CARDIAC MRI PLANNING 1
Cardiac Planning
• Basic cardiac views
– Transverse
– Long axis
– Short axis
– Four chamber
• Advanced views
– Outflow tracts
– Great arteries
– Valves Cardiac views
2
Guidelines
– Take your time
– Expiration only
– Use “Plan-Align”
• To avoid in-plane rotation / fold-over in double-oblique scan planes
– Always orthogonal • Change one orientation at the time!
Outline
Basic cardiac views
• Inflow and outflow tracts
• Through the arteries
• Flow through arteries
• Flow through valves
Basic cardiac views
• Long axis
– Vertical
– Horizontal
• Short axis
• Four chamber
(Vertical) Long Axis Long Axis (VLA / RAO):
• Plan on axial, through:
– Apex
– Centre mitral valve
Sagittal oblique
- Left ventricle
- Mitral valve
- Left atrium
(Horizontal) Long Axis
(Semi) Four Chamber (s4CH / HLA):
• Plan on long axis, through:
– Apex
– Centre mitral valve
Transverse oblique
- Septum
- Mitral valve
Short Axis
Short axis (SA, SAX)
• Plan on LA and s4CH
– Parallel Mitral valve, or
– Orthogonal septum, or
– Orthogonal line from apex to Mitral valve
Cor / Tra oblique
- Left ventricle
- Right ventricle
9. Four chamber (4CH)
• Plan on SA and LA, through:
– Center left ventricle
– Corner right ventricle
– Apex left ventricle
- Tricuspid valve
Transverse oblique
- Left + right atrium
- Left + right ventricle
- Mitral valve
Inflow and outflow tracts
• Left two chamber
• Right two chamber
• Left ventricular outflow tract
– “3chamber”, LV-inflow / outflow tract
• Right ventricular outflow tract
Left Two Chamber
Left two chamber (L2CH, VLA)
• Plan on 4CH & SA, through:
– Apex + mitral valve
– Centre LV cavity
– Centre LA cavity
Sagittal oblique
- Left ventricle
- Mitral valve
- Left atrium
Right two chamber (R2CH)
• Plan on 4CH & SA, through:
– Apex + tricuspid valve
– Centre RV cavity
– Centre RA cavity
Sagittal oblique
- Right Ventricle
- Tricuspid valve
- Right Atrium
Left ventricle (inflow / ) outflow tract
Left ventricular outflow tract (LVOT, 3CH)
• Plan on Basal SA and LA, through:
– Apex - Mitral valve
- Aortic valve
- Aorta
Tra / sag oblique
- Left atrium & ventricle
– Centre mitral valve
– Aorta
Left ventricle (inflow / ) outflow tract
Left ventricular outflow tract (LVOT, 3CH)
• Plan on coronal and 4CH, use 3pps:
– Apex
– Centre mitral valve
– Aorta
Tra / sag oblique
- Left atrium & ventricle
- Mitral & Aortic valve
- Aorta
Left ventricle (inflow / ) outflow tract
Left ventricular outflow tract (LVOT-cor)
• Plan on LVOT / 3CH, through:
– Aorta
Coronal oblique
- Left ventricle
- Aortic valve
- Aorta
Right ventricle outflow tract (sagittal)
Right ventricular outflow tract (RVOT, PA)
• Plan on transverse, through:
– Pulmonary artery
– Straight sagittal
Sagittal
- Right ventricle
- Pulmonary valve
- Pulmonary artery
Right ventricle (inflow / ) outflow tract (oblique)
Right ventricular outflow tract (RV-VLA)
• Plan on 4CH and RVOT, use 3pps:
– Pulmonary artery
– Apex right ventricle
– Centre right atrium
Sagittal oblique
- Right atrium + ventricle
- Pulmonary valve
- Pulmonary artery
InterActive
• Real-time scanning
• Update of slice position during scanning
• Easy way of defining all required views
• Possibility to store the geometry settings and apply these settings during the remainder of the examination
• Fast low-res 2D protocol
– +/- 8 - 10 frames per second
• B-TFE for highest SNR and CNR
– If in continuous mode….
Tips & Hints
Keep tilt-line short:
– Position one end of the tilt-line at the end of the anatomy in question (e.g. apex of the heart) to force rotation around a single axis
• Use in-plane transformation to align the patient axes with the magnet axes:
– Align X with AP sagittal or with RL in coronal / axial
– Align Y with FH in sagittal / coronal or with AP in axial
NOTE: InterActive planning disables PlanAlign!!
• Check fold-over direction
– Modify Scan Parameters on the fly if required
• Store geometries AND images
– To verify planning in PlanScan
– To copy geometry using 3pps
