Korean J Radiol.  2019 Sep;20(9):1313-1333. 10.3348/kjr.2019.0398.

Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 1: Standardized Protocol

• Jo Y
• Kim J
• Park CH
• Lee JW
• Hur JH
• Yang DH
• Lee BY
• Im DJ
• Hong SJ
• Kim EY
• Park EA
• Kim PK
• Yong HS

• KMID: 2455761
• DOI: http://doi.org/10.3348/kjr.2019.0398

Abstract

Cardiac magnetic resonance (CMR) imaging is widely used in many areas of cardiovascular disease assessment. This is a practical, standard CMR protocol for beginners that is designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines and includes sequence terminology used by vendors, essential MR physics, imaging planes, field strength considerations, MRI-conditional devices, drugs for stress tests, various CMR modules, and disease/symptom-based protocols based on a survey of cardiologists and various appropriate-use criteria. It will be of considerable help in planning and implementing tests. In addressing CMR usage and creating this protocol guideline, we particularly tried to include useful tips to overcome various practical issues and improve CMR imaging. We hope that this document will continue to standardize and simplify a patient-based approach to clinical CMR and contribute to the promotion of public health.

Keyword

Heart; Cardiovascular; Magnetic resonance imaging; Protocol; Guideline

MeSH Terms

Cardiovascular Diseases
Commerce
Exercise Test
Heart
Hope
Magnetic Resonance Imaging*
Public Health

Figure

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  Fig. 1 Spin echo sequence.RF = radio frequency, TE = time of echo, TR = time of repetition

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  Fig. 2 Fast spin echo sequence.

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  Fig. 3 Spoiled gradient echo sequence.

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  Fig. 4 Balanced steady-state free precession.

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  Fig. 5 Preparation pulses.A. Inversion recovery pulse (IR). B. Saturation recovery pulse.

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  Fig. 6 Magnetic susceptibility artifact by cardiac implantable electronic device.Cine image (A) and LGE image (B) show significant magnetic susceptibility artifact caused by cardiac implantable electronic device. LGE = late gadolinium enhancement

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  Fig. 7 Banding artifact.A. Cine image of 2-chamber right ventricle view shows severe banding artifact which hampers appropriate interpretation. B. After cardiac shimming and TR adjustment, image quality is improved without banding artifact.

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  Fig. 8 First pass perfusion sequence.ECG = electrocardiogram, SR = saturation, TSR = SR time

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  Fig. 9 Dark rim artifact during perfusion magnetic resonance imaging.Subendocardial dark rims are seen at basal septum on both stress (A) and rest (B) perfusion images.

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  Fig. 10 LGE sequences.Sequences of LGE with magnitude IR (A) and phase-sensitive inversion-recovery (B). FA = flip angle, TD = trigger delay, TI = inversion time

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  Fig. 11 Better image quality of single shot LGE in patient with poor breath holding.LGE image with two-dimensional segmented inversion recovery gradient-echo (A) in patient with poor breath holding shows poor image quality with significant motion artifact. Single shot LGE (B) shows much improved image quality with less motion artifact.

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  Fig. 12 VENC effect on phase-contrast flow imaging.Very low VENC factor (A, VENC factor = 90 cm/s) causes aliasing on phase contrast flow image of ascending aorta. Usual peak of ascending aorta is 100–160 cm/s (B, VENC factor = 130 cm/s; C, VENC factor = 160 cm/s). Very high VENC factor (D, VENC factor = 190 cm/s) causes noise and inaccurate measurement. VENC = velocity encoding sensitivity

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  Fig. 13 T1 mapping sequences.T1 mapping sequences with MOLLI (A) and SASHA (B). MOLLI = modified look-locker inversion recovery, SASHA = saturation recovery single-shot acquisition

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  Fig. 14 Native T1 map and post T1 map.Native T1 map image (A) acquired prior to contrast injection provides pixel-wise absolute native T1 values. Post T1 map image (B) acquired after administration of contrast agent provides pixel-wise post T1 values. Using native T1 values and post T1 values of myocardium and blood cavity and hematocrit value, extracellular volume fraction of myocardium could be calculated.

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