Basic and Advance Cardiac Planning

1. Ng Chian Keat
MR Application Specialist
Basic and Advance Cardiac
Planning

2. Cardiac Planning
• Basic cardiac views
– Transverse (Straight Axial)
– Long axis (2CH)
– Short axis (SAX)
– Four chamber (4CH)
• Advanced views
– Outflow tracts
– Great arteries
– Valves
Cardiac views

3. Basic cardiac views
Dark Blood Straight Axial
• Straight orthogonal planning on coronal and sagittal localizers.

4. Basic cardiac views
Pseudo Long Axis (pseudo 2CH)
Long Axis (VLA / RAO): Sagittal oblique
• Plan on axial, through: - Left ventricle
– Apex - Mitral valve
– Centre mitral valve - Left atrium

5. Basic cardiac views
Pseudo Four Chambers ( pseudo 4CH)
(Semi) Four Chamber (s4CH / HLA): Transverse oblique
• Plan on long axis, through: - Septum
– Apex - Mitral valve
– Centre mitral valve

6. Basic cardiac views
Pseudo Short Axis ( pseudo SAX )
Short axis (SA, SAX) Cor / Tra oblique
• Plan on LA and s4CH - Left ventricle
– Parallel Mitral valve, or - Right ventricle
– Orthogonal septum, or
– Orthogonal line from apex to Mitral valve

7. Inflow and outflow tracts
Left two chamber (L2CH, VLA) Sagittal oblique
• Plan on 4CH & SA, through: - Left ventricle
– Apex + mitral valve - Mitral valve
– Centre LV cavity - Left atrium
– Centre LA cavity
Left Two Chamber

8. Inflow and outflow tracts
Right two chamber (R2CH) Sagittal oblique
• Plan on 4CH & SA, through: - Right Ventricle
– Apex + tricuspid valve - Tricuspid valve
– Centre RV cavity - Right Atrium
– Centre RA cavity
Right Two Chamber

9. Basic cardiac views
Four Chamber
Four chamber (4CH) Transverse oblique
• Plan on SA and LA, through: - Left + right atrium
– Center left ventricle - Left + right ventricle
– Corner right ventricle - Mitral valve
– Apex left ventricle - Tricuspid valve

10. Inflow and outflow tracts
Left ventricular outflow tract (LVOT, 3CH) Tra / sag oblique
• Plan on Basal SA and LA, through: - Left atrium & ventricle
– Apex - Mitral valve
– Centre mitral valve - Aortic valve
– Aorta - Aorta
Left ventricle (inflow / ) outflow tract

11. Inflow and outflow tracts
Left ventricular outflow tract (LVOT, 3CH) Tra / sag oblique
• Plan on coronal and 4CH, use 3pps: - Left atrium & ventricle
– Apex - Mitral & Aortic valve
– Centre mitral valve - Aorta
– Aorta
Left ventricle (inflow / ) outflow tract

12. Inflow and outflow tracts
Left ventricular outflow tract (LVOT-cor) Coronal oblique
• Plan on LVOT / 3CH, through: - Left ventricle
– Aorta - Aortic valve
- Aorta
Left ventricle (inflow / ) outflow tract

13. Inflow and outflow tracts
Right ventricular outflow tract (RVOT, PA) Sagittal
• Plan on transverse, through: - Right ventricle
– Pulmonary artery - Pulmonary valve
– Straight sagittal - Pulmonary artery
Right ventricle outflow tract (sagittal)

14. Through the arteries
In-Plane
• Aortic arch
• Pulmonary artery
• Pulmonary bifurcation
• Left pulmonary artery
• Right pulmonary artery

15. Aorta arch (Candy cane view) Sagittal oblique
• Plan on transverse, use 3pps: - Aortic valve
– AAO - AAO, Arch, DAO
– Arch
– DAO
Through the arteries

16. Pulmonary artery (MPA, = RVOT) Sagittal
• Plan on transverse, through: - Right ventricle
– Pulmonary artery - Pulmonary valve
– Straight sagittal - Pulmonary artery
Through the arteries

17. Through the arteries
Pulmonary bifurcation (PB, PT) Transverse
• Plan on SAG: - Main pulmonary artery
– Straight transverse - Left & right PA*
* Not always aligned in one plane

18. Through the arteries
Left pulmonary artery (LPA) Sagittal oblique
• Plan on transverse PA, through: - Left pulmonary artery
– Left pulmonary artery

19. Through the arteries
Right pulmonary artery (RPA) Coronal oblique
• Plan on transverse PA, through: - Right pulmonary artery
– Right pulmonary artery

20. Q-flow through arteries
• Perpendicular to vessel:
• Plan on two orthogonal images
 Aortic flow
 Pulmonary flow
 Left pulmonary flow
 Right pulmonary flow

21. Q-flow Aorta
Aortic flow
• Plan on LVOT and / or arch:
– Orthogonal to aorta
– 2cm distal to valve leaflets

22. Q-flow Aorta
Aortic flow:
• AAO (red) ≈ DAO (green) + SVC (blue)*
* Validate on single Q-flow scan ONLY if both AAO and DAO are cut perpendicular

23. Q-flow Pulmonary Artery
Pulmonary flow
• Plan on RVOT and tra:
– Orthogonal to PA
– 2cm distal to valve leaflets

24. Q-flow Pulmonary Artery
Pulmonary flow:
• AAO (red) ≈ PA (green)*
* Validate on two separate Q-flow scans, where arteries are cut perpendicular

25. Q-flow Left Pulmonary Artery
Left pulmonary flow
• Plan on PB and LPA:
– Orthogonal to LPA
– 2 cm distal to bifurcation

26. Q-flow Right Pulmonary Artery
Right pulmonary artery
• Plan on PB and RPA:
– Orthogonal to RPA
– 2 cm distal bifurcation

27. Q-flow Pulmonary Arteries
Pulmonary flow:
• PA (red) ≈ LPA (green) + RPA (blue)