MRI manufacturers demonstrate the latest innovations, upgrades and enhancements

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by John Bonner

MRI has opened up the human body for radiologists to explore with remarkable precision and to gather clinical information of enduring value for physician colleagues, but the liver has so far proved a real diagnostic challenge. A combination of the organ’s complex vasculature and motion effects in free-breathing patients have meant that other modalities have often been chosen instead of MRI, particularly when looking for metastases in oncology cases.

This situation is changing due to the efforts of imaging vendors who have been working on expanding the role of this technology in body imaging. Visitors to the commercial exhibition can inspect a new software application which improves temporal resolution in MR images along with other developments that make scans both safer and more comfortable for patients.

SIEMENS is unveiling a technology that it says will make contrast-enhanced liver imaging fast and robust and allow free-breathing dynamic liver imaging, giving more patients access to high quality MR-based abdominal imaging.

Siemens’ Twist-Vibe MR sequence is designed to enable correct contrast imaging in dynamic liver MRI, allowing fast, robust liver imaging with full 4-D coverage. This series of images shows how the new technology can boost lesion enhancement within the arterial phase: with Twist-Vibe, it is now possible to generate multiple stacks of images from the arterial phase to follow the lesion enhancement over time. (Provided by University Hospital IKRN, Mannheim, Germany)

Siemens’ Twist-Vibe MR sequence is designed to enable correct contrast imaging in dynamic liver MRI, allowing fast, robust liver imaging with full 4-D coverage. This series of images shows how the new technology can boost lesion enhancement within the arterial phase: with Twist-Vibe, it is now possible to generate multiple stacks of images from the arterial phase to follow the lesion enhancement over time. (Provided by University Hospital IKRN, Mannheim, Germany)

Dr. Bernd Ohnesorge, chief executive of Siemens’ MR business unit, explained that the key software technologies underlying the company’s new Twist-Vibe and StarVibe features will be available together as a package called FREEZEit. The former is a sequence that offers high temporal and spatial resolution with full 4D coverage for multi-arterial imaging with 100% precise contrast-timing. Meanwhile, StarVibe is an application that delivers robust, free-breathing, and contrast-enhanced exams for non-compliant patients by resisting motion artefacts.

“These are acceleration techniques that allow us to do body and liver imaging at such high speed that it creates a genuine breakthrough in temporal resolution. So even in an organ as notoriously difficult to image as the liver, we can eliminate motion artefacts while also substantially enhancing contrast timing. Together that makes for a very accurate diagnosis,” he said.

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12
Mar 2014
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New ESR President wants to draw national societies close

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ECR Today caught up with incoming ESR President Professor Lorenzo Bonomo at ECR 2014, and asked him about his vision for the year to come.

ECR Today: What are your plans and ambitions regarding your presidency?
Lorenzo Bonomo: It is with great pride that I take on the presidency of one of the most important and prestigious international scientific societies in the world. I’m also particularly pleased that my presidency coincides with the ESR’s tenth anniversary, which we’ll be celebrating next year.

New ESR President, Prof. Lorenzo Bonomo, from Rome.

New ESR President, Prof. Lorenzo Bonomo, from Rome.

So much has been done over the past few years thanks to the work of my predecessors, the Executive Council, the statutory committees, subcommittees, working groups and the tireless and efficient support of the ESR staff. Many of the objectives in the roadmap approved in 2012 have been achieved together with other new important projects, started during Prof. Frija’s presidency, and it will be my duty to consolidate and bring them to a conclusion. Among them are the development of a clinical decision support system in Europe, the creation of an accreditation council, and a strengthening of relations with other scientific societies in Europe and the EuroSafe Imaging Campaign. The whole learning, education and training field certainly requires close attention and a collaborative vision.

I would also like to draw the national societies closer, by intensifying dialogue with them, trying to understand their needs, and helping them to promote and increase the visibility of radiology. I would like my role to be that of a facilitator supporting the ongoing projects and promoting the start of new activities that committee chairpersons intend to achieve.

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10
Mar 2014
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Caceres’ Corner Case 88 (Update: Solution)

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Dear Friends,

Muppet considers himself a celebrity and, like everybody else, he wants to show you a selfie. Today’s case is provided by my good friend Dr. Fernandez Alarza. Radiographs belong to a 33-year-old woman with moderate dyspnoea. I showed it to Muppet and since he is the smartest guy in the Universe, he made the right diagnosis up to the last finding.

