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Future Trends in Clinical Diagnostics with Magnetic Resonance

Future Trends in Clinical Diagnostics with Magnetic Resonance. Dieter Meier Institute for Biomedical Engineering. SNHTA Bern 12. November 2003. The “International Competence and Reference Center for MRI Methodology” Advantages of MRI Functional Information Discussion and Outlook. Topics.

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Future Trends in Clinical Diagnostics with Magnetic Resonance

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  1. Future Trends in Clinical Diagnostics with Magnetic Resonance Dieter Meier Institute for Biomedical Engineering SNHTA Bern 12. November 2003

  2. The “International Competence and Reference Center for MRI Methodology” Advantages of MRI Functional Information Discussion and Outlook Topics

  3. Scientific Environment • Swiss Federal Institute of Technology (ETH) • natural and technical sciences • 83 institutes and laboratories, > 11’000 students • University Zurich • all major scientific disciplines (7 faculties) • > 20'000 students • University Hospital Zurich • education site for medical faculty • 130’000 ambulant, 35’000 stationary patients a year, 960 beds, 5500 employees • International Relations • Excellent scientific and industrial relations

  4. Biomaterials Tissue Engineering N.N. Biomechanics Biomedical Electronics Biomechanics Bioelectronics Medical Optics P. Niederer R. Müller D-ITET D-ITET D-MAVT Institute for Biomedical Engineering Biophysics MR Competence Center MRI in Neurosci. N.N. Med. Fak. MRI / MRS P. Bösiger Med. Faculty D-ELEK MRI Technology K.P. Prüssmann D-ELEK Technical Director: Dieter Meier International Zurich Magnetic Resonance Education Center International Zurich Magnetic Resonance Education Center

  5. Competence Center CCMRI Partners at University • Dept. Radiology:Neuroradiology, Radiology, Nuclear Medicine • Dept. Internal Medicine:Cardiology , Angiology, Gastroenterology • Neuroscience:Neurology, Psychiatry, Psychology

  6. International Scientific Relations Univ. of Minnesota Minneapolis, MN K. Ugurbil R. Grütter Harvard Med. School Boston, MA W. Manning R. Botnar Univ. of California San Francisco, CA C. Higgins O.M. Weber Johns Hopkins Univ. Baltimore, MD P.van Zijl, X. Golay M. Stuber Inst. for Biomedical Engineering Division Biophysics (MRI) Univ. and ETH Zurich P. Boesiger, K.P. Pruessmann German Heart Institute Berlin, Germany E. Fleck E. Nagel, I. Paetsch Stanford University Stanford, CA C. Bammer King’s College, London, UK S. Kozerke Univ. Hospital Aarhus Aarhus, Denmark E. Pedersen Technical Univ. Graz Graz, Austria K. Perktold

  7. Industrial Relations Philips Medical Systems Philips Research Laboratory Philips Med. Systems Schweiz AG Best NL, Hamburg DE, Zurich CH Medtronicand Bakken Research Center Tolochenaz VD and Maastricht NL Bracco Imaging Milano I Inst. for Biomedical Engineering Division Biophysics (MRI) Univ. and ETH Zurich Bitplane AG Zurich Guerbet Pharmaceuticals Zurich und Paris F Roche Pharmaceuticals Basel GyroTools GmbH Zurich

  8. Funding ETH and University of Zurich Philips Medical Systems University Hospital of Zurich Project related funding: SEP; EUREKA / KTI; SNF; Dt. Stifterverband Further partners from industry and science

  9. Mission Development of new and dedicated MRI techniques for applications in diagnostics and therapy as well as in basic medical and clinical research. Application of these procedures in medical research in collaboration with highly qualified local and international scientific and medical research groups.

