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MultiTransmit propels Erasme to scan all body patients at 3.0T

Best Practice
Prof. Matos, Celso, M.D. Brussels, Erasme Hospital Belgium

Since Erasme Hospital received the MultiTransmit upgrade for its Achieva 3.0T system it has seen spectacular results, particularly in abdominal work. Patientadaptive MultiTransmit technology employs multiple, independent RF sources to nullify dielectric shading at its origin. The power, amplitude, phase and waveform of the RF sources automatically adjust to each patient's unique size, shape and relative fat and water quantities to optimize uniformity and consistency.
 Celso Matos, MD Erasme Hospital Brussels
Celso Matos, MD
Erasme Hospital Brussels

Erasme Hospital (Cliniques Universitaires de Bruxelles, Hôpital Erasme, ULB, Brussels, Belgium) uses four Philips systems - Achieva 3.0T with MultiTransmit, Achieva 1.5T and two Intera 1.5T - to perform 1,200 to 1,500 exams each month, including spinal exams done by neuroradiologists. Although the hospital installed its Achieva 3.0T system in 2005 and the field of view is smaller than in newer models, it could readily be upgraded to MultiTransmit. Since the upgrade in late 2009, more than 300 patients have been scanned on the Achieva 3.0T with MultiTransmit.

Time savings and improved image quality with MultiTransmit

Radiologist Celso Matos, MD, utilizes the Achieva 3.0T with MultiTransmit and the 16-channel SENSE XL Torso coil on average two days a week for abdomen and pelvis scanning. "MultiTransmit consistently enhances image and contrast uniformity and improves reproducibility in all clinical sequences," he says. "In addition, it allows us to scan faster or with higher resolution, which is specifically an advantage in breath hold T1-weighted sequences. Dual echo (in- and out-of-phase) T1-weighted scans can now be acquired during a single breath hold. T2-weighted TSE can be acquired faster with less blurring, and refocusing control can be avoided, thus increasing the T2 contrast. Coronal views consistently have better signal uniformity, which allows us to explore larger FOVs. MultiTransmit makes our choices easier and more flexible; the examination can be tailored to the specific patient problem."

With MultiTransmit all body scanning may be done at 3.0T

Along with Thierry Metens, PhD, Dr. Matos has achieved the greatest results with MultiTransmit in his abdomen exams. "We are obtaining excellent abdominal examinations (liver, pancreas and kidneys). Decompensated cirrhotic patients with ascites, and patients with severe acute pancreatitis and large fluid collections can now be scanned with consistent image quality." Dr. Matos says that before MultiTransmit he used to pre-select patients for 3.0T abdominal and pelvic examinations. "Especially in liver examinations, we often saw a significant drop in signal intensity in the left liver lobe due to dielectric shading; some regions in the middle of the FOV were quite dark. Patients with cirrhosis and ascites and a lot of fluid in the peritoneum were scanned on our 1.5T system to avoid such problems. Now, with MultiTransmit, we can scan anyone on our 3.0T system."
In addition, MultiTransmit's patient adaptive technology reduces local SAR, which in turn shortens scan time by up to 40 percent. So, T2-weighted imaging can be done much faster because the repetition time is significantly reduced. "Because of this TR reduction, our pelvis examinations are done significantly faster. Specifically for the high resolution TSE T2-weighted (acquisition voxel size 0.6 x 0.6 x 3 mm), the TR decreases from 6680 ms to 4230 ms, and the examination time goes from 9:47 to 6:12 minutes, while the detailed survey is nowadays performed in 35 seconds," says Dr. Matos. "For other anatomic regions we prefer to use MultiTransmit's benefits to scan with higher resolution. We can do better T1-weighted imaging, particularly double-echo T1, which was not possible before. Now we can do that during a single breath hold."

Oncology MRI benefits from MultiTransmit

Body MRI scanning at Erasme Hospital involves oncology patients. "Because of the excellent performance of MultiTransmit the hospital can now use the 3.0T system for all of its oncology patients, not just a selected group," says Dr. Matos. "The higher signal at 3.0T is a large advantage in our oncology work, but without MultiTransmit we would not have been able to use our 3.0T system for every case.

I've seen, for instance, that for small lesions within the liver 3.0T MultiTransmit is much better. MultiTransmit is enabling high quality, high resolution imaging that allows us more confidence in diagnosis, follow-up and monitoring."

In oncology patients Dr. Matos is now also performing high resolution diffusion weighted imaging (DWI) of the prostate, liver and pancreas. "The images are quite impressive. MultiTransmit consistently improves contrast and resolution in all clinical sequences, including DWI. The fat suppression uniformity is improved in those anatomical locations more sensitive to dielectric shading, such as the left liver lobe. Also the reproducibility of apparent diffusion coefficients (ADC) is better," he says. "This will certainly have an impact on the follow-up with our oncology patients."

"We are now doing some studies comparing the signal-to-noise ratio in DWI with and without MultiTransmit," he adds, "We know it has improved, but we want to quantify it."

View clinical cases:

Future is now wide open for 3.0T imaging

"MultiTransmit opens the field for more body applications at 3.0T," says Dr. Matos. "It will certainly expand whole body applications like 3.0T whole body DWI in oncology patients, and it will allow us to scan more patients. It's particularly useful for the brain, for MSK and abdomen, with much better image quality and improved signal." "The 3.0T imaging we're doing now wouldn't be possible without MultiTransmit," he adds. The image quality was previously less reproducible, and not this consistent from one patient to another. I think that 3.0T with MultiTransmit has the potential to become a new standard for MR examinations."

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Nov 4, 2010

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Best Practice
Achieva 3.0T TX
Release 2.6, Release 3.2
Quasar, Quasar Dual
Abdomen, Body, Liver, MultiTransmit, Oncology, Pancreas, Prostate

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