Hello. Thank you for watching. The one you mentioned is part of the topics we have on our agenda. Just be patient, we will discuss about that as well in the future 😊
Few things can feel so humbling as a tough CMR! I think a few things to try: 1. Coaching the patient again; be sure they understand the instructions. Otherwise try to decipher the cause: is the breath hold too long? is expiratory breath hold too difficult? CMR is a long study for most sites, it may also be helpful to speak with your reading cardiologist about what is the primary clinical question for the study, and re-prioritizing the sequences. If the main question is LGE, no sense in re-running Cine's over and over again when a limited number of breath holds might be better used for mapping, LGE, Flows, etc. 2. If breath holding is not going well, also consider having the patient do shallow breathing or just free breath it entirely. - Real time cine imaging is helpful in this scenario. It will sacrifice image quality and be much more work for the Drs to do analysis, but may also be the only way to achieve clear imaging. - LGE is frequently done with the MOCO technique as a freebreathing scan, with good image quality. It is important to know it's drawbacks though, MOCO only works in-plane, like propeller, so running a MOCO in 4 chamber orientation may look more reliable than it actually is. It is best kept as Short axis or 2 chamber. MOCO also uses non-rigid correction ie it warps the image to look right, so best to run it in systole so that the heart is definitely the same shape/size in each of the averages it uses so that it doesn't warp LGE to look more or less bad than it actually is. On a 3T, non MOCO single shot SSFP LGE image quality can be quite good free breathing. 3. Try a HASTE/SSFSE for dark blood over multiple heartbeats. If you're on a Siemens and really need a fast-ish T1 Darkblood, you can take the radial ssfp cine from the Siemens tree and beat it up into a gated GRE darkblood static image. Looking forward to future discussions on CMR!
Hi, can u upload a tips & tricks video for uncooperative Cardiac MRI pt. ? How to achieve good imaging for that?
Hello. Thank you for watching. The one you mentioned is part of the topics we have on our agenda. Just be patient, we will discuss about that as well in the future 😊
Few things can feel so humbling as a tough CMR! I think a few things to try:
1. Coaching the patient again; be sure they understand the instructions. Otherwise try to decipher the cause: is the breath hold too long? is expiratory breath hold too difficult? CMR is a long study for most sites, it may also be helpful to speak with your reading cardiologist about what is the primary clinical question for the study, and re-prioritizing the sequences. If the main question is LGE, no sense in re-running Cine's over and over again when a limited number of breath holds might be better used for mapping, LGE, Flows, etc.
2. If breath holding is not going well, also consider having the patient do shallow breathing or just free breath it entirely.
- Real time cine imaging is helpful in this scenario. It will sacrifice image quality and be much more work for the Drs to do analysis, but may also be the only way to achieve clear imaging.
- LGE is frequently done with the MOCO technique as a freebreathing scan, with good image quality. It is important to know it's drawbacks though, MOCO only works in-plane, like propeller, so running a MOCO in 4 chamber orientation may look more reliable than it actually is. It is best kept as Short axis or 2 chamber. MOCO also uses non-rigid correction ie it warps the image to look right, so best to run it in systole so that the heart is definitely the same shape/size in each of the averages it uses so that it doesn't warp LGE to look more or less bad than it actually is. On a 3T, non MOCO single shot SSFP LGE image quality can be quite good free breathing.
3. Try a HASTE/SSFSE for dark blood over multiple heartbeats. If you're on a Siemens and really need a fast-ish T1 Darkblood, you can take the radial ssfp cine from the Siemens tree and beat it up into a gated GRE darkblood static image.
Looking forward to future discussions on CMR!
@@scottgloverjohnson thank you so much for sharing these insights! I think the colleague above (and not only him) will find them extremely useful 🙏🏻