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Transcript of 1% 22% 1% Lower Extremity 6% Prostate 14% Vascularmri/seminars/slides/Spring 2014/IU... ·...
Handzettel 1
Answers for life. Restricted © Siemens AG 2014 All rights reserved.
March 22nd, 2014 Bruce Spottiswoode, Ph.D.
Advances in Cardiovascular MRI
Page 2
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Distribution of MR Studies?
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CMR: Gold Standard for a Niche Market
Brain
22%
Head/Neck
7%
Spine
25%
Prostate
1%
Vascular
6%
Upper Extremity
12%
Abdo/Pelvis
6%
Chest
3%Breast
3%
Lower Extremity
14%
Cardiac
1%
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CMR: Available on any scanner platform
*This feature is currently under development;
It is not for sale in the U.S. and all other countries. Its future availability cannot be guaranteed.
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Cardiac Dot Engine: AutoAlign Heart
• Guided Workflow
Consistent results
• Automated Workflow
Reduced exam time
• Personalization
Implement dedicated workflow
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CMR Reading and Reporting
dynamic
4D Ventricular Function
flow
wall motion
Handzettel 2
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Cardiac Flow
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Cardiac Perfusion*
• Visual Assessment of hypo enhanced regions
Motion Correction
Parameter maps
• Pixel wise analysis
• Guided workflow reduces evaluation time
*This feature is currently under development; it is not for sale in the U.S. and all other countries. Its future
availability cannot be guaranteed.
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Diagnostic Imaging and Therapy
*This feature is currently under development; it is not for sale in the U.S. and all other countries. Its future
availability cannot be guaranteed.
1Robert S. Oakes, Rob S. MacLeod et al. University of Utah; MAGNETOM Flash 2/2007
“MRI offers the most detailed anatomic and physiologic
information about normal and damaged myocardial tissue.” 1
Segmentation of left atrium,
based on MR angiography images
MR soft tissue
differentiation and catheter lab image guidance will be
delivered with
MAGNETOM Artis Combi Suite*
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Trends in Cardiovascular MR
T1/T2/T2*
QISS
Real Time Flow
Fat/Water
Self-gating
Long T1 Suppression
Non-CE MRA @ 3T
FIDDLE Edema Imaging
Motion Correction
Heart Deformation
4D Flow
Gated CE-MRA
Virtual Spectral Inversion
Inline DS
CMR
Quantify
Workflow
Outcome
Speed Robustness
Accuracy
Guidelines
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Quantitative Methods
• Motivation
• Potentially objective approach to diagnostic imaging
• Establishment of clinically relevant quantitative thresholds
• Potential Clinical Impact
• Imaging results independent from scanner, operator, vendor
• Easier assessment of non-focal cardiovascular diseases
• Reporting of quantitative results
• Challenges
• Accuracy and Precision
• Establishment of normal values difficult and expensive
• Clinical acceptance
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Variations in myocardial T1
Infarct
Amyloid
Myocarditis
Rheumatalogical
(water/protein) (metal/fat)
Iron
Gd
Fat (Fabry disease)
Pre-contrast: T1 is associated with edema or protein deposition.
T1 is associated with lipid or iron deposition.
Post-contrast: T1 corresponding to increased contrast agent concentration is associated with fibrotic
scar or diffuse fibrosis which has a greater extracellular volume than normal.
