MRI Future updates Clinical

Applications

What’s
near future?
Roy Peter
MRI Applications
Specialist,
GE Healthcare

Clinical applications that advance MRI What’s

New? Clinical applications that advance MR
¾ Ready Brain What’s
New?

¾ 3D ASL
¾ PROPELLER 3.0
¾ Enhanced DWI
¾ MR Touch ¾ Ready Brain
¾ Inhance Delta Flow
¾ Advanced Cardiac
MRI
¾ MR Enabled
Therapies

Ready Brain & Express Exams Ready Brain

or

No user interaction needed

Raw data to
Midsagittal Scan all series Post-processing
Localizers Scan planes Scan all series PACS & selected
plane per protocol completed
acquired computed per protocol series to AW
detected per protocol
per protocol

PAC
S

Reading room

How does it work? Benefits

• Automatic localizer, Rx, scan, reformatting,
postprocessing and data management
• Automatic midsagittal plane calculation for 2D/3D Rx
and ACPC determination
• Extreme (>45 deg) rotation correction
• Fully automated exam for improved productivity
• Accurate planes and reproducible intra- and inter-patient
slice positions
• Prescription made simple for non-expert users

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Clinical applications that advance MRI STROKE
T2, DWI & Dynamic EPI
What’s
New? T2

¾ 3D Arterial Spin Labeling (3D ASL) (reveals same

information)
Dynamic EPI
DWI

reveals tissue at risk

blood volume (NEI) transit time (MTE)

Diffusion Provides information about Tissue already Dead Perfusion Weighted Imaging (PWI)
Perfusion Provides information about tissue at Risk
Diffusion = dead -Perfusion MRI provides a relative measurement of the parameters
of cerebral micro vascularisation
Perfusion = dying
Dynamic EPI
-We have to use a tracer or exogenous gadolinium contrast
-Dynamic injection – Power injector, or quick hand injection
-Acquire the first pass image with a fast EPI GE or EPI SE
sequence
-Due to the magnetic susceptibility (T2*) effect of paramagnetic
Diffusion
blood volume (NEI) Blood Flow (MTE)
Blood Fow
gadolinium there will be signal drop during the first pass of
Blood volume
Shows infarct
Shows infarct
Shows tissue at risk contrast.

Perfusion Graph Brain Perfusion Haemodynamic maps

rCBV rCBF

Perfusion abnormality in the left brain

hemisphere (MCA territory).
•Reduced Blood Volume and Blood Flow
(rCBV, rCBF) (red arrow)
•TTP delay
•MTT increase

TTP MTT

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 3DASL 3D Arterial Spin Labeling (3D ASL)
How does it work?

Courtesy of Dr. Zaharchuk, Stanford Radiology

• 3D FSE acquisition with spiral readout
• Pulsed continuous labeling close to the imaged slab
• Background suppression for motion insensitivity
-In ASL the tracer is the arterial blood
itself (or we call it as endogenous
contrast)

-Magnetically labeled or saturated blood

acts as the contrast
3D ASL at 1.5T
Benefits 3x3x4 mm 5:21
min
• Full brain coverage Note strong signal Currently perform ASL on all patients with suspected or known
in the retina (arrow)
-Acquire two sets of data, one saturated • High SNR cerebrovascular disease. The 3D FSE readout permitted the visualization of
• Robust with susceptibility & motion small structures .
blood and other without saturated blood
•Free of geometrical distortion (typical for EPI)

Robust, SNR-rich ASL in 3D

Combat Patient motion

Clinical applications that advance MR What’s
New? Motion during the encoding process corrupts MR images through both
displacement-related blurring and motion-related phase artifacts.
-Patient instruction
-Restrain
¾ PROPELLER 3.0 -Fast scan

Periodically Rotated Overlapping ParallEL -Repeat scan

Lines with Enhanced Recontruction -Sedation
Propeller
Reduction of in-plane motion and rotation,
Phase changes due to motion, and
Through-plane motion

Propeller Technology Propeller Technology

How does it work ?
How does it
work?

