Table 2.

Recommended CMR protocol for ARVC

Sequence	Imaging plane	Parameters	Comments
Double inversion recovery TSE/FSE a) Axial: with and without fat suppression b) short axis: without fat suppression	a) Axial: obtain ~6-8 images centered on the left/right ventricle	TR = 2 R-R intervals, TE = 5 msec (minimum-full) (GE), TE = 30 msec (Siemens) slice thickness = 5 mm, interslice gap = 5 mm, and field of view (FOV) = 28–34 cm. ETL 16-24	This sequence provides optimal tissue characterization of the RV free wall. Prescribe from the pulmonary artery to the diaphragm. Fat suppression improves reader confidence in diagnosis of RV fat infiltration.
	b) Short axis: obtain ~6-8 images centered on the left ventricle
SSFP Bright Blood Cine Images	Axial, Four chamber and Short Axis. RV 3 chamber (optional)	TR/TE minimum, flip angle = 45-70°, slice thickness = 8 mm, interslice gap = 2 mm. FOV = 36–40 cm, 16–20 views per segment. Parallel imaging n = 2 is desirable	Axial images are best to assess RV wall motion. RV quantitative analysis is performed on the short axis cine images.
GADOLINIUM IS ADMINISTERED ACCORDING TO INSTITUTIONAL PROTOCOL (usually 0.15 – 0.2 MMOL/KG)
TI scout	Four chamber		TI scout sequences or trial TI times to suppress normal myocardium for the right inversion time.
Delayed Gadolinium Imaging (Phase Sensitive Inversion Recovery recommended)	Axial, Short Axis, Four Chamber and Vertical Long Axis	TR/TE per manufacturer recommendations flip angle = 20-25°, slice thickness = 8 mm, interslice gap = 2 mm. FOV = 36–40 cm, No parallel imaging. Use phase sensitive inversion recovery if available (PSIR)	PSIR is more robust and independent of TI time. Optimal for imaging fibrosis. LV epicardial enhancement in the infero-lateral wall has been reported in classic ARVC and in left dominant forms.

Abbreviations: ARVC Arrhythmogenic Right Ventricular Cardiomyopathy, LV left ventricle, FOV field of view, FSE fast spin echo, PSIR phase sensitive inversion recovery, RV right ventricle, SSFP steady state free precession, TE echo time, TI inversion time, TR repetition time, TSE Turbo spin echo.