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THE MAGAZINE OF MR • AUTUMN 2007
The IDEAL Approach to
Separating Water and Fat
page 16
2D Versus 3D
page 14
Re-Defining the
Next Generation
of High Definition
page 32
Making the Decision
to Add MRI
page 48
imagination at work
The information contained in this document is current as of publication of the magazine.
TA B L E O F
CONTENTS
GE News: The IDEAL Solution
for Fat and Water Separation
Page 6
Clinical Value: One Breath Away from
Volumetric In-Phase, Opposed-Phase
Fat/Water Imaging
Page 24
Technical Innovation: Enhancements
Bring Sophisticated MR Applications
Within the Reach of Everyone
Page 40
GE Healthcare News
Clinical Value
Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Volumetric Imaging Magnetizes Radiology . . . . . . . . . . . . . . . . 12
New Volume Acquisition Helps Clinicians
Detect Small Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Clinical Proof of 2D Versus 3D . . . . . . . . . . . . . . . . . . . . . . . . 14
The IDEAL Solution for Fat and Water Separation. . . . . . . . . . . 6
Introducing the Next Generation of HD MR . . . . . . . . . . . . . . . . . 7
Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
GE Opens China’s First MR Application Academy . . . . . . . . . . . 9
3.0T Continues to Bring Users Together . . . . . . . . . . . . . . . . . . . 10
Consistent, Reliable, Fat-Suppressed Imaging
Even with Difficult Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
High-Resolution, Isotropic-Voxel Acquisition Technique
Improves Quality and Utility of Diffusion-Weighted and
Diffusion Tensor Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
One Breath Away from Volumetric In-Phase,
Opposed-Phase Fat/Water Imaging . . . . . . . . . . . . . . . . . . . . . . 24
Efficient Image Quality Enhancements
in Temporal Bone Imaging Using PROPELLER HD. . . . . . . . . . 28
Validation of an Automated Left Ventricular
Segmentation Technique for Quantifying Stroke Volume. . . 30
Publications Team:
GE Contributors:
David Handler
General Manager, MR Global Marketing
Chris Fitzpatrick
MR Global Marketing Programs Manager
Renée Adelle Stasiewicz
Global Marketing Communications Manager,
Diagnostic Imaging Modalities
Joanna Jobson
MR Global Marketing Programs Manager
Katherine Patterson
Global Marketing Communications Manager, MR
Maria Piazza
MR Global Marketing Programs Manager
Mary Beth Massat
Editorial Consultant
© 2007 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.
2
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
Beyond the Scan: Medicare
Reimbursement Update
Page 52
Technical Innovations
Re-Defining the Next Generation of High Definition. . . . . . . . 32
3D FSE Reduces Scan Time, Generates Thinner Slices . . . . . 34
New Parallel Imaging Method Enhances Imaging Speed
and Accuracy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Quantitative Tool for Neurological Brain Evaluation . . . . . . . 39
Enhancements Bring Sophisticated MR Applications
Within the Reach of Everyone . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Robust NCE Techniques Remain a Viable Alternative
for MR Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Beyond the Scan
Advanced fMRI Techniques Provide Valuable Information,
Change Course of Treatment for Neurosurgical Patients. . . 44
The Right Choice for Your Community:
Making the Decision to Add MRI . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Medicare Reimbursement Update . . . . . . . . . . . . . . . . . . . . . . . . 52
Signa 3.0T Users Share Best Practices, Clinical
Techniques with Users Around the World . . . . . . . . . . . . . . . . . 53
The information contained in this document is current as of publication of the magazine.
G E H E A LT H C A R E N E W S
WELCOME
Welcome
Ever stop and think about the incredible strides medical
research has made in the last 100 years? I admit it, working
in this industry can make us harder to impress than the
average person. But think about it. In the last 100 years,
we’ve seen the discovery of the cause of rickets (1916) to the
discovery of penicillin (1940s). It was only in the last 50 years
or so when they found that smoking is a leading cause of
cancer (1956) or that chemotherapy could be used as a
treatment for cancer (1970s). Of course, we couldn’t forget
Sir Peter Mansfield and his studies that led to the development
of the MRI in 1973.
Incredible stories. But they underscore the point that the
scientific advancements in healthcare are really just starting
to gain momentum. There’s so much ahead of us – every
day brings another finding or advancement – and every day
lives are saved that previously would not have been. What
an exciting time to be in healthcare!
4
A GE Healthcare MR publication • Autumn 2007
But even the most advanced imaging tools won’t succeed
in today’s clinical environment if they aren’t delivering what
radiologists need. They must be clear, accurate and specific.
Otherwise, our mission will fail to deliver what it ultimately
needs to do: giving radiologists the tools they need to do
their job to save lives. No small task.
In his 2007 book, How Doctors Think, Dr. Jerome Groopman
discusses a study from Dr. E. James Potchen that indicates
radiologists need to be able to gather the information they
need from images in 38 seconds. Thirty-eight seconds!
What this means to us is that our images need to clearly,
consistently and accurately deliver in a very short period
of time. Something we take to heart.
This is why we at GE Healthcare are pleased to introduce to
you the next dimension in HD MR imaging – the Signa® HDxt.
These new acquisitions are truly exciting – and are in step
with our vision to give you what you need: images that
are clear, concise and consistent. Every time. For every
The information contained in this document is current as of publication of the magazine.
W E L C O M E G E H E A LT H C A R E N E W S
James E. Davis
patient and technologist. And we’re presenting you detailed
information about each in this issue of Signa PULSE that you
can put to immediate use on your Signa HDx system.
• IDEAL – consistent, exceptional fat suppression for even
the most challenging anatomies, solving the problem with
chemical shift artifacts
• Cube – the 3D, HD acquisition that allows you to view in
any plane, eliminating operator variances and minimizing
blurring to acquire complete data from scan – all while
significantly reducing total exam time
• 3D Dual Echo – Overcomes difficult imaging challenges,
such as fatty liver disease, by acquiring images at the
true TE at any Tesla strength
All of these are industry leading applications … many developed
in collaboration with our lead users. As we walk down the
path of this new era in healthcare together, it’s exciting to
look to the future. We’re working on some truly revolutionary
ideas that have our engineers buzzing with excitement. But
at GE Healthcare, we try to make sure that these ideas not
only are exciting – but realistic. That’s why we’re focused
on solutions that enable you to See more with better
image quality. Do more with solutions that make sense
and opportunities that expand your practice into other
areas. And Expect more from your vendor – with service
and solutions that won’t become obsolete.
That is our promise – we look forward to moving into
the future with you.
• ARC – A major step forward in speed and accuracy,
delivers a highly accelerated parallel imaging technique,
enabling tight field-of-view (FOV) prescriptions
• BrainSTAT – combined with diffusion imaging, provides
an effective way to visualize the effects of neurological
conditions, providing valuable treatment information faster
James E. Davis
Vice President and General Manager,
Global MR Business
GE Healthcare
A GE Healthcare MR publication • Autumn 2007
5
The information contained in this document is current as of publication of the magazine.
G E H E A LT H C A R E N E W S
NEW PRODUCTS
New Volume Acquisition Helps Clinicians
Detect Small Lesions
GE Healthcare introduces Cube™, a new volumetric fast spin
echo (FSE) imaging sequence available on the Signa® HDxt
1.5T and 3T platforms. Optimized for T2, T2 FLAIR and Proton
Density imaging, Cube captures the entire volume with high
spatial, isotropic resolution. As a result, any view, plane or
slice can be later reconstructed from a single acquisition
with the same high resolution as the native plane.
This new ability for volumetric imaging of the anatomy
can result in fewer retakes that are often due to missing or
misaligned slices or planes. It may also help radiologists to
more consistently detect lesions as small as 2mm. The Cube
sequence is based on modulated flip angles, which make
very long echo train feasible. The typical image blurring
and SAR are reduced, while high tissue contrast leads
to conspicuous appearance of pathologies.
Protocol settings are automatically optimized based on the
anatomical region of interest (ROI) and MR sequence. Cube
also provides excellent enhanced tissue contrast and specific
absorption rate (SAR) management by staggering the delivery
of energy to the patient/tissue.
When used with GE’s innovative auto-calibrating, data-driven
parallel imaging technique, ARC, clinicians will have the
Isotropic volumetric imaging with Cube
capability to acquire large high definition 3D data sets
in relatively short time for a more efficient workflow.
As part of the revolutionary HDxt platform, Cube completes
GE’s volume portfolio to allow clinicians to provide the
benefits of volume imaging for every study. The IDEAL Solution for Fat and Water Separation
Representing a new paradigm in fat suppression, IDEAL is
an innovative method for fat and water separation available
exclusively on GE Healthcare’s Signa® HDxt 1.5T and 3.0T MR
systems. IDEAL is a single acquisition technique that generates
four images – water only, fat only, in phase and out of phase.
This new sequence is particularly useful when imaging difficult
areas of the anatomy, such as the orbits, brachial plexus,
c-spine, extremities. IDEAL consistently
separates fat from water in challenging
anatomical areas, resulting in excellent
image quality. Also, because IDEAL is a
single acquisition technique, the in phase
and out of phase images are inherently
registered, leading to faster interpretation
and higher diagnostic confidence.
6
A GE Healthcare MR publication • Autumn 2007
Developed in conjunction with Stanford Radiology and the
University of Wisconsin-Madison Hospitals and Clinics, IDEAL
is enabled for 2D FSE with PD, T1 or T2 contrast and 3D
SPGR with T1 contrast. Unlike current methods, such as
spectrally selective fat saturation and STIR, IDEAL is compatible
with the new generation of phased array coils and parallel
imaging techniques. The information contained in this document is current as of publication of the magazine.
N E W P R O D U C T S G E H E A LT H C A R E N E W S
Introducing the Next Generation of HD MR
Just as high definition (HD) has transformed TV, HD MR
enables new clinical capabilities by capturing higher
resolution and consistently clear images for increased
diagnostic confidence. GE Healthcare introduces Signa®
HDxt to extend the concept of isotropic, volumetric imaging.
HD Volumetric MR can help transform imaging by addressing
some of the toughest issues facing MR imaging today. With
advanced technology, new coils and applications, Signa HDxt
provides high definition, complete data sets with enhanced
clear contrast for overall better image quality within a
shortened exam time.
New applications driving volume data acquisition include:
• Cube™, which quickly acquires isotropic resolution volume
data that allows multi-plane reconstruction, while helping
reduce the number of scans and total exam time
• ARC, a fast, robust, auto-calibrating data-driven parallel
imaging method that minimizes artifacts and significantly
decreases sensitivity to motion, ideal for smaller field of
view imaging
• 3D Dual Echo, a volumetric, high signal-to-noise ratio
imaging sequence that generates in-phase and out-of-phase
images in a single breath hold acquisition even at 3.0T
• IDEAL, a revolutionary HD technique for true fat and water
separation provides uncompromising image clarity with
consistent and robust fat suppression, especially in
difficult areas of anatomy. A GE Healthcare MR publication • Autumn 2007
7
The information contained in this document is current as of publication of the magazine.
G E H E A LT H C A R E N E W S
EVENTS
Calendar of Events
GE looks forward to seeing you at the following events
8
Conference
Dates
Conference Center
or Hotel
City and State
or Provence
Country
Web link
San Antonio Breast
Cancer Symposium
Dec. 13-16
Henry B. Gonzalez
Convention Center
San Antonio, TX
USA
www.sabcs.org
Society for Cardiovascular
Feb. 1-3
Magnetic Resonance (SCMR)
11th Annual Scientific Sessions
Hyatt Regency
Century Plaza
Los Angeles, CA
USA
www.scmr.org
Vail 2008: MRI in
Clinical Practice
Feb. 10-15
Vail Marriot
Mountain Resort & Spa
Vail, CO
USA
www.educationalsymposia.com
MRI 2008: Clinical Updates
and Practical Applications
Feb. 18-22
Rio Mar Beach Resort and Spa – Puerto Rico
Wyndham Grand Resort
Commonwealth www.cms.hms.harvard.edu
of the USA
American Society of Functional Feb. 27-29
Neuroradiology (ASfNR),
2nd Annual Meeting
Rosen Shingle Creek
Orlando, FL
USA
www.asfnr.org
American Academy
of Orthopaedic Surgeons
75th Annual Meeting
Moscone Center
San Francisco, CA
USA
www.aaos.org
European Congress of Radiology Mar. 7-11
Austria Center Vienna
Vienna
Austria
www.myesr.org
The Breast Course
Mar. 12-15
Fairmont Le Chateau
Frontenac
Quebec City, Quebec
Canada
www.thebreastcourse.com
American College of
Cardiology (ACC)
59th Annual Scientific Session
Mar. 29-Apr. 1
McCormick Place
Chicago, IL
USA
www.acc.org
The Annual Meeting of Japan
Radiological Society &
The Annual Scientific Congress
of Japanese Society of
Radiological Technology
Apr. 4-6
Pacifico Yokohama
Yokohama,
Kanagawa
Japan
www.secretariat.ne.jp
2008 3T MRI Whole Body Imaging Apr. 10-12
in Clinical Practice: Basic
Fundamentals – Adv. Apps.
Eden Roc, A Renaissance
Beach Resort & Spa
Miami Beach, FL
USA
www.educationalsymposia.com
MRI of the Head & Spine
2008 National Symposium
Apr. 28-30
The Venetian
Resort-Hotel-Casino
Las Vegas, NV
USA
www.educationalsymposia.com
Magnetic Resonance Imaging
2008: National Symposium
Apr. 28-May 2
The Venetian
Resort-Hotel-Casino
Las Vegas, NV
USA
www.educationalsymposia.com
MRI of the Body & Heart
2008: National Symposium
Apr. 30-May 2
The Venetian
Resort-Hotel-Casino
Las Vegas, NV
USA
www.educationalsymposia.com
ISMRM Sixteenth Scientfic
Meeting and Exhibition/SMRT
Seventeenth Annual Meeting
May 3-9
Metro Toronto
Convention Centre
Toronto, Ontario
Canada
www.ismrm.org
Society of Breast Imaging
May 8-10
Grande Lakes Resort
Orlando, FL
USA
www.sbi-online.org
American Society
of Neuroradiology (ASNR),
46th Annual Meeting & NER
Foundation Symposium
May 31-June 5
Morial Convention Center
New Orleans, LA
USA
www.asnr.org
European Society of
June 10-13
Gastrointestinal and Abdominal
Radiology (ESGAR) 2008
Istanbul Conference
& Exhibition Center
Istanbul
Turkey
www.esgar.org
Organization for Human
Brain Mapping
Melbourne Convention Center
Melbourne
Australia
www.hbm2008.com
Mar. 5-9
June 15-19
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
E D U C A T I O N G E H E A LT H C A R E N E W S
GE Opens China’s First
MR Application Academy
With the deployment of more than 2,000 MR units across China,
hospitals suffer from a shortage of trained technologists,
physicists, radiochemists and radiologists specializing in MRI.
To help accelerate this important area of growth and provide
training and development in this pivotal field, GE Healthcare
co-founded and opened the first MR Application Academy
in Shanghai in collaboration with the Chinese Society of
Radiology and the Chinese Society of Imaging Technology.
The academy will provide a platform to meet the demand
for training brought on by the rapid adoption of MRI technology
throughout China.
The Academy will focus on advancing MR clinical applications
and promoting research utilizing techniques and applications
among the Chinese research and academic communities.
