IJCS | Volume 32, Nº2, March/April 2019

180 Figure 1 - Evaluation of systolic mass and systolic function by three-dimensional and Simpson’s technique time-volume curve. (A) Left ventricular time-volume curve; (B) cine-magnetic resonance imaging during diastole. Left ventricular mass (blue) and final diastolic volume (green). Ribeiro et al. CMR and amyloidosis Int J Cardiovasc Sci. 2019;32(2)177-189 Review Article Similarly, fast-GRE images, previously used for functional evaluation, are more sensitive to turbulent flow, and are valuable for assessment of stenosis and valve insufficiency. Nevertheless, the method produces worse specification between the myocardium and blood in cardiac cavities when compared with SSFP. 32,33 A new sequencing technique, known as “real time” sequencing has high diagnostic quality and can be used for patients with arrhythmias and patients with inability to sustain apnea. 4 In the assessment of cardiac amyloidosis, characterization of morphology and function of the disease by cine-MR (Figure 1) is crucial, especially in established disease. This is a widely used technique and is used in all protocols of cardiac study by MR. Tagging Myocardial tagging by CMR provides a noninvasive, powerful method to quantify segmental and diastolic functions. The development of the technology, particularly of the sequences, type of devices and analysis software have facilitated the use of this technique. This will be very useful to assess patients’ conditions and course of the disease. Myocardial tagging uses a fast gradient echo sequence with saturation lines, creating a grid on the images that moves with cardiac motion, allowing an objective quantification of myocardial contraction during cardiac cycle (myocardial strain). 34-36 Myocardial tagging (Figure 2) should be used for the diagnosis of initial or subclinical amyloidosis. In addition, the technique may detect longitudinal or circumferential functional changes in individuals with mutations but without a clear phenotype determined by other techniques. 37,38 We understand that one limitation for the use of myocardial tagging in many centers is the lack of specific softwares for analysis, but we believe in the benefits of the implementation of the technology. Anatomy In the analysis of the anatomy the heart and large vessels, double-inversion fast spin-echo is the most used sequence. It is based on the acquisition of fast spin-echo combined with double inversion preparation pulse - the first applied to the whole tissue (nonselective) and the second, slice-selective. This technique has high spatial resolution (selective); blood is dark in the images (null signal) and, because of that, the technique is known as