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3.0T Liver with dynamic contrast - Emory University

ExamCard
Martin, Diego, M.D., Ph.D. Atlanta, Emory University Hospital

3.0T Liver with dynamic contrast

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ExamCard Purpose

This ExamCard makes use of a variety of imaging techniques for imaging of abdominal structures from the dome of the liver through the kidneys using the SENSE Torso coil.  Multiple combinations of imaging options are used to optimize the diagnostic quality of 3 tesla abdominal imaging:

 

  • The respiratory transducer is used for respiratory triggering of single shot TSE scans to eliminate slice misregistration. 

 

  • SENSE is used to shorten scan times for 3D THRIVE and multi-slice FFE scans and is also used to shorten the echo train length of single shot TSE scans to minimize T2 decay induced blurring.

 

  • Body-tuned CLEAR uniformity correction is used on scans not using SENSE to obtain improved phased array image uniformity and to correct for dielectric effects.

 

  • Multiple stacks with move table per stack is used to improve image quality of inferior and superior slices of 2D transverse scans.

 

  • Propagate field of view is used to propagate changes in field of view and slice parameters for same geometry scans made during the patient exam to simplify workflow and reduce operator error. 

 

  • A chemical shift selective fat suppression pulse that is insensitive to B1 RF transmit uniformity is used for fat suppression (SPAIR) and results in more uniform fat suppression over larger fields of view.

 

A number of imaging techniques are used including T2 weighted 2D single shot TSE with and without SPAIR fat suppression, 2D bTFE , T1 weighted 2D multi-slice FFE with in and out of phase TE and 3D T1 weighted TFE with SPAIR fat suppression (THRIVE). 

 

Specific timing is used for THRIVE scans for accurate timing of post contrast tissue uptake phases, in particular for the liver arterial contrast uptake phase. 

 

Pre and post contrast THRIVE scans are run as separate scans rather than a single scan with multiple dynamics to simplify reading and interpretation using PACS, allowing the separate scans to be labeled with pre and post contrast times with separate scans easily selected on PAC systems or Dicom.

ExamCard Overview

3T Abdomen
Scan 1SURVEY
Scan 2SENSE refernce
Scan 3T2 SSHh COR
Scan 4T2 SSh TRA
Scan 5T2 SSh SPAIR
Scan 6bTFE TRA
Scan 7IP T1 TRA
Scan 8OP T1 TRA
Scan 9MRCP TRA
Scan 10MRCP COR
Scan 11MRCP SLAB
Scan 12THRIVE PRE
Scan 13POST 20sec
Scan 14POST 1min
Scan 15POST 3min
Scan 16POST 5min

