“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 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 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 4ch LVOT 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 4ch LVOT 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 4ch LVOT 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