syngo MR E11 · 2.7 syngo WARP: Imaging near orthopedic implants 43 2.8 Isotropic 3D imaging 49 2.9 Parametric mapping with syngo MapIt 58 2 Measurement 2 syngo MR E11 15 Print No.

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syngo MR E11Operator Manual – Ortho

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syngo MR E11Operator Manual – Ortho

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4 Ortho | Operator ManualPrint No. MR-05017.630.10.02.24

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syngo MR E11 5Print No. MR-05017.630.10.02.24

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1 Introduction 111.1 Layout of the operator manual 111.2 The current operator manual 111.3 Intended use 121.4 Authorized operating personnel 13

1.4.1 Definitions of different persons 13

2 Measurement 152.1 Overview of orthopedic imaging concept 16

2.1.1 High throughput—high-resolutionimaging 16

2.1.2 Advanced imaging techniques 162.1.3 Dedicated orthopedic phased array coils 16

2.2 Large Joint Dot Engine 172.3 Knee Dot Engine 17

2.3.1 Planning the examination and measuringthe localizer 17

Adapting the examination to thepatient 17Starting the measurement of the scout 18Changing the examination strategysubsequently 19

2.3.2 Adjusting the slices and performing themeasurements 20

2.3.3 3D examinations with integrated MPRplanning 21

2.3.4 Configuring MPR views (optional) 22Assigning 3D measurements to theintegrated MPR post-processing 23Adding MPR views 23

Table of contents


2.4 Hip Dot Engine 252.4.1 Planning the examination and measuring

the localizer 25Adapting the examination to thepatient 25Starting the measurement of the scout 26Changing the examination strategysubsequently 27


2.4.3 Bilateral 3D hip examinations withintegrated MPR planning 29

2.5 Shoulder Dot Engine 312.5.1 Planning the examination and measuring

the localizer 32Adapting the examination to thepatient 32Starting the measurement of the scout 33Changing the examination strategysubsequently 33


2.5.3 3D shoulder examinations withintegrated MPR planning 35

2.6 High-resolution fast 2D imaging 372.6.1 Optimization with TSE sequence 37

Advantages 38Optimizing echo time 38Optimizing echo train length (ETL) 39Optimizing fat saturation 40Optimizing fat suppression 40BLADE technique 41Reducing examination noise 42Reducing SAR for hip imaging 42

2.7 syngo WARP: Imaging near orthopedic implants 432.7.1 WARP: high bandwidth 442.7.2 WARP: View Angle Tilting (VAT) technique 462.7.3 WARP: Slice encoding for metal artifact

correction (SEMAC) 47

Table of contents


2.8 Isotropic 3D imaging 492.8.1 3D SPACE 492.8.2 3D TrueFISP 502.8.3 3D DESS 512.8.4 MEDIC 532.8.5 Image examples 54

2.9 Parametric mapping with syngo MapIt 582.9.1 T2 or R2 mapping with syngo MapIt 592.9.2 T2 or R2 mapping: protocol parameters 592.9.3 Examples in cartilage repair therapies

(microfracture therapy vs MACT therapy) 602.9.4 T2* or R2* mapping with syngo MapIt 612.9.5 T2* or R2* mapping: protocol parameters 632.9.6 Clinical use in cartilage repair therapies

(microfracture therapy) 642.9.7 Fast T1 mapping with syngo MapIt 65

T1 mapping with B1 correction 652.9.8 T1 mapping: protocol parameters 66

3 Post-processing 693.1 Fusing biochemical maps and images 70

3.1.1 Loading the data 70Loading the maps 70Loading the original images 70

3.1.2 Optimizing the image display 713.1.3 Visualizing the cartilage 723.1.4 Saving and filming the images 73

Table of contents


Table of contents


Introduction

In order to operate the MR system accurately and safely, theoperating personnel must have the necessary expertise as well asknowledge of the complete operator manual. The operator manualmust be read carefully prior to using the MR system.

Layout of the operator manualYour complete operator manual is split up into several volumes toimprove readability. Each of these individual operator manuals coversa specific topic:

◾ Hardware components (system, coils, etc.)◾ Software (measurement, evaluation, etc.)Another element of the complete operator manual is the informationprovided for the system owner of the MR system.The extent of the respective operator manual depends on the systemconfiguration used and may vary.

All components of the complete operator manual may includesafety information that needs to be adhered to.

The operator manuals for hardware and software address theauthorized user. Basic knowledge in operating PCs and software is aprerequisite.

The current operator manualThis manual may include descriptions covering standard as well asoptional hardware and software. Contact your Siemens SalesOrganization with respect to the hardware and software available foryour system. The description of an option does not infer a legalrequirement to provide it.

1

1.1

1.2

Introduction 1


The graphics, figures, and medical images used in this operatormanual are examples only. The actual display and design of thesemay be slightly different on your system.Male and female patients are referred to as “the patient” for the sakeof simplicity.

Intended useYour MAGNETOM MR system is indicated for use as a magneticresonance diagnostic device (MRDD) that produces transverse,sagittal, coronal and oblique cross sectional images, spectroscopicimages and/or spectra, and that displays the internal structure and/orfunction of the head, body, or extremities. Other physical parametersderived from the images and/or spectra may also be produced.Depending on the region of interest, contrast agents may be used.These images and/or spectra and the physical parameters derivedfrom the images and/or spectra when interpreted by a trainedphysician yield information that may assist in diagnosis.Your MAGNETOM MR system may also be used for imaging duringinterventional procedures when performed with MR compatibledevices such as in-room displays and MR Safe biopsy needles.

The MAGNETOM MR system is not a device with measuringfunction as defined in the Medical Device Directive (MDD).Quantitative measured values obtained are for informationalpurposes and cannot be used as the only basis for diagnosis.

For the USA only: Federal law restricts this device to sale,distribution and use by or on the order of a physician.

