GEHealthcare SignaPulse Magazine 20071001

GE Healthcare
pulse
S I G N A
THE MAGAZINE OF MR AUTUMN 2007
The IDEAL Approach to

Separating Water and Fat
page 16
2D Versus 3D
page 14
Re-Defining the
Next Generation
of High Definition
page 32
Making the Decision

to Add MRI
page 48
imagination at work
The information contained in this document is current as of publication of the magazine.
TA B L E O F CONTENTS
GE News: The IDEAL Solution Clinical Value: One Breath Away from Technical Innovation: Enhancements
for Fat and Water Separation Volumetric In-Phase, Opposed-Phase Bring Sophisticated MR Applications
Page 6 Fat/Water Imaging Within the Reach of Everyone
Page 24 Page 40
GE Healthcare News Clinical Value

Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Volumetric Imaging Magnetizes Radiology . . . . . . . . . . . . . . . . 12
New Volume Acquisition Helps Clinicians The Clinical Proof of 2D Versus 3D . . . . . . . . . . . . . . . . . . . . . . . . 14
Detect Small Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Consistent, Reliable, Fat-Suppressed Imaging
The IDEAL Solution for Fat and Water Separation. . . . . . . . . . . 6 Even with Difficult Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Introducing the Next Generation of HD MR . . . . . . . . . . . . . . . . . 7 High-Resolution, Isotropic-Voxel Acquisition Technique
Improves Quality and Utility of Diffusion-Weighted and
Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Diffusion Tensor Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
GE Opens Chinas First MR Application Academy . . . . . . . . . . . 9
One Breath Away from Volumetric In-Phase,
3.0T Continues to Bring Users Together . . . . . . . . . . . . . . . . . . . 10 Opposed-Phase Fat/Water Imaging . . . . . . . . . . . . . . . . . . . . . . 24
Efficient Image Quality Enhancements
in Temporal Bone Imaging Using PROPELLER HD. . . . . . . . . . 28
Validation of an Automated Left Ventricular
Segmentation Technique for Quantifying Stroke Volume. . . 30
Publications Team: GE Contributors:

David Handler Chris Fitzpatrick
General Manager, MR Global Marketing MR Global Marketing Programs Manager
Rene Adelle Stasiewicz Joanna Jobson
Global Marketing Communications Manager, MR Global Marketing Programs Manager
Diagnostic Imaging Modalities Maria Piazza
Katherine Patterson MR Global Marketing Programs Manager
Global Marketing Communications Manager, MR
Mary Beth Massat
Editorial Consultant
2007 General Electric Company, doing business as GE Healthcare. All rights reserved. The copyright, trademarks, trade names and other intellectual property rights subsisting in or used in connection
with and related to this publication are, the property of GE Healthcare unless otherwise specified. Reproduction in any form is forbidden without prior written permission from GE Healthcare.
LIMITATION OF LIABILITY: The information in this magazine is intended as a general presentation of the content included herein. While every effort is made by the publishers and editorial board to see that
no inaccurate or misleading data, opinion or statements occur, GE cannot accept responsibility for the completeness, currency or accuracy of the information supplied or for any opinion expressed. Nothing
in this magazine should be used to diagnose or treat any disease or condition. Readers are advised to consult a healthcare professional with any questions. Products mentioned in the magazine may be
subject to government regulation and may not be available in all locations. Nothing in this magazine constitutes an offer to sell any product or service.
2 A GE Healthcare MR publication Autumn 2007

Beyond the Scan: Medicare

Reimbursement Update
Page 52
Technical Innovations
Re-Defining the Next Generation of High Definition. . . . . . . . 32
3D FSE Reduces Scan Time, Generates Thinner Slices . . . . . 34
New Parallel Imaging Method Enhances Imaging Speed
and Accuracy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Quantitative Tool for Neurological Brain Evaluation . . . . . . . 39
Enhancements Bring Sophisticated MR Applications
Within the Reach of Everyone . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Robust NCE Techniques Remain a Viable Alternative
for MR Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Beyond the Scan

Advanced fMRI Techniques Provide Valuable Information,
Change Course of Treatment for Neurosurgical Patients. . . 44
The Right Choice for Your Community:
Making the Decision to Add MRI . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Medicare Reimbursement Update . . . . . . . . . . . . . . . . . . . . . . . . 52
Signa 3.0T Users Share Best Practices, Clinical
Techniques with Users Around the World . . . . . . . . . . . . . . . . . 53
G E H E A LT H C A R E N E W S WELCOME
Welcome
Ever stop and think about the incredible strides medical But even the most advanced imaging tools wont succeed
research has made in the last 100 years? I admit it, working in todays clinical environment if they arent delivering what
in this industry can make us harder to impress than the radiologists need. They must be clear, accurate and specific.
average person. But think about it. In the last 100 years, Otherwise, our mission will fail to deliver what it ultimately
weve seen the discovery of the cause of rickets (1916) to the needs to do: giving radiologists the tools they need to do
discovery of penicillin (1940s). It was only in the last 50 years their job to save lives. No small task.
or so when they found that smoking is a leading cause of
In his 2007 book, How Doctors Think, Dr. Jerome Groopman
cancer (1956) or that chemotherapy could be used as a
discusses a study from Dr. E. James Potchen that indicates
treatment for cancer (1970s). Of course, we couldnt forget
radiologists need to be able to gather the information they
Sir Peter Mansfield and his studies that led to the development
need from images in 38 seconds. Thirty-eight seconds!
of the MRI in 1973.
What this means to us is that our images need to clearly,
Incredible stories. But they underscore the point that the consistently and accurately deliver in a very short period
scientific advancements in healthcare are really just starting of time. Something we take to heart.
to gain momentum. Theres so much ahead of us every
This is why we at GE Healthcare are pleased to introduce to
day brings another finding or advancement and every day
you the next dimension in HD MR imaging the Signa HDxt.
lives are saved that previously would not have been. What
These new acquisitions are truly exciting and are in step
an exciting time to be in healthcare!
with our vision to give you what you need: images that
are clear, concise and consistent. Every time. For every

W E L C O M E G E H E A LT H C A R E N E W S
James E. Davis
patient and technologist. And were presenting you detailed All of these are industry leading applications many developed
information about each in this issue of Signa PULSE that you in collaboration with our lead users. As we walk down the
can put to immediate use on your Signa HDx system. path of this new era in healthcare together, its exciting to
look to the future. Were working on some truly revolutionary
IDEAL consistent, exceptional fat suppression for even
ideas that have our engineers buzzing with excitement. But
the most challenging anatomies, solving the problem with
at GE Healthcare, we try to make sure that these ideas not
chemical shift artifacts
only are exciting but realistic. Thats why were focused
Cube the 3D, HD acquisition that allows you to view in on solutions that enable you to See more with better
any plane, eliminating operator variances and minimizing image quality. Do more with solutions that make sense
blurring to acquire complete data from scan all while and opportunities that expand your practice into other
significantly reducing total exam time areas. And Expect more from your vendor with service
3D Dual Echo Overcomes difficult imaging challenges, and solutions that wont become obsolete.
such as fatty liver disease, by acquiring images at the That is our promise we look forward to moving into
true TE at any Tesla strength the future with you.
ARC A major step forward in speed and accuracy,
delivers a highly accelerated parallel imaging technique,
enabling tight field-of-view (FOV) prescriptions
BrainSTAT combined with diffusion imaging, provides
an effective way to visualize the effects of neurological James E. Davis
conditions, providing valuable treatment information faster Vice President and General Manager,
Global MR Business
GE Healthcare
A GE Healthcare MR publication Autumn 2007 5

G E H E A LT H C A R E N E W S NEW PRODUCTS
New Volume Acquisition Helps Clinicians

Detect Small Lesions
GE Healthcare introduces Cube, a new volumetric fast spin
echo (FSE) imaging sequence available on the Signa HDxt
1.5T and 3T platforms. Optimized for T2, T2 FLAIR and Proton
Density imaging, Cube captures the entire volume with high
spatial, isotropic resolution. As a result, any view, plane or
slice can be later reconstructed from a single acquisition
with the same high resolution as the native plane.
This new ability for volumetric imaging of the anatomy
can result in fewer retakes that are often due to missing or
misaligned slices or planes. It may also help radiologists to
more consistently detect lesions as small as 2mm. The Cube
sequence is based on modulated flip angles, which make
very long echo train feasible. The typical image blurring
and SAR are reduced, while high tissue contrast leads
to conspicuous appearance of pathologies.
Isotropic volumetric imaging with Cube
Protocol settings are automatically optimized based on the
anatomical region of interest (ROI) and MR sequence. Cube capability to acquire large high definition 3D data sets
also provides excellent enhanced tissue contrast and specific in relatively short time for a more efficient workflow.
absorption rate (SAR) management by staggering the delivery
As part of the revolutionary HDxt platform, Cube completes
of energy to the patient/tissue.
GEs volume portfolio to allow clinicians to provide the
When used with GEs innovative auto-calibrating, data-driven benefits of volume imaging for every study.
parallel imaging technique, ARC, clinicians will have the
The IDEAL Solution for Fat and Water Separation

Representing a new paradigm in fat suppression, IDEAL is Developed in conjunction with Stanford Radiology and the
an innovative method for fat and water separation available University of Wisconsin-Madison Hospitals and Clinics, IDEAL
exclusively on GE Healthcares Signa HDxt 1.5T and 3.0T MR is enabled for 2D FSE with PD, T1 or T2 contrast and 3D
systems. IDEAL is a single acquisition technique that generates SPGR with T1 contrast. Unlike current methods, such as
four images water only, fat only, in phase and out of phase. spectrally selective fat saturation and STIR, IDEAL is compatible
This new sequence is particularly useful when imaging difficult with the new generation of phased array coils and parallel
areas of the anatomy, such as the orbits, brachial plexus, imaging techniques.
c-spine, extremities. IDEAL consistently
separates fat from water in challenging
anatomical areas, resulting in excellent
image quality. Also, because IDEAL is a
single acquisition technique, the in phase
and out of phase images are inherently
registered, leading to faster interpretation
and higher diagnostic confidence.

N E W P R O D U C T S G E H E A LT H C A R E N E W S
Introducing the Next Generation of HD MR

Just as high definition (HD) has transformed TV, HD MR New applications driving volume data acquisition include:
enables new clinical capabilities by capturing higher
Cube, which quickly acquires isotropic resolution volume
resolution and consistently clear images for increased
data that allows multi-plane reconstruction, while helping
diagnostic confidence. GE Healthcare introduces Signa
reduce the number of scans and total exam time
HDxt to extend the concept of isotropic, volumetric imaging.
ARC, a fast, robust, auto-calibrating data-driven parallel
HD Volumetric MR can help transform imaging by addressing
imaging method that minimizes artifacts and significantly
some of the toughest issues facing MR imaging today. With
decreases sensitivity to motion, ideal for smaller field of
advanced technology, new coils and applications, Signa HDxt
view imaging
provides high definition, complete data sets with enhanced
clear contrast for overall better image quality within a 3D Dual Echo, a volumetric, high signal-to-noise ratio
shortened exam time. imaging sequence that generates in-phase and out-of-phase
images in a single breath hold acquisition even at 3.0T
IDEAL, a revolutionary HD technique for true fat and water
separation provides uncompromising image clarity with
consistent and robust fat suppression, especially in
difficult areas of anatomy.

G E H E A LT H C A R E N E W S EVENTS
Calendar of Events
GE looks forward to seeing you at the following events
Conference Dates Conference Center City and State Country Web link
or Hotel or Provence
San Antonio Breast Dec. 13-16 Henry B. Gonzalez San Antonio, TX USA www.sabcs.org
Cancer Symposium Convention Center
Society for Cardiovascular Feb. 1-3 Hyatt Regency Los Angeles, CA USA www.scmr.org
Magnetic Resonance (SCMR) Century Plaza
11th Annual Scientific Sessions
Vail 2008: MRI in Feb. 10-15 Vail Marriot Vail, CO USA www.educationalsymposia.com
Clinical Practice Mountain Resort & Spa
MRI 2008: Clinical Updates Feb. 18-22 Rio Mar Beach Resort and Spa Puerto Rico Commonwealth www.cms.hms.harvard.edu
and Practical Applications Wyndham Grand Resort of the USA
American Society of Functional Feb. 27-29 Rosen Shingle Creek Orlando, FL USA www.asfnr.org
Neuroradiology (ASfNR),
2nd Annual Meeting
American Academy Mar. 5-9 Moscone Center San Francisco, CA USA www.aaos.org
of Orthopaedic Surgeons
75th Annual Meeting
European Congress of Radiology Mar. 7-11 Austria Center Vienna Vienna Austria www.myesr.org
The Breast Course Mar. 12-15 Fairmont Le Chateau Quebec City, Quebec Canada www.thebreastcourse.com
Frontenac
American College of Mar. 29-Apr. 1 McCormick Place Chicago, IL USA www.acc.org
Cardiology (ACC)
59th Annual Scientific Session
The Annual Meeting of Japan Apr. 4-6 Pacifico Yokohama Yokohama, Japan www.secretariat.ne.jp
Radiological Society & Kanagawa
The Annual Scientific Congress
of Japanese Society of
Radiological Technology
2008 3T MRI Whole Body Imaging Apr. 10-12 Eden Roc, A Renaissance Miami Beach, FL USA www.educationalsymposia.com
in Clinical Practice: Basic Beach Resort & Spa
Fundamentals Adv. Apps.
MRI of the Head & Spine Apr. 28-30 The Venetian Las Vegas, NV USA www.educationalsymposia.com
2008 National Symposium Resort-Hotel-Casino
Magnetic Resonance Imaging Apr. 28-May 2 The Venetian Las Vegas, NV USA www.educationalsymposia.com
2008: National Symposium Resort-Hotel-Casino
MRI of the Body & Heart Apr. 30-May 2 The Venetian Las Vegas, NV USA www.educationalsymposia.com
2008: National Symposium Resort-Hotel-Casino
ISMRM Sixteenth Scientfic May 3-9 Metro Toronto Toronto, Ontario Canada www.ismrm.org
Meeting and Exhibition/SMRT Convention Centre
Seventeenth Annual Meeting
Society of Breast Imaging May 8-10 Grande Lakes Resort Orlando, FL USA www.sbi-online.org
American Society May 31-June 5 Morial Convention Center New Orleans, LA USA www.asnr.org
of Neuroradiology (ASNR),
46th Annual Meeting & NER
Foundation Symposium
European Society of June 10-13 Istanbul Conference Istanbul Turkey www.esgar.org
Gastrointestinal and Abdominal & Exhibition Center
Radiology (ESGAR) 2008
Organization for Human June 15-19 Melbourne Convention Center Melbourne Australia www.hbm2008.com
Brain Mapping

E D U C A T I O N G E H E A LT H C A R E N E W S
GE Opens Chinas First

MR Application Academy
With the deployment of more than 2,000 MR units across China, With the wholehearted support of Chinas MR community
hospitals suffer from a shortage of trained technologists, and leaders in the MR field from the U.S., the Academy is the
physicists, radiochemists and radiologists specializing in MRI. first and only institution dedicated to MRI training in China
To help accelerate this important area of growth and provide today, stated Zhao Bin, Executive President of China MR
training and development in this pivotal field, GE Healthcare Application Academy and Director of Shandong Medical
co-founded and opened the first MR Application Academy Imaging Research Institute. Our focus is on both the provision
in Shanghai in collaboration with the Chinese Society of of opportunities for MR clinical practice and learning for
Radiology and the Chinese Society of Imaging Technology. front-line medical personnel, and on the establishment of
The academy will provide a platform to meet the demand a new scientific MR research mode for our large academic
for training brought on by the rapid adoption of MRI technology hospitals and research institutions. The China MR Application
throughout China. Academy is laying the foundation for the advancement of
medical imaging within China.
The Academy will focus on advancing MR clinical applications
and promoting research utilizing techniques and applications Among the esteemed MRI professionals serving the Academy
among the Chinese research and academic communities. are co-presidents Professor Qi Ji, Chairman of the Chinese
It will also provide essential, professional training for MRI Society of Radiology and Dr. Thomas Foo, Manager of GE
technologists, radiologists and research scientists. Located Global Research Center MRI Lab. More than 60 experts from
at the GE China Technology Center, it is comprised of the China and the U.S. have also been appointed as professors
MR Education Center China (MRECC), the Sino-U.S. MR Physics at the Academy.
Center and the Sino-U.S. MR Molecular Imaging Center.
To learn more about the academy, visit www.mriabc.org.

