SMR meeting lands on European shores as a forum for new MRI applications

Low-field magnets lead search for market segments

Next week's joint meeting of the Society of Magnetic Resonanceand the European Society for Magnetic Resonance in Medicine andBiology takes place as MRI vendors search for ways to translatethe long-term potential of the European market into tangible purchasingactivity. Vendors hope to use the meeting in Nice, France, todisplay the latest clinical results that could form the foundationfor new MRI applications and possibly increased purchasing.

With the exception of pricing pressures, Europe has avoidedmuch of the turmoil that has rocked the U.S. market for the pasttwo years. The region is a promising long-term market, due tothe lower penetration rate of MRI compared to the U.S. Accordingto Siemens estimates, there is an average of 4.5 MRI scannersper million residents in Western Europe, compared to an averageof 18.5 scanners per million residents in the U.S. The numbersare even more attractive in Eastern Europe.

Vendors are pursuing several strategies to spur acquisition.One is the development of new applications and market segmentsusing low-field magnets.

One of the most prominent new magnets in this field is theSiemens Magnetom Open scanner (SCAN 11/17/93), of which Siemenshas sold about 40 in Europe. Siemens emphasizes that Open is appropriateas a whole-body scanner for routine practice, but acknowledgesthat low-field MRI requires more clinical proof before it canbe fully accepted by the radiological community for mainstreamapplications.

"Our current focus is more related to establishing Openas a neurological and whole-body scanner, and neuro is still thebread-and-butter area. That is where low-field MRI still requiressome level of acceptance," said Hermann Requardt, generalmanager of the Erlangen company's MR division. "On the otherhand, it is ideally suited to be the platform for a niche marketthat is just evolving."

The magnet has garnered much attention for its potential asan interventional unit. For example, Siemens has placed an Openin a surgery suite, where it works in conjunction with a ViewingWand image-guided surgery workstation made by ISG Technologies.Open is used to update 3-D data sets that are sent to ViewingWand during brain surgery, according to Requardt.

At the SMR conference, Siemens will display work being doneby Dr. Dietrich Grönemeyer at Mühlheim RadiologicalInstitute. Grönemeyer is using an Open to guide interventionalprocedures intended to relieve back pain.

Picker International of Cleveland has begun selling its open-styleOutlook magnet in Europe, with the first two sites at the Universityof Helsinki and Turku University in Finland, according to LindaEastwood, marketing manager at Picker's NMR division. The systemis being sold through Nordstar, a joint venture between Pickerand Instrumentarium of Finland (SCAN 11/23/94).

Like Siemens, Picker is marketing Outlook as a whole-body scannerappropriate for claustrophobic patients. Interventional researchwith Outlook is still in early stages, Eastwood said, but Pickerwill display some work done with the scanner.

"We are marketing the system as a general-purpose scanner,with applications like claustrophobic patients, like pediatrics,like musculoskeletal," Eastwood said. "That is an areathat's seen real interest in Europe, just as it has in the U.S."

Picker will also show interventional work done with the 1.5-teslaEdge, as well as single-shot echo-planar imaging with Edge andmulti-shot EPI on the 0.5-tesla Asset.

Esaote of Genoa, Italy, has carved out a niche in orthopedicimaging for its Artoscan system, which it began selling in Europein December 1993 (SCAN 10/7/92). The company sold 40 units inEurope in 1994 and expects to sell 60 this year, slightly aheadof the company's plan, according to Fabrizio Landi, executivevice president.

The company has concentrated on supporting clinical studiesthat prove the diagnostic utility of low-field MRI for imagingjoints, Landi said. While high-field systems have obvious advantagesfor brain and spine imaging, low-field magnets are just as goodfor joint studies because their sequences can be optimized forimaging the types of tissues found in joints. One such study isunder way at the University of Munich, and clinical results willbe presented at the SMR meeting.

A number of challenges face low-field MRI in Europe, however.Europe traditionally has not been an active low-field market,and several companies report a shift toward high-field purchasingthis year, spurred by luminary university sites that are replacingolder 1.5-tesla magnets with newer systems.

Unlike other manufacturers, Philips has avoided jumping onthe low-field bandwagon. The Dutch company continues to emphasizehigh-field systems, which it believes are uniquely capable ofthe advanced applications it is developing in the cardiac andinterventional segments. The company's Gyroscan NT is sufficientlyopen to conduct many interventional MRI procedures, accordingto Han Van Driel, marketing and clinical science manager.

Researchers at the University of Aachen in Germany are usinga 1.5-tesla Gyroscan NT in conjunction with a mobile C-arm toexplore interventional MRI (SCAN 4/26/95). In addition, Philipsis working with the University of Leiden in the Netherlands, whereclinicians are using EPI techniques to study cardiac function.

Philips points out that it has been delivering real-time imagingas a product on its systems since last year. The technique iscapable of acquiring five images per second in a 256 x 256 matrixand of displaying those images as quickly as they are acquiredwith no significant delay time.

"Our approach is to explore interventional procedureswith a high-field system that is real time, high resolution, highquality," Van Driel said. "We don't believe in the low-fieldsystems of today for interventional applications that are of amore complex nature."