syngo.via MR Neurology Job Aid

SIEMENS Healthineers syngo.via MR Neurology Template Effective Date: 10 Aug 2021| HILS 2223 Job Aid Effective Date 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Table of Contents Overview 3 AHR Motion Correction 6 Perfusion Maps 8 Mismatch Evaluation 20 R RFA Mean Curve Evaluation 22 Morphometry 26 Settings 35 AHR AHR 7,2 1,2 RFA RFA There might be slight differences between software versions. MR Neurology, Mismatch evaluation, and 2 Brain Morphometry require an additional license and might not be available in all countries. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Workflow The MR Neurology* workflow can be used as a tool to help in the evaluation of MR Neurology C + MR DSC (dynamic susceptibility contrast) images in stroke or cerebral lesion cases. MR Neurology Reading It provides the calculation of perfusion parametric maps, mismatch evaluation* Learn Perfusion and the signal intensity curve evaluation. Segments Maps All the acquired images can be viewed and processed in the same workflow. Mismatch Brain Neurola. Eval. Curve Morpho ... Settings The generated maps can be read in the Parametric Maps step. Viewing Pre-Contrast Brain Morphometry* is available in the workflow, if the license is purchased. Post-Contrast 3D Series Parametric Maps Morphometry Results *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 3 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Reading MR Neurology contains the following preconfigured steps: MR Neurology C + MR Neurology Reading • Viewing • Pre-Contrast Learn Perfusion Post-Contrast Segments Maps • • 3D Series Parametric Maps Mismatch Brain Neurola. • Eval. Curve Morpho ... Settings • Morphometry Results Viewing Pre-Contrast Alternative layouts for displaying different contrast types are available in the layout gallery. Post-Contrast 3D Series Depending on the available licenses, the following functionality can be part of the Parametric Maps workflow: Morphometry Results • Mismatch Evaluation • Brain Morphometry MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 4 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers The workflow is optimized to display images of the following contrast types: MR Neurology C + MR Neurology Reading • General anatomical contrast • T1w (non-ce TSE or GRE, ce GRE, ce TSE) Learn Perfusion T2w fluid attenuated contrast Maps • Segments • T2star (for example, SWI) Time of Flight angiographic data set Mismatch Brain Neurola. • Eval. Curve Morpho ... Settings • Diffusion-weighted contrast (trace weighted and/or ADC) Viewing Pre-Contrast For calculation of the parametric maps: Post-Contrast 3D Series Dynamic susceptibility weighted perfusion contrast DSC. The images must be Parametric Maps • consistently distortion-corrected or non-distortion-corrected. Morphometry Results • For calculation with the Local AIF method a minimum of 6 dynamic phases prior to contrast agent enhancement is required. MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 5 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Motion Correction In the event of patient movement during the AHR MR Neurology Settings X dynamic perfusion scan, the motion can be Perfusion Map Settings Meancurve Settings Morphometry Settings Default Settings for Perfusion Map Generation corrected with motion correction. *Global AIF ocal AIF VTTP PBP relCBV relCBF V reIMTT relCBVCorrected Delay Correction TMax Color LUT ASIST Perfusion A Rigid motion correction is used. You can Preprocessing Settings for Perfusion Map Generation find the correction: RFP Automatic generation of local AIF maps based on default settings Automatic Selection of 4D DSC Perfusion Data Selection of 4D DSC Perfusion Data based on following Series Description: Amount of Phases of selected 4D Data used for Preprocessings 60 • In the lower right segment corner Motion Correction (Rigid) Correction Tools % Generate New 4D data with at least one of the following options Motion Correction ¥ Spatial Filter Width mm Via the Correction tools Auto Windowing Newly generated 4D Data will be used as Input Data for Perfusion Map Generation • auto Send generated perfusion results directly to configured PACS MR Color LUT Language for report English (United States) MR Presets The motion correction can be preprocessed Reset Windowing OK Cancel during the workflow assignment. This can be configured in the MR Neurology Settings. -O -O O -O 6 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Performing the MR Perfusion DSC Scan • Start the scan • Wait ~ 10 seconds: Baseline established for SI more accurate perfusion evaluation • Start the bolus injection: Following the recommendations of the contrast media manufacturer for