G E H E A LT H C A R E N E W S USER MEETINGS
3.0T Continues to
Bring Users Together
Signa 3.0T made easy in the Big Easy
As part of the conference 3.0T MRI: Whole Body Imaging
in Clinical Practice, in New Orleans, GE Healthcare hosted a
fourth 3.0T users meeting on April 28, 2007. The meeting was
geared to help optimize the clinical use of the Signa 3.0T
MR System. Guest speaker, Sheetal S. Desai, RT (R)(MR),
Chief MR Technologist, Edison Imaging Associates
(Edison, NJ), discussed MR imaging tips and techniques
for optimizing breast imaging, specifically with the
use of new fat sat pads.
Bryan Mock, PhD, GE Global 3.0T Product Manager,
provided an update on portfolio enhancements and
a glimpse into the continued future development
of Signa 3.0T systems. Mike Pellerin, GE Clinical MR
Specialist, discussed how to maintain T1 contrast at
3.0T with different alternatives, such as Spin Echo,
FSPGR and T1 FLAIR. He also showed imaging
strategies to address the dielectric effect at 3.0T.
Pam Sandow, MR QA Specialist, presented artifact
identification and management at 3.0T while Carol
Maher, GE TiP Applications Specialist, presented the
Succeed Program, a training concept designed to help
users define a new strategy that can maximize the
breadth and depth of clinical applications at 3.0T.

U S E R M E E T I N G S G E H E A LT H C A R E N E W S
Sprechen sie 3.0T?

A packed house produced an evening of sharing ideas and
information at The Global Signa 3.0T Users Event during the
International Society for Magnetic Resonance in Medicine
(ISMRM), held May 19-25, 2007 in Berlin, Germany. Users
were presented with an overview of the Signa 3.0T product
portfolio, clinical imaging techniques, advanced neuro
applications and technical performance.
Bryan Mock, PhD, GE Global 3.0T Product Manager welcomed
the 140-plus Signa 3.0T users with an update on new
portfolio enhancements. He also unveiled plans for future
enhancements to Signa 3.0T MR Systems.
Lawrence Tanenbaum, M.D., FACR, Section Chief MRI, CT
and Neuroradiology, Edison Imaging and JFK Medical Center,
presented ultra high resolution imaging techniques using
the new Cube volumetric imaging sequence at 3.0T. He also
demonstrated robust water separation imaging techniques
in a variety of anatomies.
Attendees reported they were impressed with both the
Steve Williams, PhD, Professor of Imaging Sciences, Institute diversity and depth of the information shared. The event
of Psychiatry at Maudsley, London, UK, discussed advanced followed with a reception dinner where users further
neuro imaging techniques, specifically applications in fMRI discussed applications and challenges with the guest speakers,
and diffusion imaging. Graeme McKinnon, PhD, Applied GE Scientists and Advanced Clinical MR specialists.
Science Lab, GE Healthcare talked about the technical
performance of B1 Shimming & the Dielectric Effect.
Gearing up for Signa Koshien

GE Healthcare would like to thank
Signa Users in Japan have held nearly 60 users meetings Mitsuyuki Takahashi, RT, the leader
in the first three quarters of 2007. These meetings include of Kanagawa Signa Users meeting,
preliminary contests to nominate regional representatives the first group to hold a users
for Japans Signa Koshien championship meeting, scheduled meeting in Japan. Takahashi is
for December 8, 2007. Thirteen representatives from six the father of Signa Koshien and
regional areas will present topics in neurology, body, his continued leadership drives
vascular and MSK and tips on generating better image the success of this country-wide
quality and reducing artifacts and scan time. event. He maintains a web site on
The 2007 Signa Koshien event, open to all GE Healthcare MR imaging, including an introduction to the Kanagawa
Signa users from 0.2T to 3.0T, will be held at Tokyo Mid Signa Users meeting, that can be found by visiting
Town on December 8, 2007 from 15:00 to 19:00. Of great www.asahi-net.or.jp/~tv4m-tkhs/index.html.
interest to users are topics on non contrast enhanced
MR Angiography (MRA) and PROPELLER HD technology.
To further address these topics and more, GE launched
a new Signa Users meeting website that can be found
at http://gecommunity.on.arena.ne.jp/signa-l/.
Over 400 Signa Users in Japan registered within the
first six months, averaging 1,000 visits each month.
G E H E A LT H C A R E N E W S NEW PRODUCTS
New Volume Acquisition Helps Clinicians

Detect Small Lesions
GE Healthcare introduces Cube, a new volumetric fast spin
echo (FSE) imaging sequence available on the Signa HDxt
1.5T and 3T platforms. Optimized for T2, T2 FLAIR and Proton
Density imaging, Cube captures the entire volume with high
spatial, isotropic resolution. As a result, any view, plane or
slice can be later reconstructed from a single acquisition
with the same high resolution as the native plane.
This new ability for volumetric imaging of the anatomy
can result in fewer retakes that are often due to missing or
misaligned slices or planes. It may also help radiologists to
more consistently detect lesions as small as 2mm. The Cube
sequence is based on modulated flip angles, which make
very long echo train feasible. The typical image blurring
and SAR are reduced, while high tissue contrast leads
to conspicuous appearance of pathologies.
Isotropic volumetric imaging with Cube
Protocol settings are automatically optimized based on the
anatomical region of interest (ROI) and MR sequence. Cube capability to acquire large high definition 3D data sets
also provides excellent enhanced tissue contrast and specific in relatively short time for a more efficient workflow.
absorption rate (SAR) management by staggering the delivery
As part of the revolutionary HDxt platform, Cube completes
of energy to the patient/tissue.
GEs volume portfolio to allow clinicians to provide the
When used with GEs innovative auto-calibrating, data-driven benefits of volume imaging for every study.
parallel imaging technique, ARC, clinicians will have the
The IDEAL Solution for Fat and Water Separation

Representing a new paradigm in fat suppression, IDEAL is Developed in conjunction with Stanford Radiology and the
an innovative method for fat and water separation available University of Wisconsin-Madison Hospitals and Clinics, IDEAL
exclusively on GE Healthcares Signa HDxt 1.5T and 3.0T MR is enabled for 2D FSE with PD, T1 or T2 contrast and 3D
systems. IDEAL is a single acquisition technique that generates SPGR with T1 contrast. Unlike current methods, such as
four images water only, fat only, in phase and out of phase. spectrally selective fat saturation and STIR, IDEAL is compatible
This new sequence is particularly useful when imaging difficult with the new generation of phased array coils and parallel
areas of the anatomy, such as the orbits, brachial plexus, imaging techniques.
c-spine, extremities or areas of anatomy
with metal. IDEAL consistently separates
fat from water in challenging anatomical
areas, resulting in excellent image quality.
Also, because IDEAL is a single acquisition
technique, the in phase and out of phase
images are inherently registered, leading
to faster interpretation and higher
diagnostic confidence.

N E W P R O D U C T S G E H E A LT H C A R E N E W S
Introducing the Next Generation of HD MR

Just as high definition (HD) has transformed TV, HD MR New applications driving volume data acquisition include:
enables new clinical capabilities by capturing higher
Cube, which quickly acquires isotropic resolution volume
resolution and consistently clear images for increased
data that allows multi-plane reconstruction, while helping
diagnostic confidence. GE Healthcare introduces Signa
reduce the number of scans and total exam time
HDxt to extend the concept of isotropic, volumetric imaging.
ARC, a fast, robust, auto-calibrating data-driven parallel
HD Volumetric MR can help transform imaging by addressing
imaging method that minimizes artifacts and significantly
some of the toughest issues facing MR imaging today. With
decreases sensitivity to motion, ideal for smaller field of
advanced technology, new coils and applications, Signa HDxt
view imaging
provides high definition, complete data sets with enhanced
clear contrast for overall better image quality within a 3D Dual Echo, a volumetric, high signal-to-noise ratio
shortened exam time. imaging sequence that generates in-phase and out-of-phase
images in a single breath hold acquisition even at 3.0T
IDEAL, a revolutionary HD technique for true fat and water
separation provides uncompromising image clarity with
consistent and robust fat suppression, especially in
difficult areas of anatomy.

CLINICAL VALUE VOLUMETRIC IMAGING HDXT
Volumetric Imaging
Magnetizes Radiology
GE Healthcare presents a paradigm shift
by re-imagining volumetric MR
The History of Volume Imaging

GE Healthcare has long been a leader in bringing volumetric Since the turn of the decade, advancements in information
imaging to clinical practice. In fact, GE launched one of technology created an environment suitable for handling
the worlds first volumetric ultrasound systems in the late the large data sets generated by HD volumetric imaging.
1980s. Subsequent introductions of the LOGIQ 9, Voluson Specialized coils for certain anatomic areas and faster, more
E8 and Vivid 7 Dimension products have helped redefine powerful MR platforms enabled rapid acquisition of signal-rich
ultrasound with new volume acquisition capabilities. GEs data, which led to the first break-through, clinically-relevant
LightSpeed VCT brought volume imaging to the forefront of volumetric applications such as TRICKS, LAVA and VIBRANT.
CT with advanced applications that enabled clinicians to view However, until now these volumetric MR applications
the body as never seen before. Building upon this platform, were mostly applied for a specific use and considered
GE Healthcare brought together innovative, advanced complementary to standard 2D MR acquisitions.
cardiac and neurology applications with the introduction
of the LightSpeed VCT XT configuration, further extending
the clinical capability of volume imaging.
A New Dimension to MR
Today, with the Signa HDxt and several new 3D applications,
GE continues to exhibit leadership in volumetric imaging
GE builds on the promise of HD to add a new dimension to
with the introduction of a new dimension to MR.
MR imaging. Clinicians will now have access to a solution
High resolution, isotropic volume imaging changes the way that makes it possible to conduct the entire MR exam by
image data is acquired and reviewed, such as providing new exclusively applying volumetric MR techniques. HD volume MR
clinical benefits for visualizing small lesions and improving delivers sub-millimeter resolution with gapless data volume
workflow efficiency with the ability to reconstruct the 3D and point-and-shoot simplicity to improve diagnostic
volume data into any plane or slice at a later time while confidence and reduce exam time.
maintaining the same high image resolution as the native plane.
Just as high definition (HD) has transformed television (TV), The HD Volume Revolution
HD MR is enabling new clinical capabilities by capturing higher
resolution and consistently clear images for increased diagnostic The new volumetric HD MR sequence Cube provides
confidence. Today, GE Healthcare introduces the Signa HDxt sub-millimeter isotropic resolution and enhanced tissue
and the concept of HD isotropic, volumetric imaging. contrast for high definition detail to help clinicians detect
small lesions earlier. The complete volume of data can be
Volumetric imaging is not new to MR. GE introduced MR volume reconstructed in any view or plane without compromising
applications in the 1990s. While the concept was very attractive, spatial resolution. In comparison, conventional 2D image
MR platforms, gradient technology and computational acquisitions typically provide discrete slices with gaps in
processing power for acquiring and postprocessing these one plane only. Since 2D images are acquired in one sagittal,
images were not yet ready from a technical standpoint. At coronal, axial or oblique plane, critical data vertical to the
the time, 3D MR was hindered by low resolution, long scan acquired plane or contained within the gap between the
times and slow image reconstruction/post-processing. acquired slices could be missed.

VOLUME TRIC IMAGING HDX T CLINICAL VALUE
The new Volumetric HD MR sequence Cube provides

sub-millimeter isotropic resolution and enhanced tissue
contrast for high definition detail to help clinicians detect
small lesions earlier.
Flexible, clinical region-of-interest optimized sequence protocols

simplify and speed up acquisition while generating consistent,
high definition diagnostic quality images. This is accomplished
independent of the patient for reliable image acquisition
by the MR technologist.
With the addition of Cube, Signa HDxt boasts a complete
portfolio of dedicated volumetric MR applications for a
vast array of clinical areas, which is likely to change the
paradigm of MR imaging. GE is leading the charge with
new automated, optimized MR protocols such as Cube,
IDEAL and 3D Dual Echo. These join the ranks of GEs other
volumetric MR sequences, including: LAVA and VIBRANT-XV
for anatomy; TRICKS for flow; 3D PROBE/PROSE for MR
spectroscopy; and BRAVO and BrainWave Fusion for
fMRI/DTI brain mapping.
The advantages of the 3D HD

Volumetric MR include:
Helps detect small lesions
No missing planes, slices or gaps in data,
which can minimize retakes
High tissue contrast for conspicuous lesions
Consistent IQ through automated and
ROI-optimized protocols
Reduced exam time due to a single volume
acquisition replacing several discrete slice-
by-slice/plane-after-plane acquisitions

CLINICAL VALUE VOLUMETRIC IMAGING CUBE
The Clinical Proof

of 2D Versus 3D
During the 45th Annual Meeting of the American Society of Neuroradiology, held
in Chicago June 9 -12, 2007, Lawrence N. Tanenbaum, M.D., FACR, Section Chief
MRI, CT and Neuroradiology, New Jersey Neuroscience Institute, Edison Imaging,
discussed differences between 2D and 3D MR image acquisitions.
Dr. Tanenbaum and his associates use volume acquisitions every day in their practice,
such as imaging of multiple sclerosis (MS) and for imaging of
hippocampus in epilepsy. Regarding his recent experience with GEs new volumetric
imaging applications, he remarked, We are about to enter an era with more
exciting techniques. The most impactful, new volumetric technique is Cube.
Significant to this application are pulse sequence changes that require shorter RF
pulses and provide tighter echo spacing, leading to less blur and the ability to use
longer echo trains while maintaining signal-to-noise ratio (SNR), he explained.
Clever modulation of the flip angle during acquisition tends to actually eliminate
a lot of the blur you get with fast spin echo, and provides a driven equilibrium
effect that boosts SNR, he added. Cube leverages the resultant reshaped signal
decay state with very long echo trains boosting speed while maintaining SNR.
Historically, a potential pitfall for MR acquisitions has been long acquisition
times, which limit practical application in many clinical settings and
can also lead to an increase in motion artifacts.
However, this is circumvented with the
development of an advanced, data-driven
parallel imaging technique for use with Cube.
ARC* uses information available in each plane
or dimension to help improve reconstruction
accuracy, lessen motion artifacts and reduce
calibration lines.
Figure 1. Moderate grade glioma Cube 1.5T and fibertrak images of three-year-old male
*ARC: Autocalibrating Reconstruction for Cartesian imaging

