CAC CHUI XUNG C BAN CUA CNG HNG T

BS. Bi Quang Huynh BS. Pham Hu Khuyn

Cc thng s
TR Chui xung T1 Chui xung T2 Chui xung protons 300-600 ms > 3500 ms > 3500 ms TE < 30 ms > 50 ms < 30 ms

Nu TE tng, thng tin v tng phn trn T2 tng. Nu TR gim, cc xung ng 90 gn v hiu ng T1 tr nn ti a.

CHUI XUNG SPIN ECHO

TE 90 ms

T2

20 ms

T1
500 ms

Pd TR

2500 ms

Chui xung Spin Echo

Chui xung

Spin Echo (SE) Gradient Echo (EG) Inversion/ recovery (IR) FSE hay turbo SE SSFSE hay HASTE

Thng s c bn

TR (Temps de rptition)
Thi gian lp lai ca mt sng in t (RF), nh hng trc tip ti T1 TR cng di th tnh T1 gim

TE (Temps dcho)
Thi gian thu c tn hiu sau khi pht xung ng in t, nh hng n T2 TE cng di th tnh T2 tng

Gi tr v thi gian th dui khc nhau ca cc m

T R (ms)
T E (ms) 0,5 Tesla 1,5 Tesla 870 865 3000 490 650 780 260 920 785 47 57 200

C
C tim DNT Gan Thn Lch M Cht xm Cht trng

550 580 2000 325 495 545 215 655 540

43
58 62 84 101 92

Spin Echo

T1
TR = 200-400 ms TE ti thiu 20 ms Chui xung ny ngy cng c thay th bi GE

SE:

T2
TR = 2000 ms TE = 40-60/80-120 ms Chui xung ny ngy cng c thay th bi FSE v Turbo SE

SE:

Spin echo
Chui xung c bn ++ Cht lng hnh nh tt t nhy vi tnh khng ng nht ca t trng Thi gian thm khm di

SE
Chui xung Spin echo nhanh (Turbo SE, Fast SE
Cc chui xung nhanh cho php rt ngn ng k thi gian thm khm nhng ng thi vn cho hnh nh T2 vi cht lng tt

Spin Echo
ESR hay RASE: Echo de spin rapide hay Rapid Spin Echo Lase: Low angle spin echo

FSE (GE) hay Turbo Spin Echo (Siemens, Philips)

TR 250

TR 500

TR 1000

TR 2000

TE 25

TE 60

TE 80

Gradient echo

TR: ngn TE: ngn PA

Gc p Gc p nh = gi ko di TR Cho php b lai TR rt ngn

GE

Chui xung gradient echo (FLASH, SPGR) Chui xung nhanh Nhy cm vi tnh khng ng nht ca t trng Pht hin cc sn phm do qu trnh phn hu Hb

Gradient echo

T1

GRE TR = 120, TE = 4 ms, PA = 90

T2
GRE TR = 200, TE = 20 ms, PA = 20 t gi tr tr trng hp mun nh gi s c mt ca st hoc cc cht cn t

TR 25

TR 50

TR 100

TR 200

PA 15

TE = 5 ms

PA 45

PA 90

IR (Inversion-rcupration)

TR TE TI (Temps dinversion)
TI=0,69xT1 ca t chc IR T1 vi TI di ( TI=450 ms/0,5 Tesla) IR T2: FLAIR v STIR TI ngn( TI= 110 ms /0,5Tesla)

IR
STIR Turbo STIR Short T1 Inversion/Recovery Turbo Short T1 Inversion/Recovery Xa m bng vic s dng I/R. Cng tng t chui xung s dng Turbo spin echo

FLAIR Dark Fluid (Siemens) IR thc s

Fluid Attenuated Inversion/Recovery

Xa tn hiu ca dch bng I/R, xung c tnh T2

True Inversion/Recovery

c gi tr tuyt i ca t trng ha

La chn xung
Chui xung T1 SE u im - Cht lng n nh - Thi gian ngn - Gii phu - T l SNR tt - Nhanh Nhc im - Tng phn gia cc cu trc ngoi xng km - Sn chm ( nhay) - SNR thp - phn gii khng gian thp - Nhiu nh - FATSAT - Sau plastie ACL - Chn thng sm - Thi gian di - SNR thp - Tng phn km M v dch c tn hiu tng ng Qu nhay vi tng tn hiu ca sn chm Mt khc lai km nhay do ph v m cng tn hiu Nhay cm vi artefact Xa m khng ng nht Tim thuc vo trong khp - Ch nh trong trng hp c vt th kim loai t dng nu khng FATSAT B sung trong trng hp bong bao sn chm Tt nht trong thc t Ch nh Lun c thc hin

