Initial Clinical Experience of TOSHIBA 3T MRI

The 21st Conference of the Japanese Society of Cardiovascular Imaging & Dynamics Sponsored Seminar The Leading Edge of CT/MRI Diagnosis for the Cardiovascular System Initial Clinical Experience of TOSHIBA 3T MRI Focuses on the Cardiovascular System Toshiaki Nitatori, M.D. Professor & Chairman, Department of Radiology, Kyorin University, Faculty of Medicine Our hospital has been operating its first Toshiba Vantage Titan 3T MRI in clinical practice since September 1st 2010. The Titan 3T is characterized by its wide open bore(see Fig. 1). The 71cm bore alleviates claustrophobia even in large patients, making an examination easier to facilitate. Greater space in the bore between the patient and the gantry is more suitable for emergency patients, patients encumbered with monitoring equipment, and patients unable to lie in the supine position. The Titan 3T also incorporates Toshiba s unique Pianissimo silencing technology which keeps the operating noise level equivalent to the 1.5T MRI. Multi-phase Transmission, the world's currently highest specification with two channel and four port power supply, effectively reduces image irregularities even in chest and abdomen. This seminar describes the clinical efficacy of the Titan 3T, primarily for cardiovascular region. 1 3T MRI TECHNICAL CHARACTERISTICS AND MULTI-PHASE TRANSMISSION There are 2 principles of physics which determine the extent to which the 3T MRI amplifies the NMR signal; the magnetization vector is proportional to the static magnetic field streng th, and the current induced in the receiver coils is proportional to the frequency. Since the electromotive force generated when the magnetic field cuts across the coil is proportional to the change in the magnetic field over time, in accordance with Faraday s Law of Induction, the resonance frequency for 3T MRI of 128MHz is twice that with the 1.5T. Furthermore, since signal strength is proportional to the square of the static magnetic field strength, the signal strength for 3T MRI is theoretically a maximum of four times that with the 1.5T. However, as the static magnetic field strength increases, the signalto-noise ratio is reduced by the following factors:(1)thermal noise from the body of the patient,(2)system noise generated by the equipment electrical circuits,(3)noise generated by the difference between the spin frequency and resonance frequency due to magnetic susceptibility and chemical shift effects, and(4)extension of T 1 relaxation time due to increased resonance

Initial clinical experience of TOSHIBA 3T MRI frequency, with consequent reduced signal strength which delays recovery of longitudinal magnetization. The signal-to-noise ratio for 3T MRI is therefore limited to approximately twice that with the 1.5T. There is also a significant problem with 3T MRI from an increase in RF irregularities. Since its release, therefore, the efficacy of 3T MRI has been greater for the head area while application to the abdominal area and cardiovascular organs has proved difficult. Efforts by the manufacturer to resolve this problem have led to development of Multiphase Transmission technology. Multi-phase Transmission ensures uniform RF strength distribution, and reduced image irregularities. Toshiba Medical Systems 3T equipment is the first of its type in Japan, and currently has the world s highe s t s p e c i f i c a ti o n, w i t h t w o R F amps and a four-port power supply (Fig. 2). In the Titan 3T, this technology produces images with reduced irregularities and facilitates its expanded application in the upper abdominal area and chest region, previously a problem with 3T MRI (Fig.3, 4). Open Bore Magnet Gradient coil Whole-body QD coil conventional system Vantage Titan Obese patient Claustrophobic patient Difficulty for supine position Fig. 1: Advantages of Vantage Titan 3T open bore system Phase Amplitude Phase Amplitude Phase Amplitude Phase Amplitude Fig. 2: Multi-phase Transmission to achieve homogeneous RF distribution 2

INITIAL CLINICAL EXPERIENCE OF THE TITAN 3T IN THE CARDIOVASCULAR REGION With 3T MRI, the heart is subject to the effects of susceptibility artifacts and SAR(specific absorption rate) restrictions, which has proven to make imaging this area difficult in the past. The Titan 3T, however, produces very clear images(fig. 5 8). Static and RF magnetic field irregularities as well as SAR restrictions have made it difficult to use True- SSFP images, the primary method used with the 1.5T for 3T cardiac MRI. Susceptibility artifacts and banding artifacts are particularly noticeable in cine MRI with 3T equipment(fig. 9). T1WI T2WI T1WI In Out Gd T1WI Gd FLAIR T2WI fatsat T2WI T2WI Fig. 3: Various images demonstrating encephaloma Fig. 4: Liver metastases in patient with history of breast cancer. BB FatSAT T2 Fig. 5: FSE T2 weighted Black Blood images with FatSat on a 60 y/o male with acute myocardial infarction. Improvement in the SNR and CNR for normal myocardium and myocardium with edema are demonstrated. Cine Fig. 6: Cardiac MRI -1 3

