NEWSLETTER OF THE SECTION FOR MAGNETIC ...A Step by Step Method for Coronary Magnetic Resonance...

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Number 41

2002 Issue 2

IN THIS ISSUE

Annual Meeting Highlights2 Meet the New SMRT President2 Editor’s Letter2 President’s Letter3 Education Committee Report

on the Annual Meeting in Hawai‘iand the 2002 Oral PresentationProffered Paper Award Winners

4 SMRT Forum: MR Safetyat the ISMRM Annual Meeting

4 SMRT Educational Seminars Update8 2002 Poster Presentation Proffered

Paper Award Winners9 2002 President’s Award–

Coronary Artery Imaging:A Patient Tailored Approach

10 1st Place Proffered Paper–Clinical Oral3D VIBE Whole-Body MRI forMetastases Screening

11 1st Place Proffered Paper–Research OralEvaluation of Ischemia in aPrimate Model: A Feasibility StudyCombining X-ray Digital SubtractionAngiography and Fluoroscopy withMagnetic Resonance Imaging

12 1st Place Proffered Paper–Clinical PosterOptimization of a 15-MinutePV CE-MRA Protocol UsingAutomated Table Motion for Patientswith Intermittent Claudication

13 1st Place Proffered Paper–Research PosterA Step by Step Method for CoronaryMagnetic Resonance Angiography

14 2002 Oral and Poster Presenters

Information for You17 Early Stroke Detection

Utilizing MRI, Part II20 ISMRM/SMRT Calendar20 SMRT Committee Member Directory

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SECTION FOR MAGNETIC RESONANCE TECHNOLO

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SMRT 11th Annual MeetingProgram ReportGina Greenwood, R.T. (R)(MR), 2001-2002 Program Committee Chair

hese comments were among those on the attendee evaluation formindicating that the 11th Annual Meet-ing of the SMRT was a success. Thetheme for the meeting held May 18 and19 in Honolulu, Hawai‘i, was “Strive forthe Summit” and that we did. Startingwith the Poster Walking tour on Fridayevening, attendees were able to interactwith their peers sharing both technicalinformation and social time. More than40 poster presenters were on hand this

year to display their work. We appreciatethat Mallinckrodt, Inc. sponsored thebounteous reception.

Incoming President, John A. Koveleski,moderated the first didactic sessionSaturday morning. Invited speaker,Brian David Ross, M.D., Ph.D., presentedthe technical aspects of Spectroscopyand set the tone for the rest of themeeting. Policy Board member, CindyR. Comeau, B.S., R.T. (N)(MR) C.N.M.T.,demonstrated Clinical Cardiac Imag-ing. The audience appreciated herdetailed slides and handouts. MichaelE. Moseley, Ph.D., shared his expertisewith Diffusion and Perfusion WeightedImaging.

The first session of profferedpapers included: 1st Place Award-Clinical Focus “3D VIBE Whole-BodyMRI for Metastases Screening,” byEva Wembacher, R.T.; 1st PlaceAward- Research Focus “Evaluationof Ischemia in a Primate Model: AFeasibility Study Combining X-rayDigital Subtraction Angiography andFluoroscopy with Magnetic ResonanceImaging,” by Julie Strandt-Peay,

Continued on page 6 ➠

“Great meeting.”

“This was excellent, material I canactually use, keep up the good work!”

“Excellent speakers and topics.”

“As always this course offers informativespeakers and current issues in MRI.”

2002 SMRT Program Chair,Gina Greenwood (left) andEducation Chair, Cindy Hipps.

2002 SMRT President, John A. Koveleskipresents Heidi Berns, outgoing President,the commemorative presidential plaque.

NEWSLETTER OF THE SECTION FOR MAGNETIC RESONANCE TECHNOLOGISTS

NUMBER 41 2002 ISSUE 2 S i g n a l s 2

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Getting to Know YourNew SMRT PresidentJulie Strandt-Peay, B.S.M., R.T. (R)(MR)

Signals: John, How long have you been involvedwith MR?

John: It’s been more than 16 years. Most ofthat time I worked in free standing clinicsand with Low and Mid-field scanners.

Signals: When did you first participate withthe SMRT?

John: My first involvement was in 1993when I attended a SMRT RegionalSeminar, chaired by Kelly Baron, atGeorge Washington University, inWashington, D.C. After that, I organizeda local chapter. I was elected to the PolicyBoard in 1998 and served as ProgramChair for the 1999 Annual Meeting inPhiladelphia. At that meeting, I assumedthe vacant Treasurer’s position whichI held until 2001. I also was an invitedspeaker at the Denver meeting in 2000.

Signals: What do you see as your top priorityas President of the SMRT?

John: The SMRT is an internationalsociety and I’d like to see it reach areasthat we haven’t tapped into as of yet. Justas important, I’d like to see the member-ship numbers rise in the USA. It stillamazes me that there are so many MRtechnologists who have never heard of theSMRT and don’t realize the benefits ofjoining our organization. I constantlyfield calls from MR technologists who arescrambling for credits. I tell them thatthey can join the SMRT and get all thecredits they need and they’ll all be MRcredits. There’s no reason for them to joinany other society or to get credits inmodalities in which they’re not practicing.

Signals: As a leader in the Field of MR, whatadvice do you have to others working in the field,especially those who may be getting discouragedat the shortages of trained MR technologists?

John: The technologist shortage is veryfrustrating. It often makes a trained MRtechnologist work harder. It also givesthem the opportunity to share theirexperience and teach new technologists.I’ve trained several technologists fromscratch in my 16 plus years in MR andthey’re some of the best technologists thatI’ve encountered. An excellent MRtechnologist will make a center successful.I feel as though radiologists and manage-ment are starting to realize it now. MR isa technology that can be very operator-dependant and a great technologist is anecessity. With the SMRT offeringcontinuing education via the homestudies, local chapter meetings, RegionalSeminars, and the Annual Meeting, it’s aperfect opportunity for MR technologiststo expand their knowledge and makethemselves indispensable to theiremployers.

President’s LetterJohn A. Koveleski, R.T. (R)(MR)

’m sure it’s going to be the start of a very busyyear for me. I appreciatethe trust that the SMRTmembership has in me aswe go forward yet anotheryear.

At our Annual Meetingin Honolulu, I was excited

to see the enthusiasm that the SMRTmembership displayed during anexceptional program. One of my goals aspresident is to have more technologistsget involved in the Section. It’s alwaysgreat to reacquaint with old colleaguesbut it’s exciting to meet colleagues thatare new to the SMRT. In Hawai‘i, therewas a wealth of enthusiasm among theattendees as far as wanting to becomeinvolved with the SMRT. Radiographersfrom all corners of the world and alltypes of clinical settings are valuablemembers of the SMRT. From hosting aRegional Seminar to serving on acommittee, there are numerous ways forthe newcomers to show their support.

As you’ll read in other articles inthis issue of Signals, we had quite theprogram. Special thanks go out to GinaGreenwood (Program Chair) and CindyHipps (Education Chair) for theirdedication in making the meeting thesuccess that it was. Having a tropicalbackground didn’t hurt either.

Another goal that I have for thiscoming year is to see the membershipgrow. I often field phone calls ande-mails from MR technologists who findthemselves running short on credits. Bybecoming a member of the SMRT, all ofyour CE credit worries are taken care of.The home studies will produce enoughECE to satisfy the ARRT plus they areall strictly MR. There is no reason to getcredits in other modalities when theSMRT can do it all for you.

Please enjoy this issue of Signalsand see all the fabulous work that waspresented in Honolulu. All of the SMRTExecutive Committee and Policy Boardmembers put a lot of time and effort intoour activities with the SMRT and welook forward to working with you in thenear future. �

Signals: What would you like to see the SMRTaccomplish this year and in the future?

John: I’d like to see a continuation ofinternational growth and also growth fromthe “grass roots” technologists– thoseworking in the trenches at outpatientcenters, etc., that represent well over 90%of the technologists employed in the field. �

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Editor’s LetterJulie Strandt-Peay, B.S.M., R.T. (R)(MR)

reetings to new and renewed members

of the SMRT. This issueof Signals is packed withparticulars about theSMRT 11th AnnualMeeting, held in Honolulu,Hawai‘i, USA. Gratitudeis extended to Program

Chair, Gina Greenwood, for anexcellent educational program. Theefforts of Education Chair, CindyHipps, for her efforts on behalf ofthose MR technologists who submittedtheir work to be presented is verymuch appreciated. Thank you to AnneSawyer-Glover, for once againacquiring nearly all of the photographsin this issue. This is a bigger job eachyear as more MR technologists partici-pate in the Annual Meeting. Anne alsoreports on the first invited participa-tion of the SMRT at the ISMRMAnnual Meeting. It is the custom ofSignals to publish the abstracts of theaward winning presenters. The first inthe series presented at the SMRTAnnual Meeting are included for yourinformation. More will be included infuture issues.

