biograph mmr - kivi · biograph mmr the first two years of the world's only simultaneous, ......

© Siemens AG 2012. All rights reserved.

Biograph mMRThe first two years of the world's only simultaneous, whole-body PET / MR

Siemens AGDr. Minne van der HaakBusiness Manager Biograph mMREurope, Middle East and Africa

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What happened in the first two years?Biograph mMR raised immense positive feedback

Launch and Show at RSNA 2010FDA & CE Label in 2011Since 2011: more than 30 systems worldwide

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Biograph mMR – PET/MRMarket Share Development

> 70% market sharein the integrated PET/MR segment

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sequential is now simultaneous.

two is now one.

potential is now reality.

With Biograph mMR…

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sequential is now simultaneous.Covering a large spectrum of imaging.

Morphology Physiology Biochemistry

MR

PET

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Simultaneous imaging precisely aligns a large spectrum of medical imaging including...

Exquisite details of an object’s structureOrgan and tissue function in high resolution Activity and changes at the metabolic level

... at a single point in time.

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Aid healthcare professional in:

Early detection and staging of diseasesTherapy selectionTreatment PlanningMonitoring of therapyFollow-up

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Aid healthcare professional in:

Early detection and staging of diseasesTherapy selectionTreatment PlanningMonitoring of therapyFollow-up


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sequential is now simultaneous.Clinical benefit of simultaneous imaging

“Simultaneous acquisition of MRI and PET data opens the opportunity for performance of a comprehensive cardiac stress examination. Under identical conditions we can measure perfusion and viability of the myocardium in one exam.”

Professor Pamela K. Woodard, MDHead – Advanced Cardiac ImagingMallinckrodt Institute of RadiologyWashington University, St. Louis, MO, USA

The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" setting and many variables exist there can be no guarantee that other customers will achieve the same results

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sequential is now simultaneous.Simultaneous imaging improves spatial correlation

Understanding the patient's symptoms requires detailed knowledge about anatomy and functional impairment

Exact spatial registration of PET and highly-detailed anatomy offers the full picture

Institute of Medical Physics (IMP) and University Hospital Erlangen, Erlangen, Germany

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sequential is now simultaneous.Simultaneous imaging allows temporal co-registration

The full spectrum of anatomy, function, and metabolism captured in one point in time*

Precise and accurate assessment of disease for a more confident diagnosis

*N. Schwenzer et al.: Whole-body MR/PET: applications in abdominal imaging; AbdomImaging (2011)

dwMRI

Overlay:Fludedoxyglucose F 18 PET + T2 fat sat

CT

T2 fat sat

University Hospital, Tuebingen, Germany

Stomach Lymphoma

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sequential is now simultaneous.MR data can be used to reduce motion effects in PET

Thoracic, abdominal, and pelvic structures are in constant motion (e.g. respiration, peristalsis)

Motion information collected by MR may help to minimize motion effects in both MR and PET data

Precise alignment may enable evaluation of smaller lesions

mMR Munich (TUM/LMU), funded by the DFG

Primary liver cancer

FDG PET overlayed on arterial phase

T1w DCEDWI Fludedoxyglucose F 18 PET

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two is now one.


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two is now one.Resulting in …

One examOne roomOne whole-body solution

Only Siemens can bring it alltogether

For shorter examsEasier schedulingAnd faster results

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two is now one.Shorter exams and faster results

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two is now one.One streamlined exam boosts productivity.

• 1 instead of 2 examinations• Potentially >50% faster!

Sequential MR and PET images

1. Attenuation correction 2. PET exam 3. Processing 4. MR exam 5. Post processing

MR-PET exams including AC further advanced MR exams within examination

Biograph mMR

Separate system design

transport between systems

TIME

TIME

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two is now one.More patient comfort

A single exam could mean happier patients and higher productivity

Acquiring two exams in one improves workflow and speeds exam times

Patients only endure a single exam

Excellent image quality and fusion accuracy through less motion or interruptions

Only one sedation in pediatric patients

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“Dose reduction is a major concern of ours - and this can be quite considerable.This is particularly critical in the examination of children and young adults, especially in cases of frequent follow-up examinations in therapy monitoring.”

Markus Lentschig, MDRadiologist and partner at the CEMODI practiceBremen, GermanyFirst purely private Biograph mMR user

two is now one.Dose reduction

MR scanning has not been established as safe for imaging fetuses and infants under two years of age. The responsible physician must evaluate the benefit of the MRI examination in comparison to other imaging procedures.