It will also provide essential, professional training for MRI
technologists, radiologists and research scientists. Located
at the GE China Technology Center, it is comprised of the
MR Education Center China (MRECC), the Sino-U.S. MR Physics
Center and the Sino-U.S. MR Molecular Imaging Center.
“With the wholehearted support of China’s MR community
and leaders in the MR field from the U.S., the Academy is the
first and only institution dedicated to MRI training in China
today,” stated Zhao Bin, Executive President of China MR
Application Academy and Director of Shandong Medical
Imaging Research Institute. “Our focus is on both the provision
of opportunities for MR clinical practice and learning for
front-line medical personnel, and on the establishment of
a new scientific MR research mode for our large academic
hospitals and research institutions. The China MR Application
Academy is laying the foundation for the advancement of
medical imaging within China.”
Among the esteemed MRI professionals serving the Academy
are co-presidents Professor Qi Ji, Chairman of the Chinese
Society of Radiology and Dr. Thomas Foo, Manager of GE
Global Research Center MRI Lab. More than 60 experts from
China and the U.S. have also been appointed as professors
at the Academy.
To learn more about the academy, visit www.mriabc.org. A GE Healthcare MR publication • Autumn 2007
9
The information contained in this document is current as of publication of the magazine.
G E H E A LT H C A R E N E W S
USER MEETINGS
3.0T Continues to
Bring Users Together
Signa 3.0T made easy in the “Big Easy”
As part of the conference “3.0T MRI: Whole Body Imaging
in Clinical Practice,” in New Orleans, GE Healthcare hosted a
fourth 3.0T users meeting on April 28, 2007. The meeting was
geared to help optimize the clinical use of the Signa® 3.0T
MR System. Guest speaker, Sheetal S. Desai, RT (R)(MR),
Chief MR Technologist, Edison Imaging Associates
(Edison, NJ), discussed MR imaging tips and techniques
for optimizing breast imaging, specifically with the
use of new fat sat pads.
Bryan Mock, PhD, GE Global 3.0T Product Manager,
provided an update on portfolio enhancements and
a glimpse into the continued future development
of Signa 3.0T systems. Mike Pellerin, GE Clinical MR
Specialist, discussed how to maintain T1 contrast at
3.0T with different alternatives, such as Spin Echo,
FSPGR and T1 FLAIR. He also showed imaging
strategies to address the dielectric effect at 3.0T.
Pam Sandow, MR QA Specialist, presented artifact
identification and management at 3.0T while Carol
Maher, GE TiP Applications Specialist, presented the
Succeed Program, a training concept designed to help
users define a new strategy that can maximize the
breadth and depth of clinical applications at 3.0T.
10
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
U S E R M E E T I N G S G E H E A LT H C A R E N E W S
Sprechen sie 3.0T?
A packed house produced an evening of sharing ideas and
information at The Global Signa 3.0T Users Event during the
International Society for Magnetic Resonance in Medicine
(ISMRM), held May 19-25, 2007 in Berlin, Germany. Users
were presented with an overview of the Signa 3.0T product
portfolio, clinical imaging techniques, advanced neuro
applications and technical performance.
Bryan Mock, PhD, GE Global 3.0T Product Manager welcomed
the 140-plus Signa 3.0T users with an update on new
portfolio enhancements. He also unveiled plans for future
enhancements to Signa 3.0T MR Systems.
Lawrence Tanenbaum, M.D., FACR, Section Chief MRI, CT
and Neuroradiology, Edison Imaging and JFK Medical Center,
presented ultra high resolution imaging techniques using
the new Cube™ volumetric imaging sequence at 3.0T. He also
demonstrated robust water separation imaging techniques
in a variety of anatomies.
Steve Williams, PhD, Professor of Imaging Sciences, Institute
of Psychiatry at Maudsley, London, UK, discussed advanced
neuro imaging techniques, specifically applications in fMRI
and diffusion imaging. Graeme McKinnon, PhD, Applied
Science Lab, GE Healthcare talked about the technical
performance of “B1 Shimming & the Dielectric Effect.”
Gearing up for Signa Koshien
Signa® Users in Japan have held nearly 60 users meetings
in the first three quarters of 2007. These meetings include
preliminary contests to nominate regional representatives
for Japan’s Signa Koshien championship meeting, scheduled
for December 8, 2007. Thirteen representatives from six
regional areas will present topics in neurology, body,
vascular and MSK and tips on generating better image
quality and reducing artifacts and scan time.
The 2007 Signa Koshien event, open to all GE Healthcare
Signa users from 0.2T to 3.0T, will be held at Tokyo Mid
Town on December 8, 2007 from 15:00 to 19:00. Of great
interest to users are topics on non contrast enhanced
MR Angiography (MRA) and PROPELLER HD™ technology.
To further address these topics and more, GE launched
a new Signa Users meeting website that can be found
at http://gecommunity.on.arena.ne.jp/signa-l/.
Over 400 Signa Users in Japan registered within the
first six months, averaging 1,000 visits each month. Attendees reported they were impressed with both the
diversity and depth of the information shared. The event
followed with a reception dinner where users further
discussed applications and challenges with the guest speakers,
GE Scientists and Advanced Clinical MR specialists.
GE Healthcare would like to thank
Mitsuyuki Takahashi, RT, the leader
of Kanagawa Signa Users meeting,
the first group to hold a users
meeting in Japan. Takahashi is
the “father” of Signa Koshien and
his continued leadership drives
the success of this country-wide
event. He maintains a web site on
MR imaging, including an introduction to the Kanagawa
Signa Users meeting, that can be found by visiting
www.asahi-net.or.jp/~tv4m-tkhs/index.html.
A GE Healthcare MR publication • Autumn 2007
11
The information contained in this document is current as of publication of the magazine.
G E H E A LT H C A R E N E W S
NEW PRODUCTS
New Volume Acquisition Helps Clinicians
Detect Small Lesions
GE Healthcare introduces Cube™, a new volumetric fast spin
echo (FSE) imaging sequence available on the Signa® HDxt
1.5T and 3T platforms. Optimized for T2, T2 FLAIR and Proton
Density imaging, Cube captures the entire volume with high
spatial, isotropic resolution. As a result, any view, plane or
slice can be later reconstructed from a single acquisition
with the same high resolution as the native plane.
This new ability for volumetric imaging of the anatomy
can result in fewer retakes that are often due to missing or
misaligned slices or planes. It may also help radiologists to
more consistently detect lesions as small as 2mm. The Cube
sequence is based on modulated flip angles, which make
very long echo train feasible. The typical image blurring
and SAR are reduced, while high tissue contrast leads
to conspicuous appearance of pathologies.
Protocol settings are automatically optimized based on the
anatomical region of interest (ROI) and MR sequence. Cube
also provides excellent enhanced tissue contrast and specific
absorption rate (SAR) management by staggering the delivery
of energy to the patient/tissue.
When used with GE’s innovative auto-calibrating, data-driven
parallel imaging technique, ARC, clinicians will have the
Isotropic volumetric imaging with Cube
capability to acquire large high definition 3D data sets
in relatively short time for a more efficient workflow.
As part of the revolutionary HDxt platform, Cube completes
GE’s volume portfolio to allow clinicians to provide the
benefits of volume imaging for every study. The IDEAL Solution for Fat and Water Separation
Representing a new paradigm in fat suppression, IDEAL is
an innovative method for fat and water separation available
exclusively on GE Healthcare’s Signa® HDxt 1.5T and 3.0T MR
systems. IDEAL is a single acquisition technique that generates
four images – water only, fat only, in phase and out of phase.
This new sequence is particularly useful when imaging difficult
areas of the anatomy, such as the orbits, brachial plexus,
c-spine, extremities or areas of anatomy
with metal. IDEAL consistently separates
fat from water in challenging anatomical
areas, resulting in excellent image quality.
Also, because IDEAL is a single acquisition
technique, the in phase and out of phase
images are inherently registered, leading
to faster interpretation and higher
diagnostic confidence.
6
A GE Healthcare MR publication • Autumn 2007
Developed in conjunction with Stanford Radiology and the
University of Wisconsin-Madison Hospitals and Clinics, IDEAL
is enabled for 2D FSE with PD, T1 or T2 contrast and 3D
SPGR with T1 contrast. Unlike current methods, such as
spectrally selective fat saturation and STIR, IDEAL is compatible
with the new generation of phased array coils and parallel
imaging techniques. The information contained in this document is current as of publication of the magazine.
N E W P R O D U C T S G E H E A LT H C A R E N E W S
Introducing the Next Generation of HD MR
Just as high definition (HD) has transformed TV, HD MR
enables new clinical capabilities by capturing higher
resolution and consistently clear images for increased
diagnostic confidence. GE Healthcare introduces Signa®
HDxt to extend the concept of isotropic, volumetric imaging.
HD Volumetric MR can help transform imaging by addressing
some of the toughest issues facing MR imaging today. With
advanced technology, new coils and applications, Signa HDxt
provides high definition, complete data sets with enhanced
clear contrast for overall better image quality within a
shortened exam time.
New applications driving volume data acquisition include:
• Cube™, which quickly acquires isotropic resolution volume
data that allows multi-plane reconstruction, while helping
reduce the number of scans and total exam time
• ARC, a fast, robust, auto-calibrating data-driven parallel
imaging method that minimizes artifacts and significantly
decreases sensitivity to motion, ideal for smaller field of
view imaging
• 3D Dual Echo, a volumetric, high signal-to-noise ratio
imaging sequence that generates in-phase and out-of-phase
images in a single breath hold acquisition even at 3.0T
• IDEAL, a revolutionary HD technique for true fat and water
separation provides uncompromising image clarity with
consistent and robust fat suppression, especially in
difficult areas of anatomy. A GE Healthcare MR publication • Autumn 2007
7
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
VOLUMETRIC IMAGING – HDXT
Volumetric Imaging
Magnetizes Radiology
GE Healthcare presents a paradigm shift
by re-imagining volumetric MR
The History of Volume Imaging
GE Healthcare has long been a leader in bringing volumetric
imaging to clinical practice. In fact, GE launched one of
the world’s first volumetric ultrasound systems in the late
1980’s. Subsequent introductions of the LOGIQ™ 9, Voluson™
E8 and Vivid™ 7 Dimension products have helped redefine
ultrasound with new volume acquisition capabilities. GE’s
LightSpeed® VCT brought volume imaging to the forefront of
CT with advanced applications that enabled clinicians to view
the body as never seen before. Building upon this platform,
GE Healthcare brought together innovative, advanced
cardiac and neurology applications with the introduction
of the LightSpeed VCT XT configuration, further extending
the clinical capability of volume imaging.
GE continues to exhibit leadership in volumetric imaging
with the introduction of a new dimension to MR.
High resolution, isotropic volume imaging changes the way
image data is acquired and reviewed, such as providing new
clinical benefits for visualizing small lesions and improving
workflow efficiency with the ability to reconstruct the 3D
volume data into any plane or slice at a later time while
maintaining the same high image resolution as the native plane.
Just as high definition (HD) has transformed television (TV),
HD MR is enabling new clinical capabilities by capturing higher
resolution and consistently clear images for increased diagnostic
confidence. Today, GE Healthcare introduces the Signa® HDxt
and the concept of HD isotropic, volumetric imaging.
Volumetric imaging is not new to MR. GE introduced MR volume
applications in the 1990s. While the concept was very attractive,
MR platforms, gradient technology and computational
processing power for acquiring and postprocessing these
images were not yet ready from a technical standpoint. At
the time, 3D MR was hindered by low resolution, long scan
times and slow image reconstruction/post-processing.
12
A GE Healthcare MR publication • Autumn 2007
Since the turn of the decade, advancements in information
technology created an environment suitable for handling
the large data sets generated by HD volumetric imaging.
Specialized coils for certain anatomic areas and faster, more
powerful MR platforms enabled rapid acquisition of signal-rich
data, which led to the first break-through, clinically-relevant
volumetric applications such as TRICKS™, LAVA™ and VIBRANT®.
However, until now these volumetric MR applications
were mostly applied for a specific use and considered
complementary to standard 2D MR acquisitions.
A New Dimension to MR
Today, with the Signa HDxt and several new 3D applications,
GE builds on the promise of HD to add a new dimension to
MR imaging. Clinicians will now have access to a solution
that makes it possible to conduct the entire MR exam by
exclusively applying volumetric MR techniques. HD volume MR
delivers sub-millimeter resolution with gapless data volume
and point-and-shoot simplicity to improve diagnostic
confidence and reduce exam time.
The HD Volume Revolution
The new volumetric HD MR sequence Cube™ provides
sub-millimeter isotropic resolution and enhanced tissue
contrast for high definition detail to help clinicians detect
small lesions earlier. The complete volume of data can be
reconstructed in any view or plane without compromising
spatial resolution. In comparison, conventional 2D image
acquisitions typically provide discrete slices with gaps in
one plane only. Since 2D images are acquired in one sagittal,
coronal, axial or oblique plane, critical data vertical to the
acquired plane or contained within the gap between the
acquired slices could be missed.
The information contained in this document is current as of publication of the magazine.
VOLUME TRIC IMAGING – HDX T CLINICAL VALUE
The new Volumetric HD MR sequence Cube provides
sub-millimeter isotropic resolution and enhanced tissue
contrast for high definition detail to help clinicians detect
small lesions earlier.
Flexible, clinical region-of-interest optimized sequence protocols
simplify and speed up acquisition while generating consistent,
high definition diagnostic quality images. This is accomplished
independent of the patient for reliable image acquisition
by the MR technologist.
With the addition of Cube, Signa HDxt boasts a complete
portfolio of dedicated volumetric MR applications for a
vast array of clinical areas, which is likely to change the
paradigm of MR imaging. GE is leading the charge with
new automated, optimized MR protocols such as Cube,
IDEAL and 3D Dual Echo. These join the ranks of GE’s other
volumetric MR sequences, including: LAVA and VIBRANT-XV™
for anatomy; TRICKS for flow; 3D PROBE/PROSE for MR
spectroscopy; and BRAVO and BrainWave™ Fusion for
fMRI/DTI brain mapping. The advantages of the 3D HD
Volumetric MR include:
• Helps detect small lesions
• No missing planes, slices or gaps in data,
which can minimize retakes
• High tissue contrast for conspicuous lesions
• Consistent IQ through automated and
ROI-optimized protocols
• Reduced exam time due to a single volume
acquisition replacing several discrete sliceby-slice/plane-after-plane acquisitions
A GE Healthcare MR publication • Autumn 2007
13
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
VOLUMETRIC IMAGING – CUBE
The Clinical Proof
of 2D Versus 3D
During the 45th Annual Meeting of the American Society of Neuroradiology, held
in Chicago June 9 -12, 2007, Lawrence N. Tanenbaum, M.D., FACR, Section Chief
MRI, CT and Neuroradiology, New Jersey Neuroscience Institute, Edison Imaging,
discussed differences between 2D and 3D MR image acquisitions.
Dr. Tanenbaum and his associates use volume acquisitions every day in their practice,
such as imaging of multiple sclerosis (MS) and for imaging of
hippocampus in epilepsy. Regarding his recent experience with GE’s new volumetric
imaging applications, he remarked, “We are about to enter an era with more
exciting techniques. The most impactful, new volumetric technique is Cube™. ”
Significant to this application are pulse sequence changes that require shorter RF
pulses and provide tighter echo spacing, leading to less blur and the ability to use
longer echo trains while maintaining signal-to-noise ratio (SNR), he explained.