VOLUME TRIC IMAGING CUBE CLINICAL VALUE
This application is changing the way we scan

at Edison Imaging and Cube has already replaced
other techniques in my practice.
Dr. Lawrence Tanenbaum
Combining ARC with Cube acquisitions, Dr. Tanenbaum achieved acceleration Lawrence N. Tanenbaum, M.D., FACR
factors of four to nine, providing isotropic whole brain acquisitions in approximately
three minutes. Weve experienced very impressive results. Lawrence N. Tanenbaum, M.D.,
FACR, is Chief of MR, CT and
Although Cube is a very sophisticated sequence, this application is easy-to-use, Neuroradiology at Edison Imaging
robust and very fast, Dr. Tanenbaum said. When used with ARC, he was able to Associates and Solaris Health
routinely acquire 1.2 mm to 0.6 mm isotropic voxels with T2 and FLAIR contrast. Systems. For over 30 years, the
radiologists of Edison Imaging
The reconstructed very thin, gap-free slices facilitate high resolution data have led the way in providing the
interrogation of complete volume data something we do not have with 2D. medical communities of central
He noted the clinical result is the ability to see MS lesions as small as 2 mm. New Jersey with a full range of
imaging services, utilizing the latest,
This application is changing the way we scan at Edison Imaging, Dr. Tanenbaum most advanced technologies,
said, and Cube has already replaced other techniques in my practice. including GEs Signa HDxt 3.0T
and 1.5T MR Scanners.
According to Dr. Tanenbaum, other potential uses of Cube are with fMRI and
Tractography, providing excellent fusion and automatic segmentation results with
3D rather than 2D. Volumetric techniques have the power to drive quantitative
assessments that are impractical and almost inappropriate to do with 2D because
of thick sections and intervening gaps innate to 2D imaging. With capabilities, it
can become a gold standard acquisition.
For Dr. Tanenbaum, the benefits of volumetric MR imaging go beyond speed and
the ability to reformat. The susceptibility artifact that propagates in plane does not
propagate through plane, so you get a pristine, orbital floor and skull base. He
further believes that volumetric multi-plane imaging can help minimize additional
scans, reducing total scan times in many cases. Yet, the true value lies in the ability
to arm clinicians with a better diagnostic tool. You cant argue against thin-slice,
gap-free studies for the detection of disease. This will change the way we scan.
Figure 2. Cube FLAIR and FiberTrak at 3.0T Glioma
Figure 3. Cube T2 3.0T Glioma
All clinical images courtesy of Lawrence N. Tanenbaum, M.D., FACR, Edison Imaging.

CLINICAL VALUE FAT S AT I D E A L
Consistent, Reliable, Fat-Suppressed

Imaging Even with Difficult Anatomy
In MR images, fat appears bright and can obscure or
mimic pathology, so most clinical protocols use methods Limitations of traditional
to suppress fat, improving the conspicuity of underlying
fat suppression techniques
abnormalities. There are many instances, however, where
it would be advantageous for clinicians to directly visualize Spectrally selective fat sat methods fail in challenging
fat. For example, when imaging a tumor containing fat, anatomical areas, such as the neck, extremities, off-
the typical protocol is to obtain images with and without isocenter imaging, and large field-of-view (FOV) imaging.
fat suppression. This is due to local magnetic field inhomogeneities
caused by susceptibility differences at air-tissue
To provide robust, water-only images that also retain important
interfaces and by the unfavorable geometry,
information from fat, it is critical to have methods for robust,
or inhomogeneities, induced by the presence of metallic
uniform separation of water and fat. Some limitations of
implants. Failed fat saturation can also cause inadvertent
traditional fat suppression techniques are outlined in the
saturation of the water signal (the signal of interest),
adjacent sidebar. Perhaps most important to note with these
obliterating important anatomy or pathology and
techniques, all fat signal is lost along with useful diagnostic
rendering images non-diagnostic. Spatial-spectral
information.
or water-excitation pulses suffer from the same
To address this need, GE Healthcare developed a new technique, drawbacks as fat-saturation methods.
IDEAL*, in collaboration with the University of Wisconsin and
Short TI recovery (STIR) imaging uses an inversion
Stanford University. It is available for use on the Signa HDx
pulse to null short T1 species such as fat, but in the
1.5T and 3.0T MR systems.
process alters contrast and reduces SNR. STIR images
Scott Reeder, M.D., PhD, Division Chief of MRI, University are inherently T1 weighted, and should not be used for
of Wisconsin-Madison Hospitals and Clinics, is one of the post-contrast imaging because the shortened T1 of
inventors and patent holders for IDEAL. IDEAL is robust in enhancing tissue may cause inadvertent suppression
challenging areas, Dr. Reeder said. We can achieve excellent of important pathology. STIR provides very uniform fat
fat suppression and also directly visualize the fat imaging. suppression and is commonly used with T2 weighted
imaging; however, the poor SNR performance and
The technique is related to traditional 3-point Dixon methods,
inability to perform post-contrast T1 weighted imaging
acquiring three images at slightly different echo times to
are highly limiting.
generate phase shifts between water and fat. Although three
echoes are necessary, the effective number of excitations
(NEX) for the water and fat images is three; therefore, IDEAL
coils and optimized for the best possible SNR. With IDEAL
has the maximum possible signal-to-noise (SNR) efficiency,
it is also possible to use arbitrary echo spacing and arbitrary
using all images efficiently in the separated water and
numbers of echoes (N>=3), while Dixon methods are limited
fat images.
to images acquired when water and fat signals are acquired
According to Dr. Reeder, the key advantage of IDEAL is the in and out of phase. As a result, the echo shifts are optimized
ability to use parallel imaging. We cant use parallel imaging for the highest possible SNR performance, which further
with traditional 3-point Dixon methods. Also, IDEAL is accelerates the acquisition. The SNR penalty with parallel
compatible with the newer generation of phased array imaging is offset by the increased SNR with IDEAL, he added.
*IDEAL: Iterative Decomposition of water/fat using Echo Asymmetry

and Least-squares estimation

FAT S AT I D E A L C L I N I C A L VA L U E
Fat Sat
failures
Scott Reeder, M.D., PhD
Scott Reeder, M.D., PhD, is

Division Chief of MRI, University
of WisconsinMadison Hospitals
Fat Sat IDEAL: water (uniform fat suppression) and Clinics.
About University
of Wisconsin-Madison
Another advantage of IDEAL is its ability to capture high quality images in a point-and-shoot UW Health, the academic health
system for the University of
way. Dr. Reeder said, Fat can be consistently and reliably separated from water. This can
Wisconsin, offers more than
lead to a decrease in the number of sequences within our protocols. He also noted the 60 locations throughout the state,
reliability of IDEAL reduces the need to repeat scans that previously resulted from failed including the renowned University
fat saturation with traditional methods or STIR. In addition, the separated water and fat of Wisconsin Hospitals and Clinics
and University of Wisconsin
images can be recombined into in-phase and out-of-phase images, which are commonly Childrens Hospital in Madison.
acquired as two separate acquisitions. This should further reduce overall protocol time and This comprehensive system of
provide additional information to the radiologist. healthcare providers serves
patients at more than 60 clinical
A third benefit of IDEAL is the elimination of artifacts, and chemical shift. In-phase, or non locations throughout the state.
University of Wisconsin Hospitals
fat-suppressed, images are corrected for chemical shift misregistration of fat, thereby allowing
and Clinics is a 471-bed facility that
low bandwidth acquisitions and reduced NEX. Dr. Reeder notes that the higher SNR with ranks among the finest academic
less artifact produces higher quality images that give the radiologist more confidence. medical centers in the United States.
The University of Wisconsin
IDEAL can unambiguously identify water and fat, he added. Water, fat, in-phase and Hospitals and Clinics offers more
out-of-phase images are inherently co-registered, which can lead to faster interpretation than 800 active medical staff and
and higher diagnostic confidence, particularly in difficult areas of anatomy such as: more than 80 outpatient clinics.
The hospital has six intensive care
Orbits units (trauma and life support,
pediatric, cardiac, cardiothoracic,
Brachial plexus burn, neurosurgery) with 74 total
C-spine beds, and is one of only two
organizations in Wisconsin with
Extremities (ankle/wrist/foot) designated Level One adult and
Off iso-center applications (shoulder/hip) pediatric trauma centers.
T2W Fat Sat FSE T2W IDEAL FSE T2W STIR
Brachial Plexus Imaging 1.5T, PD Weighted, 2D Fast Spin Echo

CLINICAL VALUE FAT S AT I D E A L
Clinical Applications
A common indication for MR imaging is
for the detection of masses. For example,
in the female pelvis, endometriomas are
often bright on T1 weighted imaging,
while an ovarian dermoid has fat,
which also appears bright on T1
weighted imaging. Most MR imaging
protocols include two T1 weighted
sequence scans one with and another
without fat supression. With IDEAL, it
requires only one acquisition to separate T1W Fat Sat FSE T1W IDEAL FSE
both water and fat signals, Dr. Reeder
said. We can help increase the level
of diagnostic confidence by directly
visualizing the fat. This is a unique
capability of IDEAL.
Another difficult imaging area is the
brachial plexus. This critical area of
the anatomy is prone to the invasion
of lung tumors (eg. Pancoast tumor).
Using traditional fat saturation methods,
MRI tends to fail in this area, Dr. Reeder
explained. We dont use STIR because T1W Fat Sat FSE T1W IDEAL FSE
it is incompatible with post-contrast T1 Post-surgical Cervical Spine: Neurofibromatosis
weighed imaging and its poor SNR
performance. IDEAL, he said, is T1W Fat Sat FSE T1W IDEAL FSE
an excellent solution for this
clinical study.
Benefits of IDEAL
Patient potentially reduce
on the table scan time,
Technologists reduce number
of repeat scans
Radiologists higher diagnostic
image quality for increased
confidence
Administration potential
for increased throughput
Referring physician
better image quality
Coronal Fse-xl T2 fat suppressed images (fov 30cm) demonstrates inhomogeneous fat suppression
in the slice anteriorposterior direction

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Focusing on Early Health, not late disease
Turning information into insight
Measuring healthspan, not lifespan
Increasing the transparency of quality and cost
Committing to equity in healthcare access
To download a copy of The Tipping Point in Healthcare
visit www.gehealthcare.com/tippingpoint.
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President and CEO, GE Healthcare
imagination at work
CLINICAL VALUE VOLUMETRIC IMAGING DWI & DTI
High-Resolution, Isotropic-Voxel Acquisition Technique

Improves Quality and Utility of Diffusion-Weighted and
Diffusion Tensor Imaging
By Makoto Sasaki, M.D., Associate Professor, Advanced Medical
Research Center, Iwate Medical University
Introduction Volume Diffusion Imaging Technique

Image quality in diffusion-weighted imaging (DWI) and To obtain high-resolution isotropic-voxel DWI/DTI data, we
diffusion tensor imaging (DTI) tends to be deteriorated by utilized a simple two-dimensional (2D) acquisition approach,
echo planar imaging (EPI)-related image distortions and instead of a three-dimensional (3D) approach, with ultra thin
artifacts, particularly in the case of coronal images and at sections as in the case of multidetector-row computed
high fields of 3.0T, even when a parallel imaging technique tomography (MDCT). Images were obtained on a Signa HD
is applied. This disadvantage prevents clinicians from assessing 3.0T with an eight-channel head coil using the following
changes in structures adjacent to the skull base, such as the pulse sequences: axial single-shot spin-echo EPI; repetition
medial temporal lobe and frontal base. Partial volume effects time/echo time, 1200017000/62.5; 3 or 6 motion-probing
in DWI/DTI also affect the accuracy in the calculation of gradient (MPG) directions with a b value of 1000 s/mm2;
diffusion parameters and in the generation of tractographs. a matrix size of 128 x 128, a field of view of 20 cm, a slice
A new DWI/DTI technique enables the generation of high- thickness of 1.6 mm with no interslice gaps, resulting
resolution isotropic-voxel volume datasets that can reduce isotropic voxels of 1.6 x 1.6 x 1.6 mm; 4 averaged; an array
partial volume effects and susceptibility-related distortions/ spatial sensitivity encoding technique (ASSET), reduction
artifacts near the skull base. Further, we demonstrate the factor of 2; and 80 to 90 slices for the coverage of the entire
clinical efficacies of images generated from these volume brain with an acquisition time ranging from 6 min, 24 sec
datasets using multiplanar reconstruction, volume rendering, to 8 min, 30 sec.1,2
color-coded axonography and DTI tractography.
Coronal DWI Asset (-) Coronal DWI Asset (+) Volume DWI (MPR)
Figure 1. Volume DWI can decrease geometric distortion and susceptibility artifacts in coronal images.

