“How I do” a CMR Volume study“How I do” a CMR Volume study

James@moonmail.co.uk

James Moon

For scmr.org

Heart Hospital Imaging centre,

Heart Hospital, London UK

UCL

James Moon

For scmr.org

Heart Hospital Imaging centre,

Heart Hospital, London UK

UCL

Updated version: July 2010

1. Initial pilots – multislice localiser 1. Initial pilots – multislice localiser

Localisers – all acquisitions at end expiration

Sagittal Coronal

Transverse 1 Transverse 2

2a. Transverse Stack for anatomy 2a. Transverse Stack for anatomy This is not necessary for LV volumes, but is important

Black blood (HASTE) or White blood (SSFP) can be used

Black blood

2b. Transverse Stack for anatomy 2b. Transverse Stack for anatomy This is not necessary for LV volumes, but is important

Black blood (HASTE) or White blood (SSFP) can be used

White blood

3. Vertical Long axis (VLA) pilot3. Vertical Long axis (VLA) pilot

Position from the mid ventricular transverse image. Orientate the slice along the long axis of the left ventricle (LV), bisecting the mitral valve and apex – (not necessarily completely parallel to the septum).

VLA pilotTransverse pilot

4. (optional) Horizontal Long axis (HLA) pilot4. (optional) Horizontal Long axis (HLA) pilot

Using the VLA pilot acquired in step 2, position the slice bisecting the mitral valve and apex

HLA pilotVLA pilot

5: Short axis (SA) pilots 5: Short axis (SA) pilots

Using the HLA and VLA pilots (steps 2 & 3), acquire 3 slices, the basal slice parallel to the atrio-ventricular (AV) ring. You have now defined the apex (HLA+VLA), centre of the mitral valve (HLA+ VLA+SA), Left Ventricular Outflow Tract (SA), and RV (SA).

SA pilotsVLA and

HLA pilots

6: Four chamber cine 6: Four chamber cine Now pilot the 4 chamber cine: through the apex, and the maximum lateral dimensions of both ventricles, avoiding the LVOT

4 Chamber cine

2ch

4chLVOT

7: Two chamber cine 7: Two chamber cine

2 Chamber cine

And pilot the 2 chamber cine – through the apex and mid anterior wall/mid inferior wall on the short axis slices – avoiding the LV outflow tract

2ch

4chLVOT

8: LVOT cine8: LVOT cine

LVOT cine

Modify the 4 chamber using the basal SA pilot by twisting the plane until it goes through the aortic valve into the ascending aorta. This is the LVOT view (parasternal long axis or apical 3 chamber by echo)

2ch

4chLVOT

9: LVOT coronal cine (optional) 9: LVOT coronal cine (optional)

LVOT cine (coronal)

A second LVOT view can be piloted perpendicular to the initial LVOT view (LVOT coronal view)

10: Short axis stack 10: Short axis stack

SA stack

Use the end-diastolic frames from the 2 and 4 chamber cines to plan the first slice through the AV groove seen on both views. Then acquire parallel slices; typically 7mm slice thickness with a 3mm gap (or 8+2 or 10+0) until you have covered the entire ventricle.

That’s it!That’s it!

You have now acquired the basic CMR views of Left Ventricle and your basic anatomical views