Cardiovascular magnetic resonance: myocardial perfusion.
There is growing evidence that the noninvasive assessment of myocardial perfusion with cardiovascular magnetic resonance is a valid and accurate tool for the assessment of ischemic heart disease and its introduction into routine clinical evaluation of patients is rapidly expected. Magnetic resonance measurements allow the evaluation of reversible and irreversible myocardial ischemia, the assessment of acute myocardial infarction, as well as the recognition and detection of viable myocardium. Magnetic resonance perfusion measurements are mainly performed with T1-shortening contrast agents such as gadolinium-DTPA either by visual analysis or based on the analyses of signal intensity time curves. For the detection of myocardial ischemia the first pass kinetics of a gadolinium-DTPA bolus and for the detection of myocardial necrosis and the definition of viable myocardium steady state distribution kinetics are assessed. Quantitative analysis of myocardial perfusion can be performed but requires complex modeling due to the characteristics of gadolinium-DTPA. Thus, semi-quantitative parameters are preferred. There is accumulating evidence in the literature that magnetic resonance imaging can be used for the detection of coronary artery stenosis with high diagnostic accuracy both with semi-quantitative or visual analysis. Myocardial infarction can be reliably detected and the infarcted area determined. Non-reperfused infarcted myocardium can be differentiated from reperfused myocardium by different enhancement patterns that correlates with viability. Cardiac magnetic resonance is a promising technique that can combine different functional studies during one examination, such as the assessment of wall motion and perfusion at rest and stress. With further improvements in analysis software magnetic resonance perfusion measurement may rapidly become a routine tool for the assessment of patients with coronary artery disease.
Nagel
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E
Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Germany. eike.nagel@dhzb.de
al-Saadi
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N
Fleck
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E
D003287:Contrast Media; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004452:Echocardiography; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging
D003287:Contrast Media; D019786:Gadolinium DTPA