Conventional FSE

• Each TR, one fast spin echo train collects

• Each TR, one fast spin echo train collects all phase-encoded lines for a ‘blade’
all phase-encoded lines for a ‘shot’
• The blades are successively rotated in
• Shots are repeated, until k-space fills k-space by an incremental angle, Radial k-space
filling
Only ONE shot crosses the center of k-space
Center of k-space over sampled… signal-rich FSE

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PROPELLER PROPELLER 3.0
ƒInfant and pediatric
Applications

Usual scan PROPELLER scan

Benefits
• Significantly reduced motion and flow effects
• Enhanced tissue contrast
• Reduced susceptibility artifacts in DWI
• Contrasts – T1 FLAIR, T2, T2 FLAIR, DWI

Combat patient motion, flow and susceptibility artifacts

Propeller DWI – Dental Work Susceptibility Artifact Propeller DWI – Interface Susceptibility Artifact

Conventional DWI PROPELLER DWI Conventional DWI PROPELLER DWI

PROPELLER 3.0 PROPELLER 3.0

More Contrasts, All Planes,
Everywhere
T1 PROPELLER
3.0 provides
FLAIR
virtually artifact-
free images with
fine anatomical
detail and
FSE FS
superb tissue
contrast

Benefits
• Physiologic motion pushed to background
Benefits2
• Effort free consistency • Significantly reduced motion effects such as peristalsis
• Reliable fine detail delineation and flow
• Excellent tissue contrast
• Small FOV imaging – “No phase wrap”
• Same scan time
• Over sample K-space center - high SNR FSE PROPELLER 3.0
• Free breathing acquisition with respiratory gating
2 Compared
to conventional techniques

For everyday usage – helping to leave rescans behind Combat patient motion, flow and susceptibility artifacts

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 eDWI: the Next Level in Diffusion
Clinical applications that advance MRI Imaging1 How does it work?
Pseudo-3D DWI at
1.5T
FOV 22*24
• Adjustable multiple B values
Matrix 128x128 • Tetrahedral encoding provides more SNR
Slice 2 mm • STIR for robust fat suppression (1.5T only)
TR=8500
TE=87.8
BW=125 kHz
TI 150
NEX 4
4:49 min

Enhanced Diffusion Weighted Imaging -

eDWI Benefits (vs. conventional DWI)
• Accurate, reproducible ADC maps
eDWI with coronal reformat, ADC and eADC maps
• Improved SNR and contrast
• Reduced scan time

More SNR, less scan time, more accurate ADC

eDWI: Enhanced Diffusion Imaging1 Clinical applications that advance MRI What’s
New?
How does it work?
• EPI single shot sequence with adjustable
multiple b values
• IR-prep for fat suppression
• Respiratory triggered- Free breathing acquisition

Liver mets
3 in 1 option, B500, 4 NEX MR Touch-
Elastography
Benefits (vs. conventional DWI)
• Improved quantification
• Improved SNR and contrast
• Reduced scan time … smart averaging
• Improved spatial resolution … Pancreas tumor
B800, 4 NEX
•IR-prep DWI oncology staging and treatment monitoring Respiratory Trigger

More SNR, less scan time, more accurate ADC

MR Elastography - A unique and non-invasive method for MR Elastography - Concept

evaluating tissue stiffness
Drop a pebble in a pool of water Drop a pebble in a pool of gel

• Non-invasive staging
• Early detection
Wave Length
Cirhosis
• Reduce biopsy Normal Fibrosis Short Lon
g
• Patient biopsy refusal

Tissue Stiffness

Soft Stiffness Hard

New Touch in MR Imaging – extension of diagnosing by Touch

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 MR Elastography - Technology MR-Touch / MR Elastography
Vibration Acquisition Reconstruction
MRI Image MR Elastogram
Active driver Passive driver Patient with
healthy liver

Soft Hard
Sound Waves Shear waves MRE Scan Wave Image Elastogram In these cases of advanced liver fibrosis,
Inversion 61 year old female
Shear waves Shear waves with elevated The elastograms show that the liver is much stiffer
Shear waves captured using phase contrast algorithm used
generated by transmitted to serum liver tests than subcutaneous tissues and the overall stiffness of
gradients GRE with modified cyclic to convert wave and nonalcoholic the liver.
external tissue by
motion-encoding gradients images into fatty liver disease.
acoustic driver passive driver. The heterogeneity of the stiffness of the liver is also
stiffness map
increased (compared with the normal volunteers
72 year old male shown in top row)
Motion with cryptogenic
Synthesis MEG gradient
cirrhosis
External acoustic
synchronized with
driver triggered
external acoustic
by PSD.
vibrations

New Touch in MR Imaging – extension of diagnosing by Touch

Clinical applications that advance MRI Inhance 3D DeltaFlow

- Vascular Imaging What’s
NCE Peripheral MRA How does it work?
Excellent contrast and
• 3D FSE acquisition with cardiac gating
New? surrounding tissue • Subtracts systolic from diastolic phase to help
subtraction eliminate venous and background signal
• Deploys interleaved acquisition with k-space
optimization and ASSET