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two is now one.The inside story on mMR technology

The mMR technology includes:

The first whole-body MR-friendly PET architecture

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two is now one.The first whole-body MR-friendly PET architecture

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two is now one.TrueForm Magnet and Gradient design

Same magnetic field homogeneity as our high end 3T MR systems

Cylindrical magnet and gradient homogeneity volume

Excellent MR image quality even at the edges of the field of view

Improved spectral fat saturation due to TrueForm

Less overlap needed for multi-station (multiple bed) exams

Over 1000 TrueForm MRI systems installed!*

* Data on file

Conventional magnet design

TrueFormmagnet design

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two is now one.MQ gradients designed to deliver outstanding performance.

45 mT/m with 200 T/m/s capabilities

50 cm MR Field of View (45cm in Z)

Specially designed for Biograph mMR

Fully integrated with PET architecture

Enables a full spectrum of mMRimaging from clinical to research

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two is now one.NEMA 2007 PET specifications

4 x 4 x 20 mm³ LSO crystals

4.4 mm transverse spatial resolution (FWHM @ 1 cm)

13.2 cps/kBq sensitivity

175 kcps peak NEC rate 22 kBq/cc)

25.8 cm axial FoV

58.8 cm transaxial FoV

mMR Munich (TUM/LMU), funded by the DFG

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Avalanche Photo Diodes (APDs)

Solid state electronics with secure supplyEstablished technology and well known physicsthe only currently available approach for

simultaneous MR and PET imagingAffordable technology for clinical utilizationProven high reliability and stability up to 9.4TTemperature regulation and shielding incorporated

into a compact design40% sensitivity boost (relative to Siemens’ high

end Biograph mCT) via large FOV (26cm) improves contrast and S/N

PMT

APD

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Biograph mMR detector integration enables the industries’ largest PET field of view*

Eight detectors aligned axially to form one detector headUp to 25.8 cm axial (z) field of view!

* Based on Competitive Literature available at time of Publication. Data on file.

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two is now one.TimTX TrueForm – Overview

TimTX TrueForm is Siemens’ solution for B1 homogenization.

B1 shimming with 2-channel TX array functionality.

Anatomy-specific settings save time, enhancing productivity.

More than 750 TimTX TrueForminstallations.*

* Data on file

TimTX TrueForm supports good image quality in challenging cases as shown:Good B1 homogeneity in the presence of large fluid collection.

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two is now one.Best of the world PET and MR image quality

Best MR image quality

Latest 3T Siemens magnet technology

Same gradient performance and magnet homogeneity as our high-end MR scanners

Tim technology

Best PET image quality

Largest PET FoV in industry (~26cm vs ~16cm in PET/CT)

Highest sensitivity in industry (+40% compared to mCT)

Same spatial resolution asBiograph mCT best in industry

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two is now one.The inside story on mMR technology.


The first whole-body MR-friendly PET architectureAttenuation correction for high-quality PET images

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two is now one.Fully optimized for a strong signal

Attenuation Correction

µ maps are derived from MRI data –no additional acquisitions necessary

MR-based four compartment segmentation and truncation correction methods

Attenuation correction of the whole human body

User customized µ maps are possible

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© Siemens AG 2012. All rights reserved.Institute of Medical Physics (IMP) and University Hospital Erlangen, Erlangen, Germany

Uncorrected PET

Fat

two is now one.MR-based attenuation correction of PET

Corrected PET

-Map

Water

Opp PhaseIn Phase

Dixon VIBE Sequence

Attenuationcorrection

Fused

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two is now one.Attenuation correction for rigid stationary hardware

CT-based AC for table, head/neck and spine coils

µ-map is part of PET reconstruction process

Relevant part of µ-map is automatically selected for each table position

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two is now one.The inside story on mMR technology


The first whole-body MR-friendly PET architectureAttenuation correction for high quality PET imagesTim, the Total imaging matrix.

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two is now one.Tim delivers state of the art 3T.

Biograph mMR is built on state-of-the-art 3T technology

Tim coils have been enhanced to improve PET attenuation correction

Tim is a major differentiator

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Two is now one.