the amount of contrast media and the bolus rate FITTDO - Time 7 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 A AHR SIEMENS Healthineers L R RFA .............................................................................................................................................................. AHR AHR syngo.via MR Neurology 1,2 L 1,2 Perfusion Maps RFA RFA 8 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 .................................................................................................................................... syngo.via MR Neurology SIEMENS Healthineers Creating Perfusion Maps When selecting Perfusion Maps in the case MR Neurology AHR Q. + MR_Perfusion Vida navigator, the parametric maps calculation MR Neurology Reading 1111 MAGNETOM Vida MR XA10 CURRENT HFB 2/9/2018 layout will be opened. Single Learn Perfusion Mismatch Click ep2d_perf_p2 Segments Maps Eval. latest Phase_19 9:12:39 AM 1 5019 IMA 6 Mean Brain Neurolo ... Curve Morpho .. Settings In the upper left segment, the 4D perfusion- RFP Viewing 2D F weighted images (PWI) are displayed. You can Pre-Contrast SL SPC R Post-Contrast TE 30.0 TP F 44 scroll through the dynamic phases with keyboard 3D Series TA 01:26 SP F36.8 BW 1447.0 FoV 220*220 Parametric Maps p2 PERF/DIS2D/MF SPLIT 128*128 right and left buttons or keep the left mouse Tra>Cor(-5)>Sag(3) A1/FS Zoom 3.93 HC3-6 W 1170 *epfid2d1_128 / 90 C 547 button pressed down and move right and left. Dotarem 14.00ml Scroll through the PWI images to the dynamic phase where the bolus in the vessel can be seen. Perfusion maps are calculated based on a signal- time curve, called the arterial input function (AIF). 9 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Creating Perfusion Maps | Local AIF MR Neurology AHR MR_Perfusion Vida MR Neurology Reading 1111 MAGNETOM Vida MR XA10 CURRENT HFB With Local AIF calculation, no user action is 2/9/2018 chile Learn Segment Perfusion ep2d_perf_p2 latest/Phase_19 9:12:39 AM needed. The system looks automatically for a 15019 IMA 6 Mean Brain Neurolo ... Curve Morpho ... Settings RFP Current .MR _TO representative Arterial Input Function (AIF) within Viewing 2D Pre-Contrast SL 4.0 SPC 4.0 Post-Contrast TE 30.0 TP F44 a 3 cm x 3 cm x 3 cm volume. 3D Series TA 01:26 SP F36.8 BW 1447.0 FoV 220*220 Parametric Maps p2 PERF/DIS2D/MF SPLIT 128*128 Tra>Cor(-5)>Sag(3) A1/FS Zoom 3.93 HC3-6 W 1170 *epfid2d1_128 / 90 C 547 Findings Dotarem 14.00ml No . of Timepoints : 0 Arterial Input Function (AIF) This AIF found by the system is used as a Perfusion Maps Global Al Local AIF reference for the central voxel of the volume. It is TTP PBP y VreICBF VreIMTT a local reference for the calculation. z This will be repeated through the whole scanned image data. The calculation of Local AIF can be preprocessed during the workflow assignment. This can be configured in the MR Neurology Slices Settings. x 10 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Creating Perfusion Maps | Global AIF (1/2) In the Perfusion weighted images, scroll to a dynamic MR Neurology AHR MR Neurology Reading phase where the bolus in the vessel can be seen. Single Mean Brain Neurolo. Curve: Morpho ... Settings Drag the ROI to the region of interest where the ROI RFP Current MR_TOP Viewing Pre-Contrast should be positioned over arteries. The size of the Post-Contrast 3D Series ROI is 5x5 pixels. Parametric Maps Findings Arterial Input Function (AIF) Perfusion Maps In the lower middle segment, the signal-time curves Global AIF local AIF for each voxel of the ROI are displayed. V TTP PEP relCBVCorrected relCBF ¥ reIMTT relCBV ¥TMax O 4095 Select the signal-time curves that represent the Tools ASIST Perfusion L Delay Correction Arterial Input Functions (AIF). You can select one or Synch Align Hide . Hide Lines Rezet Graphics Timepoi ... Activat Go to Set several voxels. These selected AIFs are used as a Snapshot Print Export Image Image 10:12 AM Select All Clear All Start Close global reference for the calculation. 11 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Creating Perfusion Maps | Global AIF (2/2) In the lower left segment, the range of the MR Neurology AHR MR Neurology Reading calculation needs to be set. Single Mean Brain Neurolo. Curve: Morpho ... Settings The white line shows the average AIF within this RFP Current MR_TOP Viewing Pre-Contrast slice. Post-Contrast 3D Series The red line shows the average of the selected AIFs. Parametric Maps Findings Arterial Input Function (AIF) Perfusion Maps Set the ranges by moving them with the mouse Global AIF local AIF • Baseline Start – BLs V TTP PEP relCBVCorrected relCBF ¥ reIMTT relCBV • Baseline End – Ble ¥TMax O 4095 • First Pass through end – Fpe Tools ASIST Perfusion L Delay Correction Synch Align Hide . Hide Lines Rezet Graphics Timepoi ... Activat Go to Set Only the time points between Baseline Start and First Snapshot Print Export Image Image 10:12 AM Select All Clear All Start Close Pass through end are used for calculation. This selection is saved as a finding. 