Cardiac MR Technique

Question 1

Anatomical challenges in cardiac MRI ?

Answer 1

Cardiac motion
Orientation 
Respiration
Flow in the cavity
Small and tortuous vessels
Large size of the the thoracic cavity

Question 2

Technical challenges ?

Answer 2

• high magnetic fields (1.5T/3T)
• high gradient fields
• multichannel surface coils

Question 3

Examination requirements for cardiac imaging ?

Answer 3

• perfect cardiac synchronisation

- dedicated anatomical planes

Question 4

Types of cardiac synchronisation ?

Answer 4

Prospective Triggering - con: missing information during cardiac cycle
Retrospective Triggering

Question 5

Problems with cardiac synchronisation ?

Answer 5

Known reversible effect of static magnetic field on ECG: T-wave elevation
can lead to misreading

Question 6

Cardiac MRI sequences

Basic types ?

Answer 6

Black (dark) blood images: SE/TSE sequences (T1w/STIR)

Bright blood images: SSFP/Cine, perfusion, LGE, PCI

Question 7

cardiac MRI — evaluation of cardiac masses ?

Answer 7

cine-SSFP (standard views and finding dependant views)
T1w and T2w black blood sequences
fat saturated (FS) sequences e.g. STIR
first pass perfusion
late gadolinium enhancement (early) to exclude thrombi
T1w 3D after contrast

Question 8

cardiac MRI — stress protocol ?

Answer 8

cine-SSFP (2ch, 3ch, 4ch, SA)
first pass perfusion under stress (e.g. adenosine) and at rest
LGE (late gadolinium enhancement — 2ch, 3ch, 4ch, SA)

Question 9

cardiac MRI — basic protocol in congenital heart disease ?

Answer 9

Anatomical stacks
Cine-SSFP (2ch, 4ch, LV+RV stacks, atrial stack, LVOT, RVOT)
PCI (PAFlow, AoFlow, ASD/VSD-Flow)
additional sequences: AoV, PAV, MRA, 3D-whole heart

Question 10

Cardiac devices - risks ?

Answer 10

Bo-Field:
- Reed switch activation
- change of node synchronous / asynchronous
Gradients:
- interference with sensing

Question 11

Advantages of T2-mapping ?

Answer 11

• more reproducible
• more signal
• quantitative values
• more robust in respect to metal implants, high field strength