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The main purpose of this site is to extend the intraoperative monitoring to include the neurophysiologic parameters with intraoperative navigation guided with Skyra 3 tesla MRI and other radiologic facilities to merge the morphologic and histochemical data in concordance with the functional data.
CNS Clinic
Located in Jordan Amman near Al-Shmaisani hospital, where all ambulatory activity is going on.
Contact: Tel: +96265677695, +96265677694.

Skyra running
A magnetom Skyra 3 tesla MRI with all clinical applications started to run in our hospital in 28-October-2013.
Shmaisani hospital
The hospital where the project is located and running diagnostic and surgical activity.


 
Neuro fMRI/DTI Combi Package #T+D

The Neuro fMRI/DTI Combi Package is a bundle of:
- Inline BOLD Imaging :Performing a Motor Cortex Functional Exam
- 3D PACE syngo : Prospective Acquisition CorrEction 
- BOLD 3D Evaluation syngo
- fMRI Trigger Converter
- Diffusion Tensor Imaging
- DTI Evaluation
- DTI Tractography syngo

The bundle comprehends all acquisition and postprocessing tools for comprehensive BOLD fMRI and DTI exams. BOLD fMRI experiments can be displayed fused with DTI data and anatomy. The package is particularly valuable for presurgical planning. The 3D display of anatomical images, functional brain mapping results and DTI allows a better understanding of the spatial relationship between eloquent cortices, cortical landmarks, brain lesions and tract shifts of white matter.

Inline BOLD Imaging
The BOLD imaging package allows the user to define protocols which, apart from the measurement, configure automatic evaluation of the measured data during the scan. With Inline Technology it is thus possible to generate statistical images (t-value) based on 3D motion corrected and spatially filtered data automatically in real time without any further user interaction. The Inline display of activation cards allows the user to decide during the scan whether enough statistical power has built up for his brain mapping task or if the examination is corrupted by motion. As a result examinations will be shorter with a higher success rate. Functional brain mapping can be easily integrated into the clinical routine e.g. prior to neurosurgical interventions.

Additional Features:
- Inline retrospective 3D motion detection and correction in 3 rotational and 3 translational directions
- Inline t-statistics calculation for variable paradigms and display of t-value images
- Statistical evaluation by means of “General Linear Model (GLM)”:
- Paradigms can be configured
- Transitions between passive and active states can be modeled by the hemodynamic response function
- Correction of low-frequency trends
- Allows for time delays due to the BOLD-EPI slice order during a measurement
- Display of GLM design matrix
- Display of a continuously updated t-value card during measurement
- Display of colored activation cards continuously updated during measurement, overlaid over the respective BOLD images using Inline technology
- MOSAIC image mode for accelerating display, processing and storage of images

3D PACE syngo
By tracking the patients head 3D PACE reduces motion resulting in increased data quality beyond what can be achieved with a retrospective motion correction. As a result the sensitivity and specificity of BOLD experiments are increased.
Features:
- Real time prospective motion correction: Highest accuracy real time motion detection algorithm feeding a real time feed back loop to the acquisition system with updated positioning information
- 3D motion correction for 6 degrees of freedom (3 translation and 3 rotation)
- Motion related artifacts are avoided in first place instead of correcting for them retrospectively
- Significant reduction of motion-related artifacts in statistical evaluations
- Increased sensitivity and specificity of BOLD experiments

BOLD 3D Evaluation syngo

syngo BOLD 3D Evaluation is a comprehensive processing and visualization package for BOLD fMRI.

Features

•This package provides statistical map calculations from BOLD datasets and enables the visualization of task-related areas of activation with 2D or 3D anatomical data. This allows the visualization of the spatial relation of eloquent cortices with cortical landmarks or brain lesions
•On the syngo Acquisition Workplace the unique Inline function of syngo BOLD 3D Evaluation merges, in real time, the results of ongoing BOLD imaging measurements with 3D anatomical data
•Additionally, evolving signal time courses in task-related areas of activation can be displayed and monitored
•Functional and anatomical image data can be exported for surgical planning as DICOM datasets, additionally all color fused images and results can be stored or printed
•Statistical map generation: paradigm definition, calculation of t-value map with General Linear Model or t-test
•3D Visualization: fused display of fMRI results,
color t-value maps on anatomical datasets
•Inline 3D real time monitoring of the fMRI acquisition
•On-the-Fly adjustment for t-value thresholding, 3D clustering, and opacity control
•Data export to neurosurgical planning software

Clinical Applications

•Neurosurgical planning
•Assess the effects of neurodegenerative diseases, trauma or stroke on brain function
•Brain mapping

BOLD evaluation task card BOLD evaluation task card

Step by step:
1. Load the ep2d_bold_moco series into the BOLD Evaluation Task card. From the patient browser, select this series and go to Applications and choose BOLD Evaluation.
2. Choose the moco filter 3D evaluation program. Automatically the evaluation controller dialog box will appear, when post processing BOLD data it is freely selectable to choose filters or motion
3. Adjust the simple clustering to remove noise from BOLD data. Increasing this value will remove any colored clustered pixels lower than this number. For example when setting this value to 10 any value of activated (colored) adjacent pixels less than 10 will be hidden from view.
4. Load the t1_se_tra sequence into segment
1. From the patient browser select this sequence and drag and drop into the upper left segment. This will fuse the BOLD data with anatomic data
5. Scroll thru the images using the "dog ear tab" of segment one. This will also move the fused anatomic and functional slices.
6. Set the transparency of the functional data. Reducing the Alpha Value will make the functional data more transparent.
7. Save the fused results. Go to patient, and select Save All Alpha As... This will save all slice positions and allow naming of the sequence, for easy access in the patient browser.
This series can now be viewed in the viewing card or sent via PACs for reading.

All tasks from statistical evaluation of the fMRI datasets to reading and exporting results are supported by BOLD 3D Evaluation syngo:

Generation of statistical maps:
- In cases an inline calculated statistical map is not available a statistical map can be generated easily using processing protocols. An intuitive editor UI allows the paradigm definition and offers the selection of head motion correction, image filters and statistical evaluation.
- Predefined processing protocols and paradigms are available, which can be edited if required.

Statistical evaluation using General Linear Model (GLM)
- Transitions between passive and active states modeled by the hemodynamic response function.
- Correction of low-frequency trends.
- Corrects for time delays due to the BOLD-EPI slice order during a measurement.
- Output of a t-value map and the GLM design matrix

Inline monitoring of the fMRI exam
- During an ongoing BOLD imaging exam results are calculated (by Inline BOLD imaging) and displayed in real time.
- The results are displayed and continuously updated as an overlay on online adjustable, free angulated cut planes through the anatomical 3D data set.
- The evolving signal time courses in task-related areas of activation can be displayed and monitored.

Visualization of fMRI Results
- Visualization with 3D volume rendering.
- Superimposing on cut planes through the volume.
- Interactive Navigation: Zoom, pan and rotate in 3D without noticeable delay. Free double oblique angulation of up to 6 cut planes.
- Cine display of the BOLD time series and of EPI volumes in 3 orthogonal cuts for evaluation of non-corrected head motion.

Data Quality Monitoring
- Based on the B0 field map, loaded automatically with the fMRI data, areas with less reliable results are indicated.

fMRI Trigger Converter
An optical trigger signal is available to trigger external stimulation devices in fMRI experiments.
With the "fMRI Trigger Converter" this signal can be converted to an electrical signal (TTL/BNC and RS 232 interface for PC; modes: toggle or impulse).

Diffusion Tensor Imaging
Diffusion Tensor Imaging allows for a complete description of the diffusion properties of the brain within the scope of the tensor diffusion model, both for anisotropic and isotropic diffusion. Efficient diffusion direction schemes are pre-defined to allow for optimal diffusion directional resolution. Schemes with up to 256 directions can be selected.
Inline technology enables automatic and immediate calculation of the diffusion tensor, including grey-scale and colored “fractional anisotropy" (FA) map derived from it.

Details:
- Measurements with up to 256 different directions and with up to 16 different b-values
- Inline calculation of tensor, grey-scale and colored FA map, ADC map and trace-weighted image
- Support of parallel imaging (iPAT)
- Clinical protocols with full head coverage, incl. inline calculation of tensor, FA, ADC and trace-weighted images in 4 minutes.

DTI Tractography syngo
syngo DTI Tractography is optimized for the clinical use by providing advanced 3D visualization of white matter tracts in the context of 2D or 3D anatomical datasets and DTI datasets. DTI data sets can be explored fast and intuitively using the interactive QuickTracking. QuickTracking instantaneously displays the tract originating from the mouse pointer position while moving over the DTI data set. This also allows identifying qualified regions to place seeding ROIs. Seed points can be set to assess connectivity by tracking with single ROI and with multiple ROIs. Furthermore they can be placed in fused views displaying the anatomical reference and e.g. the colored FA map simultaneously.
Texture Diffusion, a highly versatile in-plane visualization of white matter tracts, allows to display and read DTI Tractography results on PACS reading stations and in the OR.
At the same time the package provides the scientific user with the flexibility to configure the tracking algorithm and to change display settings for the tracts. Tract and seeding ROI statistics are included to support publications (e.g. mean/max FA value, min/mean/max ADC value).
All views can be exported as DICOM images or bitmaps. Tract and seeding ROI statistics can be exported as html files.

DTI Evaluation
Clinical applications are supported by a dedicated DTI evaluation mode to support diagnostics of white matter diseases (e.g. multiple sclerosis and brain maturation disorders). Based on the tensor, in addition to the already inline-calculated parameter maps, further maps characterizing the anisotropy of diffusion properties can be calculated and stored. Multiple diffusion parameter maps (e.g. Fractional Anisotropy, ADC, b=0) and an anatomical image are displayed next to each other in the same slice position for comparison. The images can be evaluated together based on ROIs and the results can be documented in a table. The display options include 2D and 3D tensor graphics, colour-coded images and overlay images on the anatomical images.

In addition, the package offers the scientific user full flexibility of 2- and 3-dimensional visualization of the diffusion tensor with measures of isotropic and anisotropic (fractional and relative) diffusion, Eigen vectors (E1, E2, E3) of the diffusion tensor and shape-descriptive measures of the diffusion tensor (linear, planar, spherical).
 

Prostate Package #T+D

The prostate spectroscopy package is an comprehensive software package which bundles:
- Single Voxel Spectroscopy
- 2D Chemical shift Imaging
- 3D Chemical Shift Imaging
- Spectroscopy Evaluation syngo
- syngo Tissue 4D Evaluation
Sequences and protocols for proton spectroscopy, 2D and 3D proton chemical shift imaging (2D CSI and 3D CSI) to examine metabolic changes in the prostate are included. Furthermore included is the comprehensive Spectroscopy evaluation software which enables fast evaluation of spectroscopy data on the syngo Acquisition Workplace.
Tissue 4D is an application for visualizing and post-processing dynamic contrast-enhanced 3D datasets.
Tissue 4D provides two evaluation options:
- Standard curve evaluation
- Curve evaluation according to a pharmacokinetic model.

The spectroscopy evaluation software is fully integrated in syngo MR.
Evaluation protocols adapted to the scan protocols carry out a complete and automatic evaluation of the measured data.
Optimized protocols for 3D CSI in the prostate are included.

The following functions are included:
- Subsequent water suppression with optional phase correction
- Apodization
- Zero filling
- Fourier transformation
- Base line correction
- Automatic or manual phase correction
- Curve fitting and peak labeling
- Summaries in tabular form of the essential results specifying the metabolites, their position, integrals and signal ratios in relation to a selectable reference.

Tissue 4D provides the tissue visualization features:
- 4D visualization (3D and over time)
- Color display of parametric cards (Ktrans, Kep, Ve, Vp, iAUC)
- Additional visualization of 2D or 3D morphological dataset

Post-processing features:
- Elastic 3D motion correction
- Fully automatic calculation of subtracted images

Standard curve evaluation:
- Calculation and display of enrichment curves

Pharmacokinetic model:
- Pharmacokinetic calculation on a pixel-by-pixel basis using a 2-compartment model
- Calculation is based on the Toft model. Various model functions are available.
- Manual segmentation and calculation on the result images.

The following result images can be saved as DICOM images:
- 3D motion-corrected, dynamic images
- Colored images
- Possibility for exporting results in the relevant layout format.

Cardiac Dot Engine #T+D

Cardiac examinations used to be the most complex exams in MR. Now Cardiac Dot Engine supports the user in many ways. Using anatomical landmarks, standard views of the heart, such as dedicated long axis and short-axis views, are easily generated and can easily be reproduced using different scanning techniques. Scan parameters are adjusted to the patient’s heart rate and automatic voice commands are given. All of this takes most of the complexity out of a cardiac exam and supports customized workflows that are easy to repeat. Every time.

