fs30_4522_962_18711_lr_psd

F i e l d StrengthPublication for the Philips MRI Community

I s s u e 3 0 - D e c e m b e r 2 0 0 6

• RSNA 2006: new Achieva 3.0T X-series and SmartExam

• Sharp and Children’s DWI protocol improves abdominal imaging

• Rolling Oaks Radiology at imaging vanguard with Achieva 3.0T

• Apollo Hospital uses 3.0T in wide variety of abdominal studies

• Yeditepe: Achieva 3.0T neuro site with Ambient Experience

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Johann Wolfgang von Goethe, the 18th century German poet, novelist and dramatist, said that

“knowing is not enough, we must apply, willing is not enough, we must do.” In the fast moving

world of MR technology, especially, turning technological advances into clinical applications is

key in creating value. As global director of the MR Applications and Clinical Science group at

Philips, I lead our company’s application specialists and clinical scientists as they strive to apply

technological know-how – in the development of novel coils, pulse sequences, reconstruction

techniques and analyses tools – to add clinical value for our customers. Among the key

success factors of our activities is the close collaboration with expert users of our equipment.

In this issue of Field Strength, we present examples of innovations that – by virtue of the

close collaboration of applications specialists, clinical scientists and clinicians – are making a

difference for patients and for radiologists.

Innovations are reflected in articles on diffusion-weighted imaging of the abdomen and

proton-density weighted TSE imaging in musculoskeletal applications. Increased ease-of-use is

stressed once more with high quality contributions describing efficiency improvements with

ExamCards and SmartExam. The RSNA news article presents the most recent SmartExam

extensions and introduces the new Achieva 3.0T X-series. The articles on abdominal and

neurological imaging at 3.0T nicely illustrate what advanced technology can do in a clinical

environment. Finally, the 7.0T users meeting showed us the great progress that can be

achieved when we apply know-how in its ultimate way in a group of experts.

Indeed, we must apply what we know and do what we said we would; in cooperation with our

clinical collaborators, this will make the difference in applying Philips’ advanced MR technology

for the patient’s benefit.

Good reading!

René G. Aarnink

Director, Applications and Clinical Science, MR

2 Field Strength Issue 30 - December 2006

Dear Friends,

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Reports from our users:

6 Whole-body DWI highlights

abdominal pathology

Dr. Low, Sharp and Children’s MRI Center

10 Achieva 3.0T enables spectrum

of abdominal studies

Dr. Rastogi, Indraprastha Apollo Hospital

14 Radiologist group begins second

year with workhorse Achieva 3.0T

Dr. Gottlieb, Rolling Oaks Radiology

16 Turkish medical center harnesses

Achieva 3.0T for neurosurgery

Dr. Kovanlikaya,Yeditepe University Hospital

MR news:

4 RSNA 2006: new Achieva 3.0T

X-series and SmartExam

20 Yeditepe has first 3.0T with

Ambient Experience

20 Philips acquires Intermagnetics

21 Second Philips 7.0T research

meeting

Application tip:

16 PDW TSE orthopedic imaging

Calendars:

22 Education calendar

23 Events calendar

3Field Strength

In this issue:

© Koninklijke Philips Electronics N.V. 2006 All rights are reserved. Reproduction inwhole or in part is prohibited withoutthe prior written consent of thecopyright holder.

Philips Medical Systems Nederland B.V.reserves the right to make changes inspecifications or to discontinue anyproduct, at any time, without notice orobligation, and will not be liable for anyconsequences resulting from the use ofthis publication.

Printed in the Netherlands.4522 962 18711.

Field Strength is also available viawww.medical.philips.com/fieldstrengthwww.medical.philips.com/mriwww.philips.com/netforum

Editor-in-chiefKaren Janssen

Editorial teamRuud de Boer (PhD), Jan De Becker,Andre van Est, Karen Janssen, HansKleine Schaars.

ContributorsRené Aarnink, Clemens Bos (PhD),Jerry Duncan, Roy Gottlieb (DO),Mariea Henry (CMRT) Karen Janssen,Jagadish Kalasthry, Ilhami Kovanlikaya(MD), Russell Low (MD), Linda Poff(CMRT), Harsh Rastogi (MD),VKSundararaman (PhD), Ping Yang,Gunes Yavuz.

SubscriptionsContact your local Philipsrepresentative or e-mail [email protected]

CorrespondenceField StrengthPhilips Medical Systems Nederland B.V.Building QR 0119P.O. Box 10 0005680 DA BestThe Netherlands

NoticeField Strength is a quarterly publicationfor users of Philips MRI systems.

Field Strength is a professional magazinefor users of Philips medical equipment.It provides the health care communitywith results of scientific studiesperformed by colleagues. Some articlesin this magazine may describe researchconducted outside the USA onequipment not yet available forcommercial distribution in the USA.

SENSE is a trademark owned byKoninklijke Philips Electronics N.V.

w w w. p h i l i p s . c o m /n e t f o r u m

Visit the NetForum User Community

for downloading ExamCards and

viewing application tips, clinical cases,

extended versions of Field Strength

articles, and more.

NetForum

4522_962_18711.qxd 11/3/06 11:33 AM


Philips highlights new Achieva 3.0T

X-series and SmartExam at RSNA 2006

New Achieva 3.0T X-series offers

new levels of performance

Philips offers major performanceimprovements with the new Achieva 3.0TX-series. Through its X-series technology,resident in the magnet, gradient and RFsubsystems, the system provides what isnecessary for advanced whole-body 3.0T imaging.

The new patient-friendly, short-bore (1.57 m) system features a maximumFOV of 50 cm that facilitates off-centershoulder imaging, large FOV spine, bodyimaging, peripheral and whole-bodyMRA, and whole body imaging in only a few stations. The Achieva 3.0T X-series’new Quasar Dual gradients provide high-performance amplitudes (max. 80 mT/m)and slew rates (max. 200 mT/m/ms) with

improved linearity across the full FOV. The X-series RF body coil for Achieva 3.0T delivers optimal SNR and SARmanagement and is designed for dielectric-free, whole-body imaging that requires no saline bags.

Philips also announces the AchievaFreeWave platform equipped with a 32-channel RF system to dramaticallyimprove existing studies and facilitateemerging applications.

Achieva’s compact 3.0T X-series design hasenabled introduction of the first mobileAchieva 3.0T X-series system. In addition,Philips introduces a wide variety of high-channel coils for Achieva 3.0T X-series,Achieva 1.5T, and new ST coils forPanorama 1.0T.

Achieva 3.0T X-series high resolution whole body imaging.

Achieva 3.0T X-series high resolution knee, matrix 2048x2048.

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5Issue 30 - December 2006 Field Strength

SmartExam for high

productivity and efficiency

At RSNA 2006, Philips continues topromote its SmartExam automated planning,scanning and processing technology, based onExamCards. New is SmartExam for spineand knee studies. Together with brain studies,this covers about 70% of all examinations.SmartExam offers remarkable inter- andintra-patient scan reproducibility andoperator efficiency, which could translate intogreater daily throughput. Users can shareExamCards via the Philips NetForumCommunity, which enables ExamCarddownload directly into the scanner.SmartExam is available for new and existingusers of Achieva 3.0T, Achieva 1.5T andPanorama 1.0T.

