Amyloid (rev. 06/23/2023)
Indication: ?infiltrative disease, r/o cardiac amyloidosis
SEQUENCES
Localizer
Axial bright blood MBH chest
2 chamber CINE
Fake short axis CINE
4 chamber CINE
Short axis stack CINE
— CONTRAST–
3 chamber CINE
Aorta through plane Phase Contrast (VENC 150)
–EARLY GADOLINIUM ENHANCEMENT (1-3 min.)–
MDE single shot SAS (TI > 400ms)
MDE single shot 2 chamber (TI > 400ms)
MDE single shot 4 chamber (TI > 400ms)
MDE single shot 3 chamber (TI > 400ms)
–LATE GADOLINiUM ENHANCEMENT–TI scout
MDE single shot SAS
MDE single shot 2 chamber
MDE single shot 4 chamber
MDE single shot 3 chamber
MDE segmented SAS
MDE segmented 2 chamber
MDE single shot 4 chamber
MDE single shot 3 chamber
optional 3D MDE (Short Axis and 4 chamber)
NOTES
This protocol differs from a routine heart w/ T2 by including Early Gadolinium Enhancement at 1 -3 minutes postcontrast, with a long TI.
With cardiac amyloid it is difficult to find a correct TI to null myocardium on the TI Scout
The diffuse infiltration of amyloid expands the extracellular space causing diffuse T1 shortening
In severe cases there may be a reversal of the normal TI scount nulling patternL
Normal: Blood becomes bright before myocardium becomes black
Amyloid: Myocardium becomes black before blood becomes bright