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MR Liver Lab

MR LiverLab step by step for examination workflow

MR LiverLab MR LiverLab is saved within the Siemens, Abdomen Dot Engine protocols. The customer can incorporate their own routine liver sequences into the LiverLab protocol within the Abdomen Dot Engine. Requirement – Must be run using a Dot Engine Note: Patient should follow the same breath-hold instructions throughout the exam 1. Position the patient for an Abdominal Examination 2. Register the patient and select the LiverLab Abdomen Dot Engine protocol created 3. Optimize the Dot settings a. Exam Strategy b. Protocol Adaption c. Decisions i. Liver evaluation ii. Contrast agent iii. Evaluation method d. Breath-hold capability e. Automatic breath-hold commands i. Language ii. Before or After scan iii. Pause between breath-holds General Parameters Breath-hold Parameters Exam Strategy Breath-hold Breath-hold capability 20 S Protocol Adaption BH + AutoCo ... Automatic breath-hold commands Decisions Language English (United States) Liver evaluation yes Before scan Hold breath (inhaled) 8.1s contrast agent without contr ... After scan Continue breathing. 1.5s Evaluation Method Both Pause between breath-holds 10 S 4. Run Abdomen Localizers > Select Apply (Green Checkmark) 5. Run Abdominal sequences > Select Apply (Green Checkmark) SIEMENS www.usa.siemens.com/healthcare Page 1 of 12 1394 Effective Date: 12/07/2016 6. Open the T1 VIBE eDIXON sequence a. Plan slice volume to include entire liver, and same breath-hold instructions b. Select Apply (Green Checkmark) Patient Applications Transfer Edit it Queue Protocol View Image Tools Evaluation Scroll System Add-On Options Help SP 3/4/2016 448-11 /60 Exam ACS Viewing Filming NORM/DIS2D Fou sontag M/NORM/DIS2D 390 COR 99 HASTE ABD .V.5 5 2M/NORM/DIS2D Fov 400 90 1124_opp-in_tra_p2_bh Fov 500 998 Dot TA: 0:18 PM: ISO PAT: Voxel size: 1.2×1.2×3.0mm Rel. SNR: 1.00 3D Guidance Parameters × ~ AX T2 HASTE TE 180 12+12_haste_tra_mbh Check slice positions and adjust them, if necessary. AX IN OUT COR 12 THICK SLAB XXX AX DWI NEW GRE REF SCAN 10 1_vibe_e-dixon_tra_bh_pre PEL LOC 00:18 12 * COR T2 HASTE PEL 00:56 13 % AX T2 HASTE PEL 00:58 20 % 2 22:11 Stimt-M SABEM 7. System performs Liver Segmentation and Evaluation SIEMENS www.usa.siemens.com/healthcare Page 2 of 12 8. Evaluation Step a. Liver segmentation is displayed in the graphic segments i. Evaluate for segmentation quality b. Note: segmentation cannot be adjusted and the same segmentation is used in the T1 VIBE qDIXON sequence ( i.e., segmentation not repeated for qDIXON) c. System provides Pre-Evaluation result i. Normal ii. Fat deposition iii. Iron deposition iv. Both, Fat and Iron Deposition d. System makes a recommendation if further evaluation is required i. Yes ii. No iii. Note: Site should follow the Radiologist recommendation if further evaluation is required am Viewing R Filming M/AWATER/NORM/DIS2D H216 p4 M/AWATER/NORM/DIS2D SP H246 P4 MAWATER/NORM/DIS2D SP H18. vibe_e-dixon_tra_bh_pr ... FoV 309380 +1 vibe_e-dixon_tra_bh_pr ... Fov 309 a 1_vibe_e-dixon_tra_bh_pr ... FoV 309 380 Dot 3D X Guidance VI.UU Check the liver segmentation as shown 22 AX T1 VIBE FS (CAIPI) POST 20 00:16 in example images 23 AX T1 VIBE FS (CAIPI) POST 20 00:16 24 AX T1 VIBE FS (CAIPI) POST 20 00:16 Segmentation volume 1156 ... ml 25 7 AX T1 FLASH FS POST 00: 45 Voxels sampled 273464 Good segmentation result Bad segmentation result 26 COR T1 FS FLASH POST 01:01 Pre-evaluation result iron deposition 27 AX T1 FLASH FS PEL 02:38 Run liver evaluation 28 . Yes (recommended) Evaluation yes No vibe a divon tra bb 00-20 SIEMENS www.usa.siemens.com/healthcare Page 3 of 12 9. T1 VIBE qDIXON sequence – opens with suggested ROI position a. Plan slice volume to include entire liver and same breath-hold instructions b. Note: ROI can be repositioned by technologists i. Reposition ROI  Left click on ROI and drag to new location (or)  Left click on ROI until cursor changes, next hover over area of liver and left click to drop the ROI to the new location. c. Tip: ROI should not be placed over the gallbladder or a large vessel Patient Applications Transfer Edit Queue Protocol View Image Tools Evaluation Scroll System Add-On Options Help 14 IMA 30 / 30 3/4/2018 1Z IMA 10 / 30 244M4-31772- 3/4/2016 SP3 P3 ACS ACS ACS. BO2 SPA SPA NORM/DISZD TP H2 SP R1.16.1 p2NORM/DIS2D SPERMA . SP 1 0.8 |74/OUT_PHASE/NORM/DIS20 JP HIZ DES HASTE FoV 3091380 Sag COR TE HASTE ADD cor 1_vibe_e-docon_tra_br_pt .. Dot TA: 0:20 PM: ISO PAT: Voxel size: 1.2×1.2×3.5mm Rel. SNR: 0.69 X Guidance Parameters 22 AX T1 VIBE FS (CAIPI) POST 220 00:16 Check ROI and slice position and adapt if necessary. 23 AX T1 VIBE FS (CAIPI) POST (position the ROI if needed with a left mouse click) 00:16 24 AX T1 VIBE FS (CAIPI) POST 00:16 25 % AX T1 FLASH FS POST 00:45 26 COR T1 FS FLASH POST 01:01 27 AX T1 FLASH FS PEL 02:38 28 Evaluation yes 29 % vibe_q-dixon tra_bh 100 % 10. HISTO Sequence (Breath-hold Spectroscopy) a. Opens with Voxel Placement copied to the Placement of the ROI b. Tips i. Plan (Voxel) off Non-Distortion Correction images ii. Before opening the HISTO sequence make sure VIBE eDIXON sequence is located in the active graphic segment SIEMENS www.usa.siemens.com/healthcare Page 4 of 12 11. System automatically generates an additional series without Distortion Correction; load eDIXON series into all 3 graphic segments. a. Select 1 graphic segment > Right click > select Series b. Main Menu > Applications > 3D MPR 12. 3D Task Card (MPR’s) a. Create Coronal and Sagittal MPR reformats b. Save Coronal and Sagittal MPR reformats to the Patient Browser c. Tip: Perform MPR’s after loading eDIXON into the graphic segments (Step 11), so MPR’s are created off of the non-distorted images loaded in the graphic segments of the Exam Task Card. 13. Open the Patient Browser a. Select Coronal MPR and drag into Exam Task Card graphic segment b. Select Sagittal MPR and drag into Exam Task Card graphic segment 14. Exam Task Card a. Plan the HISTO voxel off all 3 planes b. Axial Plane – Check Voxel placement i. Use the tools: Reference Lines, Copy Image Position and Scroll Nearest to check voxel placement on Coronal and Sagittal images. c. Depress Ctrl key and select each segment with the left mouse > Main Menu > Patient > Save As (i.e., records voxel placement for Radiologists) d. Select Apply (Green Checkmark) – run HISTO sequence with same breath-hold instructions am $P3 SP3 ACS. ACS ACS Viewing R A R BO2 BO2 SP4 SP4 10 cm 10cm Filming MPR/MPR/M/WATER/NORM/ND 9 MPRIMPR/M/AWATER/NORMIND SPR119.4 | P4 M/WATER/NORMIND SP H21.6 FOV 380-380 MPR Range[1]> Sag 11_vibe_e-dixon_tra_bh_pr ... FoV 30 380 Dot TA: 0:15 PM: REF Vol: 30 x30 x30 mm Rel. SNR: 1.00 nisto SD X Guidance Parameters VI.UU 22 AX T1 VIBE FS (CAIPI) POST 220 00:16 Check voxel position and adapt if necessary. 