TABLE 1.

Protocol for Cardiac MRI of Tumors at Our Institution

Pulse Sequence	Technical Parameters	Utility
Bright-blood, cine SSFP (Figs. 1 and S1)	Planes of acquisition: two-, three-, and four-chamber with TR/ TE, 36.27/1.22; FOV, patient size dependent between 340 and 400 mm; matrix, 162 × 192; slice thickness, 8 mm; flip angle, 50°; segments, 12 with goal of temporal resolution of 40 ms	Advantages: Good SNR and CNR; functional and anatomic assessment; T2 > T1 weighting; fast single breath-hold acquisitions and disadvantage of off-resonance artifact at 3 T
Bright-blood cine spoiled gradient- echo (Figs. 2 and S2)	Planes of acquisition: two-, three-, and four-chamber with TR/ TE, 40/2–43; FOV, 340–400 mm; matrix, 125 × 192; slice thickness, 8 mm; flip angle, 12°	Advantages: good CNR but weaker than SSFP; less susceptible to off-resonance artifact; T1 weighting Disadvantage: turbulent flow can cause signal loss and overestimation of size of lesion
T1-weighted black-blood double inversion recovery fast spin-echo (Figs 3A and 4)	Planes of acquisition: two-, three-, and four-chamber with TR/ TE, 1000 or one R-R interval (depending on heart rate)/9–11; FOV, 300–400 mm; matrix, 256 × 256; slice thickness, 6 mm; echo-train length, 10; inversion time, 340; flip angle, 60°	Black-blood effects give good SNR and CNR and allow delineation of the mass relative to adjacent structures; T1 tissue characterization
T2-weighted black-blood double inversion recovery fast spin-echo (Fig. 3B)	Planes of acquisition: two-, three-, and four-chamber with TR/ TE, two R-R intervals–2000/120; FOV, 300–400 mm; matrix, 256 × 256; slice thickness, 6 mm; flip angle, 60°	Black-blood effects give good SNR and CNR allow delineation of the mass relative to adjacent structures; T2 tissue characterization
Black-blood triple inversion fast spin-echo) (Fig. 5)	Planes of acquisition: two-, three-, and four-chamber with FOV, 300–400 mm; matrix, 256 × 256; slice thickness, 6 mm; T1/T2-weighted with additional inversion pulse between non–spatially selective and spatially selective pulse to null signal from fat	Visualization of presence of fat can help diagnose a lesion; elimination of signal from adjacent high-signal epicardial fat can allow better definition of the lesion
T1 fat-saturated 3D volumetric unenhanced and contrast-enhanced imaging (Fig. 6)	Planes of acquisition: two-, three-, and four-chamber with TR/ TE, minimum full/minimum; FOV, typically full chest; flip angle, 12–15°; contrast-enhanced imaging acquired in equilibrium phase	Permits evaluation of the presence and extent of contrast enhancement of the mass; provides fast global assessment of the chest (20–25 s)
Late gadolinium enhancement imaging (T1 turboFlash) (Fig. 7)	Planes of acquisition: two-, three-, and four-chamber; cumulative dose of 0.1–0.2 mmol/kg gadolinium IV; first-pass perfusion imaging can be acquired dynamically during contrast injection and subsequently, late gadolinium-enhanced images acquired 10 minutes after contrast injection, with a null time of myocardium typically 350 ms; high inversion times, such as 600–800 ms, can be used to null signal in thrombus	Provides definition of the presence and pattern of enhancement of the mass, presence of myocardial scar, or invasion of coronary arteries; can be used to differentiate thrombus from a mass
Tagging (Fig. S4)	Spatial presaturation pulse is applied with a line thickness of 1–2 mm and a grid tag distance of 6 mm, with the orientation of the lines perpendicular to the axis of the mass/myocardium; tagging can be in a linear or grid pattern	Can determine whether a mass is inseparable from myocardium with loss of normal separating epicardial fat plane in the case of an extracardiac mass; can determine the presence of a noncontractile intramyocardial mass, such as a rhabdomyoma

Note—Using ECG-gated Trio 3-T MR scanner manufactured by Siemens Healthcare. SSFP = steady-state free precession, SNR = signal-to-noise ratio, CNR = contrast-to-noise ratio.