syngo.via MR Neurology Job Aid

SIEMENS Healthineers MR Neurology Job Aid Template Effective Date: 27 May 2019 | HOOD05162003010284 Job Aid Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Table of Contents Overview 3 SIEMENS Healthineers R MRN_Tumor_Perfusion 1/29/1966 M 1007291189 MR Neurology Maps Generation – Local AIF/Global AIF 5 MR Neurology Reading erfusion Mismatch Settings 10 Single Segments Curve Morpho ... Neurology Analysis 12 Viewing RHP Pre-Contrast Post-Contrast 3D Series Parametric Maps Morphometry Results ..... Findings No. of Timepoints: 50 Arterial Input Function (AIF) Perfusion Maps Global AIF Local AIF TTP PBP relCBF reIMTT relCBV relCBVCorrected o 4095 ASIST Perfusion Tools Delay Correction Synch Align Hide e Lines Reset Edit Snapshot Print Export Undo Redo Layout Image Image Select A Clear All Start Close 12:45 PM 2 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Overview (1/2) The MR Neurology* workflow provides perfusion SIEMENS Healthineers MRN_Tumor_Perfusion 1/29/1966 M 1007291189 parametric maps, mismatch evaluation, and the MR Neurology MR Neurology Reading signal intensity curve evaluation of the DSC Segments Perfusion Mismatch perfusion images. The generated maps can be Curve Morpho read in the Parametric Maps step. Viewing RHP Pre-Contrast Post-Contrast 3D Series Parametric Maps The Brain Morphometry is available in the Morphometry Results ..... workflow as well. Findings No. of Timepoints: 50 Arterial Input Function (AIF) Perfusion Maps Global AIF Local AIF TTP PBP relCBF reIMTT relCBV relCBVCorrected o 4095 ASIST Perfusion Tools Delay Correction Synch Align Hide e Lines Reset Edit Snapshot Print Export Undo Redo Layout Image Image 12:45 PM Select A Clear All Start Close * MR Neurology requires an additional license and might not be available in all countries. 3 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Overview (2/2) Using the arrow keys on the keyboard, you SIEMENS.: Healthineers MRN_Tumor_Perfusion 1/29/1966 M 1007291189 AH can go through the different phases. MR Neurology MR Neurology Reading Segments Perfusion The MR Neurology workflow has Mean Brain Neurology Curve Morpho ... Settings 6 preconfigured reading steps: Viewing RHP Pre-Contrast Post-Contrast 3D Series Parametric Maps • Viewing Morphometry Results ..... • Pre-Contrast 771 Findings O. .......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... Post-Contrast No. of Timepoints: 50 Arterial Input Function (AIF) • Perfusion Maps • 3D Series Global AIF Local AIF TTP PBP • Parametric Maps relCBF VreIMTT relCBV relCBVCorrected • Morphometry Results o 4095 ASIST Perfusion Tools Delay Correction L Synch Align Full Text Hide Hide Lines Reset Graphics Timepoi. Edit 4 Snapshot Print Export Undo Redo Layout Image Image Start Close 12:45 PM Select All Clear All 4 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Maps Generation • For the evaluation of Dynamic Susceptibility Contrast (DSC) images, Perfusion Maps two methods are available: • Global AIF Global AIF Local AIF • Local AIF TTP V PBP Motion Correction is available in both methods. relCBF ¥ reIMTT • ¥ relCBV relCBVCorrected • Both methods generate qualitative parametric maps. 4095 • The maps are created with different labels, depending on the ASIST Perfusion calculation method used: Delay Correction • Map name_GLOBAL • Map name_LOCAL