23 AX T1 VIBE FS (CAIPI) POST 00:16 24 AX T1 VIBE FS (CAIPI) POST 20 00:16 25 % AX T1 FLASH FS POST 00:45 26 COR T1 FS FLASH POST 01:01 27 AX T1 FLASH FS PEL 02:38 O O 28 Evaluation yes 29 vibe_q-dixon_tra_bh 00:20 18% an LISTA SIEMENS www.usa.siemens.com/healthcare Page 5 of 12 15. Open the Patient Browser > load the following sequences into the Viewing Task card (i.e., check image quality) a. eDIXON – provides in one series, in-phase and opposed phase, fat and water, segmentation and a report. b. qDIXON – provides both segmentation and ROI Values c. HISTO Report (Histo only creates a report. ....... .. [23] t1_vibe_e-dixon_tra_bh_pre_opp [30] vibe_q-dixon tra bh_W [24] t1_vibe_e-dixon_tra_bh_pre_in MiCe_4-dixon_ra_bh_F Icom/ 11/7 IM [32] vibe q-dixon tra bh Report [25] t1_vibe_e-dixon_tra_bh_pre_F Coom1 7177 / /com/ / / / / /t [33] vibe_q dixon_ra_bh_FP [26] t1_vibe_e-dixon_tra_bh_pre_W [34] vibe_q-dixon_tra_bh_GoodnessOfFt Coom: 1177 7hs [27] t1_vibe_e-dixon_tra_bh_pre_W_SEG 35] vibe q-dixon tra bh R2s Ef [36] vite_q dixon_ra_bh_T2s_Eff [28] t1_vibe_e-dixon_tra_bh_pre_Report IL. [37] vibe_q-dixon_a_bh WP 000141 16. Viewing Task Card – IQ evaluation a. Evaluate eDIXON first i. Is the Fat image displaying Fat and Water image displaying Water? ii. Was the liver segmentation performed by the system good quality? iii. Does the segmentation include the entire liver or does it include more than liver tissue? i. Note: The segmentation cannot be altered, but if the segmentation isn’t optimal then the segmentation values in the qDIXON results page will be inaccurate. Patient Applications Transfer Edit View Image Tools Scroll Evaluation System Options Help O'HARA MARK HEURE 574-2016 23 MA 93772 O'HARA MARK HENRY F 1.31 MF 1.3 TR 6.7 TP F6 TE 2.4 D TP F6 BW 470.0 SP H4.1 TA 14.59 04 M/FAT/NORM DIS2D SL 3.0i BV 470.0 SP H4.1 309*380 p4 M/WATER/ SL 3.01 V 309*380 A1/DIXF 176*288 A1/DIXW 176*288 801-3;SP3,4 Tra Tra *fl3d2 / 10 376 BO1-3;SP3,4 154 *f13d2 / 10 377 163 AREIT O'HARA MARK HENRY 12:59.40 PM O'HARA MARK HENRY STUDY 1 MR E11 28 IMA 1 / Dual-Ratio Dixon Discrimination Result: normal Recommendation: no liver evaluation MF 1.31 TE 2.4 TA 14.59 TP F6 BW 470.0 SP H4.1 04 M/WATER/NORM/DIS2D SL 3.0i FoV 309*380 A1/DIXW 176*288 MF 1.00 BO1-3;SP3,4 Tra 1024-102 *f13d2 / 10 389 p4 SC 164 [t1_vibe_e-dixon_tra_bh_pre_Report Waiting for scan instructions Stimu=NM SAR=NM SIEMENS www.usa.siemens.com/healthcare Page 6 of 12 17. Viewing Task Card – IQ evaluation a. Evaluate qDIXON images and results i. Results Page – note Fat Signal percentage and R2* (R2* is 1/T2*) – displayed in seconds to the inverse of 1 (sec-1)   Values displayed for both the segmented volume and the ROI MR E11 STUDY 1 Liver Evaluation O'HARA MARK HENRY 32 IMA 1 / 2 voxels mean fit error ROI 58 Segmentation Volume 1.4% 66870 2.4% ROI 0% Fat signal percentage 60% mean std ROI 0.7% 0.6% Segmentation Volume 61.0% 46.6% Segmentation ROI Os^-1 