FieldStrength 49

Publication for the
Philips MRI Community
ISSUE 49 – 2013 / 2
LUMC sees fast, robust mDIXON
fat suppression in head/neck
Lyon South advances liver imaging
to high quality at high speed
PAMF shortens MSK exam slots
while maintaining excellent quality
Transforming care,
together

16
Dear
Friends,
Editorial
Because Philips understands the challenges in today’s healthcare environment, we develop
MR products and features for fast and robust MR imaging with high quality. Where
conditions demand it, our technology allows you to choose new imaging strategies, and use
inventive approaches and new applications, so you’ll be well equipped when changes come.
This issue of FieldStrength features MR users who are using the power of Ingenia with
dStream to change their way of working. You can read how liver imaging with high
dS SENSE acceleration has improved image quality so that patient management may
change at Lyon South Hospital. Leiden University Medical Center is employing mDIXON
TSE for excellent, robust head and neck imaging that is even faster.
Palo Alto Medical Foundation has reduced MSK exam times significantly while
maintaining outstanding image quality. The 32-channel dS Head coil helps Qscan
Radiology Clinic to consistently achieve excellent detail in its neuro images.
We’ve also highlighted how Cincinnati Children’s Hospital and University College London
Hospital use Ingenia with dStream to start using a different approach for performing
fetal imaging and whole body imaging respectively.
Don’t miss reading about our RSNA presence, which demonstrates products and
features that are built for fast, robust MR imaging with high image quality, giving you the
flexibility and control you need. Without you, it’s just a machine!
Enjoy reading how we are transforming care, together.
Tamanna Bembenek
Senior Director Product Marketing MRI at Philips Healthcare
NetForum
www.philips.com/netforum
EXPLORE
Share clinical results
OPERATE
Support your scanning
GROW
Support your business
Visit the NetForum online community
to download ExamCards and view
application tips, case studies, online
training and more. Scan the QR code
with your smartphone or use
www.philips.com/netforum.

4
User experiences
Transforming care, together
Philips users are utilizing the power of Ingenia with dStream to develop
new approaches in MR imaging. Solutions are designed for accelerated and
enhanced patient imaging, as well as image viewing, processing and analysis.
12 24 40
MR News
Application tips
Educational
NetForum
Calendars
In this issue
28
8 Multi-parametric prostate and whole-body oncology MRI exams
UCLH uses Ingenia 3.0T for multi-parametric MRI exams to help localize
and characterize lesions.
Dr. Punwani, University College Hospital London, United Kingdom
12 Liver imaging takes a step forward with high quality at high speed
Lyon South Hospital strives to move from several studies – first CT, then
MR or PET – to using just one comprehensive Ingenia MRI exam of the
liver for oncology cases.
Prof. Valette, Lyon South Hospital, France
16 Ingenia 1.5T helps overcome fetal imaging challenges
High SNR, digital coil setup and wide bore contribute to a smart
approach for fetal MR imaging.
Dr. Serai, Dr. Kline-Fath, Cincinnati Children’s Hospital, Ohio, USA
20 Need to decrease exam time leads to shorter, but still
excellent, MSK exams
PAMF developed Ingenia 3.0T MSK protocols that save minutes per scan.
Dr. Goumas, Palo Alto Medical Foundation, California, USA
24 32-channel dS Head coil demonstrates robustness, high image detail
Qscan uses the 32-channel head coil for all its Ingenia 3.0T neuro work
because of its consistency, clarity and exceptional spatial resolution that
even reveals detail within small structures.
Ben Kennedy, Qscan Radiology Clinic, Brisbane, Australia
28 Changing MRI methods in head and neck imaging
mDIXON TSE, Diffusion TSE address MRI challenges in the head/neck area
and allow different imaging strategies.
Dr. Verbist, Leiden University Medical Center, Leiden, The Netherlands
Results from case studies are not predictive of results in other cases. Results in other cases
may vary. Results obtained by facilities described in this issue may not be typical for all facilities.
4 Philips MR at RSNA 2013 - Transforming care, together
33 MasterSeries provides ExamCards from expert users
34 Take advantage of mDIXON TSE in MSK imaging without
time penalty
38 CSF flow compensation in spine
40 Vascular permeability analysis based on MR data
42 Fast susceptibility weighted imaging with premium
image quality
44 Most popular NetForum content
46 Education calendar 2014
47 Events calendar 2014

4 MR News
Philips MR at RSNA 2013
Transforming care, together
The Philips booth at the 2013 RSNA meeting presents MR products and services that help transform patient care.
With dStream technology and the remarkable Ingenia 1.5T and 3.0T systems, Philips continues to drive fast,
robust, high quality MR imaging, while ensuring good economic value. New solutions for neurology and oncology
and the latest edition of IntelliSpace Portal expand diagnostic capabilities for referring physicians. iPatient for MR
is introduced to deliver patient-centric imaging and support consistency and efficiency.
dStream drives clinical excellence
and productivity in MRI
dStream is a decisive solution to deliver premium
image quality. With digitization in the coil, dStream
delivers a pure digital signal that delivers up to 40% SNR
improvement* depending on the clinical area of interest.
The extra signal can be used to enhance image quality
and accelerate imaging.
Through its optimized coil topology and the SNR
advantage of the pure digital signal, dStream and dS
SENSE deliver high acceleration for clinical use. This
allows for fast and robust imaging, especially in body
imaging.
Using the advantages of the dStream platform, Philips has
developed time-efficient imaging techniques for greater
speed and consistency. The Philips patented 2-point
mDIXON technique delivers superb fat-free imaging with
premium quality at amazing speed – only 2/3 of the time
needed for a 3-point technique. Together with dStream
this allows for new approaches in imaging that support
standardization, consistency and speed.
dStream and dS SENSE come standard with every Ingenia
and SmartPath to dStream system.
* Compared to an analog system (Achieva).
mDIXON TSE with and without fat suppression in one scan.
Ingenia 3.0T, voxels 0.8 x 0.9 x 3.0 mm, scan time 5:37 min.
Courtesy of Phoenix Children’s Hospital, Phoenix, AZ, USA.
FieldStrength - I 4 ssue 49 - 2013/2

Easy access to dStream on your current magnet
Philips sees high interest among existing MR users to get access to
dStream in a cost-effective way. The SmartPath to dStream program
converts an Intera or Achieva system into a state-of-the-art digital
MR scanner, enabling fast and robust MRI imaging. Equipped with the
integrated posterior coil, powerful dS SENSE as well as workflow
enhancements, this gives essentially the same dStream benefits as
with an Ingenia. Additionally, this conversion to dStream gives access to
the above mentioned new clinical features and also includes iPatient and
the enhanced user interface.
Ingenia Intera or Achieva SmartPath to dStream
CONTINUE
iPatient provides patient-centric workflow
iPatient represents efficient, personalized
imaging, in which exams can quickly and
easily be tailored to individual patients and
situations. iPatient supports users to deliver
consistent image quality for their patients.
Lightweight and easy-to-handle coils
streamline patient setup and enhance
patient experience. ExamCards facilitate
use of personalized and automated imaging
strategies by enabling smooth routine exams
as well as advanced scanning methods.
An intuitive interface allows users to adapt
imaging to the patient in a consistent
manner, aided by SmartExam, SmartSelect
and user guidance. As fewer clicks are
needed, users can depend on a smooth,
direct route to personalized, high-quality
exams, even in high-end or complex cases.
FieldStrength 5

MR News
Advanced diagnostics: imaging, viewing and analysis
New methods for advanced neuro imaging
include SWIp for fast susceptibility weighted
imaging with exquisite quality, for instance
for imaging of venous blood. pCASL allows
non-contrast, high SNR brain perfusion
imaging. On IntelliSpace Portal this can
be easily viewed as color overlay on an
anatomical image to assist the radiologist in
diagnosis. Similar to BrainView, MSK View
provides excellent image resolution in all
orientations after just one 3D acquisition.
pCASL and overlay on anatomical images
Ingenia 3.0T. Courtesy of Phoenix Children’s Hospital, Phoenix, AZ, USA.
IntelliSpace Portal as a delighter to every MR scanner
Advanced visualization completes advanced
imaging. IntelliSpace Portal supports
efficient and comprehensive interpretation
of advanced data with applications and
features for Oncology, Cardiology,
Neurology and MSK. Whether you need to
run advanced Cardiac functional analysis,
request an Oncology therapy RECIST
follow-up analysis, or want a pre-surgical
review of the brain, all is enabled with
IntelliSpace Portal 6.
IntelliSpace Portal provides an intelligent
approach to visualization: the ability to
access and diagnose any time and virtually
anywhere without being tied to a modality
workstation. With a multi-modality clinical
approach, the user is directly taken to the
clinical dilemma at hand.
Integration into an entire radiology
department or hospital enterprise is easy
with IntelliSpace Portal; the thin-client
technology data review can be launched
virtually anywhere. With multi-vendor*
capabilities there is no concern about the
origin of data. Workflow is supported by
bookmarks to enable sharing with peers
in a comprehensive manner.
Discover the powerful combination of
intelligence, integration, and interpretation.
Philips IntelliSpace Portal can transform the
way you work, think, and care for patients,
and it adds to our advanced imaging on
Philips MR systems.
Comprehensive cardiac functional review with IntelliSpace Portal.
* Consult your Philips sales representative for
detailed information.

Advancing MRI beyond diagnostic imaging
With our innovative MR-Therapy portfolio we are committed to touching even more lives.
The unique capabilities of MRI can be used beyond diagnostic imaging in guiding and
monitoring therapeutic procedures.
Dual-room MR-OR
With a world-class Ingenia MR system
at its heart, the Ingenia MR-OR delivers
outstanding images during neurosurgery
procedures to help improve procedural
success rates. The dual-room MR-OR
layout allows regular diagnostic use
of the MR system when not in use for
intraoperative purposes.
The possibility of both front and rear
docking in a triple-room setup, and the
smooth patient transfer between OR and
MR further increase efficient utilization of
the set-up.
Ingenia MR-OR
Ingenia MR-RT Oncology Configuration
MRI in radiotherapy treatment planning
The Ingenia MR-RT Oncology Configuration
is a dedicated solution for radiation oncology
departments that want to take full advantage
of MRI’s excellent soft-tissue contrast for
their treatment planning workflow. With an
Ingenia as its backbone, the Ingenia MR-RT
provides images acquired in the treatment
New coils
A new coil on display is the open 16-channel dS Breast coil. This
coil is designed to support both diagnostic scans and breast biopsy.
Other new coils include the dedicated dS Pediatric coils and the dS
Microscopy coils.
The open dS Breast 16ch coil provides excellent
diagnostic scans and supports breast biopsy.
position and optimized for use in RT planning
with remarkable geometric accuracy. This
comprehensive solution considers the
entire workflow from scan to planning and
treatment, including quality analysis tools,
tailored training and RT-specific ExamCards.
FieldStrength 7

