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Table 2 Strengths and weaknesses of standard CMR sequences

From: Diagnostic and prognostic value of cardiovascular magnetic resonance in non-ischaemic cardiomyopathies

Sequence

Purpose

Strengths

Weaknesses

Breath hold balanced SSFP cine

Global regional myocardial function and wall thickness

High SNR (T2/T1) image contrast gives reliable blood: myocardium endocardial border definition based on long T2 of blood

Sensitive to field inhomogeneity (off- resonance banding artefact). Unreliable appearance. ECG-mistriggering/Poor breath hold

T2W-TSE with dark blood preparation and fat-suppression by STIR(short tau inversion recovery)

Oedema, Infiltration

Detection of myocardial fluid content by longer T2 relaxation time

Low SNR

Incomplete blood suppression at endocardial boundary layer

Unreliability due to diastolic cardiac motion ECG mistriggering

Poor breathhold

Stress first-pass myocardial perfusion

Cardiomyopathy related perfusion defects/exclusion of concurrent epicardial coronary artery disease

Higher resolution than SPECT

Incomplete myocardial coverage

“Dark-rim” artefact Cardiac motion during image

Early Gd enhancement (inversion-recovery spoiled gradient-echo

Microvascular obstruction Detection of intracardiac thrombus

High spatial resolution (compared to CMR perfusion)

Dependent on image timing after injection. ECG mistriggering

Poor breath hold

Late Gd enhancement (inversion recovery spoiled gradient-echo)

Myocardial fibrosis

High T1 contrast of diseased myocardium

Image contrast depends on inversion time adjustment and Gad washout. Ghosting from long T1 fluids (can be suppressed).

ECGmistriggering

Poor breath-hold

Real-time or single-shot versions of many sequences above

As above

No breath-holding Tolerates ECG mistriggering

Coarser image resolution.

Cardiac motion during image.