Get to know John Koveleski,your new President and read about hisplans for the future of SMRT. KellyBaron shares information about theaccompanying home study offering,and sponsor MRI Devices Corporation.Robin Greene-Avison provides PartII of her work on Stroke, an importantarea of practice for all MR technolo-gists. An updated listing of SMRTcommittee chairs and members isincluded for your reference.

Please consider the “Call forNominations” announcement. Perhapsit’s time that you want to become moreactive in the SMRT or you know of afriend or colleague who would like toserve. Heidi Berns is the Chair of theNominating Committee this year andwould like to hear from you.

Due to the budget limitation ofthe number of pages that Signals cansupport, the SMRT Policy Board andExecutive Committee are investigatingexpanding the information availableon the SMRT website. This wouldmean you would have more informa-tion than ever accessible with yourSMRT membership. Check theSMRT website frequently for updatesimportant to you! �


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SMRT Education Committee ReportCindy T. Hipps, B.H.S., R.T. (R)(MR), 2001-2002 Education Committee Chair

he SMRT 11th Annual Meeting held in Honolulu, Hawai‘i, was truly one of those meetings that will long be remembered. As an attendee, I came home with some wonderful and exciting new information that I have alreadyshared with my colleagues who did not have the privilege of attending. I encourage all of you to make it a top priority toattend these meetings and do whatever it takes to get there. Join a committee, run for Policy Board, present an abstract orposter, and get active. It is very rewarding to be involved in the SMRT!

I was in awe with the number of posters presented. The quality of each one was, without a doubt, some of the best workI have had the opportunity to view!

As one of the committee members who had the challenge of grading the 53 abstracts and 41 posters that were presented,it was indeed a challenging experience! Thirteen countries were represented overall in the abstracts. All the presenters,both orally and by poster should be commended for their excellent work and professional demeanor. Below is a list of thefinalists in the oral and poster presentations.

A special thank you goes to the Education Committee Members, Gina Greenwood, SMRT Program Committee Chairman,and Jennifer Olson of the SMRT office for their hard work and dedication to the meeting in Hawai‘i.It was a wonderful and successful meeting! �

2002 Award Winners at the SMRT Annual Meeting2002 President’s Award–Marcela B. Montequin, R.T. (R)(MR)MRI Advanced Research Applications Specialist, GE Medical Systems

“Coronary Artery Imaging: A Patient Tailored Approach”

1st Place Award, Oral Clinical Focus–Eva Wembacher, R.T.Department of Radiology,University Hospital Essen,Essen, Germany

“3D VIBE Whole-Body MRI forMetastases Screening”

2nd Place Award, Oral Clinical Focus–Frank J. Londy, R.T. (R)Department of Radiology,University of Michigan,Ann Arbor, Michigan, USA

“The Effect of Peripheral ArterialOcclusive Disease on Venous Filling inGadolinium-Enhanced MRA of the DistalAorta and Lower Extremities”

3rd Place Award, Oral Clinical Focus–David W. Stanley, B.S., R.T. (R)Applied Science Laboratory,GE Medical Systems,Milwaukee, Wisconsin, USA

“Alternative Approach to MyocardialViability Assessment”

1st Place Award, Oral Research Focus–Julie Strandt-Peay, B.S.M., R.T. (R)(MR)Department of Radiology,University of Wisconsin Medical School,Madison, Wisconsin, USA

“Evaluation of Ischemia in a Primate Model:A Feasibility Study Combining X-ray DigitalSub-traction Angiography and Fluoroscopywith Magnetic Resonance Imaging”

2nd Place Award, Oral Research Focus–Catherine M. Callahan, B.S., R.T. (R)(MR), R.N.Advanced MRI Consulting, Inc.,Evergreen Park, Illinois, USA

“Coronary Magnetic Resonance Angiography:New Non-Contrast Technique”

3rd Place Award, Oral Research Focus–Anne Dorte Blankholm R.T.MR Research Center,Aahus University Hospital, Denmark

“3D Virtual Reality of the Heart,Preliminary Results”


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SMRT Forum: MR Safety at the ISMRM Annual MeetingAnne M. Sawyer-Glover, B.S., R.T.(R)(MR), SMRT Forum Organizer and Moderator,SMRT Treasurer, ISMRM Safety Committee Member

he International Society for Magnetic

Resonance in Medicine,our parent society,invited the SMRT toorganize and conduct aforum during the recentAnnual Meeting of theISMRM held in Hawai‘i.

The topic selected for discussion thisyear was MR Safety. The forum tookplace during the mid-day session, onMonday, 20 May 2002. The agendaincluded four speakers and four panel

members to address questions from theaudience. Approximately two hundredpeople were in attendance.

William Faulkner, B.S., R.T. (R)(MR)(CT),started the session off with a verycomplete and inspired review of “MRScreening Policies and Procedures.”Bill, a well-known MR educator, is theMRI Education and OperationsConsultant of William Faulkner andAssociates, and the Vice President ofOutsource, Inc. Bill’s energizedpresentation included the use and

format of screening forms; the mechan-ics of screening visually and verbally;controlling areas for staff and patients;required ongoing training of MRtechnologists, physicians, and staff;significant contraindications; andfacilitating support from the MRradiologists.

Frank G. Shellock, Ph.D., followedwith a thorough examination of “MRISafety and Compatibility for Implantsand Devices: Update 2002.” Frank isan Adjunct Clinical Professor ofRadiology at the University of SouthernCalifornia and the President ofShellock Research and DevelopmentServices. Frank has recently organizedand implemented the IMRSER(Institute for Magnetic ResonanceSafety, Education, and Research). TheIMRSER is an independent, multi-disciplinary, professional organizationdevoted to promoting awareness,understanding, and communication ofMR safety issues through educationand research. Frank’s illuminatingtalk included discussions aboutneurostimulation devices, aneurysmclips, spinal fusion stimulators, druginfusion pumps, intravascular stents,filters, and coils, and many otherbiomedical implants and devices.Frank also discussed the variance ineffects by different types of magnetsincluding field strength and design.Some of Frank’s many publications onMR safety appear in most Signalsnewsletters from the SMRT. Frankmaintains a MR safety website thatprovides support worldwide:http://www.mrisafety.com.

Michael Kean, R.T., gave anenlightening presentation, combining“The Prevention of RF Burns andHeating in the MR Environment” and“Pediatric MR Safety Issues.” Michaelis the Chief MR Technologist at theHoward Florey Institute at the RoyalChildren’s Hospital in Parkville,Victoria, Australia. In addition to hiswidely-recognized expertise in imagingpediatric patients, he also conductsexaminations on a 3.0T whole body MRscanner. Michael’s comprehensive

ork on the SMRT Educational Seminars continues! Thank

you for all the comments received atthe Annual Meeting. We are glad thatthe home studies are truly benefitingMR technologists worldwide. Startingwith the current issue, MRI of theAnkle and Foot, you will see that thequiz answer sheet has been separatedfrom the booklet. This has been done

to facilitate any changes that may need to be madeto question sets when these issues are reprinted inthe future. The remaining issues for this year areMRI of the Breast, and an issue on DiffusionWeighted Imaging in the Brain. As I have notedbefore, we will be trying to downsize the issuesa bit only to allow to stay within our budget! Wewill continue to provide you with twelve approvedcredits per year in the field of MR. Please feel freeto contact me with any suggestions or comments, orif you would like to participate in putting a homestudy together at: [email protected]. �

Update on

SMRT Educational SeminarsHome Study Submissions!Kelly D. Baron B.S., R.T. (R)(MR), Chair, SMRT Publications Committee

The SMRT gratefully acknowledges MRI Devices Corporation,

Waukesha, Wisconsin, USA, for their generous support of the 2002

SMRT Educational Seminars home study series. This donation demonstrates the

consideration of MRI Devices Corporation for quality MR technologist education.

Contact information can be found at www.mridevices.com

Are you a new SMRTmember? Did you missan earlier issue?

All of the previously publishedSMRT Educational Seminarshome studies are now availablefor purchase by SMRT Membersin good standing for onlyUS$20 per issue.

For more SMRT membershipinformation or an order form,please e-mail: [email protected] visit the SMRT website:http://www.ismrm.org/smrt



review provided a very personal look atthe risks involved, the challenges weface on a daily basis, the ongoingtraining and education necessary tomaintain a safe MR facility, and themany complex issues that arise in theimaging of infants and children.

Emanuel Kanal, M.D., F.A.C.R.,completed the presentations with hisdetailed report regarding the recentlypublished white paper from theAmerican College of Radiology:ACR Recommendations for MR Safety.Manny is the director of MagneticResonance Services and Professor ofRadiology and Neuroradiology at theUniversity of Pittsburgh MedicalCenter and School of Medicine.Manny’s very motivated talk coveredthe guidelines as recommended by theACR including the establishment,implementation and maintenance ofMR safety policies and procedures foreach facility; limitation of site access todifferent areas (“zones”) within the MRfacility by patients, staff, MR technolo-gists, physicians, and others; consider-ations for pregnant patients and staff;time-varying gradient magnetic fieldrelated issues (induced voltages andauditory considerations); time-varyingradiofrequency magnetic field relatedissues (thermal); cryogen relatedissues; sedation and anesthesia; use ofcontrast agents; and, biomedicalimplants and devices. Manny alsomaintains a MR safety website thatsupports facilities worldwide:http://www.radiology.upmc.edu/mrsafety.

