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Dieter Meier Institute for Biomedical Engineering Future Trends in Clinical Diagnostics with Magnetic Resonance SNHTA Bern 12. November 2003.

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Presentation on theme: "Dieter Meier Institute for Biomedical Engineering Future Trends in Clinical Diagnostics with Magnetic Resonance SNHTA Bern 12. November 2003."— Presentation transcript:

1 Dieter Meier Institute for Biomedical Engineering Future Trends in Clinical Diagnostics with Magnetic Resonance SNHTA Bern 12. November 2003

2 Topics The “International Competence and Reference Center for MRI Methodology” Advantages of MRI Functional Information Discussion and Outlook

3 Swiss Federal Institute of Technology (ETH) natural and technical sciences 83 institutes and laboratories, > 11’000 students University Zurich all major scientific disciplines (7 faculties) > 20'000 students University Hospital Zurich education site for medical faculty 130’000 ambulant, 35’000 stationary patients a year, 960 beds, 5500 employees Scientific Environment International Relations Excellent scientific and industrial relations

4 Biomechanics Biomedical Electronics Biomechanics Bioelectronics Medical Optics P. Niederer R. Müller D-ITET D-ITET D-MAVT Biomaterials Tissue Engineering N.N. International Zurich Magnetic Resonance Education Center Biophysics MR Competence Center MRI / MRS P. Bösiger Med. Faculty D-ELEK MRI Technology K.P. Prüssmann D-ELEK MRI in Neurosci. N.N. Med. Fak. International Zurich Magnetic Resonance Education Center Institute for Biomedical Engineering Technical Director: Dieter Meier

5 Partners at University Dept. Radiology: Neuroradiology, Radiology, Nuclear Medicine Dept. Internal Medicine: Cardiology, Angiology, Gastroenterology Neuroscience: Neurology, Psychiatry, Psychology Competence Center CCMRI

6 International Scientific Relations Inst. for Biomedical Engineering Division Biophysics (MRI) Univ. and ETH Zurich P. Boesiger, K.P. Pruessmann Johns Hopkins Univ. Baltimore, MD P.van Zijl, X. Golay M. Stuber Stanford University Stanford, CA C. Bammer King’s College, London, UK S. Kozerke German Heart Institute Berlin, Germany E. Fleck E. Nagel, I. Paetsch Univ. of California San Francisco, CA C. Higgins O.M. Weber Harvard Med. School Boston, MA W. Manning R. Botnar Univ. Hospital Aarhus Aarhus, Denmark E. Pedersen Univ. of Minnesota Minneapolis, MN K. Ugurbil R. Grütter Technical Univ. Graz Graz, Austria K. Perktold

7 Industrial Relations Inst. for Biomedical Engineering Division Biophysics (MRI) Univ. and ETH Zurich Medtronic and Bakken Research Center Tolochenaz VD and Maastricht NL Guerbet Pharmaceuticals Zurich und Paris F Bracco Imaging Milano I Roche Pharmaceuticals Basel Philips Medical Systems Philips Research Laboratory Philips Med. Systems Schweiz AG Best NL, Hamburg DE, Zurich CH Bitplane AG Zurich GyroTools GmbH Zurich

8 ETH and University of Zurich Philips Medical Systems University Hospital of Zurich Project related funding: SEP; EUREKA / KTI; SNF; Dt. Stifterverband Further partners from industry and science Funding

9 Development of new and dedicated MRI techniques for applications in diagnostics and therapy as well as in basic medical and clinical research. Application of these procedures in medical research in collaboration with highly qualified local and international scientific and medical research groups. Mission

10 MRI Scanner Philips Gyroscan Intera 1.5 Tesla Worldwide fastest MRI commercially available scanner, equipped with parallel imaging technique SENSE MRI Scanner Philips Gyroscan Intera 3.0 Tesla Worldwide first 3 T scanner with compact magnet; presently being further developed in collaboration with IBT Equipment

