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Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease.

Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ - J Cardiovasc Magn Reson (2013)

Bottom Line: The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols.Variations in practice are highlighted and expert consensus recommendations are provided.Indications and appropriate use criteria for CMR examination are not specifically addressed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany. fratz@dhm.mhn.de

ABSTRACT
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.

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Schematic diagram illustrating data acquisition timing in a late gadolinium enhancement sequence. Each rectangle represents data acquisition timed to coincide with the cardiac rest period and during which a user-defined number of k-space lines are filled. Multiple data acquisitions and thus cardiac cycles are required to fill k-space and produce an image. At a heart rate of 80 bpm (A), data acquisition occurs every second cardiac cycle in order to allow sufficient time for recovery of longitudinal signal. At a heart rate of 120 bpm (B), the cardiac cycle length is shorter so the sequence is modified to acquire data every third cycle in order to maintain the same time for the recovery of longitudinal signal. In addition, the data acquisition duration is shortened to compensate for the briefer cardiac rest period associated with a faster heart rate.
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Figure 16: Schematic diagram illustrating data acquisition timing in a late gadolinium enhancement sequence. Each rectangle represents data acquisition timed to coincide with the cardiac rest period and during which a user-defined number of k-space lines are filled. Multiple data acquisitions and thus cardiac cycles are required to fill k-space and produce an image. At a heart rate of 80 bpm (A), data acquisition occurs every second cardiac cycle in order to allow sufficient time for recovery of longitudinal signal. At a heart rate of 120 bpm (B), the cardiac cycle length is shorter so the sequence is modified to acquire data every third cycle in order to maintain the same time for the recovery of longitudinal signal. In addition, the data acquisition duration is shortened to compensate for the briefer cardiac rest period associated with a faster heart rate.

Mentions: Performing the LGE technique in children requires modifications to address smaller-sized ventricles and faster heart rates (Table 6). In order to ensure adequate spatial resolution, voxel size should be 1.0-1.5 mm in-plane with a thickness of 5 mm. The resulting decreased signal-to-noise ratio can be compensated for by performing two signal averages, albeit at the expense of a longer acquisition time. At higher heart rates (>100 bpm), in order to allow time for adequate longitudinal signal recovery between successive inversion pulses and avoid excessive signal loss, the interval between data acquisition should be increased from every second cardiac cycle to every third or fourth cycle (Figure 16). If the scanner software does not allow easy adjustment of the data acquisition interval, one can try manually halving the entered heart rate which may extend the scanner’s no-trigger interval and double the data acquisition interval. In addition, the data acquisition (shot) duration should be decreased by reducing the views per segment (turbo factor) to minimize blurring from faster cardiac motion at the higher heart rate.


Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease.

Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ - J Cardiovasc Magn Reson (2013)

Schematic diagram illustrating data acquisition timing in a late gadolinium enhancement sequence. Each rectangle represents data acquisition timed to coincide with the cardiac rest period and during which a user-defined number of k-space lines are filled. Multiple data acquisitions and thus cardiac cycles are required to fill k-space and produce an image. At a heart rate of 80 bpm (A), data acquisition occurs every second cardiac cycle in order to allow sufficient time for recovery of longitudinal signal. At a heart rate of 120 bpm (B), the cardiac cycle length is shorter so the sequence is modified to acquire data every third cycle in order to maintain the same time for the recovery of longitudinal signal. In addition, the data acquisition duration is shortened to compensate for the briefer cardiac rest period associated with a faster heart rate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3686659&req=5

Figure 16: Schematic diagram illustrating data acquisition timing in a late gadolinium enhancement sequence. Each rectangle represents data acquisition timed to coincide with the cardiac rest period and during which a user-defined number of k-space lines are filled. Multiple data acquisitions and thus cardiac cycles are required to fill k-space and produce an image. At a heart rate of 80 bpm (A), data acquisition occurs every second cardiac cycle in order to allow sufficient time for recovery of longitudinal signal. At a heart rate of 120 bpm (B), the cardiac cycle length is shorter so the sequence is modified to acquire data every third cycle in order to maintain the same time for the recovery of longitudinal signal. In addition, the data acquisition duration is shortened to compensate for the briefer cardiac rest period associated with a faster heart rate.
Mentions: Performing the LGE technique in children requires modifications to address smaller-sized ventricles and faster heart rates (Table 6). In order to ensure adequate spatial resolution, voxel size should be 1.0-1.5 mm in-plane with a thickness of 5 mm. The resulting decreased signal-to-noise ratio can be compensated for by performing two signal averages, albeit at the expense of a longer acquisition time. At higher heart rates (>100 bpm), in order to allow time for adequate longitudinal signal recovery between successive inversion pulses and avoid excessive signal loss, the interval between data acquisition should be increased from every second cardiac cycle to every third or fourth cycle (Figure 16). If the scanner software does not allow easy adjustment of the data acquisition interval, one can try manually halving the entered heart rate which may extend the scanner’s no-trigger interval and double the data acquisition interval. In addition, the data acquisition (shot) duration should be decreased by reducing the views per segment (turbo factor) to minimize blurring from faster cardiac motion at the higher heart rate.

Bottom Line: The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols.Variations in practice are highlighted and expert consensus recommendations are provided.Indications and appropriate use criteria for CMR examination are not specifically addressed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany. fratz@dhm.mhn.de

ABSTRACT
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.

Show MeSH
Related in: MedlinePlus