Quantification of myocardial perfusion by cardiovascular magnetic resonance
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REVIEW
Open Access
Quantification of myocardial perfusion by cardiovascular magnetic resonance Michael Jerosch-Herold
Abstract The potential of contrast-enhanced cardiovascular magnetic resonance (CMR) for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted “gold standards”, such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a synopsis of the current status of the field, and introduces the reader to the technical aspects of perfusion quantification by CMR. The field has reached a stage, where quantification of myocardial perfusion is no longer a claim exclusive to nuclear imaging techniques. CMR may in fact offer important advantages like the absence of ionizing radiation, high spatial resolution, and an unmatched versatility to combine the interrogation of the perfusion status with a comprehensive tissue characterization. Further progress will depend on successful dissemination of the techniques for perfusion quantification among the CMR community. Introduction The title of this review, “perfusion quantification” refers to the approaches used with cardiovascular magnetic resonance (CMR) to assess or measure myocardial blood flow from the contrast enhancement observed during the first pass of a contrast agent bolus. This technique is often referred to by the name of “first pass” imaging, because the first pass of a contrast agent represents the phase of contrast enhancement most sensitive to changes in blood flow, be it from disease, pharmacological intervention, or exercise. Another approach, not requiring exogenous contrast, and referred to as arterial spin labeling, can also be employed to assess myocardial blood flow [1]. Although a promising technique that is not burdened by concerns about contrast administration in patients with poor renal function, it still remains largely confined to experimental studies, challenged by poor contrast-to-noise, and arguably only practically relevant for cardiac studies at 3 Tesla, or higher field strengths. Another promising technique for assessing myocardial perfusion is based on blood-oxygenlevel dependent (BOLD) myocardial imaging [2,3]. This type of endogeneous contrast mechanism is dependent on a combination of factors such as blood flow, but also Correspondence: [email protected] Brigham & Women’s Hospital, Boston, MA 02115, USA
oxygen extraction fraction, with the latter normally declining with increasing myocardial blood flow [4]. BOLD imaging does not provide as direct an assessment of myocardial blood flow, as contrast-enhanced perfusion imaging. This review will focus on the quantification of myocardial perfusion by the use of contrast-enhanced techniques, which in the future may include novel contrast agents such as hyper-polarized media [5], but at the presen
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