Myocardial Perfusion Protocols Dynamic First-Pass Perfusion Stress - Rest Exam Workflow Localizer views of 2ch, 3ch, 4ch Long Axis Short Axis stack of localizer views Cine of 4ch Long Axis to examine base motion Infuse stress agent (Cardiologist should attend the session) Bolus inject contrast agent + Dynamic Perfusion imaging (stress) Acquire complete cine exam (short axis + long axis views) Bolus inject contrast agent + Dynamic Perfusion imaging (rest) Infuse any remaining contrast agent Perform Delayed Enhancement Myocardial Viability imaging  Perform perfusion, cine, and delayed enhancement viability images all at same slice locations Dynamic First-Pass Perfusion Stress - Rest Exam Workflow slices 192 iPAT slices • 2ch body array + spine array elements • TFL SR prep pulse • Bandwidth 850 Hz/pix • Echo Spacing 1.9 ms • RF/Gradient Mode Fast/Fast • RF Spoiling On • Slices x mm • FOV 360 mm x 81% • Resolution 128 x 75% • Phase Encoding Lines = 78 • Partial Fourier = off • IPAT = none • TR/TE/TI 174/0.96/100ms • Flip Angle = 15 deg • Slice Order = Ascending (apex to base) • If drop to slices, then increase TI up to max 192 iPAT • 6ch anterior + 6ch posterior arrays • TFL SR prep pulse • Bandwidth 500 Hz/pix • Echo Spacing 2.6 ms • RF/Gradient Mode Fast/Fast • RF Spoiling On • Slices x mm • FOV 360 mm x 83% • Resolution 192 x 60% • Phase Encoding Lines = 96 • Partial Fourier = off • IPAT = GRAPPA, accel fact 2, ref lines 18 •TR/TE/TI 172/1.25/100ms • Flip Angle = 12 deg • Slice Order = Ascending (apex to base) • If drop to slices, then increase TI up to max Dynamic First-Pass Perfusion Rotate FOV to minimize wrap in oblique views r ad e r phase se a ph te n A r io read te s Po r ir o Dynamic First-Pass Perfusion Rotate FOV to minimize wrap in oblique views Dynamic First-Pass Perfusion Results Ischemic Region versus Infarct Resting Exam Stress Exam Infarct (a) Resting exam may or may not show infarcts as dark (in this case it was) (b) Infarct may or may not be surrounded by ischemia (in this case it was) (c) Delayed Enhancement exam clearly delineates the infarcted region Dr Ching Hon Luk, Sir Run Run Shaw Heart Center, Hong Kong Dynamic First Pass Perfusion Results Unmatched Regional Defect Indicates Ischemia STRESS REST LAD 100% stenosis, RCA 60% stenosis Dr Ching Hon Luk, Sir Run Run Shaw Heart Center, Hong Kong Argus Software: Perfusion Exam Review •Images Sorted by Position then Series •Movie Played in 8:1 Mode Stress Rest stress rest stress rest stress rest ... Perform Delayed Enhancement Myocardial Viability imaging  Perform perfusion, cine, and delayed enhancement viability images all at same slice locations Dynamic First-Pass Perfusion Stress - Rest... Bolus inject contrast agent + Dynamic Perfusion imaging (stress) Acquire complete cine exam (short axis + long axis views) Bolus inject contrast agent + Dynamic Perfusion imaging (rest) Infuse any... TI up to max Dynamic First-Pass Perfusion Rotate FOV to minimize wrap in oblique views r ad e r phase se a ph te n A r io read te s Po r ir o Dynamic First-Pass Perfusion Rotate FOV to minimize