  10. Equipment • MRI Scanner Philips Gyroscan Intera 1.5 Tesla • Worldwide fastest MRI commercially available scanner, equipped with parallel imaging technique SENSE • MRI Scanner Philips Gyroscan Intera 3.0 Tesla • Worldwide first 3 T scanner with compact magnet; presently being • further developed in collaboration with IBT

  11. Advantages of MRI • High soft tissue contrast • Contrast adaption • High spatial resolution • Arbitrary slice direction • No known hazards • Functional information

  12. MRI of the Brain • anatomy • angiography • perfusion, fMRI • diffusion • metabolite imaging

  13. Magnetic Resonance Imaging

  14. Sagital Head Images 3Tesla T2-TSE 512 matrix, 2 mm

  15. z z y y 3D Imaging with 2D SENSE NONSENSE Scan time 106 s 2D SENSE Scan time 26 s M. Weiger, K. Pruessmann, IBTZ

  16. High Resolution MRA 3Tesla 3D, Inflow MRA 3DI/TONE TR 28ms, TE 4.6ms, Flip 20o scan time 7.30 min 100 slices, thickness 1.0/-0.5 matrix 1024 IBTZ, Neuroradiology USZ

  17. High Resolution MRA 3Tesla Venogram

  18. High Resolution MRA 3Tesla Arteriovenous Malformation (AVM)

  19. Inflow Angiography 1.5 vs. 3.0T 1.5 T 3.0 T

  20. R = 3.0 NONSENSE R = 2.0 SENSE Phase Contrast MRA @ 3T 3D FFE, 3 Tesla TE=3.8ms, TR=19ms Flip angle=10o velocity encod = 50cm/s (RL-AP-FH ) slice thickn=0.5 mm 120 slices FOV=190mm matrix=163x256 M. Huber, S. Kozerke, IBTZ

  21. Brain Activation: BOLD fMRI Activation of brain area: Raise of metabolic activity Raise of blood flow Raise of concentration of oxygenated blood Decrease of relative concentration of desoxygenated blood, acting as a contrast agent Increase of T2*, increase of signal amplitude

  22. Activation of Neurons

  23. Activation of Motor Cortex

  24. SENSE: fMRI 3T low-res conventional sshEPI high-res SENSE sshEPI stimulation: bilateral opposite finger tapping, 4 x 20s on/off C. Schmidt, K. Pruessmann, IBTZ

  25. Visual Stimulation A [%] 1 2 3 4.0 4 5 6 0

  26. BOLD fMRI 1.5 vs 3T: Auditory Stimulation 1.5 T 3.0 T Courtesy: S. Sunaert, Leuven

  27. MRI and Perfusion T1w/IR-TSE TR 1400 TE 12 TI 700 PDw/TSE TR 3500 TE 16 T1w/IR-TSE TR 1400 TE 12 TI 700 after IV Gd-DOTA T2w/TSE TR 3500 TE 110

  28. SENSE: Diffusion Tensor Imaging Fractional anisotropy (ordering of fibers) Direction field map T. Jaerman, IBTZ, Neurorad USZ

  29. Diffusion Tensor Imaging Characterizing the ORIENTATION of the ellipsoid forceps minor ant. limb of internal capsule external capsule post. limb of internal capsule (corticospinal tracts) optic radiation forceps major Talk T. Jaermann et al, today, 15.00 pm

  30. 3T SENSE-DTI: Tracking Results • Functionality: • oblique rotations • introduce new slices • slice shifting • zooming T. Jaermann, IBTZ, Neurorad USZ Meiyappan Solaiyappan, Johns Hopkins University

  31. 3T SENSE-DTI: White Matter Segmentation radiation of corpus callosum volume: 200x200x108mm3 anatomy: 256x256x180 SENSE-DWIs: 128x128x36 T. Jaermann, IBTZ, Neurorad USZ

  32. NAA Cho Cr NAA +Glx Cr MI Glx Lac Chemical shift (ppm) 4.0 3.0 2.0 1.0 Metabolites in 1H MR Spectroscopy Scan time: 1:04 min, VOI 45 cc

  33. Cr (PCr): Energy buffer H + PCr + ADP  ATP + CrEnergy shuttle: “Energy transport” The Cr peak is often stable and used as internal reference : Acute and subacute stroke, brain tumor, brain metastasis, abscesses, inborn errors of Cr synthesis NAA, (P)Cr NAA: Neuronal marker (neuronal density); concentration correlates with neuronal function : Tumor, Stroke, Epilepsy, Hyp-/Anoxia, Inflammation, Dementia, Trauma : Brain Development and Maturation

