are acquired on
nurses, technologists and engineers
different systems and at different times.
staff the department.
gesignapulse 9 Spring 2019

Christian Jamtheim Gustafsson,
MSc Minna Lerner, MSc
Skåne University Hospital Skåne University Hospital
Lund, Sweden Lund, Sweden
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.

Issue Spotlight
A B
Figure 2. (A) sCT is used for dose calculations in treatment planning system; (B) sCT with dose distributions.
Image 2B 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.
many sites are developing different

C-arm X-ray images that are acquired
during implantation of the gold fiducial
markers to confirm fiducial placement.
Their study demonstrated that this
approach was feasible and using the
method as described in the paper would
completely remove the need for CT
imaging, as well as potentially provide
an MRI-independent redundant method
for gold fiducial marker verification.8
The issue of geometric accuracy was
also a key concern with the use of MR-
only radiation therapy and a potential
obstacle to its use. So, it was a logical
starting point to investigate whether Figure 4. Each patient is imaged in the treatment position with patient positioning devices.
distortions from a non-linear gradient Image courtesy of Gentle Radiotherapy.
in an MR system were a true problem
or could be resolved.
“As shown in our paper, this is a very Although the MR-OPERA study validated
manageable issue,” explains Christian the generation of sCT images for the “Improving the accuracy of our
Jamtheim Gustafsson, MSc, a medical male pelvis from T2-weighted images treatment delivery will allow us
physicist at Skåne University Hospital. using MriPlanner, an independent QA
in the future to further increase
“By using 3D distortion correction evaluation of the sCT data was desired
and managing patient magnetic prior to the first treatment. Armed with dose to specific areas with
susceptibility differences by increasing published data that demonstrated the much more precision.”
the receiver bandwidth, we can address use of CBCT for patient-specific QA in
this. We’ve shown this in our papers, as brain radiotherapy9, the team explored Dr. Adalsteinn Gunnlaugsson
well as in studies from other sites, that the use of CBCT for QA of sCT data for
this really is not a problem.” Gustafsson prostate cancer patients and to verify
Increasing radiation dose to the
is in the process of submitting his PhD the sCT data in regard to absorbed dose.
target is becoming more common in
thesis, and at the end of May he will be
Not only was the CBCT system shown cancer treatments, such as intensity
the first student in the group to get his
to be equivalent to CT in terms of HU, modulated radiation therapy (IMRT)
PhD exam from the results of this project.
but dose calculations based on CT or volumetric modulated arc therapy
The acquisition of a large field-of-view and sCT data sets had absorbed dose (VMAT), to improve tumor control and
(FOV) to cover the entire pelvic region differences that were within clinically lower the risk of recurrence. Another
for sCT generation could lead to acceptable criteria. Further, errors treatment technique is stereotactic
geometric distortions, since the non- introduced into the sCT data to test body radiation therapy (SBRT), which
linear gradient effect enhances as the the QA capabilities were detected in delivers very precise, high doses
radius from the isocenter increases. the study.7 of radiation to cancer cells while
However, when 3D distortion correction minimizing radiation exposure to
and high acquisition bandwidths were From bench to bedside surrounding healthy cells.
used for images with large FOVs, no From the start, the motivation behind
clinically relevant dose difference or the research conducted by Skåne
structure deformation was detected.6 University Hospital has been to validate
the use of MR imaging in radiation
View the Gentle Radiotherapy
therapy and to rely only on MR imaging Methodology guide:
“Our initial investigation in the data in an effort to improve the tiny.cc/sps192
accuracy of treatment delivery. This
use of MR-only for brain cancers
effort has been consolidated into a
demonstrates the same guide published by Gentle Radiotherapy.
answer, that all distortion
sources are very manageable.”
Christian Jamtheim Gustafsson

Although the department at Skåne also uses 3D T1 Cube sequences in “Because we tested and validated all
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
Figure 5. T2-weighted images are

predominantly used for target
delineation in the prostate. (A-D)
PROPELLER is used to compensate
for motion.
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
C D fiducial marker detection, geometric accuracy and
dosimetric integrity ISBN: 978-91-7619-775-2.

Figure 6. MR images are used in the treatment planning system for target delineation and dose distributions.
Image courtesy of Gentle Radiotherapy.
For example, each patient is imaged In addition to using the knowledge

in the treatment position with their gained from MR-only radiation therapy Watch videos produced by Gentle
Radiotherapy on the concept
head in an immobilization device. The of the prostate in brain cancer cases,
behind and implementation of
distance from the back of the head the team at Skåne University Hospital
MR-only radiation therapy.
to the MR table must be calculated is also focused on education. The http://gentleradiotherapy.se
for dose planning on each patient. institution hosted a 2018 GE meeting
Previously, this information would have and two international workshops on
been manually measured. Lerner is the use of MR for radiation therapy References
using an ASTM-compatible zero echo planning. 1. Siversson C, Nordstrom F, Nilsson T, et al. Technical Note:
MRI only prostate radiotherapy planning using the statistical
time (ZTE) MR imaging technique to
“That is one of our strengths—with decomposition algorithm. Med Phys. 2015 Oct;42(10):6090-7.
calculate the distance. 2. Nyholm T, Svensson S, Andersson S, et al. MR and CT data
the university, we are able to set up with multi observer delineations of organs in the pelvic
A key consideration throughout the educational events around this new area – part of the Gold Atlas project. Med Phys. 2018
Mar;45(3):1295-1300.
development of the MR-only radiation technique,” adds Professor Olsson. 3. Persson E, Gustafsson C, Nordström F, et al.MROPERA – A
therapy planning environment is to Multi-center/multi-vendor validation of MRI-only prostate
From education to sharing protocols to treatment planning using synthetic CT images. Int J Radiation
replicate the current workflow.
describing the new MR-only workflow, Oncol Biol Phys 2017;99(3):692-700.
4. Koivula L, Kapanen M, Seppälä T, et al. Intensity-based dual
Skåne University Hospital is committed model method for generation of synthetic CT images from
to sharing their insight and expertise standard T2-weighted MR images – Generalized technique
“Once we have all these tools in the development of MR-only
for four different MR scanners. Radiother Oncol. 2017
Dec;125(3):411-419.
and techniques in place for radiation therapy. While the challenge 5. Gustafsson C, Korhonen J, Persson E, Gunnlaugsson A,
Nyholm T, Olsson LE. Registration free automatic identification
MR-based radiation therapy, of being one of the first institutions of gold fiducial markers in MRI target delineation images for
in the world to embrace an MR-only prostate radiotherapy. Med Phys. 2017;44(11):5563-5574.
it is not very different from a radiation therapy workflow led to the 6. Gustafsson C, Nordström F, Persson E, Brynolfsson J, Olsson
LE. Assessment of dosimetric impact of system specific
CT-based workflow. We can development of new techniques, tools geometric distortion in an MRI only based radiotherapy
workflow for prostate. Phys Med Biol. 2017 Apr
use the same clinical criteria and processes, the team is eager to 21;62(8):2976-2989.
continue demonstrating the value
as we would in a conventional 7. Palmér E, Persson E, Ambolt P, Gustafsson C, Gunnlaugsson
A, Olsson LE. Cone beam CT for QA of synthetic CT in MRI
of MR imaging in cancer treatment
workflow and we have found planning.
only for prostate patients. J Appl Clin Med Phys. 2018 Sep 4.
doi: 10.1002/acm2.12429. [Epub ahead of print]
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.

Issue Spotlight
Jing Qi, MD Nghia (Jack) Vo, MD
Medical College of Wisconsin Medical College of Wisconsin
Milwaukee, WI Milwaukee, WI
Thirty-minute PET/MR exam for

pediatric cancer patients
By Jing Qi, MD, Assistant Professor, and Nghia (Jack) Vo, MD, Chief of Pediatric Radiology, Medical College of Wisconsin
Clinicians at the Children’s Hospital of Wisconsin have developed a

30-minute PET/MR exam for evaluating pediatric cancer patients. After
comparing the results of PET/MR to PET/CT in many patients across different
disease types and conditions, the facility has successfully converted all
PET/CT studies to PET/MR. In several instances, PET and MR are discordant,
helping improve the diagnosis.
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

SIGNA™ PET/MR
PARAMETERS
MRAC Axial LAVA Flex Axial T2 frFSE Flex
TR (ms): 4 3.8 3000 – 3600 variable
TE (ms): 1.7 1.7
FOV (cm): 50 48 48
Slice thickness (mm): 5.2 3 5
Phase: 128 256 256
NEX: 0.7 0.7 3
Scan time (min): 0:15 (sec.) 0:17 (sec.) 1:43
Options / other (b-value, EDR, Zip2, Flex SATS: S/I, Zip2, EDR, Flex, ARC FC/s. SATS: S/I, ARC, EDR,
no-phase wrap, etc.): TRF, Flex
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.

Case 2
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
Figure 2. Case 2. A 16-year-old

patient with residual disease over the
pleural surface of the diaphragm (red
arrows). Despite imaging the patient
two hours after FDG, good diagnostic
quality images were still acquired on
PET. The hyperdense residual lesion
C is well characterized by MR. (A, B) PET
with (C, D) corresponding T2 FatSat
D
MR slices.
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
Figure 3. Case 3. A 13-year-old female

with Ewing’s sarcoma. (A) PET image
from PET/MR exam; (B) T2 frFSE Flex
FatSat from PET/MR exam; and initial
diagnostic MR exam (C) T2 frFSE Flex
FatSat and (D) T1 contrast enhanced.
� � The quality of the (B) T2 frFSE Flex
FatSat on PET/MR is the same quality
as the (C) T2 frFSE Flex FatSat on the
C D
dedicated MR.
A B
C D
Figure 4. Case 3. Adjuvant therapy

shrunk the primary tumor and
two hot spots leading to negative
surgical margins. (A, C, E) PET/MR
exam prior to treatment and (B, D, F)
PET/MR two- and one-half months
E F
after start of treatment.

Case 4
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
Figure 6. Case 4. Same patient.

Uptake in the right basal ganglia
(B, E, red arrows) corresponds with
enhancement on the MR (A, D, red
arrows), suggestive of a residual
lesion. (A, D) MR; (B, E) PET; and
D E F
(C, F) fused PET/MR.