2D TOF Benefits
• Excellent arterial flow visualization with high
3DTOF
¾Inhance Delta Flow
TD1 Systolic contrast and robust venous and tissue subtraction
acquisition
• Reduced misregistration due to motion
2D PC
Fast arterial flow

• Better visualization of slow flow arteries compared

Faster flow to current runoff techniques
3DPC
TD2 • Short scan time (< 5 min for 40 cm coronal
3D Inhance Diastolic coverage)
acquisition

Inflow IR Slow arterial flow

More contrast without contrast

Clinical applications that advance MRI - Cardiac Viability Imaging … Cine IR

120

Blood Pool
Myocardium
120 Blood Pool
Myocardium
How does it work?
100
100
• Multiphase FGRE-Cine acquisition
What’s 80
Signal Intensity
Signal Intensity

80

• Captures image contrast evolution at

New? 60

40
60
different TI time
40
20

9 Minutes 20
• Adiabatic Inversion Recovery (IR)
9 Minutes
0
-100 0 100 200 300 400
TI (ms)
500 600 700 800
-100 0 100 200 300
TI (ms)
400 500 600 700 • Myocardium suppression robust to
B1 inhomogeneity
Amyloid Normal

Quick assessment of TI (left), abnormal T1 behavior for patient with amyloid

¾ Cine IR deposits compared to control (middle and right)
Courtesy Mayo clinic, Rochester

Benefits
¾ 3D Heart • Quick assessment of optimal TI time for MDE
• Detection of amyloid, vasculitis and other tissue
abnormalities detectable through T1 curve
• Rapid, single breath hold acquisition
• Simple, easy to use, fast

No-miss myocardial tissue viability, aids in confident diagnosis

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Coronary Artery Imaging … 3D Heart MR Enabled Therapies Non-radiation
Based treatment
How does it work?
• Fat sat FIESTA (1.5T) & IR-Prep FGRE (3.0T) One MR with numerous clinical capabilities
• Enhanced 3D FIESTA with more SNR & less artifacts
• Multi-slab acquisition for increased inflow effect Radiation
• More CNR with Special fat-sat & T2 prep Oncology
• Improved Navigator with algorithm optimization Multi-use Workflow US
dF
• Prospective motion correction with slice tracking ide
HD Image Quality gu
MR
Surgical
Oncology ge
ka
ac
yP
o log
Biopsy nc
Benefits M RO
Guidance
• Excellent anomalous coronaries, aorta & cardiac it e
Su
chamber assessment- w/out radiation, contrast media al
rgic
or U/S limitations Su
• High SNR and contrast, high spatial resolution MR
• Reduced motion averaging em
yst
• Easy prescription tS
as
Bre
• No anesthesia needed (free breathing) MR

Screen Diagnose Stage Treatment Plan Monitor

Sedation-free robust CHD and coronaries assessment

MR for Radiation Therapy MR Strengths for Radiation Therapy

Planning
Planning
Helping to improve tumor MR advantages
targeting accuracy • Excellent soft tissue contrast
• Multi-parametric imaging: anatomical,
functional, metabolic, MRA
• Complements CT for treatment
planning Large FOV Diffusion Tensor Imaging

• Treatment follow-up and assessment

Prostate, GYN, Brain, H&N, Spine

Spectroscopy Prostate imaging Dynamic Contrast

Imaging

Screen Diagnose Stage Treatment Plan Monitor

MR – CT Workflow for Radiation Therapy GE MR Surgical Suite

Image Acquisition MR/CT Fusion Virtual Simulation &
Treatment Planning
CT MRI
CT Extending surgical vision
Spatial accuracy
and helping to improve
outcomes in neurosurgery
Tissue Density

MRI CT

MR Utilizing updated MR
images for CT fusion may
assist in more accurate Plan Verification/
delineation of pathology and Treatment Delivery
Soft Tissue improved localization of
Metabolic & Functional adjacent critical structures.

