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New Non-Contrast MR Techniques
syngo NATIVE and syngo ASL
MR angiography and Siemens Administration issued new-boxed obtained in patients who are at risk for
warnings for all manufactures of renal insufficiency. NYU’s departmental
Contrast-Enhanced Magnetic Resonance gadolinium, which stated that patients policy for administration of MR contrast
Angiography (ce-MRA) remains the gold with severe kidney insufficiency who agent based on estimated GFR (calculated
standard for evaluating vasculature in receive these agents are at risk for using the MDRD equation) is as follows:
MR as it enables high spatial and developing NSF. Their recommendations
temporal resolution with extremely fast further state that facilities should avoid eGFR >60 (mL/min/1.73 m2)
imaging times. Siemens technological use of gadolinium in patients with known No restriction for administration
innovations in angiography along with risks for developing NSF unless the of contrast.
the implementation of stronger gradients diagnostic information is essential and eGFR >30-60
has pushed imaging times to seconds cannot be obtained with a non-contrast Discuss with the patient the risks
instead of minutes. High resolution enhanced MR or other diagnostic of administration of contrast and
ultrafast ce-MRA techniques from procedures. The FDA also stated that consider using low dose.
Siemens are in routine clinical usage facilities should assess renal dysfunction
eGFR 15-30
today along with improved workflow prior to administration of gadolinium as
Discuss risks and benefits with
with Siemens unique inline processing, well as not exceed recommended doses.
referring physician, nephrologist
subtraction and image composing Go to www.FDA.gov for more information
and patient. Consider using low
speeding up exam time. Innovative on gadolinium-containing contrast agents.
dose but not recommended.
applications like syngo TWIST and syngo
NATIVE now provide the user flexibility Due to recent events involving NSF and eGFR <15 or on dialysis
of choice of technique to do MR gadolinium, facilities such as New York Avoid administration of contrast
angiography. syngo NATIVE enables University Hospital have implemented a unless benefits outweigh risks based
excellent non-contrast angiography screening process for those patients at on assessment of the referring
imaging and reproducible results. risk and modified their routine written physicians, nephrologists and
consent form. NYU assesses for renal radiologist. Peritoneal dialysis is
dysfunction prior to administration of an absolute contraindication.
NSF (Nephrogenic Systemic Fibrosis) MR contrast agents to identify patients
and changes in hospital policies at risk for renal insufficiency and thereby NYU utilizes a non-contrast angiography
potentially at risk for developing NSF. technique called syngo NATIVE when
The use of injected contrast media has The risk factors include increased these patients cannot have contrast.
come under scrutiny as the common serum creatinine, history of renal When low dose contrast is indicated,
contrast agents containing gadolinium disease, acute renal failure or recent renal NYU utilizes syngo TWIST (Time-resolved
have been linked to a condition called surgery, proteinuria, diabetes mellitus, Angiography With Stochastic Trajectories),
Nephrogenic Systemic Fibrosis (NSF) that hypertension, gout or recent intake of a new versatile high-resolution
can occur in patients with renal nephrotoxic drugs. Documentation of angiography technique that further
insufficiency. The Food and Drug recent BUN, creatinine and estimated improves time-resolved ce-MRA.
Glomerular Filtration Rate (GFR) are
2
2A
2B
Figure 1: syngo TWIST, MAGNETOM Avanto. Figure 2A: Time of Flight (ToF).
Figure 2B: Phase Contrast (PC).
*Data on file.
3
Figure 3: syngo NATIVE TrueFISP.
Figure 4: syngo NATIVE SPACE. Figure 5: Pulsed ASL perfusion with 3D PACE. Single Shot EPI
pulsed arterial spin labeling sequence (Q2TIPS).
imaging volume (e.g. venous blood). enables dynamic angiography—for Tim is the solution that addresses the
Blood which flows into the imaging example, in the lower legs (Figure 4). real needs of today’s clinical MRI
volume during the inversion time has the environment. Tim provides the flexibility
same high signal characteristics exhibited to scan any part of the body without
in conventional TrueFISP. The contrast is Non-contrast MR perfusion studies— interrupting the exam for coil or patient
further enhanced by the suppression of syngo ASL (Arterial Spin Labeling) repositioning. Tim is also the first RF
the background by the inversion pulse. technology optimized for use with
The sequence can be made selective for Siemens has been at the forefront in parallel imaging.
arteries or veins by appropriate other non-contrast techniques beyond
positioning of the inversion pulse, which angiography. Arterial Spin Labeling
can be positioned independently from (ASL) is an MR technique using the Conclusions
the imaging volume. The sequence water in arterial blood as an endogenous
accommodates 3D, 2D, breath-hold, contrast agent to evaluate perfusion Siemens technological innovations
PACE (Prospective Acquisition and non-invasively. ASL provides unique in angiography along with the
CorEction) navigated and respiratory insight into human brain perfusion and implementation of stronger gradients
triggered approaches depending on function physiology by evaluating has pushed imaging times to seconds
clinical environment (Figure 3). cerebral blood flow (CBF). ASL is capable instead of minutes. High resolution
of high spatial resolution perfusion ultrafast ce-MRA techniques from Siemens
syngo NATIVE SPACE— imaging, making the technique very are in routine clinical usage. Improved
Siemens exclusive appealing in the evaluation of stroke, workflow with Siemens unique inline
syngo NATIVE SPACE is based on the tumors, degenerative diseases and processing, subtraction and image
SPACE technique which is a modified epilepsy, but also in basic neuroscience, composing speeds up exam time.
variable flip angle 3D Turbo Spin Echo e.g. for studies of functional CBF changes. Innovative applications like syngo TWIST
sequence in which the contrast Siemens is proud to introduce syngo ASL, and syngo NATIVE provide the user
mechanism for visualizing vessels is based powered by Tim (Total imaging matrix), flexibility of choice of technique to do
on the difference in intravascular signal thereby allowing the use of noncontrast MR angiography in any clinical scenario.
between maximal and minimal flow enhanced perfusion imaging in both the syngo NATIVE enables excellent non-
during the cardiac cycle. The subtracted clinical and research settings. (Figure 5) contrast angiography imaging and is an
image is calculated in-line and with inline excellent alternative for patients in whom
MIP generation, instantaneous clinical contrast material needs to be avoided.
results are produced for completely Tim technology With Tim and inline processing, non-
non-invasive MR angiography, further contrast MRA, head-to-toe is easy and
improving workflow at the scanner. The syngo NATIVE and syngo ASL are demonstrates excellent image quality.
syngo NATIVE SPACE technique can also powered by Tim (Total imaging matrix).
accommodate multi phase imaging that
4
Head to Toe Coverage with
Non-Contrast Techniques
Whole body ce-MRA with Tim syngo NATIVE SPACE syngo NATIVE SPACE
5
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brochure are available through the Siemens Germany
sales organization worldwide. Availability and Telephone: +49 9131 84-0
packaging may vary by country and is subject www.siemens.com/medical
to change without prior notice. Some/all of
the features and products described herein Contact Address USA
may not be available in the United States. Siemens Medical Solutions USA, Inc.
Magnetic Resonance Division
The information in this document contains 51 Valley Stream Parkway
general technical descriptions of specifications Malvern, PA 19355-1406 USA
and options as well as standard and optional Telephone: 1-888-826-9702
features which do not always have to be present
in individual cases.
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