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Ingenia 1.5T helps overcome fetal imaging challenges

Best Practice
Serai, Suraj, Ph.D. Cincinnati Children's Hospital Medical Center • USA
Kline-Fath, Beth, M.D. Cincinnati Children's Hospital Medical Center • USA

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.
 Suraj Serai, PhD Beth M. Kline-Fath, MD
Suraj Serai, PhD
Beth M. Kline-Fath, MD

“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 fetal MRI is to obtain diagnostic 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 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.”


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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.”

“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, covers 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; 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 post-processing.”

“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 the results on Ingenia.”


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Best Practice
Ingenia 1.5T
Anterior coil, Body, dStream, Fetal, Pediatric, Posterior coil, SNR, Women's health
 

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