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two is now one.Biograph mMR coil portfolio

Biograph mMR coils for simultaneousexams

mMR Head/Neck, A Tim coilmMR Spine, A Tim coilmMR Body, A Tim coil4-channel flex coil, large and small

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two is now one.Biograph mMR coil portfolio

Coils for MR specific examsAll Biograph mMR coils

Plus:32-Ch Body coil4-Ch Shoulder Array coils Tx / Rx CP Extremity coilTx / Rx 15-Ch Knee coil 16-Ch AI Breast coil 4-Ch Breast Array coil4-Ch BI Breast coilEndorectal coil and interface36-Ch Peripheral Angio coilLoop coils

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two is now one.Biograph mMR and syngo.via are one

For the first time, Biograph mMRprovides MR and PET images as one dataset - molecular MR acquisition data

Only syngo.via can

fully utilize this one dataset toenable molecular MR evaluationwith one standardized report

bring this information into yourclinical environment


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two is now one.Biograph mMR and syngo.via

syngo.mMR General takes full advantage of identical Frames of Reference:

Data preparation reduced Markings correlated automatically between the two modalitiesFindings linked exactly in the Findings Navigator

Find the MR and PET tools you need where you need them.

My cases, ready


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two is now one.Biograph mMR and syngo.via

Enables simultaneous MR and PET evaluation with standardized reporting

Comprehensive set of evaluation tools and easy creation of findings

Network wide access for viewing, reading and collaboration

Every Biograph mMR includes syngo.via in the form of syngo.mMR General

syngo.via formolecular MR


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two is now one.Biograph mMR siting

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two is now one.



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potential is now reality.A large range of clinical applications – ready to go.

Neuro-oncologyNeurodegenerative diseaseHead & Neck tumorsCardiac one-stop-shop stress studiesSecondary liver malignancies and colorectal carcinomaLymphomaFemale pelvic oncology (ovaries, cervix)Pediatric* oncologyProstateBone metastases

Based on our early users’ experience and feedback the following key clinical applications have been identified

* MR scanning has not been established as safe for imaging fetuses and infants under two years of age. The responsible physician must evaluate the benefit of the MRI examination in comparison to other imaging procedures.

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sequential is now simultaneous.A revolution in patient management

“I've been really impressed by the Biograph mMR. The combination of a fully integrated PET and MRI is something that is going to revolutionize how we actually look at and treat patients today.

In terms of personalized medicine, imaging has to be at the center: we feel that with technologies that combine molecular imaging with MRI, you really now have the best of the two worlds.”

Zahi A. Fayad, PhDProfessor, Radiology & CardiologyDirector, Translational Imaging InstituteMount Sinai Medical Center

The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.

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Clinical proof provided by first scientific publications from Munich and Tübingen:

Schwenzer et al.: Whole-body MR/PET: Applications in abdominal imaging; Abdom Imaging (2012), Vol. 37, No. 1, 20-28.Delso et al.: Performance Measurements of the Siemens mMR Integrated Whole-Body PET/MR Scanner. J Nucl Med (2011), Vol. 52, No. 12, 1914-1922.Drzezga et al.: First clinical experience of integrated whole-body PET/MR. Comparison to PET/CT in patients with oncological diagnoses; J Nucl Med(2012), Vol. 53, No. 6

potential is now reality.First scientific publications coming out…

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potential is now reality.Clinical experience at University Hospital Tübingen

Combining perfusion and receptor status for estimation of total tumor load and evaluation of therapy regime

A) arterial CT B) arterial mMRC) somatostatin receptor status D) combined mMR data

AimReview articleTechnical summaryAddress clinical applications and research interests

Schwenzer et al.: Whole-body MR/PET: Applications in abdominal imaging; AbdomImaging (2012), Vol. 37, No. 1, 20-28.

ConclusionSimultaneous measurement of PET and MRI datasets allows for insights in metabolic and functional processes, particularly in oncologic demands, but also in cardiovascular and cerebral imaging.

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AimPerformance evaluation of the Biograph mMR

Delso et al.: Performance Measurements of the Siemens mMR Integrated Whole-Body PET/MR Scanner. J Nucl Med (2011), Vol. 52, No. 12, 1914-1922.

potential is now reality.Technical evaluation at Klinikum rechts der Isar, Munich

MethodPET: NEMA NU 2-2007 protocolMRI: quality control manual of the American College of Radiology

ResultThe results compare favorably with other state-of-the-art PET/CT and MR scanners.The integration of the PET detectors in the MR and their operation within the magnet do not have a perceivable impact on the overall performance.