8
Multi-parametric
prostate and
whole-body oncology
MRI exams
UCLH uses Ingenia 3.0T for multi-parametric MRI exams to help
localize and characterize lesions
In multi-parametric MRI, the multiple contrast mechanisms provide more
information about lesions that can help in diagnosis. Multi-parametric MRI can
include T1-weighted, T2-weighted, diffusion-weighted imaging (DWI), DCE and
spectroscopy. Dr. Shonit Punwani and his team at the University College Hospital
London developed multi-parametric MRI exams for prostate imaging and whole
body imaging.
UCLH (University College London Hospital)
is a leading hospital in the UK. It has an
Achieva 3.0T and an Ingenia 3.0T installed at
the MacMillan Cancer Centre. The Achieva
system is used predominantly for prostate
MRI but also for general work. The Ingenia
system is used for dedicated scanning of
oncology patients. In addition to the clinical
services provided, the radiology department
is at the forefront of medical research.
MRI has a range of applications in
prostate imaging
“When prostate MRI is used for staging after
cancer has been diagnosed, the goal of imaging
is to visualize the lesions and determine if
and where these are extending outside the
prostate,” says Dr. Punwani. “That requires
high quality anatomical imaging. However, when
MRI is used to assist in the initial diagnosis,
a multi-parametric approach offers more
information. I use the additional information
particularly for small tumors. For instance,
when I see a lesion with low signal on T2-
weighted images, and the additional DWI and
the ADC map confirm the lesion has a reduced
ADC, then I know that the lesion is likely to
be cellular. Increased cellularity restricts the
movements of water molecules, which leads to
high signal on DWI and restricted ADC.”
User experiences
Dr. Shonit Punwani is a Senior Lecturer in
Oncological Imaging at University College London
and Honorary Consultant Radiologist specializing
in oncological radiology at University College
London Hospital. He co-leads the 3T MR Research
Facility at UCLH, developing novel MRI techniques
for first-in-man oncological imaging studies. He
has a specialist clinical and research interest in the
application and development of local and whole-body
quantitative and functional MRI methods for
imaging prostate.
“When MRI is used to
assist in the initial diagnosis,
a multi-parametric
approach offers more
information.”

“Not using an endorectal coil is more
comfortable for the patient and currently
the surface coil approach provides enough
SNR for prostate imaging. When performing
prostate MRI without endorectal coils, air in
the rectum may cause susceptibility effects,
particularly at 3.0T. So, in order to reduce the
susceptibility effect, we use a small field-of-view
DWI for generating the ADC map. We
also include a separate high b-value DWI and
have found both particularly useful. When I
see focal areas of high signal on b2000 images
and the rest of the gland is dark, I have a very
high suspicion of cancer being present.”
Why change the approach?
“There is a clear need to change the way that
we localize disease within the prostate. We
would never perform a breast biopsy without
first trying to localize the lesion using
imaging. That is why we are now developing
the necessary tools to localize disease within
the prostate with multi-parametric MRI. We
have been performing multi-parametric MRI
of the prostate without an endorectal coil at
1.5T since 2006. The arrival of our Achieva
3.0T TX system and use of the 32-channel
SENSE Cardiac coil significantly improved
the signal to noise of our T2 and diffusion
weighted images.”
Dr. Punwani and his team are also looking at
MRI to help assess the effect of treatment.
“Being able to localize lesions also opens the
possibility to provide focal therapies, which
treat only a part of the prostate rather than
removing the entire organ. In such cases
we can use MRI to monitor the effect of
treatment. For post-treatment surveillance, if
PSA is increasing, we can use multi-parametric
MRI to localize recurrent/residual disease.”
Multi-parametric whole-body MRI
provides more information
“The multi-parametric approach for whole
body oncology imaging is a more recent
development, which has been facilitated by the
installation of the Ingenia 3.0T scanner. The dS
Torso coil solution makes whole body imaging
using multiple contrasts within a reasonable
overall imaging time a reality. We are very
pleased with the results so far.”
“Being able to localize
lesions opens the possibility
to provide focal therapies.”
“One of the key benefits of multi-parametric
MRI for whole-body exams is that, unlike PET,
there is no radiation,” says Dr. Punwani. “This
is especially important for pediatric patients
who need many follow-up scans.”
“Also, FDG-PET does not detect all bone
lesions. DWI methods have been shown
to be useful at visualizing bone disease and
could complement PET or other nuclear
medicine techniques.”
“We perform all our multi-parametric
whole body MR scans on the Philips Ingenia
3.0T,” says Dr. Punwani. “The new core
technologies on the Ingenia allow us to use
a multi-parametric whole-body approach in
a reasonable amount of time. For anatomical
imaging we do a free breathing TSE sequence.
CONTINUE
Axial ADC map Axial T2W Axial b2000 diffusion weighted
Multi-parametric prostate
The axial ADC map demonstrates reduced diffusion within the anterior left transition zone of the prostate. This is consistent with increased cellularity within a
tumor. Note that this region would not be undersampled by a standard TRUS biopsy procedure, and without MRI assisting in targeting a diagnosis of localized
tumor could not be confirmed. The axial T2-weighted images demonstrate a subtle more homogenous area of reduced T2 signal within the anterior left transition
zone similar in appearance to adenoma. The axial b2000 diffusion weighted image demonstrates significant residual signal within the left anterior transition zone at
the tumor site. Signal elsewhere is almost completely absent. This was scanned on Achieva 3.0T TX.
FieldStrength 9

“Ingenia allows us to
use a multi-parametric
whole-body approach
in a reasonable
amount of time.”
UCLH (University College London Hospitals NHS Foundation Trust), situated in
the West End of London, is one of the largest NHS trusts in the United Kingdom
and provides first-class acute and specialist services. The state-of-the-art University
College Hospital that opened in 2005, is the focal point of UCLH alongside five
cutting-edge specialist hospitals. UCLH is committed to research and development
and forms part of UCL Partners, which in March 2009 was officially designated as
one of the UK’s first academic health science centers by the Department of Health.
UCLH works closely with UCL, translating research into treatments for patients.
For more information, see www.uclh.nhs.uk, Facebook (UCLHNHS),
Twitter (@UCLH) or Youtube (UCLHvideo).
User experiences
Bone scan
DWI b1000
T1 mDIXON in phase
T2W
Multi-parametric whole body using Ingenia 3.0T
Bone scan and mp-MRI concordant lesions in a patient with known prostate cancer. Two lesions
are demonstrated on the bone-scan at T12 and T7 vertebral body levels. The coronal mDIXON
in-phase image demonstrates both lesions as foci of low T1 signal. Coronal reformat of an axial
diffusion b1000 scan (inverted contrast) demonstrates restricted diffusion within the T12 lesion.
The axial T2-weighted image at the T12 level confirms low T2 signal.

“These T2-weighted images are excellent.
We also perform diffusion imaging of the
whole body. We’re using SPAIR spectral fat
suppression, not STIR as in DWIBS, to acquire
four b-values. These help us to differentiate
the diffusion components from other effects.
The ADC maps are quite good. In the neck
though, the susceptibility gradient may cause
distortion in the ADC map. One of the things
we can do is add a STIR EPI on the neck after
scanning the entire body, which tends to have
fewer artifacts.”
“Next, we use body mDIXON imaging:
acquiring in-phase, out-phase images and
deriving fat and water images. This provides
us with excellent anatomical resolution.”
“The liver is a special case in most whole-body
images, because we want to be able
to pick up liver lesions, which we don’t
necessarily see without contrast. So, we do
dynamic imaging, which is acquired every
20 seconds, and has multiple breath holds
through the liver.”
“I’m getting more and more clinical requests
in for multi-parametric MR to visualize
disease and response to treatment in different
clinical areas,” says Dr. Punwani.
Summary: why a multi-parametric
approach
“Combining multiple contrast mechanisms
allows us to look at different aspects of tumor
biology – for example, cellularity, vascularity,
fat/water percentages – and together these
provide more information than any one
particular technique. And I think that’s
very powerful, particularly where patients
have heterogeneous tumors where not all
lesions are seen by any one technique. Also
by evaluating multiple aspects of tumors we
may be able to not only see the disease but
hopefully develop methods to better predict
the responses to treatment.”
Bone scan
DWI b1000
T1 mDIXON in phase
T2W
Multi-parametric whole body using Ingenia 3.0T
Bone scan and mp-MRI discordant lesion in a patient with known prostate cancer, suggesting mp-MRI may
be more sensitive than bone scan. No iliac bone lesion is seen on the bone scan. The coronal mDIXON in-phase
image demonstrates subtle hypointense T1 signal within the left ilium (red arrow). The axial diffusion
b1000 image (inverted contrast) demonstrates restricted diffusion at the corresponding site within the left
ilium (red arrow). The axial T2-weighted image at the site confirms a typical appearance of a low T2 signal
metastatic deposit (red arrow). Combining multiple contrast mechanisms provides more information than
any one particular technique, which is powerful when not all lesions are seen by any one technique.
FieldStrength 11

12
Liver imaging takes a step
forward with Ingenia
Lyon South Hospital strives to move from several studies – first CT, then MR or PET –
to using just one comprehensive liver MRI exam for oncology cases
The Lyon South Hospital (Lyon, France) is part of the
Lyon University Hospital Center. It has nearly 1000 beds,
mostly dedicated to cancer care, including oncology,
radiotherapy, interventional radiology and surgery.
The hospital uses Ingenia 3.0T and Ingenia 1.5T to
perform about 800 MR exams a month, about 200 of
which are for abdominal conditions.
Prof. Pierre-Jean Valette, MD, is Chief of Radiology and Nuclear
Medicine Service at Lyon South Hospital. “In oncology patients, liver
MRI is performed in several situations: to help us characterize lesions,
in follow-up after chemotherapy, and to assist in treatment planning
in a concept of multidisciplinary care when a complete tumor removal
appears to be feasible,” he says. “So, we need our imaging to provide a
comprehensive visualization of the liver and all lesions, their size, volume
and location relative to other critical anatomical structures – such as bile
ducts and portal branches – that influence tumor resectability.
This helps determine the treatment options; it may be resection or
tumor ablation or maybe radiotherapy.”
Challenges and goals in liver MRI
“MRI of liver tumors offers more than CT in certain aspects,” says Prof.
Valette, “as it provides visualization and characterization of lesions with
combined T1, T2 and DWI sequences, in addition to good tumor contrast
uptake resolution and anatomical biliary tree imaging. Therefore, we
always perform MRI before surgery or interventional radiology in case of
bile duct tumor and liver primary cancers (HCC) or metastases.”
“Liver tumor MRI is almost always associated with CT and contrast-US
for imaging,” he adds. “However, we think that MRI could become the
sole examination as soon as it can provide image quality robustness
similar to CT, better control of its inherent artifacts and increased
spatial resolution for vascular imaging.”
Ingenia’s high image quality helps to overcome challenges
Lyon South Hospital installed Ingenia 3.0T in 2011, and an Ingenia 1.5T
User experiences
Prof. Pierre-Jean Valette, MD, is head of the Lyon South Hospital
imaging department. His specialties include diagnostic and interventional
gastrointestinal imaging, with a special interest in MRI applications in digestive
pathology. He has also contributed to the design of dedicated medical image
processing software and therapeutic planning of patients.