  34. MI: Astrocyte marker, second messenger : Alzheimers’ disease, renal failure, Diabetes mellitus : Abscesses, Hepatic encephalopathy, tumors, stroke Choline Containing Compounds = Cho, Myo-Inositol Cho: Involved in pathways of phospholipid synthesis and degradation. => reflecting membrane synthesis and degradation : Brain Tumors, MS-Plaques, Stroke, Inflammation, White Matter Diseases : Hepatic Encephalopathy, Necrosis

  35. Lac: Sign of impaired energy metabolism, impaired oxygen delivery (anaerobic glycolysis). : Stroke, An-/Hypoxia, mitochondrial diseases, tumors, epileptic discharges, abscesses/infection, prolonged neuronal activation Hardly detectable in normal brain tissue (~1 mM) Glutamate and Glutamine = Glx; Lactate Glutamate: excitatory neurotransmitter, substrate for Krebs-Cycle, Protein Biosynthesis Glutamine: Substrate for neurotransmitter synthesis (GABA, Glutamate), Protein Biosynthesis  Glx:Stroke, hyp-/anoxia, epilepsy, neurodegenerative diseases, hepatic encephalopathy

  36. SingleVoxelSpectroscopy @ 3T TE = 288 ms VOI = 20 x 20 x 20 mm3 Cerebellum (AMS study) NAA Cho Cr Lactate Mi U. Dydak, IBTZ

  37. Cho Lactate Cr NAA 4 3 2 1 4 3 2 1 SVS: tumor treatment Cho Scan time: 4.16 min (35cc) Cr NAA Mi Mi Lactate after treatment before treatment Courtesy: Dept. of Radiology, University of Bonn, Germany

  38. Cerebral Infarction Subacute Normal Acute Normal FLAIR - ROIs Courtesy: Tim Roberts, Toronto

  39. Alzheimer’s Disease The increase () of MI seems to differentiate Alzheimer’s Disease from other forms of dementia

  40. Whole brain TSI 6 slices, 20x20x6 isotropic voxel (1.33ml),Dn = 8.8 Hz

  41. Cho Cr NAA

  42. Cho NAA TSI6: Meningioma Single slice, 32 x 32 matrix, TR=2000 ms, 0.8 ml voxel => 5:12 min U. Dydak, IBTZ

  43. Visualization of 3D MRSI Data NAA maps 3D SENSE-SI visualization software: IMARIS by Bitplane, Switzerland Talk U. Dydak et al, Friday, 10.45 am

  44. SENSE Extremity Imaging @ 3T 3D T1w FFE 3.0 Tesla SENSE factor 2 150 microns in-plane 1mm slice thickness Scantime 8 min. K.P. Pruessmann, IBTZ D. Weishaupt, Radiology, USZ

  45. SENSE Angiography Time-Resolved 3D CE-MRA Scan time: 4 s / 3D frame SENSE R=3.0 1.6 × 2.1 × 2.4 mm3 M. Weiger, K. Pruessmann, IBTZ

  46. SENSE Angiography Time-Resolved 3D CE-MRA 4 s / 3D frame 1.6 × 2.1 × 2.4 mm3 SENSE R=3.0 ibt / mw kp

  47. SENSE R = 2.0 Breathhold: 12 sec Motion Artefact Reduction Standard Breathhold: 24 sec Dep. of Veterans Affairs, Durham

  48. Cardiovascular MRI • Problem: • Morphological imaging for many problems insufficient • Functional diagnostics on a strongly moving organ (heart motion, breathing) at rest and under stress needed. • “One stop shop”.

  49. Cardiovascular MRI Heart functions: • Coronary artery angiography • Viability and perfusion • Wall motion, ejection fraction • Flow (coronary flow reserve, valvular flow, regurgitation)

  50. viability spectroscopy motion coronaryMRA, flow,perfusion Ischemic Cascade Chestpain ECGchanges Regional systolic dysfunction Diastolic dysfunction Metabolic changes Hypoperfusion Time

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