VOLUME TRIC IMAGING DWI & DTI CLINICAL VALUE
Advantages of Volume Diffusion Imaging

The whole-brain high-resolution isotropic-voxel DWI/DTI acquisition technique using
ultra thin axial sections has several advantages over conventional DWI/DTI. These include:
reduction of geometric distortions and susceptibility artifacts near the skull base; decrease
in partial volume effects that can affect the accuracy in the calculation of quantitative
diffusion parameters and in the delineation of tractographs; and capability of multiplanar
reconstruction and further image processing. Among them, geometric distortions in the
Makoto Sasaki, M.D.
craniocaudal direction and susceptibility artifacts near the skull base on coronal images
are dramatically decreased owing to the thin-slice axial images obtained with this Makoto Sasaki, M.D., is Associate
technique.1 On the coronal images generated from the volume DWI data, as compared Professor, Advanced Medical
with conventional coronal DWI, the structures of the medial temporal lobe and frontal Research Center, Iwate Medical
University, School of Medicine. He
base showed minimal deformities and tolerable susceptibility artifacts with preservation received his medical degree and
of the in-plane spatial resolution (Figure 1). doctorate of medical sciences from
Iwate Medical University. Dr. Sasaki
currently serves as trustee of the
Clinical Applications of Volume Diffusion Imaging Japanese Society of Magnetic
Resonance in Medicine and the
The volume diffusion imaging technique enables sophisticated multimodal interactive Japanese Society of Neuroradiology.
visualization and interpretation, which has been nearly impossible to achieve using He is an active member of the
Japan Radiological Society, ISMRM,
conventional DWI/DTI. Once the volume dataset is obtained, we can observe trace maps, RSNA, Japan Stroke Society,
apparent diffusion coefficient (ADC) maps, fractional anisotropy (FA) maps and color-coded Japanese Society of Neurology
axonography images of patients with neurological conditions such as stroke, brain tumors and Japanese Society for
Detection of Asymptomatic
or degenerative disorders by using paging, multiplanar reconstruction or volume-rendering Brain Diseases.
techniques (Figures 2 and 3). Dr. Sasaki plays an important role
in the standardization of the stroke
imaging through ASIST-Japan (Acute
Stroke Imaging STandardization
group Japan) activities
(http://asist.umin.jp/index-e.htm).
He is also leading to develop
a neuromelanin-sensitive MRI
technique that can visualize
alteration of catecholamine nuclei
in mental disorders. A Certificate of
Merit was awarded to him and his
colleagues for volume diffusion
imaging (NR4667) and neuromelanin
imaging (NR4704) at RSNA2006.
About Iwate Medical University,

Morioka, Iwate Pref
Iwate Medical University, founded
in 1928, and its affiliate hospital
(1051 beds) has been the core
healthcare and research center
in northern Japan through the
establishment of several key
facilities, including Memorial
Heart Center (1997) and Advanced
Medical Research Center (1999).
Figure 2. Volume DWI enables multiplanar reconstruction and further postprocessing, The Advanced Medical Research
such as volume rendering (Provided by Okayama Kyokuto Hospital). Center, headed by Dean and
Chairman Prof. Akira Ogawa,
was established primarily for
the investigation of neuroscience
and neuroimaging, and has
made significant contributions
to research of the brain with
High Field 3.0T MRI and PET.

CLINICAL VALUE VOLUMETRIC IMAGING DWI & DTI
Figure 3. Volume DWI/DTI can visualize minute structures that belong to the limbic system.
trace FA trace FA
c c c c
i i
a a
h h
e e
e * e *
a: amygdala, c: cingulum, e: entorhinal cortex, h: hippocampus, i: substantia innominata,

*parahippocampal white matter containing the perforant path, arrows: anterior commissure.
precommissural
fornix
amygdalofugal
fibers anterior body of fornix
commissure crus of
fornix
precommissural
fornix
column of
fornix body of fornix
column of
fornix
anterior
fimbria commissure
crus of
fornix
amygdalofugal fimbria
fibers
Figure 4. Multimodal volume neuroimaging combining 3D-FSPGR, Cube (T2WI and FLAIR), and volume DTI can bring about a paradigm
shift from a 2D to a 3D approach in clinical neuro-magnetic resonance imaging.
The precise quantitative evaluation of minute structures of fibers, such as the fornix, using DTI tractography can be
the limbic system is a promising application of the volume improved; this can influence the accuracy of the estimation
diffusion technique. The ADC or FA in small limbic structures, of the ADC and FA in these fibers.2 The volume diffusion
such as the hippocampus, entorhinal cortex and substantia technique can be useful for detecting subtle changes in the
innominata, can be measured because the increase in spatial small limbic structures in patients with early Alzheimers
resolution and the decrease in susceptibility distortions/ disease, temporal lobe epilepsy or other disorders that have
artifacts synergistically improve image quality (Figure 3). barely been assessed by conventional DWI/DTI techniques.
In addition, the precision of the segmentation of small limbic

VOLUME TRIC IMAGING DWI & DTI CLINICAL VALUE
3D-FSPGR Cube T2WI Cube FLAIR
Gd 3D-FSPGR Volume DTI Volume DTI

(FA color map) (tractography)
cingulum
Figure 5.
Conclusion
Further, we believe that even in routine clinical practice, Volume diffusion imaging with high-resolution, isotropic voxels
conventional neuroimaging protocols that primarily utilize is effective in avoiding partial volume effects and EPI-related
2D imaging at 3.0T can be replaced by an advanced protocol distortions and artifacts that are particularly prominent in
involving the acquisition of multimodal volume data sets, the coronal directions and at high fields. It also enables the
including 3D fast spoiled gradient-recalled acquisition in elucidation of subtle abnormalities in minute brain structures
the steady state (3D-FSPGR), fast spin-echo with extended in central nervous system disorders using multiple diffusion
echo-train acquisition (Cube) and volume DWI/DTI (Figure 4). parameter maps visualized by multiplanar reconstruction,
tractography and further image processing.
Acknowledgement
The author thanks Mr. Wataru Takao, Okayama Kyokuto Hospital, Dr. Shunrou Fujiwara, Advanced Medical Research Center, Iwate Medical University,
and Dr. Ryonoshin Hirooka, Department of Neurosurgery, Iwate Medical University, for their generous help in MR imaging and postprocessing. DTI color
maps and tractographs were generated by VOLUME-ONE/dTV2 provided by the Department of Radiology, University of Tokyo (http://www.volume-one.org).
References
1. Fujiwara S, Sasaki M, Kanbara Y, et al. Improvement of geometric distortion in coronal diffusion-weighted and diffusion tensor imaging by using
a whole-brain isotropic-voxel acquisition technique at 3 Tesla. Magn Reson Med Sci 2007 (in press)
2. Fujiwara S, Sasaki M, Kanbara, Y, et al. Feasibility of 1.6-mm isotropic voxel diffusion tensor tractography in depicting limbic fibers. Neuroradiology
2007 (in press)

CLINICAL VALUE ABDOMINAL IMAGING 3D DUAL ECHO
One Breath Away from

Volumetric In-Phase,
Opposed-Phase
Fat/Water Imaging
By Elmar M. Merkle, M.D., Professor of Radiology, Director of Body MR Imaging,
Medical Director, Center for Advanced MR Development, Duke University Medical Center,
Department of Radiology
T1-weighted gradient-echo in-phase and opposed-phase imaging is

routinely used in abdominal MRI to identify regions of diffuse or geographic
fatty infiltration, as well as areas of focal fatty sparing in the liver. In addition,
this sequence can be valuable in the characterization of fat containing
liver lesions such as hepatic adenomas or hepatocellular carcinomas.
In- and opposed-phase imaging can also be helpful for detecting
pathologic entities such as hemosiderosis and hemochromatosis. Here,
a substantial loss in hepatic signal intensity can be detected on the
image with the longer echo time due to associated T2* effects. Finally,
susceptibility artifacts from surgical clips, metallic debris or gas may be
easily identified on this dual echo sequence.

ABDOMINAL IMAGING 3D DUAL ECHO CLINICAL VALUE
Historically, the in-phase and opposed-phase images were acquired within separate breath
holds, which caused suboptimal registration between the corresponding images. While
current 2D dual echo techniques are now being acquired within a single breath hold, these
2D techniques rely on a relatively large flip angle to achieve adequate T1 weighting and
desired hepatosplenic image contrast. In addition, slice thickness is usually in the range of
6 to 8 mm with an interslice gap of 1 to 2 mm, to allow for adequate coverage of the entire
liver within a single breath hold. This through-plane spatial resolution allows for suboptimal Dr. Elmar Merkle
image quality of multiplanar reconstructions only.

Elmar Merkle is Professor of
At 3.0T, the 2D approach oftentimes exceeds limits in the specific absorption rate requiring Radiology and Head of Body
Magnetic Resonance Imaging and
either a decrease of the flip angle, decrease of the number of images, or an increase of
heads the Center for Advanced
the repetition time. None of these requirements is desirable as either the coverage is Magnetic Resonance Development
decreased, the image contrast is altered, or the data acquisition time is prolonged. Even at Duke University. In the mid
worse is the fact that the data acquisition of the first opposed-phase echo at 1.2 msec 1990s, he conducted his MR
research fellowship in the laboratory
and the first in-phase echo at 2.4 msec usually requires a substantially higher receiver of Professor Jonathan Lewin in
bandwidth. Therefore, in addition to the first opposed-phase echo, the second in-phase Cleveland, where he made significant
echo at 4.8 msec is usually acquired which leads to accentuated T2* effects. contributions to the field of inter-
ventional MR imaging. Dr. Merkle
3D Dual Echo is a new 3D FSPGR sequence from GE Healthcare that produces fat/water is a fellow of the Society of Computed
Body Tomography and Magnetic
in-phase and opposed-phase images in a single breath hold. This sequence allows the
Resonance (SCBT), and a member
acquisition of the first opposed-phase and the first in-phase image. This allows perfect of the Radiologic Society of North
registration between corresponding images and is also helpful in the visualization of T2* America (RSNA), the International
effects and susceptibility artifacts. Using the 3D Dual Echo sequence for abdominal imaging Society for Magnetic Resonance in
Medicine (ISMRM), the American
can be particularly important for the characterization of hepatic and adrenal lesions, and Roentgen Ray Society (ARRS)
represents a significant step forward in the clinical utilization of 3.0T MR. With improved and the European Congress of
through-plane resolution of about 4 mm without an interslice gap, this new pulse sequence Radiology (ECR) among others.
Dr. Merkle is on the editorial board
also allows for excellent multiplanar reconstructions. of European Radiology and the
Journal of Endovascular Therapy.
Dr. Merkle has been invited for
Clinical Cases numerous lectures, is a visiting
professor to universities worldwide,
The following case studies demonstrate the value of the 3D Dual Echo sequence. and has published more than
100 peer-reviewed manuscripts
and 15 book chapters.
Case 1
About Duke University
The Duke University School
of Medicine is a community of
scholars devoted to understanding
the causes, prevention and treat-
ment of human disease. Ranked
in the top ten with schools twice its
age, Duke is committed to socially
relevant education, translational
research, compassionate patient
care and global healthcare solutions.
1a 1b
Patient is a 77-year-old woman with diffuse fatty infiltration of the liver. 3D Dual Echo was used to
acquire the transverse T1-weighted opposed-phase (TR/TE 4.3/1.3) (1a) and in-phase (TR/TE 4.3/2.6) (1b)
MR images at 3.0T. The image pair shows a marked decrease in the signal intensity of the liver on the
opposed-phase image, compared with that on the in-phase image.

CLINICAL VALUE ABDOMINAL IMAGING 3D DUAL ECHO
Case 2 Case 3
3a
2a
3b
Patient is a 49-year-old woman with transfusional hemosiderosis.

(3a) Transverse T1-weighted 3D opposed-phase (TR/TE 4.3/1.3)
with 3D Dual Echo and (3b) in-phase (TR/TE 4.3/2.6) MR images
2b
acquired at 3.0T demonstrate decreased signal intensity in the
liver and spleen on the image with the longer echo-time. Note the
Patient is a 36-year-old woman with diffuse fatty infiltration reversed contrast between the hepatic veins and surrounding
of the liver, focal nodular hyperplasia in the right hepatic lobe liver parenchyma on the image with the longer echo time. This
and left-sided adrenal adenoma. (2a) Transverse T1-weighted finding can be attributed to substantial iron storage in the liver
3D opposed-phase (TR/TE 4.3/1.3) with 3D Dual Echo and (2b) and spleen causing an accentuated free induction decay due
in-phase ((TR/TE 4.3/2.6) MR images acquired at 3.0T demonstrate to pronounced T2* effects.
a well defined focal liver lesion in the right lobe, which appears
hyperintense in comparison to the surrounding hepatic
parenchyma on the opposed-phase image and stealth on
the in-phase image due to substantial diffuse fatty infiltration. Conclusion
Gadolinium-enhanced series (not shown) demonstrated early
arterial enhancement, suggestive of a focal nodular hyperplasia. The 3D Dual Echo sequence marks a significant advancement
Note the signal drop in the left adrenal gland on opposed-phase in body MR imaging at both 1.5T and 3.0T.
imaging indicative of an adrenal adenoma.
The benefits include higher SNR with one breath-hold for
consistently clear images, a reduction in T2* effects by
acquiring first opposed-phase and first in-phase images
and an ability to do 3D multiplanar reformatting.
As shown by the clinical examples, 3D Dual Echo generates
high resolution, volume images that can lead to greater
diagnostic confidence.

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CLINICAL VALUE NEURO PROPELLER HD
Efficient Image Quality Enhancements in

Temporal Bone Imaging Using PROPELLER HD
By Mathieu H. Rodallec, M.D., Senior Radiologist in MRI, Saint-Joseph Hospital
Cholesteatoma and Diffusion-weighted Imaging

Cholesteatoma is a cystic lesion lined with keratin-producing squamous epithelium filled with desquamation
debris in the middle ear. Patients with the disease are treated surgically, but the procedure carries the
risk of residual cholesteatoma and tumor recurrence in a relatively high number of patients. CT has a
high negative predictive value if no soft-tissue mass is detected. However, if a patient treated surgically
has a soft-tissue mass, additional diagnosis with a CT study is not possible because cholesteatoma,
granulation tissue and cholesterol granuloma cannot be differentiated from one another on CT.
MR imaging of the temporal bone can help in characterizing potential soft-tissue abnormalities shown
on CT. Diffusion-weighted MR imaging (DWI) generates valuable information regarding diffusion
motion of water protons in biologic tissue. DWI can also help confirm residual or recurrent
cholesteatoma in patients who undergo middle ear surgery by showing a high-signal-
intensity lesion. Other tissues found in the middle ear after surgery demonstrate
a low signal intensity on diffusion-weighted MR images.
The PROPELLER HD sequence from GE Healthcare can be useful to detect
recurrent cholesteatoma in patients post middle ear surgery and helps to
minimize the numerous susceptibility artifacts that create high signal
intensity in the air-bone interfaces or in the posterior fossa.
CT examination
Figure 1.