Your MR system is a medical device for human use only!

1.3

1 Introduction


Authorized operating personnelThe MAGNETOM MR system must be operated according to theintended use and only by qualified persons with the necessaryknowledge in accordance with country-specific regulations, e.g.physicians, trained radiological technicians or technologists,subsequent to the necessary user training.This user training must include basics in MR technology as well assafe handling of MR systems. The user must be familiar with potentialhazard and safety guidelines the same way the user is familiar withemergency and rescue scenarios. In addition, the user has to haveread and understood the contents of the operator manual.Please contact Siemens Service for more information on availabletraining options and suggested duration and frequency of suchtraining.

Definitions of different persons

Term used Explanation

User/Operator/Operating per-sonnel

Person who operates the system or software,takes care of the patient or reads imagesTypically physicians, trained radiological techni-cians, or technologists

System owner Person who is responsible for the MR environ-ment. This includes legal requirements, emer-gency plans, employee information and qualifica-tions, as well as maintenance/repair.

MR worker Person who works within the controlled accessarea or MR environmentUser/Operator as well as further personnel (forexample, cleaning staff, facility manager, servicepersonnel)

1.4

1.4.1

Introduction 1


Term used Explanation

Siemens Serv-ice/service per-sonnel

Group of specially trained persons who areauthorized by Siemens to perform certain mainte-nance activitiesReferences to “Siemens Service” include servicepersonnel authorized by Siemens.

1 Introduction


Measurement

2.1 Overview of orthopedic imaging concept 162.2 Large Joint Dot Engine 172.3 Knee Dot Engine 172.4 Hip Dot Engine 252.5 Shoulder Dot Engine 312.6 High-resolution fast 2D imaging 372.7 syngo WARP: Imaging near orthopedic implants 432.8 Isotropic 3D imaging 492.9 Parametric mapping with syngo MapIt 58

2

Measurement 2


Overview of orthopedic imaging conceptOrthopedic imaging is a comprehensive clinical applications packagefocusing on the following areas.

High throughput—high-resolution imagingHigh-resolution fast 2D imaging: To deliver extremely high in-plane2D resolution within clinically acceptable examination times.( Page 37 High-resolution fast 2D imaging)Isotropic 3D imaging: To deliver enhanced workflow and increaseddiagnostic quality. ( Page 49 Isotropic 3D imaging)

Advanced imaging techniquesFor helping in early diagnosis of osteoarthritis or monitoring ofcartilage repair therapy.Parametric mapping (syngo MapIt): For improved diagnosticcapabilities and therapy planning. ( Page 58 Parametric mappingwith syngo MapIt)

Dedicated orthopedic phased array coilsThe advances in resolution, image quality, workflow, scan speed andnew imaging fields (biochemical) are only possible due to thededicated orthopedic phased Array coils and the flexible coils.Siemens coils:

◾ Flex Large 4 (knee, shoulder, hip, ankle, pediatric MSK imaging)◾ Flex Small 4 (wrist, elbow, pediatric MSK imaging)◾ Body 18 (hip)◾ Hand/Wrist 16 (hand, wrist)◾ Foot/Ankle 16 (foot, ankle)◾ Shoulder Large 16 (large shoulders)◾ Shoulder Small 16 (small shoulders)◾ CP Extremity Coil (not capable of parallel imaging)

2.1

2.1.1

2.1.2

2.1.3

2 Measurement


QED coil:

◾ Tx/Rx 15-Channel Knee Coil

Large Joint Dot EngineThe Large Joint Dot Engine provides a consistent workflow for alllarge joints. It consists of three Dot Engines:◾ Knee Dot Engine ( Page 17 Knee Dot Engine)◾ Hip Dot Engine ( Page 25 Hip Dot Engine)◾ Shoulder Dot Engine ( Page 31 Shoulder Dot Engine)

Knee Dot EngineThe Knee Dot Engine is intended to simplify and speed up theexamination workflow. It provides guidance and easy adaption of theexamination strategy.For 3D measurements the creation of MPRs is integrated into theworkflow and supported by a guidance step for MPR planning.( Page 21 3D examinations with integrated MPR planning)

The Dot Engine user interfaces shown in this operator manual areexamples only. The actual guidance texts and the design may beslightly different on your system.

Planning the examination and measuring thelocalizer✓ Patient has been registered

✓ Knee Dot Engine has been selected

Adapting the examination to the patientAfter registration, the Patient View opens automatically. The defaultexamination parameters are loaded.

2.2

2.3

2.3.1

Measurement 2


◆ From the list: Select a suitable Exam Strategy for the patient.

standard For standard procedures.

Speed focus Provides fast protocols for when the patient cannot stay in thescanner for a longer period of time.

Motion-insensitive (BLADE) For uncooperative/moving patients. Provides motion-insensitiveprotocols.

High Bandwidth (WARP) Provides protocols with reduced sensitivity to susceptibility arti-facts if the patient has MR Conditional implants.

Please adhere to all safety instructions regarding implants. (Referto Operator Manual – MR System.)

The pending protocols of the measurement queue are updatedupon your selection.

Starting the measurement of the scoutThe AAscout is used to determine anatomical structures.◆ To start the Knee Dot Engine workflow, confirm the settings in the

Patient View.

Selecting the examinationstrategy

2 Measurement


Results:

◾ The AutoAlign Scout is automatically measured and displayed.◾ The localizer is the basis for the AutoAlign functionality, which

provides consistent slice positioning of knee protocols withoutuser interaction. (For a detailed description of the AutoAlignfeature, please refer to: Operator Manual – System and datamanagement.)

◾ The next protocol opens.Changing the examination strategy subsequently

You can access the Patient View at any time during the examination.

1 To open the view, click the icon.

2 To confirm the settings and close the view, click the icon.

Changes in the Patient View only apply to pending protocols in themeasurement queue.1 To change the status of a protocol from measured to pending,

select the measured protocol.

