ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Combined Educational & Scientific Session: Proving Where MRI has Value

Skill Level: Basic to Advanced

Organizer: Garry E. Gold, M.D. & James G. Pipe, Ph.D.

Monday 09 May 2016

The healthcare environment is changing. For MRI to continue to thrive, the ISMRM needs to take a leadership role in ensuring that MRI give high value in clinical medicine. This includes identifying where MRI gives the greatest clinical impact, enabling researchers to formulate impactful methods and take them towards product, and enabling members to demonstrate costs and benefits in different situations.

Target Audience
All attendees interested in MR Value and health care economics, including members wanting to target high-value MR exams and researchers interested in the processes and outcomes necessary to have real clinical impact.

Educational Objectives
Upon completion of this course, participants should be able to:

  • Understand the needs of the Radiologist, and ways in which it would be helpful to evolve the information provided by MRI;
  • Understand the process for identifying research areas of potential impact, and the processes to take these into a product; and
  • Learn about various ways that MR Value is being introduced into the field.

Moderators: Daniel Sodickson, Garry Gold
What Makes for a Clinically Useful MR Exam?
Scott Reeder1
1University of Wisconsin, Madison, WI, United States
Development, validation, and translation of advanced new imaging methods is an exciting and important area of scientific development and clinical medicine. The development of standardized approaches and objective measures of new imaging technologies such as SNR and CNR, and subjective ordinal metrics are extremely helpful particularly in the early stages of technical development and translation. Subsequent studies comparing new imaging techniques with accepted reference standards, is the next step to establish the diagnostic performance of a technique for the detection and staging of disease.  Ultimately, clinical effectiveness and patient outcomes are the most important metric of the impact of new technologies.  Finally, there are many practical barriers that should be considered, including work flow, post-processing, that are needed to garner acceptance by technologists, radiologists, and referring physicians.

From k-Space to Pasteur’s Quadrant: Your Research Can Make the World a Better Place
Richard L Ehman1
1Radiology, Mayo Clinic, Rochester, MN, United States
The ISMRM has launched the “MR Value Initiative”, to encourage innovative optimization the value of MR-based diagnostic technologies.  Both the numerator (clinical benefit) and the denominator (cost) of the value ratio can be targeted by scientific and technical innovation.  Studies have shown that investigators in medical imaging generate innovations at a high rate, and that these inventions can often be readily translated, with extraordinary impact on patient care.  This presentation focuses on identifying time-tested strategies that aspiring innovators can use to improve the chances that their work will have an impact and perhaps make the world a better place.

Panel Discussion
Reperfusion beyond 6 hours impacts Tissue Fate of Moderate Ischemia
Hongyu An1, Andria L Ford2, Cihat Eldeniz1, Yasheng Chen2, Katie D Vo3, Hongtu Zhu4, William J Powers5, Weili Lin6, and Jin-Moo Lee2
1Washington University in St. Louis, St. Louis, MO, United States, 2Neurology, Washington University in St. Louis, St. Louis, MO, United States, 3Radiology, Washington University in St. Louis, St. Louis, MO, United States, 4Biostatistics, University of North Carolina At Chapel Hill, Chapel Hill, NC, United States, 5Neurology, University of North Carolina At Chapel Hill, Chapel Hill, NC, United States, 6Radiology, University of North Carolina At Chapel Hill, Chapel Hill, NC, United States
The fate of mild to moderate ischemic tissue is greatly impacted by both hyperacute (3-6 hr)  and acute (6-24hr) perfusion changes. Thus, such regions could be targeted for intervention beyond current treatment windows. 

Cost Effectiveness of MRI Before Prostate Biopsy
Shivani Pahwa1, Nicholas Schiltz2, Lee Ponsky3, Ziang Lu1, Sara Dastmalchian1, Robert Abouassaly3, Mark Griswold4, and Vikas Gulani5
1Radiology, Case Western Reserve University, Cleveland, OH, United States, 2Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, United States, 3Urology, Case Western Reserve University, Cleveland, OH, United States, 4Radiology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States, 5Radiology, University Hospitals Case Medical Center, Cleveland, OH, United States
The perception that MRI inflates health care costs impedes its incorporation into prostate cancer treatment algorithms, despite robust evidence of its accuracy. We evaluated the cost effectiveness of 13 different strategies using a decision tree model in which MRI is performed before non-targeted, transrectal ultrasound guided prostate (TRUS) biopsy. Our results show that MRI is cost effective in each of these strategies, and also adds incremental quality adjusted life years (QALY) to the patient over and above the standard practice of performing non-targeted TRUS biopsy. 

