High Field Spine Imaging

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1 Department of Radiology University of California San Diego 3T for MR Applications Advantages High Field Spine Imaging Increased signal-to-noise Better fat suppression Increased enhancement with gadolinium Definite measurable benefits for MRS, John R. Hesselink, M.D. MRA, & Diffusion tensor imaging 3T for Spine Imaging Problems 1. Increased SAR (Large FOV met surveys with FSE) 2. Increased chemical shift 3. Decreased T1 contrast 4. Increased susceptibility 5. Dielectric effects 6. More flow artifacts 7. Increased gradient noise (130 db) 8. Increased cost of purchase & maintenance Increased SAR Increased chemical shift 3T for Spine Imaging Problem Solutions Trade-offs 1. Parallel imaging 2. Shaped RF waveforms 3. Flip angle for acquisition rf pulses 4. ETL, TR 5. 3D acquisition 1. Bandwidth 2. FOV, Matrix 3. Fat saturation None, scan time None Minimal Scan time Scan time but SNR SNR but min TE SNR but resolution SAR & may scan time 3T for Spine Imaging 3T for Spine Imaging Problem Solutions Trade-offs Problem Solutions Trade-offs Gray CSF on T1 images Increased Susceptibility Dielectric effects 1. Reduce flip angle 2. T1 FLAIR 1. Bandwidth 2. Matrix & FOV & slice thickness 3. Parallel imaging 4. TE for T1WIs 1. High electric permittivity pads 2. Multi-transmit RF Minimal Minimal SNR but min TE SNR but resolution None, scan time Better, SNR Cumbersome None More flow Artifacts Increased gradient noise Increased cost of magnet & maintenance 1. Sat pulses 2. Change phase direction 3. Use gradient-echo 1. Better ear plugs 2. Acoustically shielded bore liners 1. Hire the Terminator as your negotiator SAR & may scan time May scan time SNR Cost Cost???

2 Parallel Imaging Decreases SAR, Susceptibility, Distortion C-Spine Sequences 32 channels 102 coil elements Siemens TIM Trio 8 channel SENSE Head coil 16 channel SENSE NeuroVas 12 element CTL Spine coil 6 channel SENSE Torso coil 8 channel ASSET Brain 8 channel ASSET NeuroVas 8 channel CTL Spine coil 16 channel ASSET Head- Neck-Spine Array (29 e) All manufacturers have 8 channel systems, moving toward 16 & Cervical Axial Sequences Cervical Axial Sequences T2 FSE T2 3D FRFSE T2 GRE T2 FSE GRE - MERGE Cervical Axial Sequences Post Gd Sequences COSMIC FIESTA / 3D CISS T1 with Gad & FS

3 Disk Extrusion Demyelinating Disease OSP Ballaria, Bologna, Italy NeuroSkeletal Imaging, Florida Susceptibility Artifact Hardware Post-op Cervical Spine Increase Bandwidth, Frequency SI / RL, Avoid GRE & Fat Suppression - IDEAL Contrast: Iterative Decomposition of Water and Fat With Echo Asymmetry and Least-Squares Estimation water fat Acquired Data Cervical Spine: Neurofibromatosis Echo 1, TE= - /6 Iterative Reconstruction Water Only Fat Only Echo 2, TE= /2 Echo 3, TE= 7 /6 In-phase Out-of-phase T1W Fat Sat FSE T1W IDEAL-FSE *Reeder et al. MRM, 54: (2005) 18 / GE / Courtesy Scott Reeder UW-Madison

4 3T Spine Protocols Cervical Spine Thoracic Spine Sequence TR/TE/ET/NEX FOV Slice Matrix Phase Bandwidth Sagittal T2 FSE 4000/110/24/4 22 3/ x224 SI 31.2 Sagittal T1 FLAIR 3300/9/8/2/TI / x224 SI 41.7 Sagittal STIR 3200/24/12/3/TI / x224 SI 31.2 Axial T2 FSE 4500/120/21/4 20 3/1 448x224 AP 41.7 Axial T2 FRFSE 2200/100/39/ /0 320x224 AP&RL 41.7 Axial MERGE 450/11/1/2/20deg 20 3/ x192 AP 41.7 Sag T1 FSE Gd 600/11/4/3 24 3/1 384x224 AP 31.2 Axial T1 FSE Gd 700/10/3/3 24 3/1 384x224 AP 31.2 Thoracic Spine Metastases T1 FLAIR at 3 T T2 FSE T1 FLAIR T1-Gd-FS - Courtesy: Meng Law, Mount Sinai, NY Sagittal T2 & T1 FSE Sagittal Lumbar Spine T2 FSE T1 FSE

5 Phase-artifacts & Chemical Shift Phase Frequency Direction Phase AP Phase SI Sagittal T2 FSE Effect of Vacation No SAT Bands, Phase AP, Low Matrix 3T MR-Cat Scan Fusion Axial Lumbar Sequences T2 FSE T1 FSE

6 Phase-artifact Reduction Lumbar Disk Protrusion Crossed SAT Bands (Vision) Proton-Density Axial No Coil No Signal Series 1 Series 2 T2 FSE T1 FSE PD FSE Post-Gd T1 with FS 1.5T Spine Imaging Post-op Lumbar Spine

7 Post-op Lumbar Spine 1.5T Spine Imaging Post-op Lumbar Spine Post-op Lumbar Spine History: 32 y/o male with back & leg pain Dx: Spinal stenosis Disk Protrusion Disk Extrusion - -

8 - Multiple Sclerosis {Page 2} History: 43 y/o man with back pain for several months {Page 2} 553 CV Dx: Hemangioblastoma History: 36 y/o man with a chronic C6-8 radiculopathy {Page 2} Dx: Spinal dural AVM

9 3T Spine Protocols Lumbar Spine History: 95 y/o woman with acute bilateral upper extremity weakness Sequence TR/TE/ET/NEX FOV Slice Matrix Phase Bandwidth Sagittal T2 FSE 4000/120/27/ / x224 SI 41.7 Sagittal T1 FLAIR 3000/30/8/2/TI / x224 SI 41.7 Sagittal STIR 3500/24/12/3/TI / x224 SI 31.2 Axial T2 FSE 4500/120/21/4 20 3/1 448x224 AP 41.7 Axial T1 FSE 600/10/4/2 20 3/1 320x224 AP 31.2 Axial PD FSE 3000/11/4/2 20 3/1 448x224 AP 31.2 Sag T1 FSE Gd 517/8/4/ / x224 AP 31.2 Axial T1 FSE Gd 600/10/4/2 20 3/1 320x224 AP 31.2 MRA FSPGR Gd 7.1/2.9/1/35deg / x224 AP-RL ml/sec Dx: Acute cord infarction History: 48 y/o women with pain down both legs {Page 2} DWI - ADC Dx: Spinal epidermoid

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