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Assessment of Regional Left Ventricular Function: Accuracy and Reproducibility of Positioning Standard Short-Axis Sections in Cardiac MR Imaging¹

¹ From the British Heart Foundation Cardiac MRI Unit (D.R.M., G.J.B., K.A., T.R.J., S.P., M.U.S.) and Department of Medical Physics (J.P.R.), Leeds General Infirmary, Leeds, England. Received February 9, 2004; revision requested April 20; revision received May 10; accepted June 15. D.R.M. supported by a Marie Curie research grant from the European Commission. Address correspondence to D.R.M., Cardiac MRI Team, Franz-Volhard-Klinik, Humboldt Universität, Charité Campus Buch, Wiltbergstrasse 50, 13125 Berlin, Germany (e-mail: messroghli@fvk-berlin.de).

View larger version (31K): [in a new window]   Figure 1. Positioning scheme for selective short-axis approach based on systolic long-axis images in two-chamber (top row) and four-chamber (bottom row) views. In step A, five sections are planned in short-axis orientation (parallel to mitral annulus). In step B, the stack is centered and the intersection gap is adjusted to align the outer boundary of the most distal section to the tip of the myocardium and the outer boundary of the most proximal section to the mitral annulus. In step C, the middle three sections are selected for imaging.

View larger version (85K): [in a new window]   Figure 2. Screenshots corresponding to step B in Figure 1 show the positioning of five sections in short-axis orientation on systolic images of four-chamber (left) and two-chamber (right) views.

View larger version (133K): [in a new window]   Figure 3. Short-axis view of midcavity shows localization of myocardial segments and landmarks for measurements of end-diastolic LV diameters (white lines) corresponding to the vertical long axis (VLA) and horizontal long axis (HLA). Arrowhead is the reference point at right ventricular insertion.

View larger version (100K): [in a new window]   Figure 4. Selective short-axis MR images (3.48/1.74, 55° flip angle, 38 x 30-cm field of view, 208 x 133 matrix, 8-mm section thickness, 18 phases) from two studies performed in a 31-year-old male volunteer. On basal section (top row), fish-mouth-like configuration of mitral valve (white arrowhead) is fully or partly visible in mid diastole. Tips of papillary muscles (black arrowheads) are fully visible in end diastole but not in end systole. Myocardium is present in 360° of LV circumference. On midcavity sections (middle row), papillary muscles (arrowheads) are clearly visible in all phases of the cardiac cycle. On apical sections (bottom row), there are no substantial papillary muscles visible; trabeculations adjacent to the lateral LV (black arrowheads) are not more prominent than those in septal regions of the same section (white arrowheads). LV cavity is preserved throughout the cardiac cycle.

View larger version (15K): [in a new window]   Figure 5. Scatterplots depict interstudy correlation of selective short-axis approach in volunteers for intersection gap (left) and end-diastolic LV diameters in vertical long-axis (VLA) (middle) and horizontal long-axis (HLA) (right) orientation.

View larger version (109K): [in a new window]   Figure 6. MR images from selective short-axis (3-of-5) (3.48/1.74, 55° flip angle, 38 x 30-cm field of view, 208 x 133 matrix, 8-mm section thickness, 18 phases) and multisection short-axis (Multi-SAX) (3.52/1.76, 55° flip angle, 38 x 30-cm field of view, 224 x 125 matrix, 10-mm section thickness, 18 phases) studies in a 47-year-old male patient with acute anteroseptal myocardial infarction (LV end-diastolic volume, 311 mL; ejection fraction, 39%). There is anteroseptal akinesia at basal and midcavity levels and anteroseptal dyskinesia associated with anterior and inferior hypokinesia and/or akinesia at apical level (white arrowheads = center of the infarction). Criterion 5 is not met as there are papillary muscles visible on the apical section with the selective short-axis approach (black arrowheads).