Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance

Ferreira, Vanessa M.; Plein, Sven; Wong, Timothy C.; Tao, Qian; Raisi-Estabragh, Zahra; Jain, Supriya S.; Han, Yuchi; Ojha, Vineeta; Bluemke, David A.; Hanneman, Kate; Weinsaft, Jonathan; Vidula, Mahesh K.; Ntusi, Ntobeko A. B.; Schulz-Menger, Jeanette; Kim, Jiwon

doi:10.1186/s12968-023-00933-0

Journal of Cardiovascular Magnetic Resonance

Table 1 Recommended CMR-protocols in adult patients with active/post COVID-19

From: Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance

Recommended CMR sequences	Answering most clinical questions
Survey	Recommended
Cine sequences: Short axis (full biventricular coverage) Long axis (HLA, VLA, LVOT) RV views (RVOT, RV 2Ch, 3Ch)	Recommended Recommended Optional
T2-weighted imaging (e.g. STIR) (myocardium/pericardium)	Optional^a
Parametric Mapping^c: Native T1-mapping Native T2-mapping Post-contrast T1-mapping (for ECV)	Recommended Recommended Recommended
Acquisition based myocardial strain (Tagging, DENSE, fSENC)^b	Optional
Stress perfusion (vasodilator)^d	Optional
Early gadolinium enhancement (EGE)^e	Optional
Late gadolinium enhancement (LGE) Short axis full coverage and long axis views RV LGE	Recommended
Real-time cine (to assess for ventricular inter-dependence, if applicable)^f	Optional
2D-flow (aorta and pulmonary arteries)^g	Optional
Angiography (pulmonary vessels)^g	Optional

2Ch two-chamber; 4Ch four-chamber; ECV extracellular volume fraction; HLA horizontal long axis; LV left ventricle/left ventricular; LVOT left ventricular outflow tract; RV right ventricle/right ventricular; RVOT right ventricular outflow tract; VLA vertical long axis
^aWhere available, T2-mapping may circumvent some of the technical limitations of conventional T2-weighted imaging (see Additional file 1)
^bStrain imaging may be considered if assessment for subclinical myocardial dysfunction is warranted
^cFor tissue characterization techniques, whole LV coverage will increase the diagnostic yield of detecting regions of myocardial inflammation, although this will lengthen scan time. At least 3 short-axis slices covering the LV should be obtained, recognizing that incomplete coverage will increase the potential of missing areas of myocardial inflammation
^dIn patients with cardiovascular risk factors, chest pain during COVID-19 illness may be an indication of significant underlying CAD; in these cases, it may be reasonable to include stress perfusion into the CMR protocol, to assess for signs of both obstructive CAD and myocarditis, as well as other cardiovascular changes potentially encountered in COVID-19, in a single examination
^eEGE may be considered for thrombi detection with extension of short-axis coverage to include the atria for screening of thrombi in the atria and LV/RV
^fReal-time cine may be considered if there is suspicion for constrictive physiology
^gDedicated pulmonary vascular imaging may be considered if involvement of pulmonary vasculature is suspected

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ISSN: 1532-429X

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