Guidance View
- Step-by-step user guidance is seamlessly integrated.
- Example images and guidance text are displayed for the individual steps of the scanning workflow.
- Both images and text are easily configurable by the user

Patient View
- Within the Patient View the user can easily tailor the exam to each individual patient (e.g. patient with arrhythmia, breath hold capability).
- Pre-defined Dot Exam Strategies are integrated. The user just selects the appropriate strategy with one click and the queue and the complete scan set-up are automatically updated

AutoFoV (automatic Field of View calculation)
- Based on the localizer images the optimal FoV is automatically estimated.
- In case the patient moves during the examination, this step can be repeated at any time

Automated parameter adaptation
- Scan parameters are automatically adapted to the patient’s condition (e.g. heart rate)

Novel heart localization method
- On-board guidance visually facilitates anatomic landmark settings which are used for calculation
- Automated localization
- Automated localization of short-axis views

Guided slice positioning
- Easy way to match slice positions (short-axis) between cine, dynamic imaging, tissue characterization

Cardiac Views
- Easy selection of cardiac views (e.g. 3 chamber view) during scan planning

Inline Ventricular Function Evaluation
- syngo Inline VF performs volumetric evaluation of cardiac cine data fully automatically right after image reconstruction.
- No user input necessary. If desired, inline calculated segmentation results can be loaded to 4D Ventricular Function Analysis for further review or processing

Inline Time Course Evaluation
- Automatic, real-time and motion corrected calculation of parametric maps with inline technology

Cardiac specific layout for the Exam task
- Automatically chosen layouts show the new physio display and are configured for every step of the exam
- Automatic display of images
- Automatic display of images in dedicated cardiac image orientations in contrast to standard DICOM orientations

Adaptive triggering
- Acquisition adapts in realtime to heart rate variations for non cine applications

Automated Naming
- Automated naming of series depending on cardiac views and contrast

Auto Voice Commands
- Auto Voice Commands are seamlessly integrated into the scanning workflow. The system plays them automatically at the right time point. This ensures optimal timing of scanning, breathing and contrast media. The user can monitor which breath-hold or pauses are actually played, and could add pauses between the automatic breath hold commands if necessary

Dot Exam Strategies
The workflow can be personalized to the individual patient condition and clinical need. The following predefined strategies are included. They can be changed at any time during the workflow:
- Standard: Segmented acquisition techniques
- Limited patient capabilities: switch to realtime and single shot imaging if breath-hold is not possible or arrhythmias occur

Customization
Existing Dot Engines can be modified by the user to their individual standard of care.
- Add/remove protocol steps
- Change guidance content (images and text)
- Change or add Dot Exam Strategies and Decision Points
- Modify the Parameter View

3D VRT syngo

This application provides a dedicated evaluation software for colored, volume rendered (VRT) visualization of MR and CT data as a complement to traditional MIP display.
The combination of automated segmentation and easy-to-use editing tools, provides users with a rapid way to visualize MRA and VIBE studies in their 3D context in a clear and precise manner.
3D VRT includes tools for:
Direct Volume Rendering Technique (VRT) for viewing 3D volumes
- Projection of volume information onto an arbitrarily orientation plane.
- For each projection ray the density, opacity, and refraction of the penetrated volume is evaluated and the resulting intensity/color is recorded.
- Independent control of color, opacity and shading of up to 4 tissue classes.
- Selection of predefined color VRT settings via an image gallery
- User selectable visualization filters for MPR, MIP, SSD or VRT
- Storage and filming of reconstructed images or ranges

Editing Functions to create and modify segmented objects
- Segmentation of 3D datasets either with manual contour creation, by thresholding, or by volume growing operations.
- Volume measurements

Ortho Package

This package includes:
- 2D TSE protocols for PD, T1 and T2-weighted contrast with high in-plane resolution and thin slices
- 3D MEDIC, 3D TrueFISP protocols with water excitation for T2-weighted imaging with high in-plane resolution and thin slices
- High resolution 3D VIBE protocol for MR arthrography (knee, shoulder and hip)
- 3D MEDIC, 3D TrueFISP, 3D VIBE protocols with water excitation having high isotropic resolution, optimized for 3D post-processing
- PD SPACE with fat saturation and T2 SPACE with high isotropic resolution optimized for 3D post-processing
- Whole spine single-step or multi-step protocols
- Excellent fat suppression in off-center positions, e.g. in the shoulder due to high magnet homogeneity
- Dynamic TMJ and ilio-sacral joint protocol
- Susceptibility-insensitive protocols for imaging in the presence of a prosthesis
- Multi-Echo SE sequence with up to 32 echoes for the calculation of T2 time maps (calculation included in the Scientific Suite)
- High resolution 3D DESS (Double Echo Steady State): T2 / T1-weighted imaging for excellent fluid-cartilage differentiation

 

Other Clinical Applications

 

syngo ASL (Arterial Spin Labeling) 2D: Arterial Spin Labeling (ASL) is an MR technique using the water in arterial blood as an endogenous contrast agent to evaluate perfusion noninvasively.
syngo ASL provides unique insight into human brain perfusion and function physiology by evaluating cerebral blood flow. syngo ASL is capable of high spatial resolution perfusion imaging, making the technique very appealing in the evaluation of stroke, tumors, degenerative diseases, epilepsy but also in basic neuroscience, e.g. for studies of functional CBF changes.
• Fully compatible with iPAT
• Includes 3D PACE motion correction for increased reliability
• Fully automated Inline calculation of regional blood flow color maps
• Supports the “Pulsed Arterial Spin Labeling” – technique (PASL)
syngo ASL (Arterial Spin Labeling) 3D: Arterial Spin Labeling (ASL) is an MR technique using the water in arterial blood as an endogenous contrast agent to evaluate perfusion noninvasively. syngo ASL provides unique insight into human brain perfusion and function by evaluating cerebral blood flow. syngo ASL is capable of high spatial resolution perfusion imaging, making the technique very appealing in the evaluation of stroke, tumors, degenerative diseases, epilepsy but also in basic neuroscience, e.g. for studies of functional CBF changes.
• Fully compatible with iPAT
• Includes 3D PACE motion correction for increased reliability
• Fully automated Inline calculation of relative blood flow color maps
• Supports the “Pulsed Arterial Spin Labeling” – technique (PASL)
• 3D-GRASE ASL sequence: A 3D volume acquisition with echo planar imaging and multiple refocusing pulses to increase signal-to-noise
and to speed-up scan times. Multi-phase and multislice acquisition is supported

syngo ASL (Arterial Spin Labeling)

syngo ASL is an MR technique using the water in arterial blood as an endogenous contrast agent to evaluate perfusion non-invasively. syngo ASL provides a robust Pulsed Arterial Spin Labeling sequence with echoplanar readout and in-line calculation of CBF maps from the acquired data.

Clinical Applications

•Acute stroke
•Evaluation of TIA (Transient Ischemic Cerebral Attack) and chronic cerebrovascular disease
•Degenerative diseases like Alzheimer’s disease and frontotemporal dementia
•Evaluation of brain tumors
•Functional evaluation of the brain with BOLD techniques
•Intervention planning

Features

•Compatible with GRAPPA parallel acquisition technique
•Compatible with standard 12 channel head matrix coil and 32 channel head coil
•Highly robust single shot EPI Pulsed Arterial Spin Labeling sequence with the use of 3D PACE and in-line calculation of CBF maps

Additional Information

In syngo ASL, first, arterial blood water is magnetically labeled just below the region of interest by applying a 180 degree radiofrequency (RF) inversion pulse. The result of this pulse is inversion of the net magnetization of the blood water. In other words, the water molecules within the arterial blood are labeled magnetically. After a period of time (called the transit time), the magnetically labeled water flows into the region of interest where it exchanges with tissue water. The inflowing inverted spins within the blood water alter total tissue magnetization, reducing it and, consequently, the MR signal and image intensity. During this time, an image is taken (called the tag image). The experiment is then repeated without labeling the arterial blood to create another image (called the control image). The tagstate is alternated with the control state, in which the magnetization of the arterial blood is not inverted. The control image and the tag image are subtracted to produce a perfusion image. This image will reflect the amount of arterial blood delivered to the slice within the transit time. There are mainly two techniques for syngo ASL; PASL (Pulsed ASL) and CASL (Continuous ASL). In PASL, the RF pulse is applied in a spatially selective manner (region-specific). Consequently the inversion of the arterial blood occurs over a specific area. PASL is particularly attractive for higher field strengths as other syngo ASL schemes such as CASL have to deal with the challenge of high Specific Absorption Rate (SAR).
 

 

 
 
Step by step guide:

1. Locate the ASL sequence under Head > Advanced applications libraries. Select the sequence labeled ep2d_tra_pasl.
2. Open the ASL sequence and position slices over the area of interest.
3. To change the ASL parameters, go to the contrast parameter tab and then the ASL sub-tab.
4. For parameter descriptions within the ASL sub-tab, float the cursor over the various parameter choices.
5. After positioning your slices over the desired location and adapting the ASL parameters (if necessary), start the measurement.
6. After measurement is complete, review inline maps in the Viewing Task Card.

       

Other Clinical Applications Packages:

  1. Syngo BLADE
    syngo BLADE reduces dramatically sensitivity to movement in MR scanning. It is a technique that incorporates a k-space trajectory radial in nature and reduces motion artifacts and helps visualize the smallest lesions in non-cooperative patients or when scanning is not optimal due to other involuntary motion like pulsation, respiration, etc.
    Features
    Images in all slice orientations
    Applicable in all body regions like head, spine, liver, knee
    Compatible with Tim coil system and parallel acquisition technique (iPAT)
    Can be used with PACE (Free-breathing technique)
    Multiple contrasts are possible (T1, T2, Dark Fluid, STIR….)
    Clinical Applications
    Reduce sedation rates in pediatric and anxious patients, and get high-quality images to make a diagnosis
    Reduce physiologic motion artifacts: Pulsation of blood vessels, respiratory artifacts, tremor
    Especially effective in reducing CSF pulsation artifacts at 3T even in non-cooperative patients
    Additional Information
    syngo BLADE is a motion insensitive, multi-shot Turbo Spin Echo (TSE) sequence. Inter-shot motion correction is applied for reducing in-plane motion artifacts. This technique continuously acquires low resolution images during motion, then measures and corrects for this motion. Data is acquired in blades which include parallel phase-encoding lines. Individual blades are rotated to cover a circle in the raw data space.
     
    Axial T2w TSE images of the brain (left: without motion correction; right: with syngo BLADE) Axial T2w TSE images of the brain (left: without motion correction; right: with syngo BLADE) Sagittal T2w TSE images of the brain (left: without motion correction; right: with syngo BLADE) Coronal T2w TSE images of the brain (left: without motion correction; right: with syngo BLADE)
    Decreased pulsation and motion artifacts in cervical spine syngo BLADE images (right) Axial T2w TSE images of the brain (left: without motion correction; right: with syngo BLADE) Axial T2w TSE images of the brain (left: without motion correction; right: with syngo BLADE) Reduced-breathing artifacts in the upper abdomen with syngo BLADE
    Improved delineation of liver vessels by reduction of pulsation artifacts with syngo BLADE Significant reduction of pulsation artifacts with syngo BLADE Motion correction in a 530-lbs obese, uncooperative patient with syngo BLADE Improved visualization of a cricoid mass with syngo BLADE T2w MRI (aneurysmal bone cyst)

    Step by step:
    1. Finding the syngo BLADE sequences in the Exam Explorer. All syngo BLADE sequences are located in the BLADE folder of each body region library.
    2. syngo BLADE trajectory, located on the common Resolution subtask-card.
    3. BLADE Coverage parameter, located on the common Resolution subtask-card.
    4. Use of Motion Correction, located on the Sequence subtask-card, part 2. A turbofactor of at least 29 must be used to activate this option.

  2. Syngo SWI: Siemens-unique sequence technique for Susceptibility Weighted Imaging is a new type of contrast in MRI which exploits the susceptibility differences between tissues. As a result syngo SWI detects substances with different susceptibilities than their neighboring tissues such as deoxygenated blood, products of blood decomposition and microscopic iron deposits much better than conventional MR techniques. Among other things, the method allows for highly sensitive proof of cerebral hemorrhage and high resolution display of venous cerebral vessels.
    Clinical Applications
    Improved detection of hemorrhage, microbleeding (diffuse axonal injury), hemorrhagic transformation (stroke)
    Detection of occult vascular disease (cavernomas, angiomas, telangiectasias)
    Diagnosis of cerebral venous thrombosis, intra-arterial clot detection
    Identification of iron and other mineral deposition
    Helpful in MR diagnosis of neurodegenerative diseases (Alzheimer’s, multiple sclerosis, etc.)
    Tumor characterization
    Features
    syngo SWI is compatible with iPAT (integrated Parallel Acquisition Technique) and takes only a couple of minutes, like conventional imaging sequences, but with improved sensitivity to blood, hemorrhage, mineralization deposits etc.
    Additional Information
    syngo SWI combines magnitude and phase information from a high-resolution, fully velocity compensated 3D FLASH sequence. Phase images are unwrapped and high-pass filtered to highlight phase changes associated with venous vessels and converted into a mask that is multiplied with the corresponding phase image.
     
    Multiple cavernomas (syngo SWI right, T2* left) Multiple cavernomas, bleedings seen with syngo SWI (SWI right, T2 left) Excellent visualization of venous congestions with syngo SWI Improved visualization of an angioma with syngo SWI
    Detection of bleedings in the gray matter interface with syngo SWI Trauma imaging with syngo SWI for improved detection of subtle bleedings Improved visualization of venous malformation with syngo SWI MS patient. Iron deposition bilaterally in globus pallidus interna is seen better with syngo SWI

    Step by step:
    1. Susceptibility Weighted Imaging of the brain
    2. Location of syngo SWI sequences. In the exam explorer go to Head, then Library and SWI.
    3. syngo SWI Parameters. Sequence variant name SWI, it is a 3d gre sequence. On the contrast card the check box for SWI must be selected to create the MinIP images.
    4. Viewing results.

