Cardiac MR Sequences - nasci.org MR Sequences... · Cardiac MRI Exam •Axial stack bright-blood...
Transcript of Cardiac MR Sequences - nasci.org MR Sequences... · Cardiac MRI Exam •Axial stack bright-blood...
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Cardiac MR SequencesGreg Kicska, MD / PhD
Thoracic Imaging, University of Washington
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Cardiac MRI Exam• Axial stack bright-blood static
• Vertical long axis single image bright-blood cine
• Short axis stack black-blood static
• Short axis stack bright-blood cine
• 4-chamber single image bright-blood cine
• Aortic valve single image phase contrast cine
• 4-chamber single image perfusion real-time cine
• Short axis stack late gadolinium enhancement static
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Orientation Sequence TimeCoverage
Short axis4-chamber
VLALVOTRHLA
Black bloodBright bloodPhase conPerfusion
LGE
CineStatic
Real Time
StackSingle Img
Sequence Breakdown
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Bright-Blood
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Balanced contrast = T2/T1Spoiled contrast = 1/T1
Bright-BloodSteady-state sequences
Tissue T2 T1 T2/T1 1/T1
Myo 30 800 40 1.25
Blood 250 1200 200 8.3
Fat 60 250 240 4
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Bright-BloodSteady-state sequences
Tissue T2 T1 T2/T1 1/T1
Myo 30 800 40 1.25
Blood 250 1200 200 8.3
Fat 60 250 240 4
Tissue Balanced SpoiledMyo
BloodFat
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Bright-BloodPros•Cine (function) •Real time imaging•High S/N (anatomy adjacent to blood pool)•Turbulent artifact (jets)Cons•No direct T1 or T2 characterization for bSSFP•Artifact prone•High SAR
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Diastole
Systole
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Black-BloodDouble inversion recover spin echo imaging
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Black-BloodDouble inversion recover spin echo imaging
T1-W, T2-W or PD
Tissue T2 T1 T2 1/T1
Myo 30 800 12 20
Blood 250 1200 100 30
Fat 60 250 24 100
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Black-BloodDouble inversion recover spin echo imaging
Tissue T2 T1 T2 1/T1
Myo 30 800 12 20
Blood 250 1200 100 30
Fat 60 250 24 100
Tissue T2-W T1-WMyo
BloodFat
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Black-BloodDouble inversion recover spin echo imaging
Tissue T2-W T1-WMyo
BloodFat
Saturate blood
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Black-BloodDouble inversion recover spin echo imaging
Tissue T2-W T1-WMyo
BloodFat
Saturate bloodSaturate fat
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Pros• T1-W, T2-W or PD• 1 slice per beat possible• Fat saturation• Artifact resistant
Cons•No cine• Slow flow artifact
Black-Blood
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Black-BloodFat saturation - edema / fat differentiation
Fat-Sat
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Black-BloodFat saturation - edema fat differentiation
Fat-Sat
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Black-BloodFat saturation - mass characterization
Fat-Sat
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• Anatomy
• Pericardium
•Mediastinum
•Masses
Late Gd EnhancementT2 Fat-Sat
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Black-BloodAnatomy - Pericardium
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Late Gadolinium Enhancement
• T1-W image
• Acquired 10-15 min post-Gd
•Myocardium is dark
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NORMAL ABNORMAL
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Abnormal myocardium bright
• Fibrosis
• Damaged microvasculature
• Expanded interstitial space
Late Gadolinium Enhancement
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Late Gadolinium Enhancement
Viable
Non-viable
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EdemaBlack Blood T2-W
Damaged MyocardiumLate Gad Enhancement
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Late Gadolinium Enhancement
320 ms 550 ms
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Phase Contrast
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Stoke VolumeForward flowBackward flowRegurgitant fractionPeak Velocity
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•Quantitate flow•Regurgitant fraction•Pressure gradient•Quantitate shunt fraction•Visualize low flow jets
Phase Contrast
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•Aortic regurgitant fraction?•ASD shunt volume?•PA pressure gradient?•Is low flow shunt present?
Phase Contrast
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Cardiac MR Summary
•Orientation and coverage targets anatomy, sequence characterizes tissue, time is for function
• Steady-state shows function and objects in the blood pool
• Black blood characterizes tissue
• LGE is highly sensitive for Gadolinium retained in fibrosis or myocyte damage.
• Phase contrast can quantitate flow.