Start Close 5 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Maps Generation – Local AIF (1/2) • No user interaction required. SIEMENS MRN_Tumor Perfusion X Healthineers * 1/29/1966 M 1007291189 MR Neurology Ca + MR Neurology Reading • The system looks automatically for a Maps Etal Cick representative Arterial Input Function (AIF) within Mean Brain Morpho .... Neurology Curve Seminge Viewing a 3 x 3 x 3 cm area. This selected AIF is used as a Pre-Contrast Post-Contrast local reference for the other pixels within the 3D Series Parametric Maps Morphametry Results same area. This will be repeated throughout the V for all scanned image data. Findings No. of Timepoints Arterial Input Function (AIF) Perfusion Maps Global AIF Local AIF V TTP PBP • Each voxel is analyzed. If signal-time curves are ¥ relCBF reIMTT relCBV relCEVCorrected identified as an AIF, these are used to calculate the 14 %. 4095 local AIF for the center voxel. ASIST Perfusion Tools Delay Correction Synch cape Hide Line: Bezet Export • At least 6 measurements without contrast are Print 12:47 PM Select All Clear All Start Close required for the detection of the baseline. 6 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Maps Generation – Local AIF (2/2) Perfusion Maps • The relCCBV map corrects the T1 effect of contrast remaining in the tissue. Global AIF Local AIF • Local AIF with T1 correction: Only the V TTP PBP relCBV will be corrected. If the T1 effects are ¥ relCBF ¥ reIMTT not corrected, this would cause the relCBV ¥ relCBV ¥ relCBVCorrected 25 to be underestimated. 20 4095 O 15 ASIST Perfusion 10 Delay Correction Corrected ΔR2* (1 / sec) -101 Uncorrected Start Close .15 20 40 60 80 100 120 140 160 Time (sec) Relative Cerebral Blood Volume Maps Corrected for Contrast Agent Extravasation Significantly Correlate with Glioma Tumor Grade, 7 Whereas Uncorrected Maps Do Not – AJNR Am J Neuroradiol 27: 859-67 / Apr 2006 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Maps Generation – Global AIF (1/2) • The user selects representative Arterial Input SIEMENS Healthineers MRN_Tumor Perfusion 1/29/1965 M 1007291189 Functions (AIF) in one image slice from a MR Neurology MR Neurology Reading MRN_Tumor_Perfusion Neuroradiologie Ertangen MRN_Tumor_Perfusion Neuroradiologie Erlangen 1007291189 Ref.: NC Station C32 1007291189 "1/20/1058, M. 44Y Ref.: NC Station C32 Trio Tim *1/20/1066, M, 44Y Trio Tim CURRENT MR B16 HES CURRENT MR B16 region of interest of 5 x 5 voxels. These 11/30/2007 11/30/2007 HES +LPH +LPH Perfusion ep2d_pert_p2 SwMI_Images Istest/Phase_16 Istest # 0004078051 selected AIFs are used as a global reference for STUDY ID 0004079951 STUDY ID 0004078861 11:33:51 AM 11:10:51 AM Morpha 13 MA 364 calculation of the parametric maps for the Viewing RAP Pre-Contrast Post-Contrast Som whole brain. 3D Series Parametric Maps F TR 1840.0 TE 32.0 TP O SP F20.0 TR 28.0 Morphometry Results T.A.00 05 BUY 1346.D FoV230-230 TE 20.0 TP C ...... p2 MYDIS2D 120*128 ENV 120.0 Tra>Con(.7)>Sag(-1) MIP : p2 AUSWUI/ND/NORM SP F29.6 206'3845 V AI/F'S Zoom 3.95 A1 Tra>Con(-7)>Sag(-1) T.HEA HEP W 1003 T.HEA HEP Tepfid2d1 128 /90 474 EsMi3dir / 15 236 • The AIF VOI needs to be placed manually. Findings 10 mi Gadovist 10 00ml No. of Timepoints: 50 Arterial Input Function (AIF) Perfusion Maps Global AIF Local AIF • The optimal AIF is near to the Circle of