JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE 1 Vol. 6, No. 4, pp. 811–816, 2004 MYOCARDIAL PERFUSION Combined Long- and Short-Axis Myocardial Perfusion Cardiovascular Magnetic Resonance Andrew G. Elkington, B.Sc., M.R.C.P., Peter D. Gatehouse, Ph.D., Sanjay K. Prasad, M.D., M.R.C.P., James C. Moon, M.R.C.P., David N. Firmin, Ph.D., and Dudley J. Pennell, M.D., F.R.C.P. * Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK ABSTRACT Purpose: 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 and Materials: 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. Conclusion: 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 * Correspondence: Professor Dudley J. Pennell, M.D., F.R.C.P., Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney St., London SW3 6NP, UK; Fax: +44-207-351-8816; E-mail: d.pennell@imperial.ac.uk. 811 DOI: 10.1081/JCMR-200036129 1097-6647 (Print); 1532-429X (Online) Copyright D 2004 by Marcel Dekker, Inc. www.dekker.com