MR新技术的临床应用

MR新技术的临床应用Signa

TwinSpeed

双梯度磁共振磁共振发展史上的飞跃最强的性能和最大的舒适度的统一神经频谱体部心脏骨关节血管精细扫描临床应用范围

AnatomicalBrainandSpine,Hi-bDWI,Perfusion,Real-timefMRIDiffusion-Tensor

Singleandmulti-voxel2D,3DBrain,prostate,MNS

Ellipticcentric,SmartPrep/Step

Fluoro-MRA,efgre3D-ASSET30mincomprehensivecardiacexamFiesta,Stress-function,FiestaASSETFRFSE,Dual-echofGRE,SCICFAME,Breast,ASSET

Highresolution,superiorfatsatFRFSE,FSE-xl,T1-FLAIR最全面的应用领域…高级的和常规的

*worksinprogress全身扫描领先的临床应用与研究心脏成像空间平行倍速成像神经及频谱成像SE-T1FSE-T2FLAIRFLAIRSE-T1神经系统3DTOF,3slab神经系统FSE-xl,3.0thick,512matrix,5min,42cmFOV神经系统T1WT2W经系神统T2W经系神统

实时脑功能成像

频谱成像

弥散张力成像

高b值弥散成像

动态灌注神经系统应用弥散加权成像(DWI)原理TissueSampleA

FreelyDiffusingWater=DarkTissueSampleBRestrictedDiffusion=BrightDiffusiongradientssensitizeMRImagetomotionofextracellularwaterMoremotion=Darkerimage

神经系统成像发病35分钟的脑卒中发病3小时的脑卒中发病7小时的脑卒中脑梗塞8小时DWI和ADC图T1,T2,T2FLAIR和Diffusion新生儿缺血缺氧的应用出生2天的婴儿,缺血17小时b=1000b=2500b=1000b=2500高B值弥散成像是为了提高急性期水肿诊断敏感性和特异性有效方法，B值的范围反映梯度与软件技术综合水平

弥散成像最大B值达7000单次激发EPIB-值可达3000s/mm2T2加权及6到55个弥散梯度方向加权图像显示评价白质束走行及形态

弥散张力成像

优点显示白质束协助制订外科手术计划&术后随访观察协助中风,肿瘤,多发性硬化病人诊断.联合脑功能成像协助作出全面诊断

弥散张力成像

25个弥散方向,18层,5:40采集

各向异性图DiffusionTensorImaging`FractionalAnisotropyMaps(55gradientdirections)OpticRadiationsSpleniumGenuCCExt.Cap.Int.Cap.Thalamusarc.fasciculusunc.fasciculus白质纤维束成像ImagesCourtesyUWMadison脑梗塞1个月后并发严重的运动性失语中重度失语时彻底恢复后

左侧弓形束

0.31±.04

右侧弓形束

0.69±.04

左侧弓形束

0.74±.03

右侧弓形束

0.72±.04

ImageCourtesyofDr.Atlas,StanfordUniversityGEMedicalSystems肿瘤病人的白质成像图ImagesCourtesyUWMadison手术后手术前六个弥散方向编码,B值=1576s/mm2SE-EPI,128x128,70秒扫描弓形纤维束弥散张力成像弥散张力图与脑功能成像融合弥散张力图显示白质束并与语言表达功能中枢图像融合脑功能成像实时梯度回波EPI26cmFOV,128x128TE/TR=50/4000ms,90o65phases弥散张力成像6个方向编码,B值

=1576s/mm2SE-EPI,24cmFOV,128x128ImageCourtesyofM.D.AndersonCancerCenterFunctionT2ADCRATR:7200msTE:106.2ms25directions19slices128x1282NEX6:15mins弥散张力图联合弥散成像可以更好地描绘肿瘤外形弥散张力成像灌注成像(Perfusion)快速注射Gd-DTPA，利用超快速扫描序列（如EPI），动态观察脑血流灌注情况（rCBV，MTT）缺血、肿瘤、炎症、代谢病等。