12 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Creating Perfusion Maps | Calculation Method In the lower right segment select the calculation method: • Global AIF • Local AIF Global AIF Local AIF V TTP V PBP relCBVCorrected The following maps can be calculated: M relCBF ¥ reIMTT relCBV / TMax Maps Global AIF Local AIF O 4095 TTP (Time To Peak) V ASIST Perfusion PBP (Percentage to Baseline at Peak) X Delay Correction relCBF (relative Cerebral Blood Flow) Global AIF Local AIF V V TTP PBP ¥ relCBVCorrected relMTT (relative Mean Transit Time) M relCBF ¥ reIMTT ¥ relCBV / TMax relCBV (relative Cerebral Blood Volume ) relCBV Corrected (Corrected relative Cerebral Blood Volume) X 4095 O ASIST Perfusion TMAX Delay Correction MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 13 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Map Overview TTP relCBF relCBV c c relCBF = ∆𝐷 ∆𝑇 c Signal intensity Signal intensity Signal intensity Time (sec) Time (sec) Time (sec) relMTT TMAX PBP 100% c MTT= 𝑟𝑒𝑙𝐶𝐵𝑉 c c 𝑟𝑒𝑙𝐶𝐵𝐹 Signal intensity Signal intensity 0% Time (sec) Time (sec) 14 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers TTP* Map Global AIF Local AIF From the start of the selection of Baseline Start From the start of the aquisition TTP TTP No. of Tim Signal intensity Signal intensity Time (sec) Time (sec) *Time To Peak 15 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Corrected relCBV Map The relCBV Corrected map is only available for Local AIF perfusion calculations. Global AIF Local AIF This map includes a T1 correction that considers special effects of the contrast TTP PBP ¥ relCBVCorrected medium in pathologies with a disrupted blood-brain barrier. The effects of any M relCBF reIMTT contrast agent extravasation on the relCBV value are minimized. relCBV / TMax 0 4095 The corrected volume maps are identified with a second C in the map name. ASIST Perfusion RE BV_LOCAL Delay Correction 25 20 relCBV uncorrected relCCBV corrected Corrected AR2" (1 / sec) c c -10 Uncorrected 20 40 60 80 100 120 140 160 Signal intensity Signal intensity Time (sec) Time (sec) Time (sec) 16 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Delay Correction relCBV Map The Delay Correction is only available for Global AIF perfusion calculations. Global AIF Local AIF The delay correction can be selected in the MR Neurology settings in the Global AIF tab. VTTP ¥ PBP relCBVCorrected M relCBF reIMTT For the delay correction the selected AIF is used as a reference. The other pixels signal time ¥ relCBV / TMax curve is referenced to the AIF and corrected for delay in other parts, where the blood flow 4095 O is slower or faster. ASIST Perfusion This is called Block-circulant deconvolution technique (Siemens Perfusion MR). The Delay Correction corrected maps are identified with DC at the end of the series name. GLOBAL_DIS2D_ep2d_perf_p2 DC MR Neurology AHR MR Neurology Reading uncorrected corrected RFP Wering Pre-Contrast Pist Contrast 30 Series Parametric Mage Findings Arterial input Function (AIF) Perfusion Maps c c Globel AIF Lixal AF TIF V PIP NIMTT Selected AIF Signal intensity Signal intensity Tools ASIST Perfusión .Diday Correction Time (sec) Time (sec) Start Close 0:15 AM 17 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers TMAX Map In the MR Neurology Workflow, it is possible to calculate TMAX maps. AHL AHL The calculation can be generated by both Global AIF (Arterial Input TMAX LOBAL IS2D_ep2d_perf_p2_DG TMAX LOCAL IS2D_ep2d_perf_p2ª # VD11 # VD11 Function) and Local AIF methods. STUDY ID 1 aaaa1 363 STUDY ID 1aaaa1 363 10:51:05 PM 10:51:03 PM 1021 IMA ~1 FRM 1030 IMA n.a. The TMAX map (Time to Maximum) is a perfusion parameter that shows the bolus delay between the position of the arterial input RAF RAF function (AIF) and the tissue. This information can help in diagnosing ischemic stroke cases. It 10cm 10cm provides a reliable estimate of the volume of the ischemic penumbra in stroke patients. TIP TMAX provides the time at which value of maximum residential curve (relCBF) is observed. The TMAX map is calculated only if relCBF is also calculated. The default window width value for the map color has been set to 6. This value is directly related to 6 s of bolus delay. For numeric display of the delay, use pixel lens from the upper right corner menu. 18 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Maps Calculation Integration and Ca (t): Artery normalization relCBV   ( ) C τ dτ relCBV 0 t Division =  C ( ) τ dτ relCBV 0 a relMTT = relCBF Graph range [-0. 