Case 5
A 12-year-old with undifferentiated Results: There are discordant findings
sarcoma, widespread disease in the between MR and PET in the post-
chest, abdomen, pelvis and the thigh treatment imaging: there is an increase
muscles. There appears to be foci in the in the lesion size on the MR image and
corpus callosum. a decrease in activity in the PET image.
There appears to be a progression of
disease and this patient will be followed
using PET/MR.
A B
C D
Figure 7. Case 5. Initial PET/MR

exam. A 12-year-old with
undifferentiated sarcoma and
widespread disease. (A, B) PET;
E F
(C, D) MR; and (E, F) fused PET/MR.

Issue Spotlight
A B C D
Figure 8. Case 5. After two cycles of chemotherapy, MR imaging depicted an increase in brain lesion size. (A-D) MR images acquired on PET/MR.
A B
C D
Figure 9. Case 5. Discordant findings

between PET and MR in post-
treatment PET/MR exam. (A, B) PET;
E F
(C, D) MR; and (E, F) fused PET/MR.

Case 6
A 9-year-old patient who underwent rejection, as well as provide sites/ References
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
Figure 10. Case 6. Seven years post-

transplant (liver, pancreas and small
bowel), patient complained of abdominal
pain with fever and vomiting. Using
PET/MR, looked for foci of infection/
inflammation/rejection for biopsy.
(A) PET MIP; (B, C) PET; (D, E) MR;
F G
and (F, G) fused PET/MR.

Issue Spotlight
Abdelhamid Derriche, MD Orkia Ferdagha
PRIISM, EHP Kara PRIISM, EHP Kara
Oran, Algeria Oran, Algeria
Whole-body diffusion for evaluation

of metastatic lesions
By Abdelhamid Derriche, MD, site radiologist, and Orkia Ferdagha, MR technologist, PRIISM, EHP Kara
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

SIGNA™ Explorer
PARAMETERS
Coronal LAVA Flex Coronal STIR Axial Diﬀusion STIR Coronal LAVA Flex
post contrast
TR (ms): 5.8 8000 6811 5.8
(2nd station 5.7) (2nd station 2225)
TE (ms): 3.1 (minimum TE) 33 60 (minimum TE) 3.1
FOV (cm): 48 48 48 48
Slice thickness 2.6 8 3 2.6
(mm):
Frequency: 192 320 110 192 (170)
Phase: 160 224 (160) 110 160 (150)
NEX: 1 1 b0 = 3, 1
b600 = 12
b-value: 0, 600
Scan time (min): 0:42 (sec.) 2:00 1:49 0:42 (sec.)
Options / other: 2nd station 0:21 sec. 2nd station 1:30 min. 20 stations 2nd station 0:21 sec.
for breath-hold with 0:18 sec. breath- for breath-hold
hold
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.

Issue Spotlight
A B C
Figure 2. Whole-body MR imaging with approximately 120 cm coverage. Binded Axial diffusion STIR 3-in-1, b600, 4.4 x 4.4 x 3 mm, 20 stations,
36:20 min. (A-B) MIP projections; and (C) volume rendered image. Red circle depicts the effusion on the glenohumeral joint of the right
shoulder. Red arrows show the bilateral swollen axillary lymph nodes. Blue circle denotes the lesion on the left iliac joint.
A C E
Figure 3. (A) Coronal STIR,

1.5 x 2.1 x 8 mm; (B) same
image with color map; (C-D)
diffusion STIR 3-in-1 b600, 4.4
x 4.4 x 3 mm; and (E-F) Coronal
water LAVA Flex post contrast,
2.5 x 3 x 2.6 mm and Axial MPR.
Lesion located on the proximal
metaphysis of the ulna of the
left arm (red circle), suspected
B D F
to be metastatic.

Figure 4. (A) Fusion STIR +
diffusion STIR 3-in-1 b600;
(B) diffusion STIR b600,
4.4 x 4.4 x 3 mm. Small
nodule was located on the
soft tissues of the right
A B
thigh (red circle).
Discussion than MR. Scintigraphy exposes the References

1. Laurent V, Trausch G, Bruot O, Oliver P, Felblinger J, Regent D.
patient to additional radiation and
The patient has several small lesions Comparative study of two whole-body imaging techniques in
MR has been found to provide similar the case of melanoma metastases: advantages of multi-contrast
suspected to be secondary bone lesions MRI examination including a diffusion-weighted sequence in
sensitivity and specificity for patients comparison with PET-CT. Eur J Radiol. 2010 Sep;75(3):376-83.
from her primary cancer, melanoma.
with a small number of bone lesions, 2. Skeletal Radiol. 2010 Apr;39(4):333-43. doi: 10.1007/
Having the ability to detect these s00256-009-0789-4. Gutzeit A, Doert A, Froehlich JM, et
58% sensitivity/33% specificity
lesions on the patient’s arms, iliac joint al. Comparison of diffusion-weighted whole-body MRI and
for whole-body DWI MR versus skeletal scintigraphy for the detection of bone metastases in
and thigh will enable the oncologist to patients with prostate or breast carcinoma. Skeletal Radiol.
67% sensitivity/58% specificity for 2010 Apr;39(4):333-43.
re-stage the cancer and adapt therapy.
scintigraphy; and patients with multiple
bone lesions, 97% sensitivity/91%
Whole-body DWI is an excellent specificity for whole-body DWI MR
versus 48% sensitivity/42% specificity
option for evaluation of
for scintigraphy.2
metastatic bone lesions
With MR, we can avoid patient
compared to PET/CT and exposure to additional radiation dose
scintigraphy. It provides good and achieve a high sensitivity and
image quality and provides specificity for detection of metastatic
lesions. Additionally, the strong
the information clinicians
magnet homogeneity on the SIGNA™
need for patient management. Explorer helps to decrease distortion
when imaging large FOVs and “3-in-1”
diffusion STIR provides the thin-slice
Even if PET/CT were recommended, data needed for a confident diagnosis
this type of system is not available in in shorter scan times.
all regions and is often more expensive

In Practice
Håkan Boström, MD Pär-Arne Svensson
The Queen Silvia Children’s Hospital The Queen Silvia Children’s Hospital
Gothenburg, Sweden Gothenburg, Sweden
Transforming the MR imaging

experience for one of Sweden’s
largest pediatric hospitals
As part of a modernization project, The Queen Silvia Children’s Hospital
upgraded to the SIGNA™ Architect with AIR Technology™‡. An initial evaluation
by the Department of Pediatric Radiology found the new AIR Technology™
Anterior Array (AA) delivers good SNR and homogeneity for high-resolution
imaging. The coil also enables flexibility and ease of positioning patients,
and when used with AIR Touch™ makes coil selection easier and helps
with workflow.
As one of the largest pediatric hospitals and future advancements in MR the 48-channel Head Coil, along
in Sweden, The Queen Silvia Children’s imaging technologies, such as AIR with new MR sequences available
Hospital at Sahlgrenska University Technology™ and the SIGNA™Works in SIGNA™Works, specifically MUSE,
Hospital in Gothenburg provides care productivity platform. PROPELLER MB (multi-blade), MPRAGE
to children from newborns up to age 18. and distortion correction with diffusion-
“We want to be on the front line of
The Department of Pediatric Radiology weighted imaging (DWI) like PROGRES.
new technology and prepare for the
performs around 45,000 exams each
future,” says Håkan Boström, MD, The radiology department has been
year. Named for the country’s current
pediatric radiologist at The Queen evaluating MUSE as a replacement
Queen, the hospital has undergone
Silvia Children’s Hospital. sequence for single-shot diffusion
a modernization project to improve
imaging in neonates. With MUSE, Dr.
workflow and enhance clinical services as In addition to the recently upgraded
Boström can obtain higher resolution
well as create a safe and secure healing SIGNA™ Architect, the hospital also has
and the distortion correction is better
environment for its young patients. an Optima™ MR450w 1.5T. Combined,
with less distortion artifacts. In
these two MR systems enable the
The pediatric radiology department addition to Dr. Boström finding that
hospital to perform more than 2,000
recently upgraded its Discovery™ MUSE delivers high resolution and
MR exams each year.
MR750w 3.0T wide-bore system to excellent image quality, PROPELLER
SIGNA™ Architect. With new gradients According to Pär-Arne Svensson, MR MB is also helpful in avoiding metal
and Total Digital Imaging (TDI), the research radiographer, a key motivation artifacts. PROPELLER MB is particularly
cutting-edge platform is designed to behind the SIGNA™ Architect upgrade beneficial when imaging the cervical
help facilities like The Queen Silvia was the ability to acquire the new spine and temporal bone with diffusion
Children’s Hospital adapt to existing AIR Technology™ Suite, including sequences. Svensson and Dr. Boström

C
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.”

In Practice
C
Figure 2. Same patient as Figure 1.

(A) Sagittal Inhance 3D Velocity NCE
MRA; (B) Sagittal 3D MERGE; and (C)
Volume rendered 3D MERGE fused
A B
with NCE MRA and FSE Flex.
Figure 3. Fetal imaging with AIR Technology™

AA improved comfort for the woman by
imaging her in the decubitus position. (A-B)
B Axial T2 SSFSE; and (C-E) Oblique T2 SSFSE.
C D E

Figure 4. Free-breathing kidney exam
with Auto Navigator in a six-year-old
patient using a combination of the
AIR Technology™ AA and the PA
embedded in the SIGNA™ Architect
table. (A) SSFSE, 0.9 x 1.3 x 6 mm,
17 sec.; (B) T2 PROPELLER with
respiratory trigger, 0.9 x 0.9 x 4 mm,
4 min.; (C) SSFSE, 0.9 x 1.0 x 5 mm,
49 sec.; (D) LAVA Flex with Auto
Navigator, 1 x 0.9 x 3 mm, 3:56 min.;
and (E) T2 frFSE FatSat with Auto
A B
Navigator, 0.8 x 0.9 x 3 mm, 4 min.
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.