GE

SE + Gado

- Nhanh - Khng c nhiu nh - S ngm thuc ca cc cu trc giu mach v vim nht l + FATSAT - t nhiu nh

T2

SE

FSE GE

Nhanh Nhay trong tm kim dch

Pd

FSE FATSAT T1, T2

Thi gian ngn SNR tt Tng phn tuyt vi Tn thng sn chm Vt th la Tn thng sn vin

Arthro IRM

ang nghin cu

Hnh nh T1
SE EG IR

Hnh nh T2
- SE - EG - Drive/CISS

Cc xung bn cht T2

Rho: T2 cho th nht (SE) IR

FLAIR STIR

Cc cu trc tng tn hiu trn T1

M v tu xng Tuyn yn thn kinh Mu giai oan MetHb Gadolinium Mt s dng chy Mt s kim loai: Mangan Cc cu trc dch giu : protides, lipides, lipiodol Mt s vi ho Mlanine

Cc cu trc gim tn hiu trn T1

Kh V xng Gn v dy chng Gadolinium Mt s dng chy Mt s kim loai Hmosidrine Mt s vi ho Phn ln tn thng

Tng tn hiu T2

Bt thng phn b nc
Mu t bn cp

Gim tn hiu T2
Mi trng ngho Proton, vi ho, x Cc cht cn t Dch giu Protein Dng chy nhanh

SSFSE / Haste = Hydro-IRM

TR di : single-shot (SSFSE) TE di (900-1000 ms)

Tn hiu yu T chc c t tn hiu Cc lp ct dy

TE ngn (100 ms)

Tn hiu thu c manh hn Quan st r t chc c Cc lp ct mng

Ap dng
Dch: DNT, nc tiu, mt ... Mylo-IRM: phn tch cc r thn kinh, kch thc ng tu Uro-IRM: cc tc nghn, suy thn Cholangio-IRM Wirsungo-IRM

Cholangio-IRM

SSFSE TE di

SSFSE TE ngn (si mt)

Cc chui xung chp mach ARM

ARM vi thi gian bay (TOF) - 2D ( bnh l tnh mach++) - 3D ( Willis++) +/- gado ARM vi tng phn v phase (PC) - 2D - 3D ARM vi tim Gadolinium

TOF = time of flight

Nguyn l Hin tng xm nhp lp ct v bt tn hiu ngc chiu: tng tn hiu Chui xung EG vi TR rt ngn / T1 ca t chc Gc p ln Xung ng RF rt gn nhau M tnh: trit tiu thnh phn th dui dc Cu trc chuyn ng: khng b bo ho

PC = Phase contrast

Nguyn l
Chui xung EG vi cc chnh t h tr p dng chnh t lng cc Lin quan ti s lch phase ca cc Proton chuyn ng Trit tiu cc m tnh v cc m c T1 ngn

PC

K thut
La chn tc : ng mach hay tnh mach Nu V chn>> V thc t : aliasing Nu V chn<< V thc t: tn hiu yu C kh nng phn tch huyt ng hc

3D PC

3D TOF

ARM c Gado

Nguyn l Chui xung EG Tng tn hiu lng mach do gim nhn tao v tam thi T1 ca mu lu thng c lp vi hin tng nhm nhp lp ct v lch phase Ch c s hin din ca Gado

ARM c Gado

u im
3D Vng thm khm rng phn gii cao Thi gian thm khm ngn t b nh hng bi dng chy ri Thm khm tt dng chy nhanh cng nh chm t b o ln bi cc cht tng tn hiu t nhin trn T1 C kh nng nn th Suy thn hoc d ng vi iode