  3. TWIST: This package contains a Siemens-unique sequence and protocols for advanced time-resolved (4D) MR angiography and dynamic imaging in general with high spatial and temporal resolution. syngo TWIST supports comprehensive dynamic MR angio exams in all body regions. It offers temporal information of vessel filling in addition to conventional static MR angiography, which can be beneficial in detecting or evaluating malformations such as shunts. syngo TWIST can be combined with water excitation.
    • Visualization of local changes of the magnetic field due to tissue properties in general and due to the presence of deoxygenated blood or blood decomposition products
    • 3D GRE sequence with full flow compensation to support venous angiography
    • Enhanced susceptibility weighting of the magnitude images by phase images to increase sensitivity to intracerebral hemorrhage.
    Features
    Substantial reduction in gadolinium chelate dose
    The ability to obtain multiple phases
    No need for a test bolus (or any other kind of bolus timing)
    iPAT in two directions with a factor up to 9 (optional with iPAT extensions)
     
    Visualization of the lower leg vessels, collaterals in a patient with stenoses and occlusions MR angiography of the lower leg vessels wit syngo TWIST Large FOV pulmonary MR angiography with syngo TWIST Large FOV MRA of the supra-aortic, carotids and vertebral vessels with syngo TWIST
    syngo TWIST MRA shows filling of the vessels and basilar artery aneurysm syngo TWIST shows left foot AVM and delayed and reduced filling of the right lower leg vessels syngo TWIST shows the AV shunt and multiple stenoses of the brachial vein Large FOV MRA of the supra-aortic, carotids and vertebral vessels with syngo TWIST


    Clinical Applications
    Peripheral angiography (Better hemodynamic evaluation of stenosis and collaterals, elimination of venous contamination)
    Dynamic cerebral MRA (Evaluation of cerebral AVMs, vascular malformations)
    Dynamic carotid, vertebral MRA (steal phenomenon, stenosis, collaterals…)
    Dynamic pulmonary MRA
    Dynamic renal MRA
    Dynamic mesenteric, portal MRA
    Dynamic Aortography (Aortic dissection visualization, differentiation of false and true lumen with the help of dynamic MRA)
    Additional Information
    syngo TWIST is based on special k-space sampling. In this setting, k-space is divided into two regions. The centrally located region of k-space provides information regarding image contrast, the peripherally located aspect of k-space contributes principally to high spatial resolution. The main factor contributing to the acceleration of the sequence acquisition in this particular imaging approach is the fact that k-space lines in the center are more frequently sampled than are the k-space lines in the periphery during the passage of the contrast medium bolus through the covered 3D volume.
    Step by step:
    1. Locating syngo TWIST in the Exam Explorer
    2. syngo TWIST: Angio parameter card
    3. Central Region A; percentage of central k-space filled per measurement
    4. Sampling Density B; percentage of outer k-space filled per measurement
    5. Dynamic Reconstruction Mode; forward or backward share of k-space
    6. Measurement temporal Information
    7. Burn Time-to-Center; burning measurement time on image
    Locating Burn Time-to-Center information

  4. NATIVE: Non-contrast MRA of ArTerIes and VEines – SPACE and TrueFISP : Integrated software package with sequences and protocols for non-contrast enhanced 3D MRA with high spatial resolution. NATIVE particularly enables
    imaging of abdominal and peripheral vessel
    NATIVE offers:
    • Non-contrast MRA
    • Separate imaging of arteries and veins
    • Visualization of – e.g. – renal arteries or peripheral vessels
    The syngo NATIVE package comprises:
    • syngo NATIVE TrueFISP
    • syngo NATIVE SPACE
    syngo NATIVE is a contrast-free MR angiography technique for visualizing the vessels of the body. The package contains protocols tailored for use in different body regions (e.g. renal arteries, peripheral vessels). Inline Subtraction and Inline Maximum Intensity Projection (MIP) further simplify the workflow.
    Clinical Applications
    Alternative to contrast-enhanced MRA examinations when there is contraindication to use of Gadolinium.
    Additional Information
    For non-contrast MR Angiography Siemens currently offers two techniques under the category of syngo NATIVE — syngo NATIVE TrueFISP and syngo NATIVE SPACE. syngo NATIVE TrueFISP is based on the TrueFISP (True Fast Imaging with Steady state Precession) sequence, which is a balanced steady state gradient echo technique. The contrast mechanism for syngo NATIVE TrueFISP comes from the preparation of the imaging volume with a spatially selective inversion pulse, resulting in the suppression of stationary tissue within the imaging volume and suppression of signal from blood in the imaging volume (e.g. venous blood). Blood which flows into the imaging volume during the inversion time has the same high-signal characteristics exhibited in that TrueFISP. The contrast is further enhanced by the suppression of the background by the inversion pulse. The sequence can be made selective for arteries or veins by appropriate positioning of the inversion pulse, which can be positioned independently from the imaging volume. The sequence accommodates 3D, 2D, breath-hold, syngo PACE (Prospective Acquisition CorrEction) navigated and respiratory triggered approaches depending on clinical environment.
    The syngo NATIVE SPACE technique is a modified variable flip angle 3D Turbo Spin Echo sequence in which the contrast mechanism for visualizing vessels is based on the difference in intravascular signal between maximal and minimal flow during the cardiac cycle. The subtracted image is calculated Inline and with Inline MIP generation, instantaneous clinical results are produced for completely non-invasive MR angiography, further improving workflow at the scanner. The syngo NATIVE SPACE technique can also accommodate multi-phase imaging that enables dynamic angiography — for example, in the lower legs.
     
    Popliteal, anterior-posterior tibial and peroneal arteries seen with syngo NATIVE VRT of the renal arteries with stenosis generated from syngo NATIVE images Multi-step syngo NATIVE examination of the pelvis and upper and lower legs vessels
    Stenosis of the renal artery of the kidney transplant (right: ceMRA) Visualization of the lower leg vessels with syngo NATIVE Coeliac, superior mesenteric and renal arteries seen with syngo NATIVE

    Step by step:
    syngo NATIVE: SPACE
    1. Run the scout.
    2. Open and position TDscout to calculate trigger time of vessels of interest.
    3. Ensure accuracy of ECG triggering and apply scan.
    4. Open syngo NATIVE SPACE sequence and position of anatomy of interest. Do not apply the scan yet.
    5. Load TDscout cine images into the "Mean Curve" program to calculate correct TD time.
    6. Draw RoI over vessel of interest and "Start Evaluation".
    7. Move the vertical bar to the beginning of the intensity curve and use the Trigger Time as the TD within the sequence.
    Apply the scan.
    syngo NATIVE TrueFISP
    1. First, position the slices and Inversion pulse groups.
    2. Locate and position the Navigator pulses on the dome of the diaphragm. Page through the axial slices to ensure the Navigator pulses do not overlap the renal arteries.
    3. Set the captured cycle in the Physio parameter card.
    4. The Navigator information can be viewed in the Inline Display while scanning.
    5. Load the 3D series into the 3D Task Card to perform reconstructions.
     

  5. Syngo inline VF: Ventricular function. Ejection fraction calculation.
    With syngo Inline VF you can perform fully automatic volumetric assessment, ejection fraction calculation - during the scan. The heart is located and the endo- and epicardial borders are detected automatically. Data output is right after the image reconstruction without any user interaction.
    Features
    Scan is done with PACE multi-breath-hold protocols and syngo Inline VF is directly integrated into the acquisition sequence.
    All cardiac phases are automatically segmented and the smallest and largest volumes are assumed to be ES (End Systolic) and ED (End Diastolic) phases.
    Slices are acquired from base (at the level of mitral valve) to apex.
    Easy user guidance with graphical selection of ED, ES, basal and apical slices.
    Contour generation is done automatically.
    Clinical Applications
    Reliable and fast cardiac volumetric and ejection fraction assessment in a busy, throughput oriented environment.
    Automatic volumetric assessment and ejection fraction calculation in cardiomyopathy (dilated, hypertrophic, etc.), pericardial disease, cardiac tumors and cardiac transplants.
     
    Shot axis view with outlined epicardial borders generated automatically Diagram showing ventricular volume change automatically generated with syngo Inline VF Result tables, automatically generated with syngo Inline VF

    Step by step:
    1. Locate Inline VF sequence in the Exam Explorer.
    2. Inline VF is found in the Physio parameter card, within the Cardiac tab.
    3. The images are displayed in the Inline Display with automatic contours as the images reconstruct.
    4. Result tables are saved in the series folder in the Patient Browser. The result tables can be viewed in the Viewing Task Card.

  6. Syngo Argus 4D VF:
    With syngo Argus 4D VF, a typical ventricular function and mass analysis can be done in less than a minute. This method uses a heart model based algorithm instead of contour tracing.
     
    Features
    A 4D model can be created with a few mouse clicks by defining the center of the LV apex on an apical short-axis cine, center of the LV base on a basal short-axis cine, mitral valve insertion points on a 2- and/or 4-chamber plane in diastole and systole.
    The model-based algorithm provides within a few seconds the appropriate endo- and epicardial contours on all slices and phases as well as a summary table including various data for volume, function and mass.
    No missing ventricular volume nor additional atrial volume deterioration due to cardiac phase adaptive 4D model.
    Clinical Applications
    Highly accurate volumetric assessment and ejection fraction calculation in cardiomyopathy (dilated, hypertrophic, etc.), pericardial disease, cardiac tumors and cardiac transplants.
    Step by step:
    1. Load cine cardiac study into Argus 4D Taskcard.
    2. Place marker in center of the LV of the most apical slice position.
    3. Place marker in the center of the LV of the most basilar slice position.
    4. Place markers at the insertion points of the mitral valve on a long axis view, at both end systole and end diastole.
    5. Adjust the markers for the position of the right ventricular insertion points.
    6. If necessary, adjust the endo and epicardial contours.
    7. View and save the ventricular results.
         
        Interactive 3D model of the heart with integrated epicardial surface depiction

     

  7. Syngo MapIt: Provides the protocols and Inline calculation of parametric maps of T1, T2, and T2* properties of the imaged tissue. The application range includes cartilage evaluation of joints, liver, kidney, prostate, and more.
    In particular, syngo MapIt supports the user in detecting osteoarthritis of the joint based on the T1, T2, and T2* properties of the cartilage.
    • 3D VIBE sequence for Inline T1 mapping
    • Multi-echo spin echo sequence for Inline T2 mapping
    • Multi-echo gradient echo sequence for Inline T2* mapping
    • Protocols for fully automated Inline parametric mapping
    Clinical Applications
    syngo MapIt allows the early detection of osteoarthritic pathology based on the T1 and T2 and T2* properties of the cartilage.
    Cartilage transplant evaluation
    It’s possible to use syngo Fusion to overlay these maps with their corresponding anatomical image
     
    Knee cartilage seen without syngo MapIt Knee cartilage seen with syngo MapIt Cartilage visualization at elbow with syngo MapIt
    Cartilage visualization at elbow with syngo MapIt syngo MapIt showing patellar cartilage syngo MapIt shows degenerative changes of the femoral cartilage

    step by step:
    1. Open and position the T2* map scan. This is found in the Knee, library MapIT section.
    2. The MapIT parameters can be found on the Inline, MapIT subtask card.
    3. Apply the sequence.
    4. The maps and original data can be reviewed in the Viewing Task Card. The T2* baseline map window level needs to be set to a default value. To set, change the window and center values each to 30.

  8. 3D CSI (Chemical Shift Imaging):
    Integrated multivoxel spectroscopy software package with sequences and protocols for 3D Chemical Shift Imaging (CSI).
    Features
    Matrix Spectroscopy – phase-coherent signal combination from several coil elements for maximum SNR with configurable prescan-based normalization for optimal homogeneity
    3D Chemical Shift Imaging
    Hybrid CSI with combined Volume selection and Field of View (FoV) encoding
    Short TEs available (30 ms for SE, 20 ms for STEAM)
    Automized shimming of the higher order shimming channels for optimal homogeneity of the larger CSI volumes
    Weighted acquisition, leading to a reduced examination time compared to full k-space coverage while keeping SNR and spatial resolution
    Outer Volume Suppression
    Spectral Suppression
    Protocols for prostate spectroscopy
    Clinical Applications
    Prostate Spectroscopy for diagnosis, localization of prostate cancer
    Improved spatial localization of metabolic changes in biopsy or radiotherapy planning
     
    Cho/Cr ratio map generated from 3D CSI measurement Spectral nap generated from 3D CSI measurement Increased Cho-signal in a medulloblastoma case

    Step by step:
    1. Perform imaging in all three planes to include the entire brain. Open the csi 3D se 135 sequence. Located in the exam explorer in the Spectroscopy, CSI, head region.
    2. Scroll thru the transversal images for area of interest.
    3. Copy image position. Right click on the selected transverse image, from the menu select copy image position.
    4. Go to the scroll drop down menu and select scroll nearest. This will align the 3D VOI in all three orientations.
    5. Rotate the VOI inplane on the transversal image to cover the area of interest.
    6. Open toolbar, and and select create sat bands. Draw saturation bands around all sides of the 3D VOI to remove lipid signal from calvarium.
    7. Select fully excited VOI, on the Geometry card.
    Apply the sequence.

  9. Syngo BOLD Evaluation:
    syngo BOLD Evaluation is the processing and visualization package for Inline BOLD imaging.
    Features
    This package provides statistical map calculations from BOLD datasets and enables the visualization of task-related areas of activation with 2D anatomical data. This allows the visualization of the spatial relation of eloquent cortices with cortical landmarks or brain lesions
    Additionally, evolving signal time courses in task-related areas of activation can be displayed and monitored
    Functional and anatomical image data can be exported for surgical planning as DICOM datasets, additionally all color fused images and results can be stored or printed
    Statistical map generation: paradigm definition, calculation of t-test maps
    2D Visualization: fused display of fMRI results, color t-test maps on anatomical datasets
    Inline real time monitoring of the fMRI acquisition
    Clinical Applications
    Neurosurgical planning
    Assess the effects of neurodegenerative diseases, trauma or stroke on brain function
    Brain mapping
     
     
      BOLD evaluation task card

    Step by step:
    1. Load the ep2d_bold_moco series into the BOLD Evaluation Task card. From the patient browser, select this series and go to Applications and choose BOLD Evaluation.
    2. Choose the moco filter 3D evaluation program. Automatically the evaluation controller dialog box will appear, when post processing BOLD data it is freely selectable to choose filters or motion
    3. Adjust the simple clustering to remove noise from BOLD data. Increasing this value will remove any colored clusteredpixels lower than this number. For example when setting this value to 10 any value of activated (colored) adjacent pixels less than 10 will be hidden from view.
    4. Load the t1_se_tra sequence into segment 1. From the patient browser select this sequence and drag and drop into the upper left segment. This will fuse the BOLD data with anatomic data
    5. Scroll thru the images using the "dog ear tab" of segment one. This will also move the fused anatomic and functional slices.
    6. Set the transparency of the functional data. Reducing the Alpha Value will make the functional data more transparent.
    7. Save the fused results. Go to patient, and select Save All Alpha As... This will save all slice positions and allow naming of the sequence, for easy access in the patient browser.
    This series can now be viewed in the viewing card or sent via PACs for reading

  10. Inline BOLD Imaging: Examination of intrinsic susceptibility changes in different areas of the brain, induced by external stimulation (e.g. motor or visual). Automatic real-time calculation of z-score (t-test) maps with Inline Technology, for variable paradigms.
    • Compatible with single-shot EPI with high susceptibility contrast for fast multi-slice imaging
    • ART (Advanced Retrospective Technique) for fully automatic 3D retrospective motion correction, for 6 degrees of freedom (3 translations and 3 rotations)
    • Mosaic images for efficient storage and transfer of large data sets
    • 3D spatial filtering
    • Inline calculation of t-statistics (t-maps) based on a general linear model (GLM) including the hemodynamic response function and correcting for slow drifts
    • Overlay of inline calculated statistical results on the EPI images
    Clinical Applications
    Neurosurgical planning
    Assess the effects of neurodegenerative diseases, trauma or stroke on brain function
    Brain mapping
     
    Activation map superimposed on original BOLD images Motor activation measured by fMRI fused with 3D MPRAGE

    Step by step:
    1. Load the bold-imaging program into the measurement queue. The program is in the exam explorer located under: Head, programs, bold-imaging.
    2. Position the t1_se_tra to cover the entire head, and apply the scan.
    3. Open the remaining sequences and copy parameters to the t1_se_tra. This will ensure all scans will have exact slice positions.
    4. Add open inline display to the ep2d_bold_moco sequence properties. To do this right click on the sequence, go to properties, AutoLoad, check the open inline display.
    5. Give a verbal command to begin finger tapping with one hand and start the BOLD exam. The scan is comprised of 60 measurements; the first 10 measurements will be with this hand.
    6. When the first 10 measurements are completed then give the command to switch hands and tap these fingers for 10 measurements.
    7. Repeat alternating finger tapping for remaining sets of 10 measurements, until the exam is complete.
    The functional statistics can be visualized as the exam is performed in the online display window.

