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“How I do” a CMR Volume study

“How I do” a CMR Volume study. James Moon For scmr.org Heart Hospital Imaging centre, Heart Hospital, London UK UCL. James@moonmail.co.uk. Updated version: July 2010. Localisers – all acquisitions at end expiration. 1. Initial pilots – multislice localiser. Sagittal. Coronal.

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“How I do” a CMR Volume study

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  1. “How I do” a CMR Volume study James Moon For scmr.org Heart Hospital Imaging centre, Heart Hospital, London UK UCL James@moonmail.co.uk Updated version: July 2010

  2. Localisers – all acquisitions at end expiration 1. Initial pilots – multislice localiser Sagittal Coronal Transverse 1 Transverse 2

  3. This is not necessary for LV volumes, but is important Black blood (HASTE) or White blood (SSFP) can be used 2a. Transverse Stack for anatomy Black blood

  4. This is not necessary for LV volumes, but is important Black blood (HASTE) or White blood (SSFP) can be used 2b. Transverse Stack for anatomy White blood

  5. 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). 3. Vertical Long axis (VLA) pilot VLA pilot Transverse pilot

  6. Using the VLA pilot acquired in step 2, position the slice bisecting the mitral valve and apex 4. (optional) Horizontal Long axis (HLA) pilot HLA pilot VLA pilot

  7. 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). 5: Short axis (SA) pilots SA pilots VLA and HLA pilots

  8. Now pilot the 4 chamber cine: through the apex, and the maximum lateral dimensions of both ventricles, avoiding the LVOT 6: Four chamber cine 2ch LVOT 4ch 4 Chamber cine

  9. 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 7: Two chamber cine 2ch LVOT 4ch 2 Chamber cine

  10. 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) 8: LVOT cine 2ch LVOT 4ch LVOT cine

  11. A second LVOT view can be piloted perpendicular to the initial LVOT view (LVOT coronal view) 9: LVOT coronal cine (optional) LVOT cine (coronal)

  12. 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. 10: Short axis stack SA stack

  13. That’s it! You have now acquired the basic CMR views of Left Ventricle and your basic anatomical views

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