11 High soft tissue contrast Contrast adaption High spatial resolution Arbitrary slice direction No known hazards Advantages of MRI Functional information

12 MRI of the Brain anatomy angiography perfusion, fMRI diffusion metabolite imaging

13 Magnetic Resonance Imaging

14 T2-TSE 512 matrix, 2 mm Sagital Head Images 3Tesla

15 y z 2D SENSE Scan time 26 s y z NONSENSE Scan time 106 s M. Weiger, K. Pruessmann, IBTZ 3D Imaging with 2D SENSE

16 3D, Inflow MRA 3DI/TONE TR 28ms, TE 4.6ms, Flip 20 o scan time 7.30 min 100 slices, thickness 1.0/-0.5 matrix 1024 IBTZ, Neuroradiology USZ High Resolution MRA 3Tesla

17 Venogram

18 High Resolution MRA 3Tesla Arteriovenous Malformation (AVM)

19 3.0 T 1.5 T Inflow Angiography 1.5 vs. 3.0T

20 M. Huber, S. Kozerke, IBTZ NONSENSE R = 2.0 R = 3.0 3D FFE, 3 Tesla T E =3.8ms, T R =19ms Flip angle=10 o velocity encod = 50cm/s (RL-AP-FH ) slice thickn=0.5 mm 120 slices FOV=190mm matrix=163x256 SENSE Phase Contrast 3T

21 Decrease of relative concentration of desoxygenated blood, acting as a contrast agent Increase of T 2 *, increase of signal amplitude Activation of brain area: Raise of metabolic activity Raise of blood flow Raise of concentration of oxygenated blood Brain Activation : BOLD fMRI

22 Activation of Neurons

23 Activation of Motor Cortex

24 C. Schmidt, K. Pruessmann, IBTZ high-res SENSE sshEPI low-res conventional sshEPI stimulation: bilateral opposite finger tapping, 4 x 20s on/off SENSE: fMRI 3T

25 Visual Stimulation A [%]

26 Courtesy: S. Sunaert, Leuven BOLD fMRI 1.5 vs 3T: Auditory Stimulation 1.5 T 3.0 T

27 PDw/TSE TR 3500 TE 16 T2w/TSE TR 3500 TE 110 T1w/IR-TSE TR 1400 TE 12 TI 700 T1w/IR-TSE TR 1400 TE 12 TI 700 after IV Gd-DOTA MRI and Perfusion

28 Direction field map Fractional anisotropy (ordering of fibers) T. Jaerman, IBTZ, Neurorad USZ SENSE: Diffusion Tensor Imaging

29 Diffusion Tensor Imaging forceps minor forceps major external capsule optic radiation ant. limb of internal capsule post. limb of internal capsule (corticospinal tracts) Characterizing the ORIENTATION of the ellipsoid Talk T. Jaermann et al, today, pm

30 3T SENSE-DTI: Tracking Results Functionality: oblique rotations introduce new slices slice shifting zooming T. Jaermann, IBTZ, Neurorad USZ Meiyappan Solaiyappan, Johns Hopkins University

31 3T SENSE-DTI: White Matter Segmentation radiation of corpus callosum volume: 200x200x108mm 3 anatomy: 256x256x180 SENSE-DWIs: 128x128x36 T. Jaermann, IBTZ, Neurorad USZ

32 Scan time: 1:04 min, VOI 45 cc Chemical shift (ppm) NAA Cr Cho MI NAA +Glx Cr GlxLac Metabolites in 1 H MR Spectroscopy

33 NAA, (P)Cr NAA: Neuronal marker (neuronal density); concentration correlates with neuronal function  : Tumor, Stroke, Epilepsy, Hyp-/Anoxia, Inflammation, Dementia, Trauma  : Brain Development and Maturation Cr (PCr): Energy buffer H + PCr + ADP  ATP + Cr Energy shuttle: “Energy transport” The Cr peak is often stable and used as internal reference  : Acute and subacute stroke, brain tumor, brain metastasis, abscesses, inborn errors of Cr synthesis