NEUR O PR OPELLER HD CLINICAL VALUE
Clinical Case
An 80-year-old female underwent right middle ear surgery for cholesteatoma. A CT image
shows a soft-tissue mass in the right middle ear. T1-weighted MR image post-contrast
media injection depicts two lesions in the middle ear surgical cavity with peripheral
granulation tissue. The DWI sequence demonstrates numerous susceptibility artifacts
in the temporal bone. Mathieu H. Rodallec, M.D.
Mathieu H. Rodallec, M.D., is a

Findings Senior Radiologist in MRI at Saint-
Joseph Hospital in Paris, France,
Image obtained on the same patient using the PROPELLER HD DWI sequence clearly and board certified in Diagnostic
demonstrates the high-signal intensity cholesteatoma (red arrow) and a cholesterol Radiology. He received his medical
granuloma (green arrow). degree from the School of Medicine
of Paris, and fellowship training at
Beaujon Hospital of the University
of Paris VII. His interests include
Conclusion neuroradiology, head and neck
radiology and musculoskeletal
The PROPELLER HD sequence improves image quality in the vicinity of bone/tissue and imaging. He has published training
air/tissue interfaces that are prone to creating susceptibility artifacts. PROPELLER HD material, authored publications
DWI can suppress susceptibility artifacts, particularly helpful in temporal bone imaging and abstracts and has given
numerous presentations at
to detect residual or recurrent cholesteatoma. educational meetings. He is a
PROPELLER diffusion member of the French Society
of Radiology (SFR), French Society
B : 600 s /mm2 of Neuroradiology (SFNR) and
Sl. thickness 3.0mm Radiological Society of North
12 slices America (RSNA).
Matrix 128X128 Saint-Joseph Hospital is a 746-bed,
private, non-profit public service
Acq. Time 03 :18
hospital. In January 2006, Saint
8 NVHEAD-A Michel Hospital and Notre Dame
de Bon Secours Hospital joined
MR examination Saint-Joseph to form the Paris
Saint-Joseph Hospital Group.
Today, the three hospitals provide
a full range of heath services for
patients south of Paris.
Acknowledgements: Case written

in collaboration with Souleiman
Amoussa, Advanced MR Applications,
GE Healthcare, Vlizy, France.
Figure 2. T1-weighted post-contrast

MR image
Figure 3. DWI-EPI Figure 4. PROPELLER HD DWI

CLINICAL VALUE CARDIOLOGY REPORTCARD
Validation of an Automated
Left Ventricular Segmentation
Technique for Quantifying
Stroke Volume
By Cindy R. Comeau, BS, RT(N)(MR), Parikshit Prasad,
Balaji Raman, Kavitha Subramanian and Steven D. Wolff, M.D., PhD
This work was presented at the 16th Annual Meeting for the Section for Magnetic Resonance
Technologists (SMRT) in Berlin, Germany on May 19-20, 2007, held in conjunction with The
International Society for Magnetic Resonance in Medicine (ISMRM) and the European Society
for Magnetic Resonance in Medicine and Biology (ESMRMB) Joint Annual Meeting.
Purpose
Many clinicians consider MRI the imaging test of choice for
quantifying left ventricular (LV) end-diastolic volume, end-
systolic volume, stroke volume (SV) and ejection fraction (EF).
Typically, volumes are derived by segmenting the LV endocardial
border on serial short axis images.
However, this method presents several clinical challenges.
First, as the endocardial contours are of low spatial frequency,
papillary muscles and trabeculations are often included in
the ventricular cavity. Second, it is difficult to determine

CARDIOLOGY REP ORTCARD CLINICAL VALUE
About the Authors:

the precise position of the LV base due to poor spatial resolution in this dimension Cindy R. Comeau, BS, RT (N)(MR) is
the Chief Technologist at Advanced
(spatial resolution is equal to slice thickness, which is typically around 8 mm).
Cardiovascular Imaging (New York,
Third, if segmentation is performed manually, the number and location of the NY), a private practice in Manhattan.
endocardial borders is subjective. Steven D. Wolff, M.D., PhD, is the
Director of Cardiovascular MRI and
The purpose of this study was to assess whether commercially available software
CT at Advanced Cardiovascular
could provide more accurate and more reproducible quantification of LV volumes Imaging.
and ejection fraction. Kavitha Subramanian is the
Engineering Director, Balaji Raman,
Lead System Designer, and
Methods Parikshit Prasad, Image Processing
Engineer, at NeoSoft, a software
We retrospectively analyzed 20 cardiac MRI studies in patients without valvular provider that works in close collab-
disease, performed on a GE Healthcare Signa1.5T HDx scanner. All MRI studies oration with GE Healthcare. The
companys principle product is
included a series of contiguous, prospectively ECG gated short-axis cines through
ReportCARD, used to view, analyze
the left ventricle and a 2-chamber long-axis cine (FIESTA pulse sequence: and report cardiac MRI studies.
TR/TE,3.1/1.4, BW=125, matrix=192x160 FOV=35-38, views-per-segment=24,
20 reconstructed phases per cardiac cycle). Prospectively ECG gated phase
contrast images of the aorta were acquired at the aortic root 1-2 cm distal 50.0
to the aortic valve (TR/TE, 7.2/2.9, BW=31, matrix= 256x128, field-of-view=35-40,
LV Stroke Volume Aortic Flow (ml)

views per segment=8, 30 reconstructed phases per cardiac cycle). 40.0
LV volumes and ejection fraction were derived using two distinct methodologies.
30.0
Method 1 (Manual): The subendocardial contours were drawn manually at end-
diastole and at end-systole. The cardiac base was determined subjectively, as
20.0
the most basal slice where myocardial tissue comprised more than 50 percent
of the circumference of the blood pool. Method 2 (Semi-automated): LV volumes
10.0
were determined using the semi-automated analysis in ReportCARD 3.0 from
GE Healthcare. The ReportCARD software produces endocardial borders with high
0.0
spatial frequency, thereby excluding papillary muscles and trabeculations from
the LV cavity. It also determines the basal and apical extent of the LV on short axis
-10.0
images, based on user input of these locations on a 2-chamber long-axis cine.
Stroke volumes were calculated using these two methodologies and compared -20.0
to the aortic flow as assessed from the phase-contrast images. In patients Manual Semi-Auto
without valvular disease, the LV SV should equal the aortic flow. -30.0
Figure 1
Results 100%
The difference between LV SV and aortic flow was 10 + 15 ml using manual traces 90%
and 0 + 10 ml using the semi-automated method of ReportCARD (mean + standard
80%
deviation; p<0.02). The difference between LV SV and aortic flow for each method
was determined (Figure 1). The average EF was 56 + 11 percent using the manual 70%
Ejection Fraction (EF)
method and 66 + 12 percent using the semi-automated method of ReportCard 60%

(P <0.01) (Figure 2).
50%
40%
Conclusion
30%
The semi-automated method of ReportCARD gives a more accurate measurement
of SV, based on better concordance of SV with aortic flow. This is most likely because 20%
of more accurate endocardial segmentation and better assessment of the precise 10%
location of the LV base. The semi-automated method also yields higher EFs, Manual Semi-Auto
indicating that manual tracing underestimates the true EF. 0%
Figure 2

T E C H N I C A L I N N O VAT I O N HIGH DEFINITION MR SIGNA HDXT
Re-Defining the Next Generation

of High Definition
Current challenges in MR imaging include obscured pathologies, New High-density Clinical Applications and Ease
inconsistent imaging and variable exam times. The introduction of Use Enhancements
of Signa HDxt culminates years of GE Healthcare research
and development on High Definition (HD) MR imaging. With Signa HDxt MR, clinicians have the tools for reliable,
Today, the need for imaging technology for reproducible detection of very small lesions with
specific exams is paramount to assist sub-millimeter spatial resolution, consistent
with imaging pathologies that were HD image quality providing excellent tissue
once thought to be too complex, contrast with automated and intelligent
produced inconsistent image out- protocols and a single 3D volume
comes and extended the exam acquisition that replaces todays
time. Grounded in the development plane-after-plane or slice-by-slice
of HD MR is technology specifically acquisitions, reducing the number
designed for each anatomical of scans and total exam time.
exam that will help maximize The new applications that are
imaging accuracy, consistency changing the paradigm of MR
and efficiency. This integrated imaging include:
technology for anatomically
Cube, a volumetric fast spin
specific coils, pulse sequence
echo (FSE) imaging sequence
applications and patient table
complete the GE HD MR 3D Dual Echo, a 3D FSPGR
imaging chain. sequence that produces fat/water
in-phase and opposed-phase images
Signa HDxt extends the concept of HD
in a single breath hold
to gapless 3D imaging for early lesion
detection and high-resolution imaging IDEAL, an innovative method for fat and
techniques for minimizing image variation for water suppression
consistent high quality outcomes. Signa HDxt
ARC, a data-driven parallel imaging method
delivers MR imaging essentials for a more
confident diagnosis. Clinicians want high quality Host enhancements further simplify the exam,
imaging with increased signal-to-noise ratio (SNR), high saving time. A selectable auto-transfer capability
resolution and no artifacts. To compare images, they require allows flexibility of image series data transfer. Auto-contrast
the same anatomy in the exact same position in each slice, copies contrast designation to the appropriate series in the
with specific and known parameter differences between prescription. GRx enhancements include reverse order slice
the images so that unexpected changes can be easily seen. numbering for visual preference, which saves the localizer
Multiple image contrast is crucial for clinicians to differentiate image for easy prescription reference, and Copy Shim
between tissues. Volume that streamlines time in managing the prescription.
An auto-voice enhancement adjusts voice speed for clear
Along with Signa HDxt, GE introduces the next generation
patient comprehension.
in high definition imaging with a series of HD pulse sequence
applications, reporting tools, surface coils and host
software improvements.

HIGH DEFINITION MR SIGNA HDXT T E C H N I C A L I N N O VAT I O N
Knee Array Cardiac Array Neurovascular Array
New Intelligent Reporting Tools

Signa HDxt addresses the need for greater efficiency while advancing SNR penetration over previous designs. This
in radiology reporting with the release of new tools proprietary coil technology enables the use of parallel imaging
on Advantage Workstation: in any plane. Designed to help minimize patient motion during
an exam, the flexible coil housing accommodates both large
BrainSTAT with diffusion imaging for an effective way
and small patients.
to assess and quantify blood circulation dynamics
in brain tissue For high-resolution foot and ankle imaging, the new 8-channel
foot/ankle coil incorporates a novel ski boot design for simple
ReportCARD 4.0, a structured reporting tool with macros
and reliable patient setup. This design permits imaging of
and a research database added to the functionality of
the foot in either a vertical or 15 degree or less plantar
post processing for cardiac imaging, to further reduce
flexed orientation with 5-degree increments. The element
the amount of time a clinician spends reporting a cardiac
layout supports a 20 cm FOV and is optimized for parallel
MRI case
imaging in any plane. The SNR of this design supports the
Flow Analysis Tool extends functionality to include multiple high-resolution clinical requirements for visualizing small
regions of interest (ROI) and ease-of-use enhancements, structures and abnormalities common in MSK imaging.
reducing the amount of time a clinician spends reporting
At 3.0T, a new 8-channel wrist coil provides easy patient
a cardiac MRI case
set up and allows positioning by the patients side or directly
Vascular Reporting Tool, a research database that allows above them. The coil locks firmly into a stabilized base-plate
searching for cases with specific pathology for faster to reduce motion artifact. With a 12 cm FOV optimized for
report generation than with standard voice dictation parallel imaging, the 8 channel wrist coil produces exquisite
Multi-Echo Signal Analysis & Reporting Tool produces images of structures.
grayscale and color maps depicting the iron concentration
estimation based on user provided input scaling A ContinuumPak for HDx Users
Signa HDx users will realize the benefits of the GE Continuum
New High-density Coils Complete the Image with the HDxt ContinuumPak, which upon release will be
An integral piece of the HDxt release is the introduction of installed via the users local GE applications field engineer.
new high-density surface coils for orthopedic imaging with The HDxt ContinuumPak includes new HD applications such
1.5T and 3.0T systems. These surface coils provide improved as 3D Dual Echo, Advantage Workstation reporting tools
SNR, coverage and parallel imaging support for shoulder, BrainSTAT, Flow Analysis and Vascular Reporting and host
wrist and foot and ankle exams. software enhancements. The HDxt ContinuumPak further
enhances GE Healthcares commitment to users by delivering
GEs new 8-channel shoulder coil utilizes a concentric coil the next generation of HD MR images.
design that provides 30 percent improvement in coverage
Breast Array Torso Array Head-Neck-

Spine Array

T E C H N I C A L I N N O VAT I O N N E U R O A N D M U S C U LO S K E L E TA L C U B E
3D FSE Reduces Scan Time,

Generates Thinner Slices
Clinicians can view smaller lesions with greater confidence
By Reed Busse, PhD, Senior Scientist, GE Healthcare
In fast spin echo sequences, scan time can be reduced by These advantages are compounded by advances in parallel
increasing the Echo Train Length (ETL). If the ETL is too long, imaging simultaneous acceleration in two directions with
however, signal decay results in a disappointing blurring of the GEs innovative auto-calibrating data-driven parallel imaging
images. Today, this challenge is resolved with a new, unique method, ARC*. Very large 3D data matrices may now be
method developed by GE Healthcare to modulate the refocusing acquired in relatively few echo trains, revolutionizing
flip angles, called Cube, which extends and reshapes the signal T2-weighted imaging.
decay curve. Cube is a single-slab 3D FSE imaging sequence
The large increase in efficiency allows additional and thinner
only available on GEs Signa HDxt 1.5T and 3.0T platforms.
slices to be acquired, producing voxels that are no larger in
When refocusing flip angles that are less than 180 are used, the slice direction than in-plane. With this isotropic resolution,
natural equilibrium exists between encoded longitudinal and the plane of acquisition becomes immaterial as the volume
transverse magnetization, which is a function of the refocusing is prescribed in a manner that yields the high image quality
flip angle. Cube utilizes this powerful phenomenon, modulating and efficiency. Images are reconstructed in axial, sagittal
the refocusing flip angle to drive this equilibrium. At the and coronal planes, or any oblique orientation, from a single
beginning of the echo train, flip angles are rapidly reduced to short acquisition. Cube removes prior limitations that result
store excess magnetization in an encoded longitudinal state. in a small number of relatively thick sections, giving clinicians
By increasing the flip angle, this sequence converts the slowly new capabilities to acquire wide anatomic coverage in a
decaying longitudinal magnetization back to transverse high-resolution 3D dataset.
magnetization to provide signal over a much longer train.
Figure 1A Figure 1B
Percent proton density signal
Flip (degrees)
RF pulse Echo
Figure 1A: A modulated flip angle refocusing train of RF pulses establishes a low-angle pseudo-steady
state, and then increasing throughout the remainder of the train. Figure 1B: This serves to decouple much
of the signal modulation from the development of contrast. Signals from tissues with different T2 values
diverge, producing contrast, while remaining relatively constant, producing sharp images with the highly
efficient Cube acquisition.
*ARC: Autocalibrating Reconstruction for Cartesian imaging

N E U R O A N D M U S C U LO S K E L E TA L C U B E T E C H N I C A L I N N O VAT I O N
This highly efficient technique enables Cube to join the ranks of GEs other rapid
3D volumetric sequences, and complement them by providing important contrast
options, such as T2, T2-FLAIR and PD. While it has the potential of being applied
to a wide range of anatomic areas, Cube is initially intended for Neuro and MSK
applications. When used in conjunction with GEs other 3D applications, Cube may
allow technologists to perform a complete MR study in a 3D acquisition mode.
Reed Busse, PhD

Benefits of Cube
Reed Busse, PhD is a Senior
With a single acquisition, the radiologist can visualize the entire data set in axial, Scientist at the GE Healthcare
sagittal, coronal and any oblique orientation. The need for image retakes due to Applied Science Lab at the
University of Wisconsin, Madison.
missing slices or planes is minimized and submillimeter voxels may help clinicians
As a lead innovator at GE,
detect small 2-3 mm lesions. Automated protocols optimize sequences for clinical Dr. Busse holds five patents
use, facilitating ease-of-use and consistency across imaging studies. and five patents pending for his
developments in MR imaging. He
Cube is convenient for patients with less SAR than conventional FSE. received his doctorate degree in
Biomedical Sciences from Mayo
Figure 2 Graduate School and a B.A. in
Physics, with magna cum laude
distinction, from Carleton College.
Dr. Busse is a member of the
International Society for Magnetic
Resonance in Medicine and
American Association of
Physicists in Medicine.
Figure 3
Whole knee imaging with 0.6mm isotropic resolution in 4min 40sec.