Time was included at the end of thepresentations for questions from theaudience and discussion with the panelmembers and speakers. The panelmembers included Cindy T. Hipps,B.H.S., R.T. (R)(MR); Maureen N. Hood,B.S., R.N.; Julia B. Lowe, B.S., R.T.(R)(MR); and, Laurian Z. Rohoman,R.T. (R)(MR), A.C.R. Cindy is the MRICoordinator at the Greenville Radiol-ogy in Greenville, South Carolina.Maureen is the MR Research Coordina-tor at the Uniformed Services Universityof the Health Services, Department ofRadiology, MR Research Division, inBethesda, Maryland. Julia is theClinical Research Specialist at theIndiana University School of Medicine,

Department of Radiology, Section ofImaging Science, in Indianapolis,Indiana. Laurian is the TechnicalCoordinator of MRI at the MontrealGeneral Hospital in Montreal, Canada.

There were many questions fromthe audience and lively discussionfollowed. Some safety issues continueto cause concern for MR facilities suchas whether to image in the presence of,for example, retained pacemaker wires,tattooed eyeliner, and brachytherapyimplants. More current issues werevoiced concerning the safety of clinicalscanning on MR scanners at 3.0 Teslaespecially when biomedical implantsand devices are present. Engagingdiscussions continued well after theend of the two-hour session.

A complete syllabus, compiled withabstracts, presentations, journalarticles and information from all of thespeakers and panel members, wasdistributed to the attendees as well asother safety documentation from theSMRT. The syllabus will be valuable tomany facilities in developing andmaintaining their MR safety policiesand procedures, and providing addi-tional educational material for theircolleagues.

Many thanks to the speakers andpanel members for sharing their MRsafety knowledge and contributingtheir MR safety documentation aswell as their extremely valuable timeduring this very busy meeting.Thank you also to the ISMRM ProgramCommittee and Executive Board forinviting the SMRT to actively partici-pate in their Annual Meeting.

This extraordinary opportunity willbe the start of a new tradition for theSMRT to contribute directly to theISMRM Annual Meeting, bringingvalue to those attendees includingclinicians, scientists, and technologists.This is one more way in which wesupport our commitment to provideeducation, promote communication anddisseminate information in the field ofmagnetic resonance. �

(Editor’s note: For those of you not able toattend, there are copies of the 2002 SMRTForum: MR Safety Syllabus available throughthe SMRT office. Call or see the website fordetails).

SMRT Forum: MRI Safety continued

The Section forMagnetic Resonance Technologists

would like to thank the following donorsfor their generous support of theSMRT Eleventh Annual Meeting:

GOLD CORPORATE MEMBERS:Amersham Health

GE Medical SystemsPhilips Medical Systems

Siemens Medical Solutions

BRONZE CORPORATE MEMBERS:Berlex Imaging/Schering AG Germany

BraccoBruker Biospin MRI, Inc.

Hitachi Medical Systems America, Inc.Mallinckrodt, Inc.

Toshiba Corporation

SMRT would like to thank:Amersham Health

Avotec, Inc.Berlex Imaging

Bracco Diagnostics Inc.Eastman Kodak Company Health Imaging

GE Medical SystensHitachi Medical Systems America, Inc.

Mallinkrodt, Inc.Medrad, Inc.Midwest RF

Nova Medical, Inc.Philips Medical Systems North America

Resonance Technology, Inc.ScanMed

Siemens Medical Solutions USA, Inc.USA Instruments, Inc.

Vital Imagesfor their generous support of theSMRT Eleventh Annual Meeting.

SMRT would also like to thank:MRI Devices Corporation

for its support of theSMRT Educational Seminars Home Studies.


SMRT Annual Meeting continued

B.S.M., R.T. (R)(MR), and 2nd PlaceAward- Clinical Focus “The Effect ofPeripheral Arterial Occlusive Diseaseon Venous Filling in Gadolinium-Enhanded MRA of the Distal Aortaand Lower Extremities,” by Frank J.Londy, R.T.

During the lunch break the SMRTBusiness Meeting incorporated thepresenting of awards (see the Educa-tion Committee report for your peerswho received awards for their submis-sions on page 3). Other awards pre-sented were: Honorary Member,Carolyn Kaut Roth; DistinguishedService, Donna Underwood O’Brien;Fellows of the Section, Kelly D. Baron,and Julie Strandt-Peay. New PolicyBoard members and officers wereintroduced and those outgoing werethanked for their service. Heidi Bernsturned the gavel over to John A.Koveleski who spoke to the attendeesand began his term as SMRT President.

Outgoing President, Heidi Berns,moderated the afternoon sessionwhich began with Alan H. Stolpen,M.D., who imparted information aboutBody MRA. Offering “The Best Work ofYour Life” was Pat Alea, M.B.A. Hermotivating talk was well received byMR technologists who often face stresson the job. Marcela B. Montequindelivered the President’s Award paperentitled “Coronary Artery Imaging:A Patient Tailored Approach.” Finish-ing the day was Joshua M. Farber,M.D., who conveyed his thoughts onMusculoskeletal Imaging Protocols.

The didactic sessions continuedSunday Morning with Cindy T. Hipps,Education Chair, moderating. Brian D.Ross, M.D., Ph.D., supplied the ClinicalImpact in Part II of his Spectroscopylecture. Policy Board member, SilkeBosk, R.T., addressed “PreventiveImaging Without Radiation” from herexperience in Germany. Peter Choyke,M.D., instructed the audience aboutFunctional Tumor Imaging with MRI.

Proffered papers followed andincluded: 2nd Place Award-ResearchFocus: “Coronary Magnetic ResonanceAngiography: New Non-ContrastTechnique,” by Catherine M.Callahan,B.S., R.T. (R)(MR), R.N.; 3rd PlaceAward-Clinical Focus: “AlternativeApproach to Myocardial Viability

Assessment,” by David W. Stanley, B.S.,R.T. (R); and 3rd Place Award-ResearchFocus: “3D Virtual Reality of the Heart,Preliminary Results,” by Anne DorteBlankholm, R.T.

The MRI Safety Forum, back byrequest of the SMRT membership washeld over the lunch break. Well knownby members of the SMRT for hiscontributions to MRI Safety, Frank G.Shellock, Ph.D., moderated the forum.Robert J. Herfkens, M.D. and MichaelKean, R.T. provided specific informa-tion. A question and answer sessionenabled a lively discussion.

Gina Greenwood, Program Chair,was the moderator for the final session.Keith Thulborn, M.D. communicatedhis experience with 3T Imaging in aClinical Setting. Proffered papersincluded: “Imaging the Prostate Using

Invited Speakers

SMRT MRI Safety Forum (l. to r.) moderator,Frank G. Shellock, and speakers Robert J. Herfkens,and Michael Kean.

(l. to r.) Patrick A. Turski, M.D., andWilliam T.C. Yuh, M.D., M.S.E.E.

(l. to r.) Donald G. Mitchell, M.D., Michael E. Moseley, Ph.D., Brian David Ross, M.D.,Ph.D., Alan H. Stolpen, M.D., and Keith Thulborn, M.D.

(l. to r.) Pat Alea, M.B.A., Silke, Bosk, R.T., Cindy R. Comeau, B.S., R.T. (N)(MR), C.N.M.T.,Peter Choyke, M.D., and Joshua M. Farber, M.D.

Phased Array Surface Coils,” byBobbie Burrow, R.T. (R)(MR)(CT);“Direct Contrast Enhanced 3D MRVenography,” by Michael Kean, RT.;and “Utilizing Fast Gradient Echo as aBreath Hold Technique in the Quanti-tative Assessment of Hepatic Steatosis,”by Mark Smith, M.S., R.T. (MR).

Invited speaker, William T.C. Yuh,M.D., M.S.E.E., presented Diagnosisand Management of Acute Stroke.Comparing CTA and MRA was PatrickA. Turski, M.D. Donald G. Mitchell,M.D., imparted Body MRI ProtocolProblems and Controversies to roundout the session.

Thanks to all of you who attendedthis year and participated in thiseducational program. Whether youwere able to come this year or not,



SMRT Annual Meeting continued

it’s not to early to think about nextyear, writing about your work, partici-pating in the meeting or becoming amember of the Policy Board. The 2002-2003 Program Committee will takeunder advisement the comments andsuggestions from this year as the nextmeeting is planned.

Thank you to all of the sponsors,listed in the Program syllabus andhere in Signals, see page 5. I wouldpersonally like to thank all the membersof the Program Committee for theirhelp and the office staff, especiallyJennifer Olson, for all their support. �

2002-2003 SMRT Board Members (seated l. to r.) Anne M. Sawyer-Glover, Heidi Berns, John A. Koveleski, William Faulkner, Nanette Keck,(standing l. to r.) Maureen N. Hood, Marcia Gervin, Laurian Rohoman, Bobbie Burrow, Cindy Hipps, James Stuppino, Michael Kean,John Christopher, Julie Strandt-Peay, Robin Greene-Avison, Kelly Baron, Scott Kurdilla, Silke Bosk, Carolyn Roth, Gina Greenwood,Cindy Comeau, and Maureen Ainslie (not pictured: Carolyn Brown, Muriel Cockburn, Raymond Cruz, Julia Lowe, and John Posh).