34 Choline Containing Compounds = Cho, Myo-Inositol Cho:Involved in pathways of phospholipid synthesis and degradation. => reflecting membrane synthesis and degradation  : Brain Tumors, MS-Plaques, Stroke, Inflammation, White Matter Diseases  :Hepatic Encephalopathy, Necrosis  :Alzheimers’ disease, renal failure, Diabetes mellitus  : Abscesses, Hepatic encephalopathy, tumors, stroke MI:Astrocyte marker, second messenger

35 Glutamate and Glutamine = Glx; Lactate Glutamate:excitatory neurotransmitter, substrate for Krebs-Cycle, Protein Biosynthesis Glutamine:Substrate for neurotransmitter synthesis (GABA, Glutamate), Protein Biosynthesis  Glx:Stroke, hyp-/anoxia, epilepsy, neurodegenerative diseases, hepatic encephalopathy Lac:Sign of impaired energy metabolism, impaired oxygen delivery (anaerobic glycolysis).  : Stroke, An-/Hypoxia, mitochondrial diseases, tumors, epileptic discharges, abscesses/infection, prolonged neuronal activation Hardly detectable in normal brain tissue (~1 mM)

36 Single Voxel 3T TE = 288 ms VOI = 20 x 20 x 20 mm 3 Cerebellum (AMS study) U. Dydak, IBTZ NAA Cr Cho Lactate Mi

37 before treatment after treatment NAA Cr Cho Lactate 4321 NAA Cr Cho Lactate Courtesy: Dept. of Radiology, University of Bonn, Germany Scan time: 4.16 min (35cc) SVS: tumor treatment Mi

38 Subacute Acute Normal Courtesy: Tim Roberts, Toronto FLAIR - ROIs Cerebral Infarction

39 Alzheimer’s Disease The increase (  ) of MI seems to differentiate Alzheimer’s Disease from other forms of dementia

40 Whole brain TSI 6 slices, 20x20x6 isotropic voxel (1.33ml),  = 8.8 Hz

41 Spectroscopic Imaging

42 Cho Cr NAA

43 TSI6: Meningioma NAA Cho Single slice, 32 x 32 matrix, TR=2000 ms, 0.8 ml voxel => 5:12 min U. Dydak, IBTZ

44 Visualization of 3D MRSI Data visualization software: IMARIS by Bitplane, Switzerland NAA maps 3D SENSE-SI Talk U. Dydak et al, Friday, am

45 SENSE Extremity 3T 3D T1w FFE 3.0 Tesla SENSE factor microns in-plane 1mm slice thickness Scantime 8 min. K.P. Pruessmann, IBTZ D. Weishaupt, Radiology, USZ

46 Scan time: 4 s / 3D frame SENSE R= × 2.1 × 2.4 mm 3 Time-Resolved 3D CE-MRA SENSE Angiography M. Weiger, K. Pruessmann, IBTZ

47 Time-Resolved 3D CE-MRA ibt / mw kp 4 s / 3D frame 1.6 × 2.1 × 2.4 mm 3 SENSE R=3.0 SENSE Angiography

48 Motion Artefact Reduction Standard Breathhold: 24 sec SENSE R = 2.0 Breathhold: 12 sec Dep. of Veterans Affairs, Durham

49 Problem: Morphological imaging for many problems insufficient Functional diagnostics on a strongly moving organ (heart motion, breathing) at rest and under stress needed. “One stop shop”. Cardiovascular MRI

50 Coronary artery angiography Viability and perfusion Wall motion, ejection fraction Flow (coronary flow reserve, valvular flow, regurgitation) Heart functions: Cardiovascular MRI