“We are moving from doing
several studies – CT first,
then MR or PET – to just
one, and it’s saving us a lot
NetForum
Visit the online NetForum
community to download the liver
ExamCard of Prof. Valette.
CONTINUE
was recently added. Prof. Valette likes using the Ingenia’s dS Torso coil
solution because it has a large coverage. “With this coil, whole abdomen
acquisition is a single step for most patients. So, it is much faster to
perform, for instance, bowel MRI for inflammatory diseases or tumors.”
With the most recent Ingenia software release installed, Prof. Valette
has worked to improve reproducibility, image quality and acquisition
time of the hospital’s liver sequences. “We were able to realize
improvements thanks to high dS SENSE in RL direction and improved
MultiVane T2-weighted imaging. We are now convinced that we are on
the way to definitely overcome the challenges. We optimized for image
quality and control of artifacts. The arterial phase detection of very
small liver or pancreatic hypervascular tumors is also improved.”
Only one MRI exam instead of multiple studies
“With all these improvements, I believe that resolution of vascular
liver MR imaging is now approaching CT,” says Prof. Valette. “That’s
important because we are moving from doing several studies - CT
first, then MR or PET – to just one, and it’s saving a lot of time.”
of time.”
“For instance, when assessing bile duct tumors, we need to see the
location and boundaries of the tumor, but also the bile ducts adjacent
to the tumor, the vessels, the hepatic artery, the portal vein, because
all these are needed to determine whether the tumor is resectable
or not. When we get, for example, bile duct images from MR or CT
and the tumor on PET and maybe the vessels from CT, it’s difficult
to combine all these views. And it means two or maybe three
examinations have to be performed. The idea is to do everything
with just one multiparametric technique, and that is MRI.”
A robust high quality MRI exam
Prof. Valette’s liver MRI includes some basic sequences and a set of
optional sequences that may be used in special circumstances. “Our
extended liver ExamCard includes a range of sequences for patients
with limited capability to hold their breath, and also for obese patients,”
he says. “If the patient is not able to maintain a breath hold we reduce
the acquisition time by limiting the coverage to a selected region of
interest and/or increase the voxel size, depending on the case.”
T1 mDIXON arterial phase
T2W
T1W mDIXON portal phase
VRT liver vessels
Focal nodular hyperplasia in liver
In a 45-year-old woman recently operated for a breast cancer, ultrasound revealed a right hepatic nodular
lesion. T1-weighted images at arterial and late phase demonstrate a small mass, markedly hypervascular at
the arterial phase, isointense to the liver at the late phase except persistent enhancement of fibrous septa,
making a characteristic aspect of FNH. On the T2-weighted image the nodule is moderately hyperintense.
The 3D image demonstrates the spatial arrangement of the hepatic artery, the portal vein and hepatic
veins showing the anatomical relationship of the hepatic nodule with the vascular liver structures.
Ingenia 3.0T with dS Torso coil solution, patient feet first, arms up.
FieldStrength 13

User experiences
“The use of high dS SENSE in RL
direction provides shorter breath
hold times, higher resolution and
sharper images.”
Liver exam at Lyon South Hospital
Basic sequences
• T2 MultiVane
• mDIXON FFE with all image types reconstructed
• mDIXON FFE water only, arterial/portal (2)/venous, breath hold ca. 18 sec.
• DWI b1200
Optional sequences
• T2 single shot: if respiratory motion artifacts in T2 MultiVane
• 3D respiratory gated T2 MRCP: for bile ducts tumor. Axial acquisition if hilar tumor +++
• single shot T2 : if artifacts in 3D T2 MRCP
• mDIXON FFE early arterial and portal if vascular anatomy is needed
T2W
DWI
T1 mDIXON arterial phase
MIP bile ducts
T1W mDIXON portal phase
VRT bile ducts and portal vein
Large centro-hepatic cholangiocarcinoma
A 54-year-old male is admitted for jaundice. CT revealed a large centro-hepatic mass but the local extension to hilar structures
could not be determined precisely. The T2-weighted image shows a large well-defined mass in segment IV. T1-weighted images
at arterial and portal phase show late heterogeneous enhancement of the lesion suggesting a fibrous component and possibly
mucinous content or central necrosis. DWI demonstrates restriction predominantly at the peripheral part of the mass. No
evidence of adjacent lesions into the liver. The MIP and VRT MRCP views confirm the hilar bile duct invasion, of which details are
clarified on reformatted views in an axial plane. There is no associated compression of portal branches. Ingenia 3.0T with dS Torso
coil solution, patient feet first, arms up. Final diagnosis is hepatic cholangiocarcinoma invading the convergence of the bile ducts with
prominent extension of the right side. Resectability may be considered in the absence of portal damage, but was not attempted
because of insufficient left lobe volume.

New way of patient positioning benefits image resolution
“Thanks to Ingenia’s wide 70 cm bore,” says Prof. Valette, “we have been
able to improve our imaging strategy by implementing the high dS SENSE
speedup in RL direction with arms-up patient positioning. This allows
using a narrowed acquisition volume without the patient’s arms causing
artifacts. This provides shorter breath hold times, higher resolution and
sharper images because of reduced blurring in TSE and less distortion in
DWI. This positioning is accepted by almost every patient, but requires
an examination time not exceeding 20 to 25 minutes.”
“The use of high RL dS SENSE factors in combination with arms-up
provides a real advantage. So often with MR, when you change
something, you lose something somewhere else. In this case, I see just
advantages,” he concludes.
“Our extended liver ExamCard
includes a range of sequences for
patients with limited capability to
hold breath, and also for
obese patients.”
CT
T1W mDIXON pre contrast
T2W
T1W arterial phase
DWI
T1W portal phase
Multifocal liver hepatocellular carcinoma
A 57-year-old male with decompensated cirrhosis is referred to MRI to visualize the hepatocellular carcinoma (HCC) and the lesion
extension and to help assess the feasibility of an Yttrium radioembolization. CT shows a heterogeneous liver without obvious nodule.
The left portal branch is the site of a suspended thrombus. T2-weighted MRI demonstrates large effusion ascites, heterogeneous liver
with the presence of multiple slightly hyperintense nodules. On DWI a multi-nodular lesion is seen in the liver with marked diffusion
restriction. The portal vein nodule is also hyperintense suggesting a tumor thrombus.
On T1-weighted mDIXON the lesion shows arterial enhancement and portal phase wash-out. MRI supports the diagnosis of
decompensated liver cirrhosis with multinodular HCC. Early opacification of the left portal vein at arterial phase suggesting the
presence of arterioportal fistulas, by which radioembolization would not appear to be safe. Ingenia 3.0T with dS Torso coil solution,
patient feet first, arms up. dS SENSE in LR direction, T2W SP with MultiVane. DWI with b0-b1200, free breathing.
FieldStrength 15

16
User experiences
Suraj Serai, PhD, MRI physicist, Department
of Radiology at CCHMC, works to improve
image quality and optimize MR imaging protocols
to suit pediatric needs, and contributes to
multiple research projects related to pediatric
radiology. His specialties include MR physics,
T2 mapping, spectroscopy, diffusion, fMRI,
and optimization of MR imaging protocols for
enhanced image quality and better diagnosis.
Beth M. Kline-Fath, MD, Associate Professor
of Radiology and Chief of Fetal Imaging at CCHMC,
developed the fetal imaging program for the
department and is a staff member of the Fetal
Care Center of Cincinnati. In addition to Pediatric
Neuroradiology, her areas of interest include fetal
imaging and MR spectroscopy.
Ingenia 1.5T helps overcome
fetal imaging challenges
High SNR, digital coil setup and the wide bore contribute to a smart approach for
fetal MR imaging at Cincinnati Children’s Hospital
Cincinnati Children’s Hospital Medical Center
(CCHMC, Cincinnati, Ohio, USA) is one of the largest
pediatric radiology facilities in the United States,
performing over 200,000 imaging studies per year.
Using an Ingenia 1.5T, the Hospital performs up to
10 fetal MRI exams per week. Most of these are
patients referred from the Fetal Care Center of
Cincinnati, which provides mothers and babies with
comprehensive prenatal and postnatal care.
“Our patients have already had an ultrasound and MR is the next stage,”
says CCHMC radiologist Beth M. Kline-Fath, MD. “We image fetal CNS
abnormalities, twins with twin/twin transfusion syndrome, chest masses
including congenital diaphragmatic hernia, lung masses, mediastinal
masses, and babies with multiple congenital anomalies. We try to help
guide their prenatal care and perinatal intervention where necessary.”
A moving fetus is a challenge for MRI
“The biggest challenge in obtaining diagnostic fetal MRI is to acquire
images when a fetus is not moving. The most important thing for us is
to get the mother extremely comfortable and alleviate her anxieties,
because a disquieted mother affects fetal motion,” says Dr. Kline-
Fath. “We do not give sedation to the mom. I do my fetal exams early

CONTINUE
“When the fetus moves, we just move the FOV and Ingenia’s
SmartSelect automatically chooses the elements to obtain the
best possible SNR. That’s very, very helpful.”
“With the extra SNR,
we were able to
improve the resolution
on our single-shot
T2 sequences.”
in the morning because, in my opinion, a fetus typically moves less
in the morning. Most of our patients prefer to lie on their side, so
we position the mother in a decubitus position and put her in feet
first, with her head outside the scanner as much as possible. In this
way, she can see the person who is with her in the room. If she’s
claustrophobic, we have her focus on the outside of the room.”
Ingenia allows a smart approach
“The other difficulty in these exams is that imaging the mother requires
a large field of view, but the fetus is very small and embedded deep
inside the mother, so SNR is inherently low,” explains Suraj Serai, PhD,
MRI physicist at CCHMC. “And because the fetus may also move, we try
to keep the image acquisition time as short as possible.”
SSh TSE Balanced TFE
Chiari II malformation with myelomeningocele
A 31-year-old pregnant female with fetus at 22 weeks with
suspected myelomeningocele was evaluated for intrauterine
repair. The sagittal T2-weighted SSh TSE image shows a
hindbrain abnormality with cerebellar tonsils in the foramen
magnum (long arrow) and lack of visualization of the fourth
ventricle (short arrow). This finding is consistent with Chiari
II malformation. The T2-weighted BFFE sagittal spine image
shows a lumbosacral spinal defect (arrow) consistent with
myelomeningocele. This was done on Ingenia 1.5T. Based on
the radiologist’s report, it was decided to be a candidate for
prenatal intrauterine repair of myelomeningocele.
FieldStrength 17

User experiences
Coronal T2-weighted SSh TSE Axial T2-weighted SSh TSE
Right congenital diaphragmatic hernia
A 22-year-old pregnant woman with a fetus at 33 weeks being
evaluated for fetal lung lesion. MRI was done on Ingenia 1.5T.
The coronal T2-weighted SSh TSE image demonstrates a fluid
filled small bowel (long arrow) and dark meconium filled colon
(short arrow) in the left chest confirming presence of congenital
diaphragmatic hernia. Note the normal location of stomach
(dotted arrow) in the left upper abdomen. The axial SSh TSE
T2-weighted image again shows small bowel (long arrow) and
meconium (short arrow) in the right chest. The heart (dotted
arrow) is displaced into the left chest. These findings led to
counseling and preparation for respiratory support at delivery.
Coronal T2-weighted SSh TSE Twin-to-twin transfusion syndrome
33-year-old female pregnant with monochorionic diamniotic twins
at 19 weeks gestation with concern for twin-to-twin transfusion
syndrome. The coronal T2-weighted SSh TSE image through the
pregnancy showing the larger “recipient” twin (arrow) and smaller
“donor” twin (dotted arrow). Note the larger twin has large
surrounding amniotic fluid and large bladder (short arrow) whereas
the smaller twin is stuck against the uterine cavity and no bladder is
present (curved arrow). Imaging shows absence of brain injury prior
to fetoscopic laser ablation of the connecting vascular anastomosis
across the placenta. MRI was done on Ingenia 1.5T.