Clinical leadership

The Achieva 3.0T X-series provides thetools necessary to perform cutting edgewhole-body 3.0T imaging. The systemenables routine clinical imaging in allapplications, including best-in-class neuro,body and musculoskeletal imaging. The FreeWave platform is designed topermit clinical techniques that requirehigher data rates, bandwidth and resolution(up to 2k imaging), including the latestPhilips-exclusive applications: 4D-TRAK,k-t BLAST and SENSE performance up to 16 times faster. Innovative applicationsinclude DWIBS, FiberTrak, SENSEspectroscopic imaging, VISTA, Asymmetric TSE.

SmartExam provides consistent planning when applied in an average knee, a large knee, a knee with a metal pin, and a pediatric knee. Courtesy Dr. Lecouvet, St. Luc University Hospital, Brussels.

T1-weighted T2-weighted

Total Neuro scanning provides high

efficiency and speed

Simultaneous brain and whole-spinescanning is now possible with the new 33-element SENSE Head/Spine coilcombination. Complete coverage – from the brain to the sacrum – is possible in a few minutes without patient repositioning.

Further techniques

under development

The MultiVane techniqueuses a radial acquisitionmethod, designed to providediagnostic images despitepatient motion in body and neuro imaging.

The THRIVE sequence offershigh resolution and excellentcontrast in body imaging.Building on this, the 4D-THRIVE technique, a highlyaccelerated 3D method, isbeing developed for highspatial resolution, isotropic T1-weighted imaging duringcontrast uptake.

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Whole-body diffusion-weighted imaging

highlights abdominal pathology

DWI is useful tool in Sharp and Children's MRI Center's abdominal-pelvic protocol

The dynamics of water diffusion apply as much in the body as they

do in the brain; restricted diffusion arising from pathological processes

causes tissues to “light up” on diffusion-weighted images – sometimes

dramatically in comparison to normal surrounding anatomy. Dr. Russell

Low at Sharp and Children's MRI Center (San Diego, Calif.) is exploiting

this variability in the Brownian motion of water in all abdominal imaging

studies. For certain body MRI applications, whole-body DWI aids in the

detection of pathology that may be virtually invisible on T1-,T2- and

contrast-enhanced images. Technical challenges, such as susceptibility

artifacts and physiologic motion, have been addressed by implementing

an optimized rapid diffusion-weighted version of EPI that enables short

breath holds and reduced artifacts when combined with SENSE.

“Radiologists aren't using diffusion-weighted imaging as extensively as theyshould due to a lack of awareness and -to a certain extent – DWI's technicallimitations in body imaging,” says Dr. Low,Medical Director of Sharp and Children'sMRI Center. “Whole-body diffusion-weighted imaging is an entirely new way to look not only at tumors but alsoinflammatory diseases in the abdomen andpelvis. Number one, abdominal DWI isfeasible and number two, the images areclinically very useful.”

Sharp and Children's radiologists becamefamiliar with whole-body DWI's potentialin abdominal and pelvic imaging in March2004, during a visit by Philips clinicalscientist Alun Jones. Dr. Low used DWI onthe Center's Achieva 1.5T to scan a patientwho later was diagnosed with a hepatoma.

“We began seeing things on the diffusion-weighted images, but we were initiallyunsure what they represented,” he recalls.“Finally, we realized we were looking atenlarged lymph nodes that were soconspicuous they stood out like light bulbs.We had never seen anything like this before.The contrast of the images and theconspicuity of the nodes in this case really

were quite striking. On conventional imageswe were used to seeing lymph nodes thatblended in with surrounding structures.”

A DWI image is worth 1,000 pictures

It soon became apparent to Dr. Low thatdefinitive whole-body DWI images mightfacilitate the task of reviewing the 1,000 or more standard T1- and T2-weighted,dynamic post-contrast and multiplanar images in an effort to detect very subtlecontrast differences. Subsequently, Sharp and Children's added a DWI sequence to its abdominal and pelvic protocol andvalidated this theory.

“The diffusion-weighted images really directmy focus to the area of the abnormality,” heobserves. “Many times I'll look at thediffusion images first to see what appearsbright – which areas have restricted diffusion– and then go back and simultaneouslyreview the conventional images. This helpsme see the abnormalities more quickly –particularly in the lymph nodes.Unequivocally, DWI is the sequence to use to look for suspected lymphadenopathy.”

DWI's value in helping to visualize possibledisease states in small lymph nodes is mostapparent because the anatomy can easily

Russell Low, M.D.

An artist conception of the new SharpMemorial Hospital, scheduled foropening in 2008.

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7Field StrengthIssue 30 - December 2006

blend in with adjacent soft tissues, Dr. Lowadds, but occasionally DWI can help revealsubtle larger nodal masses that are incon-spicuous on conventional MR images.

While lymphadenopathy is clearly the sig-nature application for DWI, he continues,the technique also is quite valuable inhelping clinicians detect all types of primaryand metastatic tumors in the abdomen andpelvis, in addition to other pathologiesassociated with restricted diffusion – such asCrohn's disease, inflammation, osteomyelitis,abscesses and cysts.

A further benefit of the DWI sequence is to guard against potential false-positiveinterpretations, Dr. Low adds. “Sometimesyou see a suspicious finding on, say, a T2-weighted series, and then you realize thediffusion-weighted image is entirelynormal,” he says.

Short breath holds make DWI

addition feasible

To cope with motion, Dr. Low opted for a breath hold strategy using a rapid DWI

pulse sequence on the Achieva 1.5T system.Other investigators favor high-NSA (i.e. 6 to 8 per station) imaging as a way to averageout motion, but the cost-benefit of breathhold imaging seemed substantial, he says.

“The diffusion-weighted version of singleshot EPI is extremely fast and can beaccomplished in a 20-second breath holdfor the abdomen and an additional 20-second breath hold for the pelvis,” heexplains. “Versus high-NSA imaging, our approach is to get the sequence donequickly and simply as an additionalsequence added to our conventionalimaging. For the short breath holdsinvolved, we gain a tremendous amount of additional information.”

Preceding the DWI sequence are a T1-weighted dual echo FFE sequence followedby axial T2-weighted and T1-weighted TSEsequences with SPIR fat suppression. Afterthese, the breath hold DWI for abdomenor pelvis is performed. Subsequently,clinicians implement a dynamic contrast-enhanced THRIVE (T1-weighted high-

Patient with lymphoma. The T1-weighted FFE image isunremarkable. On the T2-weighted single shot TSE image withSPIR it is difficult to distinguish small lymph nodes from iliacvessels.The diffusion-weighted image most clearly showsmultiple bilateral pelvic lymph nodes (arrows).The markedconspicuity of lymphadenopathy on the DW images ischaracteristic.The inverted MIP generated from the DWimages shows bilateral iliac and inguinal lymphadenopathy.

Patient with rectal bleeding. The top row images show softtissue in the rectum that is difficult to distinguish from retainedstool.The first DW image shows a markedly hyperintense mass(arrow) in the left anterior rectum.The adjacent DW imagedepicts multiple pelvic lymph nodes (arrows). Findings representa Stage 3 primary rectal cancer.

T1-weighted FFE T2-weighted SPIR

DWI b=500 Inverted MIP

Single shot TSE T1-weighted

DWI b=500 DWI b=500

"DWI is the sequence to use to look for suspectedlymphadenopathy."

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resolution isotropic volume examination),followed by a time-delayed T1-weightedFFE with WATS. SENSE factor 2 is usedin all sequences.