“Clever modulation of the flip angle during acquisition tends to actually eliminate
a lot of the blur you get with fast spin echo, and provides a driven equilibrium
effect that boosts SNR,” he added. Cube leverages the resultant reshaped signal
decay state with very long echo trains boosting speed while maintaining SNR.
Historically, a potential pitfall for MR acquisitions has been long acquisition
times, which limit practical application in many clinical settings and
can also lead to an increase in motion artifacts.
However, this is circumvented with the
development of an advanced, data-driven
parallel imaging technique for use with Cube.
ARC* uses information available in each plane
or dimension to help improve reconstruction
accuracy, lessen motion artifacts and reduce
calibration lines.
Figure 1. Moderate grade glioma Cube 1.5T and fibertrak images of three-year-old male
*ARC: Autocalibrating Reconstruction for Cartesian imaging
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A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
VOLUME TRIC IMAGING – CUBE CLINICAL VALUE
“This application is changing the way we scan
at Edison Imaging and Cube has already replaced
other techniques in my practice.”
Dr. Lawrence Tanenbaum
Combining ARC with Cube acquisitions, Dr. Tanenbaum achieved acceleration
factors of four to nine, providing isotropic whole brain acquisitions in approximately
three minutes. “We’ve experienced very impressive results.
“Although Cube is a very sophisticated sequence, this application is easy-to-use,
robust and very fast,” Dr. Tanenbaum said. When used with ARC, he was able to
routinely acquire 1.2 mm to 0.6 mm isotropic voxels with T2 and FLAIR contrast.
“The reconstructed very thin, gap-free slices facilitate high resolution data
interrogation of complete volume data – something we do not have with 2D.”
He noted the clinical result is the ability to see MS lesions as small as 2 mm.
“This application is changing the way we scan at Edison Imaging,” Dr. Tanenbaum
said, “and Cube has already replaced other techniques in my practice.”
Lawrence N. Tanenbaum, M.D., FACR
Lawrence N. Tanenbaum, M.D.,
FACR, is Chief of MR, CT and
Neuroradiology at Edison Imaging
Associates and Solaris Health
Systems. For over 30 years, the
radiologists of Edison Imaging
have led the way in providing the
medical communities of central
New Jersey with a full range of
imaging services, utilizing the latest,
most advanced technologies,
including GE’s Signa HDxt 3.0T
and 1.5T MR Scanners.
According to Dr. Tanenbaum, other potential uses of Cube are with fMRI and
Tractography, providing excellent fusion and automatic segmentation results with
3D rather than 2D. Volumetric techniques have the power to drive quantitative
assessments that are impractical and “almost inappropriate to do with 2D because
of thick sections and intervening gaps innate to 2D imaging. With capabilities, it
can become a gold standard acquisition.”
For Dr. Tanenbaum, the benefits of volumetric MR imaging go beyond speed and
the ability to reformat. “The susceptibility artifact that propagates in plane does not
propagate through plane, so you get a pristine, orbital floor and skull base.” He
further believes that volumetric multi-plane imaging can help minimize additional
scans, reducing total scan times in many cases. Yet, the true value lies in the ability
to arm clinicians with a better diagnostic tool. “You can’t argue against thin-slice,
gap-free studies for the detection of disease. This will change the way we scan.” Figure 2. Cube FLAIR and FiberTrak at 3.0T Glioma
Figure 3. Cube T2 3.0T Glioma
All clinical images courtesy of Lawrence N. Tanenbaum, M.D., FACR, Edison Imaging.
A GE Healthcare MR publication • Autumn 2007
15
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
FAT S AT – I D E A L
Consistent, Reliable, Fat-Suppressed
Imaging Even with Difficult Anatomy
In MR images, fat appears bright and can obscure or
mimic pathology, so most clinical protocols use methods
to suppress fat, improving the conspicuity of underlying
abnormalities. There are many instances, however, where
it would be advantageous for clinicians to directly visualize
fat. For example, when imaging a tumor containing fat,
the typical protocol is to obtain images with and without
fat suppression.
To provide robust, water-only images that also retain important
information from fat, it is critical to have methods for robust,
uniform separation of water and fat. Some limitations of
traditional fat suppression techniques are outlined in the
adjacent sidebar. Perhaps most important to note with these
techniques, all fat signal is lost along with useful diagnostic
information.
To address this need, GE Healthcare developed a new technique,
IDEAL*, in collaboration with the University of Wisconsin and
Stanford University. It is available for use on the Signa HDx
1.5T and 3.0T MR systems.
Scott Reeder, M.D., PhD, Division Chief of MRI, University
of Wisconsin-Madison Hospitals and Clinics, is one of the
inventors and patent holders for IDEAL. “IDEAL is robust in
challenging areas,” Dr. Reeder said. “We can achieve excellent
fat suppression and also directly visualize the fat imaging.”
The technique is related to traditional 3-point Dixon methods,
acquiring three images at slightly different echo times to
generate phase shifts between water and fat. Although three
echoes are necessary, the effective number of excitations
(NEX) for the water and fat images is three; therefore, IDEAL
has the maximum possible signal-to-noise (SNR) efficiency,
using all images efficiently in the separated water and
fat images.
According to Dr. Reeder, the key advantage of IDEAL is the
ability to use parallel imaging. “We can’t use parallel imaging
with traditional 3-point Dixon methods.” Also, IDEAL is
compatible with the newer generation of phased array
*IDEAL: Iterative Decomposition of water/fat using Echo Asymmetry
and Least-squares estimation
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A GE Healthcare MR publication • Autumn 2007
Limitations of traditional
fat suppression techniques
• Spectrally selective fat sat methods fail in challenging
anatomical areas, such as the neck, extremities, offisocenter imaging, and large field-of-view (FOV) imaging.
This is due to local magnetic field inhomogeneities
caused by susceptibility differences at air-tissue
interfaces and by the unfavorable geometry,
or inhomogeneities, induced by the presence of metallic
implants. Failed fat saturation can also cause inadvertent
saturation of the water signal (the signal of interest),
obliterating important anatomy or pathology and
rendering images non-diagnostic. Spatial-spectral
or “water-excitation” pulses suffer from the same
drawbacks as fat-saturation methods.
• Short TI recovery (“STIR”) imaging uses an inversion
pulse to null short T1 species such as fat, but in the
process alters contrast and reduces SNR. STIR images
are inherently T1 weighted, and should not be used for
post-contrast imaging because the shortened T1 of
enhancing tissue may cause inadvertent suppression
of important pathology. STIR provides very uniform fat
suppression and is commonly used with T2 weighted
imaging; however, the poor SNR performance and
inability to perform post-contrast T1 weighted imaging
are highly limiting.
coils and optimized for the best possible SNR. With IDEAL
it is also possible to use arbitrary echo spacing and arbitrary
numbers of echoes (N>=3), while Dixon methods are limited
to images acquired when water and fat signals are acquired
in and out of phase. As a result, the echo shifts are optimized
for the highest possible SNR performance, which further
accelerates the acquisition. “The SNR penalty with parallel
imaging is offset by the increased SNR with IDEAL,” he added.
The information contained in this document is current as of publication of the magazine.
FAT S AT – I D E A L C L I N I C A L VA L U E
Fat Sat
failures
Scott Reeder, M.D., PhD
Fat Sat
Scott Reeder, M.D., PhD, is
Division Chief of MRI, University
of Wisconsin–Madison Hospitals
and Clinics.
IDEAL: water (uniform fat suppression)
About University
of Wisconsin-Madison
Another advantage of IDEAL is its ability to capture high quality images in a point-and-shoot
way. Dr. Reeder said, “Fat can be consistently and reliably separated from water. This can
lead to a decrease in the number of sequences within our protocols.” He also noted the
reliability of IDEAL reduces the need to repeat scans that previously resulted from failed
fat saturation with traditional methods or STIR. In addition, the separated water and fat
images can be recombined into “in-phase” and “out-of-phase” images, which are commonly
acquired as two separate acquisitions. This should further reduce overall protocol time and
provide additional information to the radiologist.
A third benefit of IDEAL is the elimination of artifacts, and chemical shift. In-phase, or non
fat-suppressed, images are corrected for chemical shift misregistration of fat, thereby allowing
low bandwidth acquisitions and reduced NEX. Dr. Reeder notes that the higher SNR with
less artifact produces higher quality images that give the radiologist more confidence.
“IDEAL can unambiguously identify water and fat,” he added. Water, fat, in-phase and
out-of-phase images are inherently co-registered, which can lead to faster interpretation
and higher diagnostic confidence, particularly in difficult areas of anatomy such as:
• Orbits
• Brachial plexus
• C-spine
• Extremities (ankle/wrist/foot)
• Off iso-center applications (shoulder/hip)
T2W Fat Sat FSE
T2W IDEAL FSE
UW Health, the academic health
system for the University of
Wisconsin, offers more than
60 locations throughout the state,
including the renowned University
of Wisconsin Hospitals and Clinics
and University of Wisconsin
Children’s Hospital in Madison.
This comprehensive system of
healthcare providers serves
patients at more than 60 clinical
locations throughout the state.
University of Wisconsin Hospitals
and Clinics is a 471-bed facility that
ranks among the finest academic
medical centers in the United States.
The University of Wisconsin
Hospitals and Clinics offers more
than 800 active medical staff and
more than 80 outpatient clinics.
The hospital has six intensive care
units (trauma and life support,
pediatric, cardiac, cardiothoracic,
burn, neurosurgery) with 74 total
beds, and is one of only two
organizations in Wisconsin with
designated Level One adult and
pediatric trauma centers.
T2W STIR
Brachial Plexus Imaging – 1.5T, PD Weighted, 2D Fast Spin Echo
A GE Healthcare MR publication • Autumn 2007
17
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
FAT S AT – I D E A L
Clinical Applications
A common indication for MR imaging is
for the detection of masses. For example,
in the female pelvis, endometriomas are
often bright on T1 weighted imaging,
while an ovarian dermoid has fat,
which also appears bright on T1
weighted imaging. Most MR imaging
protocols include two T1 weighted
sequence scans – one with and another
without fat supression. “With IDEAL, it
requires only one acquisition to separate
both water and fat signals,” Dr. Reeder
said. “We can help increase the level
of diagnostic confidence by directly
visualizing the fat. This is a unique
capability of IDEAL.”
Another difficult imaging area is the
brachial plexus. This critical area of
the anatomy is prone to the invasion
of lung tumors (eg. Pancoast tumor).
“Using traditional fat saturation methods,
MRI tends to fail in this area,” Dr. Reeder
explained. “We don’t use STIR because
it is incompatible with post-contrast T1
weighed imaging and its poor SNR
performance.” IDEAL, he said, is
an excellent solution for this
clinical study. T1W Fat Sat FSE
T1W IDEAL FSE
T1W Fat Sat FSE
T1W IDEAL FSE
Post-surgical Cervical Spine: Neurofibromatosis
T1W Fat Sat FSE
T1W IDEAL FSE
Benefits of IDEAL
• Patient – potentially reduce
“on the table” scan time,
• Technologists – reduce number
of repeat scans
• Radiologists – higher diagnostic
image quality for increased
confidence
• Administration – potential
for increased throughput
• Referring physician –
better image quality
Coronal Fse-xl T2 fat suppressed images (fov 30cm) demonstrates inhomogeneous fat suppression
in the slice anterior–posterior direction
18
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
GE Healthcare
The Tipping Point in Healthcare.
The Tipping Point in Healthcare – a compelling and
convincing argument by GE Healthcare President and
CEO Joe Hogan for reshaping healthcare through five
powerful initiatives:
• Focusing on Early Health, not late disease
• Turning information into insight
• Measuring healthspan, not lifespan
• Increasing the transparency of quality and cost
• Committing to equity in healthcare access
To download a copy of The Tipping Point in Healthcare
visit www.gehealthcare.com/tippingpoint.
“To take healthcare into the future, we don’t have to wait for technologies
that will be available in 2025. We need only look at the technologies we
have today, and act.”
Joe Hogan
President and CEO, GE Healthcare
imagination at work
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
VOLUMETRIC IMAGING – DWI & DTI
High-Resolution, Isotropic-Voxel Acquisition Technique
Improves Quality and Utility of Diffusion-Weighted and
Diffusion Tensor Imaging
By Makoto Sasaki, M.D., Associate Professor, Advanced Medical
Research Center, Iwate Medical University
Introduction
Volume Diffusion Imaging Technique
Image quality in diffusion-weighted imaging (DWI) and
diffusion tensor imaging (DTI) tends to be deteriorated by
echo planar imaging (EPI)-related image distortions and
artifacts, particularly in the case of coronal images and at
high fields of 3.0T, even when a parallel imaging technique
is applied. This disadvantage prevents clinicians from assessing
changes in structures adjacent to the skull base, such as the
medial temporal lobe and frontal base. Partial volume effects
in DWI/DTI also affect the accuracy in the calculation of
diffusion parameters and in the generation of tractographs.
A new DWI/DTI technique enables the generation of highresolution isotropic-voxel “volume” datasets that can reduce
partial volume effects and susceptibility-related distortions/
artifacts near the skull base. Further, we demonstrate the
clinical efficacies of images generated from these volume
datasets using multiplanar reconstruction, volume rendering,
color-coded axonography and DTI tractography.
To obtain high-resolution isotropic-voxel DWI/DTI data, we
utilized a simple two-dimensional (2D) acquisition approach,
instead of a three-dimensional (3D) approach, with ultra thin
sections as in the case of multidetector-row computed
tomography (MDCT). Images were obtained on a Signa® HD
3.0T with an eight-channel head coil using the following
pulse sequences: axial single-shot spin-echo EPI; repetition
time/echo time, 12000–17000/62.5; 3 or 6 motion-probing
gradient (MPG) directions with a b value of 1000 s/mm2;
a matrix size of 128 x 128, a field of view of 20 cm, a slice
thickness of 1.6 mm with no interslice gaps, resulting
isotropic voxels of 1.6 x 1.6 x 1.6 mm; 4 averaged; an array
spatial sensitivity encoding technique (ASSET), reduction
factor of 2; and 80 to 90 slices for the coverage of the entire
brain with an acquisition time ranging from 6 min, 24 sec
to 8 min, 30 sec.1,2
Coronal DWI Asset (-)
Coronal DWI Asset (+)
Volume DWI (MPR)
Figure 1. Volume DWI can decrease geometric distortion and susceptibility artifacts in coronal images.
20
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
VOLUME TRIC IMAGING – DWI & DTI CLINICAL VALUE
Advantages of Volume Diffusion Imaging
The whole-brain high-resolution isotropic-voxel DWI/DTI acquisition technique using
ultra thin axial sections has several advantages over conventional DWI/DTI. These include:
reduction of geometric distortions and susceptibility artifacts near the skull base; decrease
in partial volume effects that can affect the accuracy in the calculation of quantitative
diffusion parameters and in the delineation of tractographs; and capability of multiplanar
reconstruction and further image processing. Among them, geometric distortions in the
craniocaudal direction and susceptibility artifacts near the skull base on coronal images
are dramatically decreased owing to the thin-slice axial images obtained with this
technique.1 On the coronal images generated from the volume DWI data, as compared
with conventional coronal DWI, the structures of the medial temporal lobe and frontal
base showed minimal deformities and tolerable susceptibility artifacts with preservation
of the in-plane spatial resolution (Figure 1).