2 Select Rerun from here from the context menu (right-click withthe mouse).

3 Open the Patient View.

– or –

Select Rerun from here with from the context menu (right-clickwith the mouse)

The Patient View opens automatically.

4 Enter the requested modifications.

Accessing the Patient View

Modifying parameters ofmeasured protocols

Measurement 2


Adjusting the slices and performing themeasurements✓ Localizers are displayed

In the GSP segments, the slices for the following protocol arepositioned by AutoAlign Knee. (For a detailed description of theAutoAlign feature, please refer to: Operator Manual – System anddata management.) Sample images with typical slice positioning aredisplayed in the Guidance View.

Example: Guidance View for coronal slice positioning.

1 Check the slice positions for all subsequent measurements andadjust them, if necessary.

You can also modify several sequence parameters of the currentprotocol using the Parameter View. Here you find the mostimportant sequence parameters, e.g. the number of slices.

To display the complete sequence parameters of the Routineparameter card, click the icon.

2 Start the measurement.

The measurement is performed. The next protocol opens.

2.3.2

2 Measurement


3 Repeat the above steps for all subsequent measurements.

3D examinations with integrated MPR planningThe 3D Knee Dot Engine provides an integrated planning step forMPR post-processing. MPRs of one or multiple 3D measurements arecalculated immediately after each measurement. The MPR planningopens after the 3D measurements have been started. You are able toplan multiple MPR views with different orientations while the 3Dmeasurements are running.

✓ During registration, the 3D Knee Dot Engine was selected

✓ 3D measurement has been started and the MPR planning step hasopened

Example: Guidance View for sagittal MPR view.

1 Select the desired MPR view from the list on the left side of theGuidance View.

The corresponding MPR slice positions and orientations aredisplayed in the GSP segments.

2 Adapt the slice positioning, if necessary.

In the Parameter View: You can also modify the view parametersalpha-numerically, e.g. the FoV.

2.3.3

Measurement 2


3 Repeat the above steps for all MPR views.

4 Save the MPR settings.

As soon as the 3D measurements have been concluded, thereconstruction of the MPRs is started automatically. For each 3Dmeasurement, the defined MPR views are generated.

The names of the resulting image series are a combination of theprotocol name and the MPR view. For example:

◾ First 3D measurement: T1_SPC_FS◾ Planned MPR views:

– transversal– coronal– sagittal

◾ Reconstructed MPR image series:– T1_SPC_FS_MPR_tra– T1_SPC_FS_MPR_cor– T1_SPC_FS_MPR_sag

If you repeat a 3D measurement, a new set of MPRs is calculated.

You may use the resulting MPR views for the slice planning ofsubsequent measurements.

Configuring MPR views (optional)Dot Engine Step: The Dot Engine Step defines which strategies,decisions and global parameters are valid for the complete DotEngine workflow examination. (For a detailed description, pleaserefer to: Operator Manual – Dot Cockpit.)Dot add-ins are predefined add-ins for Dot Engine Steps andprogram steps. Depending on the selected Dot add-in, you canconfigure different parameters of the Dot Engine Step.

2.3.4

2 Measurement


Knee Dot add-ins:

◾ Generic Views◾ MPR Assignment◾ MPR PlanningAssigning 3D measurements to the integrated MPR post-processingUsing the MPR Assignment Dot add-in you can define, for which 3Dprotocols the MPR post-processing is performed.1 In the Dot Cockpit - Explorer: Select a 3D protocol.

2 Select Edit to open the protocol in the Program Editor.

3 Open the Step Properties dialog window by double-clicking theprotocol.

4 Select AddIn Configuration.

5 Select MPR Assignment and activate the desired checkboxes.

Adding MPR viewsUsing the MPR Planning add-in, you can add new MPR views.1 In the Queue: Select the MPR planning program step.

2 Open the Step Properties dialog window by double-clicking.

Measurement 2


3 Select AddIn Configuration.

4 Select MPR Planning.

5 Add the MPR view by clicking Add MPR range.

A new default MPR view is added to the list of available views.

1 Right-click the added view with the mouse.

2 From the context menu: Select Rename.

Renaming views

2 Measurement


3 Enter the new name.

4 Set the Guidance and Parameter Views. (Refer to OperatorManual – Dot Cockpit.)

1 Right-click the view with the mouse.

2 From the context menu: Select Remove.

Hip Dot EngineThe Hip Dot Engine is intended to simplify and speed up theexamination workflow. It provides guidance and easy adaption of theexamination strategy.The Hip Dot Engine offers three workflows:

◾ Two standard conventional 2D-workflows (unilateral and bilateral)and

◾ One bilateral 3D-workflowFor 3D measurements the creation of MPRs is integrated into theworkflow and supported by a guidance step for MPR planning.( Page 29 Bilateral 3D hip examinations with integrated MPRplanning)



✓ Hip Dot Engine has been selected


Removing views

2.4

2.4.1

Measurement 2





High Bandwidth (WARP) Provides protocols with reduced sensitivity to susceptibility arti-facts if the patient has MR Conditional implants.



Starting the measurement of the scoutThe AAHip_Scout is used to determine anatomical structures.◆ To start the Hip Dot Engine workflow, confirm the settings in the

Patient View.


2 Measurement


Results:


provides consistent slice positioning of hip protocols withoutuser interaction. (For a detailed description of the AutoAlignfeature, please refer to: Operator Manual – System and datamanagement.)









– or –






Measurement 2



In the GSP segments, the slices for the following protocol arepositioned by AutoAlign Hip. Sample images with typical slicepositioning are displayed in the Guidance View.

Example: Guidance View for coronal slice positioning.


2 To modify several sequence parameters of the current protocol,open the Parameters View.

2.4.2

2 Measurement


Here you find the most important sequence parameters, e.g., thenumber of slices.