ARM c Gado
K thut

Mt phng coronal
Test

Liu dng : 0,4 ml/kg

Cc chui xung xo m

STIR: xo m trn T2
FATSAT : xo m chn lc T1, Pd, T2 In phase/ out of phase: T1

In

Out

Nam 43T

Sub

Out

Sub

Nam 50T x gan do vim gan B mn tnh

In

Sub

Nam 55T x gan do vim gan B mn tnh

In Gado

In Gado

Nam 50T x gan v HCC nt mch 3 thng trc

Out Gado

In

Out

N 43T

Sub

In Gado

Out Gado

Nam 38T X gan tin trin

Nam 62t, vim gan B man tnh

N 36T, u tuy

c tao bi cc chuyn ng ca nc Nguyn l: gim tn hiu ca nhng g chuyn ng bng ng dng chnh t trn chui xung SE T2 2 chui xung vi 2 gi tr khc nhau b (b=0, b=1000 s/mm)

Diffusion

Dch no ty gim tn hiu (rt chuyn ng, rt gim) M no bnh thng ng tn hiu Nhu m thiu mu: tng tn hiu (chuyn ng ngoi t bo gim do ph ng c TB trong t bo (ngng bm Na/K)*

Bt thng trn Diffusion: ngha ?

Tng tn hiu ca vng thiu mu: ADC gim t 20 - 60%* Gim c th pht hin c t pht 39 Vng tn thng khng hi phc** Ngoai vi tn thng: gi tr ADC bnh thng hoc di bnh thng***

Diffusion

Gim tn hiu cng nhiu khi chuyn ng ca cc phn t cng ln Trn l thuyt: Tng tn hiu=>khuch tn ca phn t gim (Proton tnh) Gim tn hiu =>khuch tn ca phn t tng (Proton chuyn ng)

Diffusion

Yu t b hay h s khuch ai, ph thuc chnh t b cng ph thuc vo: S phn b ca nc trong cc khoang: trong t bo, ngoi t bo, t do(DNT) c tnh ca mi trng: m t bo, m protein S lng nc

Diffusion

b cng cao , hiu ng T2 cng yu v hiu ng Diffusion tng b s dng trong thc t : 300-1000 s/mm2

ADC (Apparent Diffusion Coefficient), c c trng bi mc chuyn ng ca nc (mm2/s)

T2 (b=0 s/mm2)

Diffusion (b=1000)

ADC

p dng lm sng

Thiu mu ng mach hoai t (dang nang) v abcs

Nang

di nhn v nang thng b

Mc ch ca IRM giai on sm

Chn on AVC: Diffusion

AVCI

Thiu mu

Thiu mu cp tnh

ADC

AVC thiu mu bn cp Tng tn hiu trn Diffusion (b=1000) ADC gim

AVC thiu mu mn tnh

AVC thiu mu
Diffusion b=1000 ADC

Giai oan cp
Bn cp Man tnh

Tng tn hiu
ng/tng th Gim tn hiu

Bnh thng

Nghi AVC
T2, FLAIR bt Tng tn hiu Diffusion Tng tn hiu T2 v Diffusion

Tnh ADC +++

Thiu mu cp

ADC thp

ADC cao

Thiu mu

TT khc: U+++

GLIOBLASTOME HAY ABCES ?

Glioblastome hay abcs?

Nang di nhn
Diffusion (b= 1000) ADC

Nang thng b
Diffusion (b= 1000) ADC

Diffusion-Weighted Imaging

T1W

STIR

DWI

Diffusion-Weighted Imaging
N 65T: CT, K v DW gim, ADC tng Xp do chn thng

T1W

T2W

DWI

ADC

Diffusion-Weighted Imaging
Nam 57T, di cn t sng Carcinome TLT v chn thng

T2W

DWI

ADC

Tn hiu t mu
Rt phc tap
Ph thuc: - Thi gian t lc chy mu

- Kch thc khi mu t

- manh ca trng t - Chui xung s dng (EG+++)

Giai on rt cp( vi gi u)
OxyHb ( gim tn hiu T1, tng tn hiu T2)

T1

T2

Giai on ti cp (hyperaigue)

Deoxygene sm

11h

Giai on cp( sau vi gi - vi ngy u)

DsoxyHb ( gim/ng tn hiu T1, gim tn hiu T2)

<24h

Giai on bn cp
MetHb trong t bo (T1 tng, T2 gim)
T1 T2

Bn cp (sau vi ngy n vi tun u)

MetHb ngoi t bo( tng tn hiu c trn T1 ln T2)
T1 T2

Giai on mn
Hmosidrine- Fritine

T1

T2

+C

T1

3 weeks

Pd

T2