(Courtesy Dr. Garry Gold, Stanford University)
Figure 4
Whole Brain Imaging. T2-weighted 3D-FR Cube (a) and CSF-nulled 3D-FLAIR T2-weighted volumetric imaging for evaluation of uterine anomalies with
Cube (b) complement T1-weighted 3D-IR-SPGR (c) to provide a whole brain exam 3D-Cube. (Courtesy Dr. Elizabeth Sadowski, University of Wisconsin, Madison)
in just 10 minutes (2:15 for the T2 Cube, 5:00 for the FLAIR Cube, 2:45 for the
T1-IR-SPGR). Acquisition matrix of 256x256x128 (zipped to 512x512x256).
(Courtesy Dr. Howard Rowley, University of Wisconsin, Madison)

T E C H N I C A L I N N O VAT I O N PARALLEL IMAGING AR C
New Parallel Imaging Method

Enhances Imaging Speed
and Accuracy
Enables Fast, Robust Scanning Even
with Motion or Tight FOV Prescription
By Anja Brau, PhD, Senior Scientist, GE Healthcare,
Global Applied Science Lab
Over the last decade, parallel imaging technology in MRI

has progressed from early research prototype to established
clinical tool. By exploiting the spatial arrangement of phased-
array receiver coils, parallel imaging can accelerate MR data
acquisition, which in turn can reduce scan time and improve
Figure 1
diagnostic utility.
External calibration.
There are two basic classes of parallel imaging methods.
Physically-based methods, such as SENSE,1 require an
explicit coil sensitivity map to model the underlying physical
process that occurs during image acquisition. The success of
physically-based methods relies on calculating accurate coil
sensitivity maps, which can be difficult to achieve in practice.
Coil sensitivity calibration can be performed in one of two ways:
External calibration requires a separate calibration scan
(Figure 1). However, a primary source of error in this case
is motion that can occur between the calibration scan Figure 2
and the accelerated scan for example, due to different Internal calibration.
breath-hold positions causing residual aliasing artifacts
in the final image due to a mismapping of coil sensitivities.
Internal calibration embeds a small amount of calibration
data within the accelerated scan itself (Figure 2). While this
approach is more robust to motion, a primary source of
error is insufficient resolution, especially when a tight field
of view (FOV) is prescribed.

PARALLEL IMAGING AR C T E C H N I C A L I N N O VAT I O N
What makes ARC unique?
ARCs unique 3D kernel

fully utilizes available
data along ALL three
directions, unlike other Anja Brau, PhD
methods that only use
1D kernels. A 3D kernel Anja Brau, PhD, is a Senior
Scientist with GE Healthcares
means more accurate Global Applied Science Lab in
reconstructions and Menlo Park, CA. Anja specializes
improved image quality. in the development and clinical
validation of innovative MR
Only GEs efficient,
acquisition and reconstruction
streamlined ARC techniques for body imaging
reconstruction can applications. She is the author of
leverage the power several journal articles, abstracts,
and patents and is a member
of a 3D kernel. of the International Society of
Magnetic Resonance in Medicine
(ISMRM). Prior to joining GE, Anja
received an undergraduate
degree in electrical engineering
from Princeton University and
Figure 3 a doctoral degree in biomedical
engineering from Duke University.
Data-driven methods, such as GRAPPA2, comprise the The calculation of a full 3D kernel reconstruction, previously
second class of parallel imaging techniques. These methods considered a computationally prohibitive task, is now feasible
do not require an explicit coil sensitivity map but rather rely with ARCs streamlined reconstruction. Several innovations
on training data to calibrate the reconstruction directly, in the calculation of the training and synthesis phases allow
thus avoiding errors from coil sensitivity mismapping. ARC to reduce computation time.4,5 For example, while ARCs
Furthermore, the training data is typically embedded in training phase is performed in k-space (kx, ky, kz), the synthesis
the acquisition in an autocalibrated manner, minimizing phase is performed in hybrid (x, ky, kz) space (Figure 4) following
the susceptibility to motion errors. 1D Fourier Transformation along kx, reducing the 3D kernel
neighborhood to a smaller, more manageable 2D kernel
neighborhood. These strategies drive the computational
ARC: A Step Forward for Parallel Imaging efficiencies that streamline ARC reconstruction, creating
GE has developed a new data-driven parallel imaging new possibilities such as the ability to compute a 3D kernel
reconstruction known as ARC, or Autocalibrating in clinically practical reconstruction times.
Reconstruction for Cartesian imaging, that represents
ARC enables highly accelerated parallel imaging with
a major step forward in the speed and accuracy of highly
an accurate, streamlined reconstruction. Because it is auto-
accelerated parallel imaging. Unlike other methods,2,3 ARC
calibrating and requires no coil sensitivity map, ARC enables
uses a full 3D kernel to synthesize missing target data
smaller FOV prescriptions and is less sensitive to motion
(Figure 3, shown in pink) from neighboring source data
artifacts compared to conventional parallel imaging
(Figure 3, shown in green) from all three imaging directions.
techniques. ARC can potentially replace physically based
In this way, ARCs 3D kernel takes full advantage of available
methods that can suffer from image artifacts caused by
information along all three dimensions for improved
inaccuracies in coil sensitivity calibration. In clinical testing,
reconstruction accuracy with fewer required calibration
the technique used by ARC has been shown to achieve
lines. The end result is highly accelerated MR data acquisition
high quality reconstructions even in challenging imaging
with improved image quality and fewer artifacts.
applications, such as tight FOV prescription.

T E C H N I C A L I N N O VAT I O N PARALLEL IMAGING AR C
ARC reconstruction phases
Training Synthesis
Figure 4
3D kernel 2D kernel
ARC training phase is performed as a 3D kernel in k-space, whereas the synthesis phase is performed
as a 2D kernel is hybrid (x, ky, kz) space, reducing computation time.
Benefits
With ARC, clinicians can expect improved image quality and
patient throughput, increased spatial resolution or volumetric
coverage, depending on the application. Imaging FOV can be
prescribed close to or even smaller than the anatomy of interest,
Courtesy of Lawrence N. Tanenbaum, MD, Edison Imaging.

enabling higher spatial resolution and diagnostic confidence.
ARCs reliability for tight FOV prescription allows the technologist
greater tolerances for FOV placement which can reduce the
opportunity for error. Autocalibration improves workflow and
further reduces the opportunity for error, making the scanning
process easier for the operator. ARC is robust against motion,
reducing residual aliasing artifacts that would otherwise
result from a mismatch between the calibration and
accelerated scan.
Patients may experience shorter exam times and a lower
likelihood for repeat scans due to error or poor image quality.
Ease of use and less opportunity for error typically enables
the technologist to produce more consistent scans that are
less sensitive to prescription errors. Referring physicians
are likely to receive more definitive reports with better 1mm lesions with Cube on Signa 3.0T.
image quality.
ARC is available on the Signa HDxt platform for use References
in conjunction with GEs signature volumetric imaging 1. Pruessmann et al. MRM(42):952-962,1999.
2. Griswold et al. MRM 47(6):1202-10,2002.
application Cube. 3. Blaimer et al. MRM 56(6),1359-64,2006.
4. Beatty et al. p.1749. Proceedings of the ISMRM, 2007.
5. Brau et al. p.2462. Proceedings of the ISMRM, 2006.

N E U R O L O G Y B R A I N S TAT T E C H N I C A L I N N O VAT I O N
CBF quantifies the volume of

arterial blood (ml) delivered to
Quantitative Tool for 100mg of tissue per minute, thus

representing instantaneous
capillary flow in tissue.
Neurological Brain Evaluation CBV describes the blood volume

of the cerebral capillaries and
venules (not arteries) per cerebral
tissue volume.
Mental and neurological disorders affect an estimated 450 million people worldwide, MTT measures the length of time
and account for approximately 13 percent of disability-adjusted life years, or DALYs, a certain volume of blood spends
in the cerebral capillary circulation.
a measure of the amount of health lost as a result of a particular condition or disease.1
TTP is inversely related to CBF
Disorders such as Alzheimers, Parkinsons, epilepsy, dementia and stroke pose a in which reduction of blood flow
growing health problem for nearly all countries. In the U.S. alone, stroke is the third results in an increase in the time
leading cause of death, claiming one in 16 lives according to the American Stroke needed for the contrast to reach
its peak in the perfused volume
Association. Of the 700,000 people who experience a stroke each year, 500,000 are of brain tissue.
sufferers of a first attack and 200,000 experience recurrent attacks. In addition,
87 percent of all strokes are ischemic, whereas intracerebral and subarachnoid
hemorrhage strokes make up the remaining 13 percent.2
In spite of the acute stroke being a leading cause of serious, long-term illness, many
patients are not diagnosed correctly or the diagnose arrives too late for the ischemic
stroke patients to benefit from tPA (thrombolysis) treatment, which has to be administered
within three hours of the onset of the disease. Therefore, the need to quickly diagnose
and correctly differentiate stroke is an important driver in neurological imaging today.
MR offers excellent clinical properties for imaging neurological conditions, such
as stroke, allows complete assessment in a single exam, and assists physicians
in making a differential diagnosis.
To address the growing need for sophisticated neurological imaging, BrainSTAT is a new
advanced post-processing tool from GE Healthcare that allows quantitative evaluation
of neurological conditions, as well as helps visualize vascular structure and flow in the
tissue surrounding brain lesions. As a result, clinicians may use it to more precisely
diagnose the extent and severity of ischemic brain disease, and better tailor an
individualized therapy plan.
CBF (ml/100mg/min) CBV (ml/100mg) MTT (sec)

These parametric images reflect the spatial distribution of blood flow, blood volume per 100 mg of tissue,
and the time it takes for blood to perfuse through the tissue being imaged.
Designed for the new Signa HDxt MR, BrainSTAT calculates regional cerebral blood flow
References
(rCBF), blood volume (rCBV), mean transit time (rMTT) and time to peak (TTP) for every
1. Mental and Neurological Disorders. July 2006
pixel from a time series of MR image data. The results are visualized as color-coded maps. newsletter by the Disease Control Priorities Project.
Available at: http://www.dcp2.org/file/60/DCPP--
Based on the widely accepted, scientifically proven Gamma Variate Fit algorithm, Mental%20Health.pdf
2. American Heart Association/American Stroke
BrainSTAT provides objective and reproducible data on pathologies that may assist Association. Heart Disease and Stroke Statistics
clinicians in delivering better, more personalized care. 2007 Update. Available at: www.americanheart.org

T E C H N I C A L I N N O VAT I O N 1.5T MRI SIGNA HDE
Enhancements
Bring Sophisticated
MR Applications
Within the Reach
of Everyone

1.5T MRI SIGNA HDE T E C H N I C A L I N N O VAT I O N
The HDe Value Proposition

In todays healthcare market, radiologists want accurate GE Healthcare continues its commitment to an upgrade
and reliable diagnostic imaging that can lead to a confident continuum path with Signa HDe. As a facilitys diagnostic
diagnosis. Yet, todays competitive reimbursement imaging needs evolve, so too can the Signa HDe. GEs MR
environment, and, in particular, reductions that resulted continuum path enables users to completely upgrade their
from the Deficit Reduction Act (DRA) of 2005, necessitate system to the industry-leading HDx platform and todays
a cost-conscious environment. most advanced clinical applications.
The Signa HDe 1.5T MR system answers this challenge by Signa HDe fits where other 1.5T MR systems cant. The
delivering excellent clinical performance that meets a facilitys system can be sited with 30 percent less space and on
purchasing needs. With over 200 worldwide installations, average generates 25 percent less operating cost than
Signa HDe brings the clinical advantages of MR technology a traditional 1.5T MR system, which translates to facilities
to a broader population base by addressing the challenges recouping their investment with as few as five billable
of space, cost and ease of use. Plus, signature HD applications patients each day.
such as the GE-exclusive LAVA, TRICKS, PROPELLER HD
and VIBRANT sequences give users state-of-the-art
MR capabilities.
Building on this success, GE Healthcare now offers
additional capability on the Signa HDe for increased
operational efficiency and investment protection. New
applications enable increased clinical benefits for
Signa HDe users, including:
PROBE for proton brain spectroscopy
Cartilage visualization using color-coded mapping
with Cartigram
Improved gray-white matter imaging contrast and lesion
visualization on cervical spine images with MERGE
The system boasts a user-friendly interface and a full range
of High-definition (HD) coils for head-to-toe anatomical
coverage. Together, these enhancements to Signa HDe
provide the radiologist and technologist with additional
capabilities to generate clear, accurate and complete
images in key areas.
Without PROPELLER HD With PROPELLER HD

T E C H N I C A L I N N O VAT I O N ANGIOGRAPHY NON CONTRAST ENHANCED PULSE SEQUENCES
Robust NCE Techniques Remain a Viable

Alternative for MR Angiography
By Stuart Clarkson, Americas MR Training Manager, GE Healthcare
Non contrast enhanced magnetic resonance angiography NCE Techniques

(NCE-MRA) has become a global topic of interest following
GE Healthcares Signa HDx and HDe systems incorporate
the recent link between nephrogenic systemic fibrosis (NSF)
no less than 10 pulse sequences capable of imaging the
and gadolinium contrast agents.1 Reports2 dating to the year
vasculature without the use of a contrast agent. These include:
2000 identify a scleromyxoedema-like cutaneous disease in
renal-dialysis patients that may well have been associated 1. 2D Phase Contrast
with gadolinium; however, the link between NSF and MR 2. 3D Phase Contrast
contrast agents had yet to be made. 3. CINE Phase Contrast
Gadolinium-based contrast agents are used in many MR 4. 2D Time of Flight (gated and non gated)
examinations, but its use has it been of particular interest 5. 3D Time of Flight (includes MOTSA)
in NSF due to the larger doses of contrast required for 6. 2D fat sat FIESTA
cardiovascular imaging compared to MR examinations 7. 3D fat sat FIESTA
of other anatomy. Additionally, patients who receive an
8. 3D FSE (black blood angio)
MRA of the renal arteries may have been at additional
9. 2D Double Inversion Recovery
risk of NSF due to renal impairment.
10. MR Echo* (FIESTA based real time sequence on HDx 1.5T)
The Clinical Impact The imaging challenge in assessing vascular anatomy

without a contrast injection is deciding which sequence
Many institutions implemented a policy of screening patients to use for interrogating the vascular anatomy of interest.
scheduled for a contrast enhanced MR imaging study to As with all MR imaging sequences, there is a perpetual
ensure adequate renal function prior to the administration trade-off between resolution and scan time for obtaining
of a gadolinium-based agent. If the patient exhibits impaired the adequate signal-to-noise-ratio (SNR) in an image. With
renal function that prevents the institution from performing MRA, there is the additional consideration of blood flow
an intravenous injection of a gadolinium agent, then when selecting the appropriate sequence.
non-contrast imaging is utilized. Imaging renally-impaired
patients without a contrast agent presents a challenge 3D Time of Flight (ToF) sequences (Figure 1) exhibit excellent
when visualization of vascular structures is required. spatial resolution; however, due to saturation effects and
subsequent loss of signal, these are seldom used in slow
Portal Vein
Figure 1. 3D ToF Figure 2. Gated 2D ToF Figure 3. 2D FIESTA MiP