Bilateral 3D hip examinations with integrated MPRplanningThe 3D workflows of the Hip Dot Engine provide an integratedplanning step for MPR post-processing. MPRs of one or multiple 3Dmeasurements are calculated immediately after each measurement.The MPR planning opens after the 3D measurements have beenstarted. You are able to plan multiple MPR views with differentorientations while the 3D measurements are running. For a detaileddescription of configuring MPR views, please refer to:( Page 22 Configuring MPR views (optional)).

2.4.3

Measurement 2


✓ During registration, a 3D workflow was selected


Example: Parameters View for sagittal left MPR planning.

1 Select the desired MPR view from the list on the left side of theParameters View.



In the Parameters View: You can also modify the viewparameters alpha-numerically, e.g. the FoV.




2 Measurement



◾ First 3D measurement: PD_SPC_FS◾ Planned MPR views:


◾ Reconstructed MPR image series:– PD_SPC_FS_MPR_tra– PD_SPC_FS_MPR_cor– PD_SPC_FS_MPR_sag



Shoulder Dot EngineThe Shoulder Dot Engine is intended to simplify and speed up theexamination workflow. It provides guidance and easy adaption of theexamination strategy.The Shoulder Dot Engine offers two workflows:

◾ Standard conventional 2D-workflow and◾ 3D-workflowFor 3D measurements the creation of MPRs is integrated into theworkflow and supported by a guidance step for MPR planning.( Page 35 3D shoulder examinations with integrated MPRplanning)

2.5

Measurement 2




✓ Shoulder Dot Engine has been selected





Motion-insensitive (BLADE) For uncooperative/moving patients. Provides motion-insensitiveprotocols.

2.5.1


2 Measurement




Starting the measurement of the scoutThe AAShoulder_Scout is used to determine anatomical structures.◆ To start the Shoulder Dot Engine workflow, confirm the settings

in the Patient View.

Results:


provides consistent slice positioning of shoulder protocolswithout user interaction. (For a detailed description of theAutoAlign feature, please refer to: Operator Manual – Systemand data management.)










Measurement 2



– or –





In the GSP segments, the slices for the following protocol arepositioned by AutoAlign Shoulder. Sample images with typical slicepositioning are displayed in the Guidance View.

Example: Guidance View for transversal slice positioning.


2 To modify several sequence parameters of the current protocol,open the Parameters View.

2.5.2

2 Measurement


Here you find the most important sequence parameters, e.g., thenumber of slices.





3D shoulder examinations with integrated MPRplanningThe 3D workflow of the Shoulder Dot Engine provides an integratedplanning step for MPR post-processing. MPRs of one or multiple 3Dmeasurements are calculated immediately after each measurement.The MPR planning opens after the 3D measurements have beenstarted. You are able to plan multiple MPR views with differentorientations while the 3D measurements are running. For a detaileddescription of configuring MPR views, please refer to:( Page 22 Configuring MPR views (optional)).

2.5.3

Measurement 2


✓ During registration, the 3D workflow was selected


Example: Parameters View for sagittal MPR planning

1 Select the desired MPR view from the list on the left side of theParameters View.



In the Parameters View: You can also modify the viewparameters alpha-numerically, e.g. the FoV.




2 Measurement



◾ First 3D measurement: PD_SPC_FS◾ Planned MPR views:


◾ Reconstructed MPR image series:– PD_SPC_FS_MPR_tra– PD_SPC_FS_MPR_cor– PD_SPC_FS_MPR_sag



High-resolution fast 2D imagingImaging of the musculoskeletal (MSK) system requires highresolution with the necessary contrast for precise detection of smalland complex structures.

Optimization with TSE sequenceThe flexible TSE sequence is optimized for a maximum matrix size andsmall FoV. This TSE sequence, together with parallel imagingtechniques, delivers extremely high in-plane 2D resolution withinclinically acceptable examination times, allowing for a more accuratediagnosis.

2.6

2.6.1

Measurement 2


Alternative protocols with faster scan times are also available inthe Siemens protocol tree.

The concept of high-resolution fast imaging utilizing the TSE sequence. Thehigh-resolution fat-suppressed PD-weighted TSE image is a tool helping inaccurate diagnosis.

AdvantagesBy using new reordering techniques, the TSE sequence allows for:

◾ a more flexible choice of TE for better optimization of contrast◾ a more flexible choice of echo train lengths to maintain image

contrast while optimizing protocols◾ a flexible choice of fat suppression techniques (WEAK, STRONG,

SPAIR, STIR)Optimizing echo timePD-weighted contrast is the “gold standard” in differentiating cartilagedefects. Contrast is optimized by varying the echo time (the preferredTE varies from physician to physician).

2 Measurement


(1) TE 20 ms(2) TE 40 ms

Optimizing echo train length (ETL)Increasing the ETL will reduce the scan time while the contrast ismostly maintained. The flexible reordering scheme allows greaterflexibility (even and odd ETL, reduced blurring).

(1) TE 24 ms; ETL 5; 4 min(2) TE 24 ms; ETL 7; 3 min(3) TE 24 ms; ETL 10; 2 min(4) TE 24 ms; ETL 15; 1:20 min

Measurement 2


Optimizing fat saturationFat saturation is useful when imaging suspected bone trauma oredema. It allows good differentiation of surface cartilage lesions.FatSat: Uses a spectrally selective pulse to saturate the fat spinsbefore the imaging sequence. Has 2 settings: (a) STRONG whichdelivers a darker fat than (b) WEAK.SPAIR: Uses an adiabatic spectrally selective pulse which is insensitiveto dielectric effects. Useful at 3 Tesla in the hip.STIR: Uses a spatial inversion pulse with a short inversion time to nullfat. Only recommended where fat suppression is difficult due to B0issues, i.e., with MR Conditional implants.