  11. 3D PACE (Prospective Acquisition CorrEction): enhances Inline BOLD imaging with motion correction during the acquisition of a BOLD exam. In contrast to a retrospective motion correction that corrects previously acquired data, the unique 3D PACE tracks the head of the patient, correcting for motion in real time during the acquisition. This increases the data quality beyond what can be achieved with a retrospective motion correction. As a result the sensitivity and specificity of BOLD experiments are increased.
    • Fully automatic 3D prospective motion correction during data acquisition, for 6 degrees of freedom (3 translations and 3 rotations)
    • Motion correction covering the complete 3D volume
    • Provides high accuracy
    • Substantially reduced motion-related artifacts in t-test calculations
    • Significantly increased signal changes in the activated neuronal volume
    • Increased functional MRI (fMRI) sensitivity and specificity
     
     
      fMRI with 3D PACE for improved detection of the BOLD signal


    Step by step:
    1. Locate a BOLD sequence in the Exam Explorer and go to the BOLD parameter card.
    2. When the Motion Correction option is activated, syngo motion correction is performed during the calculation.
    3. Small patient movements may cause significant artifacts in the functional information. 3D motion correction can reduce relative movements between measured data sets.

  12. Syngo DTI: Acquisition of data sets with multi-directional diffusion weighting to assess anisotropic diffusion properties of brain tissue
    • Measurement of up to 256 directions of diffusion weighting with up to 16 different b-values
    • Inline calculation of the diffusion tensor
    • Inline calculation of Fractional Anisotropy (FA) maps (grey-value as well as color-coded for principle diffusion direction), Apparent Diffusion Coefficient (ADC) maps and trace-weighted images based on the tensor
  13. Multiple Direction Diffusion Weighting (MDDW) Diffusion tensor imaging measurements can be done with multiple diffusion-weightings and up to 12 directions for generating data sets for diffusion tensor imaging.
  14. Flow Quantification : Special sequences for quantitative flow determination studies
    • Non-invasive blood / CSF flow quantification
    • ECG Triggered 2D phase contrast with iPAT support
    • Retrospective reconstruction algorithms for full R-R interval coverage
  15. Interactive Realtime Sequences and hardware for interactive real-time scanning
    Uses ultra-fast Gradient Echo sequences for high image contrast
    Real-time reconstruction of the acquired data
    The user can navigate in all planes on-the-fly during data acquisition
    • Real-time cardiac examinations
    • Real-time interactive slice positioning and slice angulation for scan planning
  16. Single Voxel Spectroscopy: Integrated software package with sequences and protocols for proton spectroscopy. Streamlined for easy push-button operation
    • Matrix Spectroscopy – phase-coherent signal combination from several coil elements for maximum SNR based on the Head / Neck 20
    • Spectral suppression (user definable parameter) to avoid lipid superposition in order to reliably detect e.g. choline in the breast
    • Up to 8 regional saturation (RSat) bands for outer volume suppression can be defined by the user.
    • Physiological triggering (ECG, pulse, respiratory or external trigger) in order to avoid e.g. breathing artifacts. Clinical application: brain, liver, neck soft tissue, spine
    SVS Techniques SE and STEAM
    • Short TEs available
    • Fully automated adjustments including localized shimming and adjustment of water suppression pulses
    • Also available: Interactive adjustments and control of adjustments
    • Optimized protocols for brain applications
  17. syngo CSI 2D: Chemical Shift Imaging: Integrated software package with sequences and protocols for Chemical Shift Imaging (CSI)
    Extension of the Single Voxel Spectroscopy (SVS) package, offering the same level of user-friendliness and automation
    • Matrix Spectroscopy – phase-coherent signal combination from several coil elements for maximum SNR with configurable prescan-based normalization for optimal homogeneity
    • 2D Chemical Shift Imaging
    • Hybrid CSI with combined volume selection and Field of View (FoV) encoding
    • Short TEs available (30 ms for SE, 20 ms for STEAM)
    • Automated shimming of the higher order shimming channels for optimal homogeneity of the larger CSI volumes
    • Weighted acquisition, leading to a reduced examination time compared to full k-space coverage while keeping SNR and spatial resolution
    • Outer Volume Suppression
    • Spectral Suppression
    • Semi-LASER sequence available for CSI examination of the brain
    Protocols for head spectroscopy
    Clinical Applications
    Tumoral pathologies
    Demyelinizing pathologies
    Infectious diseases
    Metabolic pathologies
    Epilepsy
    Degenerative diseases
     

    Example for spectral quality in the head, deriving from a 2D CSI measurement

    Step by step:
    1. Set up multi-planar localizers
    2. Acquire in-plane T2 Axial localizer
    3. Position 2D CSI Slab
    4. Use Scroll>Nearest to find the reference image best suited to the area of interest.
    5. Apply the 2D CSI sequence
    6. Double click the raw data icon to load the spectroscopy data into the Spectroscopy Task Card
    7. Acquire spectral data within the Volume of Interest (VOI)

  18. syngo CSI: Chemical Shift Imaging: Integrated software package with sequences and protocols for Chemical Shift Imaging (CSI) Extension of the SVS package, offering the same level of user-friendliness and automation
    • Matrix Spectroscopy – phase-coherent signal combination from several coil elements for maximum SNR with configurable prescan-based
    normalization for optimal homogeneity
    • 3D Chemical Shift Imaging
    • Hybrid CSI with combined volume selection and Field of View (FoV) encoding
    • Short TEs available (30 ms for SE, 20 ms for STEAM)
    • Automated shimming of the higher order shimming channels for optimal homogeneity of the larger CSI volumes
    • Weighted acquisition, leading to a reduced examination time compared to full k-space coverage while keeping SNR and spatial resolution
    • Outer Volume Suppression
    • Spectral Suppression
    • Protocols for prostate spectroscopy
     
     

    Single voxel spectrography (SVS)

       
  19. Composing:
    Composing of images from different table positions to show the complete anatomy such as whole body, whole spine, etc.
    Features
    Automatic and manual composing of sagittal and coronal images
    Dedicated algorithms for spine, angiography, and adaptive composing algorithms
    Measurement on composed images (angle, distance)
     

    Composed coronal whole-body TIRM scan

    Composed whole-body MRA (MIP)

    Composed sagittal whole-spine examination


    Step by step:
    1. Send images from the Patient Browser to the Composing Task Card.
    2. Select the appropriate Composing algorithm. The Spine algorithm uses bone structures in the images as a basis, while Angio uses the vascular structures.
    3. It is important when saving the images that all of the images are saved. This is done by selecting Patient from the main menu, then “Save All As…”
    4. The final step is to name the series what you want it to be called in the Patient Browser. Enter the name for the new series in the text box, then select OK.

  20. TimCT Oncology:
    syngo TimCT Oncology uses a sophisticated patient table with excellent position accuracy and a RF shielded table drive as well as Tim (Total imaging matrix) technology: at the same time, local coils with high signal-to-noise ratio (SNR) covering the whole body enable superb image quality and very fast imaging using integrated Parallel Acquisition Techniques (iPAT).
    syngo TimCT Oncology is based on axial 2D multi-slice sequences for both T1-weighted FLASH and T2-weighted TSE imaging. The TSE variant can also be combined with syngo BLADE for motion insensitivity. The FLASH variant can also be combined with DIXON to acquire inphase, opposed-phase, water and fat images in one measurement.
    syngo TimCT Oncology allows a CT-like MR examination:
    Definition of start point and end point of scan area only
    No need to plan in multiple steps
    No need to plan overlapping areas
    No delay, no measurement pauses during table move
    No need for composing
  21. Syngo Expert-i: Interactive real-time access to imaging data and exam information from any PC within the hospital network during the MR exam.
    Until now, radiologists or other experts had to stop what they were doing and go to the MR scanner to see the acquired images, help with the scan set-up, or answer an open question.
    Now, questions can be addressed quickly and efficiently via remote PC.
    Benefits of syngo Expert-i
    • Excellent results right from the first examination
    • Streamlined workflow and faster patient throughput
    • Reduced repeat rates with a check on images while the patient is still in the examination room
    • Reduced training effort by enabling expert assistance for specialized procedure
  22. syngo Remote Assist
    Direct computer link to the local Siemens service department or the Siemens service centers (via router with telephone connection)
    Image transfer for further evaluation
    • Image and file transfer in batch mode
    • Reading of entries in the error logbook
    • Remote trouble shooting
    • Remote access to service manuals written in easy-to-use HTML format
    • Remote access to Service Site Database
    • Start of preventive maintenance and quality assurance routines. Provided in conjunction with a service contract with Siemens (UPTIME
    Services)
    • Remote access granted only with permission of the institution. Data security is ensured by secure access
  23. IDEA Integrated Development Environment for Applications
    Extensive programming environment used to create and modify pulse sequences, offering a maximum of flexibility
    Based on C++ for Windows XP. Sequences and RF pulses are displayed in a visual interface
    Features
    • Allows direct access to the Image Calculation Environment (ICE), and to all protocols
    • Testing the generated code is extensively supported by the debugger and the simulation program
    • IDEA is also usable on any standard PC with operating system Windows XP Windows 7 Pro, making developments independent of the MR system
    Processing plug-ins For development or modification of user-defined image processing steps which may be integrated into the measurement protocols
    • Individual processing is secured by a number of functions (e.g. TTP and MTT), useful for neuro or perfusion imaging
    Prerequisite IDEA training course
  24. Tim Planning Suite:
    Easy planning of extended Field of View examinations in an efficient way using Set-n-Go protocols.
    It allows planning of several stations at once e.g. on composed localizer images.
    The overlap of slice groups can be adjusted. All stations can have independent parameter settings although they are displayed together.
    A special coupling mode allows easy positioning of all stations at once according to the patient’s anatomy.
    Fully supports scan@center and Phoenix functionality.
    Tim Planning UI with optimized layout for slice positioning
    Ready to use Set-n-Go protocols for different clinical questions
    Integrated toolbar for fast, advanced slice planning: FoV-Plus, FoV-Minus, AlignParallel, AlignFieldOfViews
     
     
      User interface of the Tim Planning Suite for easy planning of extended Field of View examinations

    Step by step:
    1. Location on protocols in Exam Explorer
    2. Set-n-Go: supports in preparing the measurement and examining large regions of the body.
    3. Inline Compose: automatic composing of images from divided examination regions.
    4. Position local slices on composed image
    5. Coupled Graphics: Allows all graphical slice positions in all orientations within one scan to be moved at the same time.
    6. Auto Coil Select: All surrounding coils are selected automatically. The maximum number of coils used is limited by the number of system channels.
    7. Set-n-Go Parameters
    Viewing images in Viewing Task Card

  25. TimCT Angiography: Maximum FoV of Syngo TimCT Angiography: 205 cm.
    syngo TimCT Angiography employs the revolutionary TimCT Continuous Table move technology for large Field of View angiographies with the smoothest workflow and the most homogeneous image quality.
    syngo TimCT Angiography is built on the Tim technology as well as on a highly advanced patient table with high positioning accuracy and a RF shielded table drive.
    syngo TimCT Angiography uses a coronal 3D gradient echo TimCT sequence with strong T1-weighting and high SNR. Optimized protocols for peripheral vessel runoff exams allow for CT-like scanning with MR: Just define start & end of the scan range. No need to plan multiple steps. No need to plan overlapping sections.
    No lost time due to inter station table move. No need to compose images.
    Thanks to the streamlined and automated workflow and the fast acquisition time with syngo TimCT, a peripheral vessel runoff exam can be performed in less than 15 minutes with the most homogeneous image quality.
    Features
    iPAT compatibility utilizing Tim‘s Matrix coils capabilities
    Inline subtraction and Inline MIP of complete peripheral runoff images
    Highest image homogeneity and no boundary artifacts thanks to seamless TimCT scanning
    Maximum FoV of syngo TimCT Angiography: 205 cm
    Fast table speed during angiographic measurements up to 50 mm/ s
    Fast examination time (typically below 1 minute) for TimCT peripheral angiographic exam
    (40–70 s depending on resolution)
     
    Arteriovenous malformation of the lower right extremity

    Step by step:
    1. Load TimCT Angio Program into the measurement queue. The patient should be positioned head first in the scanner, centering at the level of the patients shoulders.
    2. The TimCT fastview scout will run automatically. It can be viewed as it is acquiring the data in the online display. When the scan is complete, inline it will MPR into all 3 orientations.
    3. Position and apply the test bolus scan. After applying a pause menu will appear, this will allow for simultaneous start of the scan and injection of a test bolus. Calculate the contrast arrival time. This will be used later.
    4. Position and apply the vessel scout protocol. This is a set-n-go scan for visualization of the peripheral vessels, which will be used to position the angio sequence.
    5. Position the TimCT angio pre scan. This is used for the inline subtractions of the post TimCT Angio scan. The post scan will automatically copy the same position.
    NOTE: Ensure all vessels are in the same plane, as this scan is one FoV, it cannot be angled.
    6. Input contrast agent information on the injection pause menu. Start your injection and scan delay based on calculations from the test bolus scan, and select continue.
    7. Subtraction images and the post TimCT Angio scan will reconstruct inline along with a coronal MIP. This data can now be loaded into the 3D Task card for additional post processing.
     