ANGIOGRAPHY NON CONTRAST ENHANCED PULSE SEQUENCES T E C H N I C A L I N N O VAT I O N
flow areas. 2D ToF techniques (Figure 2) may be utilized

when imaging long vessels that have slower flow rates. For our non-contrast MRA studies, we
In pulsatile vessels, the sequence should be gated to the generally rely on two complimentary
patients heart rate to mitigate artifacts. techniques: 2D Time of Flight (to obtain
images with venous suppression)
Steady-state free precession sequences such as FIESTA
and Steady-State Free Precession
(Figure 3) are excellent for fast scans done in a breath hold.
(i.e. FIESTA), that has very few flow
When targeted to specific vascular anatomy, high in-plane
artifacts. However, today most MRA
resolution is easily achievable.
studies are performed with sequences
Phase contrast techniques provide excellent background like eFGRE or using multi-phase, time-resolved techniques
subtraction resulting in 3D volumes (Figure 4) that are easily (e.g. TRICKS), which are very accurate and provide high
rotated into any viewing plane. 3D phase contrast techniques diagnostic confidence. An additional advantage of these
are significantly slower that the breath hold times seen with techniques is that one can also assess the dynamics of
contrast enhanced techniques; however, when combined blood flow. This can be especially helpful in patients with
with a CINE acquisition, the phase contrast techniques shunts, fistulas or vascular malformations.
are capable of quantifying flow in any vessel.
Steven Wolff, M.D., PhD, Director of Cardiovascular
MRI, Advanced Cardiovascular Imaging, New York, NY
Phase contrast techniques are also sensitive to the flow

direction of the blood any flow from Left, Inferior or
Posterior is shown as black and flow from Right, Superior
and Anterior shown as white. Flow within the right middle
cerebral artery (Figure 5) is from the left to the right and
hence is black on the phase image. Also note that 3.122 mLs
of blood passes through this vessel with each heart beat;
multiplying this by the patients heart rate (55 beats/min)
generates the vessel flow rate at 171 mLs/min.
Figure 4. 3D Phase Contrast

Future Pulse Sequences
Despite the comprehensive suite of non-contrast MRA
sequences, GE Healthcare continues to evaluate improved
techniques for imaging vascular structures without a
gadolinium injection. FIESTA-based sequences that utilize
various tissue preparation pulses are very promising
in their ability to depict vascular structures in various
anatomical locations.
Figure 5. CINE Phase
Contrast of middle
cerebral artery and Summary
resulting flow
measurements. MR provides robust visualization of vascular anatomy. In the
subset of patients that are deemed unsuitable for a contrast
Peak Positive Velocity (cm/s) 83.1 injection, it is reassuring that many techniques exist on the
Peak Negative Velocity (cm/s) -6.07 Signa HDx and HDe scanners to image vascular anatomy
Avg. flow (ml/beat) 3.122 and quantify flow. These techniques may prolong the exam
Avg. Positive Flow (ml/beat) 3.158 time, but can be used to achieve the imaging goal.
Avg. Negative Flow (ml/beat) -0.036
References:
1. Thomsen HS. Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide.
Eur Radiol. Epub October 24, 2006
2. Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE. Scleromyxoedema-like cutaneous
disease in renal-dialysis patients. The Lancet 356(9234), 16 September 2000, 1000-1

BEYOND THE SCAN FUNCTIONAL MRI BRAINWAVE AND FIBERTRAK
Advanced fMRI Techniques

Provide Valuable Information,
Change Course of Treatment
for Neurosurgical Patients
The Methodist University Hospital Neuroscience Institute, in collaboration with
the University of Tennessee Health Science Center, provides neuroscience
clinical programs, medical education and research that are comprehensive
and interdisciplinary.
Backed by the latest technologies, including a GE Signa HD 3.0T MR, the Institute
showcases advanced neurology applications, including functional magnetic
resonance imaging (fMRI) and diffusion tensor imaging (DTI) both powerful
tools that help in planning treatment in patients with brain tumors.
fMRI and DTI help physicians identify areas of the brain that affect a patients
ability to function, (i.e., speech, hearing, vision, muscle control) and therefore
must not be disturbed during surgery. fMRI also detects changes in the MR signal
that are coupled to changes in neuronal activity. An fMRI scan can produce
high-quality images that indicate which areas of the brain are being activated
by diverse stimuli. In contrast, DTI is used to examine the wiring of the organized
regions of the brain, mapping, the orientation of diffusion along white matter
tracts and helping physicians visualize neural pathways.
Immediate Benefits
Soon after the Signa HD 3.0T system was installed in November 2006,
Frank Parks, M.D., Chairman of Radiology for Methodist Healthcare noticed
an immediate impact on patient care.
Of the first 215 patients scanned using fMRI and DTI, the results changed the
course of treatment in 70 cases. In some of those patients, it has made a very
dramatic difference, such as the differences between no surgery versus surgery,
or vice versa, Dr. Parks said. It has also made a difference in the quality of
patient outcomes and the speed of recovery.
In my years in radiology, Ive seen many new technologies, but I am surprised
at the immediacy of impact in this case, he continued. Its not every day we see
a technology that directly impacts patient care so quickly after implementation.
The technology has helped the staff at Methodist provide better options for patients
fMRI activation areas are co-registered with 3D with tumors considered unresectable or inoperable. In such cases, somebody had
datasets for custom visualization. looked at an MRI and said, That must be functional tissue, said Allen Sills, M.D.,

FUNCTIONAL MRI BRAINWAVE AND FIBERTRAK BEYOND THE SCAN
Associate Professor of Neurosurgery at the University of Tennessee and medical

Director of the Methodist University Hospital Neuroscience Institute. As it turns
out, many times that estimation is just wrong. Weve been able to use fMRI
to show ourselves that indeed we can probably take the tumor out without
excessive risk.
The technologys immediate impact on patient cases soon won over some
skeptics. At first, some neurosurgeons said they were not interested, Dr. Parks
recalled. A few who have seen the results now say, I want to get my
patients scanned.
Changing Treatments
Create DTI 3D fiber maps with GE FiberTrak. In case after case, fMRI/DTI scanning non-invasively provides crucial
information that helps surgeons like Dr. Sills make informed decisions on:
Reviewing surgical approach and in choosing the safest path, based on
the location of functional brain tissue
Deciding on Operability
Tracking white-matter tracts
Choosing the Safest Path

The first patient scanned at the Methodist University Hospital with fMRI/DTI
was a 20-year-old woman with a right brain tumor diagnosed by MR at another
hospital. The team integrated fMRI and DTI with acquisition of 3D anatomical
images for the patients scheduled image-guided surgery.
Clinicians located the tumor in the eloquent cortex near the patients motor strip.
It was in an area where we knew the surgery would be delicate, said Dr. Sills.
We had identified one particular trajectory to the tumor, based on what we
believed to be the safer corridor. When we did the fMRI, much to our surprise
we found that functional tissue the tissue that controlled her leg movement
would have been right in the middle of what we had considered our corridor.
The information definitely caused me to change my approach and come in by
There is really no a different route that would be much safer. The patient had been adamant on the
front end that she didnt want any motor deficit, and we were able to accomplish
substitute for the that for her.
real-time, exact, A post-operative physical exam found no evidence of foot or ankle weakness.
precise information
Deciding on Operability
you get from studies
In another case, a 51-year-old man was diagnosed with anaplastic astrosarcoma
like (fMRI and DTI). affecting the temporal lobe. Surgeons needed to determine whether the tumor
could be resected without significant loss of function.
Dr. Allen Sills
Using fMRI and DTI scanning, clinicians found the area of concern was already
disrupted by the tumor, causing the neurosurgeon to proceed with the surgery.
The tumor had been well worked up in previous MR images, explained Dr. Parks.
The additional information from fMRI and fiber tracking was the tipping point
for go or no go.

BEYOND THE SCAN FUNCTIONAL MRI BRAINWAVE AND FIBERTRAK
Another patient, a 38-year-old man, had three areas of brain tumor, including
a large growth at the back of the brain near his vision area. Clinicians suspected
the lesions were benign, but to remove the large tumor would involve
significant resection.
We used fMRI to localize his visual function and were able to see that we could
in fact go in and take out that very large lesion at least 8 cm in size and not
put the patients vision at risk, Dr. Sills said. It gave us confidence preoperatively
that while the risk wasnt zero, the risk was certainly low that we would cause
harm to his vision.
Tracking White-Matter Fibers

Another beneficiary of fMRI and DTI was a 22-year-old woman who had a right
temporal tumor. She was left-handed, so the assumption was that her language
function must be in the right temporal area, explained Dr. Sills. Obviously, there
was a great deal of trepidation about approaching this lesion.
It looked like a benign lesion, but she was having seizures and didnt like being
on seizure medicines. She wanted to have the lesion taken out if she could. Our
concern was, can we do that safely? fMRI was very helpful. It showed that she
had language function in both hemispheres, rather than just one, and that
language function area was not anywhere near the lesion.
The DTI was incredibly useful because it showed beautifully that the fibers were
displaced laterally by the tumor, rather than being infiltrated by it, he continued.
Without DTI, we would have had no way of knowing that with any degree of
22-year-old female with right temporal lesion. certainly. In the end, the exam gave us two critical pieces of information. First, it
2D color directional image (top) shows the
displaced white matter. The fMRI image (bottom)
helped us decide whether we could even think about surgery. Second, it helped
demonstrates activation from speech and determine our surgical approach.
passive listening paradigms.
Parks added that the fMRI/DTI findings enabled clinicians to avoid performing an
invasive Wada test to locate the speech center. Surgery went forward, and the
In the end, the (DTI) womans speech was not affected.
exam gave us two

Clinical Value Added
critical pieces of
The addition of fMRI and DTI was a natural one for Methodist University Hospital,
information. First, a consistent state leader for brain tumor cases. At the time we made the investment,
it appeared these technologies had moved out of the research lab and had reached
it helped us decide the point of being clinically relevant, Dr. Parks recalled. We saw them as consistent
whether we could with our belief in individualized care. They provide information we can use to
customize therapy based on the patients exact anatomy and pathology.
even think about
Clinicians at Methodist scan many brain tumor patients on the Signa HD 3.0T
surgery. Second, scanner with fMRI and DTI before craniotomy. Hospital leaders believe the
decision to move up to a high-field 3.0T system benefits both clinicians and
it helped determine patients. In addition, Parks has found the procedures easier and the results
our surgical approach. more reproducible on the Signa HD 3.0T system than on the hospitals other
MR scanners.
Dr. Frank Parks
Technologists use the BrainWave and DTI/FiberTrak suite of applications from
GE Healthcare, which offer comprehensive, easy-to-use tools to acquire and
FUNCTIONAL MRI BRAINWAVE AND FIBERTRAK BEYOND THE SCAN
About Methodist
University Hospital
The 693-bed Methodist University
Hospital, founded in 1924, is a
post-process high-definition 3D anatomical images, neurofunctional brain maps tertiary care and referral center
and white-matter trajectories projection. and the flagship hospital for
Methodist Healthcare, a seven-
During the procedures, the technologists scan brain anatomy, run the patient hospital system ranked a Top 100
through a series of brain stimulations called paradigms that are necessary to Integrated Health Network (IHN)
by Modern Healthcare magazine.
perform an fMRI exam, generate DTI images, integrate and post-process the data. The hospital has a long history
The study results are provided to the physicians as 3D, color-coded data sets that of leadership in brain tumor
can be easily manipulated to best visualize areas of interest. treatment and MR diagnostics.
Methodist treated nearly 300 brain
The physicians can study the 3D datasets as part of surgery planning and tumor cases in 2006, and Le Bonheur
display the images in the operating room, integrating them with the surgical Childrens Medical Center, part
of Methodist Healthcare, is a
navigation system. major regional referral center
for brain tumors.
In 1985, Methodist Hospital became
Gratifying Experience the first in its area to offer MR
imaging. It has continued to add
Besides helping clinicians, the information helps put patients at ease. The exam state-of-the-art MR scanning
is not an anxiety-provoking experience, Dr. Sills explained. Our technologists and technology, the most recent
radiologists are superb. They make the experience comfortable, so its not a test purchase being a GE Signa HD 3.0T
scanner with fMRI and DTI in
that patients dread and fear. The exams are also non-invasive, unlike alternative November 2006.
technologies that are used intra-operatively, and so provide no opportunity for Other cutting-edge neurological
the surgeon to consult with the patient in advance. tools offered by this leading facility
include magneto encephalography
Dr. Sills notes that the fMRI/DTI data helps inspire confidence in patients and loved (MEG) scanning and gamma
ones. He often shows color-coded brain maps to patients before surgery, explaining knife surgery.
in simple terms what the images indicate. I can walk the patients through and
show them what were looking at, he added. Patients and family members
can easily understand it.
I think its a source of comfort to them to know we have this kind of advanced
technology available for planning and studying lesions. It also helps them to
understand that were doing everything we can to minimize risk.
Hospital staff members at all levels are gratified with the results of fMRI and DTI.
Surgeons especially appreciate the technology. When youre the guy the patients
trust to take them into surgery and bring them out of it safely, you want to have
every weapon at your disposal, Dr. Sills added.
We all learned the classic models of anatomy that tell where functions are located.
More and more, were finding that those are only approximations, and theres a lot
of variability from patient to patient. There is really no substitute for the real-time,
exact, precise information you get from studies like these.
Robert Laster, M.D., a neurointerventionalist with Methodist Healthcare says
the technologists are also enthusiastic about fMRI/DTI. Theyre getting feedback
from the neurologists and radiologists that, Hey this is helping my patients.
And the technologists say, This is why I went into the medical field to help
make a difference."
Vic Perini, Vice President of Operations at Methodist University Hospital, expects
fMRI and DTI technologies to support continued growth in the Neuroscience
Institute. The institute is of vital strategic importance, he said. We saw a great
opportunity to add differentiating technology that would enable even more
outstanding, care for every patient.

BEYOND THE SCAN 1.5T MRI SIGNA HDE
The Right Choice

for Your Community:
Making the Decision to Add MRI
In-house MRI keeps physicians happy and patients closer to home
Keeping Patients Closer to Home

According to Patrick Dailey, Manager of Imaging Services,
the primary reason was patient and physician satisfaction.
Ordering an MRI exam on Monday and having to wait until
Saturday for the procedure is not an ideal situation for the
physician or the patient. Having in-house MRI would allow
Image courtesy of Hoefer Wysocki Architects
us to provide service seven days a week if we need to.

