BM 573 Cardiac Imagıng

Imaging Modalities (general):

Introduction
- Very brief physics
- Comparison of Modalities

From various presentations and internet sites, sorry for the missing references .
Introduction (2/2) – Comparison of Modalities
Review:
Modalities:
X-ray: Measures line integrals of attenuation coefficient
CT: Builds images tomographically; i.e. using a set of
projections
Nuclear: Radioactive isotope attached to metabolic
marker
Strength is functional imaging, as opposed to
anatomical
Ultrasound: Measures reflectivity in the body.
Ultrasound
Ultrasound uses the transmission and reflection of acoustic energy.


prenatal ultrasound image

clinical ultrasound system

Ultrasound

• A pulse is propagated and its reflection is received,

both by the transducer.
• Key assumption:
- Sound waves have a nearly constant velocity
of ~1500 m/s in H2O.
- Sound wave velocity in H2O is similar to that in soft tissue.
• Thus, echo time maps to depth.
Ultrasound: Resolution and Transmission Frequency
Tradeoff between resolution and attenuation -
↑higher frequency ↓shorter wavelength ↑ higher attenuation
dB
Power loss: 1
cm  MHz
Typical Ultrasound Frequencies:
Deep Body 1.5 to 3.0 MHz
Superficial Structures 5.0 to 10.0 MHz

e.g. 15 cm depth, 2 MHz, 60 dB round trip

Why not use a very strong pulse?
• Ultrasound at high energy can be used to ablate (kill) tissue.
• Cavitation (bubble formation)
• Temperature increase is limited to 1º C for safety.
Magnetic Resonance Imaging
Main Magnetic Field

B0
 Magnetic Resonance Imaging

There are 3 magnetic fields of interest in MRI.

The first is the static field Bo.
1) polarizes the sample:

M( x,y,z)   ( x,y,z) density of 1H

2) creates the resonant frequency: ω = γB

γ is constant for each nucleus: γ

 42.57 MHz/Tesla for 1H
2π
Proton Spin Creates Signal
Source
B0

B0
w = gB
64 MHz for H+ at 1.5T
 Second Magnetic Field : RF Field

B1
An RF coil around the patient transmits a pulse of power at the
resonant frequency ω to create a B field orthogonal to Bo.
This second magnetic field is termed the B1 field.
B1 field “excites” nuclei.
Excited nuclei precess at ω(x,y,z) = γB (x,y,z)
Transmit Coils

RF Coil

Demodulat
A/D
Preamp
Spin Encoding
Magnetic Resonance
The spatial location is encoded by using gradient field coils around
the patient. (3rd magnetic field) Running current through these
coils changes the magnitude of the magnetic field in space and
thus the resonant frequency of protons throughout the body.
Spatial positions is thus encoded as a frequency.
The excited photons return to equilibrium ( relax) at different rates.
By altering the timing of our measurements, we can create
contrast. Multiparametric excitation – T1, T2
Brain Glioma
 Non-contrast-enhanced MRI

Sagittal Carotid Coronal

Contrast-enhanced Abdominal Imaging
Time-resolved Abdominal Imaging
Contrast-enhanced MR Cardiac Imaging
Fat Coronal Knee Image Water Coronal Knee Image
Comparison of modalities
Why do we need multiple modalities?
Each modality measures the interaction between energy and
biological tissue.
- Provides a measurement of physical properties of tissue.
- Tissues similar in two physical properties may differ in a
third.
Note:
- Each modality must relate the physical property it measures
to normal or abnormal tissue function if possible.
- However, anatomical information and knowledge of a large
patient base may be enough.
- i.e. A shadow on lung or chest X-rays is likely not good.
Other considerations for multiple modalities include:
- cost - safety - portability/availability
Comparison of modalities:
X-Ray
Measures attenuation coefficient μ ( x, y, z )

Safety: Uses ionizing radiation

- risk is small, however, concern still present.
- 2-3 individual lesions per 106
- population risk > individual risk
i.e. If exam indicated, it is in your interest to get exam
Use: Principal imaging modality
Used throughout body
Distortion: X-Ray transmission is not distorted.
Comparison of modalities:
Ultrasound
Measures acoustic reflectivity R( x, y, z )
Safety: Appears completely safe
Use: Used where there is a complete soft tissue and/or fluid path
Severe distortions at air or bone interface
Distortion:
Reflection: Variations in c (speed) affect depth estimate
Diffraction: λ ≈ desired resolution (~.5 mm)
Comparison of modalities:
Magnetic Resonance (MR)
Multiparametric
M(x,y,z) proportional to ρ(x,y,z) and T1, T2.
(the relaxation time constants)
Velocity sensitive
Safety: Appears safe
Static field - No problems
dB
 10 T/s - Some induced phosphenes
dt
Higher levels - Nerve stimulation
RF heating: body temperature rise < 1˚C - guideline

Use:
Distortion: Some RF penetration effects
- intensity distortion
Clinical Applications - Table
Chest Abdomen Head
X-Ray/ + widely used – needs contrast + X-ray - is good
CT + CT - excellent + CT - excellent for bone
– CT - bleeding,
trauma
Ultrasound – no, except for + excellent – poor
+ heart – problems with
gas
Nuclear + extensive use Merge w/ CT + PET
in heart

MR + growing + minor role + standard

cardiac
applications
Clinical Applications – Table continued…
Cardiovascular Skeletal / Muscular
X-Ray/ + X-ray – Excellent, with + strong for skeletal system
CT catheter-injected
contrast
Ultrasound + real-time – not used
+ non-invasive
+ cheap
– but, poorer images
Nuclear + functional information + functional - bone marrow
on perfusion

MR + getting better + excellent

High resolution
Myocardium viability
Economics of modalities:

Ultrasound: ~ $100K – $250K

CT: $400K – $1.5 million (helical scanner)
MR: $350K (knee) - 4.0 million (siting)
Service: Annual costs
Hospital must keep uptime
Staff: Scans performed by technologists
Hospital Income: Competitive issues
Significant investment and return