“The beauty of this Philips body protocol is that they're all breath hold sequencesnow,” he notes. “We can easily perform anabdominal MR exam in 15 minutes and we have some technologists who can scanan abdomen and pelvis in 20 minutes.”

“We're exploiting technological advances in scanning speed in body imaging muchmore so than in neuro and musculoskeletalimaging,” he remarks. “We're imagingprobably four times faster in the abdomenthan we did five to eight years ago, whilea lot of musculoskeletal and brain MRimaging is still being scanned at the same pace. When I began performing bodyMR 16 years ago, conventional spin echoT2-weighted images with fat sat took 12minutes. Now it takes just a breath hold of20 seconds to acquire T2-weighted imageswith better resolution and detail.”

To further increase SNR, Dr. Low also usesthe new 16-channel SENSE Torso coil,which he has been using for severalmonths. “It's a phenomenal coil,” he says.“It appears to be a relatively small coil, yetthe coverage is excellent. We can cover theabdomen and pelvis very easily, up to 48 to 50 cm.

DWI as pathfinder

Although some investigators have sought to use ADC values to characterize tumorsas benign or malignant, at Sharp andChildren's DWI is intended to serve as a guidepost mainly, indicating wherepotential problems may be. The standardsequences in the protocol are designed tofurther help characterize what is seen ondiffusion and pinpoint the pathology'sanatomical coordinates.

“One of the limitations of diffusion is thata lot of the background features fade out,”he explains. “You end up with a big brightspot or black [i.e. inverted-contrast] spot,so correlating the diffusion with theanatomic images is necessary. We rollthrough all the series simultaneously onPACS to view DWI and the other imagesconcurrently.”

Instead of post-processing the DWI data to create inverted-contrast MIP images, Dr. Low prefers to view the source images.“These inverted images are quite attractiveand they promote awareness of thetechnique, but source images – whetherthey be MRA images or DWI images –represent the unadulterated data set,” he says. “The MIP doesn't 'know' thebrightest signal intensity pixel is a tumor, so if it happens to be T2 shine-throughfrom bowel, for example, it will still beprojected as bright signal.”

Post contrast THRIVE DWI b=500 T2-weighted DWI b=500

"We can easily perform an abdominal MR exam in 15 minutes"

Patient with increasing abdominal girth. The gadolinium-enhanced THRIVE image shows peritoneal enhancement andinfiltration of the small bowel mesentery (long arrow). Omentaltumor (short arrow) is also present.The DW image showshyperintense masses in the small bowel mesentery andomentum (arrows).

Patient with primary ovarian cancer. The T2-weightedimage shows pelvic ascites (A).The DW image shows markedlyhyperintense omental (long arrows) and peritoneal tumor (shortarrow).The ascites suppresses on the DW image increasing theconspicuity of the tumor.

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DWI encompasses wide scope of

abdominal and pelvic pathology

Some specific pathologies that DWI hashelped Dr. Low and his colleagues visualize– in addition to lymphadenopathy –include tumors of the peritoneum,pancreas, liver and gastrointestinal tract.

“Contrast-enhanced imaging is very good athelping us to detect peritoneal tumors, butDWI sometimes helps us sort out complexrelationships – such as separating bowelfrom peritoneal tumors and bowel frommesenteric tumors,” he observes. “Inimaging rectal tumors, we would try tomake high resolution images, but if thebowel is collapsed it's hard to distinguishcollapsed bowel from tumor. With DWI, these tumors are exceptionallyhyperintense. And you can see the suspectedlymphadenopathy around the tumor.”

To improve hepatic imaging, Dr. Lowcredits Dr. Shadid Hussain of ErasmusUniversity of Rotterdam, The Netherlands,for a modification of the standard DWIsequence. The concept is to use a b-value of20 and replace the T2-weighted sequence,yielding nominal diffusion weighting andsubstantial T2 weighting – creating a blackblood sequence, essentially.

“All the vessels become dark, but the rest of the image will basically be a combinationof some diffusion weighting and a lot of T2 weighting,” Dr. Low explains. “I likethis sequence – it works well to show small perivascular tumors.”For all other imaging, Dr. Low prefers a

moderate diffusion sensitivity to limitartifact, therefore he uses a b-value of 500(versus a b-value of 1000 commonly used in the brain). “There still is some T2 shine-through, which may be seen as some brightsignal in the bowel; a lot of the bowel doessuppress on the DWI, but typically therestill are some remaining areas of highintraluminal signal. However, if youcompare the diffusion image to the otherimages, it's always easier to tell what's going on.”

Greater awareness is the key to more

whole-body DWI use

Given the obvious benefits that Sharp andChildren's MRI Center has experienced by adding whole-body DWI to theirabdominal and pelvic protocols, DWI's use in the body should begin to increaserapidly through increased awareness, Dr. Low predicts.

“Clinicians will follow as they learn about a technique's advantages,” he says. “Then,it's a simple matter of plugging it in andrunning it. Of course, after that they needto figure out what they're looking at, sinceDWI's dichotomous bright-dark contrastscheme is different from what clinicians areaccustomed to.

Clearly, diffusion-weighted imaging is oneof the things that Philips MR does reallywell,” Dr. Low adds. “It's a beautifulsequence that Philips has optimized forbody DWI. It works very nicely and is animportant part of our abdominal and pelvicMR protocol.”

"Clearly, diffusion-weightedimaging is one of the things that Philips MR does really well"

Net Forumw w w. p h i l i p s . c o m /n e t f o r u m

Visit the MRI NetForum Community

to view more contributions by

Dr. Low, Sharp and Children's

MRI Center.

T1-weighted Post-contrast keyhole THRIVE DWI b=500

Patient with metastatic prostate cancer. The T1-weighted and gadolinium-enhanced keyholeTHRIVE images show liver metastases and osseous metastases.The DW image best shows theinnumerable hyperintense liver metastases and osseous metastases in the spine (arrows).

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Achieva 3.0T throws doors open to

spectrum of abdominal studiesAfter just seven months, Indraprastha Apollo Hospital has a long list of routine

3.0T body studies

The abdominal MRI practice of Indraprastha Apollo Hospital (New

Delhi, India) underwent a rapid evolution and growth – from a few

simple, anecdotal cases to 20% of the entire patient volume – in their

Achieva 3.0T system’s first seven months of operation.With fast,

advanced techniques such as THRIVE, SENSE and DWIBS and the extra

SNR that 3.0T affords, Indraprastha Apollo’s abdominal MRI options

greatly expanded to include both straightforward body examinations

such as MRCP, as well as more sophisticated studies, such as evaluation

of liver and pancreas tumors, renal donors, atherosclerotic disease,

aortic aneurysms and pelvic diseases. Applications also include follow-

up studies of post-intervention patients, according to Indraprastha

radiologist/interventionalist Dr. Harsh Rastogi.

Equipped with a 64-slice CT scanner and limited to a 0.5T MRI system,Indraprastha Apollo Hospital radiologistshad little motivation to perform manyabdominal MRI studies before November2005 – when they began operating theAchieva 3.0T system.

“The 0.5T system was the workhorse forneuro and musculoskeletal cases for 10years, but in abdominal imaging, we werelimited to studies of the biliary tree by

MRCP or doing a few simple pelvicexaminations,” recalls Harsh Rastogi,M.D., senior consultant in radiology and intervention at Indraprastha ApolloHospital, a 700-bed, multi-specialty,tertiary care medical center in India’scapital, New Delhi.

