Table 2.
Study protocol for ACM patients in Padua CMR lab
| CMR sequences | Imaging parameters | Mode of acquisition | |
|---|---|---|---|
| Localizers | • Sagittal, coronal, transaxial | ||
| Cine CMR | Balanced steady-state free precession | Slice thickness 8 mm; TR/TE minimum, interslice gap 20%, flip angle 70°, parallel imaging 2. |
• Long axis 4-ch, 3-ch, 2-ch view • Short axis stack (8–10 slices) |
| Cine CMR | Balanced steady-state free precession | Slice thickness 5 mm; TR/TE minimum, interslice gap 20%, flip angle 70°, parallel imaging 2. |
• Right ventricular inflow (3–5 slices) • Sagittal RVOT (3–5 slices) |
| Black-blood CMR | T1- or proton density–weighted fast spin-echo |
Slice thickness 8 mm; TR = 2RR; TE 25 ms parallel imaging 2. |
• Long axis 4-ch, 3-ch, 2-ch view • Short axis stack (8–10 slices) • Right ventricular inflow* • Sagittal RVOT* |
| Edema CMR (optional**) | Turbo-inversion recovery magnitude | Slice thickness 8 mm; TR = 2RR; TE 76 ms; TI 160 ms parallel imaging 2. |
• Long axis 4-ch, 3-ch, 2-ch view • Short axis stack (8–10 slices) • Right ventricular inflow * • Sagittal RVOT* |
| GBCA administration | |||
| Cine CMR | Balanced steady-state free precession | Slice thickness 5 mm; TR/TE minimum, interslice gap 20%, flip angle 70°, parallel imaging 2. | • Right ventricular transaxial stack (8–10 slices) |
| Flow CMR (optional; Recommended in case of RV dilatation). | Through-plane motion-encoded phase-sensitive spoiled gradient echo | Slice thickness 6 mm; TR/TE 39/2.68; flip angle 20° |
• Pulmonary artery • Aorta |
| Time inversion scout (about 8 min after GBCA administration) | Time-inversion scout gradient echo |
• Mid short-axis view (or long-axis 4-ch view) |
|
| LGE CMR | Phase-sensitive inversion recovery gradient echo | TR/TE per manufacturer recommendations; slice thickness 8 mm; interslice gap 20%; Flip angle 25°; no parallel imaging. Use phase sensitive inversion recovery if available. |
• Long axis 4-ch, 3-ch, 2-ch view • Short axis stack (8–10 slices) • Right ventricular inflow (3–5 slices) • Sagittal RVOT (3–5 slices) |
*The study of RV should be more accurate the higher pre-test probability of RV disease is (echocardiography RV abnormalities, ECG V1-V3 Twave inversion, VA with LBBB morphology…)
**Useful in case of hot-phase presentation (chest pain/syncope/cardiac arrest plus troponin rise)
CMR cardiac magnetic resonance, LGE late gadolinium enhancement, RV right ventricle, RVOT right ventricular outflow tract, GBCA gadolinium-based contrast agent