Cardiac MRI Recognition Pattern

Systematic approach to interpreting cardiac MRI with standardized views, sequences, and pathological patterns

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1. Essential Sequences

A. Anatomical Imaging

• • Cine (SSFP/bFFE):
  - Cardiac motion assessment
  - 30-40 phases/cardiac cycle
  - Temporal resolution ≤50ms
• • Dark-blood T2/T1:
  - Myocardial tissue characterization
  - Pericardial evaluation

B. Functional Imaging

• • Late Gadolinium Enhancement (LGE):
  - Inversion time 200-300ms (null normal myocardium)
  - Phase-sensitive inversion recovery (PSIR)
• • T1/T2 mapping:
  - Native T1 (950-1050ms at 1.5T)
  - ECV calculation (25-30% normal)
• • Phase-contrast:
  - Flow quantification
  - VENC settings: 150cm/s (aortic), 100cm/s (PA), 50cm/s (mitral)

2. Standard Imaging Planes

View

Landmarks

Key Structures

Short axis

Perpendicular to LV long axis

LV/RV function, wall motion

4-chamber

Through LV apex and mitral/tricuspid valves

Atria, AV valves, ventricular septum

2-chamber

LV apex to mitral valve (no RV)

Anterior/inferior walls

3-chamber

LVOT view

Aortic valve, mitral valve

3. Functional Parameters

A. Ventricular Metrics

Parameter

Normal Range

Abnormal Threshold

LVEF (%)

55-70

<50 (mild), <40 (moderate), <30 (severe)

RVEF (%)

50-65

<45 (abnormal)

LVEDVi (mL/m²)

50-85

>90 (dilated)

LV mass index (g/m²)

43-95 (M), 41-81 (F)

>115 (M), >95 (F)

B. Strain Imaging

• • Global longitudinal strain (GLS):
  - Normal: -18% to -22%
  - Reduced in cardiomyopathy

4. Tissue Patterns

A. LGE Patterns

Pattern

Disease

Key Features

Subendocardial

Ischemic cardiomyopathy

Coronary territory distribution

Mid-wall

Non-ischemic DCM

Septal stripe in fibrosis

Epicardial

Myocarditis

Lateral wall predominance

Patchy

Sarcoidosis

RV insertion points

B. T1/T2 Abnormalities

• • Edema:
  - T2 hyperintensity
  - Increased T2 signal ratio (>2.0 abnormal)
• • Amyloidosis:
  - Global subendocardial LGE
  - Elevated native T1 (>1050ms)
  - ECV >40%

5. Disease-Specific Patterns

A. Cardiomyopathies

• • Hypertrophic (HCM):
  - Asymmetric septal hypertrophy
  - Mid-wall LGE (RV insertion points)
  - LVOT obstruction on cine
• • ARVC:
  - RV dilation/dysfunction
  - Fatty infiltration (T1)
  - LGE in RV free wall

B. Ischemic Heart Disease

• • Viability assessment:
  - Transmurality >50% = low likelihood of functional recovery
  - Dobutamine stress for hibernating myocardium

6. Congenital Heart Disease

A. Common Lesions

Condition

Key Features

Tetralogy of Fallot

RVOT obstruction, VSD, aortic override

Coarctation

Shelf-like narrowing, collateral flow on PC

ASD

Qp:Qs >1.5:1 indicates hemodynamic significance

7. Structured Reporting

• 1. Technique: Sequences performed, contrast dose
• 2. Function:
  - LV/RV volumes/EF
  - Wall motion abnormalities
• 3. Tissue characterization:
  - LGE pattern/extent
  - T1/T2/ECV values
• 4. Valvular assessment:
  - Stenosis/regurgitation
  - Phase-contrast flow quantification
• 5. Congenital (if applicable)

Always correlate with ECG and clinical history. For stress perfusion, compare rest/stress images side-by-side. In amyloidosis, measure ECV in septum for consistency. For ARVC, follow Task Force Criteria. Document incidental findings (pericardial effusion, masses). For pediatric patients, use Z-scores for chamber measurements. Always check for artifacts (e.g., arrhythmia-related ghosting).

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