Optimal imaging strategies to assess coronary blood flow and risk for patients with coronary artery disease.
OBJECTIVE
This review is meant as a balanced summary of the current state of cardiac magnetic resonance (CMR) perfusion imaging in assessing alterations in myocardial blood flow due to coronary artery disease (CAD). We aim to provide first an accessible technical overview of first-pass CMR perfusion imaging and contrast it with other conventional perfusion imaging modalities, and then address the potential advantages of CMR for a qualitative assessment of perfusion defects, as well as quantitative blood flow measurements. Most recent results from clinical trials on the utility of CMR perfusion and novel directions will be explored.


RESULTS
Recent results of the first multicenter multivendor CMR perfusion study demonstrated superior diagnostic utility in detecting CAD by CMR compared with conventional nuclear single-photon emission computed tomography. Several large clinical trials provide additional evidence indicating the strong prognostic implications when CMR perfusion was performed in a clinical setting in patients with an intermediate clinical likelihood of CAD. A negative adenosine stress CMR perfusion study conferred a favorable 3-year prognosis towards nonfatal myocardial infarction or cardiac death.


CONCLUSIONS
CMR perfusion imaging during the first pass of gadolinium-based contrast agents has undergone many technical improvements and levels of clinical validation. Rapidly increasing clinical use worldwide over the last years in diagnosing chest pain syndromes supports the role of CMR in a comprehensive and efficient noninvasive assessment of altered myocardial physiology in CAD.
Jerosch-Herold
Michael
M
Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Kwong
Raymond Y
RY
D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology*; D003326:Coronary Circulation; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D017202:Myocardial Ischemia / Q000175:diagnosis; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011868:Radioisotopes; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
D003287:Contrast Media; D011868:Radioisotopes; D005682:Gadolinium