title: Combined long- and short-axis myocardial perfusion cardiovascular magnetic resonance.
abstract: OBJECTIVE
  To date, myocardial perfusion cardiovascular magnetic resonance (CMR) has been reported in single and multiple short-axis slices. Three short-axis planes can assess 16 segments of the standard 17-segment myocardial model, but this approach fails to assess the ventricular apex that requires at least one long-axis plane. We therefore evaluated the feasibility and benefit of combined long- and short-axis perfusion CMR to enable complete 17 segments coverage for comprehensive myocardial perfusion assessment.
  
  
  METHODS
  Using a hybrid echo planar imaging (EPI) sequence, we performed rest and adenosine stress first-pass perfusion CMR studies with 3 short-axis (basal, mid, apical) planes, and additional long-axis planes in the same cardiac cycle in a broad range of cardiology patients.
  
  
  RESULTS
  Perfusion CMR was performed in 53 consecutive patients using the combined short-long-axis imaging protocol. Twenty-nine of those studied had known or suspected coronary artery disease (CAD), 18 hypertrophic cardiomyopathy, and 6 suspected microvascular perfusion abnormalities. In 39 patients (70%), it was possible to acquire 5 slices at rest and stress including both the horizontal and vertical long axes. In 15 patients (27%), only one long-axis could be acquired, and in 2 patients (5%) only 3 slices (short axis) could be obtained. However, in none of the patients with known or suspected CAD was apical ischemia demonstrated by the long-axis views, despite apical ischemia having been demonstrated with recent SPECT studies in 8 of these patients.
  
  
  CONCLUSIONS
  Rest-stress myocardial perfusion CMR is able to achieve complete segmental coverage of the myocardium using the combined short-long axis approach using an EPI sequence in 97% of a long series of consecutive cardiology patients, while maintaining excellent spatial resolution. However, the long-axis views were not found to be able to demonstrate inducible perfusion defects in the apex.
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Elkington
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gatehouse
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.forename: David N
authors.initials: DN
authors.lastname: Firmin
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D017352:Echo-Planar Imaging / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis; D015425:Myocardial Reperfusion