SMRT Presidents (l. to R.) President-Elect,Maureen Ainslie, President, John Koveleski,Past President, Heidi Berns.

(Editor’s note: For those of you not able toattend the SMRT 11th Annual Meeting, thereare syllabi available through the SMRT office.Call or see the website for details).

Call for NominationsHeidi A. Berns, M.S., R.T. (R)(MR), Past-President and Chair, Nominating Committee

A s Chair of the NominatingCommittee of the SMRT,

I am asking the membership fornominations for the Policy Board andfor President-Elect. In order for oneto be eligible for the Policy Board, anominee must be a voting member ingood standing. The term for thiscommitment is three years. There arefive vacancies for members at-largefor the Policy Board. Nominees forPresident-Elect must also be votingmembers in good standing, and alsomust be or have been at-large membersof the Policy Board. This term is oneyear in length, with the following twoyears fulfilling the Presidency and PastPresident, respectively.

We have, in the past, had membersfill these positions from not onlyvarious geographical areas, but alsofrom various work environments.There have been members fromuniversities, clinics, imaging centers,and corporations. The involvementwithin the SMRT in this capacity isrewarding in so many aspects. Success-ful nominees will learn the working

mechanisms of the SMRT and theISMRM in addition to meeting newacquaintances and making friends.Please consider nominating yourself ora colleague for these upcoming vacan-cies. You may forward your nomina-tions to me at [email protected] at my telephone work number at:+1 319 339 3801. If you should haveany questions, please feel free tocontact me. Thank you in advance foryour nominations. I look forward tohearing from you! �

Call for Nominations!Please submit nominations for:� President-Elect� Policy Board Members� Crues-Kressel Award Recipient

Deadline for Nominations:1 September 2002

Contact: Heidi Berns [email protected]


Award Winning Clinical Focus and Research Focus Poster Presentersat the SMRT Annual Meeting

2002 1st Place Clinical Poster– Cindy R. Comeau,Cardiovascular Research Foundation and the Lenox Hill Heart andVascular Institute, Advanced Cardiovascular Imaging, New York,New York. “Optimization of a 15 Minute PV CE-MRA ProtocolUsing Automated Table Motion for Patients with IntermittentClaudication”

2002 1st Place Research Poster– Richard Niemczura,Northwestern University, Chicago, Illinois, USA,“A Step by Step Method for Coronary Magnetic ResonanceAngiography”

2002 2nd Place Clinical Poster– Rhonda F. Walcarius,Department of Imaging and Bioengineering Research andMedical Imaging, Sunnybrook and Women’s College HealthScience Center, Toronto, Ontario, Canada“MRI Breast Needle Localization”

2002 2nd Place Research Poster– Julia B. Lowe,Department of Radiology, Indiana University School ofMedicine, Indianapolis, Indiana, USA“Diagnostic MRI of Zoo Animals”

2002 3rd Place Clinical Poster– Catherine M. Callahan,Advanced MRI Consulting, Evergreen Park, Illinois, USA“Contrast-Enhanced 3D MRA Screening of Non-PeripheralArterial Vasculature in 30-Minutes”

2002 3rd Place Research Poster– Anne Dorte Blankholm,MR-Centre, Skejby Sygehus, Aahus University Hospital,Aarhus, Denmark“EPI Time of Flight (TOF) MR Angiography (MRA) Comparedto Spoiled Gradient Echo (FFE T1) TOF in the Carotid Arteries”


2002 President’s Award

Coronary Artery Imaging:A Patient Tailored ApproachM. Montequin1, M. Saranathan1, T. Foo1, V. Ho2, M. Hood2, Advanced Research Specialist,1GE Medical Systems, Baltimore, Maryland, USA, 2USHUS, Bethesda, Maryland, USA

Table 1.

2D BH Spiral 2D Navigator Spiral 3D GRE Navigator Patient Tailored Approach

Success rate % 88 85 68 93

PurposeCoronary arteries are small,

narrow, tortuous vessels subject tosignificant cardiac and respiratorymotion; hence the biggest challengefacing cardiac Magnetic Resonance(MR) today is the acquisition of highresolution, artefact-free images of thecoronary arteries. Current MRstrategies use a single technique–a 2D breath-hold or a 3D free-breath-ing acquisition– without taking intoconsideration the patient’s breath-holding ability or his/her capability tomaintain a steady respiratory rhythm.Focusing on just one technique has notbeen universally successful. Tomaximize the probability of acquiringimages of diagnostic quality, a patienttailored approach using multiple,optimised, acquisition methods to imagethe coronary arteries is proposed.

Materials and MethodsAll subjects were scanned on a

1.5T MR scanner (GE Medical Systems,Waukesha, Wisconsin, USA) with a4-element cardiac phased array coilafter obtaining informed consent. Atotal of 91 subjects (60 men, 31 women,mean age 42 years), were scanned attwo centers. The three techniquesconsidered in this study were:� 3D Navigator gated FGRE:

10-15 minute duration.� 2D breath-hold spiral:

12-16 second duration� 2D navigator gated spiral:

1-2 minute duration

Early on, it was recognized thatmost patients maintained a steadyrespiratory pattern over a 1-3 minutesand could tolerate 15-20 second breath-holds. This led to a hypothesis thattailoring the acquisitions to thepatients breathing characteristicscould improve the success rate. Theselection of which sequence to use firstin each subject was based on thesubject’s ability to hold their breathor maintain a consistent respiratoryrhythm. At least two of the threetechniques were used on each subject,and an effort was made to image morethan one vessel during each study.

All images were evaluated andgraded in a blinded fashion. The rightcoronary system was graded separatelyfrom the left coronary system. Theimages (see below) were scored on ascale from 0 (worst) to 4 (best):0 = coronary artery not visualized withsevere ghosting/blurring; 1= coronaryartery barely visible, moderate ghost-ing/blurring; 2 = coronary arteryvisualized, mild ghosting/blurring;3= coronary adequately visualized,minimal ghosting/blurring; and4 = coronary very well visualized, noghosting/blurring. An image with ascore of 2 or more was considered to bediagnostically relevant, which meantthat it possessed adequate S/N, spatialresolution, was artefact-free, and thecoronary artery was well visualized.The scoring scheme was designed sothat images with scores of 3 or 4 couldbe diagnosed with high confidence.

ResultsDiagnostic quality images (score

equal or greater than 2) were used tocalculate the success rate for eachsingle individual technique and forthe combined tailored approach.

ConclusionThe patient tailored approach

significantly increases the success ratein visualizing the coronary arterieswhen compared to a single techniqueapproach while making the study moretolerable for the patients. Both the 2Dbreath-holding technique and the 2Dnavigator spiral technique scored wellfor both the right coronary artery(RCA) and the Left Anterior Descend-ing (LAD) in length of artery depictedand image quality. The 3D navigatorFGRE sequence scored lower due tolack of blood-myocardium contrast andrespiratory motion artifacts.

A multi-center evaluation iscurrently under way that will comparethe sensitivity and specificity ofcoronary angiography to the patienttailored approach in MR. �


2002 1st Place Proffered Paper–Clinical Oral Presentation

3D VIBE Whole-Body MRI for MetastasesScreeningE. Wembacher, R.T., S. Mateiescu, B.S., T.C. Lauenstein, M.D., J. Barkhausen, M.D., J.F. Debatin, M.D., S. Bosk, R.T.Department of Radiology, University Hospital Essen, Germany

Introduction

Whole-body MRI has been pro-posed for generalized tumor staging.Limitations of whole-body MRIconcepts have included long examina-tion times in combination with limitedspatial resolution. Recently VIBE(volumetric interpolated breath-holdexamination), a fat saturated 3Dgradient echo sequence with nearlyisotropic resolution has becomeavailable. Inherently low signal to-noise requires the use of surface coilsfor signal reception. Extending VIBEhigh-resolution coverage from a singleto multiple anatomic regions toward awhole-body examination mandatesrapid patient movement in conjunctionwith surface coil-based data reception.These requirements are fulfilled by arolling table platform with integratedsurface coils, actually developed forwhole-body MR angiography(AngioSURF – System for unlimitedrolling field-of-view). The techniquewas adapted for whole-body MRI(BodySURF). The purpose of this studywas to evaluate the feasibility andaccuracy of BodySURF based VIBEfor whole-body MRI in patients withmetastases using CT and nuclearmedicine techniques as the standardof reference.

