TABLE 4.
Recommended CMR Protocol for ARVD/C Evaluation*
| Sequence | Imaging Plane | Parameters | Comments |
|---|---|---|---|
Double-inversion recovery TSE/FSE
|
|
TR = 2 R-R intervals, TE = 5 ms (minimum-full) (GE Healthcare, Fairfield, Connecticut), TE 30 ms (Siemens, Munich, Germany), slice thickness = 5 mm, interslice gap = 5 mm, and 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. |
| SSFP bright blood cine images | Stack of axial images or stack of 4-chamber cine images covering the entire LV and RV. 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 and/or 4-chamber cine images are best to assess RV wall motion. The choice of axial versus 4-chamber view depends on the experience of the observer. 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 | 4 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, 4 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 is more robust and independent of TI time. Optimal for imaging fibrosis. LV epicardial enhancement in the inferolateral wall has been reported in classic ARVD/C and in left dominant forms. |
*
Reprinted with permission from te Riele et al. (15) (original publisher BioMed Central).