0283639. . 0. 471781] (ROI) Ct (t): Tissue relCBF relMTT Deconvolution C (t) relCBF C (t) R(t) 0 00 00  =  Graph range [-0.180518. . 0. 0369487] (ROI) t a Area 19 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 SIEMENS Healthineers 3711 686 0 Mismatch Evaluation ND_ep2d_diff_3sc ... RELMTT_LOCAL_e ... syngo.via MR Neurology Slice Position Mismatch Ratio Comb 10.4 cm2 52.6 cm2 42.2 cm2 408 80.3 % F54.4 10.4 cm2 52.6 cm2 42.2 cm2 80.3 % Mismatch Evaluation Save Finding Export To CSV Close 20 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Mismatch Evaluation The Mismatch Evaluation is used to calculate the comparative values (mismatch) Distance Line between the diffusion ROI and the perfusion ROI. The mismatch result may help to MMEval Freehand ROI quantify the penumbra region. MMEval Ellipse ROI O MMEval Freehand ROI In the upper right corner of the segment you will find MR Neurology Q + MR Neurology Reading the tool for drawing the regions of the: Segments • Stroke in ADC Mean Brain Neurolo. Curve Morpho ... Settings • Penumbra in MTT or TMAX map Viewing Pre-Contrast Post-Contrast 3D Series Parametric Maps If drawing the regions in several slices the Comb result line is filled. The results are shown in the evaluation Findings Mismatch Evaluation Slice Position ND_ep2d_diff_3sc ... RELMTT LOCAL e ... Mismatch Ratio segment. Comb 10.4 cm2 52.6 cm2 42.2 cm2 80.3 % F54.4 10.4 cm2 52.6 cm2 42.2 cm2 80.3 % Findings can be: Tools • Saved Bunch Align Custom Hide Hide Lines Reset Text Graphics Timepol • Exported to csv O Snapshot Print Export Undo Image Image Save Finding Export To CSV Close 1:50 PM 7 O. 21 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 SIEMENS Healthineers 303 803 1 MC3 MC3 0 MC2 MC2 MC1 o MC1 O -25 -1 ..................... MC4 MC4 Ratio (%) syngo.via MR Neurology 10 MC1 ¥ SP H34 832 MC2 V SP H34 Mean Curve MC3 -10 V SP H34 MC4 ... MC3 ¥ SP H34 ......... MC2 -20- Evaluation . MC1 ............ " -30 -40 -50 0 -60 22 MC4 10 20 30 40 50 60 70 80 90 Effective Date: 26 Sep 2022 | HOOD05162003291587 Normal time (sec) Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Mean Curve Evaluation (1/2) An evaluation with Mean Curve provides information about signal MR Neurology changes as a function of time and place. With the Mean Curve evaluation, you can analyze the contrast medium Single Learn Perfusion Mismatch Click Segments Maps Eval. uptake in the tissue, for example, to analyze the perfusion behavior of Brain Neurolo. brain tissue. You draw ROIs in the tissue of interest in different contrast Curve Morpho ... Settings images (the T1w or T2w post-contrast images, the perfusion maps, or the MR Neuro Mean Curve Statistics Table [mMC1 EmMCT Measurem ... flair_space ... diff bo-10 ... RELCCBV diffusion maps). Mean 110.5 520.2 123.7 0434.1 Min/Max 106.0/113.0 451.0/647.0 111.0/135.0 Ratio 152.8 % 85.4 % 59.5% MMC4 Mean Minittax 108.3 602.8 122.5 (134.1) 97-0/114 0 567,06647.0 117.0/125.0 MC1 MC Ratio 137.7 % 94.6% 42.0% Mean 645 9 879.7 MIAC2 MC3 MC3 0134.1 ) MirVMa 76.0/116.0 592.0/708.0 697.0/1067,0 MMC3 - 0 10 0 Rabo 129.7 % 99.4 % 335.2% The results of the ROI readings are graphically displayed in a separate Mean 127.7 955 2 83.0 O O 0134.1) Min/Max 124.00131.0 896 0/1012.0 67.0/10.0 Ratio 160.8% 173:2% 55.9 % result segment as a signal time course. These curves display the ROI specific mean value of the contrast medium uptake over the time. Ratio (%) MCI SP H34 EmMCT This helps to compare the vascular permeability and to characterize Mean Curve Statistics Table -MCT brain tissue and cerebral lesions. CZ O Mirror mMCA Selected 4D Series: 2/19/2016.MR.ep2d_perfusion_Fi3_MoC.lates Activa Go to Se 10: 20 30 40 50 60 70 80 90 Normal time (sec) Save Finding Close 23 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Mean Curve Evaluation (2/2) You can set a mirror line and mirror the drawn ROIs to compare the MR Neuro Mean Curve Statistics Table mMC1 mMC1] ID Measurem ... fair_space ... diff bo-10 ... RELCCBV Mean 110. 520 2 123.7 signal time course of the suspect tissue with normal tissue. The mirrored MC1 0134.1 Min/Max 106:0/113.0 451.0/647.0 111.0/135 0 Ratio 152.8 % 85.4 % 59,5 % nMC4 Mean 108.3 602.8 122.5 MC2. Min/Max 97.0/114.0 567,06647.0 117.0/125.0 ROIs may serve as a reference for the calculated mean curve results. MC1 MCI Ratio 137.7 % 94.6% 42.0% MC2 Mein 97.2 645 9 879.7 AMC2 MC3 TMC2 MC3 MC3 (34.1) Min/Max 76.0/116.0 592.0/708.0 697.0/1067,0 The mean signal time courses of the mirrored ROIs are displayed as a MC3 O nMC3 O Rabo 129.7 % 99.4% 335.2% O Mean 127.7 955 2 83,0 MC4 (134.1) Min/Max 124.0/131.0 896 0/1012.0 67.0/10.0 Ratio 160.8% 173:2% 55.9 % dashed line in the result segment. 