Methods

Fifty-nine patients with knownprimary malignancies potentiallymetastasising to liver, lungs, bones andcerebrum were included in this study.Patients were examined on a highperformance MR system (SiemensSonata) equipped with a rolling table

platform (BodySURF). Patients wereexamined in the supine position afterbeing placed on the rolling tableplatform (BodySURF) The system iscommercially available and can bemounted on top of the original patienttable of most MR systems manufac-tured by Siemens Medical Systems. Foreasy movement in the z-direction, therolling table platform (length 270 cm,width varying between 50 and 33 cm)is placed on 7 pairs of roller bearings,which are easily installed on thepatient table. Signal reception isaccomplished using two elements of thespine coil, which are integrated intothe patient table, and the body phasedarray coil, which remains stationaryas it is attached to the original patienttable. Positioned on the BodySURFplatform, the patient glides throughthe isocenter of the magnet bore aswell as over the posteriorly locatedspine coil and under the anteriorlylocated body phased array coil.Axial T1-weighted 3D VIBE data setswere collected in five stations followingthe intravenous application of para-magnetic contrast covering the bodyfrom skull to the knees. Sequenceparameters included TR/TE = 3.1/1.2 ms,a flip angle of 12° and an acquisitiontime of 18sec. A slab thickness of312mm was used for all measurementsand the slice thickness amounted to3mm. In addition, the chest andabdomen were imaged in the axialplane before contrast withT2 HASTE (TR/TE= 1200/60 ms, flipangle 150°, slice thickness = 7mm,acquisition time = 2x16s) andT1 FLASH (TR/TE= 124/1.83 ms,flip angle 70°, slice thickness = 7mm,acquisition time = 19s).

Mean examination time amounted to11 (± 3) minutes. MRI findings werecompared to results obtained withskeletal bone scintigraphy and CT-scans of the abdomen and chest.

Results

Whole body MR scanning waspossible in all 59 patients. All examswere considered diagnostic. MRIrevealed excellent correlation withscintigraphy and CT examinations.All pulmonary and hepatic metastases>6mm detected by CT were identifiedby whole-body MRI. Besides allcerebral metastases >8mm weredetected by MRI. In three patients bothMRI and CT detected subcutaneousmetastases. Skeletal scintigraphydetected bone metastases in nineteenpatients. In eighteen patients MRIconfirmed theses lesions. In onepatients presenting with bonemetastases in the ribs MRI failed toreveal the osseous lesions, whereas infour other patients MRI detected bonemetastases missed by scintigraphyand eventually confirmed by biopsy.

Discussion

3D VIBE whole-body MRI screen-ing for metastases correlates wellwith CT and scintigraphy. Use of therolling table platform permits rapidwhole-body imaging in 11 minuteson average. The preliminary resultsof the described technique indicatethat 3D VIBE whole-body MRI hasthe potential to emerge as an all-encompassing alternative toconventional multi-modality tumorstaging strategies. �


2002 1st Place Proffered Paper–Research Oral Presentation

Evaluation of Ischemia in a Primate Model:A Feasibility Study Combining X-ray DigitalSubtraction Angiography and Fluoroscopy withMagnetic Resonance ImagingJulie Strandt-Peay, B.S.M., R.T. (R)(MR), Charles Strother, M.D., Beverly Aagard, M.D., Alan Rappe,Department of Radiology, University of Wisconsin Medical School, Madison, Wisconsin, USA

Purpose

Our experiments tested thefeasibility, in a primate, of inducingfocal cerebral ischemia throughmechanical obstruction of a corticalartery. The ischemia was monitoredwith repetitive Magnetic Resonance(MR) imaging (diffusion/perfusion andfast spin echo). The results ofreperfusion hyperoxygenated autologousblood were assessed with additionalMR imaging.

Methods

All studies were performed in asuite equipped for both Digital Sub-traction Angiography (DSA) withfluoroscopy (OEC 9800) and MRimaging (General Electric 1.5 LX).The use of a prototype table and cradleallowed easy and repeated transfer ofsubjects between the two modalities.This prototype table also allowedsubjects to remain in a fixed positionthroughout the experiment.

After induction of general endo-tracheal anesthesia, vascular accesssheaths were placed into both commonfemoral arteries. Routine physiologicmonitoring of ECG and O2 saturationwas performed throughout the dura-tion of the experiment. The subjectwas placed on a Styrofoam platformdesigned so that the MR coil could bepositioned and removed with ease.Baseline MR imaging was performedusing the following sequences.

A T1-weighted Sagittal wasobtained as a localizer: TR/TE 450/10,FOV 22cm, 256x224, 5mm skip 1mm,1 NEX. Axial and Coronal scans wereprescribed through the brain andimages were acquired using T2- and

Diffusion-weighted imaging (DWI),and, except for the control subjects,Perfusion weighted sequences. ACoronal FLAIR sequence was obtainedat the baseline as well. Parameterswere as follows: T2/DWI: TR/TE 10000/114, FOV 14cm, 256x128, 5mm skip1mm, 4NEX, scan time, 2:40. Imageswere acquired using B values of 2500and 1000, in both the axial and coronalplanes. Perfusion weighted scans usedTR/TE 1500/ 100, FOV 14cm, 5 mmskip 1mm with an injection of dilutedGadolinium 10 seconds into the 0:54scan. Coronal FLAIR images wereacquired using: TR/TE 10002/150,TI 2200, FOV is 14, 256x224, 5mm,skip 1mm and 2 NEX for a scan timeof 6:30. All images were acquired witha transmit / receive extremity coil.

The subject was then moved tothe x-ray angiographic modality andbaseline angiography of one of thecommon carotid arteries was per-formed. Using roadmap fluoroscopicguidance, a 2.3 F microcatheter wasnavigated into one of the middlecerebral cortical branches to a pointwhere a wedge position was obtained.Vascular obstruction was documentedby way of contrast medium injection.The subject was then moved immedi-ately back into the MR imager whereimages were obtained over a 90-minuteinterval. Then the arterial obstructionwas removed and additional imageswere obtained over the subsequent90 minutes. Some (N=3) animals wereallowed to survive for an additional3 hours and then sacrificed, others(N=4) were sacrificed immediatelyfollowing the 90 minute period ofreperfusion. One of the 8 had noimages taken because we could notgain arterial access.

Results

To date eight primate studies havebeen carried out in this facility. In allinstances diffusion/perfusion imagingallowed immediate recognition ofischemic tissue. While the DWIsequence was most sensitive, changescould be also detected on the T2 andFlair images within minutes ofcreating the arterial obstruction.T1 changes were noticed on thesubsequent localizers, presumablybecause of previous injections ofGadolinium used for the perfusionimaging.

Conclusions

Working within the speciallyconstructed suite and the operationof the prototype table made theprocedure very efficient. There arechallenges within the procedure thatneed to be addressed. Obvious arekeeping the field sterile during thetransfer from one modality to theother and most challenging, withinthe bore of the magnet. Catheters andpatient monitoring equipment mustnecessarily come down the bore of themagnet, over the sterile field whenobtaining the MR images. Physiologicalmonitoring must be disconnectedduring the multiple transfers due tothe length of the associated cables. It isfeasible to evaluate ischemic diseaseusing this method, however logisticalmatters remain that must be greatlyrefined before any human subjectstudies can be performed. �


Figure 1.

Figure 2.

2002 1st Place Proffered Paper–Clinical Poster

Optimization of a 15 Minute PV CE-MRA ProtocolUsing Automated Table Motion for Patients withIntermittent ClaudicationC.R. Comeau, R. Day, and S.D. Wolff, Cardiovascular Research Foundation and the Lenox Hill Heart and VascularInstitute, Advanced Cardiovascular Imaging, New York, New York, USA

Purpose

Accurate assessment of peripheralvascular disease is now a reality withcontrast-enhanced dynamic 3Dimaging (CE-MRA). Improved hard-ware and software allows for auto-mated table movement and the abilityto image the peripheral vasculature(PV) in multiple, sequential stationsfollowing a single contrast bolus. Themore advanced commercial MRIsystems offer the ability to adjust theimaging parameters from stage tostage to optimize image quality.Imaging parameters such as scanplane orientation, spatial resolution,imaging time, and phase encodingorder can be altered for each stage soas to optimize image quality. The totalimage acquisition time for a multistation study can be less than 1minute, enabling an entire study tobe completed extremely quickly. Wewould like to report our experiencewith a protocol that we optimized andwhich requires as little as 15-minutesof scanner time.

Methods

Considerations in optimizing ourPV CE-MRA protocol included:1) method of scout localization,2) coil choice, 3) contrast dose and rate,4) MRI parameter optimization5) contrast arrival determination,6) post processing, and 7) patienttolerance. Following protocol optimiza-tion, we have performed and evaluated265 PV CE-MRA clinical studies thatwere acquired on wither a GE SignaEchospeed or CV/i scanner. Theprotocol begins with scout acquisitions.Axial 2D-TOF (stages I and II) andsagittal gradient echo (stage III) imagesare acquired to guide placement of the3D imaging volume. The total imagingtime for acquiring the scouts is 1.5 min.The bolus arrival time is then deter-mined using a real-time protocol and a2-3 ml test bolus. For the MRA, patientsreceive 40-45 ml of gadolinium contrastusing a split-rate dose of 1.2-1.5 ml/secfor 15-20 cc followed by 0.8 ml/sec forthe remainder of the contrast. 3D

imaging is performed twice, first beforeand then during contrast administra-tion. Typical imaging times for stagesI, II, and III are 18, 12, and 30 secondsrespectively. Spatial resolution is2.8-3.2 x 2.3-2.5 x 1.4-1.6 mm. Follow-ing image acquisition, the two 3D datasets are then subtracted and filmed forinterpretation.