In Practice
Figure 6. Neuro imaging
with the 48-channel Head
Coil in a three-day-old
patient. (A-B) MUSE DWI
with ADC Map, 1.2 x 1 x
3 mm, 3:09 min.; and (C)
A B C
Axial ASL CBF Map.
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

Edwin Oei, MD, PhD Alexander Hirsch, MD
Erasmus Medical Center Erasmus Medical Center
Rotterdam, Netherlands Rotterdam, Netherlands
AIR Technology: a brilliant

improvement in high-quality
imaging and patient comfort
As one of the first sites in the world to install SIGNA™ Premier and
AIR Technology™‡, Erasmus Medical Center is a leader in adopting
cutting-edge technologies. These new solutions are providing a better
patient experience while delivering high-quality imaging and advanced
applications, further enhancing the excellent care provided by clinicians
at Erasmus.
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.

In Practice
Watch Dr. Hirsch’s 2019 SCMR
presentation, “Getting consistent and
Juan Hernandez Tamames, PhD quantifiable results in cardiac imaging:”
Erasmus Medical Center https://youtu.be/dQ3-sU-kPv0
Rotterdam, Netherlands
Figure 1. Short axis 2D FIESTA. The combination

of SIGNA™ Premier and AIR Technology™ delivers
high SNR and high image quality for excellent
cardiac MR imaging results at 3.0T.
“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

Brendan Bakker Jean Paul Laarhoven
Erasmus Medical Center Erasmus Medical Center
Rotterdam, Netherlands Rotterdam, Netherlands
Professor Oei believes there is a Improving the patient experience

“With AIR Technology™, we are movement in MR imaging toward Sita Ramman has been an MR
more flexible in choosing the whole-body imaging, particularly for radiographer for nearly 28 years at
oncology. He anticipates that AIR Erasmus. Often, she has had to comfort
coil, which allows for imaging Technology™ will provide excellent and reassure patients who are nervous
specific body parts with greater results over existing coil technology about their MR exams. She will explain
accuracy. For patients with due to its wide coverage. that they have to remain very still and
chronic diseases such as may have to hold their breath while the
“Since the introduction of SIGNA™
system acquires the images.
arthritis, it may not be easy for Premier and AIR Technology™ at
Erasmus, I’ve seen image quality Since the introduction of AIR Technology™,
them to lie still in the scanner
improve over previous scans and I she has seen a noticeable difference.
for a long time with a rigid coil. believe that AIR Technology™ can
“The patients like the AIR Technology™
AIR Technology™ is lighter and greatly improve patient throughput,”
Coils because they are very lightweight
more comfortable for the Professor Oei says.
and flexible, and mold to the patient’s
patient so, indirectly, I think The AIR Technology™ Suite also anatomy,” Ramman says. “For us, it is
includes a 48-channel Head Coil. Jean very easy to position. You just put it on
it will also reduce movement
Paul Laarhoven, MR radiographer, the patient and that’s it. That’s all you
artifacts. ” has scanned patients with both the have to do.”
48-channel Head Coil and the AIR
Professor Edwin Oei She has also used AIR Touch™, an
Technology™ AA on SIGNA™ Premier.
intelligent coil localization and
With the ability to adjust the coil for
selection tool that enables automatic
AIR Technology™ also assists with larger-sized heads and necks, he can
coil element selection and uniquely
patient positioning. When using accommodate more patients. He has
optimizes uniformity and SNR. AIR
traditional rigid coils, the body part found that patients with anxiety or
Touch™ informs the system when
being imaged had to be positioned claustrophobia can better tolerate the
the coil is connected, allows the
precisely in the coil. With AIR 48-channel Head Coil because the front
technologist to landmark the patient
Technology™, this is less of an issue. part of the coil is slightly smaller and
with a single touch and even optimizes
doesn’t cover the patient’s entire face.
“We mainly now use the blanket-type the element configuration. Coil
AA Coil and have achieved great “You can immediately see the high- coverage, uniformity and parallel
imaging results in the chest wall and quality images that the AIR Technology™ imaging acceleration are generated
in joints,” adds Professor Oei. “I think Coil captures,” Laarhoven explains. dynamically to optimize image quality.
AIR Technology™ is beneficial for diverse “Of course, we also have the AIR A simplified user interface allows the
patient groups, including pediatric and Technology™ Posterior Array (PA) in technologist to focus on the patient and
elderly patients.” the table so we only have to position also maximizes examination efficiency.
the AIR Technology™ AA on top of
“We just put the AIR Technology™ Coil
the patient.”
on the patient, localize using the
AIR Touch™ button on the table and
move the patient inside the SIGNA™

In Practice
Sita Ramman
Erasmus Medical Center
Rotterdam, Netherlands
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.”

A B C
Figure 3. The 48-channel Head Coil delivers

more signal from the cortical, basal ganglia
and deep brain. (A) Axial 3D T1 FSPGR; (B)
Axial T2; (C) Axial DWI b1000; (D) Axial T2
PROPELLER; and (E) Coronal T2 PROPELLER
D E
FatSat.
explains. “By accelerating, we reduce and sequences to shorten MR scan

the echo time, which means less times, in some cases to as quick as
distortion in an EPI sequence. And that five or 10 minutes.
is important for exploring the basal
“I think SIGNA™ Premier and AIR
ganglia and frontal or temporal areas.
Technology™ are paving the way to
Not only is the signal better, but the
achieve this goal,” Professor Tamames
anatomy and morphology of the tissue
adds.
is more realistic.”
And, because the headset for the ‡‡Drug products should be used in accordance with their
approved labeling. Gadolinium-based contrast agents
48-channel Head Coil is compatible have not been approved for cardiac use in all regions.
with EEG systems, clinicians at
Erasmus can simultaneously record
EEG and capture MR images. Professor
Tamames also sees the potential for
continued innovation in technology
Watch the team at Erasmus

discuss their experience with
AIR Technology™.
https://youtu.be/MeGebBSjUNQ

In Practice
Tom Schrack, ARMRIT, MRSO
Fairfax Radiological Consultants
Fairfax, Virginia
New deep learning tool

streamlines MR slice prescription
A new deep learning software from about 15 cases on their facility’s prescription time savings can be up
GE Healthcare is helping streamline 3.0T SIGNA™ Architect MR scanner. to 62%.‡‡
MR scan prescription that may help
It precisely places slices on the smallest
reduce inconsistencies in imaging Deep learning for faster imaging and most challenging neurological
across patients and technologists. AIRx™ is built on Edison, a new platform anatomy, such as optic nerves.
AIRx™‡ is an AI-based, automated that helps accelerate the development “Everything that it says it can find, it
workflow tool for MR brain scanning and adoption of AI technology finds it with amazing accuracy,” says
that automatically “prescribes” slices and empower providers to deliver Schrack. “For example, if I tell AIRx™ that
to help reduce redundant, manual faster, more precise care. Edison is a I want an oblique sagittal of the left
steps. It uses deep learning algorithms holistic, integrated digital platform for optic nerve, it puts a slice right down
built right into the MR technologist’s healthcare, combining globally diverse the center of that left optic nerve. AIRx™
workflow to automatically detect and data sets from across modalities, does that immediately and perfectly,
prescribe slices for neurological exams, vendors, healthcare networks and life every time. It can save me some
delivering consistent and quantifiable sciences settings. eye strain, save time from tweaking
results. AIRx™ also helps produce
It enables GE Healthcare to integrate parameters, and get me going a little
images that have less variability
and assimilate data from disparate bit faster.”
between technologists and between
sources, apply advanced analytics and Schrack says AIRx™ is one step in the
scans, helping to lower the chances
AI to transform the data, and generate right direction of fulfilling the promise
a patient will be recalled due to
insights to support clinical, financial of AI, with the potential to use it on
incorrect slice placement. An increase
and operational decision-making. complicated anatomy such as the heart
in consistency is particularly important
Edison includes deployment-agnostic and joints, while continuing to simplify
when doing longitudinal assessments
intelligent applications and smart the technologist’s job.
on patients with diseases that progress
devices, designed to help achieve
over time.
greater efficiency, increase access to “You'll never hear a technologist say, ‘I
“Every time I select a landmark for the care, and improve patient outcomes. wish this was harder to use,’ or ‘I wish
prescription, the slice placement is the machine would stop automating
By leveraging this platform, AIRx™ tasks for me’,” says Schrack. “They want
dead on,” says Tom Schrack, ARMRIT,
features a pre-trained neural network the machine to make decisions for them
MRSO, Manager of MR Education and
model that leverages deep learning so that it's easier, and I think the only
Technical Development at Fairfax
algorithms and anatomy recognition way that’s going to happen is with deep
Radiological Consultants in Fairfax,
based on a database of over 36,000 learning and artificial intelligence. For
Virginia.
images sourced from clinical studies the technologist, anything that reduces
Schrack and two other senior and reference sites. the number of decisions in an MR exam
technologists at Fairfax Radiological
AIRx™ helps increase productivity will make their job better.”
Consultants have used a prototype
by simplifying workflow steps, thus
of AIRx™ – which stands for Artificial
significantly reducing user prescription
Intelligence prescription (AI Rx) – since ‡Not licensed in accordance with Canadian law. Not available
time. A study showed average for sale in Canada. Not CE marked. Not available for sale in
early November 2018, conducting all regions.
‡‡According to an internal study conducted by GE Healthcare.

Masatoshi Hori, MD, PhD
Osaka University Hospital
Suita, Osaka, Japan
An upgrade that meets the

expectation for higher resolution,
SNR and productivity
After upgrading its SIGNA™ Architect to the latest SIGNA™Works productivity
platform and acquiring the AIR Technology™‡ Anterior Array (AA), Osaka
University Hospital is delivering exceptional MR imaging that also promotes
patient-centered care—two tenets of the hospital’s core philosophy. The
combination of these three advanced technologies is delivering excellent
image uniformity across a wide range of patients and clinical exams.
For nearly 150 years, Osaka University “Our key expectation for MR is higher An important benefit of AIR Technology™
Hospital (originally Osaka Medical resolution, higher signal-to-noise is the ability to utilize higher parallel
School, circa 1869) has served the ratio and higher temporal resolution,” imaging acceleration factors with the
residents of Osaka and fostered the Professor Hori says. “This upgrade coil element configuration and lower
education of medical professionals completely meets our expectations.” g-factor of the new coils. Specifically,
throughout the region. The hospital’s in a 640 x 640 matrix T2-weighted
He found the AIR Technology™ AA to be
dedication to providing high-quality PROPELLER Multi-shot Blade (MB)
lighter than expected and anticipates it
medical care is centered on the belief FatSat pancreas exam, high-resolution
will provide a better patient experience
that adopting new and advanced images were obtained with an ARC
during an MR exam. Technologists have
technologies further promotes patient- factor of 4 in 4:24 minutes (Figure 1).
also shared with him that patient and
centered, safe and reliable holistic care
coil set-up is much easier and that PROPELLER MB is one key
that contributes to the society.
SNR gains are being realized because, enhancement that Professor Hori is
“At Osaka University Hospital, we in most cases, the coil fits the many routinely using. It combines multiple
always seek the latest innovative shapes and sizes of patients much blades together to achieve shorter
technology to provide the best clinical better than conventional arrays. TEs and improved motion correction.
performance and patient care,” says PROPELLER MB is also compatible
“The AIR Technology™ AA is one of the
Masatoshi Hori, MD, PhD, Associate with Auto Navigator, a free-breathing
biggest innovations I have seen in
Professor, Department of Radiology at approach to combat respiratory motion
the last decade,” adds Professor Hori.
Osaka University Hospital. With this in the body, cardiac and chest imaging
He believes it will become a future
philosophy, the department recently with automatic tracker placement.
standard technology and is excited
upgraded its existing Discovery™
to be an early adopter.
MR750w 3.0T to SIGNA™ Architect and
also acquired the AIR Technology™ AA.