By June 2006, Indraprastha’s new Achieva3.0T had supercharged the medical center’sabdominal MRI service, making it a 20%share of the total MRI volume. Today,


Liver imaging after tumor embolizationMultiphase THRIVE images of the liveracquired 3 days after embolization ofthe right hepatic artery. Intra-tumoralnecrosis can be recognized as non-enhancing mass in the right lobe of theliver.Viable tumor fed by the left hepaticartery shows enhancement.

Dr. Harsh Rastogi

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Indraprastha radiologists perform three to four body MRI examinations per day,encompassing routine MRCP studies andadvanced CE-MRI and CE-MRA cases to survey for tumors and other pathologyin the abdomen and pelvis. A key toIndraprastha’s present success in upperabdominal imaging – beyond the obviousbenefit of doubled SNR at 3.0T – is theTHRIVE sequence, Dr. Rastogi notes.

Efficient liver coverage

“THRIVE is fast and provides greatcontrast enhancement and backgroundsuppression and superb high resolution,” he says. THRIVE (T1 High ResolutionIsotropic Volume Examination) combines a3D T1-weighted TFE sequence with SPAIRfat suppression and SENSE, enabling fast,high-resolution imaging with large FOVcoverage and excellent fat suppression – in a single 17-20-second breath hold. Forliver, spleen, pancreas and kidney studies at Indraprastha, clinicians use the SENSETorso coil and a SENSE factor of 4, a 39.5 cm FOV, two millimeter slices withtwo parallel REST slabs and 2 x 2 x 2 mm3

isotropic voxels.

“THRIVE helps us pick up small mets orevaluate the dynamics of contrast enhance-ment per unit of time,” Dr. Rastogiobserves.

He cites the case of a 75-year-old man whopresented with a hepatic adenocarcinomametastasized from an unknown primary, for which clinicians were attempting todetermine the optimal treatment. Thepatient had undergone previous RFablation for this malignant lesion, so theIndraprastha surgeon indicated that themass was inoperable. Consequently, Dr. Rastogi suggested palliative transarterialchemoembolization (TACE) of the tumor.Baseline and post-interventional THRIVEstudies were able to show that TACE hadcompletely cut off the tumor’s bloodsupply, evidenced by a non-enhancingtumor central core in a post-therapy scan.

“We were surprised and thrilled to see and be able to document via MRI thatembolization had definitively caused theinfarction of the tumor and that thetherapy had worked for this patient,” hesays. “Now, we can follow-up with these

"It is just amazing howmuch we can do with theTHRIVE sequence alone."

THRIVE THRIVE DWIBS 3D volume rendered

Sciatic Nerve Neurofibroma CT showed a spindle-shaped mass in the popliteal fossa. MRI was done to pre-operativelyassess the relationship of the mass to the neuro-vascular bundle. Coronal and sagittal post-contrast THRIVE images of the popliteal fossa show multiple heterogenously enhancing nerve sheath tumors on the sciatic nerve and its branches.The DWIBS image showsrestricted diffusion along the sciatic nerve and multiple tumors.The 3D volume renderedimages show the “snow man” sign of multiple nerve sheath tumors.

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patients every three to six months withMRI to monitor the outcome.”

THRIVE in the pancreas

In an acute chronic pancreatitis case, upperand lower GI endoscopies were unsuc-cessful in helping determine the cause of blood in the stool, upon which thepatient was referred to Indraprastha Apollo. “We did a THRIVE study of the upperabdomen and to our surprise we found a 4 cm diameter pseudoaneursym in regionof the pancreatic tail,” Dr. Rastogi relates.“The patient’s CT scan three weeksprevious was absolutely normal. Thebleeding was caused by the pseudo-aneurysm, which I occluded by infusingliquid embolic agent. The follow-upTHRIVE examination four days pre-discharge showed that the aneurysm hadthrombosed. Another follow-up THRIVEstudy showed us that the aneurysm hadcompletely disappeared. It is just amazinghow much we can do with the THRIVEsequence alone.”

Renal applications

THRIVE has proven invaluable in renalMRA examinations of Indraprastha’s kidneydonor patients – helping doctors accountfor renal arteries pre-transplant – and thosesuffering from kidney diseases.

An elderly patient suffering from acuterenal failure had a THRIVE study insteadof standard angiogram due to her kidneys’condition as well as an allergy to iodinatedcontrast. The THRIVE study enableddoctors to detect multiple renal infarcts andocclusion of the superior mesenteric artery.“The diagnosis was a thrombus in thethoracic aorta that was embolizing into theorgans of the abdomen, including thebowel, kidneys and superior mesentericartery,” he reports.

Dynamic examinations

For the youngest patients, Dr. Rastogi hasdiscovered that he is able to forego breathholds and scan dynamically with Achieva3.0T. A benchmark case was an eight-month-old boy who presented with biliaryatresia at another hospital and who hadsurgery to correct the disorder with nocomplications five months post-surgically.Subsequently, the patient began

experiencing melena. Clinicians at theaforementioned medical center prescribed anumber of tests, including upper and lowerendoscopies and nuclear medicine studiesto identify the site of the bleeding, but allwere inconclusive.

“This patient was specifically referred toour hospital, where our primary carephysicians indicated they wanted an MR angiogram done on his abdomen,” Dr. Rastogi recalls. “Instead of an MRangiogram I suggested a dynamic contrast-enhanced MRI of his abdomen – as breathholding wouldn’t be possible. With MRI,we visualized venous congestion andectopic varices of the small intestine arisingdue to portal hypertension. This findingcompletely changed the management fromsurgery to a more conservative medicalapproach.”

Versatile THRIVE works just about

everywhere

Dr. Rastogi stresses that while THRIVE’svalue is most readily appreciated in the abdomen, Apollo clinicians havedemonstrated the technique’s utility inother regions as well, including the neck,limbs and even the tongue. “THRIVE issuch a robust technique. It seems to workwell under all circumstances,” he says.

DWIBS provides large-FOV survey

Advanced, innovative techniques such asDWIBS (diffusion-weighted whole-bodyimaging with background body signalsuppression) are now available at Indra-prastha on its Philips MRI platform.

“For visualizing neurofibromas, DWIBS is excellent,” Dr. Rastogi says. “Thistechnique also is quite valuable for nerveimaging in examinations for possiblelymphomas and for imaging the brachialplexus as a whole.”

In a recent case, a patient presented with a CT-confirmed neurofibroma in thepopliteal fossa. Dr. Rastogi wanted toclarify the relationship of this nerve sheathtumor with the popliteal arteries and veins.A whole-body DWIBS study revealed thatthe patient had not just one tumor, butmany of them “scattered all over,” heremarks.

"For visualizingneurofibromas, DWIBS isexcellent."

Indraprastha Apollo Hospital,New Delhi, India

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“This finding completely changed theperspective of the treating surgeon – therewere far too many to treat surgically,” hesays. “Moreover, surgery would have riskeddamage to one of the major leg veins andthe patient was not suffering from anyneurological or functional limitations,anyway.

“It’s interesting that on CT, we were able topick up just one neurofibroma, whereasDWIBS enabled us to visualize many,” headds. “In brachial plexus imaging for thedetection of neurofibromatosis, DWIBSalso helps visualize the nerve root entryzone in the neck and assists us inidentifying the nerve roots, per se, whichcan be difficult in conventional imagingdue to the brachial plexus’s obliqueangulation. DWIBS images can be post-processed into other planes, so precise slicepositioning is less relevant.”