Example: A cartilage tear can sometimes be better visualized using FatSattechniques (right) as shown above.

Optimizing fat suppressionFor MSK imaging the fat suppression can be optimized for TSE, SE andSPACE sequences.The main advantages are:◾ increased saturation homogeneity◾ increased saturation strength◾ decreased sensitivity to B0 inhomogeneities

2 Measurement


The optimized fat suppression region Joints for MSK imaging canbe selected in the Fat Suppression Optimization dialog window.To open the dialog window, click the button on the right side ofthe Fat suppr. dropdown menu. Prerequisite: Fat sat. is selected.

Protocols for joints imaging are provided for 3 Tesla only.

The optimized fat suppression should only be used for foot-ankle,knee, hand-wrist and elbow imaging.

BLADE techniqueThe BLADE technique is available for all MSK regions and can beconfigured for T1, T2, and PD contrasts. It is compatible with multi-channel coils, and iPAT can be employed. Any orientation can be used(sagittal, coronal and axial). BLADE is fully integrated in the TSEsequence.For a detailed description, please refer to: Application Brochure “PulseSequences”.

Measurement 2


Advantages of oversampling:

◾ Wrap-around artifacts (streaking) avoided◾ Good results with respect to movement artifacts◾ Increased SNR

(1) Knee coronal: FoV 130 × 130, 0.4 mm × 0.4 mm, TE = 47 ms(2) Wrist: FoV 100 × 100, 0.3 mm × 0.3 mm, TE = 47 ms

Reducing examination noiseThe quiet MR sequences increase patient comfort and enable MRexaminations for noise-sensitive patients. The noise reduction mainlydepends on the protocol settings. Compared to conventionalimaging, a reduction of approximately 10 dB(A) can be achieved.Quiet protocols are available in the Siemens protocol tree.The protocols for quiet MSK imaging include:◾ localizer based on GRE sequence◾ TSE sequence (proton density weighted with/without fat

saturation)For a detailed description of the quiet MR sequences, please refer toOperator Manual – Neuro.Reducing SAR for hip imagingIn particular unilateral hip examinations are limited by SAR. For thisreason, B1 shimming provides an option to reduce the SAR level of aprotocol by optimizing the transmit parameters of the pTx channels.

2 Measurement


In addition, protocols with reduced SAR are provided for unilateral hipimaging.

Select Low SAR patient specific from the B1 Shim mode list inthe System pTx Volumes parameter card.

The SAR reduction depends on the size and position of the FOVand requires an additional adjustment scan.

syngo WARP: Imaging near orthopedicimplantsMR imaging in the vicinity of metal implants is challenging, firstlybecause of safety concerns and secondly because of imagedistortions. In general, an MR examination is contraindicated forpatients with electronic or electronically conductive implants ormetals, especially those containing ferromagnetic foreign matter.

Particularly with regard to magnetic forces and heating ofimplants and surrounding tissue, please adhere to all safetyinstructions. (Refer to Operator Manual – MR System.)

The main source of artifacts seen when imaging patients with MRConditional implants is related to distortions of the local magneticfield caused by the large difference in magnetic susceptibilitybetween metal and tissue. The degree of field distortions depends onthe shape, the location and the material properties of the metalimplant.syngo WARP provides dedicated imaging techniques based on the TSEsequence in order to reduce susceptibility-related artifacts:

2.7

Measurement 2


◾ high bandwidth optimizations to reduce the level of artifacts, forexample geometric distortions and contrast changes are minimized

◾ VAT (View Angle Tilting) technique to correct for in-planedistortions (geometric distortion of the frequency encoding, forexample image pixels are displaced along the frequency-encodingdirection)

◾ SEMAC (Slice Encoding for Metal Artifact Correction) technique tocorrect for through-plane distortions (geometric distortions of theexcited slice profile, for example the excited slices are curvedinstead of being plane)

VAT and SEMAC are available if the WARP checkbox is activatedin the Sequence Part 2 parameter card.

WARP: high bandwidthBy activating the WARP checkbox, the bandwidth of the RF pulses willbe increased. In combination with a high readout bandwidthselected, the TSE sequence becomes less sensitive to field distortions.High readout bandwidth:

2.7.1

2 Measurement


◾ reduces in-plane distortions◾ avoids image blurring when using the VAT technique◾ reduces the SNR of the imageHigh RF pulse bandwidth (combined with small slice thickness):◾ reduces through-plane distortions◾ depends on the RF pulse type: Fast has a higher bandwidth, but

also a higher SAR◾ increases the specific absorption rate (SAR)

Practical hints for imaging near MR Conditional implants with theTSE sequence:◾ always select the WARP checkbox◾ select a high readout bandwidth, for most cases 400-500 Hz/

pixel is an advisable value◾ select RF pulse type Fast unless the SAR gets too high◾ SAR can be reduced by selecting a lower refocusing flip angle◾ replace conventional fat suppression by STIR imaging (Short

Tau Inversion Recovery): select magnetic preparation Slice-sel.IR with TI approx. 160ms (1.5T) or 200ms (3T)

If WARP is selected, a “W” is added to the sequence stringdisplayed in the image (only if VAT and SEMAC are not selected).

Measurement 2


(1) without syngo WARP(2) with syngo WARP

WARP: View Angle Tilting (VAT) techniqueVAT compensates in-plane distortions by adding an additionalreadout gradient in the slice direction. The corresponding value in theSequence Part 2 parameter card specifies the amplitude of the viewangle tilting gradient:◾ 0%: VAT is deactivated (no distortion correction)◾ 100%: VAT has the same amplitude as the slice-selective gradient

(full readout distortion correction)Performing the measurement with VAT may cause blurring of theimage. Blurring can be reduced by:◾ using thin slices◾ using a high readout bandwidth

The result of VAT strongly depends on the type and orientation ofthe implant, as well as other imaging parameters. In general, VATcan only reduce in-plane distortions. If VAT does not improve theimage quality, this means that other effects are dominating, forexample through-plane distortions. In that case, try to usethinner slices, RF pulse type Fast or SEMAC.