Willis on V TTP PRP relCBF reIMTT a vessel. Select the signal curves that represent relCBV relCBVCorrected the optimal healthy AIF. 4095 ASIST Perfusion Tools Delay Correction Full Text Hide Hide Lines Graphics Time po • 3 straight lines are shown on this graph: Fuport Unde Start Close • Baseline start – BLs 11:00 AM Select All Clear All Baseline end – BLe White line: The average signal intensity over time of the slice. • First pass end – FPe Red line: The average signal intensity over time of the selected voxels. • 8 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Maps Generation – Global AIF (2/2) Delay Correction is used to minimize the signal Perfusion Maps • drop delay in the different parts of the brain. Delay Correction uses the block-circulant Global AIF Local AIF • deconvolution method. V TTP ¥ PBP ¥ relCBF ¥ reIMTT ¥ relCBV relCBVCorrected O 4095 ASIST Perfusion ¥ Delay Correction Start Close 9 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Settings (1/2) Define which method should be used during workflow assignment. MR Neurology Settings X Perfusion Map Generation: Perfusion Map Settings Meancurve Settings Morphometry Settings First method offered when opening the workflow is identified by * Default Settings for Perfusion Map Generation • . *Global AIF Local AIF • Color LUT can be standardized for the maps. V TTP PBP relCBV M relCBF M reIMTT M relCBVCorrected Delay Correction Preprocessing Settings: Color LUT ASIST Perfusion • Automatic generation of local AIF maps. 4095 Either syngo.via automatically selects the dynamic data, or the user Preprocessing Settings for Perfusion Map Generation • Automatic generation of local AIF maps based on default settings defines the preferred dynamic series name. Automatic Selection of 4D DSC Perfusion Data Selection of 4D DSC Perfusion Data based on following Series Description: Number of phases required for preprocessing: Amount of Phases of selected 4D Data used for Preprocessings 60 + If the number of scanned series is higher than typed in the entered Generate New 4D data with at least one of the following options VMotion Correction Spatial Filter Width 3 mm number, only the number of series entered here will be used for the Newly generated 4D Data will be used as Input Data for Perfusion Map Generation calculation of the parametric maps. Send generated perfusion results directly to configured PACS Language for report English (United States) Restore i If the number of acquired phases is less than the preset, the system will not create the maps. OK Cancel 10 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Settings (2/2) • Patient movement during the acquisition can be corrected MR Neurology Settings X with Motion Correction. The Rigid Body model is used for the correction. Perfusion Map Settings Meancurve Settings Morphometry Settings Default Settings for Perfusion Map Generation *Global AIF Local AIF • The resulting motion-corrected series are called: V TTP PBP relCBV MoC series. M relCBF M reIMTT M relCBVCorrected Delay Correction Color LUT ASIST Perfusion 4095 • The system uses the first phase as the reference phase for correcting all subsequent phases. Preprocessing Settings for Perfusion Map Generation Automatic generation of local AIF maps based on default settings Automatic Selection of 4D DSC Perfusion Data • The Spatial Filter can