Results

The 2D-TOF scouts are quiteeffective for vessel localization andminimize the risk of arteries acciden-tally travelling outside of the 3Dimaging volume (Figure 1). No satura-tion pulses are used in the TOF se-quence so that veins as well as arteriesare visualized. This technique workswell even for those patients with severeperipheral arterial occlusive disease,because veins travel in the same generallocation as arteries and therefore markthe diseased arterial bed. Sagittalgradient echo images are acquired forstage III since they are faster to acquireand there is less variation of theiranatomic location. The acquisition timesfor the first two stages of the 3-Ddynamic imaging protocol are limited soas to avoid venous enhancement beforethe start of stage III image acquisition.The more linear trajectory of thesuperficial femoral arteries in stage IIallows for the acquisition of fewer slicelocations and hence a shorter imagingtime than for stage I. Stage III isacquired with an elliptical (true-centric)phase-encoding order so as to minimizeearly venous enhancement. Imagingtime for stage III is longer than for theother two stages to provide adequatesignal-to-noise ratio (SNR) for the smallinfrapopliteal arteries. We chose not touse a peripheral vascular array coilbecause it increases set-up and clean-uptimes, leads to decreased signal homoge-neity and is uncomfortable for manypatients. Using this protocol, imagequality is generally excellent and in only4% of our studies did venous contamina-tion interfere with the assessment of theinfrapopliteal arteries. Image subtrac-tion significantly improves visualizationof smaller arteries.

Conclusion

Our protocol yields consistent, highquality PV CE- MRA studies with avery low incidence of patient call-backs(Figure 2). This protocol is optimizedfor our patient population, which isprimarily referred for evalu-ation ofintermittent claudication. For thosepatients with more severe peripheralvascular disease (i.e. non-healing ulcers,gangrene, rest pain, etc.), we routinelyacquire 2D-TOF images of the distallower extremities and feet before CE-MRA. This increases the total imagingtime for a minority of our PV CE-MRAstudies. �


2002 1st Place Proffered Paper–Research Poster

A Step by Step Method for CoronaryMagnetic Resonance AngiographyR. Niemczura, C. Callahan,* J.P. Finn, V. Deshpande, S. Shea, D. Li, R. McCarthy and J. CarrNorthwestern University, Chicago, Illinois, USA, *Advanced MRI Consulting, Inc., Evergreen Park, Illinois, USA

Purpose

Coronary artery disease (CAD) isthe leading cause of death in theUnited States, making early detectionand treatment a high-priority goal.1

Recent MRI advancements have madeimaging of coronary arteries morepractical. Coronary MRI involvessophisticated protocol designs andtechnical challenges to deal withcardiac and respiratory motion.2-3 Thepurpose of this study was to evaluate atechnique for step-by-step preparation,localization and acquisition in order tosimplify coronary MR imaging.

Methods

Six normal adults and four adultswith CAD were examined. Informedconsent was obtained from all partici-pants. Procedures were performed on aMagnetom Sonata, 1.5 Tesla MRSystem, Siemens Medical Solutions,Iselin, New Jersey. Step 1, Prepara-tion: Chest area shaved (if needed),cleaned with NU-PREP (abrasivescrub), and palpated for apex beat.Electrodes placed along left ventricularaxis for cardiac triggering. Patientscoached on breath holding techniquesfor consistency/location of vessel ofinterest throughout exam. Anteriorbody phased array coiled utilized foroptimum signal. Step 2, Localization:Three plane scouts provided initiallocalization. Using 3D axial obliquescout parallel to left coronary artery(LCA) angle, the LCAs were localized

(Figure 1). The LCA was identifiedbranching off the aorta above the leftcoronary cusp while traveling inferiorlybefore bifurcating into left anteriordescending (LAD) and circumflex (LC).LAD was followed laterally downinterventricular septum. Using a cinesagittal oblique sequence perpendicu-lar to the LCA, mid diastolic cycle wasestablished for acquisition window.Using orthogonal 3D axial scoutperpendicular to right coronary artery(RCA) (Figure 1), RCA was localizedsuperior to right coronary cusp andfollowed anteriorly along the A-Vgroove. Step 3, Acquisition: Using the3D scouts, 3-point tool for orientationwas used for the high-resolutioncoronary acquisitions (Figure 2).Parameters were as follows using 3DTrue FISP: TR/TE = 4.05/2.03 ms, flipangle = 70°, bandwidth = 810 Hz/pixel,FOV = ( 166 –190 ) X 380 mm2, Matrix= ( 116 – 141 ) X 512 with an in-planeresolution of (1.0-1.2) X .7 mm2,# of phase encoding steps per cardiaccycle = 25-31, slab thickness =18- 24 mm, # of partitions = 12, # ofdummy pulses = 20, a fat saturationpulse and magnetization prep wereapplied before data acquisition. Anaxial-oblique orientation was used forthe LCA (Figure 3) and a sagittal-oblique orientation was used for theRCA (Figure 4). For image evaluation,MPR and maximum intensity projec-tion (MIP) were performed usingstandard Siemens software.

Results

This step-by-step method resultedin successful visualization of LM, LAD,and RCA arteries in all ten subjects.Proper electrode placement enabledreliable gating, and consistent breathholding minimized respiratory motion.The scout and 3D volume sequencesprovided excellent localization refer-ences. The cine provided diastolicinformation for optimum acquisitionwindow timing. The high-resolutionTrue FISP acquisition facilitated high-quality visualization of coronary arteryanatomy.

Conclusion

Imaging of coronary arteries withMRI is becoming practical and topical.The imaging process is demanding, butby utilizing a step-by-step method,consistent preparation can provide astable platform for vessel localizationand imaging coronary artery anatomy.�

References1. Danias, P. Cardiac Magn. Reson. Imag. 1998;

16: 207-225.2. Deshpande, V. Magn. Reson. Med. 2001; 46:

494-502.3. Li, D. Radiology. 2001; 219: 270-277.

Figure 1. Position for 3Dlocalization.

Figure 2. 3-point positioningfor LCA.

Figure 3. True FISP LCA. Figure 4. True FISP RCA.


Clinical Focus and Research Focus Oral and Poster Presentersat the SMRT Annual Meeting

Bobbie Burrow,Department of Radiology,Emory University Hospital,Atlanta, Georgia, USA“Imaging the ProstateUsing Phased ArraySurface Coils”

Michael Kean,Royal Children’s Hospital,Melbourne, Australia“Direct Contrast Enhanced3D MR Venography”

Mark A. Smith,Children’s Hospital,Columbus, Ohio, USA“Utilizing Fast GradientEcho as a Breath HoldTechnique in theQuantitative Assessmentof Hepatic Steatosis”

Cathy Blaesing,Deptartment of RadiologyMRI Division, Universityof Michigan HealthSystem, Ann Arbor,Michigan, USA“Optimization Techniquesof Gadolinium BolusAdministration for NeckMR Angiography”

Anne Dorte Blankholm,MR-Centre, SkejbySygehus, AarhusUniversity Hospital,Aarhus, Denmark“Contrast Enhanced MRAngiography of thePulmonary Veins as aClinical Approach”

Silke Bosk,Department of DiagnosticRadiology, UniversityHospital Essen,Essen, Germany“3D-Navigator MRA of theCoronary Arteries:Comparison of Gradient-Echo and Steady State FreePrecession Sequences”

Pablo Buzzi,MRI Unit, Emprendimientosde Salud S.A., HospitalNaval “Pedro Mallo,”Buenos Aires, Argentina“MRI Technologist’s Role inthe Diagnosis andManagement of Acute AorticDissection”

Anna Crawley,MRIS Department,Addenbrookes Hospital,Cambridge, England,“Does MRI Have aDiagnostic Role withinthe Breast ScreeningSituation?”