  26. iPAT Extensions: Allows iPAT in 2 directions simultaneously (phase encoding direction and 3D direction for 3D sequences). By applying PAT in 2 directions simultaneously, the effective PAT factor can be maximized, and PAT applications are extended.
    Clinical Applications:
    MR Angiography
    Ultra-fast isotropic T1-weighted 3D imaging of the head
    Whole abdomen, thorax imaging (e.g. MR Colonography)
    Step by step:
    1. Open a 3D scan.
    2. Go to the resolution tab, then the iPAT sub tab.
    3. Set the iPAT Extensions by changing the acceleration factor 3D.
    4. The maximum factor is based on the coil elements in the 3D partition direction.
  27. Syngo BreVis: The system is equipped with standard BIRADS (Breast Imaging Reporting and Data System) with NORAS BI 320.
    Accuracy, speed, and efficiency are essential when it comes to interpreting soft tissue examinations as well as performing biopsies. Siemens syngo® workplaces (e.g. MultiModality WorkPlace) are equipped with a great number of computer-aided tools such as syngo BreVis for real-time analysis and syngo BreVis Biopsy for interventional procedure planning.
    syngo BreVis is easy-to-use, fast, and reliable. Quick pre-processing and precise motion correction enable efficient breast reading and reporting. This flexible tool provides various functionalities – such as customized layouts and the ability to display and compare MR images with correlating ultrasound or X-ray mammography images. Additionally, the system is equipped with standard BIRADS (Breast Imaging Reporting and Data System) Reporting, Auto-Subtraction and Auto-MIP, elastic image correction in case of patient movement, curve evaluations, color overlay maps and the calculation of lesion volumes.
     
         

     

  28. Syngo GRAPPA: Based on k-space. Faster high resolution protocol for wide fields.
    syngo GRAPPA is a Parallel Imaging Technique, based on k-space which can be used to shorten the acquisition time or increase the spatial resolution in the same examination time.

     
    Features
    syngo GRAPPA works better with linear array coils like "Spine Coil"
    syngo GRAPPA can be used with small Field of View
    High SNR of Tim matrix coils allows to trade speed for SNR for more applications
    Clinical Applications
    Faster neuro imaging (Spine, head…)
    Cardiac imaging with high temporal and spatial resolution
    Fast dynamic contrast enhanced MR Angiography
    Abdominal Imaging with shorter breathhold times
    Fast, high resolution orthopedic imaging
    Fast whole-body imaging
    Left temporoparietal tumor, seen with isotropic SPACE (syngo GRAPPA 2.4 min) syngo GRAPPA 2, 2.56 min, SL 3 mm. 448 matrix. ( right syngo GRAPPA, left conventional images. 5 min)
    Syringomyelia and tethered cord. age 22 months. syngo GRAPPAx2(45 sec. 418 matrix.3mm) T2w TIRM for metastases screening, syngo GRAPPA, PAT 3(2.00 min per step 6 mm. 5 steps) Whole-body MRA in 48 seconds, syngo GRAPPA x3 (1.3x1.3 mm resolution, 4 steps at 12 s/step)
  29. Syngo REVEAL: Reduce susceptibility artifact when combined with GRAPPA. Excellent for mts. syngo REVEAL is an echo planar imaging (EPI) based diffusion weighted imaging technique for the body. This sequence can be combined with 2D PACE navigator technique to decrease motion artifacts.
    Features
    Combined with GRAPPA for reduced susceptibility artifacts
    Typically high b-values (600-1000) for signal suppression of normal tissue
    Dark-Vessel REVEAL with low b-values (50)
    Semi-quantitative REVEAL (ADC maps)
    Clinical Applications
    Can be useful in differential diagnosis of benign versus malignant lesions in all anatomical regions (Liver, pancreas, lymph nodes, pelvis …)
     
    Free breathing syngo REVEAL with 2D PACE provides improved image quality
     in abdomen imaging
    Malignant infiltration of iliac lymph nodes, seen with syngo REVEAL Pancreatic cancer detected by syngo Reveal Coronal MPR of a whole-body DWI examination in case of multiple myeloma
    (right b=50 mm/s2 image left ADC map
  30. Syngo Security: Security package for general regulatory security rules
    The option supports customers to achieve compliance with HIPAA (Health Insurance and Accountability Act)
    • User authentication
    • Restricts access to functions and data through privileges and permissions
    • Logs relevant data security information in audit trail
     
     
       
  31. Syngo SPACE: syngo SPACE sequence is single slab 3D TSE sequence with slab selective, variable excitation pulse.
    This sequence enables acquisition of high resolution 3D datasets with contrasts similar to those obtained from 2D T2-weighted, T1-weighted, proton density and dark fluid protocols at 1.5T and 3T within a clinically acceptable timeframe and without SAR limitations.
    Features
    When you combine syngo SPACE with Tim’s Parallel Imaging (SENSE and GRAPPA), you can acquire high-resolution 3D images within a shorter timeframe.
    3D isotropic data set allows retrospective reformatting to view multiple orientations of the anatomical area being examined.
    Low SAR
    Clinical Applications
    Brain survey to visualize minute lesions with 3D scanning (e.g. Multiple sclerosis, cranial nerves)
    MR cholangiopancreatography with navigator
    based SPACE
    Pelvic diseases
    High resolution proton density weighted images of the knee
  32. Argus Function: Automated tool for cardiac function evaluation.
    Features
    Fully automatic image segmentation
    Easy user guidance with graphical selection of ED, ES, basal and apical slices
    Global function and regional wall motion analysis with color results
    Clinical Applications
    Volumetric assessment and ejection fraction calculation in cardiomyopathy (dilated, hypertrophic...), pericardial disease, cardiac tumors and cardiac transplants.
     
    Semi-automated Argus Function cardiac output results are shown

    Step by step: 
    1. From the patient browser, load all short axis cine series into Argus Viewer.
    2. Select the "Ventricular Function" Icon within Argus
    3. Select the "Auto Adjust" tool to have the myocardial contours drawn on the basilar end diastolic (ED) image.
    4. Next select "Propagate ED". This will contour all images in the ED phase column for all slice positions.
    5. Select "Propagate ED to ES" to have contours moved to the End Systolic phase column for all slice positions.
    6. Complete the post-processing by "Accepting ED/ES Phases" and "Accepting Contours". You are now ready to produce the results.
    7. Go to the Results Tab and select "Volume" to view the results. Storing the ventricular analysis can also be accomplished by selecting "Save As" 

  33. Advanced Cardiac:
    Special sequences and protocols for advanced cardiac imaging including 3D and 4D syngo BEAT functionalities.
    It allows comprehensive exams covering morphology, function, dynamic imaging, tissue characterization, coronary imaging, plaque characterization and more.
    Features
    1-click change from FLASH to TrueFISP for easy contrast optimization, 1-click to switch arrhythmia rejection on/off, 1-click change from Cartesian to radial sampling to increase effective image resolution (e.g. in pediatric patients) and avoid folding artifacts in large patients, 1-click switch from cine imaging to tagging for wall motion evaluation, 1-click switch from 2D to 3D imaging, syngo BEAT automatically adjusts all parameters associated with the changes.
    Clinical Applications
    Ventricular function and regional wall motion evaluation: Retrospectively triggered TrueFISP with iPAT for full coverage of the cardiac cycle, T-PAT with GRAPPA for highly accelerated image acquisition, arrythmia rejection for patients with extrasystoles. 3D cine imaging, complete coverage of the heart in just one go. Visualization of myocardial contractility using various tagging techniques.
    Cardiac and vessel morphology: High resolution morphological imaging using bright- and dark-blood sequences with free breathing. Multiple contrasts such as T1- and T2-weighted imaging for use in diseases such as myocarditis (inflammation/hyperaemia), ARVD (fibrous-fatty degeneration) or acute myocardial infarction (edema).
    Dynamic myocardial imaging with syngo BEAT: Ultra-fast, high-SNR sequences for dynamic imaging using TurboFLASH,TrueFISP or GRE EPI for the detection of significant coronary artery disease.
    Tissue characterization with syngo BEAT: Highly robust and reproducible late enhancement imaging with IR (inversion recovery) and PSIR (phase-sensitive inversion recovery) technique for myocardial tissue characterization, e.g. after myocardial infarction or for differentiation of cardiomyopathies.
    Coronary imaging with syngo BEAT: Dedicated 2D and 3D sequences for high-resolution coronary artery imaging, providing free-breathing and breath-hold techniques.
    Vessel wall imaging: High-resolution sequences and protocols for vessel wall imaging (e.g. atherosclerotic plaque characterization) in small or large vessels.
     

    Grid tagging for visualization of heart kinetics

    Coronary imaging with syngo BEAT

    Visualization of the right coronary artery with syngo BEAT

    Step by step:
    1. The Advanced Cardiac package or 3D Beat enables 3D cardiac imaging.
    2. Within the function category, this TRUEFISP 3d cine sequence is prepared.
    3. Under tissue characterization, there are3D IR flash and TRUEFISP sequences available.
    4. Coronary imaging is the largest contributor to this package, as there are TRUEFISP breath hold and free breathing navigator sequences accessible.
     

    3D Syngo BEAT: This package contains special sequences and protocols for advanced cardiac imaging including 3D and 4D syngo BEAT functionalities. It supports advanced techniques for ventricular function imaging, dynamic imaging, tissue characterization, coronary imaging, and more. syngo BEAT is a unique tool for fast and easy cardiovascular MR imaging. It provides 1-click switch from cine imaging to tagging for wall motion evaluation and 1-click switch from 2D to 3D imaging. syngo BEAT automatically adjusts all parameters associated with the changes.
    Cardiac and vessel morphology
    • Multi echo technique thalassemia assessment
    • 3D aortopathy imaging with free breathing (SPACE)
    Morphology and global or regional ventricular wall motion analysis with syngo BEAT
    • 3D cine acquisition for full CT-like heart coverage
    • 2D segmented FLASH for visualization of the regional wall motion using various tagging techniques (grid or stripes)
    Dynamic myocardial imaging with syngo BEAT
    • Ultra-fast, high-SNR sequence for dynamic imaging with GRE EPI contrast for stress and rest exams
    Tissue characterization with syngo BEAT
    • Robust myocardial tissue characterization with 3D PSIR (phase sensitive inversion recovery), e.g. after myocardial infarction or for differentiation of cardiomyopathies.
    • Fast and complete coverage of the myocardium with IR 3D FLASH and TrueFISP
    Coronary imaging with syngo BEAT
    • 3D whole heart non-contrast coronary MRA
    • 3D whole heart MRA with advanced free-breathing navigator compensating diaphragm shifts during the acquisition (motion-adaptive respiratory gating)

  34. Argus Viewer on syngo Acquisition Workplace: Viewing software for cardiac MR studies and large data sets.
    Efficient CINE review of cardiac and other dynamic data sets
    Flexible multi-level sorting
    Single movie as well as 2, 4, or 8 simultaneous slices together in movie mode
    Rapid AVI creation of 1 or 4 simultaneous slices
    Creates and edits reports
     
     
      Argus Viewer on syngo Acquisition Workplace
  35. Argus Viewer:
    Viewing Software for Cardiac MR Studies and large data sets. The Argus Viewer allows users to load a large list of dynamic data sets and view it comfortably.
    For example cardiac images from a patient are loaded and then automatically sorted into user definable reading configurations. Resorting and re-display can be changed instantaneously according to the wishes of the user, either automatically or manually.
    For example:
    Grouping based on series description
    Grouping based on slice position
    Free grouping of image stacks by drag&drop in the image overview
    Additionally, integrated 8 on1 movie provides efficient review of data
    AVI creation of movie loops (up to 4on1) possible.
    Main Benefits
    Up to 8 series simultaneously in a synchronized movie displayed
    Rapid multi-level sorting
    For conferences, presentations and consultation over the internet
    Fast AVI creation
     

     

    Detailed visualization of all relevant cardiac images on one page with Argus Viewer

     
  36. AutoAlign: Automated alignment of slice positioning for head examinations. This option enables easy and accurate patient follow-up. AutoAlign references the 3D MR brain atlas and automatically aligns the slice positions in a standard reproducible way.
     
     
      Automated positioning and alignment of the anatomy-related slices using anatomical landmarks.
  37. AutoAlign Head LS: Landmark Survey. Needed for intraoperative MRI. ATLAS included. Angled with AC-PC line.
    Automated positioning and alignment of the anatomy-related sagittal, coronal and axial slices using anatomical landmarks. Independent of patient age, head position, disease or user independent positioning standards, the system automatically finds the correct position.
    Features
    •AutoAlign Head LS is independent of the coil setup or the sequence
    •AutoAlign assists the user in positioning slices with high cross-patient robustness
    •Provides excellent intra-patient reproducibility
    Clinical Applications
    Standardized and reproducible patient scanning allows more accurate diagnosis especially in follow-up patients.
     
     
      Automated positioning and alignment of the anatomy-related slices using anatomical landmarks.

    Step by step:
    1. Auto Align Head: Landmark Survey
    2. Load AA Head study into the measurement queue. The AutoAlign scout will run automatically. This scan is a 3D series, which produces 2 series. 1 with the "Head Basis" boney landmark matrix. And one with the "Head Brain" matrix angled with the AC-PC Line.
    3. To ensure proper alignment, open the "Auto Align Information Dialog".
    4. Based on positioning preferences, choose one of the AA matrixes from the Auto Align dialog.
    5. After verifying your positioning, apply the scan.
    AutoAlign Head ATLAS:
    1. Select Patient/Register
    2. On the registration menu select the Search icon.
    3. Select the Auto Align patient from the Patient Search menu and select OK.
    4. Continue with the registration, entering the Study and Patient Position.
    5. Select the Exam button and Confirm the registration.
    6. An information window will appear to inform the user that this registered patient is for planning only! Measurements are not possible. Select OK to acknowledge.
    7. Images from the auto align planning patient will appear in the GSP segments.
    8. Open the Exam Explorer by selecting the icon on the Exam card.
    9. Select the AA Scout from the Siemens protocol tree under Head/AA/Standard_1 and drag it to the measurement queue. Close the Exam Explorer.
    10. Select the remaining protocols you will use for the study and send them to the measurement queue.
    11. Open the localizer sequence and adjust the slices if needed. Apply the sequence.
    12. Open each sequence, position the slices on the AA planning images and apply each one after positioning. Continue until all sequences have been positioned and applied. Now the sequences can be saved for future use.
    13. To save, right mouse click in the black area under the sequences in the measurement queue, Select Save as Program.
    14. Assign a name for the Region, Exam, and Programs.
    15. Select the SAVE and EDIT button. Select Yes if you are replacing an existing program.

