trees

 

 

?   Routine sequences, acquire in all studies (after scout(s) and sense reference scans). For all bSSFP cine imaging, please ensure that the entire cardiac cycle is captured (especially all of diastole)

  1. T1-BB axial (aortic arch to inferior aspect of heart below diaphragm) (TSE)
  1. Horizontal long axis (HLA) (bSSFP cine)
  1. Vertical long axis (VLA) (bSSFP cine)
  1. Short axis (SHAX) stack (cover from apex to mitral valve plane) (bSSFP cine)
  1. 4-chamber stack (bSSFP cine)
  1. Aortic valve flow (Velocity encoded)
  1. Pulmonic valve flow (Velocity encoded)

 

?    Delayed (late gadolinium) enhancement (LGE) protocol:

  1. Inject 0.15 mmol/kg ProHance (gadoteridol). Reduce to 0.1 mmol/kg if CrCl < 60 ml/min/1.73m2). Inject IMMEDIATELY AFTER T1-BB sequence.
  1. Look-locker at 10 mins in mid-ventricular short axis plane
  1. PSIR (phase sensitive IR) in short axis stack, same geometry (slice location) as bSSFP cine and obtain LGE images in diastole
  1. PSIR in 4-chamber stack, same geometry as SSFP cine and obtain LGE images in diastole
  1. PSIR in 2-chamber view (single image) and obtain LGE images in diastole

 

?   T1 Mapping Protocol (for amyloid, HCM, sarcoid, myocarditis, diffuse fibrosis)

  1. Run normal cine sequences
  1. PRE-CONTRAST ? Run MOLLI 3_5 sequence for non-contrast (native) T1 map. Acquire images in short axis plane in 3 slices: basal, mid-ventricular, and apical
  1. Run standard LGE sequence as above
  1. POST-CONTRAST (> 15 mins after injection) ? Run MOLLI 3_T again in same slices as above. Please ensure that pre and post contrast images are acquired in the exact same way/parameters (i.e. FOV, matrix, slice location). Any deviation will not allow us to process the post-contrast images appropriately

 

? Dobutamine viability assessment

  1. After 3 mins. infusion of 5 mcg/kg/min dobutamine, repeat of VLA, 4 chamber, and 3 short axis slices in base, mid-, and apical LV
  1. Increase to 10 mcg/k/min, wait 3 mins., and repeat images as above

 

? Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C)

  1. T1-BB with fat suppression (SPIR) in axial and short axis planes identical to T1-BB w/o SPIR
  1. Reduce 4 chamber cine slice thickness to 5 mm

 

? Myocarditis

  1. Run normal cine sequences
  1. T2 ? BB in short axis plane, with STIR.
  1. Ensure same slice location and geometry as LGE and bSSFP SAX
  1. T1 mapping protocol 
  1. T1 BB immediately post contrast for early gadolinium enhancement (EGE)

 

[Field]  Sarcoidosis

  1. Run normal cine sequences
  1. T2 ? BB in short axis plane, with STIR.
  1. Ensure same slice location and geometry as LGE and bSSFP SAX
  1. T1 mapping protocol 

 

[Field]  Hypertrophic Cardiomyopathy

  1. LVOT plane (bSSFP cine)
  1. Aortic valve short axis (bSSFP cine)
  1. Aortic flow below valve in plane perpendicular to LVOT (Velocity encoded)
  1. 2-3 slices below the valve
  1. Single slice at the level of the valve
  1. 1-2 slices above the valve
  1. T1 mapping protocol

 

? Constrictive Pericarditis

  1. Real time (non-breath hold, non-ECG gated) in SHAX slices at base, mid-, and apex
  1. Real time in 4-chamber plane

 

? Cardiac Mass

  1. T1-BB in axial plane immediately after contrast injection
  1. Resting perfusion (dynamic images during contrast injection of 5 ml) during breath hold

 

? Iron overload

  1. T2-star sequence in mid-ventricular short axis single slice (single breath hold)

 

? Aortic stenosis

  1. LVOT plane (bSSFP cine)
  1. Aortic valve short axis (bSSFP cine)
  1. Aortic flow below valve in plane perpendicular to LVOT (Velocity encoded)
  1. T1 mapping protocol

 

? Aorta

  1. MRA of thoracic aorta
  1. Oblique sagittal view (?candy cane?) view of the thoracic aorta (usually requires 3-4 slices) with cine SSFP sequence

 

? ASD

  1. Short axis cine CMR stack (bSSFP) of the atria (from annular plane to the top of the aortic arch)
  1. Contiguous slices (i.e. no skipping)
  1. Thinner slices (5mm)
  1. 4CH stack (bSSFP), rather than the usual protocol please do contiguous, thinner slices. We want to get views parallel to the septum
  1. Contiguous slices
  1. Thinner slices (5mm)
  1. Velocity Encoding-1?3 contiguous slices positioned parallel to the atrial septal plane to obtain an?en face?view of the defect and with through-plane velocity encoding.
  1. Velocity Encoding-Stack of contiguous thin slices in a 4-chamber plane and/or in an oblique sagittal plane perpendicular to the atrial septum to completely encompass the atrial septum, and with in-plane velocity encoding in the direction of atrial septal defect flow

 

? Additional sequences or planes

Please obtain a T2 map in the short axis mid ventricular slice (same as T1 map) prior to the administration of gadolinium.