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MRI of RV Dysplasia - Tips and Clinical Imaging Protocol

ExamCard
Muthupillai, Raja, Ph.D. Philips Healthcare

MRI of RV Dysplasia - SLEH, Houston: Dr. Flamm's Protocol

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ARVD Protocol Overview:

  1. Get Scouts
  2. Run Reference Scan
  3. Get a set of good axial scouts
  4. Plan for RVOT (black blood dual inversion recovery)
  5. Plan for a set of axial slices to cover from the base of RV to the infundibulum
  6. Repeat RVOT view wtih cine bFFE
  7. Repeat oblique axial slices with cine bFFE

 

Go to Tips and Suggestions section for an extended RV dysplasia study.

Step 1: Planning for RV Outflow Tract view

Planning for the RVOT view Get a good RVOT view that visualizes the RV outflow tract well.  Ensure that the slice position in the cranio-caudal direction is such that the resulting image appears in the middle of the viewing port.
Planning for the RVOT view
Get a good RVOT view that visualizes the RV outflow tract well. Ensure that the slice position in the cranio-caudal direction is such that the resulting image appears in the middle of the viewing port.

Step 2: Plan your oblique axial images

Set of oblique axial slices Plan a set of oblique axial slices that cut the RV free wall perpendicularly.  To aid in planning, on the scanner console, draw a line as shown.  Then plan a series of slices that cover the entire RV from the base of the RV all the way to the infundibulum as shown.  This geometry information will be inherited by the stack of cine images.
Set of oblique axial slices
Plan a set of oblique axial slices that cut the RV free wall perpendicularly. To aid in planning, on the scanner console, draw a line as shown. Then plan a series of slices that cover the entire RV from the base of the RV all the way to the infundibulum as shown. This geometry information will be inherited by the stack of cine images.

Step 3: Repeat RVOT and oblique axials using balanced FFE cine imaging

Tips and Suggestions

  1. ARVD studies are perhaps one of the more complicated clinical exams to perform and interpret.  Therefore, good images would be of tremendous help for the clinician.  These patients tend to be arrhythmogenic, and therefore, the scan times could easily exceed the duration of the breath-hold.  Often, it may be necessary to optimize the protocol to reduce the acquisition time.  The preferred algorithm to reduce scan time, in the order of preference are: (a) increase TE and TSE factor (upto 90-95 msec), (b) increase SENSE factor, and (c) decrease spatial resolution.
  2. In BB imaging, you can use saturation pulses to minimize artifacts arising from patient breathing on the chest wall (if this is a problem).
  3. If you find or suspect fatty infiltration, confirm the suspicion by getting fat suppressed black blood imaging to the corresponding slices.
  4. Triggering: Pay close attention to when the imaging data is collected during the cardiac cycle.  If it falls consistently during an arrhythmic period, then manually adjust the trigger delay so that data acquisition occurs during the quiescent period of the cardiac cycle. 


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ExamCard
Achieva 1.5T
Release 1
Aorta, Cardiac, Cardiac Morphology, Coronary arteries, Function Cine, Function Non-Cine, Pediatric
 

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