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Aim“…to evaluate comparability of the clinical performance between conventional PET/CT and PET/MR in patients with oncologicaldiseases.“

Drzezga et al.: First clinical experience of integrated whole-body PET/MR. Comparison to PET/CT in patients with oncological diagnoses;J Nucl Med (2012), Vol. 53, No. 6

potential is now reality.Clinical experience at Klinikum rechts der Isar, Munich

Method32 patientsOncological diagnosesSingle-injection exam

PET/CT followed by molecular MR

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ResultsAnatomical localization was comparable using Dixon-MR versus low-dose CTMolecular MR lesion detection had good correspondence with PET/CT“Very high correlation ( =0.93) between mean SUV in suspicious lesions with MR/PET and PET/CT.“

potential is now reality.Clinical experience at Klinikum rechts der Isar, Munich

ConclusionMolecular MR is "feasible in a clinical setting with high quality and in a short examination time."

Drzezga et al.: First clinical experience of integrated whole-body PET/MR. Comparison to PET/CT in patients with oncological diagnoses; J Nucl Med (2012), Vol. 53, No. 6

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Early adopters >30

EuropeIMP Erlangen, Germany

Klinikum r. d. Isar, Munich, Germany

Univ. Hospital Tübingen, Germany

Univ. Hospital Leipzig, Germany

CEMODI Bremen, Germany

Univ. Hospital Essen, Germany

Univ. College London Hospitals, UK

SDN, Naples, Italy

DKFZ, Heidelberg, Germany

Rigshospitalet, Copenhagen, Denmark

St. Olav Hospital, Trondheim, Norway

DLRZ, Bonn, Germany

University of Padua, Italy

CERMEP/University of Lyon, France

North AmericaMGH, Boston, USA

NIH, Bethesda, USA

Washington Univ., St. Louis, USA

Univ. of N. Carolina, Chapel Hill, USA

Mt. Sinai Medical Center, New York, USA

Indiana University, Indianapolis, USA

Lawson Health Research Institute,London, Canada

UPMC, Pittsburgh, USA

NYU, New York, USA

Cleveland Clinic Foundation, Cleveland, USA

Stony Brook University, Stony Brook, USA

Weill Cornell Imaging, New York Presbyterian, NY, USA

AsiaPLA 301 Hospital, Beijing, China

Parkway Mt. Elizabeth Novena Hospital, Singapore

CIRC/NUS/A*Star, Singapore

Yeungnam Univ. Hospital, Korea

SNUH, Seoul, Korea

Apollo Hospitals, Delhi, India

Fukushima Medical Univ, Fukushima, Japan

74% global market share!

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Biograph mMRThe world’s only simultaneous, whole-body molecular MR.

Biograph mMR:

Simultaneous acquisition of MR and PET

Fully integrated PET detector architecture

Largest PET field of view in the industry*

Powerful 3T MRI with TrueForm Design

Potentially faster exams through simultaneous acquisition

Easy siting, easy workflow

For the first time, MR and PET are one.

* Based on Competitive Literature available at time of Publication. Data on file.

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© Siemens AG 2012. All rights reserved

Potential is now reality.

Biograph mMRClinical Highlights

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Clinical view

Acquisition parameters

Case images

Overview

Ewing SarcomamMR Munich (TUM/LMU), funded by the DFG

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AcquisitionAcquisition

Soft tissue tumors

MR: soft tissue contrast in high resolutionPET: metabolic information

Combining this information offers potential for improved detection and therapy monitoring in sarcoma cases.

Biograph mMRClinical view

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ImagesImages

Biograph mMRAcquisition parameters

Courtesy of mMR Munich (TUM/LMU),funded by the DFG

Clinical case Ewing Sarcoma

Tracer Fludedoxyglucose F 18 Injection

PETtotal acquistion time 12 min (4 min per bed)

PETtotal scan range 70 cm (3 beds)*

* FOV per bed 25.8 cm

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More imagesMore images

T1w ce TSE with fat saturation

Overlay of metabolic information

Biograph mMRCase images

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Overview

Corresponding T2w TSE

Corresponding native T1w TSEWater and opposed-phase T1w Dixon VIBE acquired for attenuation correction of PET mMR data


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Clinical view


Case images

Overview

University Hospital, Tübingen, Germany

Anaplastic Thyroid Carcinoma

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Imaging soft tissue with CT often requires contrast media application.

However, a number patients do not tolerate contrast media (e.g. iodine-based CM in thyroid carcinoma).

mMR is an alternative for these patients, especially for evaluation of complex anatomical structures.

