Cardiac MRI: The Basic Sequences

Black Blood Imaging

 ECG-gated spin echo (SE) or fast-spin echo (FSE) (turbo spin echo [TSE])
 ECG-gated db-HASTE (double IR-half-Fourier single-shot turbo-spin echo)

-Uses: To identify extraluminal aortic pathology, intramural hematoma, or dissection

-Cardiac gating: TR = R-R interval for SE or FSE; gating not absolutely needed for
HASTE
-Can be performed breath-hold (fast imaging) or multiple averages non-breath-hold
(NBH)
-To get more slices, one may need to concatenate slices
-HASTE can be used in arrhythmias

Bright Blood Imaging

 Cine gradient echo imaging (GRE)

 FASTCARD
 True fast imaging with steady-state precession (FISP)

-Uses: To determine flow, motion, aortic valvular disease

-Cardiac gating: Choose temporal resolution based on TR and R-R interval
# temporal phases 0.85 x (R-R/TR)
-Can be performed breath-hold (segmented k-space) or 3-4 averages NBH
-Real-time true FISP can be used in arrhythmias
-Retrospectively gated sequences can be used with peripheral pulse gating if
necessary

Velocity-Encoded CINE (Phase Contrast)

 Velocity encoded CINE imaging (Vinnie)

 FASTCARD PC

-Uses: To quantify flow at stenoses to estimate pressure gradient or collateral blood

flow
-Encoding velocity (venc) = 250-500 cm/sec for through plane velocity
-Cardiac gating: Choose temporal resolution based on TR and R-R interval
# temporal phases 0.85 x (R-R/TR)
-Can be performed breath-hold (segmented k-space, view-sharing) or multiple
averages NBH
Modified Bernouilli's equation:
P (mm Hg) 4 vmax2

P (mm Hg) P = pressure gradient across stenosis

vmax = peak velocity at or just distal to stenosis

Regurgitant fraction = reverse flow during diastole / total forward flow

Total blood flow (eg, cardiac output = total flow at ascending aorta) = area under flow-time curve

Gadolinium (Gd)-Enhanced MRA

 3D spoiled GRE (with interpolation)

-Uses: aortography or pulmonary angiography

 -Preferably breath-hold (ungated)
-Single or double dose (0.1-0.2 mmol/kg) Gd-contrast
-Timing based on test dose or fluoroscopic triggering (Care Bolus, Smart Prep etc.)

Cardiac MRI: Advanced Tools

1. Myocardial perfusion: baseline and stress
Dynamic multislice segmented GRE or echo planar imaging (EPI) during bolus
infusion of Gd
Optional adenosine or perfusion stress
2. Myocardial tagging: wall motion and thickening analysis, stress and strain, wall
velocity
Optional dobutamine stress test for wall motion abnormalities
3. Myocardial viability: enhancement on delayed postcontrast images
Inversion recovery spoiled gradient echo for nulling of normal myocardium
4. Coronary MRA (intravascular or extravascular contrast agents)
5. Coronary flow (phase contrast flow quantification)
Optional adenosine for flow reserve measurements
6. Real-time MR fluoroscopy

Cardiac MRI: General Cardiac Function Study

Set-up:

 ECG leads: check tracing before scanning

 torso phased array coil or cardiac coil
 Optional: O2 2 L by nasal cannula (optional): to improve breath-holding abilities

1. ECG-gated FSE or db-HASTE: axial (and optional oblique sagittal) (30 sec-8 min)

 FSE: TR 0.85 x R-R interval, 3-4 signal averages, NBH

Consider 2 acquisitions with concatenated slices (< 2 min each), 10-mm slices

 HASTE: 30-sec acquisition, gated or ungated, breath-holding is optional

2. ECG-gated cine GRE short axis and 2-ch, 4-ch, and LVOT long axis (15 min)

 10-mm-thick short axis to measure EF and examine wall motion

 long axes also to look at wall motion and to survey valves (optional: wall tagging)
 # phases 0.85 x (R-R/TR)
 breath-holding (segmented k-space)