In Practice
A B
Figure 1. AIR Technology™ enables the use of higher parallel imaging factors with improved SNR for high-resolution imaging and reduced scan
times. (A) Axial T2w FatSat acquisition with PROPELLER MB, 0.6 x 0.6 x 4 mm, ARC factor of 4, 4:24 min.; (B) ROI in (A) magnified.
Figure 2. A female weighing

287 lbs. (130 kg) referred for
MR imaging of
the pelvis. (A) Sagittal T2w
frFSE, 0.8 x 0.9 x 4 mm,
6:08 min.; (B) Sagittal T2w
PROPELLER MB, 0.9 x 0.9 x
A B
4 mm, 3:02 min.
“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.

A B
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.

In Practice
Figure 5. Prostate exam
using HyperCube. (A-C)
Conventional 2D T2w in
A B C 3 planes. (D-F) T2w with
HyperCube enables (E-F)
thin-slice imaging. (A) Axial
T2w, 0.6 x 0.8 x 4 mm,
3:42 min.; (B) Coronal T2w,
0.6 x 0.8 x 4 mm, 3:25 min.;
E F (C) Sagittal T2w, 0.6 x 0.8 x
4 mm, 2:36 min.; and (D-F)
T2w with HyperCube
acquired in the Axial plane
and reformatted to (E)
Coronal and (F) Sagittal,
D
0.9 x 0.9 x 2 mm, 3:54 min.
Figure 6. Patient referred for prostate exam.

(A) DWI b1000, 2.3 x 2.3 x 4 mm, 2:08 min.;
(B) FOCUS b1000, 1.5 x 1.8 x 4 mm, 4:10 min.; and
B C
(C) MUSE 3 shot b1000, 1.6 x 1.6 x 4 mm, 4:15 min.
Figure 7. Comparison of MRCP exam

with and without HyperSense.
Scan time was reduced 30% with
HyperSense. (A) Conventional MRCP
RTr, 0.7 x 1.1 x 1.6 mm, 3:51 sec. and
(B) MRCP RTr with HyperSense,
A B
0.7 x 0.9 x 1.6 mm, 2:45 min.

Takafumi Naka, RT(R)(MR)
Kawasaki Saiwai Hospital
Kawasaki, Kanagawa, Japan
Ultra-flexible AIR Technology

Suite making a difference in the
technologist’s workflow
The AIR Technology™‡ Suite simplifies patient positioning and setup with
AIR Touch™ automatic coil and element selection, a 60 percent lighter
design than prior generations of coil technology and a flexible design
that fits patients of various sizes and shapes.
Kawasaki Saiwai Hospital in Kanagawa, flexible and can be wrapped around improvement in SNR because the coil
Japan, installed the SIGNA™ Architect the patient to facilitate positioning is closer to the patient’s chest.”
3.0T MR system in late 2017. In and fits a variety of patient body sizes.
In addition, he does not have to worry
February 2019, the hospital upgraded
In musculoskeletal (MSK) extremity about setting the coil center because
to the latest version of the SIGNA™Works
imaging, coil selection for MR exams AIR Touch™ automatically detects
productivity platform and acquired
of the humerus and antebrachial bone it, providing additional workflow
the AIR Technology™ Suite. As one of
would require two coils to image from improvements and removing the
the main healthcare providers for the
the shoulder to the elbow. The AIR chance for human error.
region, especially for acutely ill patients,
Technology™ AA, however, covers a
the hospital embraces the concept Naka is also thrilled that he can use
larger region of interest (ROI) with a
of patient-centered healthcare. The higher parallel imaging acceleration
comfortable wrap-around fit and a
AIR Technology™ Anterior Array (AA) factors with the AIR Technology™ AA.
higher SNR. Naka expects the same
conforms to the human body, is flexible In one case, he applied a factor of 4x
results in lower extremity imaging,
to fit all shapes and sizes and has a for a body Coronal DWI and had less
particularly for patients with cellulitis
60 percent lighter design compared to distortion and blurring than with a
and muscle contusions where large
previous generations of conventional conventional coil (Figure 1).
ROIs need to be acquired.
coil technology—making it the ideal
“It was a single-shot EPI DWI, however,
coil to deliver both patient comfort A conventional heavy, hard-shell coil
the anatomy detail and information
and high image quality at Kawasaki on a patient’s chest could impact the
was really amazing,” he adds.
Saiwai Hospital. respiratory detection device, so Naka
would place a spacer between the coil Naka has also used higher parallel
Takafumi Naka, RT(R)(MR), Chief
and the patient. imaging acceleration factors in body
Technologist, evaluated the new
PROPELLER exams. He leveraged this
system and coils and the impact on the “However, with the AIR Technology™ AA,
capability for better image quality, such
technologist’s workflow and patient we no longer have to do that,” Naka
as refocusing the flip angle for higher
experience. He was most impressed says. “We now have better patient
T2 contrast. He sees the same impact
that the AIR Technology™ AA is ultra- positioning workflow and also get an
in neuro imaging with the 48-channel
Head Coil.

In Practice
A B Figure 1. High-resolution
MR Urography with reduced
scan time is possible using
HyperSense and HyperCube.
A urethral tumor was
visualized on the Coronal
DWI using long axis. Even
with an ASSET factor of 4.0,
there was low distortion
in the diffusion-weighted
images. All images acquired
with the AIR Technology™ AA.
(A) Axial T2w SSFSE, 1.3 x
1.4 x 4 mm, 1:28 min.; (B) Axial
DWI b1000, 2.7 x 2.7 x 4 mm,
3:57 min.; (C) MR urography,
0.7 x 1.2 x 1.4 mm, 2:40 min.
(RTr); and (D) Coronal DWI
b800, 3.1 x 1.6 x 4.5 mm,
C D
ASSET factor 4, 4:27 min. (RTr).
A B C D
Figure 2. MAGiC is routinely used at Kawasaki Saiwai for neuro MR

exams. The 48-channel Head Coil was used for this exam. (A) Axial
DW-EPI in 45 sec. and (B) Axial T2 FLAIR in 3:07 min. Using MAGiC,
from (A) and (B), the technologist can generate multiple contrasts,
E F
including (C) Axial T2w, (D) Axial T1w, (E) Axial DIR and (F) Axial PDw.

B C
A
Figure 3. (A-C) TOF MRA with HyperSense factor of 2.5 and ARC factor of 2, 0.4 x 0.5 x 0.8 mm, 6:06 min.
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

In Practice
A B C
Figure 5. MUSE acquires high resolution DWI even at high b-values (b1000) and by using 4 shots with ARC acceleration of 1, distortion can be
reduced. Fusing Sagittal T2w PROPELLER MB with the ADC map does not lead to distortion even in the presence of rectal gas. (A) Sagittal MUSE
b1000, 1.5 x 0.9 x 6 mm, 4 shots with ARC acceleration of 1, 5 NEX, 4:39 min.; (B) Sagittal T2w PROPELLER MB, 0.8 x 0.8 x 6 mm, 4:12 min.; and
(C) Fused ADC map with Sagittal T2w PROPELLER MB.
A B C
Figure 6. (A-C) DWI with

PROGRES; and (D-F)
conventional DWI. PROGRES
provides less distortion than
conventional DWI sequences,
including fewer susceptibility
artifacts (arrows) around the
D E F
eye and inner ear.
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

Paolo Sana Sandrine Debelle
Hospital Kirchberg Hospital Kirchberg
Luxembourg City, Luxembourg Luxembourg City, Luxembourg
MR Excellence Program is a beacon

for optimizing MR imaging workflow
and the patient experience
The MR Excellence Program and Imaging Insights dashboards unlock
clinical value and operational efficiency through data intelligence and
human expertise for targeted, individualized patient care. By measuring
the current status of MR imaging throughout a department or center,
facilities can improve MR imaging services to enhance the delivery of
care and the patient experience.
Kirchberg Hospital, part of the Robert DoseWatch, GE’s dose management with workflow data from radiology
Schuman Hospital Foundation, is a solution, in 2011 and the MR Excellence information systems to measure
multi-disciplinary healthcare provider Program in 2018. key performance indicators (KPIs)
situated in the Kirchberg quarter in radiology.
The MR Excellence Program combines
of Luxembourg City, Luxembourg.
machine-based data intelligence As Radiology Manager for all four
Comprised of four facilities—the
(Imaging Insights analytics) with facilities under the Robert Schuman
Clinique Bohler, specializing in OB/GYN;
human expertise (customer success Hospital Foundation, Paolo Sana is
the ZithaKlinic, a free-standing multi-
experts) to unlock clinical value and committed to digitizing healthcare and
specialty clinic; the Clinique Sainte-Marie,
operational efficiency within a radiology elevating quality through advances in
specializing in geriatric medicine; and
department. It uses LEAN and Change imaging technology. He was involved
Kirchberg Hospital. The facilities were
Acceleration Process tools to help in the DoseWatch evaluation while
organized under one foundation with
department managers and staff better in a prior position at the hospital
the goal to further modernize and
understand the data and make the and has been a key contributor to
enhance the quality of care delivered
appropriate decisions to enact clinical the evaluation of MR Excellence. The
to the residents of Luxembourg.
and operational improvements. hospital has a SIGNA™ Artist 1.5T that
On average, 200,000 imaging exams are performs on average 6,900 exams
Imaging Insights is a set of dynamic
performed yearly across all four sites. each year.
and comprehensive dashboards that
Combined, the facilities have three
provide key acquisition and analytic “The MR Excellence Program allows us
MR systems, three CT scanners, seven
measures that radiology department to evaluate the impact of the operation
radiology rooms, two mammography
staff rely on to deliver excellence in and clinical improvements we took,
systems and four ultrasound machines.
imaging services. A multi-modality step-by-step, to allow for a stable and
Since 2011, Kirchberg Hospital has
and vendor agnostic solution, Imaging sustainable change in our department,”
collaborated with GE Healthcare in the
Insights combines machine data Sana says.
evaluation of new solutions, including

The MR Excellence Program was Sandrine Debelle, Radiographer and As a result of the successful pilot
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 1. Patient throughput by weekday and hour of the day.