Prostate spectroscopy helps zero in

on target

A burgeoning pelvic application forIndraprastha Hospital’s Achieva 3.0T isprostate spectroscopy for pre-biopsycharacterization of prostate tumors. Thetechnique is valuable for patients with a large

prostate (e.g., 70-80 g), for which a moreaccurate identification of the optimal biopsyregion is desired. “In these cases, prostatespectroscopy has helped show us where thehigh citrate peaks – indicating a neoplasticprocess – are located in the prostate,” he says.

The 3.0T revolution in abdominal

imaging

Dr. Rastogi’s opinions about 3.0T forabdominal imaging may be colored by the hospital’s dramatic – and perhapsuncommon – vault from 0.5T imaging to 3.0T imaging, but it is equally true that 3.0T clinical utility has increasedtremendously in recent years.

“My understanding is that the globalradiologist community is trying torevolutionize abdominal imaging with 3.0T – and the applications are immense,” Dr. Rastogi says. “There is no radiation to the patient and the use of THRIVEimaging and similar rapid imagingsequences is significantly reducing scantime while simultaneously decreasingartifacts. The use of 3.0T can only becomemore popular as time goes on – and it willpresent a big challenge to high resolutionCT in the years to come.”





extended versions of FieldStrength

articles, and more.

STIR T2-weighted T2-weighted T1-weightedTongue AVM with bleeding The top row images show the AVM nidus in the left half of the tongue. Numerousbranches of the lingual artery feed the AVM.The median raphae is displaced to the right.MPR images of the THRIVE scan show the dilated left lingual artery, the draining vein,and two segments of a well-defined nidus along the lateral border of the tongue.The SENSE NeuroVascular coil was used.

THRIVE

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Radiologist group begins second year

with workhorse Achieva 3.0TCalifornia-based Rolling Oaks Radiology finds system a top performer for myriad applications

The perception of radiologists at Rolling Oaks Radiology (Thousand

Oaks, Calif. USA) that a 3.0T system would be unique in their market

and a top clinical performer in all imaging applications was well-

founded. In the summer of 2005, a major acquisition of Philips

equipment included Achieva 3.0T, PET and CT systems and nuclear

medicine, ultrasound, digital x-ray and mammography units –

transforming Rolling Oaks into a Philips luminary site. The Achieva

3.0T acquisition, in particular, highlights how a private, entrepreneurial

scanning facility such as Rolling Oaks Radiology can thrive, harnessing

an unfamiliar MR platform and turning it into their workhorse system

for all patients and applications.

Constrained by their former medical groupinto accepting the bare minimum in termsof MR technology, four radiologists foundedRolling Oaks Radiology, a center whosemission was to acquire only the mostadvanced equipment for the benefit of theirpatients. In the summer of 2005, a major,multi-modality Philips equipment acqui-sition, which included an Achieva 3.0Tsystem, marked Rolling Oaks Radiology’sofficial establishment and its new status as aPhilips luminary site.

“I thought the neuro images and thecartilage images were spectacular,” says RoyGottlieb, D.O., medical director at RollingOaks Radiology and one of the center’scurrent staff of five fellowship-trainedradiologists. “I also have a friend that workson 3.0T systems in Florida who is happyfrom a musculoskeletal standpoint. So, Ithought the future was trending toward3.0T, and making a big investment like thiswe wanted to look to the future.”

Cartilage characterization benefits

most in joint imaging

Musculoskeletal studies account for 40percent of Rolling Oaks Radiology’s patientvolume, and the potential for majorresolution increases with Achieva 3.0T hasmade a major impact, Dr. Gottlieb observes.“One of the best things about the 3.0T is

the resolution we can get imaging theglenoid labrum in the shoulder,” he says.“We’re able to see labral tears, such asBankhardt and SLAP tears, withoutintraarticular contrast. In patients withinstability in the shoulder, we see labraltears a lot more on the non-contrast studiesthan we would have on our 1.5T system.

“This seems to hold true for all the jointsand looking at the ligaments of the wristand the triangular fibrocartilage complex,”Dr. Gottlieb continues. “We find that wehave a better depiction of small partsbecause we’re able to increase resolution.”

In the knee, he adds, certain chondralpathologies are better appreciated,improving the ability to gauge the severityof pathology. “We have been asked tocollaborate on a study testing certain drugs’ability to improve the health of underlyingcartilage as depicted by the progression orregression of the degree of cartilagethinning/chrondromalacia,” he says.“Before we had 3.0T, we could say therewas some chondromalacia – perhaps judgemore accurately between full-thickness andnon-full-thickness. But now, we feel thatwe have a better depiction – withinpercentages – 25 to 50 percent, or 50 to 75 percent – to more finely grade chondralthickness changes and even early chondro-

Roy Gottlieb, D.O., medical directorat Rolling Oaks Radiology

Patella cartilage tear.

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15Issue 30 - December 2006

malacia changes, such as fraying. You reallyneed high resolution for that.”

3.0T neuro studies predictably better

Studies of the brain and spine represent 30 percent of Rolling Oaks’s patient volumeand include a range of examinations fromroutine brain studies to advanced scans suchas BOLD fMRI and spectroscopy. Theincreased SNR provided by the 3.0T fieldstrength enables clinicians to boostresolution and acquire very thin slices.

“We obtain exceptional gray/white differen-tiation and can see the tiny nerves that comefrom the brain stem,” he says. “We also canbetter visualize detailed structures, such aspotential tiny intracannilicular acousticneuromas involving the 7th-8th nervecomplex even without the use of contrastagents, because of the high spatial andcontrast resolution we now obtain using the 3.0T magnet.” As expected, MRA at 3.0Tis superb via a combination of high fieldstrength and the Philips 16-channelNeuroVascular coil. “We can complete awhole neck study and then an MR angiogramfrom the circle-of-Willis to the aortic archwithout changing coils,” Dr. Gottlieb says.

Anecdotally, Rolling Oaks has had successwith BOLD fMRI and spectroscopy.

In preparation for research studies with theUniversity of Southern California (USC),Rolling Oaks is gaining experience in BOLDfMRI. One project focuses on the functionalimaging of children with sickle cell anemiawhile another independent project exploreshow BOLD fMRI might guide GammaKnife® surgery.

“Gamma Knife® surgery uses multipleconvergent beams of ionizing radiation totreat brain tumors non-invasively, but precisefunctional imaging data could help USCneurosurgeons create even more focusedtreatment isocenters, helping to furtherminimize the dose to eloquent cortex,” he says.

Like many other centers, Rolling Oaks also is interested in investigating how MRspectroscopy, an application that demandshigh SNR, could benefit post-therapyfollow-up studies and has used thetechnique in a few patient cases so far.

“Patients return for follow-up scans andmay be having some new symptoms thatcould be indicative of recurrence of theirbrain tumor,” Dr. Gottlieb explains.“Sometimes it’s very difficult todifferentiate between radiation necrosis andrecurrent or residual tumor on contrast-

enhanced MRI. With MRS, we can oftendistinguish these conditions. The quality ofour spectroscopy is better on our 3.0Tsystem than it was on our 1.5T system.”

Higher resolution helps 3.0T

abdominal studies

Rolling Oak Radiology leverages Achieva3.0T system’s higher SNR to both increaseresolution and decrease breathhold times in abdominal studies. This strategy hasworked well in breathhold diffusion studiesto view possible lymphadenopathy or lesionsin the abdomen and pelvis, Dr. Gottliebnotes.