Clinical Applications of Volume Diffusion Imaging
The volume diffusion imaging technique enables sophisticated multimodal interactive
visualization and interpretation, which has been nearly impossible to achieve using
conventional DWI/DTI. Once the volume dataset is obtained, we can observe trace maps,
apparent diffusion coefficient (ADC) maps, fractional anisotropy (FA) maps and color-coded
axonography images of patients with neurological conditions such as stroke, brain tumors
or degenerative disorders by using paging, multiplanar reconstruction or volume-rendering
techniques (Figures 2 and 3).
Makoto Sasaki, M.D.
Makoto Sasaki, M.D., is Associate
Professor, Advanced Medical
Research Center, Iwate Medical
University, School of Medicine. He
received his medical degree and
doctorate of medical sciences from
Iwate Medical University. Dr. Sasaki
currently serves as trustee of the
Japanese Society of Magnetic
Resonance in Medicine and the
Japanese Society of Neuroradiology.
He is an active member of the
Japan Radiological Society, ISMRM,
RSNA, Japan Stroke Society,
Japanese Society of Neurology
and Japanese Society for
Detection of Asymptomatic
Brain Diseases.
Dr. Sasaki plays an important role
in the standardization of the stroke
imaging through ASIST-Japan (Acute
Stroke Imaging STandardization
group Japan) activities
(http://asist.umin.jp/index-e.htm).
He is also leading to develop
a neuromelanin-sensitive MRI
technique that can visualize
alteration of catecholamine nuclei
in mental disorders. A Certificate of
Merit was awarded to him and his
colleagues for volume diffusion
imaging (NR4667) and neuromelanin
imaging (NR4704) at RSNA2006.
About Iwate Medical University,
Morioka, Iwate Pref
Figure 2. Volume DWI enables multiplanar reconstruction and further postprocessing,
such as volume rendering (Provided by Okayama Kyokuto Hospital).
Iwate Medical University, founded
in 1928, and its affiliate hospital
(1051 beds) has been the core
healthcare and research center
in northern Japan through the
establishment of several key
facilities, including Memorial
Heart Center (1997) and Advanced
Medical Research Center (1999).
The Advanced Medical Research
Center, headed by Dean and
Chairman Prof. Akira Ogawa,
was established primarily for
the investigation of neuroscience
and neuroimaging, and has
made significant contributions
to research of the brain with
High Field 3.0T MRI and PET.
A GE Healthcare MR publication • Autumn 2007
21
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
VOLUMETRIC IMAGING – DWI & DTI
Figure 3. Volume DWI/DTI can visualize minute structures that belong to the limbic system.
trace
FA
c
c
i
trace
FA
c
c
i
a
a
e
e
h
h
e *
e *
a: amygdala, c: cingulum, e: entorhinal cortex, h: hippocampus, i: substantia innominata,
*parahippocampal white matter containing the perforant path, arrows: anterior commissure.
precommissural
fornix
amygdalofugal
fibers
anterior
commissure
body of fornix
crus of
fornix
precommissural
fornix
column of
fornix
body of fornix
column of
fornix
anterior
commissure
fimbria
crus of
fornix
amygdalofugal
fibers
fimbria
Figure 4. Multimodal volume neuroimaging combining 3D-FSPGR, Cube™ (T2WI and FLAIR), and volume DTI can bring about a paradigm
shift from a 2D to a 3D approach in clinical neuro-magnetic resonance imaging.
The precise quantitative evaluation of minute structures of
the limbic system is a promising application of the volume
diffusion technique. The ADC or FA in small limbic structures,
such as the hippocampus, entorhinal cortex and substantia
innominata, can be measured because the increase in spatial
resolution and the decrease in susceptibility distortions/
artifacts synergistically improve image quality (Figure 3).
In addition, the precision of the segmentation of small limbic
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A GE Healthcare MR publication • Autumn 2007
fibers, such as the fornix, using DTI tractography can be
improved; this can influence the accuracy of the estimation
of the ADC and FA in these fibers.2 The volume diffusion
technique can be useful for detecting subtle changes in the
small limbic structures in patients with early Alzheimer’s
disease, temporal lobe epilepsy or other disorders that have
barely been assessed by conventional DWI/DTI techniques.
The information contained in this document is current as of publication of the magazine.
VOLUME TRIC IMAGING – DWI & DTI CLINICAL VALUE
3D-FSPGR
Cube T2WI
Cube FLAIR
Gd 3D-FSPGR
Volume DTI
(FA color map)
Volume DTI
(tractography)
cingulum
Figure 5.
Conclusion
Further, we believe that even in routine clinical practice,
conventional neuroimaging protocols that primarily utilize
2D imaging at 3.0T can be replaced by an advanced protocol
involving the acquisition of multimodal volume data sets,
including 3D fast spoiled gradient-recalled acquisition in
the steady state (3D-FSPGR), fast spin-echo with extended
echo-train acquisition (Cube) and volume DWI/DTI (Figure 4).
Volume diffusion imaging with high-resolution, isotropic voxels
is effective in avoiding partial volume effects and EPI-related
distortions and artifacts that are particularly prominent in
the coronal directions and at high fields. It also enables the
elucidation of subtle abnormalities in minute brain structures
in central nervous system disorders using multiple diffusion
parameter maps visualized by multiplanar reconstruction,
tractography and further image processing. Acknowledgement
The author thanks Mr. Wataru Takao, Okayama Kyokuto Hospital, Dr. Shunrou Fujiwara, Advanced Medical Research Center, Iwate Medical University,
and Dr. Ryonoshin Hirooka, Department of Neurosurgery, Iwate Medical University, for their generous help in MR imaging and postprocessing. DTI color
maps and tractographs were generated by VOLUME-ONE/dTV2 provided by the Department of Radiology, University of Tokyo (http://www.volume-one.org).
References
1. Fujiwara S, Sasaki M, Kanbara Y, et al. Improvement of geometric distortion in coronal diffusion-weighted and diffusion tensor imaging by using
a whole-brain isotropic-voxel acquisition technique at 3 Tesla. Magn Reson Med Sci 2007 (in press)
2. Fujiwara S, Sasaki M, Kanbara, Y, et al. Feasibility of 1.6-mm isotropic voxel diffusion tensor tractography in depicting limbic fibers. Neuroradiology
2007 (in press)
A GE Healthcare MR publication • Autumn 2007
23
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
ABDOMINAL IMAGING – 3D DUAL ECHO
One Breath Away from
Volumetric In-Phase,
Opposed-Phase
Fat/Water Imaging
By Elmar M. Merkle, M.D., Professor of Radiology, Director of Body MR Imaging,
Medical Director, Center for Advanced MR Development, Duke University Medical Center,
Department of Radiology
T1-weighted gradient-echo in-phase and opposed-phase imaging is
routinely used in abdominal MRI to identify regions of diffuse or geographic
fatty infiltration, as well as areas of focal fatty sparing in the liver. In addition,
this sequence can be valuable in the characterization of fat containing
liver lesions such as hepatic adenomas or hepatocellular carcinomas.
In- and opposed-phase imaging can also be helpful for detecting
pathologic entities such as hemosiderosis and hemochromatosis. Here,
a substantial loss in hepatic signal intensity can be detected on the
image with the longer echo time due to associated T2* effects. Finally,
susceptibility artifacts from surgical clips, metallic debris or gas may be
easily identified on this dual echo sequence.
24
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
ABDOMINAL IMAGING – 3D DUAL ECHO CLINICAL VALUE
Historically, the in-phase and opposed-phase images were acquired within separate breath
holds, which caused suboptimal registration between the corresponding images. While
current 2D dual echo techniques are now being acquired within a single breath hold, these
2D techniques rely on a relatively large flip angle to achieve adequate T1 weighting and
desired hepatosplenic image contrast. In addition, slice thickness is usually in the range of
6 to 8 mm with an interslice gap of 1 to 2 mm, to allow for adequate coverage of the entire
liver within a single breath hold. This through-plane spatial resolution allows for suboptimal
image quality of multiplanar reconstructions only.
At 3.0T, the 2D approach oftentimes exceeds limits in the specific absorption rate requiring
either a decrease of the flip angle, decrease of the number of images, or an increase of
the repetition time. None of these requirements is desirable as either the coverage is
decreased, the image contrast is altered, or the data acquisition time is prolonged. Even
worse is the fact that the data acquisition of the first opposed-phase echo at 1.2 msec
and the first in-phase echo at 2.4 msec usually requires a substantially higher receiver
bandwidth. Therefore, in addition to the first opposed-phase echo, the second in-phase
echo at 4.8 msec is usually acquired which leads to accentuated T2* effects.
3D Dual Echo is a new 3D FSPGR sequence from GE Healthcare that produces fat/water
in-phase and opposed-phase images in a single breath hold. This sequence allows the
acquisition of the first opposed-phase and the first in-phase image. This allows perfect
registration between corresponding images and is also helpful in the visualization of T2*
effects and susceptibility artifacts. Using the 3D Dual Echo sequence for abdominal imaging
can be particularly important for the characterization of hepatic and adrenal lesions, and
represents a significant step forward in the clinical utilization of 3.0T MR. With improved
through-plane resolution of about 4 mm without an interslice gap, this new pulse sequence
also allows for excellent multiplanar reconstructions.
Clinical Cases
The following case studies demonstrate the value of the 3D Dual Echo sequence.
Case 1
Dr. Elmar Merkle
Elmar Merkle is Professor of
Radiology and Head of Body
Magnetic Resonance Imaging and
heads the Center for Advanced
Magnetic Resonance Development
at Duke University. In the mid
1990s, he conducted his MR
research fellowship in the laboratory
of Professor Jonathan Lewin in
Cleveland, where he made significant
contributions to the field of interventional MR imaging. Dr. Merkle
is a fellow of the Society of Computed
Body Tomography and Magnetic
Resonance (SCBT), and a member
of the Radiologic Society of North
America (RSNA), the International
Society for Magnetic Resonance in
Medicine (ISMRM), the American
Roentgen Ray Society (ARRS)
and the European Congress of
Radiology (ECR) among others.
Dr. Merkle is on the editorial board
of European Radiology and the
Journal of Endovascular Therapy.
Dr. Merkle has been invited for
numerous lectures, is a visiting
professor to universities worldwide,
and has published more than
100 peer-reviewed manuscripts
and 15 book chapters.
About Duke University
The Duke University School
of Medicine is a community of
scholars devoted to understanding
the causes, prevention and treatment of human disease. Ranked
in the top ten with schools twice its
age, Duke is committed to socially
relevant education, translational
research, compassionate patient
care and global healthcare solutions.
1a
1b
Patient is a 77-year-old woman with diffuse fatty infiltration of the liver. 3D Dual Echo was used to
acquire the transverse T1-weighted opposed-phase (TR/TE 4.3/1.3) (1a) and in-phase (TR/TE 4.3/2.6) (1b)
MR images at 3.0T. The image pair shows a marked decrease in the signal intensity of the liver on the
opposed-phase image, compared with that on the in-phase image.
A GE Healthcare MR publication • Autumn 2007
25
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
ABDOMINAL IMAGING – 3D DUAL ECHO
Case 2
Case 3
3a
2a
3b
2b
Patient is a 36-year-old woman with diffuse fatty infiltration
of the liver, focal nodular hyperplasia in the right hepatic lobe
and left-sided adrenal adenoma. (2a) Transverse T1-weighted
3D opposed-phase (TR/TE 4.3/1.3) with 3D Dual Echo and (2b)
in-phase ((TR/TE 4.3/2.6) MR images acquired at 3.0T demonstrate
a well defined focal liver lesion in the right lobe, which appears
hyperintense in comparison to the surrounding hepatic
parenchyma on the opposed-phase image and stealth on
the in-phase image due to substantial diffuse fatty infiltration.
Gadolinium-enhanced series (not shown) demonstrated early
arterial enhancement, suggestive of a focal nodular hyperplasia.
Note the signal drop in the left adrenal gland on opposed-phase
imaging indicative of an adrenal adenoma.
Patient is a 49-year-old woman with transfusional hemosiderosis.
(3a) Transverse T1-weighted 3D opposed-phase (TR/TE 4.3/1.3)
with 3D Dual Echo and (3b) in-phase (TR/TE 4.3/2.6) MR images
acquired at 3.0T demonstrate decreased signal intensity in the
liver and spleen on the image with the longer echo-time. Note the
reversed contrast between the hepatic veins and surrounding
liver parenchyma on the image with the longer echo time. This
finding can be attributed to substantial iron storage in the liver
and spleen causing an accentuated free induction decay due
to pronounced T2* effects.
Conclusion
The 3D Dual Echo sequence marks a significant advancement
in body MR imaging at both 1.5T and 3.0T.
The benefits include higher SNR with one breath-hold for
consistently clear images, a reduction in T2* effects by
acquiring first opposed-phase and first in-phase images
and an ability to do 3D multiplanar reformatting.
As shown by the clinical examples, 3D Dual Echo generates
high resolution, volume images that can lead to greater
diagnostic confidence. 26
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
GE Healthcare
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and every body
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The open concept of our Open MR family helps
reduce patient anxiety while the remarkable
resolution and high-performance applications
give you more access, more image quality and
more peace of mind.
Service to keep you up and scanning
GE technology offers more worldwide support
than any other MR available today. We have more
service engineers. More application specialists
worldwide. More parts distribution centers.
You also get more physician training options.
Even remote diagnostic and solutions network
for real-time, on-line support.
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Every GE MR system is designed with the future in
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©2007 General Electric Company GE Medical Systems,
a General Electric Company doing business as GE Healthcare
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
NEURO – PROPELLER HD
Efficient Image Quality Enhancements in
Temporal Bone Imaging Using PROPELLER HD
By Mathieu H. Rodallec, M.D., Senior Radiologist in MRI, Saint-Joseph Hospital
Cholesteatoma and Diffusion-weighted Imaging
Cholesteatoma is a cystic lesion lined with keratin-producing squamous epithelium filled with desquamation
debris in the middle ear. Patients with the disease are treated surgically, but the procedure carries the
risk of residual cholesteatoma and tumor recurrence in a relatively high number of patients. CT has a
high negative predictive value if no soft-tissue mass is detected. However, if a patient treated surgically
has a soft-tissue mass, additional diagnosis with a CT study is not possible because cholesteatoma,
granulation tissue and cholesterol granuloma cannot be differentiated from one another on CT.
MR imaging of the temporal bone can help in characterizing potential soft-tissue abnormalities shown
on CT. Diffusion-weighted MR imaging (DWI) generates valuable information regarding diffusion
motion of water protons in biologic tissue. DWI can also help confirm residual or recurrent
cholesteatoma in patients who undergo middle ear surgery by showing a high-signalintensity lesion. Other tissues found in the middle ear after surgery demonstrate
a low signal intensity on diffusion-weighted MR images.
The PROPELLER HD™ sequence from GE Healthcare can be useful to detect
recurrent cholesteatoma in patients post middle ear surgery and helps to
minimize the numerous susceptibility artifacts that create high signal
intensity in the air-bone interfaces or in the posterior fossa.
CT examination
Figure 1.
