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Advanced MRI in the Clinic

X Zhou1*, Y Jung2*, H Liu3*, S Einstein4*, (1) University Illinois at Chicago, Chicago, IL, (2) Wake Forest School of Medicine , Winston-salem, NC, (3) UT MD Anderson Cancer Center, Houston, TX, (4) UT MD Anderson Cancer Center, Houston, TX


(Tuesday, 7/31/2018) 7:30 AM - 8:30 AM

Room: Karl Dean Ballroom B1

Speaker 1 (Xiaohong Joe Zhou, PhD) – Diffusion MRI
Following its success in early detection of cerebral ischemia, diffusion MRI has been increasingly used in the clinic with a broad range of applications spanning from neurologic disorders to cancer, and from the brain to the body. These applications are propelled by the development of diffusion models and significant advance in diffusion MRI acquisition strategies. This lecture will review recent technical developments and clinical applications of diffusion MRI, with a special emphasize on how a clinical medical physicist can help translating diffusion MRI into the clinic. In this lecture, we will first describe how molecular diffusion information can be encoded into the MR signal in several common pulse sequences. Second, we will provide an overview of diffusion models that can be used to relate MRI measurement to biologically relevant tissue properties, such as cellularity, vascularity, and microstructures. Third, we will discuss several practical issues, including imaging protocols, motion management, reproducibility and reliability, and quality assurance. Lastly, we will highlight a few ongoing research areas that will likely impact clinical practice in the near future.

Learning Objectives:
1. To understand commonly-used diffusion MRI pulse sequences in the clinic;
2. To understand the common diffusion models in diffusion MRI analysis;
3. To be able to implement diffusion imaging protocols and conduct quality assurance.

Speaker 2 (Youngkyoo Jung, PhD) – Perfusion MRI
Blood perfusion is a physiological function that delivers oxygen and nutrients to tissue. Perfusion can be assessed with MRI using an exogenous contrast agent or blood itself. The MRI techniques using a gadolinium based contrast agent include dynamic susceptibility contrast MRI and dynamic contrast enhanced MRI. In contrast, arterial spin labeling MRI is a technique using blood as an endogenous contrast agent. Each perfusion MRI technique is based on its unique physical characteristics and, therefore, can be used to derive different perfusion-related parameters. A perfusion MRI method can be chosen depending on physiological parameters that relates to a certain pathologic condition.

Learning Objectives:
1. To understand physiological and physical principles of perfusion MRI methods;
2. To understand perfusion models and parameters derived from different techniques;
3. To be able to choose and implement the relevant perfusion MRI method in the clinic.

Speaker 3 (Ho-Ling Anthony Liu, PhD) – Functional MRI
Functional MRI (fMRI) based on blood oxygenation level-dependent (BOLD) signal has been widely applied in clinical imaging studies for the management of neurological diseases. In particular, it is a promising tool for presurgical functional mapping of eloquent brain areas to help maximizing the lesion resection while preventing post-operative functional deficits. However, it remains technically challenging to reliably provide accurate information for clinicians. These challenges include compromised spatial accuracy with the imaging resolution of echo-planar imaging and the existence of susceptibility artifact, potential lesion-related impairment in neurovascular coupling during neuronal activation, and the compliance of patients to perform the task paradigms. This lecture will provide an overview of basic fMRI methods used in the clinic, issues related to pathological conditions and lesions of the patient, and potential solutions/tools to address these issues.

Learning Objectives:
1. Understand the basic principle, paradigms, imaging techniques and analysis methods of fMRI.
2. Understand the limitations and artifacts in clinical fMRI.
3. Understand the hardware/software requirements and be able to setup a presurgical fMRI service.

Speaker 4 (Samuel A. Einstein, PhD) – MR Spectroscopy
MR spectroscopy (MRS) is a rapidly-expanding clinical technique for non-invasive assessment of tissue metabolites. MRS has proven to be a powerful tool for the diagnosis, monitoring, and evaluation of lesions, neoplasms, and metabolic disorders in the brain and other regions of the body. This segment will begin by presenting the basic physics of MRS, clinically-available MRS pulse sequences, and the many clinical applications of MRS. Recommended analysis approaches for the clinic will then be discussed along with common MRS artifacts. Subsequently, the best practices for MRS QA and patient billing will be described. Finally, we will introduce non-proton MRS, hyperpolarized MRS, and spectroscopic imaging.

Learning Objectives:
1. Understand the basic physics, acquisition techniques, and clinical applications of MR spectroscopy.
2. Understand the different methods for analyzing MR spectra.
3. Identify common artifacts and be able to implement suggested MR spectroscopy QA.

Funding Support, Disclosures, and Conflict of Interest: Funding Support: Zhou XJ (NIH, Abbvie, Inc.), Jung Y (NIH, NASA, UNCG). Disclosures and Conflict of Interest: Jung Y (Consultancy, Digital Harmonic LLC. Not related to the contents in the presentation).



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