Can you guess Muppet’s diagnosis? What do you see?

Leave your thoughts in the comments section and come back on Friday for the answer.

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10
Mar 2014
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Shoulder imaging and intervention

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Watch this session on ECR Live: Monday, March 10, 08:30–10:00, Room B
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Shoulder imaging and intervention are becoming more important in clinical practice as ageing populations and patient expectations have increased demand. The shoulder is also one of the joints in the human body that can suffer from a number of pathologic conditions, in both young and elderly patients, such as rotator cuff tears and tendinosis, subacromial-subdeltoid bursitis, calcific tendinopathy, and degenerative conditions.

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Shoulder imaging and surgery have developed in parallel over the last 20 years, and the introduction of minimally invasive surgical techniques has revolutionised shoulder interventions, which have been facilitated by accurate pre-operative diagnosis. The shoulder is an anatomic area that is very commonly evaluated with musculoskeletal ultrasound as it is accurate, quick, cheap, easily performed, well-tolerated by patients and can be combined with a dynamic examination and interventional procedures.

“MRI provides more general information about the shoulder, but many patients find the examination unpleasant due to noise and pain. Others are excluded from MRI because of claustrophobia or having an embedded electronic device such as a pacemaker. Also MRI cannot be performed as a dynamic examination, it often misses rotator cuff calcification, and the equipment is very expensive. As in many other fields, both techniques rely on high-quality equipment and are operator or interpreter dependent”, said Dr. Ian Beggs, musculoskeletal radiologist at the Royal Infirmary of Edinburgh.

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10
Mar 2014
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Experts share strategies to help radiologists justify their imaging decisions

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Watch this session on ECR Live: Sunday, March 9, 16:00–17:30, Room F1
Tweet #ECR2014F1 #SF15B

Evidence-based radiology, comparative effectiveness research and health technology assessment all play a role in the radiologist’s decision-making nowadays. Radiologists must ensure that they are imaging patients at the right time using the right test, and they need to justify radiological examinations and imaging-based interventional procedures on the basis of the best available evidence. The dedicated Special Focus session today at ECR 2014 will teach attendees how to use evidence to justify imaging decisions in day-to-day clinical practice.

The case against overtesting

The case against overtesting

Evidence-based radiology is a relatively new approach designed to inform clinicians of the most appropriate technique to use in a given clinical scenario. It has always been an important topic, but people have recently become more aware of this theme and expect more justification from the physicians, according to Professor Myriam Hunink, who will chair the session. She is a professor of radiology and clinical epidemiology at the Erasmus University Medical Centre in Rotterdam, the Netherlands, and adjunct professor of health decision sciences at Harvard University, Boston, USA.

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Sunday’s sessions for radiographers

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This year’s ECR programme features another great selection of sessions aimed at radiographers. ECR Today spoke to Jonathan McNulty, co-chairman of the ECR 2014 radiographers subcommittee, and Prof. Graciano Paulo, president of the European Federation of Radiographer Societies (EFRS), for their views on the sessions taking place on Sunday.

RC 1214: How important are state-of-the-art displays to radiology?
Watch it on ECR Live: Sunday, March 9, 08:30–10:00, room BRA
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Jonathan McNulty: Most of the technology we use now in Europe is digital, so what this session aims to look at is the state-of-the-art displays we are using today in medical imaging. Their quality is essential so that we continue to be able to pick up on the most subtle anatomical and pathological detail in our images, so the resolution and contrast specifications are important, as are design features that help minimise reflection or glare. A lot of research and design goes into the primary class displays that radiologists use to report from, because that report is vital and can change things dramatically for a patient if a pathology is picked up or missed. There has also been a lot of discussion about handheld devices and the appropriateness of using iPads, other tablets, smartphones or PDAs to view radiology images. Dr. Rachel Toomey, one of the speakers in this session, has done quite a lot of research looking at such devices, which can be very good for reviewing certain types of radiological images but are far from suitable for others.

So this session is going to show what the primary class displays are capable of and why we use them; what the advantages of the more portable devices are and when they can be used appropriately; and then the final presentation will look at quality assurance. Whatever display you use, whether it is a primary class display, a smartphone, or a regular PC monitor, what do we need to keep in mind? What are the quality assurance requirements for clinical use? What do we need to do to on a daily, weekly, or monthly basis to make sure that our displays are not dropping below their peak performance level?