R2* 400s^-1 mean std ROI 35.35^-1 2.6s^-1 MF 1.00 Segmentation Volume 34.1s^-1 14.2s^-1 512*512 vibe_q-dixon_tra_bh_Report 18. Poor Liver Segmentation leads to poor results for the segmented volume a. ROI will still have good results with proper placement. A Aera Aera Liver Evaluation MR E11 MR E11 # 26944020 HFS # 26944020 HFS STUDY 165524443 COHEN JENNIFER STUDY 165524443 +LPH voxels mean fit error 3/8/2016 COHEN JENNIFER 21 IMA 1 / 2 ROI 55 13.9% 9:17:28 AM Segmentation Volume 116299 10.5% 22 IMA 25 / 64 ROI _Segmentation 0% Fat signal percentage 60% mean std ROI 0.2% 0.7% Segmentation Volume 10.7% 1.6% Segmentation ROI 10cm Os4.1 R2* 400s^-1 mean sta BMW 1080 0 2 ROI 188.3s^-1 108.0s^-1 MF 1.00 p4 DIXON/ND FAT_FRACTION Segmentation Volume 138.3s^-1 128.3s^-1 p4 512*512 ibe_q-dixon_tra_bh_Report BO2,3; SP3,4 f13d6 / 4 Gray value 1 equals 0.1% SIEMENS www.usa.siemens.com/healthcare Page 7 of 12 19. Goodness of Fitness Map – Evaluation a. Image shows the segmentation and the ROI used b. Image Text, lower portion of the images – States “Gray value = .1%” i. Check Goodness of Fit and get a Mean Value  Draw an ROI over the liver (or)  Place a Pixel Lens ii. Mean Value times .1 = Goodness of fit %  Example: ROI/Pixel lens = 43, then Goodness of Fit = 4.3%  The Goodness of Fit should be 5% or less. Then this is an indication of the fitting residual errors, the fat parentage and the R2* results.  The smaller the value the more reliable the results MR E # 26919879 B/4/2016 165154091 ARA MARK HENRY 28:45 PM 55 IMA 25 / 64 1 Min/Max: 7 /136 1 Mean/SD: 43.7 /24.8 Area: 4.78 sq.cm 1 Pixel: 89 MF 1.16 EP 15,6 A,18 .7 64 DIXON/ND SL 5.51 FoV 314*380 A1. 208*320 | BO1-3;SP3,4 f13d6 / 4 9ml multihance Gray value 1 equals 0.1% Waiting for scan instructions Stimu=NM SAR=NM SIEMENS www.usa.siemens.com/healthcare Page 8 of 12 20. R2* Map – Evaluation a. Evaluate i. If Liver segmentation not performed properly ii. If Radiologist wants to evaluate an area of the liver not included in the ROI b. Image Text, lower portion of the images – ROI Mean Value = Value in sec-1 c. R2* Values are for Iron evaluation i. R2* Values increase – iron deposition increases MR 513 26919879 STUDY 165154091 3/4/2016 O'HARA MARK HENRY LPR 12:28:45 PM 56 IMA 23 / 64 Min/Max: 34 /297 Mean/SD: 160.5 /62.3 Area: 6.78 sq.cm Pixel: 125 10cm MF 1.16 HE 356 D TA 18.17 TP H17 SP H50' p4 DIXON/ND/R2_STAR_MAP SL 3.51 A1 208 320 1 BO1-3;SP3,4 9ml multihance ra f13d6 / 4 Gray value 1 equals 1.0 (s^-1) : 285- altiin for sean instructions Stimu- NM SAR- 21. T2* Map – Evaluation a. Decreasing T2 values – indication of increased iron deposition b. Acquire Mean Value i. Draw ROI on T2* Map ii. Multiple the Mean Value by 0.1 = Value displayed in ms Aera MR E11 # 26919879 HFS STUDY 165154091 +LPH 3/4/2016 O'HARA M HENRY 12:28:45 PM 57 IMA 21 / 64 Mean,3D 60.4.28. 