2.7.2

2 Measurement


If VAT is selected, a “V” is added to the sequence string displayedin the image (only if SEMAC is not selected).

(1) without VAT(2) with VAT

WARP: Slice encoding for metal artifact correction(SEMAC)SEMAC provides a through-plane distortion correction by performingadditional phase encoding in the slice direction. SEMAC is mosteffective for severe field distortions, for example near large metalstructures such as full joint replacement of the hip or knee.SEMAC can only be applied in combination with:◾ VAT set to 100%◾ slice distance of 0%A SEMAC value of 0 means that no SEMAC is applied.

2.7.3

Measurement 2


The measurement time will be prolonged by the number ofSEMAC steps. Since SEMAC increases the SNR, try to reduce thescan time by reducing averages, apply parallel imaging or partialfourier.The required number of SEMAC phase-encoding steps dependson the size, shape and material of the implant and may vary frompatient to patient. For joint arthroplasty 8-12 SEMAC steps isusually a reasonable value. Metals causing stronger artifacts,such as stainless steel or cobalt chromium alloys, require higherSEMAC steps, whereas titanium implants usually require lowervalues or even no SEMAC at all.SEMAC cannot be used in combination with 3D TSE, BLADE,TimCT, multiple slice groups, and DIXON.

If SEMAC is selected, a “S” is added to the sequence stringdisplayed in the image text.

(1) without SEMAC(2) with SEMAC

2 Measurement


Isotropic 3D imagingHigh-resolution fast isotropic 3D imaging is becoming increasinglymore important as a means of enhancing workflow and providingmore accurate diagnosis. Isotropic 3D imaging allows for fully flexibleexamination, i.e. depending on the suspected diagnosis, images canbe reformatted in any plane.Isotropic sequences: Using an isotropic 3D sequence, the images canbe reformatted with high in-plane and through-plane resolution.Utilization of such a sequence introduces further improvements in theworkflow by acquiring one 3D series that can be reformatted in thedifferent planes needed for precise diagnosis.Siemens provides five different sequences with specified contrasts:

◾ 3D SPACE ( Page 49 3D SPACE)◾ 3D TrueFISP ( Page 50 3D TrueFISP)◾ 3D DESS (Dual Echo Steady State) ( Page 51 3D DESS)◾ 3D MEDIC ( Page 53 MEDIC)◾ 3D FISPFor a detailed description of the sequences, please refer to:Application Brochure “Pulse Sequences”.

3D SPACEConcept: Different planes can be reconstructed from the isotropicdata set for high-resolution diagnosis of cartilage, ligaments, andmeniscus in the knee joint.

2.8

2.8.1

Measurement 2


(1) PD-weighted SPACE, isotropic resolution 0.5 mm(2) PD-weighted SPACE with FatSat, isotropic resolution 0.5 mm

3D TrueFISPThe TrueFISP sequence is used for balanced steady state imaging. Oneach of the gradient axes the net gradient moment is zero. It has agood SNR, but is prone to banding artifacts in regions ofcompromised homogeneity, i.e., MR Conditional implants.

(1) RF(2) Slice selection

2.8.2

2 Measurement


(3) Phase encoding(4) Frequency encoding(5) Signal (SS-FID/SS-echo)

Minimize TR by selecting a high readout bandwidth to avoidinterference streaks in the image.

Ankle, isotropic resolution 0.3 mm, reformatted below in sagittal, coronal, andaxial direction.

3D DESSIn the steady state, two signals are produced—an FID signal and anecho. With DESS (Dual Echo Steady State) these two signals aremeasured and combined to produce a single image.

2.8.3

Measurement 2


(1) RF(2) Slice selection(3) Phase encoding(4) Frequency encoding(5) Signal (SS-FID/SS-echo)

Use primarily in orthopedic imaging with good contrast betweensynovial fluid and cartilage. A non-selective excitation pulse isactivated beforehand for fat suppression at a short TR.

2 Measurement


(1) Shoulder, isotropic resolution 0.7 mm(2) Knee, isotropic resolution 0.6 mm

MEDICThe MEDIC sequence is a multi-echo GRE sequence where up to 6echoes are combined to produce a single image.

(1) RF(2) Slice selection(3) Phase encoding

2.8.4

Measurement 2


(4) Frequency encoding(5) Signal (dashed line: T2* decay)

Gives very good contrast for meniscus evaluation.

(1) Shoulder coronal(2) Knee sagittal

Image examplesExample: 10 minute knee exam

2.8.5

2 Measurement


Isotropic data set 0.5 mm.

Measurement 2


Reformat along x diagnosis-based planes:

(1) Meniscus reformat(2) ACL reformat(3) Coronal reformat(4) Patella reformat

Example: Precise localization of anatomy (meniscus)

2 Measurement


Example: Complex geometry—simple reformatting (radial reformatsfor hip imaging)

Measurement 2


Parametric mapping with syngo MapItParametric mapping with syngo MapIt may improve both theaccuracy of diagnosis and planning and also may monitor theeffectiveness of therapy.At present, the main focus is on:

◾ T2 and T2* mapping,◾ T1 mapping

2.9

2 Measurement


T2 or R2 mapping with syngo MapItClinical use to aid in:

◾ Cartilage repair therapies (microfracture therapy vs MACT therapy).(MACT = Matrix-associated Autologous ChondrocyteTransplantation).

