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GE Healthcare Excellence in Body Imaging with Optima* MR450w GEM Review of Abdomen & Pelvic Clinical Cases Body imaging is one of the fastest-growing areas in MR. Of all imaging modalities, MR delivers the most comprehensive insight on anatomy, tissue, and function. Imaging the abdomen and pelvis with MR with high and consistent image quality used to be challenging. But not any more. GE designed new MR imaging techniques to enhance patient comfort, workflow efficiency and ultimately, clinical confidence for every examination. Uncompromised field of view with GEM suite Fast, Simple & Easy workflow Automated workflow with linking & Inline post-processing Linking provides automatic graphic prescription by propagating slice locations throughout the entire protocol. • GEM Anterior Array provides 54 cm S/I anatomical coverage, taking advantage of the magnet large FOV capabilities • Embedded GEM Posterior Array provides 100 cm high-density total coverage • Automatic selection of enabled elements in the posterior and anterior array optimally match the prescribed FOV • Uncompromised 50 cm FOV allows large coronal coverage in one take; especially important for imaging large patients “ The GEM solution delivers higher signal to noise, shorter exam times, and improved image quality in all anatomies... All my staff is amazed by the speed and workflow of GEM! „ JM Pinon, Imaging Manager GIE IRM Creil Inline post-processing provides automatic calculation of parametric maps, reformats, pasted and binded series for simplified workflow and reporting. Detachable Express patient table Fully prepare patients for exams outside the scan room on the detachable Express patient table with up to 227 kg weight capacity. Save valuable time by transferring in-patients only once to help reduce anxiety and increase scanner productivity. IntelliTouch strips pinpoint patient positioning Easy-to-use IntelliTouch strips help enable fast, accurate landmarking. Simply press the IntelliTouch strip at the landmark location, and directly move the patient into the bore. Auto Voice guides patient breathing Auto Voice provides breath-hold instructions in the patient’s native language during the scan. Create new or modify existing messages to fit the patient needs. “ In our radiology department of Prince Philip Hospital Llaneli South Wales, we are impressed with the speed and diagnostic quality of the images produced by the Optima MR450w GEM scanner. We are also finding the patient experience relative to previous mri equipment is very positive. Dr Andy Richards, Consultant Radiologist Prince Philip Hospital, UK „ LAVA POWER & PRECISION WITH the LAVA Suite High spatial resolution Focal nodular hyperplasia imaging of multiple imaged with LAVA Flex hemangiomas with Lava Flex and PROPELLER a a b c d Abdominal imaging with uncompromised FOV a b c d Shorter scans with no misregistration Offering excellent coverage and reliability, the LAVA 3D FSPGR acquisition affords a single breath-hold scan with 1D or 2D acceleration to shorten scan times. LAVA optimizes the waveform for short TE/TR, and utilizes an ARC 2D selfcalibrating parallel technique to help elimination misregistration. LAVA Flex Obtain four image contrasts with greater SNR in a single, fast, one-breath-hold acquisition LAVA Flex is a 3D FSPGR imaging technique that generates water-only, fat-only, in-phase, and out-of-phase images in one single acquisition, typically completed in a single 20 s breath-hold. This innovative technique provides 3D images with excellent homogeneous fat suppression over the entire field of view. e b In a single breath-hold, LAVA Flex improves the visualization of small lesions, and makes it possible to reformat the 3D dataset into any slice orientation with an almost isotropic resolution (courtesy Dr Khouri, Policlinico di Monza, Italy). a- LAVA Flex Water image, TR 6.2 ms, TE 3.1 ms, resolution 1.43x1.87x1.9 mm3, 19 s b- Cor and Sag reformats from LAVA Flex axial acquisition (a) a- PROPELLER T2w fat sat with Resp.Trig., TR 12000 ms, TE 86.7 ms, resolution 1.18x1.18x6 mm3, 4 min 48 s b & c - LAVA Flex Water image, TR 6.3 ms, TE 3.1 ms, resolution 1.31x1.87x1.7 mm3, 19 s d- eDWI b200 with Resp.Trig.,TR 10000, TE 76.1 ms, resolution 2.3x1.7x6 mm3, 3 min 20 s e- ADC map calculated from (d) Follow up liver exam of a FNH and multiple adenomas. The FNH located in the left lobe shows slight hypersignal on the PROPELLER T2w (a), while on the LAVA Flex the enhancement in the arterial phase (b) is lobulated with no enhancing septation. On the