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Simplicity in design
• Multi-Functional Patient Transport
Single transfer board between prep,
OR, MR and recovery
• Fully compatible with standard
diagnostic 1.5 and 3.0T GE MR
• Engineered for maximum
utilization of OR and MR assets
• Lower infrastructure cost versus
other high field iMRI systems
Integration with strategic partner’s solutions
Helping to improve intra-operative
surgical navigation and outcomes.
• Integrates multiple GE and industry
leading strategic partners to improve
surgical outcomes and workflow.
GEHC Aestiva/5® BrainLab® VectorVision Sky™
• Flexible multi-room design offers
Navigation Station
uncompromised surgical freedom
InVivo Precess™
Wireless MR Safe
while maximizing MR productivity.
Patient Monitor

Mayfield® Integra™
Skull Clamp Maquet® Surgical Tables
MR/X-Ray compatible

Intra-operative 6 Channel Flex Coil GE iMRI – 3T HDxt – Meningioma Case Study

Intra-operative imaging
Pre-operative imaging Demonstrating successful resection
Intra-operative MR (iMRI) scans enhance surgical decision-
making prior to concluding surgery
• Innovative open design allows for flexible
coil placement
• Coils provide exquisite high resolution T1 post gadolinium
imaging for intra-operative imaging
T1 +/- C

SV Spectroscopy Pre-surgical
tractography

6 channel flexible coils

Time of Flight

Courtesy of UVN, Dept of Neurosurgery, Central Military Hospital, Prague, Czech Republic

GE iMRI Surgical Suite ExAblate® 2000

Enhancing Neurosurgery
Helping to improve outcomes
Excellence. Experience. ExAblate®.
• Uncompromised OR and MR suites
• Simplified Integration between OR and MR Non-invasive
• Integrated with OR industry leading strategic partners targeted treatment for
• Cost effective asset maximizing solution
uterine fibroids using
MR guided Focused
Ultrasound

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How does ExAblate work? Why is MR important for guidance
MR guided focused ultrasound combines: and control?
• High intensity focused ultrasound that heats and destroys targeted tissue, non-
invasively.
Because it provides you with:
• Magnetic Resonance Imaging system (MRI) which allows the physician to identify • Imaging in 3 orientations for precise tumor
and target tumors, and provides temperature monitoring of the treated tissue in real targeting and accurate identification of pathology
time. • Beam path visualization for controlled treatment
Fibroid • MR thermometry for real-time temperature feedback
Focused Ultrasound
generates heat by focusing allowing you to see temperature changes in the tumor
ultrasound waves, ablating during treatment
tissue only at the focal point… • Post treatment contrast imaging for precise
an effect similar to a treatment validation
magnifying glass used to
focus the sun’s energy on a
Focused Ultrasound single point.
To improve accuracy in treatment!

MRgFUS Bone vs. Soft Tissue Treatment

current and future Milestones
In soft tissue: In bone tissue:
Product Other
CE/ FDA Approval Launch Benign
Indications:
Brain • Narrow, point-shaped focus is required • Wide Beam Approach
@ Indications: Oncology
2004 Uterine Fibromas Oncology
1.5T & 3.0T
After • High energy density at focal point • Low energy usage
Women Health Care 2008-2012
2004
2005-2007 • Shorter Treatment Time

Bones
Ablated Tissue
Uterine Fibroids After
Before
Bone

Acoustic Beam
Breast

Cutting-edge technology Prostate

Transducer
without the cutting!
Typical Sonication Energy – 2500J Typical Sonication Energy – 1000J

Liver

Conformal Bone system ExAblate 2100 Bone - system overview

Patient
Table

Transducer

Water
System

Equipment
Cabinet

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MRgFUS for Breast Cancer MRgFUS for Breast Cancer
The positioner is used as an interface for the breast treatment in MRgFUS. Table Setup
A breast MR coil is embedded into it as well as a cooling device.

Cooling
device

Breast coil

Positioner

MRgFUS for Breast Cancer ExAblate for Prostate Probe

Voltage cables
Water pipes Transducer
Balloon
Transducer
Neck

Coil
Shell

• Transducer is inside a balloon filled with cooled degassed water.

• Transducer frequency: 2.3MHz (higher than in the body system)

Positioner and Probe

Treatment Demonstration
In-Out,
Probe Left-Right • Supine head first
Pitch •Trans-rectal transducer is
inserted and then fixed
•Balloon is inflated with cold
circulating water

Work in Progress
Company Confidential

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 Closed Loop Treatment Concept

Trans Cranial
MR guided
Focused
Clinical Research
Ultrasound Helmet-like Transducer Patient Setup Patient in MR

Surgery

Offer your patients cutting edge technology

……….without the cutting

Thank You
Trans Cranial
MR guided
SIMPLY
Focused
POWERFULL
Ultrasound
POWERFULL
Surgery
Y SIMPLE

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