脑组织的异常血流灌注肿瘤与水肿中风梗塞预报各种原因的脑损伤阵发性癫痫紧缩型偏头痛吸毒的研究……心肌的异常血流灌注心肌梗塞……

灌注成像临床应用负性增强图(NEI)rCBV动态灌注成像动态灌注成像平均通过时间图（MTT）动态灌注成像相对血容量图（rCBV）动态灌注成像相对血容量图（rCBV）SPECTROSCOPYClinicalapplicationof1HMRS

Geriatrics:Alzheimerdiseaseorotherdementia?Pediatrics:

Intensivecare:near-drowning,headinjury

AbnormaldevelopmentTumorvs.infectionvs.edemaEpilepsyWhiteMatterdiseases(MS,CanavanD,LeighD)StrokeProstatecancerSingleVoxel

BrainSpectraPROBE-SI

TheNatureoftheDataPROBE-SI1500/14424x2414.4minInvivoBiochemicalNMRASpectralMnemonic–ReadingRighttoLeft(CourtesyofDr.B.Ross,HMRI)LyingLazyNoGoodCrooksCollectedMyInsuranceLipidsVisibleChemicalsintheBrain(MnemonicCourtesyofDr.B.Ross,HMRI)

COMMON

PPMLocation

MnemonicLipids 0.9-1.3 LYINGLactate 1.3 LAZYN-Acetyl 2.0 NOGlutamate/Glutamine GOODCreatine 3.0 CROOKSCholine 3.2 COLLECTEDmyo-Inositol 3.6 MYINSURANCEOTHERS…Alcohol(andotheringestedsubstances)Solvents,e.g.,mannitolChemicalsAssociatedwithInfectiousAgentsFromClinicalApplicationsofMRS,B.Ross&T.Michaelis,MRQ,Vol10,4,1994Primarytumorshowing-verylowNAA,-HighCho/Cr-SomeLactateTumorTR=5secTR=1.5secNormaltissueAtypicalexampleCholine

CreatineNAAChemical/AnatomicDifferencesPhaseSensitive2DPROBE-SI14.4min(zoomregion)ChoroidGreyMatterWhiteMatterChangesinBrainSpectrainapatientwithChronicHepaticEncephalopathySerialMRSStudy:ResponseofGlioblastomaMultiformetoBrachytherapy3wksbeforeBT5wksafterBT14wksafterBT17wksafterBT.LocalandPhasedArraycoils(WIP)provideimprovedspatialresolutionin3DFocalMRSI3DMRSNAACHOCR脑肿瘤频谱TEMPORALLOBEEPILEPSYTEMPORALLOBEEPILEPSYLactatePresentinAcuteInfarctsLactateInvertsatTE144Alzheimer’sDisease:ChangesinNAAandmyo-InositolNAAmIPROBESI–临床频谱成像1000/144PRESSFOV2110mm层厚,1NEX采集时间12x12,144体素,2:2816x16,256体素,4:2024x24,576体素,9:40内置优化水抑制程序

三维多体素频谱成像最小FOV14cm,层厚5mm2D3D三维频谱三维频谱只有三维频谱才有可能进行肿瘤性质的准确描述sensitivity1-specificity0.81.00.81.0Radiology1999;213:481-488MRI+MRSI,Az=0.83,significantly(P<0.01)betterthanMRIalone

MRI,Az=0.77DecreasesInter-observervariability.MRSIImprovesAccuracyOfAssessmentMRSPECTROSCOPYOF…Theclinicalfocusishydrogenbutothernucleiareofsomeinterest:31P -CellEnergetics,TumorGrowth.13C -KnownBiochemicalPathwaysOnly1%NaturalAbundance.19F -FluorinatedDrugs23Na-Extra-andIntra-cellularConc.7Li -Psycho-active,NaAnalogue3He-Hyper-polarizedGas129Xe-Hyper-polarizedGasOthernucleioflittleinterest:

17O-VerificationofPETResults11B-BNCT29Si-Metabolites2H-?19FSpectroscopy:5-FU(5-fluorouracil)19FSpectroscopy:5-FU(5-fluorouracil)3DGRESodiumImagesTE1.6ms,TR30ms60flipangle8kHzbandwidthFOV38cm,1.1cmthick1286412matrix3x6x11mm3res.28NEX14:20scantimewhitematterS/N=20to25ventriclesS/N=40to50