equilibrium phase (c) the lesion is not different from normal liver parenchyma. The adenoma located in the segment II shows the same enhancement pattern, while the DWI image shows higher signal but same ADC value than the FNH. Notice the clear fat suppression with the Special adiabatic fat saturation pulse used on the eDWI sequence (d) (courtesy GIE IRM du Bassin Hyérois, France). The large FOV of 50 cm covered by the Anterior Array coil (AA), combined with the Posterior Array coil (PA) makes it possible to scan the liver and the small bowel in the same acquisition. Cube (a) and LAVA Flex (b) provide high resolution images (3D) for the evaluation of oncologic and inflammatory diseases, while Fiesta 2D (c & d) provide dynamic information on the motility of the small bowel (courtesy GIE IRM Creil, France). a-Cube T2w, TR 5998 ms with RT, TE 139 ms, resolution 1.25x1.92x1 mm3, 3 min 37 s b-LAVA Flex Water image, TR 6,5 ms, TE 3.2 ms, resolution 1.25x1.92x1.4 mm3, 22 s c-Fiesta, TR 4.1 ms, TE 1.9 ms, resolution 1.87x1.31x6.5 mm3, 14 s d-LAVA Flex Water image, TR 6,5 ms, TE 3.2 ms, resolution 1.25x1.92x1.4 mm3, 22 s a b Dynamic multi-arterial liver imaging with LAVA & LAVA Flex The LAVA Suite sequences (LAVA & LAVA Flex) extends the possibilities of liver dynamic exam: the short duration of the sequence allows the acquisition of several volumetric datasets within a single breath hold time, while covering the whole liver at high spatial resolution. This clinical case presents the benefit of a multi arterial acquisition (2 phases) for the detection of secondary liver lesions from a primary thyroid tumor. c POWER & PRECISION WITH the LAVA Suite High spatial resolution Focal nodular hyperplasia imaging of multiple imaged with LAVA Flex hemangiomas with Lava Flex and PROPELLER a c d e b- arterial phase 2 of LAVA Flex Water image c-late phase of LAVA Flex Water image, TR 6.2 ms, TE 3.1 ms, resolution 1.11x1.42x0.8 mm3, 22 s d- PROPELLER T2w with fat sat, Respiratory triggered (RT), resolution 0.81x0.81x7 mm3, 3 min 16 s e b The early arterial phase of the LAVA Flex acquisition (a), clearly depicts several lesions in the liver and the lung (arrow heads), while the liver lesions became less visible on the later arterial phase 2 (b), and practically invisible on the late phase (c). They are also clearly identified on the PROPELLER T2w (d) and DWI images (e) (courtesy GIE IRM Creil, France). a- arterial phase 1 of LAVA Flex Water image, TR 6.2 ms, TE 3.1 ms, resolution 1.43x1.9x1.9 mm3, 11 s per phase d a e- DWI b800 RT with Special fat sat, resolution 2.12x1.51x7 mm3 2 min 42 b In a single breath-hold, LAVA Flex improves the visualization of small lesions, and makes it possible to reformat the 3D dataset into any slice orientation with an almost isotropic resolution (courtesy Dr Khouri, Policlinico di Monza, Italy). a- LAVA Flex Water image, TR 6.2 ms, TE 3.1 ms, resolution 1.43x1.87x1.9 mm3, 19 s b- Cor and Sag reformats from LAVA Flex axial acquisition (a) Abdominal imaging with uncompromised FOV a b c d a- PROPELLER T2w fat sat with Resp.Trig., TR 12000 ms, TE 86.7 ms, resolution 1.18x1.18x6 mm3, 4 min 48 s b & c - LAVA Flex Water image, TR 6.3 ms, TE 3.1 ms, resolution 1.31x1.87x1.7 mm3, 19 s d- eDWI b200 with Resp.Trig.,TR 10000, TE 76.1 ms, resolution 2.3x1.7x6 mm3, 3 min 20 s e- ADC map calculated from (d) Follow up liver exam of a FNH and multiple adenomas. The FNH located in the left lobe shows slight hypersignal on the PROPELLER T2w (a), while on the LAVA Flex the enhancement in the arterial phase (b) is lobulated with no enhancing septation. On the equilibrium phase (c) the lesion is not different from normal liver parenchyma. The adenoma located in the segment II shows the same enhancement pattern, while the DWI image shows higher signal but same ADC value than the FNH. Notice the clear fat suppression with the Special adiabatic fat saturation pulse used on the eDWI sequence (d) (courtesy GIE IRM du Bassin Hyérois, France). The large FOV of 50 cm covered by the Anterior Array coil (AA), combined with the Posterior Array coil (PA) makes it possible to scan the liver and the small bowel in the same acquisition. Cube (a) and LAVA Flex (b) provide high resolution images (3D) for the evaluation of oncologic and inflammatory diseases, while Fiesta 2D (c & d) provide dynamic information on the motility of the small bowel (courtesy GIE IRM Creil, France). a-Cube T2w, TR 5998 ms with RT, TE 139 ms, resolution 1.25x1.92x1 mm3, 3 min 37 s b-LAVA Flex Water image, TR 6,5 ms, TE 3.2 ms, resolution 1.25x1.92x1.4 mm3, 22 s c-Fiesta, TR 4.1 ms, TE 1.9 