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1.5T ExamCard Acute Myocardial Infarct - Pau

ExamCard
Ms. Hermant, Aude Philips Healthcare France
Borocco, Antoine, M.D. Pau, Centre Hospitalier de Pau France

Acute Myocardial Infarct - Pau

MR examination

*Note this ExamCard is not yet available for download

 

This MR protocol can be used to scan a patient with suspicion of acute infarct, or for follow-up.

 

  • Plan the cardiac views using the "Cardiac Scan planning" ExamCard
  • Run a BB T2 in SA (Black Blood dual inversion recovery)
  • Run a BB T2 STIR in SA
  • Perform a cine BTFE in SA for volume quantification of the Left Ventricle, and to assess contractility
  • Run a cine BTFE in LA for Ejection Fraction estimation, and to assess contractility
  • Run perfusion BTFE at rest to see if there's an occlusion or a >80% grade stenosis.
  • Run a Look-Locker sequence 10 minutes after contrast injection to determine the optimal TI (TFE prepulse delay) for the late enhancement sequence.
  • Perform Late enhancement scan in SA

 

If enhancement is found, perform the same scan in LA and/or 4CH view to appreciate the extent of the lesion.

MR images and interpretation

T2 BB SA M2D sequence (7 mm thickness) covering the LV in short axis. An hypersignal on the inferior zone can already be seen.T2 BB STIR SA M2D sequence (7 mm thickness) covering the LV in short axis. It shows hyper intense signal on LV inferior
zone in a more obvious way. Fat
suppression enhances the oedema hyper signal.M2D cine BTFE SA M2D sequence (7mm slice thickness) covering the LV in short axis. It allows to assess the contractility of the LV,
and volume quantification.
T2 BB SA
T2 BB STIR SA
M2D cine BTFE SA
M2D sequence (7 mm thickness) covering the LV in short axis. An hypersignal on the inferior zone can already be seen.
M2D sequence (7 mm thickness) covering the LV in short axis. It shows hyper intense signal on LV inferior zone in a more obvious way. Fat suppression enhances the oedema hyper signal.
M2D sequence (7mm slice thickness) covering the LV in short axis. It allows to assess the contractility of the LV, and volume quantification.
M2D cine BTFE LA M2D sequence (7mm slice thickness). 1 center slice is enough to perform ALEF
estimation.BTFE perfusion MS sequence with a saturation
prepulse, using a T1 enhancing
contrast agent. 3 to 6 slices can be acquired during one RR cycle depending on heart rate of the patient.Late enhancement IR TFE SA 3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold.The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium.
M2D cine BTFE LA
BTFE perfusion
Late enhancement IR TFE SA
M2D sequence (7mm slice thickness). 1 center slice is enough to perform ALEF estimation.
MS sequence with a saturation prepulse, using a T1 enhancing contrast agent. 3 to 6 slices can be acquired during one RR cycle depending on heart rate of the patient.
3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold.The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium.
Late enhancement IR TFE LA 3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold.The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium.Coronary flow territory The color coding shows the supplying coronary artery for each of the 17 segments of the heart.
Late enhancement IR TFE LA
Coronary flow territory
3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold.The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium.
The color coding shows the supplying coronary artery for each of the 17 segments of the heart.

Tips and suggestions

With the T2 weighted sequences (T2 BB with and/or without STIR) a prolonged T2 relaxation time, which is typically observed during the acute phase of a cardiac infarction, is shown as a regional hyperintense signal. Note that this hyperintense signal is not necessarily related to loss of viability. The Cine BTFE in SA must cover the entire LV (6-12 slices depending on the thickness of slices) with a good temporal resolution (to be sure not to miss the ES and ED phases). This scan will be used to quantify cardiac function (EF, EDV, ESV, SV) in post-processing on the ViewForum. An extra cine BTFE in LA (1 - 3 slices with 25-35 phases) is added to get an idea of the LV deformation and to be able to perform an ALEF evaluation of EF and SV.

Contrast agent / injection protocol

For the perfusion scan a contrast dose of 0,1 mmol/kg is injected at 3 to 4 ml/s followed by a saline flush (0,1 mmol/kg at 3 to 4 ml/s).

 

Just after the perfusion sequence, inject a second dose of 0,1 mmol/kg with a low rate (O,5 to 1 ml/s) followed by a saline flush (0,1 mmol/kg at 0,5 to 1 ml/s) and wait at least 10 minutes

before performing the viability (late enhancement) scan.

 

Note: It is important not to inject the entire dose at once during the perfusion scan, as this could lead to saturation of the signal in perfusion scan.

Impact of SENSE imaging

SENSE enables to:

  • make breathhold shorter if the patient is suffering from dyspnea (for cine, T2 BB, T2 BB STIR, late enhancement sequences).
  • obtain a higher resolution and so sharper images if it's possible to make a longer scan ( e.g. when the patient is in good shape (for T2 BB, T2 BB STIR, late enhancement sequences).
  • get more slices during an RR interval for the perfusion sequence so that it's possible to cover the entire LV or to get thinner slices in the zone of interest.


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ExamCard
Achieva 1.5T
Release 1
Nova
Cardiac, Cardiac Morphology, Function Cine, Function Non-Cine
 

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