◾ Cartilage repair therapies (MACT therapy follow up)◾ Early OA detection (femoral acetabular impingement). (OA =

Osteoarthritis).T2 provides information on structural changes in the collagen withinthe cartilage. T2 depends on the orientation as a function of the“magic angle” effect.T2 provides information on changes in the water content of thecartilage. Compressed areas show less water content—lower T2. Lesscompressed areas show greater water content—higher T2.T2 has been used to study cartilage repair therapies and to provideinformation on cartilage softening.T2 is measured using a multi-echo spin echo with up to 32 echoes.Each echo produces an image. The map is produced by a pixel-by-pixel analysis.Instead of T2, R2 = 1/T2 can optionally be calculated.

T2 or R2 mapping: protocol parameters

For T2 or R2 mapping use the “se_mc” sequence. Use the InlineMapIt parameter card.

2.9.1

2.9.2

Measurement 2


MapIt Select T2 or R2 to turn on the Inline tech-nology.

Measurements Are set to 1.

Contrasts Up to 32 echoes possible. More echoesprovide a better fit.

TE Set the echo time for each echo. Keepmaximum TE to less than or similar toexpected T2 values.

TR Use TR values > 1000 ms.

Noise threshold Echoes with signals less than this valuewill be ignored in the fit. If in doubt, leaveat default value.

Save original images Keeps the morphological base images inthe database.

Examples in cartilage repair therapies (microfracturetherapy vs MACT therapy)MFX therapy creates microfractures in the bone. Cartilageregeneration is promoted by the released blood and marrow.

2.9.3

2 Measurement


These are the characteristics of this method:

◾ Reduced T2 in the region of MFX therapy.◾ Matrix-associated autologous chondrocyte transplantation (MACT).◾ An operative procedure using a cell seeded collagen matrix.◾ Used for the treatment of localized full thickness cartilage defects.

Courtesy of S. Trattnig, Dept. Radiology, University Vienna.

T2* or R2* mapping with syngo MapItT2* is the apparent transverse relaxation rate and has a T2component. It can be used as a substitute for T2 mapping.Instead of T2*, R2* = 1/T2* can be optionally calculated.

2.9.4

Measurement 2


T2* also has a component which depends on the field change withinthe voxel, resulting from:

◾ Macroscopic field changes, i.e. main field homogeneity, largesusceptibility fields from implants.

◾ Macroscopic field changes due to susceptibility variations, i.e.bone-cartilage interface.

◾ Microscopic field changes from the microstructure within thevoxel.

T2* is measured using a multi-echo gradient-echo sequence.Each TE gives an image. A pixel-by-pixel analysis produces theT2* map.

(1) RF(2) Slice selection(3) Phase encoding(4) Frequency encoding(5) Signal (dashed line: T2* decay)

2 Measurement


T2* or R2* mapping: protocol parameters

For T2* or R2* mapping use the “gre” sequence. Use the InlineMapIt parameter card.

MapIt Select T2* or R2* to turn on the Inlinetechnology.

Measurements Are set to 1.

Contrasts Up to 12 echoes possible.

TE Set the echo time for each echo. Keepmaximum TE to less than or similar toexpected T2 values.

Noise threshold Echoes with signals less than this valuewill be ignored in the fit. If in doubt, leaveat default value.

Save original images Keeps the morphological base images inthe database.

In the Sequence Part 1 parameter card:

2.9.5

Measurement 2


Contrasts Up to 12 echoes possible.

Bandwidth Must be entered for each echo. Use thesame bandwidth for all echoes.

Flow comp. Useful in the abdomen

Readout mode Select mono or bi-polar

Clinical use in cartilage repair therapies(microfracture therapy)MFX therapy creates microfractures in the bone. Cartilageregeneration is promoted by the released blood and marrow. T2* isreduced in the region of MFX therapy. A small patient study suggeststhat variability is better with T2*.

2.9.6

2 Measurement


Fast T1 mapping with syngo MapItClinical use to aid in:

◾ dGEMRIC◾ Pre-operative staging◾ Prediction of therapy outcome◾ Therapy follow upT1 mapping is used in cartilage to track proteoglycans. The goldstandard was multiple IR spin echo measurements. However, the verylong acquisition time of up to 30 minutes makes it clinically difficult.Fast T1 mapping with syngo uses a 2 angle VIBE measurement. Theacquisition time is significantly reduced to 3 minutes. To calculate T1,this technique utilizes 2 spoiled GRE measurements, each identicalexcept for different flip angles.syngo MapIt calculates T1 on a pixel-by-pixel basis.T1 mapping with B1 correctionVariable flip angle techniques used by syngo MapIt are intrinsicallysensitive to inhomogeneities of the transmit RF field (B1). syngoMapIt can perform B1 corrections to improve the spatial homogeneityand the reproducibility of the acquired T1 maps.

2.9.7

Measurement 2


To enable this feature, run the Siemens B1mapForT1mappingprotocol prior to the T1 mapping protocol. The three-dimensional FoVof the B1mapForT1mapping protocol should be greater or equal tothe FoV of the T1 mapping protocol. B1 corrections will be performedautomatically. The image series with the corrected T1 maps is markedas T1_Images_B1corr instead of T1_Images.

Please note: The resulting T1 map values may overestimate theabsolute T1 values! This behavior is expected due to thetechnique used – the variable flip angle method. Thus a relativecomparison of T1 values within tissues should be made.

T1 mapping: protocol parameters

For fast T1 mapping use the “vibe” sequence. Use the InlineMapIt parameter card.

MapIt Select T1 map.

Auto angle calcula-tion

Select, if required.

T1 estimate Two optimum angles will be automaticallycalculated, based on the estimated T1.

2.9.8

2 Measurement


Flip angle Alternatively, select two flip angles.

Measurement 2


2 Measurement


Post-processing

3.1 Fusing biochemical maps and images 70

3

Post-processing 3


Fusing biochemical maps and imagesThe following example describes how to overlay T2/T2* mapsgenerated with syngo MapIt with their corresponding anatomicalimages. Subsequently, manual cartilage segmentation is performed.

The same procedure applies when using T1 maps. In this case,two series containing the morphological base images for the twoflip angles are stored together with the T1 map series.