“Our breathhold diffusion sequenceprovides very good contrast resolution,making areas of restricted diffusion appear white,” he says.

“All in all, the 3.0T field strength, andAchieva 3.0T in particular, has proven to be the right selection for us and our patients.”

MRI MRI

Post-contrast CT Post-contrast CT MPR CT

Liver masses are bettervisualized by 3.0T MRI than by 64-slice CT.

Brachial plexus neurofibromatosis



for more 3.0T contributions.

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Application tip

PDW TSE orthopedic imaging

The TSE PDW (proton density-weighted) sequence is widely used for diagnostic imaging in orthopedics. This application tipfocuses on joint imaging – in particular on image contrast and the reduction of imaging blurring, and on time-efficient PDW imaging with asymmetric TSE.

Optimize TE/TR for good contrast

Typically, PDW contrast is characterized by intermediate articularcartilage signal, lower meniscus, ligament and tendon signal andhigh synovial fluid signal. Use a TE of about 30 ms and a TRbetween 4000 ms and 5000 ms to easily achieve this contrast. Note that a relatively short TE (TE <25ms) might increase the risk of magic angle artifact.

When using a relatively short TR (e.g. TR <2500 ms), DRIVEhelps to maintain high fluid signal.

Contributed by Ping Yang, Philips MRApplication, Best,The Netherlands.

Optimize TSE shot length to control image blurring

In TSE imaging, tissues with shorter T2 relaxation times (such asarticular cartilage, bone marrow and muscle) produce more blurringthan those with longer T2’s. TSE shot length is the most importantparameter to control image blurring for a given TSE profile orderand TE. TSE shot length is displayed on the Info page.

Linear halfscan PDW TSE is a clinically practical sequence. The challenge in using linear halfscan is to control TSE shot lengthwhen modifying other parameters. In addition, the images haverelatively low SNR. Echo spacing and TSE shot length changewhen the halfscan factor, TSE factor and TE are modified. When using TE 30 ms, keep TSE shot length <100 ms to obtainsharp PDW images. A halfscan factor >0.65 is recommended.

In low-high TSE, raising TE increases echo spacing and TSE shotlength, thereby increasing image blurring. For a TE of 20-35 ms,typical for PDW imaging, using start-up echoes is a way to controlecho spacing and TSE shot length. Keep TSE shot length <80 msto minimize image blurring. Challenges include long scan time andthe time-consuming start up echoes.

Asymmetric TSE is a new functionality that provides time-efficientPDW imaging: high TSE factors can be used. This allows selectionof echo spacing and TE independently. The TSE shot length is easyto control via the TSE factor and echo spacing, while TE can befreely selected. For a TE of 30 ms, keep the TSE shot length <130ms to acquire sharp PDW images.

Asymmetric TSE with fat suppression

Fat-suppressed (STIR or SPAIR) scans are faster when combinedwith asymmetric TSE. For a specified resolution, adjusting echospacing controls the number of packages. When TR is set asshortest, a long echo spacing (10-14 ms) will produce a one-package scan. Decreasing echo spacing to 6-9 ms easily provides a two-package scan. When using TE 30 ms, keep TSE shot length<130 ms to obtain sharp images.

TR 2500 ms, without DRIVE.


Visit the MRI NetForum Community

to view more applications tips and

download ExamCards for

orthopedic imaging.

TR 2500 ms, with DRIVE.

Asymmetric TSE. Achieva 1.5T, TE 30 ms,TR 5000 ms,voxel size 0.41 x 0.63 x 3 mm, scan time: 3 min.

4522_962_18711.qxd 11/3/06 11:33 AM


Linear halfscan TSEshot length 95 ms,scan time 3 min.

Low-high TSE 2 startup echoes, shot length 80 ms, scan time 5 min.

Achieva 1.5T,TR 5000 ms,TE 30 ms,echo spacing 10 ms,voxel size 0.41 x 0.63 x 3.0 mm.

PDW TSE SPAIRAchieva 1.5T,TE 30 ms,TR shortest.

Asymmetric TSEshot length 130 ms,scan time 3 min.

Low-high, 4:30 min.TSE factor 8, 2 startup echoes,shot length 80 ms,echo spacing 10 ms,actual TR 4900 ms,1 package.

Asymmetric, 3:20 min.TSE factor 12,shot length 120 ms,echo spacing 10 ms,actual TR 5400 ms,1 package.

Asymmetric, 2:20 min.TSE factor 18,shot length 126 ms,echo spacing 7 ms,actual TR 2700 ms,2 packages.

Short TE STIRAchieva 1.5T,TE 30 ms,TR shortest,IR 135 ms.

Low-high, 4 min.TSE factor 8, 2 startup echoes,shot length 80 ms,echo spacing 10 ms,actual TR 4900 ms,1 package.

Asymmetric, 3 min.TSE factor 10,shot length 100 ms,echo spacing 10 ms,actual TR 4900 ms,1 package.

Asymmetric, 2 min.TSE factor 15,shot length 98 ms,echo spacing 6.5 ms,actual TR 2400 ms,2 packages.

Asymmetric TSE with fat suppression

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"Achieva was chosenbecause we thought it hadthe most sophisticatedneuro package"


Turkish medical center harnesses Achieva 3.0T

for advanced neuroradiology techniques

Yeditepe University Hospital employs multiple techniques to make interventions more precise

Just over a year since Yeditepe University Hospital (Istanbul) became

operational, the multi-specialty medical center has built a reputation as

a world-class facility. A centerpiece at Yeditepe is its thriving neurological

science institute.Yeditepe acquired the Achieva 3.0T system – only the

second whole-body 3.0T in Turkey – to provide the imaging power

needed to fully characterize brain tumors pre-surgically. Using diffusion

tensor imaging, perfusion-weighted imaging, spectroscopy, BOLD fMRI

and conventional imaging techniques,Yeditepe radiologists provide

neurosurgeons with the imaging data they need to avoid eloquent cortex.

By virtue of advanced imaging techniques,such as MR spectroscopy, BOLD fMRI,diffusion tensor imaging and perfusion-weighted imaging, most brain tumors leavevery little to hide in terms of composition,vascularity, dimensions and proximity tosensitive cortical tissues. And these methodsare even more powerful when paired withthe 3.0T field strength, which affordsmaximum signal to resolve even subtleanatomical details.

Yeditepe neuroradiologists and neurosciencephysicians appreciated this fact, and –realizing that neuro cases would representabout 60 percent of the hospital’s MRIvolume – lobbied the center’s funding body,the non-profit Iztek Foundation to investin a 3.0T scanner. Ultimately, thefoundation chose to partner with Philips inequipping the entire facility with not justan MRI system, but also top-of-the-linemulti-detector CT, PET-CT, flat paneldigital subtraction angio, nuclear medicinesystems and ultrasound units.

“The Achieva 3.0T with Quasar Dualgradients and Ambient Experience (seepage 20) was chosen because we thoughtAchieva had the most sophisticated neuropackage, including multi-nuclearspectroscopy,” says Professor IlhamiKovanlikaya, M.D., chief of thedepartment of radiology. “Philips alsooffered automatic software updates and

committed to a multi-year technicalsupport contract.”

Optimal tumor characterization

Every brain tumor patient referred toYeditepe’s department of radiology receivesan advanced brain scan, which includesMR spectroscopy, BOLD fMRI, DTI,perfusion-weighted imaging andconventional sequences.

