Topic

MRI

Phased array coil SNR

Saturation band

T1T2

T1T2

Localizer( ) T2WI + T1WI ( )

-

Option

PROPELLER BLADE BLADE

Blade (-) Blade (+)

SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions) T2WI (4mm thickness) SPACE (1mm thickness)

MRI Staging II

staging 0 I Ia Ia1 3mm 7mm Ia2 3mm 5mm 7mm Ib Ia Ib1 4cm Ib2 4cm II 1/3 IIa IIa1 4cm IIa2 4cm IIb III 1/3 IIIa 1/3 IIIb IV IVa IV

Edvard Munch

MR staging 0 I Ia Ia1 3mm 7mm Ia2 3mm 5mm 7mm Ib Ia Ib1 4cm Ib2 4cm II 1/3 IIa IIa1 4cm IIa2 4cm IIb III 1/3 IIIa 1/3 IIIb IV IVa IV

1/3

1/3

Oblique axial Sagittal T2WI T2WI Axial Oblique Axial MRI 39-86%

Oblique Axial T2WI Sagittal

MRI dynamic MRI * * T2 ** *Yamashita Radiology 1992 *Seki AJR 1997 **Scheidler Radiology 1998 **Fujiwara Gynecol Oncol 2000

T2WI Gd T1WI Diffusion

staging Ia Ib staging 1/2 (1/2) II III IV IIIa III III III Iva IVb

T2WI or T2WI T2WI Shibutani Abdom Imaging 1999

Dynamic MRI PRE 20s 40s 60s 80s 100s 120s 180s

Dynamic MRI Yamashita, Radiology 1993

Manfredi et al. Radiology 2004 T2WI oblique Ax T2WI Sag Dynamic pre 40sec 120sec 180sec

(MDA Mullerian duct anomaly) Muller

(MDA Mullerian duct anomaly)

() *Troiano Radiology 2004

Wunderlich syndrome

Pitfall

Plica Palmatae Ax T2 ObAx T2

Size variation

Localizer HASTE, True FISP cor T2WI Sag + Axi T1WI Sag (or Axi) GRE T1WI Sag (or Axi) T1WI

T1WI T2WI T1WI T1WI

vs.

T1 (CHESS) Dixon (in-phase/opposed-phase) * STIR (short TI inversion recovery) signal SPAIR (Spectral Attenuated Inversion Recovery) IR pulse *Yamashita AJR 1994 *Yamashita Radiology 1994

STIR T1WI T2WI STIR

MR»»,»

»»,» T1WI T2WI, T1WI T1WI

Contents»»,»

Clear cell carcinoma T2WI T1WI GdT1

Clear cell carcinoma T2WI T1WI Gd-subtratction 49F

Pitfall T1WI T2WI

Contents»»,»

Mucinous bordeline tumor T1WI T2WI Gd T1WI

T1WI T2WI Gd T1WI

Contents»»,»

Uterine sarcoma T2WI T1WI Gd T1WI

topics

High resolution image on 3T 3T 1.5T Voxel size: 0.8 0.6 2.0 mm Overall image quality and zonal appearance: 3T = 1.5T Tissue contrast at cervix and vagina: 3T > 1.5T Image inhomogeneity: 3T > 1.5T Kataoka M et al, JMRI, 2007

3T T1 T2 TR (msec) 8000 6400 4800 3200 SAR (%)** 36.3±2.3 45.4±3.3 60.4±4.0 90.1±5.9 Total acq. time 4'47'' 3'52'' 2'54'' 1'57'' **SAR limit of 4.0W/kg in the body region corresponds to 100%.

Cervical cancer: 3T vs 1.5T 3T 1.5T

SWI susceptibility-weighted imaging

SWI

Brown ADC(Apparent Diffusion Coefficient) Courtesy of A.Yamamoto

1. Proton 2. Brown : :

77 F T2WI Fusion Image with DWI onto T2WI

ADC is a potential caner biomarker However there are several problems Biomarker ADC MRI b values Cutoff values

Well-differentiated (G1, pt1b) 35 y.o. T2WI fusion image ADC map Low grade tumor ADC value = 1.13 x 10-3 mm 2 /s Poorly-differentiated (G3, pt3a) 69 y.o. High grade tumor The ADC value = 0.62 x 10-3 mm 2 /s T2WI fusion image ADC map

ADC ADC overlap ADC = 1.05x10-3 cutoff Rechichi G et al. AJR 2011;197:256-262

ADC ChemoRadiation 14 ADC MR Harry et al. Gynecologic Oncology (2008) 213-220

DCE-MRI

DCE (perfusion) MRI Curve analysis arrival time, slope, wash in speed Compartmental modeling analysis Ktrans, Kep, Ve

Dynamic contrast-enhanced MRI Curve analysis vascularity Sagittal T2WI Dynamic pre 40sec 120sec 180sec

Perfusion MRI using DCE-MR (Ktrans, Kep, Ve) Sequence: 3D Flash FOV: 300 x 300 mm Matrix: 192 x 173 TR/TE: 2.13/0.76ms 0.25 sec / slices, 180 sec (720 slices) Ktrans kep AIF Ve

Two- compartment model for contrast agent kinetics (Tofts 1999) Intravenous injection of CM Whole body extracellular space Leak Vessels (artery and vein) Red blood cells and plasma Leak(K trans ) *first pass in tumor: 12-45% Return Return(k ep ) Tumor extravascular, extracellular space (Ve) Tumor intracellular space Elimination of CM through the kidneys *low molecular weight contrast media do not cross cell membranes

Ktrans kep Ve

Ktrans

Sawlani R N et al. Radiology 2010;255:622-628

Perfusion MRI Mayr NA, J Magn Reson Imaging. 2000;12:1027 Yamashita Y et al. Radiology 2000;216:8-3 DCE- MRI Zahra MA et al. Int. J. Radiation Oncology Biol.Phys., 2009:74;766

Take Home Message

Acknowledgements kfb@kuhp.kyoto-u.ac.jp