Cerebral MR Cerebral MR
MR of the lumbar spine MR of the lumbar spine
MR of the left knee MR of the left knee
MR of the right knee MR of the right knee
Prostate MR Prostate MR
MR of the cervical spine MR of the cervical spine
Cardiac MR with stress test Cardiac MR with stress test
MR of the pelvis MR of the pelvis
MR of the right shoulder MR of the right shoulder
Cardiac MR Cardiac MR
Mammo MR Mammo MR
MR of the left shoulder MR of the left shoulder
Liver MR Liver MR
MR of the neck, torso, lumbar MR of the neck, torso, lumbar
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.
Before (Q4’17) After (Q3’18)

Figure 4. With the Imaging Insight dashboards, inactive time of the MR scanner was quantified, leading to a change in scheduling rules.

In Practice
Figure 5. Waiting times decreased by approximately 15 days.
In addition to evaluating the schedule According to Debelle, any change

for knee exams, the team also analyzed made based on the Imaging Insights The result has been a 15 percent
lumbar spine and cervical spine exams dashboard data goes through a step- increase in patient throughput,
and found that the scheduling for all by-step process. The data team first
or an average of 16 more
three exams could be reduced to follows the indicators and analyzes the
15-minute slots. This increased the data. Then, modifications are proposed exams each week. Further,
volume of exams but also shortened and communicated to all stakeholders. patient wait time to get an
patient wait times to get an appointment. With the Imaging Insights dashboards, appointment for a knee, lumbar
she could analyze exam duration with
exam distribution to identify the most
spine or cervical spine exam—
“This impact shows how using common and most lengthy MR exams the hospital’s top three MR
the dashboard analysis to (Figures 1 and 2). procedures—decreased by
make a decision can improve For example, the first step is to assess 15 days (Figure 5).
throughput for each day and each hour
the patient experience. It has of the day. Then, by evaluating the exam
also changed the way our staff mix and average duration, Debelle can Protocol standardization was another
works with the introduction investigate how to improve quality of key area where Kirchberg Hospital
care and workflow. She can compare utilized the power of MR Excellence
of MR Excellence. There has to measure and quantify variability.
scheduled exam times with the actual
been less downtime because appointment time (Figure 3) and MR “We have always placed a priority on our
we can detect inactivity system downtime (Figure 4) to quantify radiologists’ opinions and their different
slots, understand why they the time that the SIGNA™ Artist is idle ways of working and reading studies,”
and not scanning patients. says Sana. This process, common for
are happening and take action
“From this data, we were able to many hospitals, led to changes in
to reduce them.”
determine that at 10 am and 11 am, protocols and an increase in the number
we had 20 minutes of inactivity, or of protocols for a particular exam.
Paolo Sana
no patient scanning, in the MR room,” Consistency of studies is a factor in the
Debelle explains. “By changing our overall quality of MR imaging, from the
scheduling rules, we were able to image acquisition to the interpretation.
reduce the inactivity by almost Plus, having more protocols means it
30 percent for a more consistent takes more time and work to optimize
patient workflow.” each variation for image quality and
acquisition time.

Protocols used in Q4’17 for the head exam Protocols used in Q3’18 for the head exam
Figure 6. A 47 percent decrease in the number of protocols.
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

In Practice
Karl Vigen, PhD Christopher Francois, MD
University of Wisconsin Hospital University of Wisconsin Hospital
Madison, WI Madison, WI
Cardiac MR in patients with CIEDs

By Karl Vigen, PhD, Senior Scientist, and Christopher Francois, MD, Professor, University of Wisconsin Hospital, Madison, WI
MR imaging volume in patients with Cardiovascular Implantable Electronic

Devices (CIEDs) is growing due to the adoption of MR-Conditional devices.
Modified cardiac protocols can address common artifacts and distortions
resulting from the device, battery or other electronic components, while
also complying with MR-Conditional device labeling.
MR imaging was historically 110
contraindicated for patients with CIEDs 100
including pacemakers, implantable 90
cardioverter defibrillators (ICDs), and 80
cardiac resynchronization therapy 70
pacemakers and defibrillators (CRT-P/Ds), 60
due to concerns over possible lead 50
heating, device migration and device 40
malfunction. However, recent CIED 30
development has led to devices with 20
improved resistance to environmental 10
electromagnetic interference, and many 0
2012 2013 2014 2015 2016 2017 2018
recent models have MR-Conditional Figure 1. Number of MR exams in patients with MR-Conditional devices, all types (cardiac and
labeling with approval from regulatory non-cardiac) at the University of Wisconsin Hospital.
agencies such as the FDA.
As more patients are implanted with left upper chest, distortions in B0 device to the pacing parameters
MR-Conditional devices, our volumes and B1 due to the battery and other corresponding to the device’s “MRI
have grown (see Figure 1) to more electronic components can lead to mode” or another acceptable mode,
than 100 in 2018. The adoption of severe artifacts in cardiac MR (CMR), as determined by the device clinic
MR-Conditional implants improves particularly with ICDs and CRT-Ds. team. This is generally a setting such
access and the use of MR in these Nearly five years ago, our institution that pacing is off, or a backup mode
patient subgroups. developed a modified CMR protocol such that the patient’s underlying
Due to the location of the CIED for use in patients with CIEDs. rhythm is maintained. Occasionally,
generator, most commonly in the an asynchronous pacing mode can be
Prior to the imaging exam, a cardiac
used, which paces the patient’s heart at
device nurse programs the patient’s

Figure 2. (A) Axial FIESTA.
(B) Axial Fast SPGR Cine
post-contrast. Note the
banding artifact in the
A B
FIESTA acquisition.
Figure 3. Acquired using Fast

SPGR Cine. Comparison of a
(A) conventional 8 mm thick/
0 mm gap slice with a (B) 4 mm
thickness and 4 mm spacing
to maintain coverage. Note the
decrease in artifact with the
A B
thinner slice imaging.
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.

In Practice
A B
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.

Case 1
Patient with a history of dilated cardiomyopathy and
worsening ejection fraction; pacing dependent. With MR,
the left atrium and left ventricle were shown to be mildly
dilated. Global hypokinesis was seen with regional variation
specifically with focal hypokinesis/dyskinesis in the mid/apical
septal and apical anterior segments. There is curvilinear late
gadolinium enhancement consistent with scarring in the
basal-anterior septal mid myocardium.
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.

Case 2
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
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
Figure 6. (A) Short axis Fast

SPGR Cine; (B) long axis Fast
SPGR Cine; (C-D) phase-sensitive
C D
long axis LGE.

Vicente Martinez de Vega, MD Manuel Recio Rodríguez, MD
Quirónsalud Madrid University Hospital Quirónsalud Madrid University Hospital
Madrid, Spain Madrid, Spain
Body imaging with AIR Technology

Anterior Array and Posterior Array
Submitted by Quirónsalud Madrid University Hospital
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.
38-year-old pregnant woman; fetus with hydrocephalus.

Coil: AIR Technology™ AA
Parameters:
T2 SSFSE in - Sagittal: 0.7 x 0.7 x 3 mm, 1:00 min.
three planes:
- Coronal/Axial: 0.7 x 0.7 x 2.5 mm,
1:22 min.
DWI, b800: - Axial: 2.8 x 2.8 x 2.5 mm, 0:50 sec.
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;
™
(C) Axial T2 SSFSE; and (D) Axial DWI b800.

Abdominal imaging
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.
48-year-old male with Crohn’s disease.

Coils: AIR Technology™ AA and Posterior Array (PA)
Parameters:
T2 SSFSE in two - Axial: 0.8 x 1 x 4 mm, 0:52 sec.
planes with and
without FatSat: - Axial w/FatSat: 0.9 x 0.9 x 4 mm, 0:54 sec.
- Coronal: 1 x 1.25 x 4 mm, 0:38 sec.
Axial DWI: b1000, 2.9 x 1.2 x 5 mm
T1 LAVA ASPIR in - Axial 1 x 1.25 x 2.4 mm, 0:24 sec.
two planes:
- Coronal: 1 x 1.25 x 3 mm, 0:19 sec.
Coronal T1 DISCO: 1 x 1.6 x 2 mm, 7 sec./phase
Coronal T2 FIESTA 1 x 1 x 3 mm, 0:54 sec.
dynamic:
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.

A B C
Figure 3. A thickening of the terminal ileum (red arrows) is consistent with Crohn’s disease. (A) Coronal T2 SSFSE; (B) Coronal T1 LAVA ASPIR;
and (C) MIP from DISCO, arterial phase.
Figure 4. Same patient as Figure 3. (A) Coronal T2

A
FIESTA and (B) Axial T1 LAVA ASPIR.

Prostate imaging
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.
71-year-old male with prostate cystic adenoma.

Coils: AIR Technology™ AA and PA
Parameters:
Axial T2 FSE: 3 x 0.4 x 0.7 mm, 4:47 min.
Axial T2 Cube: 0.5 x 0.8 x 0.8 mm, 5:31 min.
FOCUS DWI: b800, 3 x 2 x 2 mm
MAGiC DWI: b1500
Axial DISCO LAVA: 1.5 x 1 x 1 mm, 4.5 sec./phase
Figure 5. AIR Technology™ AA

and PA provide high spatial
resolution in T2 sequences,
which improves visualization of
the cancerous lesion for staging.
Note the lesion with a high
signal in the central prostate.
A B
(A) Axial T2 and (B) Axial T2 Cube.
A B
Figure 6. There is no enhancement in the

dynamic sequence and restricted diffusion
is consistent with a prostate abscess.
(A) Axial DISCO LAVA; (B) enhancement
integral map; (C) Axial DWI FOCUS b800;
C D E
(D) ADC map; and (E) MAGiC DWI b1500.

