Transcript Navigator Echos - Respiratory Gating

“How I do” a CMR Volume study
James Moon
For scmr.org
Heart Hospital Imaging centre,
Heart Hospital, London UK
UCL
Updated version: July 2010
[email protected]
1. Initial pilots – multislice localiser
Localisers – all acquisitions at end expiration
Sagittal
Transverse 1
Coronal
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
HLA pilots
SA 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
4 Chamber cine
4ch
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
2 Chamber cine
4ch
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
LVOT cine
4ch
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