be configured between 0 and 10 mm. Selection of 4D DSC Perfusion Data based on following Series Description: The higher the number, the blurrier the image. Amount of Phases of selected 4D Data used for Preprocessings 60 + Generate New 4D data with at least one of the following options VMotion Correction Spatial Filter Width 3 mm Newly generated 4D Data will be used as Input Data for Perfusion Map Generation Send generated perfusion results directly to configured PACS Language for report English (United States) Restore OK Cancel 11 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Analysis Dedicated layouts for reading the parametric SIEMENS • Healthineers R MRN_Tumor Perfusion * 1/29/1966 M 1007291189 ? MR Neurology maps. MR Neurology Reading MAN_Tumor_Perfusion Neuroradiolachs Erlangen MEN Tumor Perfusion Neuroradiologie Erlangen MRN_Tuner_Perfusion 1007291189 : NC Station C32 100723 1198 Ref .: NC Station C32 100720 1108 "1/228/1008, M. 44Y "1/20/1966, M. 44Y Trio Tim *1/29/1996. M. 44Y CURRENT MR BIS CURRENT MR 815 CURRENT 11/30/2007 HES 11/10/2017 HFS # 1/36/2007 Flak ora_5mm_TR-10000 gat Diff_3_0_1000 track_sp24_AOC RELCCBV_LOCAL_sp26_perf_p2 latest latest # #00-4378951 0804078651 STUDY ID 0004076851 STUDY ID 0004073861 STUDY ID 0004072351 11 :01:16 AM 11 :05:57 AM 11 :23:23 /4 Vean Bon Mean curve evaluation. Morphe. Sanings 4 IMA 10 1047 MA 1 FRM 16.025 • Viewing Pre-Contrast RAP RHP Post-Contrast 3D Series Parametric Maps 10 20 SL Mismatch evaluation. SPC F SPC • Morphametry Result: TI 2300.0 E R V TE 1040 TP O TR 340D.D TR 1940.₽ TA 01:53-2 SP 18.8 TE 91.0 TP O TE 32.0 SF FS. V 180"240 TA DO 04 FoV310-310 WOW 1345.0 FoV200 230 WNORWDI52D 24003304 BWV 1240.D p3 PDC/DIS2D 102;" 182s p2 MAGN/PERFIRCBY 128-120 Cor(-7)> Sag(-1) Con(7)> Sag(-1) ALAR Zoem 1.51 AUPEPWS Zoom 2.26 AUFS Zoom 3.42 1.HEAHEP THEA HEP THEANEP "epfid241_128 /99 n • Arbitrary units scale (relCBV, relCCBV, relCBF, Findings relMTT, PBP, and GBP). MEN_Tumor_Perfusion Neuroradiolapas Erlaspin MRN_Tumor_Perfusion roradiologie Erlangen MRN_Tunce_Partesion 1007291180 Ref.: NC Station C32 100723 1196 ef - NC Station C22 Tile Tim Trio Tim *1/20/1000. M. 44Y CURRENT CURRENT HES REIMIT LOCAL sp24 part_p2 ALAH 11/30/2017 CURRENT 11/20/2007 HES 11/36/ 2007 TIS sp24_part_p2 ALAH RELCBF_LOCAL_epid gert je Ester Latwat # 000-4078951 # 0004078951 # 030-4078951 STUDY ID 0004078851 STUDY IO 0004073851 11:33:36 AM 11:23:25 AM STUDY ID 0004078351 11 23:25 PM 1020 PAR 1 FRM 10/26 1028 MAI FRM 10025 1027 MAI FRM 16.25 • The color in the TTP map represents the time RAP RHP in seconds, while the color in the other maps 20 SPC F SPC 6.0 represents the signal intensity. Tools TIR 1840 D TPO TR 1840 D TP O TR 1940.2 Synch Ful Text Hice Lines TE 32 D TE 32.D TE 32.0 &P FS.8 Graphics Timepof. TA 00 05 SP F5.0 SP F5.6 FeV 230"200 TA DO.DS iner 1345.0 128 128 BrVS 1345 D FoV230 230 128-128 BOW 1345.0 FoV 230-230 PZ MAGN/PERFAMIT 128-128 ra>Con(-T>> Sage1) PZ MAGN/PERF/TTP Cer(-7)> Bag(-1) p2 MADN/PERFIRCOF Tra>Con(-7>> Sag(-1) AL/FS Zoom 3.02 AUFS Zoom 2.02 AUFS Zoom 3.92 Pring Expor Undo THEAHEP THEA HEP THEANEP Peptid261_129 / 60 "spfid241_128 /90 11:32 AM Centraet agere 10 00ml 12 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Mean Curve Analysis (1/2) • Dedicated layout with morphology image and SIEMENS MRN_Tumor Perfusion Healthineers . 