28
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
NEUR O – PR OPELLER HD CLINICAL VALUE
Clinical Case
An 80-year-old female underwent right middle ear surgery for cholesteatoma. A CT image
shows a soft-tissue mass in the right middle ear. T1-weighted MR image post-contrast
media injection depicts two lesions in the middle ear surgical cavity with peripheral
granulation tissue. The DWI sequence demonstrates numerous susceptibility artifacts
in the temporal bone.
Mathieu H. Rodallec, M.D.
Mathieu H. Rodallec, M.D., is a
Senior Radiologist in MRI at SaintJoseph Hospital in Paris, France,
and board certified in Diagnostic
Radiology. He received his medical
degree from the School of Medicine
of Paris, and fellowship training at
Beaujon Hospital of the University
of Paris VII. His interests include
neuroradiology, head and neck
radiology and musculoskeletal
imaging. He has published training
material, authored publications
and abstracts and has given
numerous presentations at
educational meetings. He is a
member of the French Society
of Radiology (SFR), French Society
of Neuroradiology (SFNR) and
Radiological Society of North
America (RSNA).
Findings
Image obtained on the same patient using the PROPELLER HD DWI sequence clearly
demonstrates the high-signal intensity cholesteatoma (red arrow) and a cholesterol
granuloma (green arrow).
Conclusion
The PROPELLER HD sequence improves image quality in the vicinity of bone/tissue and
air/tissue interfaces that are prone to creating susceptibility artifacts. PROPELLER HD
DWI can suppress susceptibility artifacts, particularly helpful in temporal bone imaging
to detect residual or recurrent cholesteatoma. PROPELLER diffusion
B : 600 s /mm2
Sl. thickness 3.0mm
12 slices
Matrix 128X128
Acq. Time 03 :18
8 NVHEAD-A
Saint-Joseph Hospital is a 746-bed,
private, non-profit public service
hospital. In January 2006, Saint
Michel Hospital and Notre Dame
de Bon Secours Hospital joined
Saint-Joseph to form the Paris
Saint-Joseph Hospital Group.
Today, the three hospitals provide
a full range of heath services for
patients south of Paris.
MR examination
Acknowledgements: Case written
in collaboration with Souleiman
Amoussa, Advanced MR Applications,
GE Healthcare, Vélizy, France.
Figure 2. T1-weighted post-contrast
MR image
Figure 3. DWI-EPI
Figure 4. PROPELLER HD DWI
A GE Healthcare MR publication • Autumn 2007
29
The information contained in this document is current as of publication of the magazine.
CLINICAL VALUE
CARDIOLOGY – REPORTCARD
Validation of an Automated
Left Ventricular Segmentation
Technique for Quantifying
Stroke Volume
By Cindy R. Comeau, BS, RT(N)(MR), Parikshit Prasad,
Balaji Raman, Kavitha Subramanian and Steven D. Wolff, M.D., PhD
This work was presented at the 16th Annual Meeting for the Section for Magnetic Resonance
Technologists (SMRT) in Berlin, Germany on May 19-20, 2007, held in conjunction with The
International Society for Magnetic Resonance in Medicine (ISMRM) and the European Society
for Magnetic Resonance in Medicine and Biology (ESMRMB) Joint Annual Meeting.
Purpose
Many clinicians consider MRI the imaging test of choice for
quantifying left ventricular (LV) end-diastolic volume, endsystolic volume, stroke volume (SV) and ejection fraction (EF).
Typically, volumes are derived by segmenting the LV endocardial
border on serial short axis images.
However, this method presents several clinical challenges.
First, as the endocardial contours are of low spatial frequency,
papillary muscles and trabeculations are often included in
the ventricular cavity. Second, it is difficult to determine
30
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
CARDIOLOGY – REP ORTCARD CLINICAL VALUE
About the Authors:
the precise position of the LV base due to poor spatial resolution in this dimension
(spatial resolution is equal to slice thickness, which is typically around 8 mm).
Third, if segmentation is performed manually, the number and location of the
endocardial borders is subjective.
Cindy R. Comeau, BS, RT (N)(MR) is
the Chief Technologist at Advanced
Cardiovascular Imaging (New York,
NY), a private practice in Manhattan.
Steven D. Wolff, M.D., PhD, is the
Director of Cardiovascular MRI and
CT at Advanced Cardiovascular
Imaging.
The purpose of this study was to assess whether commercially available software
could provide more accurate and more reproducible quantification of LV volumes
and ejection fraction.
Kavitha Subramanian is the
Engineering Director, Balaji Raman,
Lead System Designer, and
Parikshit Prasad, Image Processing
Engineer, at NeoSoft, a software
provider that works in close collaboration with GE Healthcare. The
company’s principle product is
ReportCARD, used to view, analyze
and report cardiac MRI studies.
Methods
LV volumes and ejection fraction were derived using two distinct methodologies.
Method 1 (Manual): The subendocardial contours were drawn manually at enddiastole and at end-systole. The cardiac base was determined subjectively, as
the most basal slice where myocardial tissue comprised more than 50 percent
of the circumference of the blood pool. Method 2 (Semi-automated): LV volumes
were determined using the semi-automated analysis in ReportCARD 3.0™ from
GE Healthcare. The ReportCARD software produces endocardial borders with high
spatial frequency, thereby excluding papillary muscles and trabeculations from
the LV cavity. It also determines the basal and apical extent of the LV on short axis
images, based on user input of these locations on a 2-chamber long-axis cine.
Stroke volumes were calculated using these two methodologies and compared
to the aortic flow as assessed from the phase-contrast images. In patients
without valvular disease, the LV SV should equal the aortic flow.
50.0
LV Stroke Volume – Aortic Flow (ml)
We retrospectively analyzed 20 cardiac MRI studies in patients without valvular
disease, performed on a GE Healthcare Signa®1.5T HDx scanner. All MRI studies
included a series of contiguous, prospectively ECG gated short-axis cines through
the left ventricle and a 2-chamber long-axis cine (FIESTA pulse sequence:
TR/TE,3.1/1.4, BW=125, matrix=192x160 FOV=35-38, views-per-segment=24,
20 reconstructed phases per cardiac cycle). Prospectively ECG gated phase
contrast images of the aorta were acquired at the aortic root 1-2 cm distal
to the aortic valve (TR/TE, 7.2/2.9, BW=31, matrix= 256x128, field-of-view=35-40,
views per segment=8, 30 reconstructed phases per cardiac cycle).
40.0
30.0
20.0
10.0
0.0
-10.0
-20.0
Manual
Semi-Auto
-30.0
Figure 1
Results
Conclusion
The semi-automated method of ReportCARD gives a more accurate measurement
of SV, based on better concordance of SV with aortic flow. This is most likely because
of more accurate endocardial segmentation and better assessment of the precise
location of the LV base. The semi-automated method also yields higher EFs,
indicating that manual tracing underestimates the true EF. 90%
80%
Ejection Fraction (EF)
The difference between LV SV and aortic flow was 10 + 15 ml using manual traces
and 0 + 10 ml using the semi-automated method of ReportCARD (mean + standard
deviation; p<0.02). The difference between LV SV and aortic flow for each method
was determined (Figure 1). The average EF was 56 + 11 percent using the manual
method and 66 + 12 percent using the semi-automated method of ReportCard
(P <0.01) (Figure 2).
100%
70%
60%
50%
40%
30%
20%
10%
Manual
Semi-Auto
0%
Figure 2
A GE Healthcare MR publication • Autumn 2007
31
The information contained in this document is current as of publication of the magazine.
T E C H N I C A L I N N O VAT I O N
HIGH DEFINITION MR – SIGNA HDXT
Re-Defining the Next Generation
of High Definition
Current challenges in MR imaging include obscured pathologies,
inconsistent imaging and variable exam times. The introduction
of Signa® HDxt culminates years of GE Healthcare research
and development on High Definition (HD) MR imaging.
Today, the need for imaging technology for
specific exams is paramount to assist
with imaging pathologies that were
once thought to be too complex,
produced inconsistent image outcomes and extended the exam
time. Grounded in the development
of HD MR is technology specifically
designed for each anatomical
exam that will help maximize
imaging accuracy, consistency
and efficiency. This integrated
technology for anatomically
specific coils, pulse sequence
applications and patient table
complete the GE HD MR
imaging chain.
Signa HDxt extends the concept of HD
to gapless 3D imaging for early lesion
detection and high-resolution imaging
techniques for minimizing image variation for
consistent high quality outcomes. Signa HDxt
delivers MR imaging essentials for a more
confident diagnosis. Clinicians want high quality
imaging with increased signal-to-noise ratio (SNR), high
resolution and no artifacts. To compare images, they require
the same anatomy in the exact same position in each slice,
with specific and known parameter differences between
the images so that unexpected changes can be easily seen.
Multiple image contrast is crucial for clinicians to differentiate
between tissues.
Along with Signa HDxt, GE introduces the next generation
in high definition imaging with a series of HD pulse sequence
applications, reporting tools, surface coils and host
software improvements.
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A GE Healthcare MR publication • Autumn 2007
New High-density Clinical Applications and Ease
of Use Enhancements
With Signa HDxt MR, clinicians have the tools for reliable,
reproducible detection of very small lesions with
sub-millimeter spatial resolution, consistent
HD image quality providing excellent tissue
contrast with automated and intelligent
protocols and a single 3D volume
acquisition that replaces today’s
plane-after-plane or slice-by-slice
acquisitions, reducing the number
of scans and total exam time.
The new applications that are
changing the paradigm of MR
imaging include:
• Cube™, a volumetric fast spin
echo (FSE) imaging sequence
• 3D Dual Echo, a 3D FSPGR
sequence that produces fat/water
in-phase and opposed-phase images
in a single breath hold
• IDEAL, an innovative method for fat and
water suppression
• ARC, a data-driven parallel imaging method
Host enhancements further simplify the exam,
saving time. A selectable auto-transfer capability
allows flexibility of image series data transfer. Auto-contrast
copies contrast designation to the appropriate series in the
prescription. GRx enhancements include reverse order slice
numbering for visual preference, which saves the localizer
image for easy prescription reference, and Copy Shim
Volume that streamlines time in managing the prescription.
An auto-voice enhancement adjusts voice speed for clear
patient comprehension.
The information contained in this document is current as of publication of the magazine.
HIGH DEFINITION MR – SIGNA HDXT
Knee Array
Cardiac Array
T E C H N I C A L I N N O VAT I O N
Neurovascular Array
New Intelligent Reporting Tools
Signa HDxt addresses the need for greater efficiency
in radiology reporting with the release of new tools
on Advantage Workstation:
• BrainSTAT with diffusion imaging for an effective way
to assess and quantify blood circulation dynamics
in brain tissue
• ReportCARD 4.0, a structured reporting tool with macros
and a research database added to the functionality of
post processing for cardiac imaging, to further reduce
the amount of time a clinician spends reporting a cardiac
MRI case
• Flow Analysis Tool extends functionality to include multiple
regions of interest (ROI) and ease-of-use enhancements,
reducing the amount of time a clinician spends reporting
a cardiac MRI case
• Vascular Reporting Tool, a research database that allows
searching for cases with specific pathology for faster
report generation than with standard voice dictation
• Multi-Echo Signal Analysis & Reporting Tool produces
grayscale and color maps depicting the iron concentration
estimation based on user provided input scaling
New High-density Coils Complete the Image
An integral piece of the HDxt release is the introduction of
new high-density surface coils for orthopedic imaging with
1.5T and 3.0T systems. These surface coils provide improved
SNR, coverage and parallel imaging support for shoulder,
wrist and foot and ankle exams.
GE’s new 8-channel shoulder coil utilizes a concentric coil
design that provides 30 percent improvement in coverage
Breast Array
Torso Array
while advancing SNR penetration over previous designs. This
proprietary coil technology enables the use of parallel imaging
in any plane. Designed to help minimize patient motion during
an exam, the flexible coil housing accommodates both large
and small patients.
For high-resolution foot and ankle imaging, the new 8-channel
foot/ankle coil incorporates a novel “ski” boot design for simple
and reliable patient setup. This design permits imaging of
the foot in either a vertical or 15 degree or less plantar
flexed orientation with 5-degree increments. The element
layout supports a 20 cm FOV and is optimized for parallel
imaging in any plane. The SNR of this design supports the
high-resolution clinical requirements for visualizing small
structures and abnormalities common in MSK imaging.
At 3.0T, a new 8-channel wrist coil provides easy patient
set up and allows positioning by the patient’s side or directly
above them. The coil locks firmly into a stabilized base-plate
to reduce motion artifact. With a 12 cm FOV optimized for
parallel imaging, the 8 channel wrist coil produces exquisite
images of structures.
A ContinuumPak™ for HDx Users
Signa HDx users will realize the benefits of the GE Continuum™
with the HDxt ContinuumPak, which upon release will be
installed via the user’s local GE applications field engineer.
The HDxt ContinuumPak includes new HD applications such
as 3D Dual Echo, Advantage Workstation reporting tools
BrainSTAT, Flow Analysis and Vascular Reporting and host
software enhancements. The HDxt ContinuumPak further
enhances GE Healthcare’s commitment to users by delivering
the next generation of HD MR images. Head-NeckSpine Array
A GE Healthcare MR publication • Autumn 2007
33
The information contained in this document is current as of publication of the magazine.
T E C H N I C A L I N N O VAT I O N
N E U R O A N D M U S C U LO S K E L E TA L – C U B E
3D FSE Reduces Scan Time,
Generates Thinner Slices
Clinicians can view smaller lesions with greater confidence
By Reed Busse, PhD, Senior Scientist, GE Healthcare
In fast spin echo sequences, scan time can be reduced by
increasing the Echo Train Length (ETL). If the ETL is too long,
however, signal decay results in a disappointing blurring of the
images. Today, this challenge is resolved with a new, unique
method developed by GE Healthcare to modulate the refocusing
flip angles, called Cube™, which extends and reshapes the signal
decay curve. Cube is a single-slab 3D FSE imaging sequence
only available on GE’s Signa® HDxt 1.5T and 3.0T platforms.
When refocusing flip angles that are less than 180° are used,
natural equilibrium exists between encoded longitudinal and
transverse magnetization, which is a function of the refocusing
flip angle. Cube utilizes this powerful phenomenon, modulating
the refocusing flip angle to drive this equilibrium. At the
beginning of the echo train, flip angles are rapidly reduced to
store excess magnetization in an encoded longitudinal state.
By increasing the flip angle, this sequence converts the slowly
decaying longitudinal magnetization back to transverse
magnetization to provide signal over a much longer train.
These advantages are compounded by advances in parallel
imaging – simultaneous acceleration in two directions with
GE’s innovative auto-calibrating data-driven parallel imaging
method, ARC*. Very large 3D data matrices may now be
acquired in relatively few echo trains, revolutionizing
T2-weighted imaging.
The large increase in efficiency allows additional and thinner
slices to be acquired, producing voxels that are no larger in
the slice direction than in-plane. With this isotropic resolution,
the plane of acquisition becomes immaterial – as the volume
is prescribed in a manner that yields the high image quality
and efficiency. Images are reconstructed in axial, sagittal
and coronal planes, or any oblique orientation, from a single
short acquisition. Cube removes prior limitations that result
in a small number of relatively thick sections, giving clinicians
new capabilities to acquire wide anatomic coverage in a
high-resolution 3D dataset.