“MR spectroscopy gives us informationregarding the lesion’s metaboliccomposition – whether we’re dealing withan aggressive malignant neoplasm or abenign mass, while perfusion-weightedimaging can help us determine the bloodsupply of the mass,” Prof. Kovanlikayaobserves. “Furthermore, BOLD fMRI is anextremely valuable technique to assist inunderstanding the mass’s relationship withthe motor strip or language areas – whichare critical to avoid during surgery.”

Diffusion tensor imaging (DTI) helpsYeditepe radiologists appreciate therelationship between the tumor and white matter fiber tracts – the brain’scommunication superhighway, which alsomust be avoided during surgery.

“For DTI and tractography, the PRIDEworkstation has been very useful,” he says.“I input all the raw DTI data from thescanner and the PRIDE software

Prof. Ilhami Kovanlikaya, M.D.

4522_962_18711.qxd 11/3/06 11:33 AM


automatically calculates and outputsfractional anisotropy maps and tractographyfor whatever fiber region I select. It’s anexcellent program for determining thecourse of white matter fibers.”

Yeditepe radiologists also use their batteryof neuro techniques in assessing the post-

T2 weighted TSE T1-weighted Aggressive brain tumor32-year-old female with loss of sensation in left lower extremity andincreased difficulty in walking for a year was examined with Achieva3.0T. The T2W TSE axial image shows a 3.5 cm hyperintense mass in the right frontal lobe extending to the precentral and superiorfrontal gyri.The mass has minimal enhancement on the post-contrast T1-weighted image.The perfusion MR image reveals significantlyincreased perfusion within the tumor. Multi-voxel multislice PRESSproton MRS was also obtained from the mass.The spectral voxelobtained from the same region of interest where pMRI measurementswere done revealed a markedly increased choline/creatine ratio.Functional MRI, DTI fiber tractography were done for surgical planning.The FA values measured from the tumor and contralateral normalwhite matter were 0.15 and 0.47 respectively.

DTI FA map

Perfusion

Spectroscopy

BOLD fMRI right and left hand motor tasks

BOLD fMRI left lower extremity

surgical and/or post-radiation treatmentfollow-up of patients, Prof. Kovanlikayasays. “We can instantly determine thepatient’s response to treatment regimes, and also it is much easier to differentiate,for example, possible radiation necrosisfrom recurrent tumor using these advancedneuroimaging techniques.”





extended versions of Field Strength

articles, and more.

4522_962_18711.qxd 11/3/06 11:33 AM


Philips acquires leading MRI component and

accessory maker, Intermagnetics

In June 2006, Royal Philips Electronicsannounced it had signed a definitiveagreement to acquire IntermagneticsGeneral Corporation. Intermagneticsdevelops, manufactures and markets highfield superconducting MRI magnets and isviewed as the technological innovator inthis market. Intermagnetics also providesspecialized MRI-compatible patientmonitoring devices and RF coils.

The Intermagnetics acquisition willstrengthen Philips’ position in the MR market, allowing the company tosignificantly improve its supply chain,enhance its competitive position andparticipate in the fast-growing RF coil market.

“Intermagnetics’s leading positions in themarkets of RF coils and MRI patientmonitoring will enable us to build uniquesolutions for our customers. In the longterm, we believe MRI technology willbecome important in molecular imaging,which positions us well for the future,” said Jouko Karvinen, member of the PhilipsBoard of Management and CEO ofMedical Systems.

Intermagnetics headquarters in Latham,New York will become the globalheadquarters of Philips’ enlarged MagneticResonance business.

Yeditepe University Hospital officialsdetermined to make MR scans as patient-friendly as possible, a key component ofwhich was Ambient Experience. AmbientExperience features soothing, thematicaudio-visual surroundings in theexamination room.

It empowers patients to modify theirscanning environment – thereby givingthem a feeling of control over the diagnosticprocedure. Yeditepe’s Achieva 3.0T is theworld’s first with Ambient Experience.

“Our hospital’s board of trustees’ chairman,Mr. Bedrettin Dalan, believes it is crucial toprovide a very supportive and friendlyhospital environment for patients and theirfamilies,” says Prof. Ilhami Kovanlikaya.“Patients often enter hospitals under a

certain amount of stress, so we wanted tostrengthen the patient’s ties to life while inthe hospital. Ambient Experience definitelyfulfills that requirement.”

From Prof. Kovanlikaya’s point-of-view, theidyllic scenery and lighting and the calmingsound effects that Ambient Experienceprovide not only make the patient’sexperience less intimidating, but it avoidsputting patients under stress that couldresult in a substandard scan.

“When patients are relaxed, everything justgoes easier,” he says. “Plus, AmbientExperience gives the patient the ability tochoose their favorite theme. At Yeditepe, theSunrise theme is most popular – you get thevisual of a rising sun and audio effects, suchas birds chirping.”

Yeditepe has first Achieva 3.0T with Ambient Experience

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Interest and enthusiasm in the Philips 7.0Tresearch system remain incredibly highamong both Philips and customer groups,if the second annual Philips 7.0T usermeeting is any indication. On June 18-20,the Philips 7.0T community gathered inNottingham, U.K. for the meeting,drawing 36 customers and prospects –representing 10 prominent MR researchinstitutions – in addition to 26 Philipsparticipants from the USA and Europe.

The Ohio State University (OSU,Columbus, Ohio) and the University ofNotthingham (Nottingham, U.K.) arecurrently operating 7.0T scanners.Representatives of these sites presentedtheir first imaging and spectroscopy results.In fact, OSU recently received approvalfrom its Investigational Review Board toconduct patient/volunteer studies, andinvestigators have begun planned projectswith all due speed. At Nottingham, manystudies are already underway, as wasillustrated in presentations and hands-onscanning sessions.

The meeting agenda consisted of lectures byPhilips staff and customers, as well asbreakout “carousel” groups, which focusedon topics such as: siting, service, IRB/ethics,safety, hands-on 7.0T scanning, technology,design and devices and the Philips 7.0T

development roadmap and priorities. “Ballots” gathered from users and follow-updiscussions indicated strong interest infurther 7.0T developments, such as newtechnology and more applications.

New sites look into the future

Customers from the Institute of Biomedical Engineering (IBTZ) of theETH/University of Zurich, VanderbiltUniversity in Nashville, TN, the Universityof Texas Southwestern (UTSW), Dallas,TX, Leiden University Medical Center(LUMC) and University of Utrecht(UMCU) in the Netherlands, presentedtheir 7.0T plans and reported on the statusof preparations. Zurich, for its part, beganclinical research involving 7.0T scanning ofhuman subjects just one week after the7.0T meeting ended.

Official opening of Nottingham Centre

Participants at the 2006 Philips 7.0T MRuser meeting also stayed for the officialopening of the Sir Peter MansfieldMagnetic Resonance Centre (SPMMRC),which houses Nottingham’s Achieva 7.0Tand other Philips systems. At the openingSir Peter Mansfield spoke about his earlyexperiments, performed in his labs on theNottingham campus, which led to thefounding of MRI and the 2003 Nobel Prizefor Medicine.

News

Second Philips 7.0T research meeting

indicates steady platform development

Philips 7.0T user meeting participants


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Calendars

Education calendar 2007


Contrast-enhanced MRA in clinical practice: a hands-on course

Maastricht,The Netherlands

Date: t.b.d.