1/23/1966 M 1007291189 maps for evaluating different parts of the brain. MR Neurology MR Neuro Mean Curve Statistics Table MR Neurology Reading MRN_Tumer_Perfusion radiologe Erlangen MRN_Tumor_Perfusion Neuroradiclapis Erlangen 1007291180 1007201180 Ref.: NC Station C32 ID Measurements Flair tra 5m ... Diff tra_0 10 ... RELCCBV LOC ... 1/20/1005: M. 44Y @f.: NC Station C32 Trio Tim *1/29/1000, M. 44Y Trio Tim CURRENT MR 815 Mean 321.7 1567.6 482.8 HFS CURRENT 11/3/2007 11931/2007 HE'S MC1 LAH +LPH (F5.6) Min/Max 148.01400.0 993.0/2105 0 157.0/698.0 Sm_TR-10000_pus Dittaim_0_1000_trase_sp26_ADC Ratio 175.3 % 127.0 % 175.9 % ID 009-4078951 800 076851 STUDY ID 0004073851 11:0965 AM STO • Hemisphere line and mirror ROI for referencing the Viewing ROI on the other hemisphere. Pre-Contrast Post-Contrast 30 Series Parametric Maps LF F Morphometry Results TI 2500 0 V TR 10000.0 TP O ROI pixel information statistics that can be TE 1040 SP F5 8 TR 3400.0 • SLOD TE 910 SP F5.0 SLO.0 FoV 260-276 Bre 125) 40.0 FoV 256-275 MPR THICK: ANORMDIS2D 192; 192: Tra>Co (-7)>Sap(-1) MER THICK : p3 ADC/DIS2D JW/PFPFS Con(-7>> Sag(-1) THEAHEP THEAHEP 26 21 exported as csv file. "tir ld ir 21 / 168 392 "sp_to_1000 790 Findings mvc1 Ratio (%) MRN_Tumor_Perfusion 1007291180 "1/20/1001. M. 44Y CURRENT Possible to use two types of ROIs: 1 1/10/2007 • RELCEFV_LOCAL_ep2d_pert_PZ DOD4178951 STUDY ID 002-078351 • MCEval Ellipse ROI 1047 [MAA -1 FFIA -15 • MCEval Free Hand ROI Tool Selected 4D Series: Current.MR.ep2d_perf_p2.latest TR 1840 0 Hide Graphics Hide Lines Reset Tinte pot TE 32 D DA01346 0 MPR THICK : p2 PERF/RCBV AVES Print Export T:HEATHER Image "aptid2d1_128 / 00 imal time (see) 11:37 MC1 Save Finding Close 13 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 MR Neurology SIEMENS Healthineers Mean Curve Analysis (2/2) • Two types of curves: Mean MRN_Tumor_Perfusion Neuroradiologie Erlangen 1100 1007291189 Ref.: NC Station C32 , MC1 • Signal Intensity Curve *1/29/1966. M. 44Y V SP F5.6 Trio Tim CURRENT VB6DA 11/30/2007 1000 906 Normalized Curve RELCCBV_LOCAL_ep2d_perf_p2 • latest # 0004078851 STUDY ID 0004078851 11:23:24 AM 1047 IMA ~1 FRM ~16 • The Signal Intensity Curve shows the true signal intensity value of both ROIs. 600 500 The Normalized Curve shows the signal intensity TR 1840.0 • TE 32.0 SP F5.6 PLO.0 B\nº1345.0 FoV 275*256 MPR THICK : p2 PERF/RCBV 128"128 value in relation to the value in the first phase. A1/FS Tra>Con(-7)>Sag(-1) 300 T:HEA; HEP 906 "epfid2d1_128 / 90 453 100 Local AIF: relCBVCom Normal time (sec) Ratio (%) MRN_Tumor_Perfusion Neuroradiologie Erlangen 1007291189 Ref.: NC Station C32 MC1 *1/29/1966, M. 44Y VSP F5.6 Trio Tim CURRENT VB6DA 11/30/2007 HFS RELCCBV_LOCAL_ep2d_perf_p2 +LPH latest # 0004078851 STUDY ID 0004078851 11:23:24 AM 1047 IMA ~1 FRM -16 -20 F TR 1840.0 TE 32.0 SP F5.6 SL 6.0 BUL01345.0 FoV 275 256 MPR THICK : p2 PERF/RCBV 128*128 A1/FS on(-7)> Sag(-1) T:HEA;HEP 906 "epfid2d1_128 / 90 453 80 100 Local AIF : relCBVCom Normal time (sec) MC 10 ml Gadovist 10.00ml myMC1 14 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021 SIEMENS Healthineers Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. © Siemens Healthcare GmbH 2021 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens-healthineers.com 15 Effective Date: 12 Nov 2021 | HOOD05162003237330 Unrestricted © Siemens Healthineers, 2021