NetForum
Visit NetForum to view or
download the fetal ExamCard
developed by CCHMC.
References
Serai S, Merrow A, Kline-Fath B.
Fetal MRI on a multi-element digital
coil platform
Pediatric Radiology – May 2013,
www.ncbi.nlm.nih.gov/pubmed/23649206
“We use two of the digital Anterior coils;
together with the integrated Posterior coil,
we obtain our best SNR.”
“The key is to maximize SNR. We can do that using Ingenia with its
digital architecture. Because the signal is digitized directly in the coil,
it helps to obtain high SNR,” he says. “Our approach is to – with the
mother on her side – use one digital Anterior coil on her back and
another one on her front. These two coils used together with the
Posterior integrated table-coil, cover the patient on all sides. This
setup offers big advantages; when the fetus moves, no repositioning of
the coil is needed. We just move the field of view as the coil elements
are already there and Ingenia’s SmartSelect automatically chooses the
elements to obtain the best possible SNR. That’s very, very helpful.”
“Ingenia’s wide bore is another advantage. With pregnant patients,
it really makes a difference.”
Tailoring the ExamCards
“We worked on our ExamCards to get the image quality to where we
want. We generally strive for better image quality over speed. It’s really
all about making a diagnosis,” says Dr. Kline-Fath.
“We typically run single shot T2W, 3D T1W, and Balanced TFE (SSFP)
sequences,” says Dr. Serai. “Ingenia’s strong gradients allow us to set
up fast imaging and that helps reduce fetal motion that can influence
the scan. The gradients also helped to reduce the TR and TE for high
quality in the Balanced SSFP images. With the high SNR, we were able
to improve the resolution on our single-shot T2 sequences. We also
changed some of the filter settings later on in postprocessing.”
“Our techs are trained in fetal MR imaging,” he adds. “It takes a bit
of time to get used to the anatomy, especially in the presence of a
malformation, and to image a moving fetus. In fetal imaging, much like
any imaging, we want to see the fetus’s standard anatomy, so we need a
standard axial, a good coronal and a great sagittal, which can be a little
more difficult with a moving fetus.”
Cincinnati Children’s also performs fetal diffusion imaging regularly and
sometimes fetal spectroscopy on Ingenia. “The diffusion of the fetus is
very nice and spectroscopy is great,” says Dr. Kline-Fath. “The Ingenia
performs very well with routine imaging as well as these newer, higher-end
imaging techniques. I’ve been very happy with the results on Ingenia.”
FieldStrength 19

20 User experiences
“We have chosen to shorten our MSK exams
by decreasing the acquisition times.”
Chris G. Goumas, MD
Need to decrease exam time
leads to shorter MSK scans while
maintaining high resolution
Palo Alto Medical Foundation has developed MSK protocols for Ingenia 3.0T
that save several minutes per scan
In response to an anticipated influx of patients due to U.S. healthcare reforms next year Palo Alto
Medical Foundation (PAMF, Palo Alto, California, USA) needed to find a way to increase throughput in
the MRI department. Since it had already expanded its hours to the limit, the only option was to
shorten its examination times. PAMF looked to its Ingenia 3.0T system to help them shorten
examination time slots to about 20 minutes while maintaining a high level of quality.
The USA sees pressure on reimbursements and the upcoming
healthcare reforms in 2014. “We think the healthcare reforms will
increase the number of patients seeking healthcare who have never
really had access to healthcare in the past. This made us decide to make
our muskoloskeletal MRI faster,” says radiologist Chris G. Goumas,
MD. “We have chosen to decrease the length of our MSK exams by
decreasing the acquisition times of each series to about 3 minutes,
whereas in the past we focused on very high resolution acquisition in
about 5 minutes. We usually run 5-6 acquisitions for a full study, so
we’re saving 10-15 minutes of time per study, so about 40% overall.”
“Because of the high SNR on Ingenia 3.0T, the shortened MSK scans
are still exceeding the resolution of our 1.5T exams, and those are
5-minute acquisitions,” explains Dr. Goumas. “So, I’m confident that
we’re still doing excellent work, while exceeding 1.5T capabilities.
In a sense, we’re just making Ingenia a much more cost-efficient unit.
A 3.0T system may cost more up front, but if you have higher
throughput over the typical lifespan of the system, the long-term
economic benefit is quite favorable.”
High resolution and fast scans: how it’s done
The challenge, of course, was being able to maintain high resolution
within a time limit of approximately 3 minutes per sequence. “It was a
matter of trial and error, just seeing how much time we could save and
still do better than we can on our 1.5T; that was our mark. We found

Cor T1W 0.27 x 0.38 x 1.5 mm, 1:14 min.
Cor PDW FS 0.27 x 0.39 x 1.5 mm, 1:41 min.
Sag T1W 0.27 x 0.39 x 2.25 mm, 2:56 min.
Sag PDW FS 0.28 x 0.38 x 2.25 mm, 2:48 min. Ax PDW FS 0.27 x 0.39 x 2.0 mm, 1:40 min.
that we were able to increase the voxel size of our images slightly, but
then decrease the number of signal acquisitions by one; that’s basically
how we achieved the time savings.”
“What’s changed,” he adds, “is that the slice thickness went up a bit so
we can get faster coverage through the joint. We’re essentially back to
doing our Achieva 3.0T protocols, but we’re doing them faster. We’re
doing this in both our MSK and neuro exams. Our knee ExamCards
used to take about 25 minutes – now they’re down to 11 minutes. But
we still want to keep a very high level of quality, particularly in our local
market, where we have academic centers and other very competitive
groups surrounding us. It’s a difficult balance.”
Ingenia helps achieve the balance
The high SNR and excellent homogeneity of Ingenia 3.0T with dStream,
Xtend FOV, and MultiTransmit have been essential in achieving this
balance. “When we first got the Ingenia system we immediately
noticed about a 30% increase in SNR compared to our Achieva 3.0T.
In a collaborative effort with Philips MR specialist Dave Hitt, we really
pushed the resolution. We were able to further decrease the voxel size
by about 30% on the same patient, on the same knee, with similar SNR.
However, we’ve now dialed it back a bit in order to get still outstanding
images that are equivalent to our Achieva images; these take 5 minutes
on Achieva, and we’re doing it on Ingenia in 3 minutes.”
CONTINUE
“The 3-minutes Ingenia 3.0T scans are still exceeding
the resolution of our 5-minutes 1.5T exams.”
Ax T1W 0.27 x 0.38 x 2.0 mm, 0:57 min.
Tears in TFCC ligaments
69-year-old female fell with outstretched arms, landing on both wrists. Triquetral fracture was immediately diagnosed, but 6-8
weeks later she has continued pain on the ulnar side of the wrist. She underwent MRI on Ingenia 3.0T with 8-channel dS Wrist coil.
The coronal sequences demonstrate tears in the scapholunate and triangular fibrocartilage complex (TFCC) ligaments. The axial fat
suppressed proton density images also show intraosseous cysts in the trapezoid.
FieldStrength 21

User experiences
Scan times
and voxel size
Ingenia 3.0T
fast
Ingenia 3.0T
high resolution
Achieva 3.0T
high resolution
Knee 12:01 min.
0.26 x 0.42 x 2.5 mm
26:50 min.
0.23 x 0.34 x 2.0 mm
24:58 min.
0.28 x 0.37 x 2.5 mm
Shoulder 17:12 min.
0.26 x 0.42 x 2.5 mm
30:50 min.
0.22 x 0.36 x 1.75 mm
32:14 min.
0.27 x 0.39 x 3.0 mm
Ankle 17:50 min.
0.29 x 0.43 x 2.0 mm
32:02 min.
0.25 x 0.36 x 1.75 mm
30:32 min.
0.27 x 0.35 x 3.5 mm
Wrist 11:16 min.
0.27 x 0.39 x 2.25 mm
31:14 min.
0.23 x 0.33 x 1.1 mm
29:19 min.
0.23 x 0.33 x 1.25 mm
T1W 0.26 x 0.41 x 2.5 mm, 1:22 min.
PDW 0.26 x 0.40 x 2.5 mm, 2:24 min.
“Our knee exams used to take
about 25 minutes – now they’re
down to 11 minutes.”
PDW FS 0.26 x 0.42 x 2.5 mm, 2:50 min.
PDW FS 0.26 x 0.42 x 2.5 mm, 2:32 min.
PDW F S 0.26 x 0.42 x 2.5 mm, 3:10 min.
Cartilage defect and ruptured Baker’s cyst
52-year-old female with anterior knee pain underwent MRI on Ingenia 3.0T with 16-channel dS Knee coil. This examination
demonstrates cartilaginous defect lateral tibial plateau with subchondral sclerosis and marrow edema. Edema/hyperemia is
also seen in the superior aspect of the fat pad abutting the inferior margin of the patella. On the axial proton density
fat suppressed image, a ruptured Baker’s cyst is visualized posteromedially.
22 FieldStrength - Issue 49 - 2013/2

“Ingenia gives us the flexibility needed in today’s demanding healthcare
environment. The way Philips has designed its hardware and software
allows us to go for extreme resolution or extreme speed, and every
balance in between,” says Dr. Goumas. “If we have a very critical case
where we need a second look, or a professional athlete where it’s
important to be highly diagnostic, then we can adjust to that. Ingenia
gives us the ability to adjust not only to our local environment but also
to the overall healthcare environment as it changes over time.”
Cor P DW FS 0.26 x 0.42 x 2.5 mm, 2:57 min.
“A 3.0T system may cost more up front,
but if you have higher throughput, the long-term
economic benefit is quite favorable.”
Cor T1W 0.26 x 0.41 x 2.5 mm, 2:43 min.
Sag PDW FS 0.26 x 0.41 x 2.5 mm, 2:48 min.
Cor T2W 0.26 x 0.42 x 2.5 mm, 2:42 min.
Sag T2W 0.26 x 0.42 x 2.5 mm, 2:53 min. Axial PDW FS 0.26 x 0.43 x 2.5 mm, 3:09 min.
Shoulder sprain
58-year-old male with chronic shoulder pain underwent MRI on Ingenia 3.0T with 8-channel dS Shoulder coil.
The study demonstrates tendonosis of the supraspinatus tendon with calcific tendonitis. Associated degenerative
cysts are seen in the humeral head. Minimal fluid is seen in the subacromial subdeltoid bursa. Advanced degenerative
changes are seen in the acromioclavicular joint.
FieldStrength 23