51 Ischemic Cascade Hypoperfusion Metabolic changes Diastolic dysfunction Regional systolic dysfunction ECG  changes Chest  pain Time spectroscopy coronary MRA, flow, perfusion motion viability

52 Frank H. Netter

53 Balanced FFE, SENSE R=1.5, 1 breathhold Courtesy R. Springorum, PMS Mitral Valve Tricuspid Valve High Contrast Cardiac Imaging

54 Chronic Myocardial Injury S. Flamm, Texas Heart Institute

55 M. Schaer, S. Kozerke, K.P. Pruessmann, IBTZ T R = 3.8 ms, Matrix = 213 x 160 Slice = 8 mm, 20 phases No SENSE 15 sec SENSE 2 x 7 sec SENSE 3 x 5 sec Balanced 3T

56 8  k-t SENSE 5 coils 8  k-t BLAST 1 coil J. Tsao, K.P. Pruessmann, IBTZ Real-time SSFP with k-t

57 No SENSE 9 sec BH, 25 fphb SENSE R=2 5 sec BH, 25 fphb SENSE R=2 9 sec BH, 50 fphb Courtesy M. Kouwenhoven, PMS fphb = frames per heart beat Balanced FFE, breathhold SENSE Cardiac Imaging

58 ibt 35 ms / frame Resol 2.5 mm SENSE R=2.7 Rest Stress 155 bpm SENSE Real Time Cardiac Imaging

59 Coronary Arteries

60 0.75 x 1.0 x 1.5 mm x 1.0 x 0.75 mm 3 No SENSE, 20 slicesSENSE 2 x, 40 slices RCA Coronary 3T Talk M.E. Huber et al, Friday, am

61 Left coronary arteries; intravascular contrast agent Right coronary artery; without contrast agent IBT Zurich / BIDMC Boston / DHZ Berlin / Bracco Milan Coronary Artery Angiography

62 2D Selective real-time NAV Free-breathing VECG 3D TFE 600  m in-plane resolution 3mm slice thickness LAD Ao LCX M. Stuber, BIDMC Boston Coronary Angiography 3T

63 IBT Zurich / BIDMC Boston / A FE D C B Coronary Artery Angiography

64 Myocardial Tagging 45 heart phases with interval of 13ms 8mm grid width, 2.8mm x 2.8mm resolution spiral readout: 12 spirals, acquisition window 5ms S. Ryf, M. Spiegel, IBTZ M. Stuber, BIDMC Heart Wall Motion

65 basal levelapikal level Stuber M. et al, Circulation 100, 361, 1999 Heart Wall Motion

66 anatomyflow Regurgitation S. Kozerke, IBTZ Heart Valve Function : STrack

67 Heart Valve Prosthesis: Particle Tracing Flow Imaging: STrack S. Kozerke, IBTZ

68 Outlook and Discussions Higher field strength Faster techniques Cardiac functions Brain organization And the costs ??? New techniques will be more expensive! BUT: Modern technique allows for a much better diagnosis! It is not the medical equipment, which will influence the cost! The medical staff has to choose the appropriate methods for an optimal diagnosis and to propose the best therapy or surgery!

69 Doctoral Students Christof Baltes, el. eng. Holger Eggers, el. eng. Michael Huber, el. eng. Thomas Jaermann, phys. Thomas Lange, phys. Roger Luechinger, phys. Markus Oelhafen, el. eng. Salome Ryf, phys. Michael Schär, phys. Conny Schmidt, phys. Rolf Schulte, phys. Andreas Steingoetter, el. eng Reto Treier, phys. Florian Wiesinger, phys. Chairmen Peter Boesiger, PhD Klaas Pruessmann, PhD Research Assistants Ulrike Dydak, PhD Roger Luechinger, PhD Jeff Tsao, PhD Andreas Trabesinger, PhD Gérard Crelier, PhD Project Leaders Dieter Meier, PhD Sebastian Kozerke, PhD Markus Scheidegger, PhD Present Team


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