Initial clinical experience of TOSHIBA 3T MRI Artifacts were therefore suppressed by shifting the center frequency(f 0 ). Changing the center frequency from 0ppm, to 1.0ppm and to 1.5ppm resulted in a shifting of banding artifacts on the screen as shown in Fig. 10. The area of interest to image the heart is narrow and shifting banding artifacts to other areas ensures a satisfactory image as shown in Fig. 11, however, there is still room for improvement. For example, with cardiac muscle perfusion MRI, the use of TrueSSFP results in pseudo defects due to irregularities in the local magnetic field, with consequent deterioration in image quality. IR-FFE is therefore currently used in place of TrueSSFP to resolve this problem. On the oth- Cine HEART Rate 87 Fig. 7: Cardiac MRI -2 Fig. 8: Cardiac MRI on patient with elevated heart rate of 87 bpm Shift the center frequency(f0)to control artifact TrueSSFP TR4.2/TE2.1/ FA44/7mm Fig. 9: Cine MRI on 3T(normal volunteer)demonstrating susceptibility and banding artifacts. TR/TE=4.2/2.1, FA 46 myocardium short axis illustration Fig. 10: Prevention of banding artifact Occurrence repetition Acquisition with long TR/TE Region difficult to achieve field homogeneity Region of occurrence Depends on individual difference Occurrence frequency Variation cycle of +/ 1ppm from center frequency Prevention method Use short TR/TE SSFP sequence 4

er hand, with 3T equipment used in cardiac MRI, extension of the tissue T 1 relaxation time has the major advantage of extending the duration of tags with the tagging method (Fig. 12). USE OF 3T HIGH SIGNAL-TO-NOISE RATIO IN THIN SLICING The most significant characteristic of 3T equipment in cardiac MRI is the ability to use the high signal-tonoise ratio in thin slicing. Thin slice imaging was not practical with 1.5T equipment, however it is now used aggressively with 3T MRI(Fig. 13, 14). The advantage of thin slice i m a g i n g l i e s i n t h e a b i l i t y t o use whole heart late gadolinium enhancement for delayed cardiac contrast MRI. The heart is imaged in thin slices as with multi-slice CT imaging, and these images are assembled together to produce a variety of images (e.g. short and long axis, and fourchamber views)for observation. With the 1.5T equipment, slice thickness was 3mm, reducing to 1.5mm with interpolation, however 3T MRI permits a slice thickness of 1. 5 mm o r 0.75 mm, p r o v i d i n g assembled images of high spatial resolution(fig.15). 1.5T Diastole Systole 3T Fig. 11: Cine MRI(SSFP) old myocardial infarction TR/TE=3.4/1.7, FA42 Diastole Systole Fig. 12: Tagging method comparison between 1.5T and 3T Tagging label is sustained over time because of extended T1 relaxation time on 3T 3D-FLAIR MPV T1WI DWI Fig. 13: Multiple sclerosis Fig. 14: Hepatocarcinoma Hepatic cellular phase TR/TE=3.7/1.3; MX=588*640 NS=100; ST=2; Time=19s 5

Initial clinical experience of TOSHIBA 3T MRI Furthermore, both FBI and Time- SLIP methods can be used to extract very fine detail from 3T MRI when using non-contrast magnetic resonance angiography(fig. 16). SUMMARY This seminar has described our initial clinical experience with the Titan 3T, primarily in the cardiovascular field. I would like to take this opportunity to express my thanks and respect to the technical personnel who strives to improve the system s technical performance. Toshiaki Nitatori, M.D. 1978 M.D. in Medical school of Iwate Medical University. Trainee doctor, Surgery department of The University of Tokyo Hospital. 1983 Assistant professor, Radiology department of Kyorin University. 1989 University of California, San Francisco(UCSF), U.S.A. 1994 Associate professor, Radiology department of Kyorin University. From 2001, Professor, Radiology department of Kyorin University. a b Slice thickness interpolation 1.5T Reconstruction image 1.5T 3 mm 1.5mm 3T 1.5mm 0.75mm 3 T Reconstruction image short axis view long axis view four-chamber view Fig. 15: Whole heart late gadolinium enhancement a: 1.5T; b: 3T a b Fig. 16: Non-contrast MRA a : Arterial MRA of the lower extremity(fbi: Fresh Blood Imaging) TR/TE=3423/60 ST=1.0 NS=100 b : Renal artery MRA(Time-SLIP: Time-Spatial Labeling Inversion Pulse) TR/TE=4.8/2.4 ST=1.0 NS=80 6

TOSHIBA MEDICAL SYSTEMS CORPORATION MR SYSTEMS DIVISION 1385,Shimoishigami,Otawara-Shi, Tochigi 324-8550, Japan Tel +81-287-55-5027 Fax +81-287-55-5028 http://www.toshibamedicalsystems.com *This article is a translation of the INNERVISION magazine, Vol.26, No.3, 2011.