Krisztina Baráth, MD Brigitte Trudel, RT(R)(MR)
RNR Institute of Radiology and Neuroradiology RNR Institute of Radiology and Neuroradiology
Glattzentrum, Wallisellen, Switzerland Glattzentrum, Wallisellen, Switzerland
Neuro imaging with

48-channel Head Coil
By Krisztina Baráth, MD, neuroradiologist, and Brigitte Trudel, RT(R)(MR), MRI Chief Technologist,
RNR Institute of Radiology and Neuroradiology at Glattzentrum
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

Case Studies
D
Figure 1. Cervical spine and carotid

CE-MRA. (A) Sagittal T2 FSE Flex,
0.9 x 0.9 x 3 mm, 3:45 min.; (B)
Sagittal T1 optimized, 0.8 x 1 x 3 mm,
2:47 min.; (C) Coronal carotid
CE-MRA, 0.9 x 0.9 x 1.2 mm, 0:40 sec.;
and (D) Axial T2 HyperCube, 0.7 x
A B C
0.7 x 1.8 mm, 2:24 min.
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 B C Figure 3. Patient with low-grade
glioma. Higher SNR with the (A-C)
48-channel Head Coil enables better
in-plane resolution (green arrow)
and enhanced lesion depiction (red
arrow) than (D-F) images acquired
with conventional HNU. (A, D) Cube
FLAIR with HyperSense, 1 x 1.1 x
1.2 mm, 3:38 min. with 48-channel
Head Coil and 3:45 min. with
conventional HNU; (B, C, E, F) Axial
T2 PROPELLER, 0.5 x 0.5 x 3 mm,
2:10 min. with 48-channel Head Coil
and 0.6 x 0.6 x 3 mm, 2:23 min. with
D E F
conventional HNU.
Figure 4. Patient with low-grade

glioma. (A, B) DTI HyperBand with
32 directions, 2.2 x 1.8 x 4 mm,
A B
3:43 min.

Case Studies
A B C
Figure 5. Patient with meningioma scanned with the 48-channel Head Coil. (A) Coronal T2, 0.5 x 0.6 x 3 mm, 2:15 min.; (B) Axial LAVA ASPIR
post contrast, 0.8 x 0.8 x 1 mm, 3:50 min. with (C) Coronal reformat.
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.

Diffusion imaging with
AIR Technology Suite
Submitted by Kawasaki Saiwai Hospital
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 2
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.
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.
Whole-body 2 station Coronal DWI,

DWI, b800: 1.8 x 4.2 x 5 mm
Acc 2.0/4.0
4:00 min.
Figure 2. (A) Coronal T2w STIR PROPELLER MB;

(B) Coronal LAVA; (C) Coronal DW-EPI, 2 stations;
(D) whole-body DWI, radial MIP; (E) whole-body
A B Coronal DWI radial MIP, 2 stations.
C D E

Claire Moisson, RT(R)(MR) Stephanie Sellie, RT(R)(MR)
Medipole de Savoie Medipole de Savoie
Challes-les-Eaux, France Challes-les-Eaux, France
Free-breathing liver imaging using

DISCO with Auto Navigator
By Claire Moisson, RT(R)(MR), and Stephanie Sellier, RT(R)(MR), Lead Technologist, Medipole de Savoie
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)

Case Studies
A B
Figure 1. (A, C) LAVA Flex breath-hold where

the patient was unsuccessful holding their
breath; (B, D) free-breathing LAVA Flex with
Auto Navigator made the difference for
C D
patient comfort as well as quality.
A B
Figure 2. DWI at high b-values delivers a high

signal that enables the visualization of new
lesions on the hepatectomy side and near
the hepatic hilum (red arrows). Different
slices from the (A, C) DWI b50-1000 RTr with
C D
(B, D) ADC Maps, 3.9 x 3.4 x 5 mm, 3:18 min.
Procedure six view-shared arterial phases at MR findings

Axial LAVA Flex with Auto Navigator 14 seconds per phase and six phases Patient had an increase in unresectable
replaced a breath-hold sequence delayed, non-view shared at 46 seconds. HCC lesions despite targeted therapy.
because the patient could not hold his Biliary duct dilatation was also noted
DWI with high b-values may help
breath longer than seven seconds. Free- despite prosthesis.
provide additional information for the
breathing DISCO with Auto Navigator
evaluation of lesions while the SIGNA™
was also employed to provide high
Artist Total Digital Imaging (TDI) provided
temporal and high spatial resolution.
adequate signal-to-noise ratio (SNR).
For the dynamic T1, DISCO captured

A B C
Figure 3. Free-breathing DISCO Flex with Auto Navigator, 1.3 x 1.9 x 4.4, Zip 2, 6 phases view-shared k-space (14 sec per phase) + 6 phases full
non-view shared k-space (46 sec. per phase), in 5:34 min. (A) Phase 0; (B) phase 2 @ 28 sec. (arterial); (C) phase 4 @ 60 sec. (venous).
Figure 4. Contrast enhancement of DISCO

with Auto Navigator. (A) b1000 and
(B) phase 5; (C) ROI 1 = HCC (blue line),
A B
ROI 2 = normal liver (yellow line).
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.

Case Studies
David Bowden, FRCR
Addenbrooke’s Hospital
Cambridge, UK
Free-breathing navigator-echo triggered

diffusion-weighted imaging in the
evaluation of hepatobiliary disease
By David Bowden FRCR, Consultant Hepatobiliary & GI Radiologist, Addenbrooke’s Hospital,
Cambridge University Hospitals NHS Foundation Trust
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.

Case 1
Optima™ MR450w
Patient history PARAMETERS
A 65-year-old man with a history of recent removal of a DWI T1 LAVA Flex
malignant melanoma from the scalp. CT staging demonstrated TR (ms): 7056 6.7
an indeterminate liver lesion within segment 5, requiring
TE (ms): 62 3.2
further characterization. If solitary, the patient was to be
considered for radiofrequency ablation or resection. FOV (cm): 38 x38 38 x 38
Slice thickness 6 4.4
(mm):
Technique
Standard imaging protocol included navigator-echo triggered Frequency: 80 320
DWI using b-values of 50 and 600 in addition to MAGiC Phase: 128 224
DWI (synthetic DWI), a sequence allowing the calculation of NEX: 8 1
additional high b-values without separate acquisitions. This
b-value: 50, 600, n/a
approach reduces scan time and delivers excellent image 800 (synthetic),
sharpness and SNR at the synthetically calculated high 1000 (synthetic)
b-values. Scan time 4:05 0:15 (sec.)
(min):
Figure 1. (A) Unenhanced LAVA Flex T1w

imaging at baseline demonstrates a
tiny hyperintense lesion within segment
5 adjacent to a blood vessel, with (B)
corresponding high signal on MAGiC DWI
b1000. Appearances on ADC mapping
were indeterminate. (C) Follow-up imaging
three months later confirmed a subtle but
persistent T1 hyperintense lesion but with
marked motion artifact across all T1w
images. (D) High signal on MAGiC DWI
b1000 was again demonstrated, however,
now with (E) corresponding hypointensity
on ADC mapping, therefore, confirming
diffusion restriction consistent with
A B
melanoma metastasis.
C D E

MR findings consistent with melanoma metastasis.
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
Figure 2. (A) Small nodule of diffusion

A B restriction within the right lung base,
MAGiC DWI b1000 image. (B) On
reinspection of original baseline imaging
from three months prior, a less conspicuous
focus of diffusion restriction was present at
the same location, possibly corresponding
with (C) a 2 mm nodule seen only in
retrospect at contemporaneous baseline
CT. Given its location adjacent to a blood
vessel, this would be almost impossible to
identify in the absence of a DWI correlate.
(D) A repeat CT staging study was therefore
performed, which confirmed the presence
of an enlarging pulmonary metastasis,
C D
equivalent to the nodule seen in (A).

Case 2
Discovery™ MR450
Patient history PARAMETERS
A 57-year-old man with primary Axial DWI 3D MRCP Axial T2-weighted
sclerosing cholangitis (PSC) resulting PROPELLER with
Auto Navigator
in cirrhosis, listed for transplantation
and under surveillance due to elevated TR (ms): 8000 3750 1500
risk of cholangiocarcinoma and with TE (ms): 51 665.4 75.2
deteriorating liver function tests. FOV (cm): 36 x 29 38 x 28 36 x 36
Slice thickness 6 1.6 6.5
Technique (mm):
Standard liver MR protocol including
navigator-echo triggered high-
Phase: 128 224 288
resolution magnetic resonance
cholangiopancreatography (MRCP), NEX: 3 1 2
Axial T2-weighted PROPELLER image b-value: 50, 600, n/a n/a
acquisition and navigator-echo 800 (synthetic),
triggered DWI (using b-values of 50 1000 (synthetic)
and 600) with MAGiC DWI-generated Scan time 4:35 5:10 4:41
b-values of 800 and b1000 images. (min):
Options/other: Navigator ASSET
MR findings
T2-weighted PROPELLER images
demonstrated a typical dysmorphic
liver with left lobe atrophy consistent
with advanced PSC, widespread areas
of geographic hyperintensity and
subtle diffusion restriction consistent
with fibrosis (Figure 3). Increasing
extrahepatic duct dilatation was seen
with an irregular stricture of the inferior *
common bile duct. High b-value (1000)
MAGiC DWI clearly showed a ring of
restricted diffusion at the level of the
stricture, which could be matched to
a subtle T2 hyperintense lesion aided
A B
by the use of image fusion (Figure 4).
Endoscopic ultrasound evaluation Figure 3. (A) Axial T2w PROPELLER image. Dysmorphic liver typical of advanced PSC with
increasing dilatation of the common bile duct (arrow). Note the extensive T2 signal change
confirmed the presence of a mural within the background liver parenchyma consistent with fibrosis (asterisk). (B) Coronal
lesion with a luminal soft tissue MRCP maximum intensity projection (MIP) image demonstrating a shouldered, irregular
component (Figure 5); biopsy confirmed stricture within the inferior duct.
cholangiocarcinoma. The patient was
therefore removed from listing for
transplantation. management. Previously, DWI has been the acquisition of additional b-value
partly hampered by issues relating images. An additional benefit of MAGiC
Discussion to movement, susceptibility artifact DWI is the ability to calculate high
In both cases the high quality resolution and poor resolution; cases such as b-value synthetic images without the
and motion resistance of navigator- these clearly demonstrate that time lengthened TE that an acquisition
triggered DWI, in conjunction with invested in image acquisition during would require, thereby improving image
utilization of high b-value synthetic certain critical sequences is well- resolution and SNR as shown in the
images derived using MAGiC DWI, spent, while utilization of MAGiC DWI cases described.4
led to the identification of lesions enabled time-savings from avoiding
that dramatically changed patient