Handzettel 3
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Quantitative Methods: Mapping at SCMR 2014
T1 Mapping Working Group Anderson-Fabry Disease (P2)
Normal values (P3, P18, P23) Transplants (P100, P391, P394)
Amyloid (O4-5, P294, P322, P341) Cardioversion (P157)
HOCM (O61, P393) MI (P205, P211, P222)
Myocarditis (O6, O62-3, P287, 290) Regurgitation (P238)
Systemic Sclerosis (O64) Dilative Cardiomyopathy (P289)
Resistant Hypertension (O65) Cyanosis in CHD (P108)
Kidney Disease (O66) Muscular dystrophy (P296)
Intramyocardial Hemorrhage (O7) Iron (O86, O02, P309, P323)
Non-isch. Cardiomyopathy (O88) Diabetes (O144)
Edema (O16) Aortic Stenosis (M7)
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Quantitative Methods: T1 Mapping
0
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1997 1999 2001 2003 2005 2007 2009 2011 2013
Jo
urn
al public
atio
ns o
n T
1 m
appin
g /
EC
V
Courtesy: Dr. James Moon
The Heart Hospital London, UK
Downloads: 01/2014: >3200
Journal Publications on T1/ECV
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• T1 Mapping in Amyloid
Imaging Biomarker
Predictor for cardiac events
• Planned Trial: UK Biobank*
100,000 healthy volunteers
Native T1
• Planned Trial: HCMR**
2,750 HCM Patients
Native T1 and ECV
T1 Mapping: Imaging Biomarker
Courtesy: Dr. James Moon
SCMR 2014, O005
The Heart Hospital London, UK
*http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668194/
**http://clinicaltrials.gov/show/NCT01915615
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Speed
• Motivation
• Shorter breath holds, higher temporal-spatial resolution
• Reduction of motion artifacts
• Potential Clinical Impact
• Shorter scan times
• Enabler for non-cooperative patients
• Pediatrics
• Challenges
• Sophisticated reconstruction approaches
• Identification of specific artifacts
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Robustness
• Motivation
• Consistent image quality for every patient condition
• Independent of operator
• Potential Clinical Impact
• Benchmarked diagnostic image quality across hospital system
• Shorter scan times, higher throughput
• Less re-calls of patients
• Challenges
• Engineering of robust sequences and reconstruction methods
• Clinical adoption of novel approaches
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Motion Correction – Already Clinical Routine?
Inline Time
Course Analysis
Doesch et al.; Invest Radiol-48(9):678
Handzettel 4
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Image Registration
“Finding a spatial transformation that relates positions in one image, to corresponding positions in one or more other images.”
http://biocomp.cnb.csic.es/~iarganda/bUnwarpJ/
Non-rigid
http://www.mathworks.com/matlabcentral/fileexchange/19086-
automatic-2d-rigid-body-image-registration
Rigid
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Nonrigid image registration: An engineering challenge
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Robustness: Introduction
Circ Cardiovasc Imaging. 2013 May 1;6(3):423-32 Page 22
Restricted © Siemens AG 2014 All rights reserved. *This product is currently under development; is not for sale in the U.S and other countries.
It‘s future availability cannot be guaranteed.
Motion Correction in T1 Mapping*
• Registration of original IR prepared images
• Challenge: Contrast inversions, zero crossing
• Solution:
Phase sensitive approach using
synthetic image estimation
Original Direct Registration Registration Using
synthetic estimates
0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200
T1 (ms)
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Workflow
• Motivation
• Efficiency and Reliability
• Consistent quality of care
• Potential Clinical Impact
• Higher throughput
• Standards across hospital system
• Challenges
• Clinical adoption of workflow
• Consensus of approaches in community
• Implementation of guidelines into dedicated workflow
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Dedicated Protocol Trees
*This product is currently under development; is not for sale in the U.S and other countries. It‘s future availability cannot be guaranteed.
Acute Infarct
Adenosine Stress
Aortic Disease
Arrhythmogenic RV Myopathy
Chronic Ischemia
Coronary MRA
Mass & Thrombus
Nonischemic Myopathy
Pericardial Disease
LA and Pulmonary Veins
Valve Disease
*
Handzettel 5
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Guidelines and Outcome
• Motivation
• Efficient delivery of healthcare with impact
• Cost pressure
• Changes in healthcare systems worldwide
• Challenges
• Demographic trends
• Insecurity of changes in healthcare systems
• Value proposition of medical imaging
Page 26
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Socio-economical costs of chronic diseases
Cumulative Costs
between 2011-2025
for chronic diseases
33%
18%
35%
10%
4% Lost output 2011-2030
by disease type Diabetes
4%
Chronic respiratory
diseases
10%
Mental health
35%
Cardiovascular
Diseases
33%
Cancer
18%
Breakdown of chronic disease cost, based on EPIC model
Trillion US $ (average of nearly US $500 billion per year) 7
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CMR: Market Trends
„
„
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EuroCMR Registry
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Summary
• Cardiovascular MRI
• Comprehensive cardiac assessment
• Niche market in MR
• Emerging Technologies: “Free breathing exam”
• Fast Imaging
• Motion Correction
• Quantitative Approaches
• Growth Opportunities
• Demonstrate cost efficiency and value proposition of CMR
• Standardization of imaging and workflow solutions
• Impact guidelines, appropriateness criteria and reimbursement
Page 30
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Contact page
Bruce Spottiswoode, Ph.D.
Staff Scientist, US MR Research and Development
Siemens Healthcare USA, Inc.
737 North Michigan Ave Suite 1600
Chicago, IL 60611
Phone: +1 (312) 337-9287
E-mail: [email protected]