Abstract
Functionally significant coronary artery disease impairs myocardial blood flow and can be detected non-invasively by myocardial perfusion imaging. While multiple myocardial perfusion imaging modalities exist, the high spatial and temporal resolution of cardiovascular magnetic resonance (CMR), combined with its freedom from ionising radiation make it an attractive option. Dynamic contrast enhanced CMR perfusion imaging has become a well-validated non-invasive tool for the assessment and risk stratification of patients with coronary artery disease and is recommended by international guidelines. This article presents an overview of CMR perfusion imaging and its clinical application, with a focus on chronic coronary syndromes, highlighting its strengths and challenges, and discusses recent advances, including the emerging role of quantitative perfusion analysis.
Highlights
Myocardial perfusion imaging (MPI) plays a central role in the diagnosis, management, and risk stratification of patients with coronary artery disease (CAD) and is recommended by international guidelines [1]
Flow limiting stenoses blunt the augmentation of myocardial perfusion during hyperaemia, manifesting as a relative perfusion defect at stress, which is not seen at rest, compared with myocardium subtended by unobstructed coronary arteries (Figure 2) [4]
The clinical feasibility of tracking the first-pass of contrast through the myocardium with cardiovascular magnetic resonance (CMR) was first demonstrated by Atkinson et al in 1990 who used an inversion recovery gradient echo (GRE) sequence to track the first-pass of contrast agent (CA) through rodent and human hearts [2, 7]
Summary
Clinical Application of Dynamic Contrast Enhanced Perfusion Imaging by Cardiovascular Magnetic Resonance. Significant coronary artery disease impairs myocardial blood flow and can be detected non-invasively by myocardial perfusion imaging. While multiple myocardial perfusion imaging modalities exist, the high spatial and temporal resolution of cardiovascular magnetic resonance (CMR), combined with its freedom from ionising radiation make it an attractive option. Dynamic contrast enhanced CMR perfusion imaging has become a well-validated non-invasive tool for the assessment and risk stratification of patients with coronary artery disease and is recommended by international guidelines. This article presents an overview of CMR perfusion imaging and its clinical application, with a focus on chronic coronary syndromes, highlighting its strengths and challenges, and discusses recent advances, including the emerging role of quantitative perfusion analysis
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