Figure 1B
Flip (degrees)
Percent proton density signal
Figure 1A
RF pulse
Echo
Figure 1A: A modulated flip angle refocusing train of RF pulses establishes a low-angle pseudo-steady
state, and then increasing throughout the remainder of the train. Figure 1B: This serves to decouple much
of the signal modulation from the development of contrast. Signals from tissues with different T2 values
diverge, producing contrast, while remaining relatively constant, producing sharp images with the highly
efficient Cube acquisition.
*ARC: Autocalibrating Reconstruction for Cartesian imaging
34
A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
N E U R O A N D M U S C U LO S K E L E TA L – C U B E
T E C H N I C A L I N N O VAT I O N
This highly efficient technique enables Cube to join the ranks of GE’s other rapid
3D volumetric sequences, and complement them by providing important contrast
options, such as T2, T2-FLAIR and PD. While it has the potential of being applied
to a wide range of anatomic areas, Cube is initially intended for Neuro and MSK
applications. When used in conjunction with GE’s other 3D applications, Cube may
allow technologists to perform a complete MR study in a 3D acquisition mode.
Reed Busse, PhD
Benefits of Cube
With a single acquisition, the radiologist can visualize the entire data set in axial,
sagittal, coronal and any oblique orientation. The need for image retakes due to
missing slices or planes is minimized and submillimeter voxels may help clinicians
detect small 2-3 mm lesions. Automated protocols optimize sequences for clinical
use, facilitating ease-of-use and consistency across imaging studies.
Cube is convenient for patients with less SAR than conventional FSE. Figure 2
Reed Busse, PhD is a Senior
Scientist at the GE Healthcare
Applied Science Lab at the
University of Wisconsin, Madison.
As a lead innovator at GE,
Dr. Busse holds five patents
and five patents pending for his
developments in MR imaging. He
received his doctorate degree in
Biomedical Sciences from Mayo
Graduate School and a B.A. in
Physics, with magna cum laude
distinction, from Carleton College.
Dr. Busse is a member of the
International Society for Magnetic
Resonance in Medicine and
American Association of
Physicists in Medicine.
Figure 3
Whole knee imaging with 0.6mm isotropic resolution in 4min 40sec.
(Courtesy Dr. Garry Gold, Stanford University)
Figure 4
Whole Brain Imaging. T2-weighted 3D-FR Cube (a) and CSF-nulled 3D-FLAIR
Cube (b) complement T1-weighted 3D-IR-SPGR (c) to provide a whole brain exam
in just 10 minutes (2:15 for the T2 Cube, 5:00 for the FLAIR Cube, 2:45 for the
T1-IR-SPGR). Acquisition matrix of 256x256x128 (zipped to 512x512x256).
(Courtesy Dr. Howard Rowley, University of Wisconsin, Madison)
T2-weighted volumetric imaging for evaluation of uterine anomalies with
3D-Cube. (Courtesy Dr. Elizabeth Sadowski, University of Wisconsin, Madison)
A GE Healthcare MR publication • Autumn 2007
35
The information contained in this document is current as of publication of the magazine.
T E C H N I C A L I N N O VAT I O N
PARALLEL IMAGING – AR C
New Parallel Imaging Method
Enhances Imaging Speed
and Accuracy
Enables Fast, Robust Scanning Even
with Motion or Tight FOV Prescription
By Anja Brau, PhD, Senior Scientist, GE Healthcare,
Global Applied Science Lab
Over the last decade, parallel imaging technology in MRI
has progressed from early research prototype to established
clinical tool. By exploiting the spatial arrangement of phasedarray receiver coils, parallel imaging can accelerate MR data
acquisition, which in turn can reduce scan time and improve
diagnostic utility.
Figure 1
External calibration.
There are two basic classes of parallel imaging methods.
“Physically-based” methods, such as SENSE,1 require an
explicit coil sensitivity map to model the underlying physical
process that occurs during image acquisition. The success of
physically-based methods relies on calculating accurate coil
sensitivity maps, which can be difficult to achieve in practice.
Coil sensitivity calibration can be performed in one of two ways:
External calibration requires a separate calibration scan
(Figure 1). However, a primary source of error in this case
is motion that can occur between the calibration scan
and the accelerated scan – for example, due to different
breath-hold positions – causing residual aliasing artifacts
in the final image due to a mismapping of coil sensitivities.
Internal calibration embeds a small amount of calibration
data within the accelerated scan itself (Figure 2). While this
approach is more robust to motion, a primary source of
error is insufficient resolution, especially when a tight field
of view (FOV) is prescribed.
36
A GE Healthcare MR publication • Autumn 2007
Figure 2
Internal calibration.
The information contained in this document is current as of publication of the magazine.
PARALLEL IMAGING – AR C
T E C H N I C A L I N N O VAT I O N
What makes ARC unique?
ARC’s unique 3D kernel
fully utilizes available
data along ALL three
directions, unlike other
methods that only use
1D kernels. A 3D kernel
means more accurate
reconstructions and
improved image quality.
Only GE’s efficient,
streamlined ARC
reconstruction can
leverage the power
of a 3D kernel.
Figure 3
“Data-driven” methods, such as GRAPPA2, comprise the
second class of parallel imaging techniques. These methods
do not require an explicit coil sensitivity map but rather rely
on “training” data to calibrate the reconstruction directly,
thus avoiding errors from coil sensitivity mismapping.
Furthermore, the training data is typically embedded in
the acquisition in an autocalibrated manner, minimizing
the susceptibility to motion errors.
ARC: A Step Forward for Parallel Imaging
GE has developed a new data-driven parallel imaging
reconstruction known as ARC, or Autocalibrating
Reconstruction for Cartesian imaging, that represents
a major step forward in the speed and accuracy of highly
accelerated parallel imaging. Unlike other methods,2,3 ARC
uses a full 3D kernel to synthesize missing target data
(Figure 3, shown in pink) from neighboring source data
(Figure 3, shown in green) from all three imaging directions.
In this way, ARC’s 3D kernel takes full advantage of available
information along all three dimensions for improved
reconstruction accuracy with fewer required calibration
lines. The end result is highly accelerated MR data acquisition
with improved image quality and fewer artifacts.
Anja Brau, PhD
Anja Brau, PhD, is a Senior
Scientist with GE Healthcare’s
Global Applied Science Lab in
Menlo Park, CA. Anja specializes
in the development and clinical
validation of innovative MR
acquisition and reconstruction
techniques for body imaging
applications. She is the author of
several journal articles, abstracts,
and patents and is a member
of the International Society of
Magnetic Resonance in Medicine
(ISMRM). Prior to joining GE, Anja
received an undergraduate
degree in electrical engineering
from Princeton University and
a doctoral degree in biomedical
engineering from Duke University.
The calculation of a full 3D kernel reconstruction, previously
considered a computationally prohibitive task, is now feasible
with ARC’s streamlined reconstruction. Several innovations
in the calculation of the training and synthesis phases allow
ARC to reduce computation time.4,5 For example, while ARC’s
training phase is performed in k-space (kx, ky, kz), the synthesis
phase is performed in hybrid (x, ky, kz) space (Figure 4) following
1D Fourier Transformation along kx, reducing the 3D kernel
neighborhood to a smaller, more manageable 2D kernel
neighborhood. These strategies drive the computational
efficiencies that streamline ARC reconstruction, creating
new possibilities such as the ability to compute a 3D kernel
in clinically practical reconstruction times.
ARC enables highly accelerated parallel imaging with
an accurate, streamlined reconstruction. Because it is autocalibrating and requires no coil sensitivity map, ARC enables
smaller FOV prescriptions and is less sensitive to motion
artifacts compared to conventional parallel imaging
techniques. ARC can potentially replace physically based
methods that can suffer from image artifacts caused by
inaccuracies in coil sensitivity calibration. In clinical testing,
the technique used by ARC has been shown to achieve
high quality reconstructions even in challenging imaging
applications, such as tight FOV prescription.
A GE Healthcare MR publication • Autumn 2007
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The information contained in this document is current as of publication of the magazine.
T E C H N I C A L I N N O VAT I O N
PARALLEL IMAGING – AR C
ARC reconstruction phases
Synthesis
Training
Figure 4
2D kernel
3D kernel
ARC training phase is performed as a 3D kernel in k-space, whereas the synthesis phase is performed
as a 2D kernel is hybrid (x, ky, kz) space, reducing computation time.
Benefits
Patients may experience shorter exam times and a lower
likelihood for repeat scans due to error or poor image quality.
Ease of use and less opportunity for error typically enables
the technologist to produce more consistent scans that are
less sensitive to prescription errors. Referring physicians
are likely to receive more definitive reports with better
image quality.
ARC is available on the Signa® HDxt platform for use
in conjunction with GE’s signature volumetric imaging
application Cube™. 38
A GE Healthcare MR publication • Autumn 2007
Courtesy of Lawrence N. Tanenbaum, MD, Edison Imaging.
With ARC, clinicians can expect improved image quality and
patient throughput, increased spatial resolution or volumetric
coverage, depending on the application. Imaging FOV can be
prescribed close to or even smaller than the anatomy of interest,
enabling higher spatial resolution and diagnostic confidence.
ARC’s reliability for tight FOV prescription allows the technologist
greater tolerances for FOV placement which can reduce the
opportunity for error. Autocalibration improves workflow and
further reduces the opportunity for error, making the scanning
process easier for the operator. ARC is robust against motion,
reducing residual aliasing artifacts that would otherwise
result from a mismatch between the calibration and
accelerated scan.
1mm lesions with Cube on Signa 3.0T.
References
1. Pruessmann et al. MRM(42):952-962,1999.
2. Griswold et al. MRM 47(6):1202-10,2002.
3. Blaimer et al. MRM 56(6),1359-64,2006.
4. Beatty et al. p.1749. Proceedings of the ISMRM, 2007.
5. Brau et al. p.2462. Proceedings of the ISMRM, 2006.
The information contained in this document is current as of publication of the magazine.
N E U R O L O G Y – B R A I N S TAT
Quantitative Tool for
Neurological Brain Evaluation
Mental and neurological disorders affect an estimated 450 million people worldwide,
and account for approximately 13 percent of disability-adjusted life years, or DALYs,
a measure of the amount of health lost as a result of a particular condition or disease.1
Disorders such as Alzheimer’s, Parkinson’s, epilepsy, dementia and stroke pose a
growing health problem for nearly all countries. In the U.S. alone, stroke is the third
leading cause of death, claiming one in 16 lives according to the American Stroke
Association. Of the 700,000 people who experience a stroke each year, 500,000 are
sufferers of a first attack and 200,000 experience recurrent attacks. In addition,
87 percent of all strokes are ischemic, whereas intracerebral and subarachnoid
hemorrhage strokes make up the remaining 13 percent.2
T E C H N I C A L I N N O VAT I O N
CBF quantifies the volume of
arterial blood (ml) delivered to
100mg of tissue per minute, thus
representing instantaneous
capillary flow in tissue.
CBV describes the blood volume
of the cerebral capillaries and
venules (not arteries) per cerebral
tissue volume.
MTT measures the length of time
a certain volume of blood spends
in the cerebral capillary circulation.
TTP is inversely related to CBF
in which reduction of blood flow
results in an increase in the time
needed for the contrast to reach
its peak in the perfused volume
of brain tissue.
In spite of the acute stroke being a leading cause of serious, long-term illness, many
patients are not diagnosed correctly or the diagnose arrives too late for the ischemic
stroke patients to benefit from tPA (thrombolysis) treatment, which has to be administered
within three hours of the onset of the disease. Therefore, the need to quickly diagnose
and correctly differentiate stroke is an important driver in neurological imaging today.
MR offers excellent clinical properties for imaging neurological conditions, such
as stroke, allows complete assessment in a single exam, and assists physicians
in making a differential diagnosis.
To address the growing need for sophisticated neurological imaging, BrainSTAT is a new
advanced post-processing tool from GE Healthcare that allows quantitative evaluation
of neurological conditions, as well as helps visualize vascular structure and flow in the
tissue surrounding brain lesions. As a result, clinicians may use it to more precisely
diagnose the extent and severity of ischemic brain disease, and better tailor an
individualized therapy plan.
CBF (ml/100mg/min)
CBV (ml/100mg)
MTT (sec)
These parametric images reflect the spatial distribution of blood flow, blood volume per 100 mg of tissue,
and the time it takes for blood to perfuse through the tissue being imaged.
Designed for the new Signa® HDxt MR, BrainSTAT calculates regional cerebral blood flow
(rCBF), blood volume (rCBV), mean transit time (rMTT) and time to peak (TTP) for every
pixel from a time series of MR image data. The results are visualized as color-coded maps.
Based on the widely accepted, scientifically proven Gamma Variate Fit algorithm,
BrainSTAT provides objective and reproducible data on pathologies that may assist
clinicians in delivering better, more personalized care. References
1. Mental and Neurological Disorders. July 2006
newsletter by the Disease Control Priorities Project.
Available at: http://www.dcp2.org/file/60/DCPP-Mental%20Health.pdf
2. American Heart Association/American Stroke
Association. Heart Disease and Stroke Statistics –
2007 Update. Available at: www.americanheart.org
A GE Healthcare MR publication • Autumn 2007
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The information contained in this document is current as of publication of the magazine.
T E C H N I C A L I N N O VAT I O N
1.5T MRI – SIGNA HDE
Enhancements
Bring Sophisticated
MR Applications
Within the Reach
of Everyone
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A GE Healthcare MR publication • Autumn 2007
The information contained in this document is current as of publication of the magazine.
1.5T MRI – SIGNA HDE
T E C H N I C A L I N N O VAT I O N
The HDe Value Proposition
In today’s healthcare market, radiologists want accurate
and reliable diagnostic imaging that can lead to a confident
diagnosis. Yet, today’s competitive reimbursement
environment, and, in particular, reductions that resulted
from the Deficit Reduction Act (DRA) of 2005, necessitate
a cost-conscious environment.
GE Healthcare continues its commitment to an upgrade
continuum path with Signa HDe. As a facility’s diagnostic
imaging needs evolve, so too can the Signa HDe. GE’s MR
continuum path enables users to completely upgrade their
system to the industry-leading HDx platform and today’s
most advanced clinical applications.
The Signa® HDe 1.5T MR system answers this challenge by
delivering excellent clinical performance that meets a facility’s
purchasing needs. With over 200 worldwide installations,
Signa HDe brings the clinical advantages of MR technology
to a broader population base by addressing the challenges
of space, cost and ease of use. Plus, signature HD applications
such as the GE-exclusive LAVA™, TRICKS™, PROPELLER HD™
and VIBRANT® sequences give users state-of-the-art
MR capabilities.
Signa HDe fits where other 1.5T MR systems can’t. The
system can be sited with 30 percent less space and on
average generates 25 percent less operating cost than
a traditional 1.5T MR system, which translates to facilities
recouping their investment with as few as five billable
patients each day. Building on this success, GE Healthcare now offers
additional capability on the Signa HDe for increased
operational efficiency and investment protection. New
applications enable increased clinical benefits for
Signa HDe users, including:
• PROBE for proton brain spectroscopy
• Cartilage visualization using color-coded mapping
with Cartigram™
• Improved gray-white matter imaging contrast and lesion
visualization on cervical spine images with MERGE
The system boasts a user-friendly interface and a full range
of High-definition (HD) coils for head-to-toe anatomical
coverage. Together, these enhancements to Signa HDe
provide the radiologist and technologist with additional
capabilities to generate clear, accurate and complete
images in key areas.