同时采集重建和后处理实时T-检验反馈单次激发EPI全脑采集超大图像存储能力实时脑功能成像WristActivation脑功能成像目前进展中枢反射区的研究运动中枢视觉中枢听觉中枢语言中枢针刺麻醉发射区吸毒的研究……临床应用手术计划系统功能恢复帕金森治疗……

BloodOxygenLevelDependent

BOLDBOLDBOLDOxygen

De-Oxy-Hb

Capillaryvein脑功能成像BOLDBasisofBOLDfMRI=>TaskcausesincreasedneuralactivityHigherbloodflowand

oxygencontentofbloodMoresignalfrom

activebrainBrainActivationSurplusHbO2BalanceHb/HbO2RESTACTIVATIONArterialBloodVenousBloodAVAV脑功能活动区是何以成像的呢?脑功能成像原理 刺激局部脑神经活动局部血流速度与速率增加局部氧合血红蛋白增加局部脱氧血红蛋白减少(顺磁性+)T2*信号强度增加上肢运动中枢反射区测定fMRI用于手术计划系统Boldtechnique:f-motorMRIBOLDtask:stimuluswithmotionMotor

F-MRIMotorstripsfingertapping右手左手针刺AcupuncturetaskCentralsulcusPrecentral

gyrus–MotorcortexPostcentralgyrus–SensorycortexPostcentral

sulcusPreCentralsulcusNormalanatomicallocationofMotor&SensorycortexBOLDthumbtapping

f-MRIClinicalcasesstudy(A)InsularCortexAVMThis54yearold,right-handedfemalewasdiagnosedwithanleftinsularcortexAVMfollowingasingleseizure.PreoperativefunctionalriskwasdeterminedwithBOLDImaging(A)InsularCortexAVMEloquentcorticalregion

***Corticalmappingrevealedahighdegreeofcorrectalation(within3mm)betweencorticalregionsactiveduringBoldImaging(eloquentlanguagecortex)(A)InsularCortexAVMABOLDImagingbasedexpressivelanguagetaskidentifiedeloquentcorticalregionsalongtheanterioraspectofthelesionCorticalmappingrevealedahighdegreeofcorrectalation(within3mm)betweencorticalregionsactiveduringBoldImaging(eloquentlanguagecortex)(C)LeftpostfrontaltumorThis64yearold,right-handedmaleunderwentBOLDImagingAnalysistoassistwithpreoperativeriskassessmentfollowingthediagnosisofhisleftinsularcortexlesion.(C)Leftpostfrontaltumor

BOLD

languagetaskTumor

LanguagecortexLanguagecortexwithin3mmofthesametaskcorticalregions

(D)Insularcortextumor&languagetrackfMRI(BOLDImage)DWTensorImage

TumorLanguagecortex

Arcuate

Fasciculas(E)Olfactorycortex

activationofolfactorycortexforair-sniffingparadigm.VisualheadachewithmovinglightRighteyeblurringwithlightstimulation

3D成像的应用观察内耳及面、听神经心血管Quantification

导管

超声

核医学 心脏磁共振心脏形态学 + +++ ++++左室功能-Global ++++ +++ ++++ ++++左室功能-Regional ++++ +++ +++ ++++瓣膜病变 +++ ++++ + +++心包病变 + ++++ +++速率/流量测量 +++ +++ +++显示粥样斑块 ++ ++心肌灌注 ++ ++++ ++++冠状动脉 ++++ ++颈动脉病变 ++++ +++ ++++主动脉病变 ++++ +++ ++++外周血管病变 ++++ ++ ++++诊断方法评价心脏形态及运动功能黑血技术双反转(DoubleIR)

