KNEE IMAGING Eric Lévêque Benoit Hainaux Nathalie Chemla MD Paris V Clinic France COIL Dedicated 8 channels phased array Or flex coil type Closer to B0 center for ID: 556729
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HOW I DO IT ?KNEE IMAGING
Eric Lévêque, Benoit Hainaux,Nathalie Chemla M.D Paris V Clinic, FranceSlide2
COIL
Dedicated 8 channels phased arrayOr flex coil typeCloser to B0 center for a better FAT SATSlide3
PATIENT POSITION
Lying on his backSlightly flexed by an angle of 15°External rotation of the lower limb by an angle of 10/15° Mustn’t
contract
thigh
and move footSlide4
SLICES POSITION
fbSlide5
CRITERIA
OF SUCCESS
fb
pmSlide6
KNEE IMAGING
MRI accurate non invasive techniqueUsed to asses internal derangement of knee2 principals methodsCurrent conventional two dimensonial
(2D) MR
imaging
More
recenntly
,
three
dimensional
(3D)
Isotropic MR (CUBE).Slide7
WHAT IS CUBE?
3D Séquence
FastSpin
écho
Isotropic
Multi-
contrast
( T1, PD, T2, FLAIR )
With
or
without
Fat
SatSlide8
GOAL:
easy to use on knee MRI THREE IMPORTANT CONDITIONS:
Total time < 3
DP
FS
sequences
Same
contrast
as 2D
(
méniscus
, ligaments,
bone
marrow
and cartilages
)
Q
uality
of reformat as good
even
better
than
2D
WHY DO WE USE CUBE?Slide9
MRI OF KNEE
2D MRTime consumingThick sectionsSmall gaps between sectionsPartial volume artifacts
3
planes,sagittal
, axial and coronal
ISOTROPIC 3D MR
Thin
section data acquisition
Without
intersection gap
Imagis
reformatted
in
arbitrary
planes
Helpfull
in
analysis
of
complex
structuresSlide10
2D versus 3D MRI
2D protocolTime 2D three planes= 3mn07 +2mn+2mn + 20s of pré scanning
for
each
séquence
(60s
)
DP FAT SAT
Non
isotropics
pixels.
Multiplanar reformat not possible.Gap between slice is bad for good visualization of cartilage defects.
3D
protocol
Time 3D
cube=6’30 +/- 30s + 20s
of
pré
scanning
(
less
time to
permorf
study of all knee)Isotropic pixelFast Spin EchoMulti contrast T1, T2, DP, T2 FLAIRWith or without
FAt
SATSlide11
CORONAL, SAGITTAL AND AXIAL REFORMATS OBTAINED AFTER 3D CUBE ACQUISITIONSlide12Slide13
CUBE APPLIED TO PATHOLOGY
CARTILAGINOUS DEFECTMENISCAL TEARSACL EXPLORATIONOTHERS….Slide14
14
T2 MAPPINGSlide15
ARTHRO CT
CARTILAGINOUS DEFECT
CUBE AND PATHOLOGYSlide16
3D REFORMAT 0,5 mm
CARTILAGINOUS DEFECT
2DSlide17
2D
2D
3D
3D
MENISCAL TEAR AND CARTILAGINOUS LESIONSlide18
BUCKET HANDLE MENISCAL LESION
3D REFORMAT
Cobra
signSlide19
2D/3DSlide20
ACL : 2
distincts ligamentsAM Ligament
PL
LigamentSlide21
3D CUBE ACQUISITIONSlide22
3D MRI MULTIPLANAR REFORMATSlide23
PARTIAL TEAR OF ACLSlide24
MR ARTHROGRAPHY
SAGITTAL FAT SAT FST1
SAGITTAL FST1Slide25
3D CUBE MRI
First developped to improve cartilage analysis because good contrast betwween joint fluid (hyper T2) and cartilage (intermediar signal) and gap between
slice
in 2D acquisition not
good for good
visualization
of cartilage
defects
.
Than
proved
superiority in analysis of ligaments and meniscusPrincial
hardware: motion
artifactSlide26
CONCLUSION
Favorable tissue contrast of isotropic 3D fast SE in the assessment of ligaments, menisci, and cartilage yields high sensitivity and specificity that seems tu us better with those
yielded
by
conventional
2D fast
SE MR
imaging
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