Case Studies
*
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.
Being able to confidently identify employ navigator-triggered DWI and References

1. Schmid-Tannwald C, Oto A, Reiser MF and Zech CJ. Diffusion-
lesions only millimeters in size, T2-weighted PROPELLER imaging to weighted MRI of the abdomen: current value in clinical
including within the lung bases where optimize image quality in challenging routine. J Magn Reson Imaging. 2013 Jan;37(1):35-47.
2. Kircher, MF et al. Comparison of Breath-hold versus
technical issues such as motion and patient groups. Free-breathing versus Respiratory Triggered and Navigator
susceptibility artifact are normally Triggered Diffusion Weighted Imaging of the Liver. Proc. Intl.
Soc. Mag. Reson. Med. 19 (2011).p840.
significant factors of image degradation, Acknowledgements 3. Taouli B, Sandberg A, Stemmer A, et al. Diffusion-weighted
leads to significantly improved Martin Graves, PhD, Consultant Clinical imaging of the liver: comparison of navigator triggered
and breathhold acquisitions. J Magn Reson Imaging. 2009
diagnostic confidence. While breath- Scientist and Head of MR Physics, Sep;30(3):561-8.
hold DWI has its place in certain Cambridge University Hospitals; Simon 4. Higaki T, Nakamura Y, Tatsugami F, et al. Introduction to
patient groups with a low pre-test Dezonie, Zone Clinical Leader, UK, the Technical Aspects of Computed Diffusion-weighted
Imaging for Radiologists. Radiographics. 2018 Jul-
probability of disease, we now routinely GE Healthcare. Aug;38(4):1131-1144.

Marc Zins, MD
Saint-Joseph Hospital
Paris, France
3D MRCP with HyperSense:

an evaluation of respiratory-triggered
and breath-hold sequences
By Marc Zins, MD, Head of the Radiology Department, Saint-Joseph Hospital
Magnetic resonance cholangiopancreatography (MRCP)

Discovery MR750™ is a highly accurate, non-invasive diagnostic test used
to assess the hepatobiliary and pancreatic systems.
PARAMETERS
A challenge is that patient compliance is required for
3D Coronal 3D Coronal 3D Coronal respiratory-triggered and breath-hold sequences to
MRCP RT MRCP RT HS MRCP BH HS
achieve diagnostic-quality images.
TR (ms): 6000 3333 1878
In October 2016, our institution implemented
TE (ms): 888 882 1055
SIGNA™ Works, GE Healthcare’s productivity platform
FOV (cm): 34 x 27 34 x 27 36 x 28 of pulse sequences across core imaging techniques.
Slice thickness 1 1 2.8 SIGNA™ Works includes HyperSense, a compressed
(mm): sensing acceleration technique based on sparse data
Frequency: 416 416 384 sampling and iterative reconstruction that enables
Phase: 352 352 300 faster scan times or higher resolution.
HyperSense – 1.6 2.2 To evaluate the impact of HyperSense in MRCP exams,
factor: we performed a series of comparisons using our
NEX: 0.5 0.5 0.5 existing protocol, a conventional respiratory-triggered
Scan time 6:32 2:19 0:24 (sec.) Coronal 3D MRCP, a Coronal 3D MRCP respiratory-
(min): triggered with HyperSense and a Coronal 3D MRCP
Options: Zip2, FatSat, Zip2, FatSat, Zip2, FatSat, breath-hold with HyperSense.
RT, Sat A/P, RT, 50 kHz 62.5 kHz
50 kHz Technique
Each exam was performed on the Discovery™ MR750
3.0T system with a 32-channel torso coil. The protocol
included patient fasting of at least four hours, which
reduced the amount of fluid in the stomach and
digestive tract, distended the gallbladder and limited
duodenal peristalsis. There was no prior administration
of anti-peristalsis. The ingestion of pineapple juice just
before the examination helped to act as a negative
contrast agent, due to the paramagnetic properties
of the manganese contained in the juice, thus limiting
signal interference related to the digestive tract fluid
onto the resultant images.

Case Studies
A B C
Figure 1. A 57-year-old female with unique IPMN of 12 mm situated in the head of the pancreas. (A) Conventional MRCP with respiratory-
triggered sequence was acquired in 5:27 min.; (B) MRCP with respiratory-triggered and HyperSense acquired in 1:59 min.; and (C) MRCP
breath-hold with HyperSense. The breath-hold sequence provides the same diagnostic information as the conventional sequence but
in a far shorter scan time of 24 sec. and with fewer motion artifacts.
A B
Figure 2. A 77-year-old female with a cystic lesion located in the

pancreas body, in favor of an IPMN. (A) Conventional MRCP with
respiratory-triggered sequence was acquired in 3:39 min.; (B) MRCP
with respiratory-triggered and HyperSense was acquired in 2:19
min.; and (C) MRCP breath-hold with HyperSense was acquired in
21 sec. In this case, the patient could not hold their breath perfectly.
The respiratory-triggered sequence with HyperSense was able
to provide the same diagnostic information as the conventional
C
sequence with a reduced scan time.
MR findings however, with HyperSense we were Next, we evaluated the respiratory-

First, we compared the respiratory- able to reduce the sequence scan triggered HyperSense sequence against
triggered conventional 3D MRCP time by at least 34 percent. We were the HyperSense breath-hold sequence
against the respiratory-triggered also able to reduce artifacts in the using the same factor of 2.2. While the
HyperSense 3D MRCP sequence using respiratory-triggered sequence with spatial resolution was not the same
a factor of 1.6. In almost all cases, the addition of HyperSense due to the between these two sequences, we
we achieved similar image quality, shortened exam time. found that the 3D MRCP breath-hold
HyperSense sequence could often

A B C
Figure 3. A 53-year-old female with a 3 cm mass located in the pancreas head, which led to main and secondary pancreatic ducts dilation as
well as intra- and extra-hepatic biliary ducts dilation. (A) Conventional MRCP with respiratory-triggered sequence was acquired in 6:32 min.;
(B) MRCP with respiratory-triggered and HyperSense was acquired in 4:08 min.; and (C) MRCP breath-hold with HyperSense was acquired in
21 sec. All sequences provided the same diagnostic information.
A B
Figure 4. A 62-year-old female with a 8 mm cystic mass located

in the pancreas tail. (A) Conventional MRCP with respiratory-
triggered sequence was acquired in 3:46 min.; (B) MRCP with
respiratory-triggered and HyperSense was acquired in 2:29 min.;
and (C) MRCP breath-hold with HyperSense was acquired in
23 sec. The breath-hold sequence provides the same diagnostic
information as the conventional sequence but in a far shorter
scan time of 23 sec. The main pancreatic duct is better depicted
on the breath-hold sequence, due to motion artifacts present
C
on both triggered sequences.
provide the information needed for respiratory-triggered Coronal 3D MRCP

a confident diagnosis. Plus, by using sequence in our facility. Additionally,
HyperSense, the breath-hold sequence in patients who cannot tolerate the
could be reduced to 24 seconds or less high-resolution, respiratory-triggered
without respiratory-induced artifacts. 3D MRCP with HyperSense scan,
the Coronal 3D MRCP breath-hold
As a result of our evaluation, the
HyperSense factor of 2.2 sequence
Coronal 3D MRCP respiratory-triggered
is an excellent option that can result
with HyperSense factor of 1.6 sequence
in a successful examination.
has now replaced the conventional

Case Studies
Abdelhamid Derriche, MD Orkia Ferdagha
PRIISM, EHP Kara PRIISM, EHP Kara
Oran, Algeria Oran, Algeria
Detecting ischemia-induced cardiac

fibrosis with phase sensitive MDE
By Abdelhamid Derriche, MD, site radiologist, and Orkia Ferdagha, MR technologist, PRIISM, EHP Kara
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 1. Comparison of 2D MDE and PS MDE. PS MDE provides better visualization of the fibrosis and better suppression of healthy
myocardium signal even with non-optimal TI values. (A) 2D MDE SA, 2:06 min; (B) magnitude PS MDE; (C) phase PS MDE SA. Yellow arrows
indicate ischemia induced fibrosis; (B-C) red arrows depict a healthy myocardium signal not suppressed on magnitude PS MDE with sub-
optimal TI value; using the phase sensitive image from the same acquisition helped to fix this issue.
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.
Patient history enhancement with predominance on • No regional myocardial parietal

A 60-year-old male with a history the subendocardial antero-septo-lateral thinning of less than 6 mm.
of cardiac ischemia referred for a midventricular region.
Patient underwent angioplasty and
myocardial viability MR exam including
MDE demonstrates a systematic recovered some cardiac function.
function, perfusion and the qualitative
myocardial fibrosis belonging to the
analysis of the myocardial viability. The
left anterior descending (LAD) coronary Discussion
patient has ischemia-induced fibrosis
territory (see Figure 2). With contrast Using PS MDE, it was possible to assess
on diseased heart tissues.
uptake we found: myocardial necrosis with systematized
• Transmural on apical anteroseptal; transmural fibrosis on the LAD coronary
MR findings
territory in the apical anteroseptal
The left ventricular (LV) function study • Transmural on midventricular septal; region and midventricular septal region
provides an estimated fractional
• Inferior to 50% of myocardial as non-viability criteria. Additionally,
ejection of 24% and depicts a diffuse
thickness on subendocardial we determined myocardial ischemia
akinetic apical contraction with
anterior midventricular region; with subendocardial fibrosis inferior
midventricular hypokinesia with
to 50% of parietal thickness of the
anteroseptal predominance. • Sub-endocardial no-reflow anterior segment of the midventricular
Perfusion study shows an anomaly phenomenon on the infero-septal region with viability criteria as
with delayed and reduced contrast region of the apex (also observed well as hypokinesia of apical and
on perfusion sequence); midventricular regions with diminution
of LV fractional ejection.