三反转(TripleIR)白血技术Fast-cardFIESTA心肌标记技术TaggingStandardSEDoubleIRFSEStandardFastCardTripleIRFSE黑血技术Acq.time=16R-R,1sliceTR=2xRR/TE=60/ETL=32/256x256黑血技术DoubleIRDoubleIR+FatSat怀疑右室发育不良CardiacAnatomyBlood&MyocardiumSuppressedDouble/TripleIRSequenceHighresolutionimageofAorticValveECG-GatedDoubleIRFSE-黑血技术黑血技术肺动脉肺动脉扩张高血压性心脏病（HCM）TD:558msET:32TR:1558msTE:41.7msTORSOFOV:36X36cm5.0thk/0.0sp256X160/2NEX肺尖癌黑血技术黑血冠脉成像RCACxCxLMTR1600TE45TR1600TE122黑血技术造影剂增强MRA肺动脉扩张黑血技术CE-MRCA我院应用CE-MRA技术显示左、右冠状动脉可达12cmFastCineinpatientwithturbulentflowFIESTA即使在有明显涡流时也能产生良好的图像

白血技术FIESTAFASTCARD正常心脏电影瓣膜关闭不全FIESTA的优势

高信噪比，高时间分辩.

心肌血池对比极佳.

无心脏搏动伪影.

Fast

Imaging

EmployingSTeadyStateAcquisitionExcellentContrastFIESTA心脏功能

肥厚性心肌病FIESTA

FIESTA心肌标记

评价室壁运动CardiacTaggingFASTCARD-心脏标记正常志愿者MASSAnalysis心脏功能分析高级心血管分析软件高级心血管分析软件高级心肌–血池描绘

自动探测血池轮廓

快速心脏功能分析左室轮廓自动检测MASSAnalysisPackage快速精确的分析多种报告生成格式心脏质量

射血分数

每搏输出量

室壁厚度

室壁增厚率

还有更多...高级心血管分析软件心室功能/室壁运动MASSAnalysis快速精确的心脏内外膜轮廓描绘左室功能报告生成心脏质量

射血分数

每搏输出量简明易懂的左室功能报告高级心血管分析软件左右室壁及心内外膜运动易于评价心室功能/室壁运动高级心血管分析软件评价心肌缺血和存活情况冠心病的磁共振无创检查：心脏灌注成像右侧冠状动脉狭窄导致的缺血区

利用FastCard-ET采集序列进行血管负荷和休息状态下的心肌灌注成像

室间隔下部可见缺血区

与ECT及导管介入的结果相符合StressRest首次通过法心肌灌注首次通过法心肌灌注判断缺血心肌的存活情况延迟法心肌灌注梗塞的组织即指细胞已破坏（坏死）延迟法心肌灌注原理尽管缺乏造影剂的灌注，坏死细胞外的造影剂可扩散进入细胞内外间隙

造影剂的聚集使T1弛豫时间降低在延迟造影剂灌注时不可逆的梗塞区表现为高信号5daysafteracuteposteriormyocardialinfarction

StentinterventionLateralhypokinesiaintheCINEimagesDetectionofsubendocardiallateralnecrosisintheareaofhypokinesia

STIR-FSEPre-Contrast20minpostcontrast延迟法心肌灌注左前降枝的病变手术吗

?

磁共振显示病变部位的心肌已经完全死亡不要手术！又一例类似的病人手术吗

?磁共振显示出仅有内膜下的心梗马上手术！急诊手术…

3天后的恢复情况Imagescourtesyof:TedMartin,MD.,OklahomaHeartInstitute低信号的灌注缺损区可清楚的反映在形象的“牛眼”图中心肌灌注分析软件Imagescourtesyof:TedMartin,MD.,OklahomaHeartInstituteAgraphicalrepresentationofthesignalenhancementforeachsegmentinrelationtothetriggerdelay,showsthesixthsegment(greenline)representingasloweruptakeofcontrast.心肌时间-强度曲线心肌灌注分析软件原始图像修正后图像体部：SCIC表面线圈信号修正