Competition was another factor. As the demand for MRI
services grew, so did the number of scanners in the
surrounding communities. At present, there are at least
nine fixed MRI systems within 30 miles of Wahoo, from
hospital-based systems in Lincoln and Omaha to scanners
in freestanding imaging centers.
Saunders Medial Centers new campus. We knew we were losing a lot of patients to MRI services
in the surrounding areas to facilities that offered longer hours
and more flexibility in scheduling, said Dailey. But why
should a patient have to drive 25 miles for a procedure
The town of Wahoo, Nebraska is changing. What was that we could do here, if we had our own scanner?
once primarily a farming community is now becoming
a fast-growing suburb of Lincoln and Omaha, and home
to an increasing number of commuters. Encouraging Numbers
Until recently, Saunders Medical Center could meet the With plans for the new facility on the drawing board,
communitys MRI needs with a mobile service that was hospital management floated the idea of acquiring an MRI
onsite for five hours a week. But with Wahoo flourishing system to the board, which then authorized a feasibility
and MRI becoming a more widely-used diagnostic test, study. The numbers were encouraging, Sheehy noted.
the demand for exams has grown. We determined that about 42 procedures a month would
MRI has become a state-of-the-art diagnostic tool for many pay for the acquisition and operating costs, as well as the
types of conditions, said Earl Sheehy, CEO of Saunders structural expense to accommodate the scanner, he said.
Medical Center. We decided to make the investment in We were already doing 35 procedures a month with the
a fixed system in order to improve the quality of care we mobile service and physicians told us that they were
provide to patients and to make sure they dont have to wait referring another 30 to 40 patients a month to other
for an appointment or drive 20-plus miles to get an exam. facilities because of our scheduling difficulties. We knew
that our volume would go up because physicians would
utilize a system that was more convenient for their patients.

1.5T MRI SIGNA HDE BEYOND THE SCAN
We showed the board how in-house MRI would improve our ability to provide
patients and physicians with better access to quality care. And from a financial
perspective, the pro forma revealed that if we averaged just two exams
a day, we could easily reach the volume that would justify the decision
economically, said Sheehy. MRI needs to be
readily available
Quality Levels the Playing Field
to your patient
High performance and application flexibility were critical. The hospital
wanted to offer a wider range of MRI procedures, such as neurological studies, base. If you make
and provide more advanced applications. your patients go
The medical center team evaluated a variety of MR systems and manufacturers
and selected a Signa HDe 1.5T MRI system from GE Healthcare. Image quality
out of town for
was a key factor in choosing the HDe system, said Dailey. Ive also found these procedures,
from past experience working with physicians that they prefer images from
a closed MR system versus those from an open scanner. youre going to
Virtually all of the imaging equipment that the center uses is from eventually lose
GE Healthcare. Weve had a very good history with GE as far as service
and technical support are concerned, added Dailey. Theyre always
them for everything.
dependable and willing to help us whenever we need them. That helped Earl Sheehy, Chief Executive Officer
make the decision to choose GE very easy.
Sheehy noted that acquiring a state-of-the-art HDe system from GE was
also critical from a competitive standpoint. It enabled Saunders to level the
playing field by offering the same MRI services as those available in larger
medical facilities so that patients and their physicians could be assured
of receiving superior MRI without having to leave the community.
Immediate Physician Buy-in

The medical centers primary medical staff consists of six physicians and
two physician assistants who live and practice in the Wahoo area. Referrals
also come from approximately 15 specialists who are based in the
surrounding communities.
The physicians bought into the idea of in-house MRI the minute we started Image quality
looking at it, said Sheehy. The hospital intends to offer the service five days
a week in the beginning and add evenings and weekends in the future, based
was a key factor
on demand. in choosing the
Athletic injuries and other orthopedic conditions dominate the hospitals HDe system.
current MRI case mix. Says Dailey, We have an orthopedic surgeon who
holds a weekly clinic at the hospital. There were procedures that he wanted Pat Dailey,
done sooner and now well be able to have the exams done when he Manager of Imaging Services
wants them, said Dailey.

BEYOND THE SCAN 1.5T MRI SIGNA HDE
A Technologists Perspective
Rachele Malousek, RT, sees a number of advantages to replacing Saunders mobile
MRI service with a fixed system. Patients who have a spine injury or a possible stroke
A detachable need MRI right away. They cant wait for a mobile service or to be transferred 30 miles
away. Now, well be able to take care of them right away.
table can help She says there will be more time for personalized care, to take better patient histories
save a life. and visit with patients because technologists wont have to rush against the clock,
trying to get all the cases through in the few hours the mobile system is on-site.
Rachele Malousek, Malousek also feels that the hospital will be well poised to stay current with the
MRI Technologist latest MRI protocols and that turnaround time for reports will be reduced, improving
patient care.
1.5T MRI SIGNA HDE BEYOND THE SCAN
About Saunders Medical Center

Saunders Medical Center is an
independent community hospital
in Wahoo, Nebraska, a town of
4,200 in the eastern part of the
state. The town sits approximately
23 miles between Lincoln, the state
capital, and Omaha, Nebraskas
largest city. The primary focus
Malousek is particularly pleased that the hospital selected a Signa HDe system with of Saunders Medical Center is
its unique detachable table. A detachable table can help save a life, she said. If outpatient care. The Critical Access
hospital includes full-service
a patient codes or needs help immediately, you just unhook the table and bring the
laboratory and radiology services,
patient outside the magnet room for assistance. a 24-hour emergency room,
physical and respiratory therapy
A detachable table also reduces the number of steps in preparing a patient for an and surgical services. A long-term
exam, she added. You just move the patient from the bed onto the table, take them care facility and a physician clinic
to the imaging room and scan them. It eliminates having to transfer patients onto are also part of the campus.
a cart. That saves time and contributes to greater patient comfort. The facility conducts approximately
6,000 imaging procedures a year.
Malousek has worked with GE systems in the past and feels they are very user Radiology studies, except for
friendly and easy to learn. Ive trained with GE before and someone is always there mammograms, are read remotely
by a group of board-certified
to help you, going over the protocols and explaining the software. Its very reassuring
radiologists based in Omaha.
to have someone behind you all the way. Images are transmitted digitally
via PACS to the radiologists. Their
One support tool that Malousek has come to depend on is iLinq, an exclusive GE dictated reports are transcribed
service feature that enables users to communicate with GE applications specialists at the hospital and distributed
by simply touching a button on the operator console. If youre ever stuck trying to to the physicians.
figure out something thats happening with the system, you just push the little button.
A GE person always gets back to you within 10 to 15 minutes and usually is able to
resolve the issue. Its very, very cool.
The Community is Excited

The new GE Signa HDe at Saunders Medical Center became operational in August
2007. Were convinced it was the right decision because weve heard back from
the community how grateful they are that we have a fixed MRI system, said Sheehy.
Our staff is excited. Our physicians are excited. Our board is excited. Even the county
board of supervisors is excited about it.
Sheehy believes that having in-house MRI is essential for an independent community
hospital to provide state-of-the-art medicine today and to continue thriving. MRI
needs to be readily available to your patient base. If you make your patients go out
of town for these procedures, youre going to eventually lose them for everything.

BEYOND THE SCAN REIMBURSEMENT
Medicare Reimbursement Update

As payors continue to look for ways to rein in the rapid advocacy and educational activities aimed at ensuring
growth in healthcare costs, imaging remains at the forefront access to imaging. More information can be obtained
of policy and cost debates. Understanding, following and at the AMIC website (www.imagingaccess.org).
acting upon the numerous complexities of proposed
GE also joined AdvaMed in 2007, a successful, international
reimbursement changes is challenging for many healthcare
medical device industry association representing over
providers to manage. To support customers in understanding
1300 companies and subsidiaries. GE plays leadership
this continuously evolving and highly regulated area, and
roles in this organization with Joe Hogan on the
to ensure that all customers have access to the latest
Board of Directors and Mark Vachon as the
information and resources, GE Healthcare has a dedicated
Vice Chair of the newly created
website on reimbursement that includes:
Diagnostic Imaging sector. There is
The latest Medicare Payment Rates for procedures in also broad GE Healthcare participation
all the major imaging modalities including listings by at the working group level to engage
site of care and geographic area on important customer topics such as
payment advocacy, state legislation,
Links to Payer Medical Policies to help providers
and quality.
understand the conditions under which a given
procedure may be covered As a long-term member, GE continues to
strongly influence the advocacy program
GE Reimbursement Customer Advisories with coding,
for the Medical Imaging & Technology
coverage and payment information
Alliance (MITA), a division of NEMA
For MRI, recently updated Customer Advisories include (National Electrical Manufacturers
Breast MR Imaging, Breast MR Biopsy and Functional MRI Association), which represents
(fMRI). These documents are posted on GEs reimbursement companies whose sales
website (www.gehealthcare.com/reimbursement). comprise more than 90 percent
Education and awareness is only one aspect of what of the global market for
GE Healthcare is doing to support medical imaging customers. medical imaging technology.
Under the guidance of Mike Becker, General Manager of Global Jim Davis, Vice President
Reimbursement and John Schaeffler, General Manager of and General Manager of the
GE Healthcare Government Relations, GE has been working GE Healthcare MR Business
to identify current and future customer imaging risks and chairs the MITA section. MITA has
developing various strategies to mitigate these risks. To this focused on educating lawmakers,
end, GE continues to partner with strong industry organizations the media and key stakeholders
to protect and preserve access to quality imaging for all on the Value of Imaging
patients and to stabilize the market after the shock of the (www.medicalimaging.org)
DRA (Deficit Reduction Act). with a formal public relations
campaign.
GE is a founding member of the national Access to Medical
Imaging Coalition (AMIC) comprised of equipment manufactures, For more information, please
healthcare providers, key medical societies and patient visit www.gehealthcare.com/
advocacy groups that represent more than 75,000 patients, reimbursement.
physicians, and imaging providers. GE serves on the executive
board of AMIC and like other participating members,
contributes resources to support the public relations,

E D U C AT I O N P E E R V I S I O N : S I G N A 3 . 0 T S O C I E T Y B E Y O N D T H E S C A N
Figure 1
The GE Signa 3.0T Society welcome page
on the PeerVision Online Community web site.
Signa 3.0T Users Share Best

Practices, Clinical Techniques
with Users Around the World
Launched September 2007, the GE Signa 3.0T Society on the Signa MR 3.0T Users. PeerVision has several online communities
PeerVision Online Community web site brings Signa MR 3.0T for users with different interests to join and participate in any
Users together to interact and learn from one another. Through discussion, including: Advanced Visualization, Outpatient
PeerVision, users can openly share ideas or opinions, forming Imaging Centers and Reading Rooms.
an online community with user-generated content that shares
The GE Signa 3.0T Society is open only to Signa MR 3.0T Users.
the latest techniques in 3.0T imaging across the globe.
The System ID, found on or near the Signa MR 3.0T System
Within the Signa MR Imaging Community, users will find MR Monitor, is required for initial log in. Join the community today,
educational opportunities and events. The GE Signa 3.0T www.healthcare.com/peervision.
Society includes discussion forums, polls, a gallery for clinical
case images and a library of tools and tips. Guest bloggers
periodically post topics for open discussion and participants
can elect to share comments on the topic or merely read With PeerVision, you can
along with the dialog. Join a discussion on imaging challenges
PeerVision is the result of research on MR-users information or share a clinical case
needs, incorporating customer feedback to create a non-
promotional environment for authentic communication among Find out what your peers think, or share
your own insights
PeerVision. Its your community GE provides

the medium. You decide how it evolves.

GE Healthcare
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most comprehensive HD solution available for breast MR. It starts with
VIBRANT, the first ever bilateral, volumetric acquisition technique introduced
for breast, and still the industry standard for speed and resolution. And its
supported by BREASE, a breast-specific proton spectroscopy solution,
CADstream automated analysis and reporting to drive efficient workflow,
and the HD Breast Array that enables outstanding image quality and easy
access for procedures. Combine all this with the Vanguard Breast Table
from Sentinelle Medical, and these solutions add up to excellent specialization
capabilities and diagnostic confidence. When Breast MR is technologys focus,
every detail becomes very clear. Breast MR Re-imagined.
Visit GE Healthcare at RSNA Booth #1929
imagination at work
2007 General Electric Company.

GEHealthcare SignaPulse Magazine 20071001

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GE Healthcare

THE MAGAZINE OF MR AUTUMN 2007

The IDEAL Approach to

Making the Decision

GE Healthcare News Clinical Value

Publications Team: GE Contributors:

2 A GE Healthcare MR publication Autumn 2007

Beyond the Scan: Medicare

Beyond the Scan

4 A GE Healthcare MR publication Autumn 2007

A GE Healthcare MR publication Autumn 2007 5

New Volume Acquisition Helps Clinicians

The IDEAL Solution for Fat and Water Separation

6 A GE Healthcare MR publication Autumn 2007

Introducing the Next Generation of HD MR

A GE Healthcare MR publication Autumn 2007 7

8 A GE Healthcare MR publication Autumn 2007

GE Opens Chinas First

A GE Healthcare MR publication Autumn 2007 9

10 A GE Healthcare MR publication Autumn 2007

Sprechen sie 3.0T?

Gearing up for Signa Koshien

New Volume Acquisition Helps Clinicians

The IDEAL Solution for Fat and Water Separation

6 A GE Healthcare MR publication Autumn 2007

Introducing the Next Generation of HD MR

A GE Healthcare MR publication Autumn 2007 7

CLINICAL VALUE VOLUMETRIC IMAGING HDXT

The History of Volume Imaging

12 A GE Healthcare MR publication Autumn 2007

VOLUME TRIC IMAGING HDX T CLINICAL VALUE

The new Volumetric HD MR sequence Cube provides

Flexible, clinical region-of-interest optimized sequence protocols

The advantages of the 3D HD

A GE Healthcare MR publication Autumn 2007 13

CLINICAL VALUE VOLUMETRIC IMAGING CUBE

The Clinical Proof

*ARC: Autocalibrating Reconstruction for Cartesian imaging

14 A GE Healthcare MR publication Autumn 2007

VOLUME TRIC IMAGING CUBE CLINICAL VALUE

This application is changing the way we scan

Figure 2. Cube FLAIR and FiberTrak at 3.0T Glioma

Figure 3. Cube T2 3.0T Glioma

A GE Healthcare MR publication Autumn 2007 15

CLINICAL VALUE FAT S AT I D E A L

Consistent, Reliable, Fat-Suppressed

*IDEAL: Iterative Decomposition of water/fat using Echo Asymmetry

16 A GE Healthcare MR publication Autumn 2007

Scott Reeder, M.D., PhD

Scott Reeder, M.D., PhD, is

T2W Fat Sat FSE T2W IDEAL FSE T2W STIR

Brachial Plexus Imaging 1.5T, PD Weighted, 2D Fast Spin Echo

A GE Healthcare MR publication Autumn 2007 17

CLINICAL VALUE FAT S AT I D E A L

18 A GE Healthcare MR publication Autumn 2007

The Tipping Point in Healthcare.

The Tipping Point in Healthcare a compelling and

CLINICAL VALUE VOLUMETRIC IMAGING DWI & DTI

High-Resolution, Isotropic-Voxel Acquisition Technique

Introduction Volume Diffusion Imaging Technique

20 A GE Healthcare MR publication Autumn 2007

VOLUME TRIC IMAGING DWI & DTI CLINICAL VALUE

Advantages of Volume Diffusion Imaging

About Iwate Medical University,