Denise Davis,Department of Radiology,University of Pittsburgh,Pittsburgh, Pennsylvania,USA“In-Vivo Quantification ofSkeletal Muscle LipidContent by MagneticResonance Imaging”

Tsukasa Doi,Radiological TechnologistMRI Unit, CentralDepartment of Radiology,Nara Medical UniversityHospital, Shijo, Kashihara,Nara, Japan“Evaluation of Appearancewith High Spees CE-3DDSA”

Benny Ehrnholm,MR Center, NorwegianUniversity of Scienceand Technology,Trondheim, Norway“MR Imaging withQuantitative Diffusion inPatients with Parkinson’sDisease”

Kaye Evans,Department of Radiology,Department of Neurology,University of Michigan,Chicago, Illinois, USA“Improved MRI Protocolsfor Patients withRefractory Epilepsy”

Eun Hoe Goo,Department of DiagnosticRadiology, Seoul NationalUniversity Hospital, Seoul,Korea“The Effect of Matrix Sizeon Contrast-EnhancedMRA of Portal Venous”

Kuniaki Haradak,Sapporo Medical University Hospital,Sapporo, Hokkaido, Japan“Absolute Quantitative Analysis for theIntramyocellular Lipid”

(photo unavailable)

Ho Yong Jung,Department of DiagnosticRadiology, Inje University,Sang Gye Paik Hospital,Seoul, South Korea“A Study for the BetterQuality of Fat Suppres-sion Images by Varyingthe ChemSAT Flip Angle”



Clinical Focus and Research Focus Oral and Poster Presenters

Nondas Leloudas,Northwestern University,Chicago, Illinois, USA“Evaluating Cardio-thoracic Pathology withContrast EnhancedSub-second 3D MRA”

Marcella Montequin,GE Medical Systems,Baltimore, Maryland, USA“Dobutamine MRI vs. FirstPass Myocardial StressPerfusion”

Ian T. Morris,MRI Unit, Departmentof Radiology, Sir CharlesGairdner Hospital,Nedlands, Australia“Application of FunctionalBold MRI in Pre-OperativeNeuro-surgical Planning”

Kate Negus,Barwon Medical Imaging,The Geelong Hospital,Geelon, Victoria, Australia“Diffusion Imaging–The Effect of Resolution onSensitivity for DetectingIschemic Lesions”

Nita Patel,Department of Radiology,University of Michigan,Ann Arbor, Michigan, USA“Magnetic ResonanceSpectroscopy: A Tool forAssessment of BrainMetabolism”

R.K. Puni,MRI Unit, UrologyDepartment, SolihullHospital, West Midlands,England, UK“Magnetic ResonanceImaging in ProstaticCancer: A ComparisonStudy Between an InflatableEndorectal Coil with theSynergy Body Coil withPathological Correlation”

Katrina Read,Department of Radiology,University of MarylandMedical Systems,Baltimore, Maryland, USA“MR Technique ForEvaluation of Adult LivingDonor Liver TX”

Gunvor Robertsen,MR-Center, Trondheim,Norway“Benefits of StrongGradients”

Laurian Rohoman,Department of Radiology,Montreal General Hospital,McGill University HealthCenter, Montreal,Quebec, Canada“Added Value of HighResolution Fast-SpinEcho Relative to SingleShot Fast Spin Echoin the Evaluation ofBile Duct Obstruction”

Carol Rozell,Department of Radiology,MR Research Center,University of PittsburghMedical Center, Pittsburgh,Pennsylvania, USA“A Protocol for ImagingBrain Lithium in BipolarPatients with MagneticResonance Spectroscopyon a High Field Scanner”

Susan Ryan,Department of Radiology,LaGrange MemorialHospital, LaGrange,Illinois, USA“MRI As A DefinitiveDiagnostic Imaging Toolin Assessing Patients forVertebroplasty”

Sandra E. Kaminsky,Department of Radiology,Wake Forest UniversityBaptist Medical Center,Winston-Salem,North Carolina, USA“Diagnosing UpperExtremity Veno-OcclusiveDisease: A Comparisonof GD-Enhanced MRto ConventionalVenography”

Scott Kurdilla,Department of Radiology,MR Research Center,University of PittsburghMedical Center, Pittsburgh,Pennsylvania, USA“Reward and Punishmentin the Striatum”

Zahid Latif,MR Research Facility,Wayne State University,Detroit, Michigan, USA“Reduction of fMRI MotionArtifacts andReproducibility of HeadPositioning Using CustomFitted Foam Head Holder”

Shirase Ryuji,Division of Radiologyand Nuclear Medicine,Sapporo MedicalUniversity Hospital,Sapporo, Hokkaido, Japan“Visualization ofAdamkiewicz Arteryusing MRDSA”



Motomichi Sakata,Division of Radiologyand Department ofOtorhinolaryngology,Sapporo MedicalUniversity Hospital,Sapporo, Hokkaido, Japan“High Resolution MRIof the Labyrinth Selectionof Scan Parameter with3D-FSE”

Elin Smenes,MR-Center, UniversityHospital, Trondheim,Norway“Presurgical Mapping ofEloquent Brain of BrainTumor Patients with Boldcontrast fMRI”

Mark Smith,Children’s Hospital andThe Ohio State UniversityMedical Center, Columbus,Ohio, USA“General Guidelines andRecommendations forClinical MRI of the CanineBrain at 1.5T”

Cho Sup Soon,Department of Radiology,Seoul National UniversityHospital, Seoul,South Korea“A Study on the Change ofthe Body Temperature inUsing MRI”

David Stanley,GE Medical Systems,Milwaukee, Wisconsin, USA“Initial Experiences ofCardiac MRI at 3T”

George Tezapsidis,Radiology Departement,General HospitalPapagerogiou,Thessaloniki, Greece“MRI Comparative Studyof Two Methods Used forthe Calculation of IronDeposition to Liver and theCalculation of the T2 Timeof Myocardium in Patientswith Thalassemia” and“Direct MR VenographyUsing ParamagneticContrast Agent”

Y.M. van der Meulen,Department of Radiology, UniversityMedical Center Nijmegen, Nijmegen,The Netherlands“Short and Long Echo Time in 1H MRSpectroscopy”

(photo unavailable)

Judy Wood,Department of Radiology,Northwestern MemorialHospital, Chicago,Illinois, USA“High Resolution 4DBreast MRI”

Clinical Focus and Research Focus Oral and Poster Presenters

Scenes from the Friday eveningPoster Exhibit and Walking Tour.This event provides an opportunityfor SMRT meeting attendees tointeract with Poster Presentersand discuss their work.

At the Poster Walking Tour (l to r) HeidiBerns, 2001 SMRT President, Lisa Vogt,Marketing Manager, Mallinkrodt, Inc.,Gina Greenwood, SMRT Program Chair, andThomas Coogan, Senior Product Managerfor MR Products, Mallinkrodt, Inc.


Stroke remains the third leadingcause of death throughout industri-

alized countries. The incidence of strokeis approximately 250-400 per 100,000people, with a mortality rate of nearly30%. Major break throughs in pharma-cological treatments and therapies haveprompted a world-wide campaign toeducate patients about the earlysymptoms of stroke. The early diagnosisof stroke is crucial. Current medicalpractice states that if neurons aretreated while still in the process of dying,the process may be reversed, resultingin less permanent damage.

The two major factors for patientsreceiving early treatment involve: (1)Getting the patient to a hospital as soonas possible after the onset of the stroke(this is where stroke symptom aware-ness education is crucial), and (2)Having the mechanisms in place forearly detection (MR scanners should bepreprogrammed with an acute strokeprotocol and must have diffusionweighted (DWI) and perfusion weighted(PWI) imaging capabilities).

Many clinical MRI sites are nowutilizing protocols that assess the effectsof thrombolytic therapy in acute strokevictims. If your facility is not yetinvolved in stroke imaging, you soonmay be. The latest “fashion trends” indiagnostic neurology are moving towardthe administration of tissue salvagingpharmaceutical agents. The remainderof this article shall offer explanations asto how neurologists are requesting theMRI acute stroke protocols (i.e. whycertain pulse sequences are of benefit ornot).

Here is a sample protocol for anacute stroke patient. Your protocol mayvary slightly because distinct radiolo-gist, neurologists, and pharmaceuticalmanufacturers may have differentpreferences:

Acute MRI Stroke Protocol:1. Scout/Localizer..2. Diffusion Weighted Imaging (DWI).3. MR Angiography (MRA).4. Fluid Attenuated Inversion Recovery

(FLAIR).5. Perfusion Weighted Imaging (PWI).6. T1/T2 Weighted (Optional).

Early Stroke Detection Utilizing MRIPart II: The Stories the Imaging Sequences TellRobin Greene-Avison, C.N.M.T., R.T. (N)(MR), The University of Kentucky, Lexington,Kentucky, USA. Part I of this article: “What is a Stroke,” appeared in Signals issueNumber 38, 2001, Issue 3.

Figure 1a. Autoshim process.

Figure 1b. Manual shim process.

Figure 2.


ShimmingWe are familiar with the use of

Scout or Localizer images to ensureour successful positioning. In acutestroke imaging, is it often useful toutilize these images to perform the taskof manual shimming. Shimming refersto the process of making adjustments tosmall shim currents in the magnet inorder to regain any of the homogenietieslost by putting objects into the magneticfield (i.e. coils, patients, etc.) Mostscanner manufacturers build theshimming into the pulse sequences, sothat the computer makes the necessaryadjustments without any input from thetechnologist.

MR technologists who are knowl-edgeable in the art of MR Spectroscopywill already be familiar with theprocedure for performing a manualshim adjustment. Manual shimmingrequires practice before it can beperformed correctly and efficiently.

Magnetic susceptibility refers to themagnetic conformity of material to anexternally applied magnetic field.Manual shimming is extremely impor-tant in DWI and PWI (Echo PlanarImaging [EPI] based sequences) becausethese sequences are highly susceptibleto distortion due to susceptibilityartifacts.