Case Studies
A B C
Figure 3. Myocardial viability study. (A-C)

PS MDE SA, 2 min.; (D, E with color map) 2D
MDE 4 chambers, 1:59 min. Green arrows
demonstrate midventricular anterior segment
of LAD coronary territory showing viability
D E
criteria.
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

SIGNA™Works: tuned for productivity
and efficient workflows
By Steve Lawson, RT(R)(MR), Global MR Clinical Marketing Manager, and Heide Harris, RT(R)(MR),
Global Product Marketing Director, MR Applications and Visualization, GE Healthcare
Patient motion and magnetic field distortions, such as susceptibility

effects, are common issues impacting image quality and efficiency (e.g.,
scan times) in MR imaging. GE Healthcare provides an array of sequences
and solutions designed to take MR to the next level of productivity. Even
better, SIGNA™Works is value-added technology that is upgradable and
customizable to meet the specific needs of different practices.
MR is one of the most complex imaging Respiratory motion is a leading Magnetic field distortions can also
studies a radiologic technologist cause of artifacts degrading imaging be created by susceptibility effects
acquires. From patient positioning with quality. Many elderly or acutely ill that lead to signal loss, primarily in
phased array coils to determining the patients cannot hold their breath for T2-weighted relaxation and spatial
precise prescription for the imaging the duration of the acquisition. Other mismapping. The result is a signal void
study, there are many variables that can causes of motion artifacts include in the MR image or areas that have a
impact not only the quality of the study cardiac movement and CSF pulsation/ very bright signal due to a “pile up,”
but the efficiency and productivity of blood flow. where the signal is “assigned” to the
technologists and the MR system. wrong area(s). Susceptibility artifacts
One approach to reducing motion
may be common in patients with metal
One of the most common issues artifacts is to increase scanning speed
implants, screws or clips (e.g., aneurysm
impacting productivity is patient to decrease overall MR exam times.
clip), as well as in diffusion-weighted (DWI)
motion. In a published study, a This can be accomplished with parallel
sequences. MR exams suffering from
retrospective review of one calendar imaging and compressed sensing
susceptibility effects can decrease
week of MR exams found significant techniques, which can also have the
system and technologist productivity
motion artifacts on sequences in 19.8 added impact of reducing total scan
when the region of interest in the MR
percent of the total completed MR time and potentially enabling additional
image is distorted due to these artifacts.
exams.1 The authors estimated the scheduling slots. For respiratory
potential cost to the hospital to be $592 motion, there are free-breathing Here’s a look at the available sequences
per hour in lost revenue and a median techniques for patients that cannot and techniques that GE Healthcare
revenue foregone of approximately hold their breath, including respiratory- offers in the SIGNA™Works productivity
$115,000 per scanner, per year.1 gating, respiratory-triggered and Auto platform to address these issues.
Navigator techniques.
Figure 1. Cube PD with HyperSense

and ARC enables a 10-min isotropic
knee exam. (A) Cube PD with
HyperSense and ARC; (B) Cube PD
FatSat with HyperSense and ARC.
Both sequences acquired in 5 min
TE/TR = min/1000 ms, FOV 16 cm,
ARC 2 x 2, HyperSense factor of 1.2,
A B
0.5 mm isotropic.

Tech Trends
A B C D E F G
Figure 2. An eight-year-old patient pre-epileptic surgery

exam. Conventional contrast (top row) and parametric
maps (bottom row) were all generated in one 5 min. scan.
(A) T1w, (B) T2w, (C) T2 FLAIR‡, (D) PSIR, (E) STIR, (F) T1
FLAIR, (G) PD, (H) T1, (I) T2, (J) R1=1/T1, (K) R2=1/T2.
Images acquired on a Discovery™ MR750w GEM. Images courtesy of Queen
H I J K Silvia Hospital, Sweden.
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.

A
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).

Tech Trends
A B C
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.

Jim Wild, PhD
University of Sheffield
Sheffield, England
Hyperpolarized gas lung imaging

The POLARIS group at University of Sheffield, led by Jim Wild, PhD,
Professor of Magnetic Resonance Physics and a NIHR Research Professor
in Pulmonary Imaging, has been working on hyperpolarized gas lung MR
imaging. Their research and technical developments have made a clinical
impact on the National Health Service (NHS) practice in the diagnosis and
management of patients with asthma, chronic obstructive pulmonary
disease (COPD), cystic fibrosis, interstitial lung disease, lung cancer and
pulmonary hypertension.
In 2016, the Medicines and Healthcare airway diseases, like cystic fibrosis, (500 ml). Using conventional MR
products Regulatory Agency (MHRA) in asthma and COPD.” scanners (Optima™ MR450w) fitted with
the United Kingdom approved the use a broadband RF amplifier‡, the MR is
Also, because xenon is soluble, the gas
of hyperpolarized gas lung MR imaging tuned to a frequency that can detect
dissolves in the alveoli in the lungs and
for clinical diagnostic referral at the the hyperpolarized 129Xe. Xenon has a
goes into the capillaries. This allows
University of Sheffield. Professor Wild resonant frequency of approximately
measuring and quantifying interstitial
now manufactures helium 3 (3He) and 25 percent of proton MR; therefore,
changes in fibrotic lung disease
xenon 129 (129Xe) for diagnostic MRI dedicated RF coils are required.‡
and provides insight on ventilation
for clinical imaging use. Through the NHS,
perfusion (VQ) matching. Clinicians “Our research is geared to making
patients are referred to the Royal
can also measure alveoli dimensions this methodology work on clinically
Hallamshire Hospital, Sheffield Children’s
by measuring the diffusivity of the available MR systems,” Professor Wild
Hospital, and other NHS trusts
gas, which provides metrics on early says. “It involves retuning the MR
throughout the UK for hyperpolarized
emphysema changes in smokers and scanner to pick up xenon, designing
gas and proton lung MR imaging. With
on lung development in infants. additional coils to do lung and brain
MR, they can obtain more insight on a
xenon imaging, developing methods
patient’s lung function beyond ventilation. Xenon is an MR-sensitive gas. To
to interpret the signals and deriving
image the low concentrations of gas
“The technology allows us to image physiological biomarkers from this
inhaled in the air in the lungs, the spin
lung ventilation, gas exchange and kind of imaging. We work closely
magnetization needs to be boosted
microstructure,” Professor Wild with GE on the MR hardware and
by laser optical pumping. The Sheffield
explains. “We can image the ventilated software development for this,
group has built a laser polarizer1‡
air spaces and obtain information on particularly in the area of RF coil
that generates highly polarized 129Xe
lung ventilation changes in obstructed and pulse sequence developments.”
on demand in order to allow high-
throughput clinical lung imaging The team has explored the use
‡ Technology in development that represents ongoing research
and development efforts. These technologies are not products
with modest inhaled doses of xenon of parallel imaging methods for
and may never become products. Not for sale. Not cleared
or approved by the US FDA or any other global regulator for
commercial availability.

Tech Trends
Figure 1. Pediatric patient with cystic fibrosis.
(A) Baseline, ventilation defect percent
(VDP) = 3.14%, CVmean = 16.94%, forced
expiratory volume in 1 sec. (FEV1) (z-score) =
-0.51, LCI = 6.63. (B) Two-year follow-up,
VDP = 20.70%, CVmean = 20.15%, FEV1
A B
(z-score) = -0.75, LCI = 8.68.
Figure 2. A 13-year-old cross country

runner with decreasing race times with
chronic cough and increased sputum
production. FEV1 was normal. Patient
underwent hyperpolarized 129Xe MR imaging,
was diagnosed with non-cystic fibrosis
bronchiectasis and treated with IV antibiotics.
A B
(A) Baseline, (B) two-weeks after IV therapy.
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

Figure 3. Cystic fibrosis, 25-minute lung
structure-function MR imaging. (A) 129Xe
end-inspiratory tidal volume (EIVt); (B) total
lung capacity (TLC); (C) ultrashort echo time
(UTE); (D) TLC SPGR; and (E) residual volume
A B
(RV) SPGR.
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.
mapping with hyperpolarized gas

lung MR imaging provided regional References
1. Norquay G, Collier GJ, Rao M, Stewart NJ, Wild JM. ^{129}
quantitative information on changes Xe-Rb Spin-Exchange Optical Pumping with High Photon
in ventilation, complementing current Efficiency. Phys Rev Lett. 2018 Oct 12;121(15):153201.
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.”

Edison a common, integrated
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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
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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.

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6 Video game tech fueled ViosWorks 37 New deep learning tool

8 Localizing pain with PET/MR 51 Cardiac MR in patients with CIEDs

Publications Team: Editorial Board:

gehealthcare.com/mr 2 SIGNA Pulse of MR

60 Neuro imaging with

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77 Detecting ischemia-induced cardiac

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SIGNA Pulse of MR – digital library

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To learn more about

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Localizing pain with PET/MR

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Development of an MR-only radiation

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many sites are developing different

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Christian Jamtheim Gustafsson

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Figure 5. T2-weighted images are

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For example, each patient is imaged In addition to using the knowledge

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Thirty-minute PET/MR exam for

Clinicians at the Children’s Hospital of Wisconsin have developed a

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Figure 2. Case 2. A 16-year-old

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Figure 3. Case 3. A 13-year-old female

Figure 4. Case 3. Adjuvant therapy

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Figure 6. Case 4. Same patient.

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Figure 7. Case 5. Initial PET/MR

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Figure 9. Case 5. Discordant findings

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Figure 10. Case 6. Seven years post-

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Whole-body diffusion for evaluation

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Figure 3. (A) Coronal STIR,

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Discussion than MR. Scintigraphy exposes the References

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Transforming the MR imaging

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Figure 2. Same patient as Figure 1.

Figure 3. Fetal imaging with AIR Technology™

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AIR Technology: a brilliant

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Figure 1. Short axis 2D FIESTA. The combination

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