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1.5T XR enables excellent cardiac imaging at Cleveland Clinic

Best Practice
Flamm, Scott, M.D. Cleveland Clinic USA

Achieva 1.5T XR enables excellent cardiac imaging at Cleveland Clinic

The Cleveland Clinic chose Achieva 1.5T XR for its cardiac work because of its excellent image quality and rampability; it's the only 1.5T scanner upgradeable to 3.0T without a magnet swap.


The Cardiovascular Imaging section of the world-renowned Cleveland Clinic performs about 2,500 cardiovascular MRI exams every year, mainly related to aortic vascular disease, ischemic heart disease and infiltrative cardiomyopathies.


Scott D. Flamm, MD, Head, Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, says, "We were intrigued and impressed that the Achieva XR is a 3.0T scanner that can begin its life at 1.5T and then be ramped up to 3.0T with a very simple conversion and no forklift. Even when it's running at 1.5T, we have the gradient capabilities of a 3.0T scanner." The Clinic will likely ramp up to 3.0T within the year.

Cleveland Clinic, Ohio Scott D. Flamm, MD
Cleveland Clinic, Ohio
Scott D. Flamm, MD



Achieva XR offers multiple advantages for cardiac work

"There are a number of things that I really like about the Achieva XR," says Dr. Flamm. "In particular, the integration of ExamCards. We are able to set up excellent discrete and focused protocols for cardiac examinations. It's a terrific tool that allows us to get systematically consistent examinations."


Shorter scan times are another advantage of using Achieva XR. "I monitor our scan times each quarter, and they have decreased consistently after Achieva XR was installed,"says Dr. Flamm.


Dr. Flamm says he doesn't aim for shorter breath holds with Achieva XR 3.0T gradients, but better images. "We are able to have shorter TRs and TEs and, as a result, in the same breath hold, we are able to accomplish imaging that has higher spatial resolution, higher temporal resolution, or both. Even if we could reduce the breath hold length to 8 seconds or even 6 seconds, we'd rather maximize our imaging for each patient's breath hold."


The Clinic uses the SENSE XL Torso coil, which has a very large coverage area. Many of Dr. Flamm's scans extend from the arch of the aorta to the bifurcation of the aorta. He can often acquire this in one scan with the SENSE XL Torso coil.



Related ExamCards

Multiple sequences help provide a more complete diagnosis

For each cardiac exam, Dr. Flamm includes additional scans that enable a thorough diagnosis, such as a series of axial images through the chest, with both bright blood and dark blood sequences instead of only focused, small field of view images of the heart.


"We do a flow quantification sequence, which is performed in an axial orientation at the level of the right pulmonary artery that allows us to calculate blood flow through the ascending aorta and ensure the valve is working properly. On the same imaging plane we have the superior vena cava and the right upper lobe pulmonary vein and evaluate the flow curves of both of those vessels, to categorize right and left atrial pressure, respectively," explains Dr. Flamm.


Dr. Flamm acquires these additional flow quantification images with good reproducibility, within a single breath hold, and with retrospective gating to cover the entire cardiac cycle. "These flow quantification sequences really have continued to get better and better," he says. "This Achieva XR system seems to produce the most reliable that I have seen."


Dr. Flamm also regularly performs functional non-cine imaging using a balanced FFE sequence. "To detect infiltration within or permanent damage to the myocardium, we can use the balanced FFE sequence with an inversion recovery pulse. A variation on this technique is a Phase Sensitive Inversion Recovery (PSIR) acquisition. A PSIR approach is less sensitive to variations in choice of the inversion time TI, so it allows us to go through an examination with fewer adjustments to TI, which speeds our exam workflow. Normal myocardium shows up on this scan as black, while damaged myocardium shows up as white. For ischemic disease the pulse sequence is particularly helpful as we have nearly a binary evaluation process - black or white."



Related Clinical Cases

Workflow improves with EWS workstation

The integration of the ExamCards with the Extended Workspace (EWS) is particularly advantageous, says Dr. Flamm. "With the customizable display protocols and the tight integration with the EWS display protocols we can bring up a series of long and short axis images on a single display screen and have them all synchronized. It's very logical and efficient - and clinically useful - to be able to put images that are acquired in the same orientations together, as it enables you to directly match function with tissue characterization. The EWS is a sophisticated cardiac MR workstation and analysis tool."

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Apr 30, 2010

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Best Practice
Achieva 1.5T XR
Release 2.6
Quasar Dual
Aorta, Cardiac, Cardiac Morphology, Function Cine, Function Non-Cine

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