Loading the data✓ T2/T2* maps have been generated with syngo MapIt

✓ Anatomical base images are available (Save original imagesactivated during mapping)

Loading the maps1 Select the mapping series in the Patient Browser.

2 Click the 3D MPR icon to start image processing as MPR.

3 Window the mapping images to optimize their contrast andbrightness.

Loading the original imagesThe series preceding the T2/T2* maps contains the morphologicalbase images for all echoes.1 Select the morphological series in the Patient Browser.

2 Load the data to 3D Fusion with the icon.

3 In the 3D Series List, select the echo images you want to use.

3.1

3.1.1

3 Post-processing


The Fusion Registration dialog window is displayed. Registrationis not needed in this case.

4 Skip Fusion Registration with OK.

Optimizing the image display1 Open the Fusion Definition MPR dialog window with Fusion >

Fusion Definition.

2 In order to get access to the mask menu, click Advanced.

3 Hide the background noise in the mapping images by increasingthe L value for Masking to “1” (left spin box).

4 Select suitable Color Lookup Tables for the map and themorphological images to optimize their view.

Recommended settings: Rainbow for mapping images (leftselection list), Gray Scale for morphological images (rightselection list).

5 Set the T2/T2* baseline map Window Level to a default value bychanging the left C and W values (e.g. “45” each).

3.1.2

Post-processing 3


Visualizing the cartilageIt is easier to segment the cartilage if you work on the morphologicalimages.1 In the Fusion Definition MPR dialog window, move the Mixing

Ratio slider to the right to display the morphological image only.

2 Activate VOI Punch Mode with the icon in the Settings subtaskcard.

The VOI Punch Mode dialog window opens.

VOI drawing is activated automatically.

3 Trace the cartilage in the morphological image. Double-click tofinish.

4 Remove the non-cartilage part of the mapping image with theKeep Inside icon.

5 In order to provide for good fusion, set a Mixing Ratio of 50% inthe Fusion Definition MPR dialog window.

3.1.3

3 Post-processing


Saving and filming the images1 Select the respective segment for saving or filming.

2 Save the images as a new series with the icon.

3 To film the images selected, click the icon.

3.1.4

Post-processing 3


3 Post-processing


1,2,3 …2D imaging 373D DESS sequence 513D examinations

Dot Engine 21, 353D imaging

Image examples 54Isotropic sequences 49

3D SPACE sequence 493D TrueFISP sequence 50

BBilateral 3D examinations

Dot Engine 29BLADE technique 41

CCoils 16

DDot add-in

MPR Assignment 23MPR Planning 23

Dot Engine 17, 17, 25, 313D examinations withintegrated MPR planning 21, 35Adjusting slices 20, 28, 34Bilateral 3D examinations withintegrated MPR planning 29Changing the examinationstrategy 19, 27, 33Configuring MPR views 22Examination strategy 17, 25, 32Measuring the scout 18, 26, 33Performing measurements 20,28, 34

EEcho time

TSE sequence 38Echo train length

TSE sequence 39Examination strategy

Dot Engine 17, 19, 25, 27, 32,33

FFat saturation

TSE sequence 40Fat suppression

TSE sequence 40Fusing biochemical maps and images

Refer to MapIt image fusion 70

HHip Dot Engine

Refer to Dot Engine 25

IIsotropic sequences 49

3D DESS 513D SPACE 493D TrueFISP 50MEDIC 53

KKnee Dot Engine


LLarge Joint Dot Engine


MMapIt

T1 mapping 65T2 mapping 59T2* mapping 61

MapIt image fusion 70Cartilage 72Loading images 70Optimizing image display 71Visualizing the cartilage 72

MEDIC sequence 53MPR views (Dot Engine)

Configuration 22

OOrthopedic coils 16

PParametric mapping 58Protocol parameters

T1 mapping 66T2 mapping 59T2* mapping 63

QQuiet TSE

Quiet GRE 42

SSAR reduction

TSE sequence 42Scout

Dot Engine 18, 26, 33Shoulder Dot Engine

Refer to Dot Engine 31Strategy

Dot Engine 17, 19, 25, 27, 32,33

syngo WARPSEMAC 43

TT1 mapping 65

Protocol parameters 66T2 mapping 59

Examples in cartilage repairtherapies 60Protocol parameters 59

T2* mapping 61Examples in cartilage repairtherapies 64Protocol parameters 63

TSE sequence 37BLADE technique 41Optimizing echo time 38Optimizing echo train length 39Optimizing fat saturation 40Optimizing fat suppression 40

Index


Quiet Ortho imaging 42

VVAT

orthopedic implants 43


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Manufacturer’s note:

This product bears a CE marking in accordance with theprovisions of regulation 93/42/EEC of June 14, 1993 formedical products.

The CE marking applies only to medico-technical products/medical products introduced in connection with the above-mentioned comprehensive EC regulation.

Global Business UnitSiemens AGMedical SolutionsMagnetic ResonanceHenkestr. 127DE-91052 ErlangenGermanyPhone: +49913184-0www.siemens.com/healthcare

Global Siemens HeadquartersSiemens AGWittelsbacherplatz 280333 MuenchenGermany

Global Siemens HealthcareHeadquartersSiemens AGHealthcare SectorHenkestraße 12791052 ErlangenGermanyPhone: +49 9131 84-0www.siemens.com/healthcare

Legal ManufacturerSiemens AGWittelsbacherplatz 2DE-80333 MuenchenGermany

Print No. MR-05017.630.10.02.24 | © 2014, Siemens AG

www.siemens.com/healthcare

syngo MR E11 · 2.7 syngo WARP: Imaging near orthopedic implants 43 2.8 Isotropic 3D imaging 49 2.9 Parametric mapping with syngo MapIt 58 2 Measurement 2 syngo MR E11 15 Print No.

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