25 Ratio (%) The ROI statistics can be set when clicking with the right mouse button 10 MMC1 on one of the ROIs. [Mean Curve Statistics Table MC1 MC2 -20 MC3 O -30 Min / Max 451.00 /647.00 ID To Area D.12.cm2. mMC4 Selected 4D Series: 2/19/2016.MR.ep2d_perfusion_Fi3_MoC.lates Activat Meets: 845 84 /33.46 Go to: Se 10: 20 30 40 50 50 70 80 Normal time (sec) Save Finding Close W/ M33 886 00 /1012 00 Area 1.4 Delete ROI Delete All ROI Ratio (%) Show ROI Statistics Show All ROI Statistics The results are saved with a snapshot and the numeric table of the signal intensity. 24 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Mean Curve Settings Two types of curves: Ratio (%) -:-mMC2 Normal time 26.82 sec Mean 249.79 Ratio Mean -:-mMC2 Normal time 26.82 sec Mean 249.79 5- 500 • Signal intensity curve: Shows the true signal MC1 MC1 SP H8 ¥ SP H8. 0 MC2 475 intensity value of both ROIs. SP H8 SP HE. 450 Normalized curve: Shows the signal intensity -5 • 425 value as a ratio to the value in the first phase. -10 400 375 -15 ... ... . 350 You can change the default settings for the mean -20 ₿25 curve evaluation in the lower part of the time curve -25 300 ...... 275 .......... segment. ......... -30 . . ....... 250 csy Plot Display CSy Plot Display Signal Signal Previous Next Curve Info Export to Previous Next Curve Info Export to CSV Normalized CSV Normalized Normal time (sec) 25 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 SIEMENS Healthineers H A HAR Brain Morphometry Report - 2/20 Current Prior syngo.via MR Neurology Tissue Absolute Normalized Normative Rate Of Absolute Normal ized Normative Range [x] Change[%/y] [m] ] A[X] Range^^[x] TIV 1562.5 1553.8 Brain 1253.2 8 43:0 - 45:3 1259.9 81.1 [73.2 81.7] GM 742.9 -1.69 755.3 48.6 Cortical GM [43.1 - 50.1] 587.7 37 6 596.5 38.4 [32. 8 38.7] 510.3 28.0 - 35 32 504.6 32.5 [28.0 - 33.7] Morphometry WMAb 0.0 0.0 [19.2 - 25.4] 0.0 0.0 CSF 309.3 19 8 6.02 293.9 18.9 [19.0 - 25.2] A Percentage of TIV (Total Intracranial Volume) A10th and 90th percentiles of healthy age-/gender-matched population Below/above usual normal range volumes Report based on automated processing! Include original data for diagnosis. Activate Windows Go to Settings to activa 26 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Morphometry* Overview The morphometry function is for estimating the volume of MR Neurology different brain regions in a single 3D T1-weighted MPRAGE series, for example, to assess neurodegenerative diseases like Alzheimer’s disease or multiple sclerosis. Single Learn Perfusion Mismatch Click Segments Maps Eval. Brain Neurolo .. Processing can be done interactively in the Brain Morphometry layout, Curve Morpho. Settings or it can be done fully automatically during the preprocessing. This can HAR HAR MPRAGE GRAPPAZ MPRAGE GRAPPAZ_Fused_DM be enabled in the MR Neurology settings. 8:18:17 AM 8:18:17 AM 5 IMA.94 1003 IMA1 FRM 475140 AFL AFL As a result, a morphometry report, deviation map and label map are 10cm created. In the label maps, each brain region is visualized in a different Zoom 1.96 bom 1.es color. HAR HAR MPRADE GRAPPA2_FOLLOW_UP_REPORT MPRADE GRAPPAZ_LABEL 8:18:17 AM 1003 INA1 1002 IMA 1 FRM 10/1 0 Results are sent to PACS automatically. AFL AFL Zoom 0 64 Zoom 1.95 *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 27 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Morphometry* Input Images The input images used are a T1 MPRAGE series in sagittal myExam Cockpit - Explorer MR Neurology Explorer Program Editor Browse Import Export Edit Simulate orientation that should be acquired with the Siemens morphometry protocol using the Morpho Add In (please SIEMENS ... >> head >> library >> 3D t1_f13d_sag_p2_iso 05:52 see the user manual for the scan parameters). Single Learn Perfusion Mismatch Click Segments Maps Eval. To head Brain Assist t1_mprage_sag_p2_iso 05:35 [ clinical libraries t1_mprage_sag_p2_iso_MoCo 05:35 Brain Neurolo. [ advanced applications libraries Curve Morpho. Settings GOBrain The scan parameters should be compliant with a widely t1_mprage_tra_p2_iso 05:38 library El localizer t1_mprage_tra_p2_iso_MoCo 05:38 accepted standard. To ensure adequate image quality E T1 E T2 t1_mprage_sag_p2 05:12 @ Morpho E PD+T2 the scan parameters must fulfill dedicated criteria E 3D El diffusion t1_space_sag_p2_iso 06:06 defined by morphometry protocol guideline ADNI. El perfusion E BOLD t1_space_sag_cs4_iso 03:27 E BLADE E SWI E flow t2_space_sag_p3_iso 05:57 E Head32 E HeadNeck 20 TCS t2_space_sag_cs4_iso 02:32 E QUIET E StarVIBE El SyMRI t2_space_dark-fluid_sag_p2_ns-t2prep 05:10 