Val M. Runge, MD Editor-in-Chief Investigative Radiology

Transcription

1 Val M. Runge, MD Editor-in-Chief Investigative Radiology

2 Patients First RSNA 2012 The classical model of medical care which portrays the authoritative physician evaluating and treating an obedient, non-inquisitive patient is rapidly crumbling, Patients have immediate access to countless resources for information. Radiologists should be a part of the movement to build another model in its place George S. Bisset III, MD (President, RSNA 2012)

3 RSNA 1982 ASNR 1984 Kidney Gd DTPA (Magnevist) MR Cr EDTA Brain Abscess CT Cornelius G. Dyke Award Courtesy of: Val M. Runge, MD

4 1982 Vanderbilt Aberdeen Courtesy of: Val M. Runge, MD

5 Magnevist AJR 142: , 190: , March w AJR 142: , March 1984 Hanns-Joachim Weinmann

6 Primovist Magn Reson Med 22: , December 1991

7 Primovist Gadovist Magn Reson Med 22: , December 1991 Invest Radiol 29: , July 1994

8 Linear Gd Chelates Macrocyclic Gd Chelates

9 Perfusion, Permeability Invest Radiol 2012;47:252 Imaging faster, providing improved patient comfort, and obtaining assessments of disease hereto not possible Quantification of Perfusion and Permeability in Multiple Sclerosis Dynamic Contrast-Enhanced MRI in 3D at 3T Michael Ingrisch, MSc,* Steven Sourbron, PhD, Dominik Morhard, MD, Birgit Ertl-Wagner, MD, Tania Kümpfel, MD, Reinhard Hohlfeld, MD, Maximilian Reiser, MD, and Christian Glaser, MD Assessing cerebral blood flow (CBF) and cerebral blood volume

10 Lesion (Gd 3+ ) Detectability Invest Radiol 2013;48:55 Technological advances are providing improved tumor detection

11 CE-MRI plays a key role in multiple sclerosis (MS) diagnostic imaging CE-MRI is the diagnostic gold standard for MS w Incorporated into the McDonald evaluation criteria w CE-T1 MRI recommended for each patient in consensus guidelines Enhancing T1 lesions are active indicate acute disease w Uniform enhancement of new lesions w Ring-like enhancement of acute lesions as they temporally evolve, and of reactivated old lesions

12 Gadovist in Follow-up and Therapy Monitoring Case history Before treatment with Betaferon 33-year-old woman with previous diagnosis of relapsing-remitting multiple sclerosis Results w No enhancing 12 months after start of treatment with Betaferon lesions, no new T2 lesions w Excellent clinical treatment response Courtesy of: Alex Rovira MD Rovira A et al. Mult Scler 2009; 15: Rovira A J. EJHP Practise 2009: 15(6): T2 T1 with gadobutrol

13 Gadobutrol in Pediatrics CNS: Suprasellar tumor (astrocytoma) 9-year-old boy Kidney: Solid nephroblastoma 6-year-old boy Mild increased signal intensity within the lesion with gadobutrol (arrow) Contrast excretion (arrows); localization and appearance suggest nephroblastoma Courtesy of: G. Hahn, Dresden, Germany Courtesy of: H-J. Mentzel, Jena, Germany

14 CAD analysis: malignant lesion Non-enhanced T1w imaging Post contrast T1w imaging Subtraction imaging CAD Analysis Courtesy of: Lale Umutlu, University of Essen

15 Multiparametric MR Invest Radiol 2012;47:624 Increasing the certainty of diagnosis, leading to improved patient treatment and outcomes

16 Invest Radiol 2012;47:376, 2013 (on line) Improved efficacy of contrast media, leading to improved depiction of disease Gadovist Dotarem

17 Compressed Sensing (for CE-MRA) Magn Reson Med 2013;69:346 This approach will have impact in many areas, initially for dynamic processes but eventually for all of clinical MR, leading to improved patient satisfaction (enabling shorter, and less invasive diagnostic exams) 0.8x0.8x0.8 mm 3 1 sec/volume Courtesy of: Mark Griswold, PhD

18 Cardiovascular MR Imaging beyond and 1M GBCA MRA 0.8x0.8x0.8 mm 3 ; R=4 Dynamic MRA 0.8x0.8x0.8 mm 3 ; R=4 3D PC GRE (300cm/s) 2.5x2.2x2.8 mm 3 ; R=2 Courtesy of: Bernd J. Wintersperger, University of Toronto

19 Myocardial Assessment beyond Late Enhancement Myocardial T1 Mapping and ECV Assessment ms +HCT % T1-Map pre-gd T1-Map post-gd Extracellular Volume Map Courtesy of: Bernd J. Wintersperger, University of Toronto

20 CAIPIRINHA-DIXON-TWIST (CDT) VIBE A new technique for fast time-resolved dynamic 3D imaging of the abdomen with high spatial resolution Invest Radiol 2013;(in press) Allowing dynamic imaging of the upper abdomen with high temporal resolution and maintained high spatial resolution Michaely, Morelli, Budjan, Riffel, Nickel, Kroeker, Schoenberg, Attenberger 14 dynamic 3D frames acquired in a single breath-hold (colorectal cancer) Courtesy of: Stefan Schoenberg, MD, and Henrik Michaely, MD

21 MR-PET Pancreatic neuroendocrine tumor 68 Ga DOTA-TATE Combining the high sensitivity of PET with that of contrast enhanced MR, and its intrinsic high spatial resolution Colorectal cancer recurrence after hemihepatectomy Courtesy of: Michael Lell MD

22 Future Developments w Higher relaxivity w Targeted agents w Lower dose Carbon Nanotubes, with a 4000 fold gain in sensitivity Thrombus imaging, lymph node (metastasis) imaging M M Courtesy of: Hubertus Pietsch, PhD

23 Conclusion w Contrast media are an integral part of MR today, providing increased sensitivity and specificity critical to improving diagnosis, therapy, and outcome w In the next decade we will see further advances in contrast media design and safety, playing an important role in a patient centric approach