Figure 1. shows two DWI images.Figure 1a. demonstrates a studyperformed with the manufacturer’sautoshim process. Figure 1b. demon-strates the study on which the technolo-gist performed the manual shim:

MR technologists who wish to learnhow to perform this function on theirspecific MR scanner should be able tofind instructions for manual shimmingin the application manuals or by callingthe local service or applications repre-sentative.

Diffusion is basically the random“walk” a molecule takes as it bumps intothings that change its direction. As themolecule bumps into things it losessome of its energy. Therefore, on anormal diffusion weighted image, theareas of normal tissue will appear dark,because of this energy loss.

Ischemic tissue is believed tochange the dynamics of various biologicionic pumps in the area. This changesthe gradients and the diffusion isreduced. These areas in which diffusionis compromised will appear bright onthe MR image. See figure 2.

The superior sensitivity of DWIenables an acute stroke to be identifiedbefore a conventional T1 or T2 weightedsequence (which may require severalhours to elapse before the occurrence ofan acute stroke episode can be detected)Decreases in diffusion can be seen asearly as 1 hour post onset of symptomswith DWI. Figure 3a, b, c.

MRAs are usually requested fordetection of the presence of a largevessel occlusion. The MRA informationcan assist in the interpretation of theperfusion weighted imaging sequence.The inclusion of the MRA in the acutestroke protocol is a matter of preference


Stroke, Part II continued


Figure 3a. DWI. Figure 3b. T2-weighted image.

Figure 3c. T1-weighted image.

and may not be necessary. This isespecially true if the time to perform thescan would prevent the patient fromreceiving thrombolytic therapy withinthe critical “administration after strokeonset” window.

FLAIR imaging is also not crucial,but may be of use to clinicians who wantto compare the images with DWIsequences. Lesion volumes may be moreaccurately assessed with FLAIRbecause this sequence suppresses flowartifact from cerebral spinal fluid (CSF).By suppressing the signal from CSF inthe ventricles and sulci, the lesionboundaries will be less ambiguous.

If you compare the boundaryaround the abnormal vs normal areas ofdiffusion, on the images in Figure 4a, b,slight differences in the ischemic areawill be seen. The ability of FLAIR tosuppress CSF motion artifact that maybe present in the DWI will enable theclinician or researcher to measure thestroke volume with more precision.

Perfusion: The PWI can bequalitatively inspected for the presenceof a perfusion defect without the needfor image post-processing. The techniqueis a dynamically acquired imagesequence, during which a rapidly

injected bolus ofcontrast agent isadministered after theacquisition of severalbaseline images. Theinjection of IV contrastagent distorts themagnetic field aroundthe capillaries (andlarge blood vessels).This distortionproduces a signal loss

due to differences in magnetic suscepti-bility (T2 shortening). Tissues withhigher flow show greater signal loss.Thus, normal tissue will demonstrate adramatic signal drop and recovery.Ischemic tissue will show lack of orcompromised response.

The IV contrast bolus must betimed perfectly in order to use theadvantage of the sequence for differenti-ating between dead and strugglingneurons. If your imaging site is fortu-nate to have a power injector, then poorbolus administrations will be mini-mized. IV infiltration is an exception.

The bolus should be sufficiently fastto produce a 25-40% drop in signalintensity on passage. The advantage ofincluding the PWI sequence becomesmore apparent when considering thepharmaceutical study MRI protocol.Figure 4c shows a baseline image and4d shows the signal drop in the viabletissue upon entry of the contrast agent.

Conventional MRI T1- and T2-weighted images were listed in theprotocol as options because in the acutestages of stroke both will be negative.The diagnostic advantage with thesesequences is only if the patient did nothave a stroke.

How MRI Can Be Used in Determin-ing Pharmaceutical Efficacy inAcute Stroke Victums

According to animal studies,thrombolytic therapy appears to bebeneficial for the treatment of acuteischemic stroke. However, there areseveral grounds in the determination ofmatching the pharmacological efficacyin humans. The most crucial factor isthe time limitation. Early therapy mayhelp to salvage cells that are in theprocess of dying. Delivering the thera-peutic too late will not save the dyingcells.

MRI techniques offer promise as anobjective method to help assess differentpharmaceutical agent's efficaciousnessin saving dying neurons. As well, thesestudies assist in the selection as to

which patients will best benefit fromtreatment.

Ideal imaging protocols will assist in:1. Identification of the size and location

of the ischemic penumbra. That is thestunned but still salvageable tissue.

2. Identification of the infarct core. Thatis the irreversibly injured tissue.

3. Identification of (via MRA) anocclusion that may benefit fromtherapy and can benefit from a lateradministration time as well.

4. Quantification of stroke changes withtime.

5. Selectivity for inclusion/exclusioncriteria.

6. Accessibility to a range of tissuedamage types.

7. Volume of Stroke which will increasewith time.

8. Determination of whether pharma-ceutical therapy arrests the progressof the death of cells.

The protocol previously describedminus the Spin Echo T1- and T2-weighted images offers an example of anadequate study design that providesscientists with qualitative as well asquantitative information for pharmaco-logical investigations. (Remember, theT2 images typically do not show changesindicative of a stroke event until manyhours have elapsed. The spin echoimages may be omitted in these studiesto save time).

The essence of what MRI relatesabout pharmaceutical efficacy isindicating the potential areas of strokethat can be reversed. Certain areas onthe image represent the primary site ofthe stroke (infarct core- denoted asorange). This tissue has been irrevers-ibly compromised and will die. The DWIwill appear hyper-intense and the PWIwill demonstrate no flow (a classicalmismatch). The secondary stroke sitewill surround the infarct core, and isreferred to as the penumbra (denoted inblue). This area is the reversiblediffusion abnormality and containstissue / cells that are possibly salvage-able but are at high risk.

Within the penumbral area (blue),the DWI is normal and the PWI has aperfusion deficit. If untreated, the DWIcore lesion will grow into the penumbralregion. Note how the area of injury looksslight larger in figure 6b than in figure6a. This difference in lesion size betweenthe DWI and PWI is the penumbralarea and is the target area for throm-bolytic therapy.

Figure 4c. Baseline. Figure 4d. Bolus entry.

Figure 4a. DWI. Figure 4b. FLAIR.


Figure 7.

Figure 8.

Normal

Penumbral

Infarct core

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Stroke, Part II continued

There are models that demonstratethe natural history of early diffusionlesions is to grow, over time, into part orall of the perfusion abnormality. Thus,mismatch symptoms are more favorablefor those receiving thrombolytic therapy.

What investigators are racing tofind out is, whether or not the infusionof certain pharmaceutical agents canprevent the migration of the infarct coreinto the area of the penumbra, thereby,salvaging the dying cells residing in thepenumbra. This in turn may reducepatient suffering by confining thepermanent, long term effects of thestroke. See figure 7.

In addition to quantifying the DWI /PWI data in order to extract match/mismatch information, the PWI can alsoprovide additional dynamic information.The PWI imaging allows the creation ofbolus contrast delivery curves. WhenT2* weighted images are rapidlyacquired following a bolus injection ofthe intravascular paramagnetic contrastagent, Gd-DTPA, changes in local bloodvolume over time can be evaluated.

It should be apparent, that thebolus needs to be intact and delivered atthe proper rate in order to perform theperfusion curves. These curves are beingcalculated to distinguish normal frominfarct core or penumbral region. Seefigure 8.

The natural history of most lesionsis enlargement from the acute to chronicperiod. Lesions may not reach their finalvolume for as long as 24 hours. The PWIcan be qualitatively inspected withoutthe need for image post processing forthe presence of a perfusion defect and ofan obvious diffusion-perfusion mis-match. For quantification of perfusion

defect, the time curve of signal change isused to derive relative indices of bloodvolume, blood flow, and mean transittime (MTT). The MTT map delineatesthe region of perfusion delay and is usedfor further quantification of hypo-perfused lesion volume.

One of the promising applicationsfor EPI MRI has been to evaluate theneuro-protective effects of pharmaceuti-cal agents in clinical trials. By studyingpatients longitudinally (acute, andseveral follow-ups) MRI in conjunctionwith other neuro-evaluations may tellresearchers if the particular therapywas efficacious. There are currentlymany manufacturers of therapeuticagents which are being evaluated bymulti-center, multinational trials. Thesetrials include MRI data analysis as partof the stroke evaluation.

To conclude, it must be rememberedthat the most important point is torecognize the symptoms of stroke andget the patient to a proper facility assoon as possible. With more and moreclinical MRI systems possessing thetools required to visualize the infarctcore from the penumbral regions, moreand more patients my benefit frompossibly being included in one of theneuro protective therapies. Thesetherapies will eventually becomeroutine practice in neurology. Once theclinical trials reveal which of the neuro-protective agents are efficacious,neurologists will be able to treat allpatients with the hope of saving dyingneurons. This will be an attempt toreduce the level of long term conse-quences as the result of stroke. �

Figure 5.

Figure 6a. DWI. Figure 6b. PWI.

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