ExamCard Image steps

T2 SSh COR - TE 78 A single shot T2 weighted TSE scan used to visualize low T2 signal intensity lesions. Acquired with the patient free breathing with one respiratory triggered slice acquired during each expiration. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SENSE is used to reduce echo train length and associated T2 decay blurring.T2 SSh TRA - TE 76 A single shot T2 weighted TSE scan used to visualize low T2 signal intensity lesions. Acquired with the patient free breathing with one respiratory triggered slice acquired during each expiration. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SENSE is used to reduce echo train length and associated T2 decay blurring. Coverage is from the dome of the liver through the kidneys.T2 SSh SPAIR - TE 78 A single shot T2 weighted TSE scan with SPAIR fat suppression used to visualize medium to high T2 signal intensity lesions. Acquired with the patient free breathing with one respiratory triggered slice acquired during each expiration. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SENSE is used to reduce echo train length and associated T2 decay blurring. Coverage is from the dome of the liver through the kidneys.
T2 SSh COR - TE 78
T2 SSh TRA - TE 76
T2 SSh SPAIR - TE 78
A single shot T2 weighted TSE scan used to visualize low T2 signal intensity lesions. Acquired with the patient free breathing with one respiratory triggered slice acquired during each expiration. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SENSE is used to reduce echo train length and associated T2 decay blurring.
A single shot T2 weighted TSE scan used to visualize low T2 signal intensity lesions. Acquired with the patient free breathing with one respiratory triggered slice acquired during each expiration. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SENSE is used to reduce echo train length and associated T2 decay blurring. Coverage is from the dome of the liver through the kidneys.
A single shot T2 weighted TSE scan with SPAIR fat suppression used to visualize medium to high T2 signal intensity lesions. Acquired with the patient free breathing with one respiratory triggered slice acquired during each expiration. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SENSE is used to reduce echo train length and associated T2 decay blurring. Coverage is from the dome of the liver through the kidneys.
bTFE TRA A balanced TFE scan giving high signal from fluids with good anatomical detail. The scan is acquired free breathing. 2 stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. Coverage is from the dome of the liver through the kidneys.IP T1 TRA - TE 2.3 This is a T1 weighted field echo scan with an in phase TE and is used to visualize low T1 weighted signal intensity lesions. Acquired with 2 breath holds. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SENSE is used to shorten acquisition time.OP T1 TRA - TE 1.15 This is a T1 weighted field echo scan with an in phase TE and is used with the in phase scan to characterize fat and iron content in the liver. Acquired with 2 breath holds. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SENSE is used to shorten acquisition time.
bTFE TRA
IP T1 TRA - TE 2.3
OP T1 TRA - TE 1.15
A balanced TFE scan giving high signal from fluids with good anatomical detail. The scan is acquired free breathing. 2 stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. Coverage is from the dome of the liver through the kidneys.
This is a T1 weighted field echo scan with an in phase TE and is used to visualize low T1 weighted signal intensity lesions. Acquired with 2 breath holds. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SENSE is used to shorten acquisition time.
This is a T1 weighted field echo scan with an in phase TE and is used with the in phase scan to characterize fat and iron content in the liver. Acquired with 2 breath holds. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SENSE is used to shorten acquisition time.
MRCP TRA - TE 185 A thin slice single shot T2 weighted TSE scan used to visualize bile ducts, pancreatic duct, gall bladder and bowel. Acquired with the patient free breathing. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SPAIR fat suppression is used. SENSE is used to reduce echo train length and associated T2 decay blurring.MRCP COR - TE 235 A thin slice single shot T2 weighted TSE scan used to visualize bile ducts, pancreatic duct, gall bladder and bowel. Acquired with the patient free breathing. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices.  SPAIR fat supression is used. SENpSE is used to reduce echo train length and associated T2 decay blurring.MRCP SLAB- TE 920 A high resolution thick slab single shot T2 weighted TSE scan used to visualize the biliary system. Acquired with a breath hold.  SPAIR fat suppression is used.
MRCP TRA - TE 185
MRCP COR - TE 235
MRCP SLAB- TE 920
A thin slice single shot T2 weighted TSE scan used to visualize bile ducts, pancreatic duct, gall bladder and bowel. Acquired with the patient free breathing. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SPAIR fat suppression is used. SENSE is used to reduce echo train length and associated T2 decay blurring.
A thin slice single shot T2 weighted TSE scan used to visualize bile ducts, pancreatic duct, gall bladder and bowel. Acquired with the patient free breathing. 2 slice stacks with table move is used to minimize the head / foot isocenter offset for inferior and superior slices. SPAIR fat supression is used. SENpSE is used to reduce echo train length and associated T2 decay blurring.
A high resolution thick slab single shot T2 weighted TSE scan used to visualize the biliary system. Acquired with a breath hold. SPAIR fat suppression is used.
THRIVE PRE - TE1.43 A 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize bright T1 weighted lesions. Also used as the pre-contrast comparison for post contrast dynamic scans.  Acquired in a breath hold.  Transverse coverage is from dome of liver through the kidneys.  Suitable for MIP or MPR reconstruction.POST 22sec - TE 1.43 A THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the arterial phase of the liver. Acquired in a breath hold.  Transverse coverage is from dome of liver through the kidneys.  Suitable for MIP or MPR reconstruction.POST 1min - TE 1.43 A THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the venous phase of the liver. Acquired in a breath hold.  Transverse coverage is from dome of liver through the kidneys.  Suitable for MIP or MPR reconstruction.
THRIVE PRE - TE1.43
POST 22sec - TE 1.43
POST 1min - TE 1.43
A 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize bright T1 weighted lesions. Also used as the pre-contrast comparison for post contrast dynamic scans. Acquired in a breath hold. Transverse coverage is from dome of liver through the kidneys. Suitable for MIP or MPR reconstruction.
A THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the arterial phase of the liver. Acquired in a breath hold. Transverse coverage is from dome of liver through the kidneys. Suitable for MIP or MPR reconstruction.
A THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the venous phase of the liver. Acquired in a breath hold. Transverse coverage is from dome of liver through the kidneys. Suitable for MIP or MPR reconstruction.
POST 3min - TE 1.43 A THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the delayed interstitial phase of the liver. Acquired in a breath hold.  Transverse coverage is from dome of liver through the kidneys.  Suitable for MIP or MPR reconstruction.POST 5min - TE 1.51 A coronal THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the delayed interstitial phase of the liver. Acquired in a breath hold.  Suitable for MIP or MPR reconstruction.
POST 3min - TE 1.43
POST 5min - TE 1.51
A THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the delayed interstitial phase of the liver. Acquired in a breath hold. Transverse coverage is from dome of liver through the kidneys. Suitable for MIP or MPR reconstruction.
A coronal THRIVE 3D T1 weighted TFE scan with SPAIR fat suppression used to visualize uptake of contrast in the delayed interstitial phase of the liver. Acquired in a breath hold. Suitable for MIP or MPR reconstruction.

Patient preparation

The patient is positioned supine in the SENSE Torso coil. The respiratory transducer should be placed on the abdomen under the coil.  An adequate respiratory trace should be verified before moving the patient to magnet isocenter.

 

Adequate positioning of the SENSE torso coil should be verified with the SCOUT images and the coil repositioned as needed to obtain coverage from the dome of the liver through the kidneys.

 

Prescribed breath holding recommendations should be followed:

  • At least one inspiration breath hold during the SENSE reference scan.

 

  • Breath holds for anatomical scans using SENSE should be done in expiration.

Contrast agent / injection protocol

The radiologist prescribed contrast injection protocol is:

 

  • Run the PRE THRIVE scan before start of contrast injection.

 

  • Single dose contrast injected at a rate of 2cc/sec, followed by a 20cc/sec saline flush with the same injection rate.

 

  • Start the POST 22sec THRIVE scan 22 seconds after start of the contrast injection (this time is specific for the prescribed injection dose, rate and the duration of the post contrast scan).  For this example a 17sec breath hold THRIVE scan was acquired.  The specified delay should result in images acquired in the liver arterial capillary phase.  Visually one should see contrast in the hepatic artery and portal vein, but absolutely no contrast in the hepatic vein.

 

  • The remaining post contrast scans should be run at the prescribed delay times.  Timing for the arterial phase is critical [to within seconds].  The timing for the venous phase [within 10's of seconds] and the timing for the delayed interstitial phase [within minutes] is less critical.

Post-processing / analysis:

MPR and MIP reconstructions can be performed on the THRIVE dynamic sequence. Subtraction of the pre-contrast phase from the post contrast phases to allow better visualization of the contrast uptake can be done but is not typically needed.



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ExamCard
Intera 3.0T
Release 10, Release 11, Release 9
Body, Liver
 

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