24 User experiences
Ben Kennedy, Chief MRI
Technologist at Qscan Radiology
Clinics in Queensland, Australia,
holds a Postgraduate Master’s
Degree in MRI from the University
of Queensland, Australia. Kennedy
has been an invited speaker for the
ISMRM/SMRT, the European Society
of Magnetic Resonance and Micro
Biology (ESMRMB), the Australian
Institute of Radiography (AIR) and
the Queensland Radiology training
program.
“Looking at IACs or the pituitary, we can easily
see the structures within small structures, rather
than just identifying structures.”
32-channel dS Head coil
demonstrates robustness,
high image detail
Qscan Radiology Clinic uses 32-channel dS Head coil for all its Ingenia 3.0T
neuro work because of its robustness, image quality and exceptional spatial
resolution that even reveals detail within small structures
Qscan Radiology Clinic (Brisbane, Australia) has five MRI systems, including an Ingenia 3.0T
while most of the other systems are 1.5T. The Ingenia 3.0T services all types of MR imaging,
including neuro, MSK, cardiac, body, prostate, breast and sports injuries. Since Qscan
received the 32-channel dS Head coil, this coil is being used for almost all head imaging,
because of its robustness and excellent performance.
The 32-channel dS Head 32ch coil for
Ingenia 3.0T is designed for advanced
neuro applications including fMRI,
spectroscopy, MRA. The coil includes
both front and rear facing mirrors for
visual stimuli and movie projection. It
allows comprehensive high resolution
coverage of the brain and allows dS
SENSE parallel imaging in all three
directions.

Ben Kennedy is Chief MRI Technologist at Qscan. “Before we had
the 32-channel coil, we were already happy with our neuro imaging,”
he says. “The standard dS Head coil is a very good coil. But we
have a great interest in increasing the amount of work we do for
neurosurgeons. The desire to implement advanced neuro imaging,
such as fiber tracking and fMRI, was an important reason to get the
32-channel dS Head coil. Meanwhile, we use the 32-channel coil for
all our brain imaging now.”
Exceptional resolution reveals tiny structures
“The 32-channel dS Head coil excels in visualizing tiny but important
structures within the brain,” says Kennedy. “This coil is very robust
in providing uniform signal distribution across the whole brain; we
see less noisiness in the center of the brain. We are seeing structure
within the pons and the midbrain, and within the brain stem, which
I can’t remember ever seeing before. In the pons and the basal ganglia,
the images are just so excellent. We’re seeing small vasculature and
tiny vessels inside, and recognize areas of degenerative brain where
the vasculature is slightly more obvious. It’s just so much clearer;
our radiologists like what they see.”
“With the 32-channel dS Head coil we are using smaller voxel sizes than
we used before, to visualize anatomy that we assumed is there but we
couldn’t see nearly as well as we do with this coil. For instance, when we
look at IACs (internal auditory meatus) or at the pituitary, we are able to
use sub-half-millimeter voxel size, and we can easily see the structures
within small structures, rather than just identifying structures.”
CONTINUE
3D T1W 0.5 x 0.5 x 2 mm
3D FLAIR 0.6 x 0.8 x 1.5 mm
Ax T2W 0.4 x 0.49 x 3.5 mm
Venous BOLD 1 x 1 x 0.6 mm reformatted
Brain MRI demonstrating
amyloid angiopathy
76-year-old male with history of
amyloid angiopathy was imaged on
Ingenia 3.0T with 32-channel dS
Head coil. The sagittal T1-weighted
images show chronic deep white
matter ischemic changes. Axial
T2-weighted and FLAIR show high
quality brain anatomy demonstrating
chronic ischemic changes and
old hemorrhage / hemosiderin
staining. On the axial Venous BOLD
(Susceptibility Weighted Imaging)
image, the high quality vascular
anatomy and increased sensitivity
to chronic ischemic changes and old
hemorrhage / hemosiderin staining
are seen. Imaging appears consistent
with amyloid angiopathy, no other
intracranial lesions found. The
32-channel dS Head coil is allowing
excellent SNR and resolution in
routine clinical imaging. It enhances
visualizing of the subtle anatomy of
brain parenchyma, fibers and fine
vascular structures.
FieldStrength 25

User experiences
3D T1W 0.5 x 0.5 x 2 mm
3D FLAIR 0.6 x 0.8 x 1.5 mm
T1W FS 0.5 x 0.5 x 2 mm
T2W 0.4 x 0.49 x 3.5 mm
3D FLAIR 0.6 x 0.8 x 1.5 mm 3D FLAIR 0.6 x 0.8 x 1.5 mm
T1W FS 0.5 x 0.5 x 2 mm
T2W
T1W FS 0.5 x 0.5 x 2 mm
Follow up of MS progression
A 60-year-old male with a history of Multiple Sclerosis (MS) underwent an MRI exam on Ingenia 3.0T with 32-channel dS Head coil.
On the sagittal 3D T1W image some hypointense MS plaques are seen. Plaques are also well visible on the high quality T2-weighted
and FLAIR images. Note also the excellent quality of the pons and peduncle brain fibers and vascular structures on the T2-weighted and
FLAIR images. The T1-weighted ProSet fat suppressed images show high quality brain anatomy and high detail fine vascular information in
conjunction to the MS plaques.
The multiple pericallosal and subcortical white matter hyperintense foci with several small foci in the posterior fossa and a single focus at
the craniocervical junction are consistent with the history of Multiple Sclerosis. Two of the foci were not seen in previous examinations.
This has been thought to be likely due to the high SNR and high resolution demonstrated by the 32-channel dS Head coil, as there are no
indications to suggest any acute lesions.

“After seeing the image quality we currently get, it’s hard
to go backwards. We use the 32-channel coil for all our
neuro imaging now.”
Robustness and diagnostic confidence
“I think it is quite amazing how we are able to use such small fields of view
and really thin slices for small anatomy,” says Kennedy. “However, I think
the biggest thing for us is just the robustness; we can trust the coil. We
know the dStream benefits on top of the 32-channel coil’s architecture are
really adding to the signal to noise and the quality of the signal that we’re
getting. Obviously, the more pathology we see using the coil, the more we
appreciate how diagnostically confident we can be with what we’re seeing.”
“The other great thing about this coil is that it’s quite roomy inside,
so we can fit a large-sized head in if needed,” Kennedy adds.
Fine-tuning 3.0T neuro exams
“There are two ways you can go with this type of hardware: being fast
and being really high detail. We have a good balance with this coil, in
that we can go relatively fast and still have very good detail. Generally,
instead of super-fast scans, we lean toward good image quality, which
the neurosurgeons appreciate,” says Kennedy.
“One of the biggest challenges in 3.0T neuro imaging is the higher
sensitivity to pulsatile CSF flow. Adjusting the TR to a lower range is
one way to reduce this, as it leaves less time for CSF flow to affect the
acquired dataset. In general, that makes a big difference for avoiding
vascular artifacts, and for 3.0T it works as well.”
“Besides, using 3D acquisitions instead of 2D makes a big difference.
The SNR and contrast that we get from the 3D FLAIR is higher than
traditional 2D FLAIR – especially when looking for demyelination – and
allows us to obtain really thin contiguous slices in the brain. Similarly,
I’ve been able to get much thinner slices with sagittal 3D T1-weighted
imaging. And because 3D provides much higher SNR than 2D, it allows
a very nice in-plane resolution as well, in a relatively short time. We can
do it in two minutes. With 2D FLAIR, we often spend as much time - if
not longer – for the same sequence. The techniques that we’ve been
using, we have hardly any artifacts at all.”
32-channel dS Head coil used for almost all head imaging
“The dS Head 32ch coil has basically replaced the standard dS Head
coil for all our brain imaging. We only still use the standard head coil
when we need to scan from the skull base and move downwards as,
for instance, in oncology neck. From the cases where we’ve done
one view through the brain and then went back to the standard head
coil to go down through the neck, we’ve noticed a marked difference
between coils; it’s just a jump in image quality.”
“Before we received the dS Head 32ch coil, the voxel size we were using
was just a little bit larger and we were very happy with the SNR. But
after seeing the image quality we currently get, it’s hard to go backwards.
We use the 32-channel coil for all our neuro imaging now.”
“We’re seeing small vasculature and tiny vessels inside,
and recognize areas of degenerative brain where
the vasculature is slightly more obvious.”
NetForum
Visit the online NetForum
community to download
ExamCards devleoped by
Ben Kennedy for use with
the dS Head 32ch coil.
FieldStrength 27

Changing MRI
methods in
head and neck
imaging
mDIXON TSE, Diffusion TSE address MRI
challenges in the head/neck area and allow different
imaging strategies.
Robust head and neck imaging is becoming routine at Leiden
University Medical Center (Leiden, The Netherlands) thanks
to new techniques that provide better fat suppression and
shorter scan times. Large-coverage, fat-free imaging is now
a reality in imaging skull-base lesions, in otology, and in
imaging of the orbit and nerves.
User experiences
Berit Verbist, MD, PhD, became certified radiologist
at the Catholic University of Leuven, Belgium. She is senior
staff member in head/neck radiology and neuroradiology at
Leiden University Medical Centre and Radboud University
Nijmegen Medical Centre. In 2003 she spent visiting
fellowships in Head and Neck radiology at the University
of Florida, Gainesville, USA and Oregon Health and
Science University, Portland, USA. She is board member
of the ESHNR.
Berit M. Verbist, MD, PhD, points out the challenges of obtaining
good image quality in head and neck images. “We need very detailed
images from a complex anatomical area, and the area is prone to
movement artifacts so we need short acquisition times. We also
need to minimize the number of sequences because it gets tiring for
the patient if it takes too long. Another big problem is susceptibility
artifacts, because of the boundaries between air, bone and tissue, and
because many patients have undergone complex surgical procedures
that include osteosynthetic materials, which leads to more artifacts and
inhomogeneous fat suppression. There is also an interest in scanning
with a large field of view, mainly for the lower neck and thoracic inlet.”
To overcome these challenges, Dr. Verbist is using mDIXON TSE
(turbo spin echo) on the Ingenia 3.0T with the dS HeadNeckSpine coil.
The mDIXON technique provides four images in one acquisition:
water images (fat suppressed), in-phase images (without fat
suppression), out-of-phase images and fat images. “mDIXON TSE
delivers very homogeneous fat suppression, even when we use a
large field of view. It addresses the problems with distortion due to
susceptibility and it allows us to use large fields of view. I’ve applied it in
“These techniques simply
provide better images with
fewer artifacts.”
28