MRF Do angiography t2_space_dark-fluid_sag_cs6_iso 04:21 angiography ce t1_space_ir_cor_p2_iso 06:10 [ c-spine *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 28 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Morphometry* Scanning Recommendations If all scan parameters are within the required AGE GRAPPA2.latest Prior Compatibilty Warning ! Not consistent with morphometry protocol guideline range, the morphometry results will be Current.MR.MPRAGE GRAPPA2. latest & Prior ADNI Warning 01.MR.t2_tse_cor_448_2mm_hippocampus.latest are not compatible Message calculated. However, if one of the defined scan 7.5.99.3 Prior 01.MR.t2_tse_cor_448_2mm_hippocampus.latest is not ADNI 1. Matrix size of current and prior studies different. Current : compatible [ Rows :256 Columns : 240] Prior : [Rows 448 Columns : 448] parameters is not compliant, calculation is Message deactivated, and no result series are created. 1. Acquisition Type 2D [expected '3D] 2. Orientation: CORONAL [expected 'SAGITTAL"] 3. MagneticFieldStrength. 3T SliceOverSampling: 0,5 [expected: <= 0.3 when MagneticFieldStrength = 1.5T, <= 0.2 when MagneticFieldStrength In the Morphometry Settings, you can allow 4. MagneticFieldStrength: 3T VoxelReadoutFov: 175 [expected >= 240 when MagneticFieldStrength = 1,5T; >= 256 when MagneticFieldStrength calculation even if a scan parameter is not 5. Magn. preparation: 4 [expected: 2] 6. MagneticFieldStrength, 3T BaseResolution: 448 [expected: 192 when MagneticFieldStrength = compliant. In this case, results will be 1.5T, 256 when MagneticFieldStrength = 31] 7. Number of Slabs: 24 [expected: 1] 8. EllipticalFilter. 1 [expected Tag absent] 9. Auto-Align reference mode: 1 [expected: 2 (Basis)] 10 Auto-Align region mode: 1 [expected: 2 (Head)] Close generated but with possible loss of image -450201 15/ 150 quality. high Close 1 Current is not compatible with Prior A warning message shows which protocol parameters were not compliant. A note in the report documents that the MPRAGE protocol used for the input image was not consistent with the protocol guideline. *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 29 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Morphometry* Results Color codes for the different brain areas Lobar WM (white matter): Lobar GM (gray matter): . Frontal lobe Frontal lobe - Parietal lobe . Parietal lobe The individual brain structures are automatically segmented, and their volumes Occipital lobe Occipital lobe Temporal lobe Temporal lobe - Corpus callosum Cingulate gyrus are measured and compared to a normative database. - Deep WM Cerebellum GM Cerebellum WM The label map is displayed in the right image segment and shows the different CSF White Abnormal (WMAb) brain regions, each region in a different color. Thalamus (left/right) Lateral ventricle left Caudate (left/right) Lateral ventricle right Putamen (left/right) Third ventricle The deviation map is displayed in the left image segment and shows the different Pallidum (left/right) Fourth ventricle brain regions, color-coded to indicate the degree of deviation from the average Hippocampus (left/right) Insula (left/right) normative volume. The color range (from green to red) is based on the standard Pons Mesencephalon deviation. No deviations or minor deviations are shown in green, and large Medulla oblongata deviations in red. You can also configure these colors. MR Neurology MR Neurology Settings MR NOL Pultudon Map Setti Morphometry Settinge MRC31/7E341876 1965E6 69336 B Available Colors MFRAGE GRAPPAZ Default Settings Bend Factor Forcebills for Volumes" 90 % X Preprocessing Set Automatic gere Automatk Findings Selection language fol Enable Fo Disable p Standard Cokes V Send ger 1.3 Tools Min Destation MER THICK ; NORMIDEDO Enatie Follow Up Mode Furt Export Best Fechar für Label Nap 1:01 PM *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 30 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Brain Morphometry* Report The report includes volume estimates for the different brain regions. Brain 3rd percentile Both absolute and relative (percentage of total intracranial volume) 10th percentile 25th percentile 50th percentile 75th percentile -> 90th percentile 100 97th percentile volumes are reported. Additionally, for each brain region, a normative range is displayed that corresponds to the 10th and 90th percentiles of an age- and gender-matched healthy population. An asterisk is shown next to the relative volume if its value is below the 10th percentile for cerebral tissue, or above the 90th percentile for internal and external cerebrospinal fluid spaces. The percentile Volume in % of TIV (+/- scan-rescan variability) values can be configured. 