Without PROPELLER HD
With PROPELLER HD
A GE Healthcare MR publication • Autumn 2007
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The information contained in this document is current as of publication of the magazine.
T E C H N I C A L I N N O VAT I O N
ANGIOGRAPHY – NON CONTRAST ENHANCED PULSE SEQUENCES
Robust NCE Techniques Remain a Viable
Alternative for MR Angiography
By Stuart Clarkson, Americas MR Training Manager, GE Healthcare
Non contrast enhanced magnetic resonance angiography
(NCE-MRA) has become a global topic of interest following
the recent link between nephrogenic systemic fibrosis (NSF)
and gadolinium contrast agents.1 Reports2 dating to the year
2000 identify a scleromyxoedema-like cutaneous disease in
renal-dialysis patients that may well have been associated
with gadolinium; however, the link between NSF and MR
contrast agents had yet to be made.
Gadolinium-based contrast agents are used in many MR
examinations, but its use has it been of particular interest
in NSF due to the larger doses of contrast required for
cardiovascular imaging compared to MR examinations
of other anatomy. Additionally, patients who receive an
MRA of the renal arteries may have been at additional
risk of NSF due to renal impairment.
NCE Techniques
GE Healthcare’s Signa® HDx and HDe systems incorporate
no less than 10 pulse sequences capable of imaging the
vasculature without the use of a contrast agent. These include:
1. 2D Phase Contrast
2. 3D Phase Contrast
3. CINE Phase Contrast
4. 2D Time of Flight (gated and non gated)
5. 3D Time of Flight (includes MOTSA)
6. 2D fat sat FIESTA
7. 3D fat sat FIESTA
8. 3D FSE (black blood angio)
9. 2D Double Inversion Recovery
10. MR Echo* (FIESTA based real time sequence on HDx 1.5T)
The Clinical Impact
Many institutions implemented a policy of screening patients
scheduled for a contrast enhanced MR imaging study to
ensure adequate renal function prior to the administration
of a gadolinium-based agent. If the patient exhibits impaired
renal function that prevents the institution from performing
an intravenous injection of a gadolinium agent, then
non-contrast imaging is utilized. Imaging renally-impaired
patients without a contrast agent presents a challenge
when visualization of vascular structures is required.
The imaging challenge in assessing vascular anatomy
without a contrast injection is deciding which sequence
to use for interrogating the vascular anatomy of interest.
As with all MR imaging sequences, there is a perpetual
trade-off between resolution and scan time for obtaining
the adequate signal-to-noise-ratio (SNR) in an image. With
MRA, there is the additional consideration of blood flow
when selecting the appropriate sequence.
3D Time of Flight (ToF) sequences (Figure 1) exhibit excellent
spatial resolution; however, due to saturation effects and
subsequent loss of signal, these are seldom used in slow
Portal Vein
Figure 1. 3D ToF
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A GE Healthcare MR publication • Autumn 2007
Figure 2. Gated 2D ToF
Figure 3. 2D FIESTA MiP
The information contained in this document is current as of publication of the magazine.
ANGIOGRAPHY – NON CONTRAST ENHANCED PULSE SEQUENCES
flow areas. 2D ToF techniques (Figure 2) may be utilized
when imaging long vessels that have slower flow rates.
In pulsatile vessels, the sequence should be gated to the
patient’s heart rate to mitigate artifacts.
Steady-state free precession sequences such as FIESTA
(Figure 3) are excellent for fast scans done in a breath hold.
When targeted to specific vascular anatomy, high in-plane
resolution is easily achievable.
Phase contrast techniques provide excellent background
subtraction resulting in 3D volumes (Figure 4) that are easily
rotated into any viewing plane. 3D phase contrast techniques
are significantly slower that the breath hold times seen with
contrast enhanced techniques; however, when combined
with a CINE acquisition, the phase contrast techniques
are capable of quantifying flow in any vessel.
T E C H N I C A L I N N O VAT I O N
“For our non-contrast MRA studies, we
generally rely on two complimentary
techniques: 2D Time of Flight (to obtain
images with venous suppression)
and Steady-State Free Precession
(i.e. FIESTA), that has very few flow
artifacts. However, today most MRA
studies are performed with sequences
like eFGRE or using multi-phase, time-resolved techniques
(e.g. TRICKS), which are very accurate and provide high
diagnostic confidence. An additional advantage of these
techniques is that one can also assess the dynamics of
blood flow. This can be especially helpful in patients with
shunts, fistulas or vascular malformations.”
Steven Wolff, M.D., PhD, Director of Cardiovascular
MRI, Advanced Cardiovascular Imaging, New York, NY
Phase contrast techniques are also sensitive to the flow
direction of the blood – any flow from Left, Inferior or
Posterior is shown as black and flow from Right, Superior
and Anterior shown as white. Flow within the right middle
cerebral artery (Figure 5) is from the left to the right and
hence is black on the phase image. Also note that 3.122 mLs
of blood passes through this vessel with each heart beat;
multiplying this by the patient’s heart rate (55 beats/min)
generates the vessel flow rate at 171 mLs/min.
Figure 4. 3D Phase Contrast
Future Pulse Sequences
Despite the comprehensive suite of non-contrast MRA
sequences, GE Healthcare continues to evaluate improved
techniques for imaging vascular structures without a
gadolinium injection. FIESTA-based sequences that utilize
various tissue preparation pulses are very promising
in their ability to depict vascular structures in various
anatomical locations.
Figure 5. CINE Phase
Contrast of middle
cerebral artery and
resulting flow
measurements.
Peak Positive Velocity (cm/s)
83.1
Peak Negative Velocity (cm/s) -6.07
Avg. flow (ml/beat)
3.122
Avg. Positive Flow (ml/beat)
3.158
Avg. Negative Flow (ml/beat) -0.036
Summary
MR provides robust visualization of vascular anatomy. In the
subset of patients that are deemed unsuitable for a contrast
injection, it is reassuring that many techniques exist on the
Signa HDx and HDe scanners to image vascular anatomy
and quantify flow. These techniques may prolong the exam
time, but can be used to achieve the imaging goal. References:
1. Thomsen HS. Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide.
Eur Radiol. Epub October 24, 2006
2. Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE. Scleromyxoedema-like cutaneous
disease in renal-dialysis patients. The Lancet 356(9234), 16 September 2000, 1000-1
A GE Healthcare MR publication • Autumn 2007
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The information contained in this document is current as of publication of the magazine.
BEYOND THE SCAN
FUNCTIONAL MRI – BRAINWAVE AND FIBERTRAK
Advanced fMRI Techniques
Provide Valuable Information,
Change Course of Treatment
for Neurosurgical Patients
The Methodist University Hospital Neuroscience Institute, in collaboration with
the University of Tennessee Health Science Center, provides neuroscience
clinical programs, medical education and research that are comprehensive
and interdisciplinary.
Backed by the latest technologies, including a GE Signa® HD 3.0T MR, the Institute
showcases advanced neurology applications, including functional magnetic
resonance imaging (fMRI) and diffusion tensor imaging (DTI) – both powerful
tools that help in planning treatment in patients with brain tumors.
fMRI and DTI help physicians identify areas of the brain that affect a patient’s
ability to function, (i.e., speech, hearing, vision, muscle control) and therefore
must not be disturbed during surgery. fMRI also detects changes in the MR signal
that are coupled to changes in neuronal activity. An fMRI scan can produce
high-quality images that indicate which areas of the brain are being activated
by diverse stimuli. In contrast, DTI is used to examine the wiring of the organized
regions of the brain, mapping, the orientation of diffusion along white matter
tracts and helping physicians visualize neural pathways.
Immediate Benefits
Soon after the Signa HD 3.0T system was installed in November 2006,
Frank Parks, M.D., Chairman of Radiology for Methodist Healthcare noticed
an immediate impact on patient care.
Of the first 215 patients scanned using fMRI and DTI, the results changed the
course of treatment in 70 cases. “In some of those patients, it has made a very
dramatic difference, such as the differences between no surgery versus surgery,
or vice versa,” Dr. Parks said. “It has also made a difference in the quality of
patient outcomes and the speed of recovery.
“In my years in radiology, I’ve seen many new technologies, but I am surprised
at the immediacy of impact in this case,” he continued. “It’s not every day we see
a technology that directly impacts patient care so quickly after implementation.”
fMRI activation areas are co-registered with 3D
datasets for custom visualization.
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A GE Healthcare MR publication • Autumn 2007
The technology has helped the staff at Methodist provide better options for patients
with tumors considered unresectable or inoperable. “In such cases, somebody had
looked at an MRI and said, ‘That must be functional tissue,’” said Allen Sills, M.D.,
The information contained in this document is current as of publication of the magazine.
FUNCTIONAL MRI – BRAINWAVE AND FIBERTRAK BEYOND THE SCAN
Associate Professor of Neurosurgery at the University of Tennessee and medical
Director of the Methodist University Hospital Neuroscience Institute. “As it turns
out, many times that estimation is just wrong. We’ve been able to use fMRI
to show ourselves that indeed we can probably take the tumor out without
excessive risk.”
The technology’s immediate impact on patient cases soon won over some
skeptics. “At first, some neurosurgeons said they were not interested,” Dr. Parks
recalled. “A few who have seen the results now say, ‘I want to get my
patients scanned.’”
Changing Treatments
Create DTI 3D fiber maps with GE FiberTrak.
In case after case, fMRI/DTI scanning non-invasively provides crucial
information that helps surgeons like Dr. Sills make informed decisions on:
• Reviewing surgical approach and in choosing the safest path, based on
the location of functional brain tissue
• Deciding on Operability
• Tracking white-matter tracts
Choosing the Safest Path
The first patient scanned at the Methodist University Hospital with fMRI/DTI
was a 20-year-old woman with a right brain tumor diagnosed by MR at another
hospital. The team integrated fMRI and DTI with acquisition of 3D anatomical
images for the patient’s scheduled image-guided surgery.
Clinicians located the tumor in the eloquent cortex near the patient’s motor strip.
“It was in an area where we knew the surgery would be delicate,” said Dr. Sills.
“We had identified one particular trajectory to the tumor, based on what we
believed to be the safer corridor. When we did the fMRI, much to our surprise
we found that functional tissue – the tissue that controlled her leg movement –
would have been right in the middle of what we had considered our corridor.
“There is really no
substitute for the
real-time, exact,
precise information
you get from studies
like (fMRI and DTI).”
Dr. Allen Sills
“The information definitely caused me to change my approach and come in by
a different route that would be much safer. The patient had been adamant on the
front end that she didn’t want any motor deficit, and we were able to accomplish
that for her.”
A post-operative physical exam found no evidence of foot or ankle weakness.
Deciding on Operability
In another case, a 51-year-old man was diagnosed with anaplastic astrosarcoma
affecting the temporal lobe. Surgeons needed to determine whether the tumor
could be resected without significant loss of function.
Using fMRI and DTI scanning, clinicians found the area of concern was already
disrupted by the tumor, causing the neurosurgeon to proceed with the surgery.
“The tumor had been well worked up in previous MR images,” explained Dr. Parks.
“The additional information from fMRI and fiber tracking was the tipping point
for go or no go.”
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BEYOND THE SCAN
FUNCTIONAL MRI – BRAINWAVE AND FIBERTRAK
Another patient, a 38-year-old man, had three areas of brain tumor, including
a large growth at the back of the brain near his vision area. Clinicians suspected
the lesions were benign, but to remove the large tumor would involve
significant resection.
“We used fMRI to localize his visual function and were able to see that we could
in fact go in and take out that very large lesion – at least 8 cm in size – and not
put the patient’s vision at risk,” Dr. Sills said. “It gave us confidence preoperatively
that while the risk wasn’t zero, the risk was certainly low that we would cause
harm to his vision.”
Tracking White-Matter Fibers
Another beneficiary of fMRI and DTI was a 22-year-old woman who had a right
temporal tumor. “She was left-handed, so the assumption was that her language
function must be in the right temporal area,” explained Dr. Sills. “Obviously, there
was a great deal of trepidation about approaching this lesion.
“It looked like a benign lesion, but she was having seizures and didn’t like being
on seizure medicines. She wanted to have the lesion taken out if she could. Our
concern was, can we do that safely? fMRI was very helpful. It showed that she
had language function in both hemispheres, rather than just one, and that
language function area was not anywhere near the lesion.
22-year-old female with right temporal lesion.
2D color directional image (top) shows the
displaced white matter. The fMRI image (bottom)
demonstrates activation from speech and
passive listening paradigms.
“In the end, the (DTI)
exam gave us two
critical pieces of
information. First,
it helped us decide
whether we could
even think about
surgery. Second,
it helped determine
our surgical approach.”
Dr. Frank Parks
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A GE Healthcare MR publication • Autumn 2007
“The DTI was incredibly useful because it showed beautifully that the fibers were
displaced laterally by the tumor, rather than being infiltrated by it,” he continued.
“Without DTI, we would have had no way of knowing that with any degree of
certainly. In the end, the exam gave us two critical pieces of information. First, it
helped us decide whether we could even think about surgery. Second, it helped
determine our surgical approach.”
Parks added that the fMRI/DTI findings enabled clinicians to avoid performing an
invasive Wada test to locate the speech center. Surgery went forward, and the
woman’s speech was not affected.
Clinical Value Added
The addition of fMRI and DTI was a natural one for Methodist University Hospital,
a consistent state leader for brain tumor cases. “At the time we made the investment,
it appeared these technologies had moved out of the research lab and had reached
the point of being clinically relevant,” Dr. Parks recalled. “We saw them as consistent
with our belief in individualized care. They provide information we can use to
customize therapy based on the patient’s exact anatomy and pathology.”
Clinicians at Methodist scan many brain tumor patients on the Signa® HD 3.0T
scanner with fMRI and DTI before craniotomy. Hospital leaders believe the
decision to move up to a high-field 3.0T system benefits both clinicians and
patients. In addition, Parks has found the procedures easier and the results
more reproducible on the Signa HD 3.0T system than on the hospital’s other
MR scanners.
Technologists use the BrainWave and DTI/FiberTrak suite of applications from
GE Healthcare, which offer comprehensive, easy-to-use tools to acquire and
The information contained in this document is current as of publication of the magazine.
FUNCTIONAL MRI – BRAINWAVE AND FIBERTRAK BEYOND THE SCAN
About Methodist
University Hospital
post-process high-definition 3D anatomical images, neurofunctional brain maps
and white-matter trajectories projection.
During the procedures, the technologists scan brain anatomy, run the patient
through a series of brain stimulations called paradigms that are necessary to
perform an fMRI exam, generate DTI images, integrate and post-process the data.
The study results are provided to the physicians as 3D, color-coded data sets that
can be easily manipulated to best visualize areas of interest.
The physicians can study the 3D datasets as part of surgery planning and
display the images in the operating room, integrating them with the surgical
navigation system.
Gratifying Experience
Besides helping clinicians, the information helps put patients at ease. “The exam
is not an anxiety-provoking experience,” Dr. Sills explained. “Our technologists and
radiologists are superb. They make the experience comfortable, so it’s not a test
that patients dread and fear.” The exams are also non-invasive, unlike alternative
technologies that are used intra-operatively, and so provide no opportunity for
the surgeon to consult with the patient in advance.
Dr. Sills notes that the fMRI/DTI data helps inspire confidence in patients and loved
ones. He often shows color-coded brain maps to patients before surgery, explaining
in simple terms what the images indicate. “I can walk the patients through and
show them what we’re looking at,” he added. “Patients and family members
can easily understand it.