oncology patients and in brachial plexopathy patients. Soon I will use it
for eye and orbit pathology and skull base lesions as well.”
mDIXON TSE addresses fat suppression, speed and
image quality
“We often had to choose between scanning with or without fat
suppression to keep the examination short. Sometimes it turned out
we made the wrong choice because of imperfect fat suppression,” says
Dr. Verbist. “The great thing about mDIXON TSE is that we don’t
have to choose; we get both in one acquisition – and excellent image
quality within an acceptable time. ExamCard times are reduced as fewer
sequences need to be used.”
Philips’ patented mDIXON TSE uses 2-echo technology instead of
the slower 3-echo method, and this enables fast scan time and high
resolution simultaneously.
“With better image quality, we get better diagnostic accuracy,”
Dr. Verbist explains. “mDIXON TSE can trigger a change in imaging
strategies in head and neck imaging, as it provides excellent image quality
and we need fewer scans in an exam, because we get the images with and
without fat suppression in only one scan. We can also enlarge the field of
view, so it will be easier to image the entire neck. And, reading these high
quality images is faster; it’s just easier to look at them.”
“For fat suppressed spine imaging of post-operative patients, patients
with suspicious lesions or spondylodiscitis, we currently use the STIR
sequence, but that has an inherently lower SNR and T2 weighting isn’t
very good with this technique. The homogeneous fat suppression of
mDIXON TSE can also be an attractive alternative here. For MSK
scanning, mDIXON TSE can allow us to enlarge the field of view and,
for instance, easily scan both hips at the same time.”
CONTINUE
“mDIXON TSE delivers
homogeneous fat suppression, even when
we use a large field of view.”
T2W mDIXON TSE
T1W mDIXON TSE
T1W mDIXON TSE
T1W mDIXON TSE
T1W mDIXON TSE
T1W mDIXON TSE
mDIXON TSE in a patient with brachial plexopathy
An 88-year-old female presented with painful progressive paralysis of
the right arm. She had a history of breast carcinoma on the right 6 years
earlier, which was treated with mastectomy. Five years ago she underwent
radiotherapy for a local recurrence. In the right brachial plexus. MR images
show thickening and high intensity in cervical roots C5, C6 and C7 extending
to the lateral and posterior cords (white arrows). A parasternal lymph node
(arrow head) and a lesion in the sternum (black arrow) are also noted. Note
also an enlarged multinodular thyroid gland. (sa: subclavian artery).
The mDIXON TSE images provide homogeneous fat suppression in a large
field of view, even in areas with air-bone-soft tissue interfaces. This delivers
good visualization of the lower neck region and thoracic inlet, revealing
pathologic changes to the brachial plexus and other abnormalities. Biopsy
has confirmed recurrence of the breast cancer. The diagnosis is lymphatic
and hematogenous tumor spread. Ingenia 3.0T with dS HeadNeckSpine coil
was used. Scan time 5:41 min. for T2-weighted, 6:23 min. for mDIXON TSE.
Scans were optimized for high image quality rather than speed.
FieldStrength 29

User experiences
“The great thing about mDIXON TSE is that we don’t
have to choose between scanning with or without fat
suppression; we get both in one acquisition.”
T1 TSE SPIR
T1 TSE SPIR
mDIXON TSE water only
mDIXON TSE water only
mDIXON TSE in-phase
mDIXON TSE in-phase
mDIXON TSE skull base imaging of trigeminal neuralgia (maxillary branch)
A 56-year-old female with severe pain along the cheekbone and upper jaw on
the left and unremarkable clinical examination was referred for imaging of the
trigeminal nerve (CN V). This requires highly focused imaging of the peripheral
and central segments of the CN V. Fat suppression may be needed but has the
risk of increased susceptibility artifacts along the skull base. With mDIXON,
images with and without fat suppression can be obtained at the same time.
Images are from the levels of the infraorbital nerve (top row) and the foramen
rotundum (bottom row). Post-contrast T1 TSE SPIR images (0.47 x 0.59 mm
pixels) show inhomogeneous fat suppression (for instance in the cheek) and
susceptibility artifacts along the orbital floor and skull base, which obscure the
regions of interest. Scanning an additional T1 TSE without fat suppression is
required for better visualization of the infraorbital nerve (white arrows) and
foramen rotundum (other color arrows). Instead, one mDIXON TSE scan
provides four image types including images with and without fat suppression
(water only and in-phase, respectively) in one acquisition. Homogenous fat
suppression and decreased susceptibility artifacts in the mDIXON images
provide excellent delineation of all branches of the trigeminal nerve. Shown
here are the infraorbital nerve (arrows top row), maxillary nerve in the
foramen rotundum (arrow bottom row) and inferior alveolar nerve (branch
of the mandibular nerve V3; arrowheads). This image quality is indispensable
to help rule out underlying disease in neuralgia – as in our patient – or for
evaluation of perineural area in oncologic patients. Ingenia 3.0T with dS Head
coil was used. Scans were optimized for high image quality rather than speed.
T1 TSE SPIR scan time 4:32 min. and 9:04 min for both with and without fat
suppression; mDIXON TSE scan time 4:03 min.

Diffusion TSE helps reduce susceptibility distortion
Dr. Verbist has also begun to use Diffusion TSE in head/neck
imaging. “Again, the motion and the susceptibility in this
area can distort standard EPI diffusion images enormously.
In the brain we can use EPI diffusion, but in head and neck
we need a method that is less prone to susceptibility
artifacts. In addition, we need very thin slices, and yet
it shouldn’t take too long. Diffusion TSE solves this by
providing high quality images in a short acquisition time.”
“There are several indications for Diffusion TSE in head and
neck, such as otology and oncology. It’s a very interesting
and growing field at the moment. I’ve been using it a lot to
help in assessment for cholesteatoma, which can result after
chronic infection in the middle ear. Usually when patients
have surgery for this condition, they will have another
surgery about a year later to look for residual disease, but
when we are able to visualize recurrent or residual disease
with Diffusion TSE, we can make a better selection of the
patients who will undergo a second operation. It’s also
becoming more common to use Diffusion TSE for imaging
primary cholesteatoma, in patients who have not yet had
surgery. Those patients are first scanned with CT, but often
CT shows total obscuration of the middle ear making it
difficult to determine whether it’s inflammatory changes or
cholesteatoma. Diffusion TSE helps to differentiate that.”
As Dr. Verbist brings mDIXON TSE and Diffusion TSE into
routine practice, she is pleased with the process. “It’s an
easy transition, because these are time-efficient techniques;
they simply provide better images with fewer artifacts.”
Senior technologist
Guido van Haren at LUMC.
Preoperative CT
T2 weighted
Diffusion TSE
ADC
T1 weighted
Postoperative Diffusion TSE of residual cholesteatoma
A 44-year-old male was operated on for recurrent cholesteatoma after previous ear surgeries.
Due to the extent of the disease and the patient’s wish to preserve hearing, the cholesteatoma
could not be completely removed. Preoperative CT images show a large, expansive mass
extending along the posterior border of the temporal bone towards the superior semicircular
canal (SSCC) (arrows). Postoperative MRI was ordered to evaluate the residual disease.
Coronal T2-weighted images show hyperintense signal medial to the SSCC (arrow) as well as
lateral to the vestibular system (asterisk). On Diffusion TSE (non-EPI DWI, pixels 1.79 x 2.32
mm, scan time 4:20 min.) hyperintense signal is present medial to the SSCC, with low signal
intensity on the corresponding ADC mapping. This restricted diffusion is compatible with
residual cholesteatoma. T1-weighted images (pixels 0.47 x 0.59 mm, 3:47 min.) confirm the
presence of cholesteatoma (arrows) medial to the SCC, whereas the mastoid cavity is filled
with granulation tissue (asterisk). Diffusion TSE (non-EPI DWI) is quick and easy to obtain
and has been shown to have a high sensitivity and specificity for detection of cholesteatoma.
Achieva 3.0T, 32-channel SENSE Head coil.
FieldStrength 31

productivity
fast patient setup
training
t r opportunity a n scfaorrem accelerating
ing together
transforming care
multiparametric technique
patient experience
high quality
full body scan
clinical performance
easy operation
use the full potential
intuitive
change
upgrading
advanced neuro
wide bore
biopsy
cardio oncology
more per timeslot
Ingenia
speed-up with dS SENSE
low lifecycle cost
throughput
musculoskeletal
multi-modality viewing
comfortable scanning
mDIXON
digital clarity and speed
consistent fat suppression
dStream premium image quality
diagnostic accuracy
new clinical indications
iPatient reproducible diagnostic quality
do more with your scanner
me dical resea rch
spectroscopy
challenging patients
easy coil handling
advanced viewing
IntelliSpace Portal
motion-free
MR-guided biopsy
pleasure to work with
support
contrast
expand clinical applications
multi-parametric MR
SmartPath to dStream
fast image processing
plug and play expansion
focal therapy
challenges
short breath hold times
high resolution
premium image quality
coronal
MRI
sagittal
axial
high image detail
advanced viewing
clarity
32 FieldStrength - Issue 49 - 2013/2

MR News
MasterSeries provides
ExamCards from expert users
ExamCards developed by experts now available on every Ingenia
The latest Ingenia software release includes ExamCards designed and
validated by expert Philips users. In addition to the standard Philips
factory protocols, the MasterSeries ExamCards are delivered directly
on the scanner.
Based on clinical workflows of key opinion leaders in MR imaging,
the MasterSeries include ExamCards for both 3.0T and 1.5T systems,
created by world-renowned institutions as Barmherzigen Bruder Hospital
(Trier, Germany), Palo Alto Medical Foundation (Palo Alto, California,
USA) and Fletcher Allen Health Care (Burlington, Vermont, USA).
A multitude of ExamCards encompasses brain, spine, MSK and more.
The MasterSeries can help Ingenia users leverage the expertise of
Ingenia expert users around the world. It may also help new users
to reduce their adoption time after receiving a new system or when
redesigning their workflow. The MasterSeries will be continually
updated and expanded, as new experts are added to the collaboration.
Ingenia 3.0T MSK MasterSeries
from PAMF
The high resolution musculoskeletal
ExamCards developed by Chris
Goumas, MD, of Palo Alto Medical
Foundation (PAMF), are now available
as MasterSeries on every Ingenia 3.0T
at software level 4.1.3 and above.
“The MasterSeries allows users to
have a choice in how they want to run
their scanners, and saves them up to
hundreds of hours of imaging time
to work it all out,” says Dr. Goumas. “Instead of having to reinvent the
wheel, somebody has already gone through that process and discovered
the current capability of the system. It maximizes their efficiency because
they can just select an ExamCard on their own scanner and go, and they
can produce the high resolution images on their own system.”
33
FieldStrength 33

34 Application tips
Contributed by Marius van Meel and Vijayasarathy Elanchezhian,
MR Clinical Marketing Managers, Best, The Netherlands
Take advantage of mDIXON TSE in
MSK imaging without time penalty
mDIXON provides excellent fat suppression and can save time by providing images with and without
fat suppression in one scan
Philips mDIXON provides images with and without fat suppression in a time efficient manner.
The patented 2-echo implementation, versus conventional 3-point techniques, is key to delivering
superb fat suppression at routine scan times.
The fast and robust fat suppression provided by mDIXON TSE makes the method well suited for
enhancing routine musculoskeletal (MSK) MR imaging. These tips are intended to help you implement
mDIXON TSE in your MSK protocols and ExamCards.
TIP 1
Choose a good
starting point
Use a fat suppressed protocol as starting
point. Choose a protocol in which SNR,
resolution and scan time are already well
balanced for your purpose.

