1. “How I do” a CMR Volume study
James Moon
For scmr.org
Heart Hospital Imaging centre,
Heart Hospital, London UK
UCL
Updated version: July 2010

2. 1. Initial pilots – multislice localiser
Localisers – all acquisitions at end expiration
Sagittal
Coronal
Transverse 1
Transverse 2

3. 2a. Transverse Stack for anatomy
This is not necessary for LV volumes, but is important Black blood (HASTE) or White blood (SSFP) can be used
Black blood

4. 2b. Transverse Stack for anatomy
This is not necessary for LV volumes, but is important Black blood (HASTE) or White blood (SSFP) can be used
White blood

5. 3. Vertical Long axis (VLA) pilot
Position from the mid ventricular transverse image. Orientate the slice along the long axis of the left ventricle (LV), bisecting the mitral valve and apex – (not necessarily completely parallel to the septum).
Transverse pilot
VLA pilot

6. 4. (optional) Horizontal Long axis (HLA) pilot
Using the VLA pilot acquired in step 2, position the slice bisecting the mitral valve and apex
VLA pilot
HLA pilot

7. 5: Short axis (SA) pilots
Using the HLA and VLA pilots (steps 2 & 3), acquire 3 slices, the basal slice parallel to the atrio-ventricular (AV) ring. You have now defined the apex (HLA+VLA), centre of the mitral valve (HLA+ VLA+SA), Left Ventricular Outflow Tract (SA), and RV (SA).
VLA and
HLA pilots
SA pilots

8. 6: Four chamber cine
Now pilot the 4 chamber cine: through the apex, and the maximum lateral dimensions of both ventricles, avoiding the LVOT
2ch
4ch
LVOT
4 Chamber cine

9. 7: Two chamber cine
And pilot the 2 chamber cine – through the apex and mid anterior wall/mid inferior wall on the short axis slices – avoiding the LV outflow tract
2ch
4ch
LVOT
2 Chamber cine

10. 8: LVOT cine
Modify the 4 chamber using the basal SA pilot by twisting the plane until it goes through the aortic valve into the ascending aorta. This is the LVOT view (parasternal long axis or apical 3 chamber by echo)
2ch
4ch
LVOT
LVOT cine

11. 9: LVOT coronal cine (optional)
A second LVOT view can be piloted perpendicular to the initial LVOT view (LVOT coronal view)
LVOT cine (coronal)

12. 10: Short axis stack
Use the end-diastolic frames from the 2 and 4 chamber cines to plan the first slice through the AV groove seen on both views. Then acquire parallel slices; typically 7mm slice thickness with a 3mm gap (or 8+2 or 10+0) until you have covered the entire ventricle.
SA stack

13. That’s it!
You have now acquired the basic CMR views of Left Ventricle and your basic anatomical views