Progress towards Robust Spiral MRI for Rapid Brain Exams
James Grant Pipe1, Ashley Gould Anderson1, Akshay Bakhru2, Zhiqiang Li1, Suthambhara Nagaraj2, Melvyn B Ooi3, Ryan K Robison1, Dinghui Wang1, and Nicholas R Zwart1
1Imaging Research, Barrow Neurological Institute, Phoenix, AZ, United States, 2MRI, Philips Healthcare, Bangalore, India, 3MRI, Philips Healthcare, Phoenix, AZ, United States
This work gives an overview of an effort to build the infrastructure for rapid, robust clinical Spiral MRI of the brain.  The current goal is to achieve comparable or better Image quality than conventional scans with reduced overall scan time.  A long-term (future) goal is to achieve a comprehensive high-quality brain MR exam in 5 minutes.

The value of MRI in Traumatic Brain Injury: experiences in the Collaborative European NeuroTrauma Effectiveness Research in TBI study
Pim Pullens1, Andrew IR Maas2, David Menon3, Wim van Hecke4, Jan Verheyden4, Lene Claes4, Paul M Parizel1, and On behalf of CENTER-TBI participants and investigators5
1Radiology, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium, 2Neurosurgery, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium, 3Anaesthesia, University of Cambridge, Cambridge, United Kingdom, 4icometrix NV, Leuven, Belgium, 5University Hospital Antwerp, Antwerp, Belgium
Traumatic Brain Injury (TBI) is regarded as “the most complex disease in our most complex organ”. Clinical outcome is unpredictable, especially in repetitive mild TBI, in terms of behavior, cognition, emotion and associated long-term effects such as dementia. The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study is a pan-European prospective longitudinal observational study aiming to improve care for TBI patients. One of the key goals is to improve the quality of imaging-derived data by the application of a clinical standardized MR imaging protocol including structural, SWI, DTI and rs-fMRI, across up to 25 clinical sites in a large, heterogeneous sample of TBI patients. Harmonization of these protocols has been a challenging task. As data collection is underway, 265 datasets have been inspected for quality. Data quality is variable across sites and scanners. In order for such large-scale observational studies to be really effective, sequence harmonization and standardization is of key importance, but lacking at the moment.

Capturing clinical MRI complexity: a first step towards realizing the maximum research value of neuroradiological MRI.
Marzena Wylezinska-Arridge1, Mark J White1,2, Indran Davagnanam1, M Jorge Cardoso3, Sjoerd B Vos3,4, Sebastien Ourselin3, Olga Ciccarelli5, Tarek Yousry1, and John Thornton1,2
1Neuroradiological Academic Unit, UCL Institute of Neurology, University College London, London, United Kingdom, 2Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom, 3Translation Imaging Group, Centre for Medical Imaging Computing, University College London, London, United Kingdom, 4MRI Unit, Epilepsy Society, Chalfont, St Peters, United Kingdom,5Institute of Neurology, University College London, London, United Kingdom
The huge number of hospital MRI examinations routinely obtained for clinical purposes offers a potentially valuable “big data” resource for largescale experimental neurology. However, acquisition-scheme variation may compromise the research value of clinical imaging data. A first step towards reducing variation by prospective protocol harmonization is to systematically capture sequence-use statistics. Using an in-house tool developed to automate capture of long-term, MRI sequence deployment statistics in routine practice within our neuroradiological service, we identified “core“, most used sequences and the deployment frequency of their respective variants, to enable efficient, targeted protocol harmonization.

Adjournment & Meet the Teachers

The International Society for Magnetic Resonance in Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.