  38. AutoAlign Knee: Automated positioning and alignment of the anatomy related sagittal, coronal and axial slices using anatomical landmarks. This provides a fast, easy, standardized and reproducible patient scan and supports reading, by delivering a higher and more standardized image quality.
     
     
      AutoAlign Knee software application

    Step by step:
    1. Load AA scout and knee protocols into the measurement queue.
    2. Open the AA scout and apply the scan. Ensure that AutoAlign Knee is selected.
    3. Ensure remaining scans have AutoAlign Knee selected on the Routine Card.
    4. Open remaining sequences and adjust coverage if necessary, and apply the scans. The AutoAlign feature automatically positions the slice group to the adjusted condyle landmarks.
    5. Review the resulting images.

  39. AutoAlign Spine: Single mouse click double oblique positioning of transverse slice packages in spine imaging. AutoAlign Spine localizes the intervertebral disk on sagittal images and positions the transverse slice packages parallel to the disk in a standardized way. This allows for a faster and easier exam and supports reading by delivering a higher and more standardized image quality.
     
     
       


    Step by step:
    1. Automatic Positioning of transversal slices.
    2. Move axial sequence into Program control area.
    3. Switch AutoAlign on. To do this select Main Menu > Tools > AutoAlign Spine or open the protocol properties dialog window and select Properties > Auto Load > AutoAlign Spine.
    4. Open the protocol and select the slice group.
    5. Press and hold the left mouse button and drag the axial slice group to any position within an intervertebral disk
    6. Release the left mouse button and slice group is automatically positioned.
    7. To manually position a slice group, hold the Shift key down while moving the slice group
     

  40. BOLD Imaging: BOLD (Blood Oxygenation Level Dependent) Imaging
    BOLD Imaging is a technique for non-invasive detection of functional neuronal activities. MR BOLD Imaging is available for non-invasive detection of regions of human brain where functional activities take place: high temporal and spatial resolution, anatomical and functional images may be displayed in the same manner.
     
         
  41. Breast Biopsy: Easy to use syngo based post-processing software helps finding the coordinates for needle insertion for biopsy or localization of breast lesions detected by MR.
    Allows calculation of the coordinates after clicking the center of the lesion and the Zero marker of the breast biopsy device.
     
     
       
  42. BreVis Biopsy: With Sentinelle Vanguard and related accessories. Accuracy, speed, and efficiency are essential when it comes to interpreting soft tissue examinations as well as performing biopsies. Siemens syngo® workplaces (e.g. MultiModality WorkPlace) are equipped with a great number of computer-aided tools such as syngo BreVis for real-time analysis and syngo BreVis Biopsy for interventional procedure planning.
    syngo BreVis Biopsy is a professional solution for a fast and accurate MR biopsy workflow with automatic calculation of target coordinates. The user interface offers a guide for MR interventional planning and supports breast biopsies, i.e. Sentinelle Vanguard and related accessories. The easy-to-handle workflow enables shorter examination times for both patient and operator.
     
       
  43. CARE Bolus: (Combined Applications to Reduce Exposure)
    Online-visualization of contrast enhancement for exact timing of ceMRA.
    CARE Bolus protocols and program
    Switching from 2D to 3D MRA on-the-fly
    Stop and Continue in Exam Taskcard
    Centric, elliptical phase reordering
     
     
       
  44. CISS & DESS: Constructive interference in Steady State and Double Echo Steady State.
    3D DESS (Double Echo Steady State)
    T2/T1-weighted
    High resolution cartilage imaging
    3D CISS (Constructive Interference in Steady State)
    Excellent visualization of fine structures such as cranial nerves
    High resolution imaging of inner ear and spine 
     
    CISS C-spine imaging CISS C-spine imaging DESS Knee imaging

    Thick-slice MPR of CISS data shows internal acoustic canal
     tumor and inner ear structures.

    Step by step:
    CISS
    1. Finding the CISS sequence in the Exam Explorer; go to Head, Library and 3D
    2. Viewing CISS images in the 3D Task Card
    DESS
    1. Finding DESS sequences in the Exam Explorer; go to knee, cartilage
    2. Viewing DESS images in the 3D Task Card

  45. Echo Planar Imaging: EPI sequences including: Single-shot and segmented 2D/3D SE-EPI, Maxwell term corrected IR-EPI and FID-EPI for diffusion imaging, perfusion imaging and ultra fast T2* weighted 2D and 3D anatomical imaging.
    Diffusion Imaging
    Single-Shot diffusion- weighted EPI with max. b-value of 10 000 s/mm²
    Trace-weighted imaging with 3-scan technique for highest image quality
    Protocols for agitated patients providing artifact minimized trace weighted images
    Dark Fluid IR diffusion measurement for suppression of CSF signal
    Inline Technology: automatic real-time calculation of trace-weighted images and ADC maps
    Multi-directional Diffusion-Weighted Imaging (DWI) with multiple diffusion directions and b-values: suitable for investigation of anisotropic diffusion in tissue such as calculation of diffusion tensors
    Perfusion Imaging
    Single-Shot EPI for Perfusion
    Inline Technology: automatic real-time calculation of Global Bolus Plot (GBP), Percentage of Baseline at Peak map (PBP) and Time-to-Peak map (TTP)
     
     
      Echo Planar Imaging
  46. Flow Quantification: Special sequences (only AWP) for quantitative flow determination studies, measuring blood/CSF flow non-invasively. Requires Patient monitoring unit (PMU) option. Retrogated Flow Dynamic representation of temporally changing flow.
     
    Color-coded sagittal phase images of the thoracic aorta Phase image of the aortic arch and major pulmonary vessels.

    Step by step:
    1. Run localizer scans. Ensure all scans are set to "iso" mode, so the area of interest will be located in isocenter.
    2. For in-plane flow imaging, position the slices parallel to the flow. For thru plane imaging, position the slices perpendicular to the flow.
    3. Set 1st signal mode for triggering, always using "Retro gating". If pulse triggering use Pulse/Retro, if ecg triggering use ECG/Retro.
    4. Apply the scan.
    5. Load the phase image into the UI.
    6. Right click the phase image and select Movie On to visualize the flow.

  47. Fly Through: Simulated endoscopic views of the bronchi, vessels, colon and other hollow structures. Multi-modality application for CT, MR and 3D AX data.
    Fully integrated into the familiar syngo 3D workflow and user interface.
    Step by step:
    1. Load a MRA sequence into 3D MPR. Select the MRA sequence, go to applications and select MPR.
    2. Change segments 1 and 2 images into MIP views. Select the 1st segment, the outline will turn bold, and select the MIP icon, repeat for the 2 segment.
    3. Create the endoscopic view. Select the 3rd segment, and then left click the Fly Through icon.
    4. Set the window for the endoscopic view. Right click the SSD icon and change the High Value to remove the pink coloring from the inside of the vessels. In this case it was 50.
    5. Right click within the endoscopic view to activate navigation tools. Auto navigation will allow holding the left key of the mouse and sliding it forward to move forward thru the aorta.
    6. Rotating around a viewing point, within the navigation tool, allows viewing left-right, or top-bottom.
  48. GRACE: GeneRAlized breast speCtroscopy Exam- Choline level follow up to evaluate Ca breast: (GeneRAlized breast speCtroscopy Exam)
    SVS technique (spin echo sequence) optimized for breast spectroscopy.
    The technique contains a special spectral lipid suppression pulse (user definable) for lipid signal reduction. Siemens unique water reference detection to visualize the normalized choline ratio.
    Online frequency shift correction for reduction of breathing related artifacts, Inline implementation – no additional user interaction is required.
    Clinical applications:
    • Differentiating benign from malignant breast lesions
    • Predicting clinical response to neoadjuvant chemotherapy in an early stage (24hours after receiving the first dose)
     
     
      Increased Choline-signal within breast tumor, shown with syngo GRACE
  49. Inline Composing: Composed images can be automatically loaded into graphical slice positioning for planning purposes. Automatic anatomical or angiographic composing of multiple adjacent coronal or sagittal images for presentation and further evaluation.
     
     
      Inline Composing


    Step by step:
    1. To find sequences with Inline Composing set up, open the Exam Explorer and locate regions where Inline Composing is utilized.
    2. Open a sequence.
    3. It the system has the Tim Planning Suite, Inline Composing can be found in the Geometry parameter card.
    4. The first Inline Composing parameter is the checkbox for Inline Composing. This invokes the Inline Composing function.
    5. The Composing Function controls the algorithm that will be used to reconstruct the images.
    6. Composing Group identifies all steps that will be composed.
    7. The last step function identifies the sequence that is the last step of a multi-station examination; e.g., the lumbar spine measurement in a whole spine protocol.
    8. If the system does not have Tim Planning Suite, the same information can be found in the Inline parameter card, in the Composing tab.

  50. Inline Diffusion: Automatic creation of Trace weighted and ADC diffusion maps.
    Automatic real-time calculation of trace-weighted images and ADC maps with Inline Technology. Compatible with single-shot diffusion weighted EPI.
    Inline Diffusion enables syngo REVEAL body diffusion applications.
    Clinical Applications
    Stroke imaging
    Tumor differentiation in head and body applications
     
    Automatic real-time calculation of trace-weighted images and ADC maps Automatic real-time calculation of trace-weighted images and ADC maps


    Step by step:
    1. Add the epi2d_diff_3scan_trace sequence to the measurement queue. It is located in the exam explorer, advanced applications library, then diffusion and perfusion. Right click the sequence and select Append to Queue.
    2. Open the sequence and position.
    3. The inline functions are located on the Diff sub task card of the sequence.
    4. Ensure that the Trace and Average ADC maps are selected and apply the scan.
    5. With inline Diffusion there are 4 images produced per slice position.
    6. Without this option, using orthogonal diffusion, there are 10 images per slice position. There are also no Trace images available.

  51. Inline Perfusion: Automatic real-time calculation of Global Bolus Plot (GBP), Percentage of Baseline at Peak map (PBP) and Time-to-Peak map (TTP) with Inline technology. Creating color perfusion maps of the brain.
     
     
      Automatic real-time calculation of perfusion parameters

    Step by step:
    1. First, locate and open a perfusion sequence in the Exam Explorer.
    2. Go to the Perfusion parameter card.
    3. GPB (Global Bolus Plot): This parameter determines whether a global time-density curve has been determined for evaluating the bolus passage.
    4. PBP (Percentage of Baseline at Peak Map): This parameter determines whether a percental signal image should be reconstructed for every slice. This image shows the signal change of the bolus peak relative to the base line. The brighter an image area, the less contrast agent arrived onsite.
    5. TTP (Time-to-Peak-Map): This parameter determines whether a time-to-peak image is reconstructed for every slice. The pixel intensity value in the image shows the time that expired until the signal peak was reached. The brighter an area in the grayscale image, the more time expired until the signal peak was reached.

  52. Soft Tissue Motion Correction:
    3D elastic motion correction, for offline 3D correction in all directions over entire 2D and 3D data sets suitable for e.g. soft tissue MR exams. Allows higher conspicuity and accuracy especially for multi-focal lesion detection. New image data is reconstructed and saved in a separate series within the patient browser. It can be combined with the original non-corrected image data.
     
     
      Clear reduction of artifacts by the soft tissue motion correction
  53. MR Elastography: For liver fibrosis needs hardware and software. Anew MRI-based biomarker for characterizing tissue non-invasively is provided. Furthermore this represents a new approach of improved treatment decisions, especially in the field of liver fibrosis. The MR Elastography package includes hardware and software.
    Clinical Applications
    New approach for improved decisions, especially in liver fibrosis
    Non-invasive assessment of variations in tissue stiffness
    Features
    iPAT enables shortened breath-hold time
    Fully integrated processing of the elastogram at the scanner
    Completely automated calculation of wave images and corresponding elastograms
    Statistical confidence map for reliability
    Hardware and software*
    Resoundant® active and passive drivers
    Sequence and protocols with 2D gradient-echo sequences with cyclic motion-encoding gradients (MEG)
     

    Elastogram calculated from wave image providing reliable data about tissue stiffness

    Wave image obtained by mechanical waves while measuring with a motion-sensitive MR sequence

    Resoundant@ passive driver Resoundant@ active driver
  54. 31 P Spectroscopy: Optimized for liver and heart applications.
    Integrated package with RF coil, sequences and protocols for 31P spectroscopy.
    Offering the same level of user friendliness and automation as 1H spectroscopy.
    1H/31P transmit/ receive Heart Liver coil for 31P spectroscopy
    Short TE CSI sequence and protocols optimized for heart and liver applications
    NOE (Nuclear Overhauser Effect) and 1H decoupling available
    ECG triggering available
    Weighted acquisition available
     
     
       
  55. Advanced 3D Imaging Package: 3D DESS and 3D CISS.
    Advanced 3D Applications Package contents of sequences and protocols which are unique to Siemens.
    3D DESS for high-resolution 3D studies of joints with excellent T1 and T2 contrast. DESS is a double echo gradient sequence in which a FISP (transversally rephased gradient echo) and a PSIF (RF-refocused gradient echo) echo are simultaneously acquired and added, resulting in an increased signal-to-noise ratio.
    3D CISS for excellent very high resolution studies, especially useful in inner-ear examinations.
    These Advanced 3D data sets provide very thin contiguous slices with high signal-to-noise ratio which are also well suited to MPR post-processing along straight (oblique or double oblique) or curved lines. In some cases such as MR Myelography or inner ear work, the MIP algorithm also provides very useful information.
     
