Development of a common MRI protocol for the collaborative European neuro trauma effectiveness research in TBI study

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1 Development of a common MRI protocol for the collaborative European neuro trauma effectiveness research in TBI study Poster No.: B-0294 Congress: ECR 2015 Type: Scientific Paper Authors: P. Pullens 1, J. Verheyden 2, W. Van Hecke 2, A. Maas 1, P. M. Keywords: DOI: Parizel 1 ; 1 Antwerp/BE, 2 Leuven/BE Neuroradiology brain, Trauma, MR, MR-Diffusion/Perfusion, MR-Functional imaging, Efficacy studies, Imaging sequences, Structured reporting, Quality assurance /ecr2015/B-0294 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Purpose CENTER-TBI [1,2] is an international consortium study, which aims to improve care for patients with traumatic brain injury (TBI). A key component is neuroimaging to characterize the disease course. Over the next years, 1,800 patients with mild, moderate and severe TBI will undergo dedicated (follow-up) MRI sessions from as early as 72 hours after presentation up to 2 years. MRI scans will be collected at 30 European sites. The challenge is to develop standardized imaging protocols to be used in a clinical setting using 3T MRI vendor sequences. Images for this section: Page 2 of 10

3 Fig. 1: CENTER-TBI MRI sites overview. Page 3 of 10

4 Methods and materials 72 clinical sites (hospitals, imaging centers) are enrolled in CENTER-TBI. 30 centers will collect 3T (follow-up) MRI on 1800 patients with mild, moderate and severe TBI from as early as 72 hours up to two years after injury. The imaging protocol was based on the TRACK-TBI [3] protocol and consists of 3D-T2, 3D-FLAIR, 3D-T1, SWI, DTI and rs-fmri. Total imaging time is approx. 45 minutes. T2, FLAIR and T1 are based on recommendations from TRACK-TBI; SWI based on [4]; DTI 2mm isotropic with b=1000 s/ mm 2, 64 directions; 7 minutes rs-fmri with TR=2500ms. The protocol was developed on a reference scanner (Siemens Magnetom TIM Trio) and then converted to GE and Philips with vendor assistance. The same healthy subject was scanned at each vendor (Siemens Trio/Skyra, Philips Achieva and GEE 750W). Based on the results, sequence adjustments were made to find the common denominator. A fully automated image upload tool [5] was developed to facilitate DICOM upload from within each site. Images for this section: Page 4 of 10

5 Fig. 1: CENTER-TBI MRI sites overview. Page 5 of 10

6 Results MR Sites Fig. 1 shows an overview of the included MR sites. Not all sites have provided the required information (scanner type, serial number, software version) for participation in the study. Sequences Highly similar 3D-T2, 3D-FLAIR and 3D-T1 images were obtained, see fig 2, but adjustments of stock sequences were needed. T1 MP-RAGE (Philips-Siemens) and IR-SGPR (GE) were accelerated with a factor two. FLAIR, SWI, DTI and rs-fmri required most adjustments. To obtain visually similar contrast, FLAIR inversion time is 1650ms on Philips Achieva, 2100ms on Siemens Trio, 1650ms on Skyra and 2152ms on GE 750W. SWI was implemented successfully on GE, Philips and Siemens based on [3]. Due to unavailability of SWI at participating Philips sites, SWI was replaced with 3-D T2*. It was not possible to fully standardize DTI due to limitations in the number of directions that are available on participating systems (Siemens max 30 or 64, Philips max 32 and GE max 64), and secondly because of sequence implementation and hardware (gradient) differences. DTI TR/TE=9900/92ms on Siemens Trio, 11600/91ms on Skyra, 10062/97ms on Philips Achieva, 15550/74ms on GE 750W. For rs-fmri, we could not achieve the same coverage on all scanners in a TR=2500ms (41 slices at Siemens Trio, 41 on Skyra, 45 on Philips Achieva, 32 on GE 750W). Siemens and Philips B1 correction was applied on all sequences except SWI. On GE, B1 adjustment ("PURE") is not available at selected sites. Total scan time for this protocol on Siemens Trio is 40:05, Philips Achieva 47:10 and GE 750W 46:48. In figure 3 an example of a patient scan is shown. Images for this section: Page 6 of 10

7 Fig. 1: CENTER-TBI MRI sites overview. Page 7 of 10

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9 Fig. 2: Example images (healthy subject, male 34 y/o) at 3 different scanner vendors acquired with the CENTER-TBI protocol. Fig. 3: TBI patient (59 y/o male, fall from 2.5m ladder) scanned according to the CENTER- TBI protocol. Besides 3D T2, 3D FLAIR, 3D T1, the protocol includes SWI, DTI and rsfmri. Fiber tracts and Independent Component Analysis (ICA) results are shown as an example of data quality. Page 9 of 10

10 Conclusion Harmonization of an imaging protocol on such a large multi-site, multi-vendor scale with many different clinical set-ups is a daunting challenge. Vendor specific sequence implementations, licenses and software release versions cannot be ignored. Our experiences in setting up MR acquisition protocols for CENTER-TBI demonstrated great challenges, but these could largely be overcome. We consider this work as a 'trailblazing' effort and, hopefully, future studies will be able to benefit from the foundations laid down now. Personal information Pim Pullens, Ph.D. Dept of Radiology, Antwerp University Hospital & University of Antwerp, Antwerp, BE. pim.pullens AT uantwerpen.be Jan Verheyden, MSc icometrix NV, Leuven, BE. Wim van Hecke, Ph.D. icometrix NV, Leuven, BE. Andrew Maas, M.D. Ph.D. Dept of Neurosurgery, Antwerp University Hospital & University of Antwerp, Antwerp, BE. Paul M Parizel, M.D. Ph.D. Dept of Radiology, Antwerp University Hospital & University of Antwerp, Antwerp, BE. References [1] [2] Maas, A et al. Neurosurgery Jan;76(1):67-80 [3] Yue, JK et al. J Neurotrauma 30(22): (2013) [4] Haacke EM et al. jmri 32: (2010) [5] Page 10 of 10