50 35 40 45 50 Age *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 31 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Brain Morphometry* | Follow up Report • Volume estimates for the different brain regions. Both absolute and relative (percentage of total intracranial volume). For each brain region, a normative range is displayed and corresponds to the 10th and 90th percentiles • of an age- and gender-matched healthy population. • For follow-up cases, the report includes the data for the prior timepoint and the rate of change between the current and the prior. The rate of change is only calculated if current and prior are at least 180 days apart. Trending plots depicting the current data, prior data, and normative percentiles are available for selected brain regions at the end of the report. HAR Brain Morphometry Report - 2/20 Current Prior Tissue Absolute [m] ] Normalized Normative A[X] Rate of Change[x/y] Absolute Normalized Range/[x] [m]] A[X] Normative Range [x] TIV 15 1553 Brain 1253 2 80. 2 47.5 [73.0 - 81.4] 49.91 -0.61 1259. GM 742.9 -1.88 755.3 81.1 48.6 [73.2 - 81.7] 50.1 Cortical GM 587 37.6 728.0 - 33.71 -1.69 596.5 38 WMM 510.3 32.7 1.30 504.6 32 [28.0 - 33.71 WAD 0.0 0.0 0.0 O. CSF 309.3 19.8 [19.2 - 25.4] 6.02 293 18 [19.0 - 25.2] *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 32 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Morphometry* | Normative Reference Database (1/2) For the comparison of the individually measured volumes of the brain structures for a specific Age distribution for all subjects 20% - subject, a normative database is provided in Brain Morphometry. 15% - The normative database is composed of a total of 303 healthy subjects (50.8% males, median age percentage 5% - 73.25 years, min age = 19 years, max age = 90 years). The subjects are partly collected by the = Alzheimer’s Disease Neuroimaging Initiative (ADNI) based on a pre-defined subject selection 25 50 Age [years] 7's Age distribution for females process and partly collected by Siemens following the ADNI selection guidelines. 20% Please note the relatively low number of normative data in the 45–60-year-old age group. As 15% - described in Wyman et al. [Alzheimers Dement. 2013 May; 9(3): 332–337], all subjects from the 0% percentage ADNI collection received screening MR scans and underwent clinical and cognitive assessments, 5% biomarker and genetic sample collection. 0% - 25 50 Age [years] 75 20%. For the imaging data, a quality check was established to ensure consistent imaging protocol 15% parameters and image quality [ADNI3 Procedures Manual published by the ADNI]. Subjects from 10% - percentage the Siemens collection are selected based on a health assessment questionnaire and an initial MRI 5% - scan. Only subjects in good health and without a history of neurological diseases were selected. 0% - 25 50 Age [years] 75 *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 33 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Morphometry* | Normative Reference Database (2/2) Data fitting and reference ranges More specifically, reference ranges are defined as the linear regression prediction intervals corresponding to a given percentile under the simplifying assumption that normalized volumes are normally distributed at each age with constant variance. The reference normative volumes for all 50 brain structures were tested for lognormality, using the Shapiro-Wild statistics (p-value less than 0.05 rejects normality, using Benjamini-Hochberg False Discovery (FDR) correction for multiple comparisons). Comparison with normative ranges In the morphometry report, measured sub-volumes falling into the 10%-ranges below 10th percentile or above 90th percentile are referred to as “below/above usual normal range” marked with the * (asterisk) sign to indicate decreased volume structures, for example, cerebral structures or hypertrophied structures, for example, internal and external cerebrospinal fluid spaces. Please note: Hypertrophied cerebral structures or decreased cerebrospinal fluid spaces are not marked with the * (asterisk) sign. *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 34 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 MR Neurology Settings X SIEMENS Healthineers Perfusion Map Settings Meancurve Settings Morphometry Settings Default Settings for Perfusion Map Generation *Global AIF Local AIF VTTP VPBP ¥ relCBV M relCBF ¥ reIMTT relCBVCorrected Delay Correction VTMax Color LUT ASIST Perfusion O 4095 Preprocessing Settings for Perfusion Map Generation Automatic generation of local AIF maps based on default settings Automatic Selection of 4D DSC Perfusion Data syngo.via MR Neurology Selection of 4D DSC Perfusion Data based on following