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BioMed Central

Open Access

Review

Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art Bernhard L Gerber1, Subha V Raman2, Krishna Nayak3, Frederick H Epstein4, Pedro Ferreira5, Leon Axel6 and Dara L Kraitchman*7 Address: 1Department of Cardiovascular Diseases, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium, 2Davis Heart and Lung Research Institute, Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA, 3Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA, 4Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA, 5National Heart and Lung Institute, Imperial College, London, UK, 6Department of Radiology, New York University Medical Center, New York, NY, USA and 7Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA Email: Bernhard L Gerber - [email protected]; Subha V Raman - [email protected]; Krishna Nayak - [email protected]; Frederick H Epstein - [email protected]; Pedro Ferreira - [email protected]; Leon Axel - [email protected]; Dara L Kraitchman* - [email protected] * Corresponding author

Published: 28 April 2008 Journal of Cardiovascular Magnetic Resonance 2008, 10:18 18

doi:10.1186/1532-429X-10-

Received: 25 February 2008 Accepted: 28 April 2008

This article is available from: http://www.jcmr-online.com/content/10/1/18 © 2008 Gerber et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement. The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols. This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.

Introduction The clinical assessment of myocardial perfusion plays a central role in the diagnosis, management, and prognosis of ischemic heart disease patients. Whereas X-ray angiography demonstrates the patency of the coronary arteries, perfusion imaging detects the downstream microvascular blood flow within the myocardium.