3. Optional: velocity-encoded cine GRE (phase contrast) (3-12 min)

 For measurement of cardiac output by measuring total flow through ascending aorta
 ECG-gated Vinnie/FASTCARD GRE: # phases 0.85 x (R-R/TR)
 venc = 250 cm/sec, breath-holding (segmented k-space) or NBH (3 averages)

Total table time: 30-45 min

Cardiac MRI: Cardiac Viability Study

Set-up:

 ECG leads: check tracing before scanning

 torso phased array coil or cardiac coil
 20-22G IV in arm (contralateral to area of subclavian artery disease, if any suspected)
 0.2 mmol/kg (approximately 20-40 mL Gd-contrast) plus flush (syringe or power
injector)
 Optional: O2 2 L by nasal cannula (optional): to improve breath-holding abilities

1. ECG-gated FSE or db-HASTE: axial (and optional oblique sagittal) (30 sec-8 min)

 FSE: TR 0.85 x R-R interval, 3-4 signal averages, NBH

 HASTE: 30-sec acquisition, gated or ungated, breath-holding is optional

2. ECG-gated cine GRE short axis and 2-ch, 4-ch, and LVOT long axis (15 min)

 10-mm-thick short axis to measure EF and examine wall motion

 long axes also to look at wall motion and to survey valves (optional: wall tagging)

# phases 0.85 x (R-R/TR)

breath-holding (segmented k-space)
3. ECG-gated perfusion

 4-6 short axis turboFLASH during rapid bolus Gd (0.1-0.2 mmol/kg at 2-3 mL/sec)

4. Viability: ECG gated inversion-recovery turboFLASH or true FISP (TI 225-250 ms)

 Slice positions and planes identical to cine GRE (#3)

Total table time: 45 min

Sequence GE Philips Siemens Sequence
SE, MEMP,
Spin Echo SE SE Spin Echo
VEMP
Turbo Spin Echo / Fast Turbo Spin Echo / Fast Spin
FSE TSE TSE
Spin Echo Echo
Single Shot Single Shot
     Technique
SSFSE
TSE
HASTE      Single Shot Technique

FSE/TSE with 90° FSE/TSE with 90°

     Flip-Back Pulse
FRFSE DRIVE RESTORE      Flip-Back Pulse
Gradient Echo GRE FFE GRE Gradient Echo
Coherent Gradient GRASS, Coherent Gradient
     Echo FGR, FMPGR
FFE FISP      Echo
Incoherent Gradient SPGR, Incoherent Gradient
     Echo (RF spoiled) FSPGR
T1 FFE      Echo (RF spoiled)
Incoherent Gradient
Incoherent Gradient
     Echo (Gradient MPGR FLASH      Echo (Gradient spoiled)
spoiled)
Steady State Free SSFP, DE Steady State Free
     Precession FGR
T2 FFE PSIF      Precession
Balanced Sequence / Balanced Balanced Sequence /
     True Fisp
FIESTA
FFE
TrueFISP      True Fisp
True FISP / Dual True FISP / Dual
     Excitation
FIESTA-C CISS      Excitation
Fast GRE,
Ultrafast Gradient Fast SPGR TurboFLAS Ultrafast Gradient Echo
     Echo Sequence (IR/DE
TFE
H
     Sequence
prep)
3-D FGRE,
Ultrafast Gradient Ultrafast Gradient Echo
     Echo 3D
3-D Fast 3D TFE MPRAGE      3D
SPGR
Gradient and Spin Gradient and Spin
     Echo
GRASE TGSE      Echo
IR, MPIR,
Inversion Recovery IR, IR-TSE IR, TIR Inversion Recovery
FastIR

Short T1 Inversion Short T1 Inversion

     Recovery
STIR STIR STIR      Recovery

Long Tau Inversion Turbo Dark Long Tau Inversion

     Recovery
FLAIR FLAIR
Fluid
     Recovery

True Inversion True Inversion

     Recovery
T1 FLAIR Real IR True IR      Recovery

Echo Planar Imaging EPI EPI EPI Echo Planar Imaging