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Courtesy of University Hospital, Tübingen, Germany

Clinical case Anaplastic Thyroid Carcinoma

Patient weight 69 kg


Activity 347 MBq iv

Uptake time 140 min




ImagesImages

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Overview

attenuation corrected PET overlay of metabolic information T2w TIRM


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Clinical view

Case images

Overview

Metastatic Spread of Head/Neck CancerMallinckrodt Institute of Radiology, Washington University, St. Louis, USA

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Case of patient with head/neck cancer and advanced disease

Key benefits of mMR in head/neck cancer

detailed information about soft tissue

outstanding degree of spatial co-registration due to the simultaneously acquired PET

With fast and detailed imaging techniques like HASTE and VIBE, efficient mMR scanning is made available.

ImagesImages

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Overview

+

original PET of mMR attenuation corrected PET

CorrespondingPET of mMR

MPR

coronal T2w HASTE


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Clinical view


Case images

Overview

Institute of Medical Physics (IMP) and University Hospital, Erlangen, Germany

Bronchial Carcinoma

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For best results in staging exams the most valuable information from medical imaging has to be combined.In this case, the real nature of changes of lung tissue and mediastinum as visualized by MRI is only understandable by adding the metabolic information from PET.Gating information from the MR helps to reduce motion effects in the PET.


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Courtesy of Institute of Medical Physics (IMP) and University Hospital Erlangen, Erlangen, Germany

Clinical case Bronchial Carcinoma



Activity 221 MBq iv

Uptake time 167 min


PETtotal scan range 92 cm (4 beds)** FOV per bed 25.8 cm

ImagesImages

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More imagesT2w TSE with PACE navigator overlay of metabolic information


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Overview

T2w TSE with PACE navigator overlay of metabolic information


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Clinical view


Case images

Overview

Hepatocellular CarcinomamMR Munich (TUM/LMU), funded by the DFG

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Tumor biology is defined by various parameters, e.g. vessel supply including perfusion, glucose turn-over, or cellularity.

Tumors do adapt to their environment and to therapy.

These factors may have an impact on selecting patient-individualized therapeutic approaches.

Providing the right biomarkers will be a key for these decisions.

Acquisition

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Courtesy of mMR Munich (TUM/LMU), funded by the DFG

Clinical case Hepatocellular Carcinoma





Images

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Cellularity derived from diffusion weighted imaging (syngo REVEAL)

High-resolution morphologyT2w TSE with navigator (syngo PACE)

Perfusion derived from3D T1w DCE (syngo VIBE)

Overviewoverlay metabolic informationacquired simultaneously with MRI


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Clinical view


Case images

Overview

Institute of Medical Physics (IMP) and University Hospital, Erlangen, Germany

Pheochromocytoma

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X-ray and CT visualize bone structures in high detail. However, changes of bone marrow and developing bone lesions can be missed, especially at early stages, when changes of bone density have not yet occurred.

Combining MRI (detection of bone marrow changes) and PET (metabolic information) may provide better diagnostic information.

High soft tissue contrast is also relevant to evaluate involvement of adjacent structures e.g. infiltration of the spinal canal.


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Courtesy of IMP and University Hospital Erlangen, Erlangen, Germany

Clinical case Pheochromocytoma



Activity 328 MBq iv

Uptake time 184 min


PETtotal scan range 114 cm (5 beds)** FOV per bed 25.8 cm

ImagesImages

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More images

low-dose CT for attenuation correctionsoft-tissue kernel / window

corresponding PET/CT image

T2w TSE simultaneous mMR


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Overview

simultaneous mMR

low-dose CT for attenuation correctionbone kernel / window

corresponding PET/CT image

T1w TSE


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Clinical view


Case images

Overview

CEMODI, Bremen, Germany

Breast Cancer

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PET enables the visualization of mineralization processes of the bone.

The following case of a 91 year old patient with bone metastases demonstrates the potential of mMR to help in the diagnosis of bone processes either osteoplastic, osteolytic or infiltrative.

Acq. parametersAcq. parameters

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ImagesImages

Courtesy of Center of Modern Diagnostics (CEMODI), Bremen, Germany

Clinical case 91 yrs old with breast cancer and history of ovarian cancer

Tracer Sodium Fluoride F 18 Injection

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More images

T2w TIRM overlay of metabolic datasodium fluoride F 18 PET of mMR scan


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Overview

T1w TSE T2w TIRM overlay of metabolic data


sodium fluoride F 18 PET of mMR scan

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Thank you foryour attention!

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biograph mmr - kivi · biograph mmr the first two years of the world's only simultaneous, ......

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