Series Description: Settings Amount of Phases of selected 4D Data used for Preprocessings 60 Generate New 4D data with at least one of the following options Motion Correction Spatial Filter Width 3 mm Newly generated 4D Data will be used as Input Data for Perfusion Map Generation Send generated perfusion results directly to configured PACS Language for report English (United States) Restore 35 OK Cancel Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Settings | Perfusion Map Settings Define which method should be used during workflow assignment Perfusion Map MR Neurology Settings Generation: Perfusion Map Settings Meancurve Settings Morphometry Settings • First method offered when opening the workflow is identified by * Default Settings for Perfusion Map Generation *Global AIF Local AIF TTP PBP M relCBV relCBF reIMTT relCBVCorrected Delay Correction TMax Color LUT ASIST Perfusion • Color LUT can be standardized for the maps 4095 Preprocessing Settings for Perfusion Map Generation ~Automatic generation of local AIF maps based on default settings • Preprocessing settings: Automatic Selection of 4D DSC Perfusion Data Selection of 4D DSC Perfusion Data based on following Series Description: • Automatic generation of Local AIF maps Amount of Phases of selected 4D Data used for Preprocessings 60 Generate New 4D data with at least one of the following options Automatic selection of the dynamic data Motion Correction ¥ Spatial Filter Width mm • Newly generated 4D Data will be used as Input Data for Perfusion Map Generation Send generated perfusion results directly to configured PACS Language for report English (United States) • Number of phases required for preprocessing: • If the number of scanned series is higher than typed in here, only the number OK Cancel of series typed here will be used for the calculation of the parametric maps • If the number of scanned series is lower than typed in here, no calculation is done • Automatic Motion correction 36 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Settings | Meancurve Settings • Selection of the input data MR Neurology Settings X • Statistics to be shown for the ROI statistics Perfusion Map Settings Meancurve Settings Morphometry Settings Define Priority of 4D Input Data 1 The top most available series will be used for Mean Curve Evaluation 4D MoCo DSC 4D DSC 4D MoCo DCE 4D DCE 4D Unknown Type Up Down Measurement Options for MC Statistics Table Mean Min/Max Ratio Restore OK Cancel 37 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 syngo.via MR Neurology SIEMENS Healthineers Settings | Morphometry* Settings In Morphometry Settings the following can be configured: MR Neurology Settings X Perfusion Map Settings Meancurve Settings Morphometry Settings • Default settings for the Blend factor for the Deviation Map, Label Map and Percentile for Default Settings the Volumes Blend Factor for Deviation Map 50 % Percentile for Volumes* 90 + Blend Factor for Label Map 50 % Preprocessing of morphometry: Preprocessing Settings • Automatic generation of morphometry results Automatic Selection • Follow-Up Mode Selection based on following Series Description Language for report English (United States) • Processing of improperly acquired data Enable Follow-Up Mode Disable processing of improperly acquired image data Send generated morphometry results to PACS • To allow calculation if a scan parameter is not compliant or if the data is coming from a Deviation Map Colors non-Siemens scanner, activate the option Disable processing of improperly acquired Max Deviation data. In this case, results will be generated but with possible loss of image quality Percentile* • To allow calculation only for ADNI compliant input data, disable the option Disable Min Deviation processing of improperly acquired data. In this case, the input data will be checked, and only compliant data is processed. If the data is not compliant, only a report is created including the information that the data is not ADNI compatible. The calculation OK Cancel is not performed • Automatic sending of results to PACS • The deviation map colors can be changed permanently *MR Neurology, Mismatch evaluation, and Brain Morphometry require an additional license and might not be available in all countries. 38 The functionality Caudate Structure segmentation is not released for USA. Its future availability cannot be guaranteed. Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022 SIEMENS Healthineers Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. © Siemens Healthcare GmbH 2022 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens-healthineers.com 39 Effective Date: 26 Sep 2022 | HOOD05162003291587 Unrestricted © Siemens Healthineers, 2022