ms, resolution 1.87x1.31x6.5 mm3, 14 s d-LAVA Flex Water image, TR 6,5 ms, TE 3.2 ms, resolution 1.25x1.92x1.4 mm3, 22 s PROPELLER 3.0 Overcome patient motion, flow, and susceptibility artifacts anywhere PROPELLER 3.0 significantly reduces the effect of patient voluntary and physiologic motion such as breathing, flow, and peristalsis, while also reducing magnetic susceptibility artifacts. Compared to conventional MR imaging techniques, PROPELLER 3.0 generates virtually artifact-free images with fine anatomic detail and excellent tissue contrast—all in a free-breathing acquisition and in about the same scan time as conventional T2w acquisition. INnovations for consistent image Quality High resolution imaging of a rectal polyp with T2w PROPELLER 3.0 a The excellent spatial resolution of the T2w PROPELLER sequence and the absence of motion artifacts from peristalsis allows you to depict clear details such as this well defined 4 cm polyp in mid rectum. No breaching of the muscularis propria layer or spread to the mesorectal fat is seen. c b “ The images of this rectal polyp are illustrative of the quality we have obtained routinely „ Dr Andy Richards, Consultant Radiologist Prince Philip Hospital, UK Cube a, b, c- PROPELLER T2w, TR 6583 ms, TE 106 ms, resolution 0.87x0.87x4 mm3, 2 min 28 s Scan once then view any way you want High-resolution volumetric T2w body scans with Cube can be reformatted to the desired planes for further evaluation. eDWI Motion artifact-free imaging of a complex pelvic cyst with T2w PROPELLER Enhanced DWI. Designed to maximize SNR, shorten scan times, and generate an accurate ADC map The uterine junctional zone is clearly depicted with an excellent T2w contrast, showing an homogeneous myometrium. The cystic pelvic mass demonstrated several loculi which are in favour of an epithelial tumour of mucinous type (courtesy GIE IRM du Bassin Hyérois, France). The enhanced Diffusion Weighted Imaging (eDWI) technique is designed to provide high signal-to-noise ratio diffusion images of the body in short-acquisition times. eDWI supports multiple b values in one acquisition with flexible control of NEX for each b value. Novel diffusion techniques, 3in1, and tetrahedral allow applying gradients in multiple directions to improve scan efficiency and signal-to-noise ratio. a & b- PROPELLER T2w, TR 6316 ms, TE 124 ms, resolution 0.75x0.75x3.5 mm3, 4 min 19 s c- PROPELLER T2w, TR 6201 ms, TE 122 ms, resolution 0.75x0.75x3.5 mm3, 4 min 14 s a b c High contrast resolution with T2w PROPELLER The uterine junctional zone appears thickened and globular with an excellent T2w contrast (a, b), with no evidence of myomas. Moreover, there are several Nabothian cysts, the one close to the cervix appears haemorrhagic. There is no enhancement defect on the 3D T1w image after contrast injection (c, d), which implies no additional lesion within the cervix. a “ The T2w PROPELLER sequence provides an excellent contrast between the different layers of the uterus, and can be acquired in any orientation with the same image quality. „ Dr D’Anthouard, GIE IRM Creil, France b INnovations for consistent image Quality High resolution imaging of a rectal polyp with T2w PROPELLER 3.0 a The excellent spatial resolution of the T2w PROPELLER sequence and the absence of motion artifacts from peristalsis allows you to depict clear details such as this well defined 4 cm polyp in mid rectum. No breaching of the muscularis propria layer or spread to the mesorectal fat is seen. c b “ The images of this rectal polyp are illustrative of the quality we have obtained routinely a- PROPELLER T2w, TR 7730, TE 114 ms, resolution 0.76x0.76x3.5 mm3, 2 min 15 s „ Dr Andy Richards, Consultant Radiologist Prince Philip Hospital, UK b- PROPELLER T2w, TR 6387 ms, TE 126 ms, resolution 0.78x0.78x4 mm3, 4 min 22 s a, b, c- PROPELLER T2w, TR 6583 ms, TE 106 ms, resolution 0.87x0.87x4 mm3, 2 min 28 s c&d- 3D T1w image post contrast, TR 6,4 ms, TE 3.1 ms, resolution 1x1.33x1 mm3, 2 min 40 s Motion artifact-free imaging of a complex pelvic cyst with T2w PROPELLER c d The uterine junctional zone is clearly depicted with an excellent T2w contrast, showing an homogeneous myometrium. The cystic pelvic mass demonstrated several loculi which are in favour of an epithelial tumour of mucinous type (courtesy GIE IRM du Bassin Hyérois, France). a & b- P ROPELLER T2w, TR 6316 ms, TE 124 ms, resolution 0.75x0.75x3.5 mm3, 4 min 19 s c- PROPELLER T2w, TR 6201 ms, TE 122 ms, resolution 0.75x0.75x3.5 mm3, 4 min 14 s a b c Data subject to change. 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