For physicians and radiographers. Includes teaching sessions and volunteer

and patient scanning.

Info: Tim Leiner, MD PhD, [email protected]

Fetal MR course and Congress

Vienna,Austria

Date: May 15-18, 2008

For physicians and radiographers. Includes teaching sessions and volunteer

and patient scanning.

Info: www.meduniwien.ac.at/radiodiagnostik/fetal_MRI_vienna/,

[email protected]

Hands-on Clinical fMRI Course

Leuven, Belgium

Date: t.b.d.

Teaching sessions, volunteer and patient scanning, image analysis and

interpretation, and case presentations.

Info: www.kuleuven.ac.be/radiology/Research/fMRI/

[email protected]

CVMRI Practicum: New Techniques and Better Outcomes

St. Luke’s Episcopal Hospital, Houston,Texas

Date: July 17-21, October 9-13

On principles and practical applications of Cardiac MRI.

Info: [email protected],Tel. +1-832-355-4201

Cardiac MRI Training

Washington Hospital Center,Washington DC, USA

Date: Three-month fellowship

Info: www.cvmri.com, Pamela Wilson,Tel. +1-202-877-6889

Erasmus Course on Cardiovascular MRI

Leiden,The Netherlands

Date: October 4-5

Focuses on clinical applications of cardiac MR.

Info: www.emricourse.org

MRI: Musculoskeletal Structured Fellowship

University of California at San Francisco, California, USA

Date: t.b.d.

Info: www.radiology.ucsf.edu/postgrad/visit_fell_index.shtml

[email protected],Tel. +1-415-502-2984

Cardiac MR courses at CMR Academy

3-months Complete courses level II

5-days Compact courses

1-2 days modules

German Heart Institute, Berlin, Germany

All courses are for cardiologists and radiologists. Some parts will be

offered in separate groups.

Info: www.cmr-academy.com, [email protected],Tel. +49-30-4502 6280

Consists of three parts per course:

German English German English

Part 1: Six-week intensive course, Jan. 10- Feb. 28- May 30- Sept. 26-

including hands-on training at the Feb. 16 Apr. 4 July 6 Nov. 2

German Heart Institute.

Part 2: Reading and partially 160 hours private study (> 250 cases).

quantifying over 250 cases. The

CMR Academy provides the cases

and the necessary hardware and

software.

Part 3: Two weeks of case Apr. 16-27 Sep. 10-21 Nov. 12-23 Dec. 3-14

reviews, discussion and further

hands-on training.

CMR diagnostics in theory and German English German English

practice, including performance Jan. 15-19 Mar. 5-9 Jun. 4-8 Oct. 1-5

of examinations and case

interpretation.

(e.g. Perfusion, DSMR, Infarct Imaging, Details on www.cmr-academy.com

Heart Failure, CAI, 3.0T CMR, etc).

Breast MRI and MR-guided Interventions in Clinical Practice

University of Bonn, Bonn, Germany

Date: t.b.d.

Imaging, image interpretation and MR guided interventions, including

needle localization and biopsy.

Info: [email protected],Tel. +49-228-287-9875

International Cardiac MR course

Leeds, England

Date: October 16-20

Deals with theoretical principles and practical applications of Cardiac MRI.

Daily practical scanning and post-processing sessions in small groups.

Info: www.leedscmr.org/cardiac_course/index.htm, [email protected]

Cardiovascular MR training courses and fellowships

St. Louis, Missouri, USA

Date: March 6-9

Lecture format (2.5 days) or lecture plus hands-on (4 days).

Also offered are hands-on technologist training courses and

three-month fellowships.

Info: cmrl.wustl.edu/education, [email protected],

Tel. +1-314-454-7459

Breast MRI in the Garden State

Erasmus Course on Breast MRI, Chios, Greece

Date: July 1-6

Info: www.emricourse.org, [email protected]

4522_962_18711.qxd 11/3/06 11:33 AM

Events calendar 2007


Jan. 2-4 Society for Cardiovascular Magnetic Resonance – SCMR Rome, Italy www.scmr.org

Jan. 29-Feb. 1 Arab Health Dubai, UAE www.arabhealthonline.com

Jan. 30-Feb. 3 International MRI Symposium Garmisch, Germany www.mr2007.org

March 9-13 European Congress of Radiology – ECR Vienna,Austria www.myecr.org

Feb. 14-18 American Academy of Orthopaedic Surgeons – AAOS San Diego, CA, USA www.aaos.org

March 1-6 Society of Interventional Radiology – SIR Seattle,WA, USA www.sirweb.org

March 24-27 American College of Cardiology – ACC New Orleans, LA, USA www.acc.org

Apr. 12-15 Jornada Paulista de Radiogia – JPR Sao Paolo, Brazil www.spr.org.br

Apr. 13-15 Japan Radiology Congress – JRC Yokohama, Japan www.j-rc.org

Apr. 14-17 Charing Cross Symposium London, UK www.cxsymposium.com

Apr. 22-24 International Medical Instruments and Equipment Exhibition – China Med Beijing, China www.chinamed.net.cn

Apr. 29-May 5 American Society of Neuroradiology – ASNR San Diego, CA, USA www.asnr.org

May 19-25 International Society for Magnetic Resonance in Medicine and European Society Berlin, Germany www.ismrm.org

for Magnetic Resonance in Medecine and Biology – ISMRM – ESMRMB

May 22-25 Paris Course on Revascularization – EuroPCR Barcelona, Spain www.europcr.com

May 16-19 Deutschen Röntgenkongress Berlin, Germany www.drg.de

May 16-19 Association for European Pediatric Cardiology – AEPC Warsaw, Poland www.aepc.org

June 10-14 Human Brain Mapping – OHBM Chicago, IL, USA www.humanbrainmapping.org

June 11-13 UK Radiological Congress – UKRC Manchester, UK www.ukrc.org.uk

MR Basics

MR Essentials for Achieva Intera, Panorama 1.0T users

MR Advanced for Achieva Intera, Panorama 1.0T users

MR Spectroscopy courses (1.5T and 3.0T)

Magnetic Resonance Spectroscopy

MR Spectroscopy application course

Zurich, Switzerland

Daily practical scanning and post-processing sessions in small groups.

Date: Spring 2007

Aimed at clinicians who will use MR spectroscopy in the clinical practice.

Focuses on how to perform, interpret, quantify, and also includes advanced

methods for use in research.

Info: www.mr.ethz.ch/courses/spectro2006/

[email protected]

Date: Fall 2007

Aimed at clinicians who will use MR spectroscopy in the clinical practice.

Focuses on how to perform, interpret, and quantify.

Info: www.gyrotools.com

Essential Guide to Philips in MRI

Different locations, UK

Date: January 15-18, June 11-14, October 22-25

Specifically designed for Philips users, past, present and future. It is designed

to provide a modular approach to accommodate all levels of knowledge.

Info: [email protected]

North American off-site training courses

Dates upon request.

Info: [email protected],Tel. +1-440-483-2471,

Fax: +1-440-483-7946

Chattanooga,TN, USA

Designed for beginner technologists with little or no previous MR

experience. Lecture covers the basic concepts and theory of MRI.

Cleveland, OH, USA

This comprehensive course for technologists covers all basic scanning

and system functionality.

Cleveland, OH, USA

Didactic and hands-on course covering advanced applications including

advanced pulse sequences, cardiac and spectroscopy.

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