The 693-bed Methodist University
Hospital, founded in 1924, is a
tertiary care and referral center
and the flagship hospital for
Methodist Healthcare, a sevenhospital system ranked a Top 100
Integrated Health Network (IHN)
by Modern Healthcare magazine.
The hospital has a long history
of leadership in brain tumor
treatment and MR diagnostics.
Methodist treated nearly 300 brain
tumor cases in 2006, and Le Bonheur
Children’s Medical Center, part
of Methodist Healthcare, is a
major regional referral center
for brain tumors.
In 1985, Methodist Hospital became
the first in its area to offer MR
imaging. It has continued to add
state-of-the-art MR scanning
technology, the most recent
purchase being a GE Signa HD 3.0T
scanner with fMRI and DTI in
November 2006.
Other cutting-edge neurological
tools offered by this leading facility
include magneto encephalography
(MEG) scanning and gamma
knife surgery.
“I think it’s a source of comfort to them to know we have this kind of advanced
technology available for planning and studying lesions. It also helps them to
understand that we’re doing everything we can to minimize risk.”
Hospital staff members at all levels are gratified with the results of fMRI and DTI.
Surgeons especially appreciate the technology. “When you’re the guy the patients
trust to take them into surgery and bring them out of it safely, you want to have
every weapon at your disposal,” Dr. Sills added.
“We all learned the classic models of anatomy that tell where functions are located.
More and more, we’re finding that those are only approximations, and there’s a lot
of variability from patient to patient. There is really no substitute for the real-time,
exact, precise information you get from studies like these.”
Robert Laster, M.D., a neurointerventionalist with Methodist Healthcare says
the technologists are also enthusiastic about fMRI/DTI. “They’re getting feedback
from the neurologists and radiologists that, ‘Hey this is helping my patients.’
And the technologists say, ‘This is why I went into the medical field – to help
make a difference."
Vic Perini, Vice President of Operations at Methodist University Hospital, expects
fMRI and DTI technologies to support continued growth in the Neuroscience
Institute. “The institute is of vital strategic importance,” he said. “We saw a great
opportunity to add differentiating technology that would enable even more
outstanding, care for every patient.” A GE Healthcare MR publication • Autumn 2007
47
The information contained in this document is current as of publication of the magazine.
BEYOND THE SCAN
1.5T MRI – SIGNA HDE
The Right Choice
for Your Community:
Making the Decision to Add MRI
In-house MRI keeps physicians happy and patients closer to home
Image courtesy of Hoefer Wysocki Architects
Keeping Patients Closer to Home
Saunders Medial Center’s new campus.
The town of Wahoo, Nebraska is changing. What was
once primarily a farming community is now becoming
a fast-growing suburb of Lincoln and Omaha, and home
to an increasing number of commuters.
Until recently, Saunders Medical Center could meet the
community’s MRI needs with a mobile service that was
onsite for five hours a week. But with Wahoo flourishing
and MRI becoming a more widely-used diagnostic test,
the demand for exams has grown.
“MRI has become a state-of-the-art diagnostic tool for many
types of conditions,” said Earl Sheehy, CEO of Saunders
Medical Center. “We decided to make the investment in
a fixed system in order to improve the quality of care we
provide to patients and to make sure they don’t have to wait
for an appointment or drive 20-plus miles to get an exam.”
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A GE Healthcare MR publication • Autumn 2007
According to Patrick Dailey, Manager of Imaging Services,
the primary reason was patient and physician satisfaction.
“Ordering an MRI exam on Monday and having to wait until
Saturday for the procedure is not an ideal situation for the
physician or the patient. Having in-house MRI would allow
us to provide service seven days a week if we need to.”
Competition was another factor. As the demand for MRI
services grew, so did the number of scanners in the
surrounding communities. At present, there are at least
nine fixed MRI systems within 30 miles of Wahoo, from
hospital-based systems in Lincoln and Omaha to scanners
in freestanding imaging centers.
“We knew we were losing a lot of patients to MRI services
in the surrounding areas to facilities that offered longer hours
and more flexibility in scheduling,” said Dailey. “But why
should a patient have to drive 25 miles for a procedure
that we could do here, if we had our own scanner?”
Encouraging Numbers
With plans for the new facility on the drawing board,
hospital management floated the idea of acquiring an MRI
system to the board, which then authorized a feasibility
study. The numbers were encouraging, Sheehy noted.
“We determined that about 42 procedures a month would
pay for the acquisition and operating costs, as well as the
structural expense to accommodate the scanner,” he said.
“We were already doing 35 procedures a month with the
mobile service and physicians told us that they were
referring another 30 to 40 patients a month to other
facilities because of our scheduling difficulties. We knew
that our volume would go up because physicians would
utilize a system that was more convenient for their patients.
The information contained in this document is current as of publication of the magazine.
1.5T MRI – SIGNA HDE BEYOND THE SCAN
“We showed the board how in-house MRI would improve our ability to provide
patients and physicians with better access to quality care. And from a financial
perspective, the pro forma revealed that if we averaged just two exams
a day, we could easily reach the volume that would justify the decision
economically,” said Sheehy.
Quality Levels the Playing Field
High performance and application flexibility were critical. The hospital
wanted to offer a wider range of MRI procedures, such as neurological studies,
and provide more advanced applications.
The medical center team evaluated a variety of MR systems and manufacturers
and selected a Signa® HDe 1.5T MRI system from GE Healthcare. “Image quality
was a key factor in choosing the HDe system,” said Dailey. “I’ve also found
from past experience working with physicians that they prefer images from
a closed MR system versus those from an open scanner.”
Virtually all of the imaging equipment that the center uses is from
GE Healthcare. “We’ve had a very good history with GE as far as service
and technical support are concerned,” added Dailey. “They’re always
dependable and willing to help us whenever we need them. That helped
make the decision to choose GE very easy.”
“MRI needs to be
readily available
to your patient
base. If you make
your patients go
out of town for
these procedures,
you’re going to
eventually lose
them for everything.”
Earl Sheehy, Chief Executive Officer
Sheehy noted that acquiring a “state-of-the-art” HDe system from GE was
also critical from a competitive standpoint. It enabled Saunders to “level the
playing field” by offering the same MRI services as those available in larger
medical facilities so that patients and their physicians could be assured
of receiving superior MRI without having to leave the community.
Immediate Physician Buy-in
The medical center’s primary medical staff consists of six physicians and
two physician assistants who live and practice in the Wahoo area. Referrals
also come from approximately 15 specialists who are based in the
surrounding communities.
The physicians “bought into the idea of in-house MRI the minute we started
looking at it,” said Sheehy. The hospital intends to offer the service five days
a week in the beginning and add evenings and weekends in the future, based
on demand.
Athletic injuries and other orthopedic conditions dominate the hospital’s
current MRI case mix. Says Dailey, “We have an orthopedic surgeon who
holds a weekly clinic at the hospital. There were procedures that he wanted
done sooner – and now we’ll be able to have the exams done when he
wants them,” said Dailey.
“Image quality
was a key factor
in choosing the
HDe system.”
Pat Dailey,
Manager of Imaging Services
A GE Healthcare MR publication • Autumn 2007
49
The information contained in this document is current as of publication of the magazine.
BEYOND THE SCAN
1.5T MRI – SIGNA HDE
A Technologist’s Perspective
“A detachable
table can help
save a life.”
Rachele Malousek,
MRI Technologist
Rachele Malousek, RT, sees a number of advantages to replacing Saunders’ mobile
MRI service with a fixed system. “Patients who have a spine injury or a possible stroke
need MRI right away. They can’t wait for a mobile service or to be transferred 30 miles
away. Now, we’ll be able to take care of them right away.”
She says there will be more time for personalized care, to take better patient histories
and visit with patients because technologists won’t have to rush against the clock,
trying to get all the cases through in the few hours the mobile system is on-site.
Malousek also feels that the hospital will be well poised to stay current with the
latest MRI protocols and that turnaround time for reports will be reduced, improving
patient care.
The information contained in this document is current as of publication of the magazine.
1.5T MRI – SIGNA HDE BEYOND THE SCAN
About Saunders Medical Center
Malousek is particularly pleased that the hospital selected a Signa HDe system with
its unique detachable table. “A detachable table can help save a life,” she said. “If
a patient codes or needs help immediately, you just unhook the table and bring the
patient outside the magnet room for assistance.”
A detachable table also reduces the number of steps in preparing a patient for an
exam, she added. “You just move the patient from the bed onto the table, take them
to the imaging room and scan them. It eliminates having to transfer patients onto
a cart. That saves time and contributes to greater patient comfort.”
Malousek has worked with GE systems in the past and feels they are “very user
friendly and easy to learn. I’ve trained with GE before and someone is always there
to help you, going over the protocols and explaining the software. It’s very reassuring
to have someone behind you all the way.”
One support tool that Malousek has come to depend on is iLinq™, an exclusive GE
service feature that enables users to communicate with GE applications specialists
by simply touching a button on the operator console. “If you’re ever stuck trying to
figure out something that’s happening with the system, you just push the little button.
A GE person always gets back to you within 10 to 15 minutes and usually is able to
resolve the issue. It’s very, very cool.”
Saunders Medical Center is an
independent community hospital
in Wahoo, Nebraska, a town of
4,200 in the eastern part of the
state. The town sits approximately
23 miles between Lincoln, the state
capital, and Omaha, Nebraska’s
largest city. The primary focus
of Saunders Medical Center is
outpatient care. The Critical Access
hospital includes full-service
laboratory and radiology services,
a 24-hour emergency room,
physical and respiratory therapy
and surgical services. A long-term
care facility and a physician clinic
are also part of the campus.
The facility conducts approximately
6,000 imaging procedures a year.
Radiology studies, except for
mammograms, are read remotely
by a group of board-certified
radiologists based in Omaha.
Images are transmitted digitally
via PACS to the radiologists. Their
dictated reports are transcribed
at the hospital and distributed
to the physicians.
The Community is Excited
The new GE Signa HDe at Saunders Medical Center became operational in August
2007. “We’re convinced it was the right decision because we’ve heard back from
the community how grateful they are that we have a fixed MRI system,” said Sheehy.
“Our staff is excited. Our physicians are excited. Our board is excited. Even the county
board of supervisors is excited about it.”
Sheehy believes that having in-house MRI is essential for an independent community
hospital to provide state-of-the-art medicine today – and to continue thriving. “MRI
needs to be readily available to your patient base. If you make your patients go out
of town for these procedures, you’re going to eventually lose them for everything.” A GE Healthcare MR publication • Autumn 2007
51
The information contained in this document is current as of publication of the magazine.
BEYOND THE SCAN
REIMBURSEMENT
Medicare Reimbursement Update
As payors continue to look for ways to rein in the rapid
growth in healthcare costs, imaging remains at the forefront
of policy and cost debates. Understanding, following and
acting upon the numerous complexities of proposed
reimbursement changes is challenging for many healthcare
providers to manage. To support customers in understanding
this continuously evolving and highly regulated area, and
to ensure that all customers have access to the latest
information and resources, GE Healthcare has a dedicated
website on reimbursement that includes:
• The latest Medicare Payment Rates for procedures in
all the major imaging modalities including listings by
site of care and geographic area
• Links to Payer Medical Policies to help providers
understand the conditions under which a given
procedure may be covered
• GE Reimbursement Customer Advisories with coding,
coverage and payment information
For MRI, recently updated Customer Advisories include
Breast MR Imaging, Breast MR Biopsy and Functional MRI
(fMRI). These documents are posted on GE’s reimbursement
website (www.gehealthcare.com/reimbursement).
Education and awareness is only one aspect of what
GE Healthcare is doing to support medical imaging customers.
Under the guidance of Mike Becker, General Manager of Global
Reimbursement and John Schaeffler, General Manager of
GE Healthcare Government Relations, GE has been working
to identify current and future customer imaging risks and
developing various strategies to mitigate these risks. To this
end, GE continues to partner with strong industry organizations
to protect and preserve access to quality imaging for all
patients and to stabilize the market after the shock of the
DRA (Deficit Reduction Act).
GE is a founding member of the national Access to Medical
Imaging Coalition (AMIC) comprised of equipment manufactures,
healthcare providers, key medical societies and patient
advocacy groups that represent more than 75,000 patients,
physicians, and imaging providers. GE serves on the executive
board of AMIC and like other participating members,
contributes resources to support the public relations,
52
A GE Healthcare MR publication • Autumn 2007
advocacy and educational activities aimed at ensuring
access to imaging. More information can be obtained
at the AMIC website (www.imagingaccess.org).
GE also joined AdvaMed in 2007, a successful, international
medical device industry association representing over
1300 companies and subsidiaries. GE plays leadership
roles in this organization with Joe Hogan on the
Board of Directors and Mark Vachon as the
Vice Chair of the newly created
Diagnostic Imaging sector. There is
also broad GE Healthcare participation
at the working group level to engage
on important customer topics such as
payment advocacy, state legislation,
and quality.
As a long-term member, GE continues to
strongly influence the advocacy program
for the Medical Imaging & Technology
Alliance (MITA), a division of NEMA
(National Electrical Manufacturers
Association), which represents
companies whose sales
comprise more than 90 percent
of the global market for
medical imaging technology.
Jim Davis, Vice President
and General Manager of the
GE Healthcare MR Business
chairs the MITA section. MITA has
focused on educating lawmakers,
the media and key stakeholders
on the “Value of Imaging”
(www.medicalimaging.org)
with a formal public relations
campaign.
For more information, please
visit www.gehealthcare.com/
reimbursement. The information contained in this document is current as of publication of the magazine.
E D U C AT I O N – P E E R V I S I O N : S I G N A 3 . 0 T S O C I E T Y B E Y O N D T H E S C A N
Figure 1
The GE Signa 3.0T Society welcome page
on the PeerVision Online Community web site.
Signa 3.0T Users Share Best
Practices, Clinical Techniques
with Users Around the World
Launched September 2007, the GE Signa 3.0T Society on the
PeerVision Online Community web site brings Signa® MR 3.0T
Users together to interact and learn from one another. Through
PeerVision, users can openly share ideas or opinions, forming
an online community with user-generated content that shares
the latest techniques in 3.0T imaging across the globe.
Within the Signa MR Imaging Community, users will find MR
educational opportunities and events. The GE Signa 3.0T
Society includes discussion forums, polls, a gallery for clinical
case images and a library of tools and tips. Guest bloggers
periodically post topics for open discussion and participants
can elect to share comments on the topic or merely read
along with the dialog.
PeerVision is the result of research on MR-users’ information
needs, incorporating customer feedback to create a “nonpromotional” environment for authentic communication among
Signa MR 3.0T Users. PeerVision has several online communities
for users with different interests to join and participate in any
discussion, including: Advanced Visualization, Outpatient
Imaging Centers and Reading Rooms.
The GE Signa 3.0T Society is open only to Signa MR 3.0T Users.
The System ID, found on or near the Signa MR 3.0T System
Monitor, is required for initial log in. Join the community today,
www.healthcare.com/peervision. With PeerVision, you can
• Join a discussion on imaging challenges
or share a clinical case
• Find out what your peers think, or share
your own insights
PeerVision. It’s your community – GE provides
the medium. You decide how it evolves.
A GE Healthcare MR publication • Autumn 2007
53
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© 2007 General Electric Company.