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“Cooperation, not competition,” say speakers ahead of ESR Meets ESC session

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Watch this session on ECR Live: Saturday, March 8, 16:00–17:30, Room B
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At each ECR Since 2007, the ‘ESR meets’ programme has included a partner discipline along with the three guest countries, as a way to build formal bridges between the European Society of Radiology (ESR) and other branches of medicine, and to give congress participants an opportunity to learn about something a little different. At ECR 2014, the programme includes a visit from undoubtedly the largest medical discipline to take part in the initiative so far: cardiology, represented by one of the biggest medical societies in Europe, the European Society of Cardiology (ESC). Cardiology has much in common with radiology, but this is the first time that the two European societies have come together for an official joint session at a major meeting.

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Radiographers sessions on Saturday

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This year’s ECR programme features another great selection of sessions aimed at radiographers. ECR Today spoke to Jonathan McNulty, co-chairman of the ECR 2014 radiographers subcommittee, and Prof. Graciano Paulo, president of the European Federation of Radiographer Societies (EFRS), for their views on the sessions taking place on Saturday.

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MRI reveals the human connectome

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Watch this session on ECR Live: Friday, March 7, 16:00–17:30, room BRB
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Radiologists often say that the brain is the next frontier. But as diffusion MRI techniques progress, the most mysterious organ in the human body starts to unveil more and more of its secrets, and what was once inconceivable a decade ago is now almost at hand.

White matter fibre pathways of the brain as depicted with MR tractography. (Provided by Patric Hagmann, CHUV-UNIL, Lausanne, Switzerland)

White matter fibre pathways of the brain as depicted with MR
tractography.
(Provided by Patric Hagmann, CHUV-UNIL, Lausanne, Switzerland)

Researchers are now better able to understand how neurons connect with one another and how disease affects these connections in the human brain. The production and later study of maps of neural connections obtained with MRI are vital to this task. A dedicated New Horizons session will cover this fascinating topic today at the ECR.

Patric Hagmann, who will chair the session, is an attending physician and neuroradiologist at Lausanne University Hospital (CHUV, Centre hospitalier universitaire vaudois) in Switzerland. In his introduction, he will describe what he calls the connectome, a term he coined in his thesis on diffusion MRI and brain connectomics back in 2005*.

“We could sum up the connectome as a comprehensive map of neural connections in the brain. The production and study of connectomes is what we refer to as connectomics; it may range from a detailed map of neurons and synapses within part of, or all of, the nervous system to a description of the functional and structural connectivity between all cortical areas and subcortical structures,” he said.

In his presentation, Hagmann will not only introduce important concepts related to connectomics like scaling, the relation between structural and functional connectivity, and the integration-segregation, but also show how advances in MRI facilitate the mapping of the human connectome.

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07
Mar 2014
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American and European emergency radiologists compare experiences

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Watch this session on ECR Live: Friday, March 7, room F1
Four separate sessions, starting 08:30, 10:30, 14:00, and 16:00
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For the fourth year in a row, the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA) will hold a joint course on a hot topic in radiology. After oncologic imaging for the past three years, emergency radiology will be under the scope of North American and European radiologists, who will share and compare their experiences in the dedicated Mini Course today at the ECR*.

MDCT is the best modality for identifying lesions as subtle as active mesentric bleeding and infiltration (arrow) caused by blunt abdominal injury (lap-belt compression). (Provided by András Palkó)

MDCT is the best modality for identifying lesions as subtle as active mesentric bleeding and infiltration
(arrow) caused by blunt abdominal injury (lap-belt compression). (Provided by András Palkó)

Medical emergencies and trauma are responsible for high levels of morbidity and mortality in all age groups worldwide, and trauma is the leading cause of death in people younger than 45. Consequently, the use of imaging in emergency departments has been increasing exponentially since the 1990s. The demand for CT examinations from emergency departments is, for instance, growing annually by 5% to 15%, depending on the institution.

Even with all the advanced tools imaging has to offer, trauma remains a challenge for most emergency services, according to Ulrich Linsenmaier, associate professor of radiology and head of the department of diagnostic and interventional radiology at KMPP Clinics in Munich, Germany. “Even for advanced level 3 medical centres running their own emergency radiology unit, it is a challenge to integrate advanced radiology services into an interdisciplinary team treating patients with acute traumatic and non-traumatic emergencies,” he said.

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Mar 2014
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