1 Area 5.67 sq.cm 1 Ocra 4 DIXON/ND/T2_STAR_MAP FoV 314*380 208*320 | BO1-3;SP3,4 9ml multihance Tra Gray value 1 equals 0.1 ms W 3250 1048 SIEMENS www.usa.siemens.com/healthcare Page 9 of 12 22. Fat Fraction and Water Fraction – Evaluation a. Mean can also be displayed and evaluated Aera MR E11 # 26919879 HFS STUDY 16515 +LPH 3/4/2016 O'HARA MARK HENRY 32 1MA 23 / 64 Min/Max: 0 /153 SD: 27.7 139.1 Pixel: 61 64 DIXONIND/FAT_FRACTION FOV 208 32 BO1-3;SP3,4 9ml multihance Gray value 1 equals 0.1% Fat Fraction sera MR E11 26919879 HFS STUDY 165154091 +LPH 3/4/2016 O'HARA MARK HENRY 12:28:45 PM 58 IMA 20 / 64 1 Min/Max, 806/1009 5 Areat 11.48 sa.cm i Pixel: 221 10cm MF 1.16 54 DIXONIND/WATER_FRACTION FOV 31 `208 3 301-3;SP3,4 f13d6 / 4 9ml multihance Gray value 1 equals 0.1% = 1846 Water Fraction SIEMENS www.usa.siemens.com/healthcare Page 10 of 12 23. HISTO Results a. Displays i. Fat Percentage ii. R2 Value for Water (for Iron Evaluation)  Shows Fat that was T2 corrected and R2 of Water b. Spin Echo sequence with multiple echoes i. R2 value is displayed, not the R2* c. Color Bar Map i. Fat shown at top in a percent (%) ii. R2 Water = value in seconds inverted over 1 iii. Fit value = rsq fit “R-squared”  Value should be as close to 1 as possible, preferably >0.95 Patient Applications Transfer Edit View Image Scroll Evaluation System Options Help STUDY 1 MR E11 HISTO O'HARA MARK HENRY 80 IMA 1 / 3 Voxel 0% Fat signal percentage 60% value rsq. fit Voxel 2.2% 0.69 Voxel 10s-1 R2 water 30s-1 35s-1 45s-1 60s-1 value rsq. fit Voxel 27.6s-1 1.00 MF 1.00 512+512 HISTO_reports Colorbar_Report Waiting for ss Stimm-NM SAD- SIEMENS www.usa.siemens.com/healthcare Page 11 of 12 24. PACS – Image Archiving a. Tip – on some PACS systems the eDIXON, qDIXON and HISTO results will need to be saved as RGB (Red, Green, Blue) images i. Save As RGB Workflow  Open the Patient Browser  Select the Series  Main Menu > select Application > DICOM Tools > Save as RGB  New series created with RGB at end of series name (e.g., t1_VIBE_e- DIXON_tra_th_pre_F_RGB) 25. Tips a. When drawing ROI”s on the PACS system, confirm results have the same values as those drawn on the MR system. b. If Fat/Water Swap on the qDIXON the system will note an unusually high fat signal percentage on the qDIXON Report. (e.g., Water image displays fat, and fat image displays water) i. Refer to HISTO results in these instances Patient Applications Transfer Edit View Image Tools Scroll Evaluation System Options Help A A Aera HFS MR E11 STUDY 1 3/4/2016 STUDY 1 HFS +LPH 1:14:14 PM O'HARA MARK HENRY 3/4/2016 O'HARA MARK HENRY 50 IMA 17 / 64 51 IMA 64 / 64 R 1.20 MF 1.20 10 cm TR 15.6 D TR 15.6 TE 2.4 TE 2.4 D TA 18.17 TP F2 BW 1080.0 SP H52.4 TA 18.17 SL 3.51 BW 1080.0 SPF112 p4 DIXON WATER NORM DIS2D oV 281*340 p4 DIXON FAT NORM DIS2D FOV 281+347 A1/DIXW 208*320 1 Tra A1/DIXF BO1-3;SP 294 BO1-3;SP Tra ZU ZU *f13d6 / 4 116 *f13d6 / 4 349 151 STUDY 1 Liver Evaluation HFS O'HARA MARK HENRY STUDY 1 3/4/2016 +LPH voxels mean fit error 1:14:14 PM O'HARA MARK HENRY 52 IMA 1 / 2 ROI 69 1.7% 53 IMA 64 / 64 Segmentation Volume 69265 2.5% Unusually high fat signal percentage. Check for fat/water swaps. Run HISTO for comparison. 0% Fat signal percentage 60% mean std ROI 99.3% 0.6% Segmentation Volume 98.4% 4.5% Segmentation ROI 0cm MF 1.20 R2 400s^-1 std TA 18.17 mean BW 1080.0 SP F112.1 ROI 36.4s^-1 4.45^-1 p4 DIXON/ND FAT_FRACTION MF 1.00 Segmentation Volume FoV 281*340 13.5s^-1 512*512 208*320 p4 BO1-3;SP2-4 Gray value 1 equals 0.1%. Unusually ... vibe_q-dixon_tra_bh_Report f1396 74 Check for fat/water swaps. Run HIS .. C 1023 Waiting for scan instructions. Stimu=NM SAR=NN SIEMENS www.usa.siemens.com/healthcare Page 12 of 12