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Ingenia 1.5T proves exceptional for cardiac imaging

Best Practice
Shapiro, Michael, D.O. Oregon Health & Science Univers • USA

Ingenia 1.5T, the first-ever digital broadband system, is an excellent choice for cardiac MR, with a 55 cm FOV, a wide 70 cm bore and lightweight coils. The combination of Ingenia’s high SNR and dS Torso coil is ideal for the high volume of cardiac work at OHSU, providing the beautiful image quality necessary for diagnostic confidence.


 Michael D. Shapiro, DO. Oregon Health and Science University
Michael D. Shapiro, DO.
Oregon Health and Science University

OHSU sees very diagnostic exams with the robust, reliable Ingenia system

Oregon Health and Science University (OHSU, Portland, Oregon, USA) installed Ingenia 1.5T in April 2011, and is now scanning 15-20 cardiac patients a week for viability imaging, valvular heart disease, specifically aortic and mitral regurgitation, myocarditis, cardiac masses, evaluation of potential ARVD, congenital heart disease, pericardial disease, cardiomyopathy and ischemic heart disease. The only academic medical center in the state of Oregon, OHSU is a high-volume medical center that provides tertiary/quaternary care to patients throughout the state of Oregon, as well as parts of California, Washington and Idaho.

Michael Shapiro, DO, is Director of Cardiac MRI and CT within the Division of Cardiovascular Medicine at OHSU. He says cardiac MR at OHSU is generally reserved for specific applications when more conventional imaging is equivocal or non-diagnostic. For this, he says, Ingenia 1.5T is ideal. Ingenia’s dStream technology digitizes the signal directly in the coils and sends it by fiber-optics, providing up to a 40% increase in SNR compared to Achieva.

High SNR and patient comfort yield diagnostic confidence

“As promised, we get a high signal-to-noise ratio with Ingenia, so the image quality is excellent and we have very good and diagnostic exams. The specific area where we really felt the advantages of this system, is in our IR prepared TFE imaging, which is critically important because many of our referrals for cardiac MRI are performed to evaluate for myocardial fibrosis. To have this very robust and reliable scanner is extremely helpful. That’s probably the biggest advantage we’ve noticed. Also from a patient perspective, having the wider bore and lightweight coils is very comfortable. And we have many patients who can go through an exam without needing sedation. I think patients are very comfortable on this scanner.”

Dr. Shapiro says that these advantages support diagnostic confidence. “It’s just a more satisfying exam to look at. We don’t leverage the options that would allow us to go faster because we put more of an emphasis on image quality than efficiency. This scanner allows you to be extremely efficient, and we do use that option in individuals who have breath-holding issues or who are anxious and need to move through the scanner quickly, but excellent image quality is our primary goal, so the high SNR is very important to us. We’re very, very pleased with the image quality on this scanner.”

Lightweight, easy-to-use coils provide large coverage too

Dr. Shapiro uses the dS Torso coil. “It’s an excellent coil for cardiac purposes,” he says. “The dS-SENSE factors are very high. We certainly use it in patients who can’t hold their breath for too long.”

With smaller coils, placement of the coil can be a challenge, he adds. “The goal of any exam is to optimize the signal-to-noise ratio in the body part of interest, and of course for a cardiac exam that means centering the coil exactly in the middle of the heart. You often have to do some scouts and maybe fine-tune the placement of the coil and do the scouts over again. But with this coil, that’s never an issue – you just put the coil on and go. And there’s plenty of coverage, which is an advantage when we’re looking at extra-cardiac structures, including the aorta and its branches. Because of this good coverage, we get to see things with good signal to noise and good homogeneity on a wider field of view, and that’s a great benefit.”

Overall, for cardiac imaging, Dr. Shapiro finds the Ingenia 1.5T an excellent system. “Ingenia 1.5T is a real cardiac scanner; it really was developed with cardiac MR in mind, and it is ideal for our work.”
 
  
 
   

Case studies



Cardiac amyloidosis
A 69-year-old male developed generalized fatigue, dyspnea, and malaise for 8 months. Prior to his recent admission he had developed severe exertional dyspnea which limited him to 10 feet of ambulation. He also reported pronounced three-pillow orthopnea, lower extremity edema and paroxysmal dyspnea. After ultrasound demonstrated concentric left ventricular hypertrophy and a restrictive filling pattern, he was referred to cardiac MRI for further evaluation.
 
 Cine image Cine image
Cine image
Cine image
Ingenia 1.5T cine images demonstrate stereotypical features of cardiac amyloidosis, including valvular regurgitation (arrows), pericardial effusion (asterisk), and biventricular hypertrophy (right image).


Delayed enhancement imaging demonstrates characteristic findings associated with cardiac amyloidosis. There is circumferential subendocardial hyperenhancement, most prominently at the base. There is also marked enhancement of the atria. Notice the relatively poor signal from the blood pool, which is typical of amyloid. 

 



Hypertrophic cardiomyopathy
A 20-year-old female experienced several pre-syncopal episodes associated with palpitations. She also had episodic chest discomfort (lasting seconds and associated with activity) for about 5 months. EKG was abnormal, ultrasound was abnormal.
Prominent asymmetric septal hypertrophy measuring up to 25 mm.

Hyperdynamic left ventricular systolic function (LVEF=81%) with cavity obliteration at the apical level. Left ventricular diastole (left image) and systole (right image).

Mild systolic anterior motion (arrow) of the anterior mitral valve leaflet. Left ventricular diastole (left image) and systole (right image).

 
Focal delayed enhancement noted within the mid-wall of the interventricular septum at the mid-ventricular and apical levels (both images) at the inferior RV insertion point (arrow). This finding is typical in the context of hypertrophic cardiomyopathy and is suggestive of myocardial fibrosis.





Myocarditis
A 38-year-old male with no cardiac history developed a GI illness two weeks prior to admission. He recovered but then presented to the ED with chest pain. He had ST elevations on his ECG and modestly elevated troponin.
 T2W T2W
T2W
T2W
T2W images demonstrate signal hyperintensity (as demarcated by the arrows) in the lateral of the left ventricle, seen in the horizontal long axis (left image) and short axis (right image) views. This signal hyperintensity on T2W images is consistent with myocardial edema as a result of myocardial inflammation.

A gadolinium enhanced coronary MRA demonstrated a normal right coronary artery (left image) as well as normal left coronary system (right image).

Ten minutes after the administration of gadolinium, there is an area of delayed hyperenhancement (arrows) located in the subepicardium. Importantly, the subendocardium is spared. This location of hyperenhancement is highly suggestive of myocarditis.


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Feb 11, 2014

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Best Practice
Ingenia 1.5T
amyloidosis, Cardiac, Cardiology, cardiomyopathy, dS Torso coil, myocarditis, SNR
 

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