TIP 2
Contrast adjustments
T1-weighted scans PD-weighted scans T2-weighted scans
TE 15 ms 30 ms 60-80 ms
TE spacing user defined, 10-11 ms user defined, 10-11 ms user defined, 10-11 ms
TSE factor 3 or 5 12 or 13 20
TR range 450-650 ms 2500-5000 ms 3000-6000 ms
TIP 3 TIP 4
Switch on mDIXON Adjust NSA to balance scan time
and SNR
mDIXON TSE is compatible with all common profile orders,
however protocol optimization is easiest with an asymmetric
profile order as it gives full control over TE, TR, BW and echo
spacing.
On the Contrast tab, set ‘profile order’ to asymmetric. TE and
TR may be adjusted according to your preference. Use a TR
range for convenience. The table provides some recommended
settings.
On the Contrast tab:
Set ‘Fat suppression’ to No to switch off SPIR or SPAIR.
Set ‘mDIXON’ to yes.
If volume shim is present, set to Auto to reduce workflow steps.
Set ‘WFS’ to user defined, select 1.3 (pixels).
mDIXON uses 2 echoes (2-point mDIXON) to calculate the in-phase
(IP) and water (W) images. This effectively doubles scan time
but also increases the signal-to-noise ratio, similar to doubling NSA
which doubles scan time and increases SNR by 41% (factor √2).
After switching to mDIXON, the easiest way to revert to the
original scan time is by reducing NSA on the Motion tab to use less
averages. If a scan has only 1 NSA, use SENSE to reduce scan time.
Scan time
Scan time first increases by switching on mDIXON Scan time reduces again by changing NSA
CONTINUE
FieldStrength 35

Application tips
Adjusting to partial fat suppression
Specifically in MSK imaging, some radiologists prefer
a partial fat suppression. This is easy to obtain with
mDIXON.
To achieve this, also the fat (F) images need to be
reconstructed. On the Postproc tab, expand the
parameter ‘mDIXON images’ and add the fat image.
When the mDIXON scan is finished:
• Load the scan into the ‘Image Algebra’
post processing package.
• Choose Addition: (A+B).
• In viewport A (lower left) scroll to the
fat (F) image using the left and right
arrow keys.
• Viewport B (lower right) should contain
the water (W) image.
• Use the ratio slider to adjust the
amount of fat added. In general, a ratio
of 0.05 to 0.10 is advised for MSK. The
upper right viewport displays a preview,
helping the user to fine-tune the level
of fat suppression interactively.
• Create the series by clicking the
‘Generate’ button.
• After performing this once, this
postprocessing step will be saved in the
ExamCard as a SmartLine step. It can
be copied to other mDIXON scans.
TIP 5
Viewport A, fat image (F) Viewport B, water image (W)

Ideas to simplify your ExamCards with mDIXON TSE
This example is based on Ingenia 1.5T MasterSeries ExamCards.
2-point mDIXON TSE allows you to explore new scan strategies.
One mDIXON sequence can replace both the fat saturated and
non-fat saturated scans in an ExamCard. Depending on the setup of
an ExamCard this can save a considerable amount of scan time.
mDIXON TSE may also allow reduction of the number of ExamCards
needed in a site’s collection. For example, optional scans with fat
saturation can be integrated into the routine ExamCard. Ultimately, every
TSE scan in an ExamCard could be replaced by the 2-point mDIXON TSE
technique to deliver two image weightings in one acquisition.
TIP 6
ExamCards without mDIXON TSE
mDIXON TSE can help to simplify
an ExamCard by replacing two ore
more separate sequences. This can
reduce redundancy and support
standardization.
Why not take advantage of
mDIXON for each TSE scan to
double the information in the
same scan?
NetForum
Visit the online Philips
NetForum community for
more application tips.
FieldStrength 37

38 Application tips
Contributed by Mark Pijnenburg and Marco Nijenhuis, MR clinical
application specialists, Best, The Netherlands
CSF flow compensation in spine
In TSE imaging of the spine, CSF flow may cause flow voids. These may be most notable in
axial imaging of the cervical spine where CSF flow velocity can be quite high and the imaging
plane is perpendicular to the flow direction. Flow voids are visible as dark areas. The signal loss
occurs because moving spins may not experience both the full excitation pulse and the
refocusing pulse and thus have a slightly different phase than immobile spins in the slice.
The tips below apply to Ingenia 3.0T and 1.5T release 4.1.3 SP1 as well as Ingenia and Achieva
systems at release 5.
TIP 1
Reducing flow voids
Flow void reduction is more relevant at 3.0T than at 1.5T.
• In general, sensitivity to flow voids may be decreased by increasing
slice thickness and shortening TE. However, in cervical spine a
small slice thickness is usually desired.
• Increasing the number of packages can also help, but this will
usually increase scan time.
At 3.0T, acquire the T2W TSE sequence in multiple packages, for
instance 6 packages for cervical spine. A lower number of packages
may be used for the thoracic spine (4 packages) and the lumbar
spine (2 packages). For 1.5T using 4 packages for cervical spine is
recommended to maintain a reasonable scan time.
• Set scan direction to interleaved.
• Switch on flow compensation in the slice direction
(through-plane).

TIP 2
Through-plane flow compensation
Through-plane flow compensation is another way to address flow
voids. This flow compensation in slice direction maintains the phase
of the signal for spins moving with constant velocity. Signal losses
(flow voids) due to CSF flow will therefore be reduced.
In general, flow voids are more pronounced at higher field strengths.
So, particularly 3.0T users may want to switch on through-plane
flow compensation in their 2D multislice TSE scans.
Combining it with a multiple package approach is recommended for
robust flow artifact reduction on transversal T2-weighted spine images.
To enable through-plane (slice direction) flow compensation, go to
the Motion tab and set Flow compensation to yes. That offers the
option to select in-plane or through-plane flow compensation.
TIP 3
Through-plane flow compensation in spine
Through-plane flow compensation can help to reduce flow voids in
transverse T2W TSE sequences in the spine.
Example for cervical spine on Ingenia 3.0T:
Without flow compensation, 2 packages With through-plane flow compensation, 6 packages
References
C. Lisanti, C. Carlin, K.P. Banks, D. Wang
Normal MRI Appearance and Motion-Related Phenomena of CSF
AJR 2007; 188:716–725 or http://www.ajronline.org/doi/full/10.2214/AJR.05.0003
A.T. Vertinksy, M.V. Krasnokutsky, M. Augustin, R Bammer
Cutting Edge Imaging of the Spine
Neuroimaging Clin N Am. 2007 February ; 17(1): 117–136.
Visit the online Philips
NetForum community for
more application tips.
NetForum
FieldStrength 39

40 Educational
Vascular permeability analysis
based on MR data
MR Permeability package on the IntelliSpace Portal calculates permeability based on MR data
Vascular permeability depends on tissue and its condition
Fast cell growth requires extra blood and nutrient supply and is often
characterized by angiogenesis (growth of extra blood vessels from
existing vessels). Angiogenesis is a process that occurs in tissue
growth and repair.
Angiogenesis is often accompanied by increased vascular permeability.
Vascular permeability is the ability of a blood vessel wall to allow molecules
to pass through. Permeability depends on tissue type and organ.
In a healthy brain the blood brain barrier (BBB) effectively separates
circulating blood from the extracellular fluid in the central nervous
system. This means that the vessel wall restricts diffusion of larger objects
like bacteria and certain molecules into the brain. Only small molecules
like O2, hormones and CO2 can pass into the tissue. Therefore, the
measured permeability in a healthy brain is very low, close to zero.
The vessels in other organs, for instance the prostate, are much more
permeable, with values larger than zero.
Acquisition and processing of MR data for calculating permeability
Based on MR data, the MR Permeability tool on IntelliSpace Portal can
be used to determine the leakage of contrast agent (gadolinium chelates)
into the extra-vascular, extracellular space (EES). The most important
use is currently in prostate and brain.
The MR scanning starts with two separate 3D T1-weighted scans with
different flip angles to determine the T1 relaxation time of the tissue.
Then, Dynamic Contrast Enhanced (DCE) imaging is performed with
high spatial and high temporal resolution [1].
The Permeability analysis tool will automatically combine the 3D
T1-weighted and DCE series to immediately provide permeability
results. An important choice for the calculation is the Arterial Input
Function (AIF) used to fit all results to the Tofts model [1]. The MR
Permeability package provides two ways to define the AIF: based on
the injection protocol or based on actual DCE data.
The MR Permeability tool calculates permeability maps, but it also
conveniently provides color maps that combine the quantitative results
with the source data and with anatomical data – typically T2-weighted
and diffusion images – always geometrically aligned with the original
DCE acquisition.
Permeability parameters
Based on the Tofts model [1], the MR Permeability tool provides maps
of the kinetic parameters Ktrans and Kep.
Ktrans describes the transfer of the diffusible tracer (contrast agent) into
the EES. This transfer will depend largely on the permeability, and also
on the flow of the blood plasma that carries the contrast agent.
Kep describes the efflux of the same tracer from the EES back to the
blood plasma. This efflux rate depends on permeability, but also on
the EES volume compared to the blood plasma volume: a tissue with
a small percentage of EES will have a relatively large vessel wall area
to enable the efflux.
Schematic representation of physiology related to flow
and permeability in blood vessels. Depending on the tissue
characteristics, some of the contrast agent leaks into the
extravascular extracellular space (EES). The MR contrast agent does
not enter the cells, but will wash in and out of the EES.