屏气腹部T1加权

屏气腹部T1加权,＋Ｃ静脉期动脉期造影前FAME…FastAcquisitionwithMultiphase

Efgre3d

3维快速多期扫描技术平扫In-phaseandopposed-phaseimage用于观察细胞的脂肪变性(如脂肪肝)肝脏弥散成像肝脏转移瘤MRCPwith512-ETLSSFSE多角度定位长TEMRCP回波链（ETL）512较好地显示微细结构Outstandingdefinitionoffinestructures256x256512x320优化SS-FSE提供高分辨率MRCP图像胰胆管造影(MRCP)磁共振胰胆管成像（MRCP）技术背景384ETLSSFSE临床病例该患者多发肝囊肿。胆囊和胆总管内有结石。尿路造影,2秒多囊肾,24秒先进的高分辨率成像磁共振水成像的其他应用OriginalKidneyTransplantedKidneyOcclusionCarcinomaLumen三维成象与MR内镜NavigatorSS-FSE超快速水成象MR内镜EndoscopeMRNavigatorIncreasetemporalresolutionBreastImaging:MR乳腺成像:eFGRE3DwithSPECIALPre-contrastPost-contrastPost-contrastEnhancementMR乳腺成像重度脂肪抑制乳腺成像：--高分辨率形态学检查造影剂注射前后扫描，

3Dvolumeof323mm

slices,256x256,20cm

FOV,扫描时间分别为1:38min

注射造影剂后的图像清晰显示大块边缘毛刺状肿块

伴强化和中央坏死

Pre-contrastPost-contrastMRMammography

-Casestudy

Patientpresentedwithpositiveaxillarylymphnodes,noprimarybreasttumordetectedusingX-rayandUltrasound

ContrastenhancedMRbreastimagingidentified

potentialprimarylesions,sizeand<4mm

三维频谱成像前列腺频谱Cancer3.0PPM2.02.5CitrateChoPolyaminCreatineHealthyCitrateCholinePolyaminesCreatine3.0PPM2.02.5前列腺频谱0.24cc三维频谱前列腺频谱…无创伤性的组织学检查手段治疗前六个月12个月放疗过程的疗效跟踪前列腺频谱有效地监测治疗过程前列腺频谱的临床意义早期诊断跟踪疗程良好预后ChoCitrateMetabolicAtrophy=undetectablelevelsofallmetabolites.ResidualWater成功的治疗后显示癌组织的异常代谢消失前列腺频谱有效地监测治疗过程前列腺增生磁共振关节显微成像MR血管成像MRA文献检索

(Medline)2.智能造影剂跟踪血管成像3.自动移床下肢血管造影剂跟踪分组成像５椭圆中心相位编码法血管造影1.BolustimingTest--2ccGd-DTPA4.透视血管造影

ceMRA的优点简便快捷，非侵袭性安全（无辐射及肾毒性）精确3维任意旋转费用相对低廉造影剂越多!

Gd:20mlGd:40ml信噪比越高!BolustimingTest--2ccGd-DTPA2DGREpulsesequenceoriDriveProSmartPrepAutomaticBolusDetection智能造影剂跟踪血管成像imagingvolumeTrackervolume

智能化血管造影

跟踪区

扫描区开始注射造影剂Gd探测造影剂Gd开始扫描BestGuess-AutomaticBolusDetectionImagescomplimentsofSteveWolffMDPhD,AdvancedCardiovascularImagingNewYork肾动脉造影智能造影剂跟踪血管成像77yearold,withlargeleftpoplitealaneurysm,probableleakfromaabdominalaorticaneurysmstentgraft.ImagescomplimentsofSteveWolffMDPhD,AdvancedCardiovascularImagingNewYork腹主动脉及腘窝动脉瘤智能造影剂跟踪血管成像移植肾ImagesComplimentsofUniversityofMichiganRenalAngiography智能造影剂跟踪血管成像RenalAngiographyImagesComplimentsofUniversityofMichigan移植肾智能造影剂跟踪血管成像FluoroTrigger-SeeTheBolusArriveandScanGo3DPeripheralVascularRunoffsSmartStepAutomaticBolusDetectionandTableMotion自动移床下肢血管造影剂跟踪分组成像BolusChaseMRA

PVorBodyCoillevellegssecurefeetandlegsdeterminelengthofstations1ststation40cmFirststationarterialphaseimagesoptimizedwithSmartPreptriggeringandultra-fast,12sec,3Dacquisition.2nds