     
      3D DESS sequence with T1/T2
  56. Advanced Angio: Sequences and protocols optimized for the head/neck, body and peripheral region.
    Turbo contrast-enhanced MRA technique for up to 50% faster studies than conventional MRA
    2D Time-of-Flight (ToF) triggered and segmented
    2D/3D Phase Contrast (PC) Angiography with multi velocity encoding
    3D VIBE. Breath-hold examination based on 3D FLASH using interpolation and quick fat saturation.
    Isotropic voxels allow multiplanar volume imaging of organs
    Parenchymal imaging and angiography with a single dose of contrast agent
    Protocols for virtual MR Colonoscopy
     
           
  57. Advanced Diffusion: DWI base on HASTE and REVEAL
    Selection of advanced fast imaging techniques optimized for ultrafast imaging.
    Diffusion weighted imaging based on HASTE
    REVEAL: diffusion imaging for liver, ortho and spine exams. Prerequisite for abdominal applications (e.g. liver diffusion) is the option “PMU Wireless Physio Control“
     
    Dark Fluid tra Diffusion HASTE tra Hyperintense signal on b-value 50 correlates with the low
    ADC map showing mts in the liver
    Hypointense signal on ADC map inverted demonstrating metastases
     in the liver
    High-signal intensity demonstrating metastases in the liver
  58. Advanced Turbo: Ultra fast imaging
    Selection of advanced fast imaging techniques optimized for breath-hold and ultrafast imaging.
    2D/3D TrueFISP for fast T2 imaging, compatible with FatSat (protocols for virtual MR Colonoscopy)
    2D/3D HASTE (Half-Fourier Acquisition with Single-Shot Turbo Spin Echo)
    2D/3D HASTE IR for fat suppression
    2D/3D Single Shot Turbo SE for very heavy T2-weighting
    PSIF Diffusion
    Segmented 2D/3D EPI (SE and FID)
    HASTE and TrueFISP compatible with 2D PACE
    Shared phases real-time TrueFISP
     
           
  59. Panoramic Table for Integrated Panoramic Positioning
    Automatic and software controlled table positioning for imaging of large anatomies (spine, chest/abdomen, peripheral angiography).
    Automatic patient table movement
    Simultaneous setup of multiple exams
    Imaging with body coil, optional surface coils and
    CP PAA coil
    Includes automatic switch of active coil elements
     
     
      Panoramic Table for Integrated Panoramic Positioning (IPP)
  60. TGSE: (Turbo Gradient Spin Echo): Ultra-fast sequence providing high resolution imaging or extremely short acquisition times
    Hybrid Turbo Spin Echo / Gradient Echo used primarily for T2-weighted imaging
    • Shorter measurement time
    • Decreased RF power deposition
    • Improved visualization of hemorrhage, due to magnetic susceptibility differences
    • High resolution imaging of brain and spine
     
     
      TGSE - Turbo Gradient Spin Echo
  61. Spine Composing: Seamless composition of images acquired in multiple stages. (e.g. whole CNS studies)
     
     
      Spine Composing
  62. Multi-Channel Application Suite:
    2D PACE (Prospective Acquisition CorrEction)
    LOTA (Long Term Data Averaging) technique for motion and flow artifact reduction without increasing scan time
    Elliptical scanning reduces scan time for 3D imaging
    Selectable centric elliptical phase reordering via the user interface
    Inversion Recovery to nullify the signal of fat, fluid or any other tissue
    True Inversion Recovery to obtain strong T1-weighted contrast
    Dark blood inversion recovery technique that nulls fluid blood signal
    Saturation Recovery for 2D TurboFLASH, gradient echo, and T1-weighted 3D TurboFLASH with short scan time (e.g. MPRAGE)
    Presaturation Technique. RF saturation pulses to suppress flow and motion artifacts. Up to six saturation bands may be positioned in any orientation


    Tracking SAT Bands maintain constant saturation of venous and/ or arterial blood flow, e.g. for 2D/3D sequential MRA
    Water Excitation. Spectral selective RF pulses for exclusive water excitation
    Dixon for fat and water separation
    RF Fat Saturation. Spectral selective RF pulses for saturation of fat
    MTC (Magnetization Transfer Contrast). Off-resonance RF pulses to suppress signal from certain tissues, thus enhancing the contrast. Used e.g. in MRA
    TONE (Tilted Optimized Non-saturating Excitation). Variable excitation flip angle to compensate inflow saturation effects in 3D MRA. TONE pulse selectable depending on
    GMR (Gradient Motion Rephasing). Sequences with additional bipolar gradient pulses, permitting effective reduction of flow artifacts
    Freely adjustable receiver bandwidth, permitting studies with increased signal-to-noise ratio
    Freely adjustable flip angle. Optimized RF pulses for image contrast enhancement and increased signal-to-noise ratio
    Simultaneous Excitation. Doubles the number of slices per TR for 2D GRE
    Integrated Parallel Acquisition Technique (iPAT)
    PAT averaging for motion artifact suppression using Self-Calibration
     

    Foot imaging with 8-channel Foot/Ankle coil. 3D FISP

    Orthopedic imaging with 8-channel Foot/Ankle coil. 3D FLASH water excitation

    Intracranial MRA with various techniques syngo SPACE for cerebral imaging Off-center imaging with the Shoulder Array coil
  63. Multinuclear Option: Hardware and IDEA software package to investigate 3He, 7Li, 13C, 19F, 23Na, 31P, 129Xe. NOE (Nuclear Overhauser Effect and 1H decoupling).
    Integrated hardware and system software package.
    Transmit/ receive experiments can be realized to investigate 3He, 7Li, 13C, 19F, 23Na, 31P, 129Xe
    Highly flexible design of imaging and spectroscopy sequences using the IDEA package NOE (Nuclear Overhauser Effect) experiments and 1H decoupling can be realized
     
     
      Multinuclear Option
  64. Interactive Realtime Imaging:
    The user can navigate in all planes on-the-fly during data acquisition.
    Real-time cardiac examinations
    Real-time interactive slice positioning and slice angulation
    3D Magellan SpaceMouse included

Post-Processing Packages:

  1. syngo Argus 4D Ventricular Function
    syngo Argus 4D VF software processes MR cine images of the heart and generates quantitative results for physicians in the diagnostic process.
    It provides volumetric cardiac data of a given patient very quickly and easily. Parametric results and volume-time curves are being calculated upon automatic creation and adaptation of a 4D model of the left ventricle. The resulting 4D model of the patient’s heart can be visualized superimposed to anatomical images as reference.
    syngo Argus 4D VF includes the well-known functionalities of Argus Function, the automated tool for cardiac function evaluation.
    • Fully automatic left ventricle and semi-automatic right ventricle segmentation
    • Easy user guidance with graphical selection of ED, ES, basal and apical slices
    • Volumetric and regional wall motion analysis (e.g. stroke volume and bull’s-eye plots)
    Features
    A 4D model can be created with a few mouse clicks by defining the center of the LV apex on an apical short-axis cine, center of the LV base on a basal short-axis cine, mitral valve insertion points on a 2- and/or 4-chamber plane in diastole and systole.
    The model-based algorithm provides within a few seconds the appropriate endo- and epicardial contours on all slices and phases as well as a summary table including various data for volume, function and mass.
    No missing ventricular volume nor additional atrial volume deterioration due to cardiac phase adaptive 4D model.
    Clinical Applications
    Highly accurate volumetric assessment and ejection fraction calculation in cardiomyopathy (dilated, hypertrophic, etc.), pericardial disease, cardiac tumors and cardiac transplants.
    Step by step
    1. Load cine cardiac study into Argus 4D Taskcard.
    2. Place marker in center of the LV of the most apical slice position.
    3. Place marker in the center of the LV of the most basilar slice position.
    4. Place markers at the insertion points of the mitral valve on a long axis view, at both end systole and end diastole.
    5. Adjust the markers for the position of the right ventricular insertion points.
    6. If necessary, adjust the endo and epicardial contours.
    7. View and save the ventricular results

  2. Argus Flow
    Automated tool for analysis of blood and CSF flow.
    • Semi-automatic detection of regions of interest over time
    • Color-coded display of velocity values
    • Calculation of flow and velocity parameters (e.g. peak velocity, average velocity, flow, integral flow)
    Clinical Applications
    Evaluation of valvular diseases
    Evaluation of hydrocephalus
    Carotid stenosis
    Pulmonary hypertension
    Evaluation of bypass grafts
     
    Descending and ascending aortic flow measurement with Argus Flow

    Step by step
    1. From the patient browser, load the Rephased and phase series into the Argus Viewer. This is done by selecting both series and left clicking on the "Argus Icon".
    2. Use the "zoom-pan" icon to magnify the series to better visualize the vessel contours. Be sure to select all series using the icon between the "A" and "1" prior to left clicking on the outer edges of the image segment and zooming.
    3. Select the "Flow analysis" Icon within Argus, new tools will appear to begin the post-processing.
    4. Select the drawing tool and move the curser over first region, up to 4 regions can be evaluated. Left click and drag curser over vessel to cover lumen.
    5. The contour drawn will automatically adjust to the vessel shape.
    6. Next choose "Propagate within Slice". This will transfer the contour you have drawn over all phases and automatically adjust the contour for vessel contractionexpansion.
    7. Repeat these steps for all regions you wish to evaluate. To draw another region, select the next region button, for example R2 under the active region tools.
    8. To create the results of this analysis, go to the "Results" tab. Results for Velocity, Peak Velocity, Flow, Net Flow, Area and a Summary Page can be seen for a region or all regions a contour has been drawn.
    9. Once the result have been generated, select the "save as" icon to store in the Patient Browser as dicom images.
    10. These reports and the contouring are stored as an Argus file. These can be loaded into the viewing taskcard, or sent to a PACS station for reporting.
     

  3. Argus Dynamic Signal
    Automated tool for dynamic data analysis.
    • Manual or automatic segmentation
    • Automatic compensation of contours in regard to translation or deformation of organs over time
    • Sector-based or ROI-based evaluation
    • Evaluation of Time-to-Peak, Peak Value, Uptake Slope, Area under the Curve
    • Graphical display of results in parameterized bull’s eye plots
     
     
       
  4. Vessel View
    Interactive analysis of vessel disease using MR or CT angiography data.
    Viewing with VRT, MPR, or MIP mode.
    • Semi-automatic detection of vessel segments
    • Quantification of changes in vessel size (e.g. stenosis graduation, aneurysm volume measurement)
    • Protocol-based software for workflow support
    • Creates and edits DICOM structured reports
     
     
      Vessel View
  5. Vessel View Artery-Vein-Separation
    This package allows for semi-automated segmentation and separation of arteries and veins, as well as suppression of surrounding tissue. Supports modes allowing the display of only arteries or only veins, or arteries and veins together in different colors. (Prerequisite: Vessel View)
  6. 3D VRT Volume Rendering Technique
    3D visualization for clearer depiction of complex anatomy and relationship of anatomy in 3D for contrast MR Angiography and VIBE imaging.
    More productive surgical planning and discussion with referring physicians.
    • Integrated with other 3D functionality
    • Color image creation
    • Color gallery of icon presets
    • Additional threshold-based segmentation of 3D objects
    • Volume measurements
    Clinical Applications
    MR Angiography
    MR Cholangiopancreatography
    Step by step:
    1. Load 3D series from the Patient Browser into the 3D Task Card by selecting Applications from the menu, then select 3D>VRT.
    2. Change VRT settings by right mouse clicking on the VRT icon and selecting the appropriate image type from the VRT Gallery.
    3. Change all segments to the same CRT type by selecting each segment and left mouse clicking on the VRT icon.
    4. Left mouse click on the VRT thin icon to change the image type. To modify the image thickness, right mouse click on the VRT thin icon and change the thickness in the dialogue window.
    5. Left mouse click on the Radial Ranges icon to create a series of rotated images.
    6. It is important to first select the image you want to set the rotations off of; e.g., for a left to right rotation, select the axial (bottom left) image.
    7. Save radial ranges as a new series to the Patient Browser by selecting Patient>Save as. Type the name of the new series into the “Range series name” text area.
  7. syngo BOLD 3D Evaluation
    Comprehensive processing and visualization package for BOLD fMRI. It provides a full set of features for clinical fMRI, as well as advanced features for more research oriented applications.
    This package provides statistical map calculations from BOLD datasets and enables the visualization of task-related areas of activation with 2D or 3D anatomical data. This allows the visualization of the spatial relation of eloquent cortices with cortical landmarks or brain lesions.
    On the syngo Acquisition Workplace the unique Inline function of BOLD 3D Evaluation merges, in real time, the results of ongoing BOLD imaging measurements with 3D anatomical data. Additionally, evolving signal time courses in task-related areas of activation can be displayed and monitored.
    Functional and anatomical image data can be exported for surgical planning as DICOM datasets, additionally all color fused images and results can be stored or printed.
    • Statistical map generation: paradigm definition, calculation of t-value map with General Linear Model or t-test
    • 3D Visualization: fused display of fMRI results, color t-value maps on anatomical datasets
    • Inline 3D real time monitoring of the fMRI acquisition
    • On-the-Fly Adjustment for t-value thresholding, 3D clustering, and opacity control
    • Data export to neurosurgical planning software
    • Fly Through the Volume: Zoom, pan, rotate, cut planes
    • Analysis of Signal Time Curves
    • Data Quality Monitoring: B0 field map, cine display of the BOLD time series
    • Archiving & Distribution of results and views as colored DICOM images and bit maps
    • If the respective options are available, results from Diffusion Tensor Imaging and DTI Tractography can be displayed together with fMRI results and anatomy
  8. DTI Evaluation
    Offline post-processing to generate and visualize parametric maps derived from the diffusion tensor in order to assess anisotropic diffusion properties of brain tissue
    • Generation of diffusion maps based on tensor including: Fractional Anisotropy (FA), Volume Ratio (VR), trace-weighted, ADC, E1–E3, E1,
    linear, planar, tensor maps
    • Display of maps in scalar mode (grey scale), vectorized mode (directions color coded) and tensorized mode (using tensor graphics like ellipsoid or cuboids); overlay of maps onto anatomical images
    • Side by side display of several maps (e.g. ADC, FA, and trace-weighted) and anatomy for simultaneous ROI based evaluation; generation of a results table in order to support the assessment of diseases of the white matter
    • Integrated into Neuro 3D task card: display of DTI maps in the context of an anatomical 3D data set; arbitrary oriented clip planes allow to explore the 3D volume
    • Fused display with white matter tracts if the “DTI Tractography” option is present.
    • Export of reformatted images for neuronavigation
    • Together with the “BOLD 3D Evaluation” option: simultaneous display of anatomical, fMRI, and DTI data
     
     
      FA map generated with syngo DTI and inline function

    Step by step:
    1. From the patient browser, load the Tensor series into Neuro3D application.
    2. The data automatically loads into the diffusions mode. With the first segment showing a FA map, the second an ADC map, the third a Trace weighted map and the fourth a B0
    3. Select the Diffusion subtask card to change selected segment to a new map.
    4. Scroll thru the images by using any of the "dog ears".
    5. Additional maps can be found under the diffusion drop down menu.
    6. To save any of these maps; select segment of map, go to Patient, and select "save Diffusion"
    7. These maps can be loaded in the Viewing Task card or sent via PACs.