“The MR Permeability analysis from Philips is an easy tool
for quantification of permeability and will allow independent
groups to characterize prostate lesions and, hopefully, improve
diagnostics and patient management.”
An 18-year-old female underwent surgical resection in the frontobasal region and combined radio/
chemotherapy. Three months post-radiotherapy, MRI shows enhancement. DCE-perfusion shows
regions with lower forms of leakage (orange ROI and curve), indicative of therapy-related changes.
Six weeks later MRI also shows a further reduced enhancement in these regions.
Courtesy Leuven University Hospitals, Belgium.
Permeability analysis in brain
In brain imaging, permeability analysis may be an important addition
to anatomical imaging to detect areas with changes in permeability.
“This technique uses T1-weighted acquisition, which does not suffer
from susceptibility artifacts – as experienced with EPI-based sequences
like T2* perfusion – which can make proper diagnosis of e.g. the
frontobasal region very challenging. This can be of considerable
importance, especially in post-surgery patients where the absence
of distortions due to suture material and/or blood deposits allows a
cleaner read and analysis of the images.”
“Differentiation of therapy-related tissue changes is often challenging.
Values like Ktrans and Kep by themselves do not provide an absolute truth,
but they can help in monitoring of therapy effectiveness, especially when
used in a multimodal approach.”
Dr. S. van Cauter, University Hospitals Leuven, Belgium
This article is based on the white
paper Extra window in oncology with
vascular permeability analysis by
S van Cauter, MD, PhD (University
Hospitals Leuven), O Rouvière, MD,
PhD (Edouard Herriot Hospital,
Lyon), U van der Heide, MD, SWTPJ
Heijmink, MD (The Netherlands
Cancer Institute – Antoni van
Leeuwenhoek Hospital, Amsterdam),
FGC Hoogenraad, PhD (Philips
Healthcare).
References
1. P.S. Tofts et al.
Estimating Kinetic Parameters from
dynamic contrast-enhanced T1-weighted
MRI of a diffusible tracer: standardized
quantities and symbols.
JMRI 10: 223-232 (1999).
2. Sciarra, A. et al.
Advances in magnetic resonance imaging:
how they are changing the management
of prostate cancer.
Eur Urol 59, 962-77 (2011).
3. Barentsz, J.O. et al.
ESUR prostate MR guidelines 2012.
Eur Radiol 22, 746-57 (2012).
4. Girouin, N. et al.
Prostate dynamic contrast-enhanced MRI
with simple visual diagnostic criteria: is it
reasonable
Eur Radiol 17, 1498-509 (2007).
Dr. O. Rouvière, Edouard Herriot Hospital, Lyon, France
FieldStrength 41

42 Educational
Fast susceptibility weighted imaging
with premium image quality
The new SWIp method for susceptibility weighted imaging provides exquisite contrast and resolution
in short scan times
T2 FFE, 2-3 min. 3D T2 FFE, long TE Typical SWI, 5 min.
SWIp combines premium image quality with fast and robust scanning
Single echo SWI SWIp Typical susceptibility weighted imaging has relatively long scan times, which
limits feasibility for routine use. Philips therefore developed the SWIp
technique. It is based on a high resolution 3D whole brain acquisition.
It uses phase information to get enhanced susceptibility contrast, in
combination with a 4-echo FFE acquisition to increase SNR compared to
single echo techniques. A short scan time, while maintaining high SNR,
may then be obtained leveraging dS SENSE.
Comparing multi-echo SWIp to single-echo SWI shows the gain in SNR.
The gain in SNR is demonstrated to
be 55% to 110%, depending on the
T2* of the tissue.
Susceptibility weighted imaging (SWI) enhances the contrast between
tissues with susceptibility differences; for instance, the contrast between
deoxygenated blood or some mineral deposits (e.g. calcium deposits)
and surrounding tissue. Due to this contrast enhancement, SWIp images
are sensitive for structures containing venous blood. When used in
combination with other clinical information, SWIp may help radiologists
in the diagnosis of various neurological pathologies.
Typical SWI methods
Image contrast in susceptibility weighted imaging is based on differences
in tissue susceptibility. The susceptibility of a tissue is the degree of
magnetization it gets in a magnetic field, which influences T2* and the phase.
The long available T2*FFE technique is fast with well established contrast.
A high resolution 3D T2*FFE method with long TE already shows
some contrast in veins. Conventional SWI uses phase information, which
enhances the contrast in veins, but this typically takes a long scan time.
0 50 100 150
T2*
2.4
2.2
2
1.8
1.6
1.4
1.2
1
SNR ratio
X: 67
Y: 2.107

The SWIp technique provides exquisite
images with high sensitivity to venous
blood products. SWIp can be acquired
with high resolution and quite short
scan time.
1.0 x 1.0 x 1.0 mm 6:17 min.
0.6 x 0.6 x 1.0 mm 4:30 min.
0.6 x 0.6 x 1.0 mm 4:32 min.
0.6 x 0.6 x 1.0 mm dS SENSE 4.5, 2:30 min.
Venous blood
Calcification
Adding dS SENSE factor 4.5 to SWIp
with high resolution (voxels 0.6 x 0.6 x
1.0 mm) reduces scan time from 4:30
min. to only 2:30 min. while maintaining
excellent image quality. Ingenia 3.0T
with 32-channel dS Head coil.
SWIp may help provide arterial and
venous information based on signal
intensity differences.
Phase maps may be used for advanced
diagnosis. On phase images venous blood
typically shows as hypointense signal
whereas as calcification typically shows
as bright signal.
Courtesy of University of Michigan,
USA.
VenBOLD SWIp
SWIp SWIp
SWIp SWIp phase
SWIp phase
Artery
Vein
FieldStrength 43

44
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1 Application Tip Metal artifact reduction for MRI of metal prostheses and implants
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3 Application Tip Tips for cardiac triggering in MRI
4 Application Tip Optimizing SPIR and SPAIR fat suppression
5 Application Tip Tips for body diffusion weighted imaging (DWI)
Most viewed recent content
1 Application Tip ACR bandwidth calculator
2 Application Tip Tips for wireless cardiac triggering in MRI
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All rights reserved. Reproduction in whole or in part
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Philips Medical Systems Nederland B.V. reserves the right
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product, at any time, without notice or obligation, and will
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of this publication.
Printed in Belgium.
4522 962 93021
FieldStrength is also available via the Internet:
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Editor-in-chief
Karen Janssen
Editorial team
Annemarie Blotwijk, Paul Folkers (PhD), Liesbeth Geerts
(PhD), Diana Hoogenraad, Karen Janssen, Stephen Mitchell,
Marc Van Cauteren (PhD).
Contributors
Tamanna Bembenek, PJ Early, Vijayasarathy Elanchezhian,
Chris G. Goumas (MD), Gwenael Herigault (PhD),
Dave Hitt, Frank Hoogenraad (PhD), Karen Janssen,
Ben Kennedy, Beth M. Kline-Fath (MD), Marco Nijenhuis,
Mark Pijnenburg, Dr. Shonit Punwani, Suraj Serai (PhD),
Pierre-Jean Valette (MD), Marius van Meel, Berit Verbist
(MD, PhD), William Ward.
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FieldStrength 45

46
Body MR
Pancreas workshop
Lisbon, Portugal
Date: May 15-16
Info: www.esgar.org
Body and Pelvic MR
Reston, VA, USA
Dates: Jan 10-12; Apr 4-6; Jul 11-13
Three-day intensive practical course on abdominal
and pelvic MR image interpretation.
Info: www.acr.org
Abdominal Radiology Course
Boca Raton, FL, USA
Date: March 23-28
Website: www.abdominalradiology.org
Breast MR
European Workshop on MRI-guided
vacuum Breast biopsies
Bruges, Belgium
Dates: t.b.d.
European Workshop for radiologists with
experience in breast imaging. Organized by
Dr. Casselman, AZ St. Jan.
Info: jbenecke@mammotome.com
Phone: +49 40 593559116
Erasmus course: Breast and female imaging
Vienna, Austria
Date: May 8-10, 2014
This three-day program provides different
workshops and lectures on breast and female
imaging. Organized by Dr. B. Brkljacic.
Info: www.emricourse.org/breast_2014
Breast MR with guided biopsy
Reston, VA, USA
Dates: Feb 4-5; May 1-2; Aug 5-6; Nov 4-5
This 100-case course is designed to provide
practicing radiologists with an intensive, hands-on
experience in reading breast MRI. Participants will
develop their interpretive skills through extensive
case reviews at individual work stations.
Info: www.acr.org
Email: EDCTR-WebReg@acr-arrs.org
Phone: +1 800-373-2204
Neuro MR
Erasmus course: Head and Neck
Bruges, Belgium
Date: February 3-7
Five-day program with lectures and workshops
on head and neck MR imaging. Organized by
Dr. Casselman.
Info: www.emricourse.org/head_neck_2014
Musculoskeletal MR
Current issues of MRI in orthopaedics and
sports medicine
San Francisco, CA, USA
Date: September 7-10
Info: www.stollerscourse.com
Musculoskeletal Diseases
Hong Kong, China
Date: June 28-30
The International Diagnostic Course Davos (IDKD)
offers interactive teaching workshops, presented by
an international faculty.
Info: www.idkd.org/cms/
Cardiac MR
Cardiac MR courses at CMR Academy
German Heart Institute, Berlin
All courses are for cardiologists and
radiologists. Some parts will be offered
in separate groups.
Info: www.cmr-academy.com
Email: info@cmr-academy.com
Phone: +49-30-4502 6280
Complete course
Dates: Part 1: Feb 17 - Mar 28, Oct 27 - Dec 5
Part 2 - home study
Mar 29 - May 9; Dec 6 - Jan 16, 2015
Intensive course including hands-on training at
the German Heart Institute, and reading and
partially quantifying over 250 cases.
Compact course
Dates: Feb 17-21; Jun 16-20; Oct 27-31
CMR diagnostics in theory and practice,
including performing examinations and case
interpretation.
CVMRI Practicum: New Techniques and
Better Outcomes
St. Luke’s Episcopal Hospital, Houston,
TX, USA
Date: t.b.d.
On principles and practical applications of
Cardiac MRI.
Info: ddees@sleh.com and lvillareal@sleh.com
Clinical Workshop on Cardiac MR stress
imaging
London, United Kingdom
Date: t.b.d.
Dedicated, intense, individualized and hands-on
CMR stress imaging training to a small number of
participants (max 10). Aimed at cardiologists and
radiologists. Theoretical and practical aspects will
be addressed.
Info: www.cvti.org.uk
Email: admin@cvti.org.uk and enquiries@cvti.org.uk,
Phone: +44 20 8983 2216
Hands-on technologist CMR training
St. Louis, MO, USA
Date: Offered monthly, by appointment.
Two-day course is designed for technologists,
nurses and sonographers interested in cardiac MRI.
Maximum of 3 participants per class.
Info: ctrain.wustl.edu/ClinicalResearch/
TechTraining2
Phone: +1-314-454-7459
Fax: +1-314-454-7490
MR Spectroscopy
MR Spectroscopy course
Zurich, Switzerland
Date: t.b.d.
Theory sessions and daily practical scanning and
post-processing sessions in small groups.
Info: www.biomed.ee.ethz.ch/education/
Email: henning@biomed.ee.ethz.ch
General MR
Essential Guide to Philips in MRI
Cheltenham, UK
Dates: November 10-13
Designed for Philips users. Includes 2 days on
basics of MR physics and 2 days on advanced
concepts. The course can be attended for 2-4 days.
Info: www.cobalthealth.co.uk/education
Calendars
Education calendar 2014
Register on NetForum to have free access to
online training modules on use of Philips
MR scanners and packages, use of coils, use
of EWS, MR safety.
NetForum

FieldStrength 49

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