“How I do” a CMR Volume study

James
James Moon
Moon
For
For scmr.org
scmr.org
Heart
Heart Hospital
Hospital Imaging
Imaging centre,
centre,
Heart
Heart Hospital,
Hospital, London
London UK
UK
UCL
UCL

Updated version: July 2010 James@moonmail.co.uk

 1. Initial pilots – multislice localiser

Localisers – all acquisitions at end expiration

Sagittal Coronal

Transverse 1 Transverse 2
 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
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) 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).

Transverse pilot VLA pilot

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

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

VLA pilot HLA pilot

 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).

VLA and SA pilots

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

4 Chamber cine
 7: Two 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
LVOT
4ch

2 Chamber cine
 8: 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
LVOT
4ch

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

LVOT cine
(coronal)
 10: Short axis 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.

SA stack
 That’s it!

You have now acquired the basic CMR views of Left

Ventricle and your basic anatomical views