  9. syngo DTI Tractography
    syngo DTI Tractography allows the visualization of multiple white matter tracts based on diffusion tensor imaging data. DTI Tractography is optimized to support the presurgical planning and to allow for neuro physiological research with respect to connectivity and white matter pathology.
    • Advanced 3D visualization of white matter tracts in the context of 2D or 3D anatomical and DTI datasets
    • Texture Diffusion, a highly versatile in-plane visualization of white matter tracts, allows to display and read DTI Tractography results on PACS reading stations and in the OR
    • Seed points for tracking with single ROI and with multiple ROIs to assess connectivity
    • Tract and seeding ROI statistics (mean / max FA value, min / mean / max ADC value, and more)
    • DICOM export of views, HTML export of Tract, and seeding ROI statistics
    • Interactive QuickTracking displays the tract originating from the mouse pointer position while moving over the DTI data set
  10. Neuro Perfusion Evaluation
    Dedicated task card for quantitative processing of neuro perfusion data.
    • Color display of relative Mean Transit Time (relMTT), relative Cerebral Blood Volume (relCBV), and relative Cerebral Blood Flow (relCBF)
    • Flexible selection of Arterial Input Function (AIF) for reliable analysis. This function takes into account the dynamics over time of the contrast agent enhancement
     
       

    Step by step:
    1. Load the ep2d_perf images into the MR Perfusion task card via the applications dropdown in the patient browser menu.
    2. Locate an artery and select AIF input.
    3. Move the arterial input function box over the selected artery, and choose the optimal curve. This curve should have the flattest baseline and deepest curve.
    4. Proceed to setting the time ranges. Place the time points for 1. Start of enhancement and 2. end of enhancement
    5. Confirm Time Ranges
    6. Select color maps to generate. Choose all maps to generate all selections.
    7. Select the "Execute" Icon Four series of color maps will be displayed. In the 3rd are the relMTT and TTP maps. In the 4th segment are the relCBV and relCVF maps.
    Window and save series. Each series must be windowed and saved separately. They can then be reviewed in the Viewing task card or sent to PACs.

  11. Composing
    Composing of images from different table positions.
    • Automatic and manual composing of sagittal and coronal images
    • Dedicated algorithms for spine, angiography, and adaptive composing algorithms
    • Measurement on composed images (angle, distance)
  12. Fly Through
    Simulated endoscopic views of the inside of bronchi, vessels, colon, and any other hollow structures.
    Multi-modality application for CT, MR, and 3D AX data.
    Fully integrated into the familiar 3D workflow and user interface.
    • Ready-to-use from day one
    • One click to action
  13. syngo Tissue 4D
    syngo Tissue 4D facilitates the detection of tumor tissues in organs such as the prostate or the liver.
    It is an application card for visualizing and post-processing dynamic contrast-enhanced 3D datasets.
    Evaluation options
    • Standard curve evaluation
    • Curve evaluation according to a pharmacokinetic model
    Visualization features 4D visualization (3D and over time)
    Color display of parametric maps describing the contrast media kinetics
    such as:
    • Transfer constant (Ktrans)
    • Reflux constant (Kep)
    • Extra vascular extra cellular volume fraction (Ve)
    • Plasma volume fraction (Vp)
    • Initial Area-Under-Curve (iAUC) for the first 60 seconds
    Additional visualization of 2D or 3D morphological dataset
    Post-processing features Elastic 3D motion correction
    Fully automatic calculation of subtracted images
    Pharmacokinetic model Pharmacokinetic calculation on a pixel-by-pixel basis using a 2-compartment model.
    Calculation is based on the Tofts model. Various model functions are available.
    Manual segmentation and calculation on the resulting images.
    The following resulting images can be saved as DICOM images:
    • 3D motion-corrected, dynamic images
    • Colored images
    • Storage of calculated results
    • Export of results in the relevant layout format
     
     
      Evaluation of dynamic liver MR examination with syngo Tissue 4D

    Step by step:
    1. Open the patient browser and load program data sets into the Tissue4D Task-card. Use the Tissue4D icon after selecting the patient.
    2. Select the Registration tab, step 2. Select the Registration Icon. This will automatically align the dynamic data sets to the pre-contrast data set.
    3. Select Curve Calculation, Step 3. Select Drawing to and create ROI1 over area of interest. Up to 4 ROI's can be drawn.Select Start Ploting
    4. Continue to Pre Evaluation, step 4. Here we select the contrast agent used,and draw the VOI to cover the entire anatomy of interest. Draw the VOI. To do this left click and drag the curser.
    5. Select Evaluation, step 5. Select the AIF modeling. Change selection of evaluation to VOI, and start evaluation.
    6. Select the Results tab to generate final results, Step 6. Calculate and show statistics. Maps and results are created for each ROI. Resulting statistics are: kTrans, Kep, Ve and iADC.
    7. The results can be exported, step 7.

  14. Spectroscopy Evaluation
    Integrated software package with extensive graphical display functionality
    Comprehensive and user-friendly evaluation of spectroscopy data
    Display of CSI data as colored metabolite images or spectral overview maps, overlaid on anatomical images
    • Export of spectroscopy data to a user-accessible file format
    • Relative quantification of spectra, compilation of the data to result table
    Automated peak normalization tissue, water or reference
    New dedicated Single Voxel Spectroscopy breast evaluation protocols
  15. Image Fusion
    Image fusion of multiple 3D data sets with alpha blending, i.e. overlay of two images with manual setting of the opacity
    • Multiple 3D data sets from different modalities (MR, CT, Nuclear Medicine, PET)
    • Visual alignment, automatic registration, or landmark based registration
    Image Fusion provides a dedicated evaluation software for spatial alignment (matching) and visualization of image data either from different modalities (CT, MR, NM, PET) or from the same modality but from multiple examinations of the same patient. It supports optimal diagnostic outcome (fusion of morphological and functional information) and therapy planning. CT, MR, NM or PET images are accepted as input for image fusion.
    Clinical Applications
    Combination of functional information and excellent anatomical data to improve diagnostic accuracy. Eg: syngo MapIt results combined with MR joint images.
    Features
    Dual modality applications like MR&PET or CT&MR by combining the 3D data sets with alpha blending
    Combination of functional and morphological information
    Up to 4 data sets can be fused.
    Additional Information
    Registration Algorithms: Easy-to-use visual alignment with 6 degrees of freedom (3x translation, 3x rotation). Landmark-based registration with convenient landmark edit for point-based registration using anatomical landmarks. Automatic registration. Storage of transformation matrix after registration for later retrieval with data sets.
    Visualization Techniques: side-by-side visualization of both data sets with correlated pointer and correlated scrolling with dog ears. 2D alpha-blending in monochrome or pseudo-color with adjustable balance between the two superimposed data sets. Storage of fused results as secondary capture images.
     
    High b-value DWI for visualization of tumor activity fused with T1w morphology Improved visualization of multiple neurofibroma with DWI. superimposed on T2w images Fused image (Reveal (Diffusion weighted)+ T1 fat-sat) showing a kidney tumor

    Step by step:
    1. Aligning and superimposing multimodality images
    2. Open Patient Browser; select the first modality series and load into MPR within the 3D Task-card.
    3. Re-open the Patient Browser, select the second modality series.
    4. Left click on the Fusion icon; this will add the second modality into the 3D Task-card.
    5. Go to the Image sub-task card, and left click on the Registration icon.
    6. The Fusion Registration page will appear, left click on the Auto Icon and choose "Precise Registration". Then register, and okay. Choose save registration when this pop-up appears.
    7. Left click the Side x Side tool to evaluate the 2 modality series in parallel.

  16. syngo Breast Biopsy Software
    Easy to use syngo-based post-processing software helps finding the coordinates for needle insertion for biopsy or localization of breast
    lesions detected by MR
    Allows calculation of the coordinates after clicking the center of the lesion and the 0 marker of the breast biopsy device
    • Printout of working sheet
    • Multi-lesion calculation
    Prerequisites • Breast Biopsy Device
    • Loop Flex coil, large
The value of the clinical applications

The real power of MR imaging lies in the wide range of applications for which it can be used. Current applications include soft-tissue delineation, determining extent of disease, tumor staging, functional and metabolic information, and monitoring response to treatment. Some of these newer applications are outlined herein.



T1- and T2-weighted Imaging

T1- and T2-weighted imaging are the most widely used sequences for soft-tissue delineation of anatomic structures and related pathologic conditions. For example, in the brain, T2-and T1-weighted imaging with or without contrast material can be used to see changes in white or gray matter. In other body organs, such as the breast, extremities, and liver, and in uterine lesions, imaging has been performed by using T2- and T1-weighted MR imaging.

Diffusion-weighted and Perfusion-weighted Imaging

Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) are used in neurologic applications, such as brain tumor imaging and cerebral ischemia. The use of perfusion and diffusion MR imaging techniques can identify regions of abnormal brain tissue after cerebral ischemia. PWI readily depicts areas of brain with a compromised cerebral blood flow, whereas DWI can depict regions of ischemic tissue that may or may not recover, depending on the duration of reduced blood flow. By combining PWI and DWI methods, three scenarios can be observed: PWI > DWI (mismatch), PWI = DWI (match), or DWI > PWI (reverse mismatch). For example, if PWI is larger than DWI, then the area depicted may represent “at risk” or penumbral tissue. Evaluation of these tissue characteristics is important for the targeting of therapeutic measures to maximize clinical outcomes.

DWI has been used in other organs of the body, for example, in the liver for demonstration of metastatic disease and response to treatment, in the uterus for monitoring treatment response from interventional procedures such as uterine arterial embolization and high-intensity focused ultrasound surgery, and for classification of breast lesions. Still larger studies are needed to fully understand the impact that DWI will have in these applications.

Spectroscopy

Proton spectroscopy has been used primarily for brain applications and recently for other organs, such as the liver, breast, prostate, and soft tissue. The use of spectroscopy expands the repertoire of clinical information by providing information on intracellular metabolites, such as choline (3.2 ppm), creatine (3.0 ppm), citrate (2.6 ppm), N-acetyl aspartate (2.02 ppm), and lactate (1.4 ppm). (The unit “ppm” is defined as “parts per million” and is independent of the strength of the imaging unit.)

These metabolites are known to change in different pathologic conditions; for example, in brain tumors, N-acetyl aspartate (2.02 ppm) decreases with a subsequent increase in choline. In the breast, the presence of a choline peak (3.2 ppm) is suggestive of malignancy. In the prostate, MR spectroscopy is being increasingly used in conjunction with MR imaging to provide information on the presence or absence of citrate (2.6 ppm) and/or choline (3.2 ppm). These applications will become routine procedures in the near future.

23Na (Sodium) MR Imaging

Sodium is abundant in most tissues and is actively pumped out of healthy cells by the Na+/H+-ATPase pump, which maintains a large concentration difference across the cell membrane at the cost of energy-rich adenosine triphosphate. Thus, an increase in intracellular sodium concentration can be a good indicator of compromised cellular membrane integrity or impaired energy metabolism. In the presence of tissue perfusion, the intracellular changes and concurrent increase in vascular or interstitial volume appear to be an equally good indicator of cellular membrane integrity and energy metabolism.

The intracellular sodium cannot be imaged separately from the extracellular sodium concentration without toxic shift reagents or special MR methods that cause a significant reduction in SNR and resolution. However, the total sodium concentration in tissue can be resolved by using MR imaging, and there has been increased interest in the application of sodium MR. In particular, sodium imaging has been performed in the brain, breast, heart, kidney, and uterus. In recent reports, sodium MR imaging has shown promise in monitoring therapeutic response.

Beyond 3 T: Emerging High-Field-Strength MR Imaging (7 T and Greater)

Although there have been vast technological advances in MR imaging over the past 40 years, the central principle for advancing MR imaging technology has been based on finding ways to increase SNR in the MR image. The most fundamental approach to increasing SNR has been to increase the field strength of the MR imaging magnets. As a result, the impetus for improved MR imaging has driven progressive increases in its magnetic field strengths from fractions of a tesla to fields of 1.5 T in the 1980s then to fields of 3 T by the mid-1990s. The next push for increasing MR imaging field strength was possible with the advancement of superconducting technology. In the late 1990s and early 2000s, the development of a human MR imaging unit above 4.1 T, in this case 8 T, was achieved.


As a result of its tremendous potential, human MR imaging is currently performed at field strengths reaching 7 T, 8 T, and 9.4 T. The three major MR imaging vendors—GE Healthcare, Siemens Medical Solutions, and Philips Medical Systems—are developing 7-T whole-body human imaging units. However, as with many scientific breakthroughs, the potential of ultrahigh-field-strength imaging can be achieved only if other challenges are overcome. The most significant of these challenges include (a) safety concerns regarding exceeding RF power deposition in tissue and (b) noninherent inhomogeneity of MR imaging signal detection across the human head.

Conclusions

MR imaging provides a powerful tool for diagnosis and excellent soft-tissue contrast because the image contrast can be finely optimized for specific clinical questions. Moreover, novel pulse sequence techniques allow image contrast to be based on tissue physiology or even cellular metabolism in a noninvasive manner. In addition, with ever-increasing improvement in both hardware and software, MR imaging may one day be used for screening of different pathologic conditions and provide a window into cellular metabolism and tissue physiology.

This is a neurosurgical site dedicated to intraoperative monitoring to catch in time the early signs of possible functional complications before they evolve to morphologic ones.



Complications in neurosurgery

So as to have a digital data, the best ever made Inomed Highline ISIS system was put in service to provide documented information about the complications.

Directed by Prof. Munir Elias

Team in action.

Starting from July-2007 all the surgical activities of Prof. Munir Elias will be guided under the electrophysiologic control of ISIS- IOM



ISIS-IOM Inomed Highline

 

 

         
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